Key takeaways

High cholesterol affects over 38% of American adults and can increase the risk of heart disease, stroke, and high blood pressure, but can be managed through lifestyle changes, medication, and diet.
The best diets for lowering cholesterol include the Mediterranean and DASH diets, which emphasize fruits, vegetables, whole grains, and healthy fats while limiting red meat and processed foods.
Foods to add to a low cholesterol diet include fruits and vegetables high in fiber, legumes, oily fish, nuts, healthy fats, and whole grains.
To manage high cholesterol, it is recommended to avoid or limit red meats, fried and processed foods, saturated and trans fats, refined sugars, and egg yolks, while considering intermittent fasting and other lifestyle changes like regular exercise and weight loss.

Hypercholesterolemia, or high cholesterol, affects more than 38% of American adults. High cholesterol levels can increase your risk of heart disease, stroke, and high blood pressure. The good news is that lifestyle interventions, medication, and a low cholesterol diet, can lower cholesterol levels and reduce the risk of developing serious medical conditions.

What is high cholesterol?

You have two main types of blood cholesterol in your body: low-density lipoprotein (LDL), which is often called bad cholesterol, and high-density lipoprotein (HDL), often referred to as good cholesterol. Total cholesterol is a combination of LDL cholesterol, HDL cholesterol, and triglycerides. The normal range for total cholesterol is 125-200 mg/dL (depending on the laboratory reference range). Anything above that is considered high.

According to Robert Greenfield, MD, cardiologist and lipidologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center, certain foods and diets can influence cholesterol levels in your body.

The best diet for high cholesterol will include specific foods you should eat and ones to avoid. Read on to discover tips on how to lower cholesterol levels through medication, exercise, and other lifestyle modifications.

The best diets to lower your cholesterol

To help reduce high cholesterol levels and improve heart health, Dawn Jackson Blatner RDN, nutritionist partner at Daily Harvest and author of The Superfood Swap, says to focus on foods that are high in fiber along with plenty of fruits, vegetables, legumes, healthy fats, and whole grains. There are two eating plans that experts typically recommend:

Mediterranean-style diet

A Mediterranean-style diet often includes fruits, vegetables, potatoes, nuts and seeds, olive oil, dairy products, eggs, fish, and poultry in small amounts. Avoid red meat, if possible. “Patients who are significantly overweight and not following a low fat, low-cholesterol diet, eating too much saturated fat and trans fats, can lower their cholesterol significantly by following a Mediterranean diet along with a reduction in daily calories and regular exercise,” says Dr. Greenfield.

DASH diet

Another heart healthy diet to consider is the DASH (Dietary Approaches to Stop Hypertension) diet, which helps lower high blood pressure and improves cholesterol levels. Dr. Greenfield recommends this program because it emphasizes vegetables, fruits, legumes, and whole grains.

The DASH eating plan also encourages fat-free or low-fat dairy products, beans, fish, nuts, and vegetable oils, but limits fatty cuts of meat, full-fat dairy products, refined and processed carbohydrates like sweets, and tropical oils.

6 foods to eat when following a low cholesterol diet

With that in mind, here are six foods to include in your low cholesterol diet.

1. Fruits and vegetables

Fruits and vegetables high in fiber top the list of foods to add to a low cholesterol diet. Some excellent choices include Brussels sprouts, avocado, dark leafy greens like spinach and kale, okra, eggplant, carrots, pears, apples, and berries.

2. Legumes

Legumes are packed full of fiber. They’re also an excellent source of plant-based protein. Blatner recommends eating kidney beans, chickpeas, black beans, pinto beans, and lentils.

3. Oily or fatty fish

Oily fish such as salmon, herring, mackerel, and sardines are excellent sources of omega-3 fats, which are beneficial for your heart. If you’re not a fish lover, Dr. Greenfield says taking omega-3 fish oil gel caps that contain a large quantity of EPA as the omega-3 fatty acids can be very helpful.

4. Healthy fats and nuts

Two types of fats are key to a low cholesterol diet: monounsaturated and polyunsaturated fats (as opposed to foods high in saturated fats). Blatner says one essential way to improve cholesterol levels is to eat healthy fat found in foods like avocados, olives, walnuts, almonds, pecans, flaxseeds, chia seeds, sunflower, and pumpkin seeds.

5. Healthy cooking oils

Using heart-healthy cooking oils can help keep cholesterol levels in check. When working in the kitchen, consider using olive oil, canola oil, avocado oil, safflower oil, and peanut oil. Soybeans, sunflower, and sesame also make great oil sources. Canola and avocado oil are high in monounsaturated fats, which are a good source of vitamin E. Grapeseed, safflower, and flaxseed oil are high in polyunsaturated fats, which contain vitamin E and high levels of omega-3 and omega-6 fatty acids. As mentioned above, monounsaturated and polyunsaturated are the two kinds of unsaturated fats.

6. Whole grains and oat bran

Oat bran is an excellent source of a soluble fiber known as beta-glucan, which may reduce the amount of cholesterol in your blood. Also, increasing your intake of whole grains like brown rice, bulgur, quinoa, and steel-cut oats can help lower LDL cholesterol levels, according to a 2015 systematic review published in The American Journal of Clinical Nutrition.

