What Diet Is Good for High Cholesterol? A Registered Dietitian's Guide to Eating Smart

After routine lab work at doctor's appointments, many people find out they have high cholesterol levels and need to make lifestyle changes. Cholesterol levels affect cardiovascular health, and a high level of one type of cholesterol — low-density lipoprotein cholesterol (LDL-C) — increases your risk of heart disease and stroke. While high LDL-C is a cause for concern, a balanced heart-healthy diet and lifestyle changes can often help lower cholesterol levels.

As a registered dietitian, I've worked with countless people to improve their cholesterol levels. Below, I'll share a list of foods to eat and avoid to improve high cholesterol, and tips that have helped my clients lower their LDL cholesterol.

What is cholesterol, and how does it affect health?

Cholesterol is a waxy, fat-like substance made by the liver. Cholesterol is essential to body functions, but too much increases your risk of coronary artery disease and other cardiovascular complications.

In particular, LDL-C is known as the bad type of cholesterol in the popular media. LDL-C is the main cause of fatty buildup and narrowing in the arteries, also known as atherosclerosis, and a major causal factor for cardiovascular disease. High LDL-C at any age increases the risk of heart disease and stroke.

Routine bloodwork through a healthcare provider will help you understand if your cholesterol levels are high. The optimal level for total cholesterol is approximately 150 mg/dL with LDL-C at or below 100 mg/dL, as adults in this range have lower rates of heart disease and stroke.

How your eating habits affect cholesterol levels

Diet has a significant role in cholesterol levels. Eating too much saturated fat increases LDL-C levels. According to the Dietary Guidelines for Americans, saturated fat intake should be limited to less than 10 percent of calories per day for anyone over the age of two.

Replacing saturated fats with polyunsaturated fats can help lower LDL levels. Increasing soluble fiber intake can also help lower LDL levels.

What diet is good for high cholesterol?

There isn't one specific diet that is best to lower high cholesterol. Instead of recommending a specific diet, the 2018 Clinical Practice Guidelines from the American College of Cardiology and American Heart Association recommend an overall diet pattern that emphasizes:

Any diet that meets these criteria could help lower cholesterol if followed with consistency, though results take time. A long-term approach to healthy eating is needed to improve cholesterol levels rather than a quick fix.

Specific diets that help lower cholesterol include the Dietary Approaches to Stop Hypertension diet (DASH) and the Therapeutic Lifestyle Changes Program (TLC). These diets also have other health benefits, such as helping control blood pressure.

Foods to eat

To lower your LDL cholesterol and support heart health, incorporate foods from the following groups into your diet. In particular, focus on foods with soluble fiber, such as whole grains, legumes, and some fruits and vegetables, for their cholesterol-lowering benefits.

Whole grains

The whole grain category includes:

• 100% whole wheat or whole grain bread
• Brown rice
• Quinoa
• Oats or oat bran
• Bulgur
• Whole grain cereals

Fruits and vegetables

Try to eat a variety of fruits and vegetables each day, and aim to include produce at each meal and snack. Choose any fresh or frozen fruits or vegetables that you enjoy.

Plant-based protein

Legumes, such as kidney beans, black beans, peas, lima beans, or soy products, are excellent plant protein sources. Nuts and seeds are also a part of a heart-healthy diet and contribute to plant-based protein.

Lean meat

If you eat animal proteins, choose leaner cuts of meats and poultry. Choose skinless poultry most often, such as skinless chicken breast or thighs or white meat turkey. When you eat red meats or pork products, look for loin or round cuts since they're typically lower in fat.

Low-fat dairy

If you drink or eat cow's milk products, choose the lowest percentage you can. Aim for 1% or nonfat dairy products most of the time to lower saturated fat intake. Plant-based milks, such as oat, soy, or almond milk, are also included in the heart-healthy diet.

Nontropical vegetable oils

Choose liquid vegetable oils that are rich in polyunsaturated fats. This includes extra virgin olive oil, canola, soybean, safflower, sunflower, peanut, or corn oils.

Omega-3 fatty acids

Try to incorporate fatty fish twice weekly because they contain heart-healthy omega-3 fats. This includes salmon, tuna, mackerel, and sardines. Plant sources of omega-3 fatty acids include walnuts, flaxseed, and chia seeds.

Foods to limit

Foods high in saturated fats

Reading food labels can help identify foods with more saturated fat. In general, processed meats, fatty cuts of beef and pork, high-fat dairy (cheese, butter, whole cow's milk), baked goods, and deep-fried foods are high in saturated fat.

While heart-healthy versions of many of the following foods exist, the American Dietary Guidelines list the following examples as top sources of saturated fat for adults: burgers, tacos, burritos, grilled cheese, hot dogs, spaghetti and meatballs, and quesadillas.

Trans fats

Trans fats are a type of unsaturated fat that increases LDL cholesterol. They are naturally present in some animal products. Some processed foods also contain trans fats from partially hydrogenated oils. Avoid stick margarine and heavily processed packaged products such as cakes, pie crusts, biscuits, and crackers to reduce trans fat intake.

Sweets

Reduce your sweet intake and limit sugar-sweetened foods to special occasions. This includes candy, cookies, ice cream, brownies, and pastries. Avoid sugar-sweetened drinks, including sodas, teas, and juice drinks with added sugar.

Fried foods

While pan-frying in small amounts of vegetable oil is a heart-healthy way to cook lean meats occasionally, deep frying in large amounts of oil should be avoided. Examples of typically fried foods include French fries, onion rings, crunchy breaded seafood or meats, and donuts.

Tropical vegetable oils

Tropical vegetable oils are high in saturated fat. Avoid palm oil, palm kernel oil, and coconut oil most of the time.

Dietitian-approved tips to decrease cholesterol

Simple diet strategies to lower your cholesterol include:

• Pack a heart-healthy lunch every day instead of opting for takeout. In your lunch, include at least one whole grain option, one lean protein, one vegetable, and one fruit. A quick lunch that fits this framework is: a sandwich made with lean turkey, lettuce, and a low-fat cheese slice on 100% whole wheat bread, a side of cherry tomatoes and carrot sticks, a banana, and one serving of whole grain crackers with hummus.
• Fill half of your plate with vegetables at dinner each night to increase your vegetable intake.
• Add a serving of fresh fruit after dinner for a sweet snack without any added sugars. If you crave a warm dessert, bake fruit with an oat and cinnamon topping for a snack that feels indulgent.
• Start with one or two meatless meals each week. Try legume-focused dishes, such as red beans and rice, a lentil stew, or a tofu stir fry.
• Skip the heavy cream, cheese, and butter in vegetable dishes. Instead, season with fresh herbs or low-sodium seasoning blends, or add a squeeze of lemon or lime juice for a citrusy fresh taste with no saturated fat.
• Incorporate fatty fish two times per week by eating one serving for lunch and one serving for dinner per week. At lunch, try tuna salad made with a small amount of reduced-fat mayonnaise and mashed white beans for additional creaminess. Eat pan-seared salmon with a vegetable and whole grain side at one dinner per week.
• Instead of eating fried chicken or fish, try dipping a protein in raw egg, then coating it with whole wheat panko bread crumbs and baking it in the oven to make a satisfyingly crispy main dish with minimal added fat.
• Add a few cups of chopped frozen spinach to soups, curries, or stews to increase vegetable servings in your entree with little effort.
• In place of butter or ghee, dip bread in olive oil with fresh herbs for extra flavor.

Here is a downloadable grocery list to help you shop for heart-healthy foods.

Beyond diet: other steps for managing high cholesterol

Lifestyle changes are usually the first step a healthcare provider will recommend to control cholesterol. While diet plays a key role, other important changes — such as maintaining a healthy weight, staying active, limiting alcohol, and quitting smoking or vaping — also contribute to effective cholesterol management, according to the American Heart Association guidelines.

Seeking guidance from healthcare professionals

Always check with your doctor before making changes to your diet or medications. Consider working with a registered dietitian for personalized heart-healthy diet recommendations and strategies that work for you and your lifestyle. Dietitians can also help with weight management if needed.

If lifestyle changes don't lower your LDL cholesterol level enough, or you have other risk factors that increase your chances of health complications, your healthcare provider may want to start medication. Statins are one type of medication prescribed for high LDL cholesterol levels.

Final word

Keeping cholesterol levels in check is important for heart health. To help lower LDL cholesterol, eat a diet that includes healthy fats, fruits, vegetables, soluble fiber, plant proteins, and whole grains. Avoid foods high in saturated fat, sweets, and trans fat. Work to eat a balanced diet over time, as long-term lifestyle changes are needed to lower cholesterol. As always, check with your healthcare team to make the most personalized changes and plan to improve your health.