There are two types of fiber: soluble fiber and insoluble fiber. Soluble fiber is the main cholesterol-lowering fiber type. Blatner says fiber can act like a sponge to soak up excess cholesterol and remove it from the body. Including foods with soluble fiber in your diet can help reduce LDL cholesterol.

5 foods to avoid in a low cholesterol diet

A low cholesterol diet requires avoiding saturated fat, trans fat, and refined sugars like high-fructose corn syrup. Here are some food and beverages to avoid or reduce in a diet for high cholesterol:

1. Red meats and processed meats

Aim to reduce or eliminate animal products such as fatty cuts of beef or red meat and processed meat such as sausage and hot dogs. Examples of red meat with a higher saturated fat and cholesterol content include steak, beef roast, full-fat ground beef, and ribs.

If you’re going to eat animal proteins, opt for lean meats like turkey, chicken (white meat), and pork loin. Healthier red meats like 90% lean ground beef and lean cuts of beef like tenderloin and flank steak are good alternatives to fatty cuts of red meat.

2. Fried foods and highly processed foods

There is little to no room in a low cholesterol diet for fried foods, fast food, and highly processed foods. Everything in moderation is acceptable, but if you’re trying to reduce LDL levels, eliminating foods high in cholesterol like deep-fried items, chips, deli meat, bacon, and hot dogs, can go a long way in keeping your cholesterol levels in check.

3. Saturated and trans fats

Foods high in saturated and trans fats top the list of items to reduce or eliminate on a low cholesterol diet. The American Heart Association recommends reducing saturated fat to less than 6% of total daily calories if you need to lower cholesterol levels. Trans fats are found in margarine, baked goods, non-dairy coffee creamer, and fried foods. Saturated fats are in many common foods, so it’s helpful to read food labels while shopping.

Interestingly, lard, which is pork fat, is lower in saturated fat and higher in monounsaturated fat than butter. It has higher levels of omega-3 fatty acids. That said, it is still a middle-of-the-road choice when it comes to cooking, and whenever possible, you should opt for healthier fats like olive oil.

4. Sugar

Highly processed and refined sugars found in sodas, desserts, cakes, pastries, and other packaged foods are loaded with sugar such as high fructose corn syrup. A 2016 study review published in Progressive Cardiovascular Disease found that dietary sugar poses an increased risk for coronary heart disease. Moreover, the research points to an increase in triglycerides when consuming refined carbohydrates like sugar.

5. Egg yolks

Although eggs can be part of a healthy diet, people with high cholesterol should opt for egg whites over egg yolks when possible. Egg whites contain protein whereas egg yolks are full of cholesterol, fat, and calories. One large egg contains 186 mg of cholesterol, which is more than half of the daily recommendation, according to the American Heart Association.

Is fasting good for high cholesterol?

Intermittent fasting alternates between periods of eating and periods of fasting. The fasting method you follow depends on goals and comfort level. For example, some people follow the 16/8 method, which involves fasting daily for 16 hours and eating for 8 hours. Another popular fasting style is the eat-stop-eat method which requires fasting for 24 hours once or twice per week.

When it comes to fasting and high cholesterol, one 2021 study published in Frontiers in Nutrition found that intermittent fasting may protect cardiovascular health by improving lipid profile. More specifically, the researchers found that it raises HDL levels, which is the “good” or protective cholesterol.

Other ways to lower cholesterol

Eating a low cholesterol, heart-healthy diet is an effective way to manage cholesterol levels in the body. However, dietary changes alone may not be enough to bring cholesterol levels down to the normal range. Other non-dietary treatments for high cholesterol include:

Regular exercise
Losing weight
Cholesterol-lowering medication

Regular exercise

Lifestyle changes like increasing the amount of exercise can increase HDL cholesterol levels while offsetting increases in LDL cholesterol levels, according to a 2014 study review published in Sports Medicine. Plus, the health benefits of physical activity are endless.

Losing weight

According to the American Heart Association, a weight loss of 5% to 10% of your body weight can improve total cholesterol levels.

Cholesterol-lowering medications

Although dietary modifications and increased physical activity are necessary and helpful, it’s not always sufficient. “Many cholesterol problems run in families and are genetically determined,” Dr. Greenfield says. In these situations, a prescription for cholesterol-lowering medications called statins can be beneficial. Examples of statins include:

If statins aren’t enough, your physician may recommend the newer injectables, given once or twice a month. The FDA-approved drugs include Praluent (talirocumab) and Repatha (evolocumab), which are a category of medications known as PCSK9 inhibitors. Both are given by a self-administered injection once or twice a month. While newer than statins, Dr. Greenfield says these injectables are already demonstrating their ability to reduce heart attack and strokes, as well as reduce admission to the hospital for unstable angina.

When to see your doctor

If you have a family history of high cholesterol, and are concerned about your own levels, it’s a good idea to see your healthcare provider. High levels of LDL cholesterol increase the risk of heart disease. Some people have familial hypercholesterolemia (FH), which is an inherited disorder that makes it more challenging to remove low-density lipoprotein (LDL) cholesterol from your blood. This results in high LDL cholesterol levels in the blood.