Cholesterol-Lowering Diet Overview

The primary goal of this diet is to lower your levels of LDL, or “bad” cholesterol. This diet may also raise your levels of HDL, or “good” cholesterol. Having too much bad cholesterol—and/or not enough of the good kind—can cause plaque to build up in your arteries. Over time, this build-up narrows your arteries, increasing your risk of having a heart attack or stroke.

Modifying your diet can be challenging, especially if you need to make big changes. In addition to consulting with your physician, consider working with a nutritionist, dietitian or health coach to help customize meal plans, find suitable and exciting recipes, and build new, healthy habits.

Diet is one of several factors that affect cholesterol levels. (Other factors include heredity, age, sex, physical inactivity, and being overweight.) The main dietary components that impact cholesterol levels are fat, cholesterol, and fiber. This diet works by focusing on these components, helping to reduce levels of LDL ("bad" cholesterol) and increase levels of HDL ("good" cholesterol).

General Guidelines

• Make whole grains, fruits, and vegetables the base of your diet. (For more tips, see "How to eat healthy grains" and "How to eat a diet rich in fruits and vegetables.")
• Look for products that are labeled as “fat free,” “low-fat,” cholesterol free,” “saturated fat free,” and “trans fat free." However, a product can claim 0 grams trans fat, even on the label, but still have a small amount. Be sure to look for “partially hydrogenated oil" on the ingredients list. If a product has this, avoid it.
• Become familiar with the Nutrition Facts panel, which lists information, such as the amount of calories, saturated fat, trans fat, and cholesterol per serving of the item.
• Eat foods rich in omega-3 fatty acids (eg, fatty fish such as salmon, mackerel, and tuna; flaxseed; walnuts; canola oil). Some studies suggest that this supplement may help improve HDL levels. See Lipid Disorders & Fish Oil for more information.

Suggestions for Meal Preparation

• Prepare foods by using low-fat methods, such as steaming, boiling, grilling, poaching, baking, broiling, or roasting. If you are sautéing or stir frying, use a cooking spray or small amount of vegetable oil.
• Trim any visible fat off meat or poultry before cooking. Drain the fat after browning.
• Limit high-fat sauces. Add zest to foods by topping them with low-fat items such as fresh herbs, salsas, or chutneys.
• Increase fiber by adding fruit to your cereal or yogurt, beans to your salad, and choosing whole grain breads.
• Cook at home more often. Restaurant food tends to be high in fat and calories.

Grains

• Recommended foods: Whole grain breads and cereals, pasta, rice, potatoes, low-fat crackers
• Foods to avoid: High-fat baked goods (eg, muffins, donuts, pastries); crackers made with trans fat

Fruits & Vegetables

• Recommended foods: All fruit (choose whole fruit over juice for added fiber); all vegetables
• Foods to avoid: Vegetables with added fat or sauce

Dairy

• Recommended foods: Nonfat or low-fat (1%) milk; nonfat or low-fat yogurt, sour cream, buttermilk; cottage cheese; low-fat cheeses
• Foods to avoid: Whole milk; malted and chocolate milk; most cheeses

Meat, Beans, Nuts & Seeds

• Recommended foods: Lean cuts of beef, pork, veal, or lamb (look for the word “loin” or “round”; be sure to trim visible fat before cooking); poultry without the skin; fish and most shellfish (shrimp should be limited); egg whites and egg substitutes (limit whole eggs to two per week); tofu and tempeh; seeds, nuts, peanut butter (should be eaten in moderation due to high calorie content); dried peas, beans, and lentils
• Foods to avoid: Fatty cuts of meat; organ meats (eg, brain, liver, and kidneys); poultry skin; breaded fish or meats; more than two egg yolks per week (includes those found in baked goods, cooked foods, or processed foods)

Fats & Oil

• Recommended foods: Vegetable oils high in unsaturated fat (eg, olive, canola, corn, safflower, soybean); trans fat-free soft or liquid margarines (first ingredient should be unsaturated liquid vegetable oil); stanol/sterol-containing margarine; low-fat salad dressings and mayonnaise
• Foods to avoid: Butter, stick margarine, coconut and palm oils, bacon fat; salad dressings made with egg yolk;

Snacks, Sweets & Condiments

• In moderation: Fat-free or low-fat cookies, ice cream, frozen yogurt; sherbet; angel food cake; baked goods made with unsaturated oil or trans-free margarine, egg whites or egg substitutes, and nonfat milk; jello; candy made with little or no fat (eg, hard candy, jelly beans)
• Foods to avoid: High-fat desserts; baked goods made with butter, lard, shortening, egg yolks, or whole milk

The main dietary components that impact your serum (blood) cholesterol levels are fat, cholesterol, and fiber, as well as stanols and sterols.

Fat

Fat is an essential nutrient with many responsibilities, including transporting the fat soluble vitamins A, D, E, and K, protecting vital organs, and providing a sense of fullness after meals.

Saturated fat raises your blood cholesterol more than any of the other types of fat or cholesterol. For this reason, less than 7% of calories should come from saturated fat on a cholesterol-lowering diet. (See below for sources of saturated fat.) On an 1,800 calorie diet, this translates into less than 14 grams of saturated fat per day, leaving 46 grams to come from mono- and polyunsaturated fats.

Fat can be broken down into four main types:

• Fats that increase LDL levels and should be avoided or limited:
  1. Saturated fat: Found in margarine and vegetable shortening, shelf stable snack foods, and fried foods; increases total blood cholesterol, especially LDL levels. Animal fats that are saturated include: butter, lard, whole-milk dairy products, meat fat, and poultry skin. Vegetable fats that are saturated include: hydrogenated shortening, palm oil, coconut oil, and cocoa butter.
  2. Hydrogenated or “trans” fat: Found in margarine and vegetable shortening; increases total blood cholesterol, including LDL levels

• Fats that improve cholesterol profile and should be eaten in moderation:
  3. Monounsaturated fat: Found in oils such as olive and canola; can decrease total cholesterol level while keeping levels of HDL high
  4. Polyunsaturated fat: Found in oils such as safflower, sunflower, soybean, corn, and sesame; can decrease total cholesterol (both HDL and LDL)

Cholesterol

Dietary cholesterol is found only in animal products. Although dietary cholesterol can increase LDL cholesterol, it does not affect it as much as saturated fat. On a cholesterol-lowering diet, you should consume no more than 200 milligrams of cholesterol a day.

Fiber

Eating a diet high in soluble fiber can help lower your LDL cholesterol. There are two main types of fiber: soluble and insoluble. While both are very important to health, only soluble fiber impacts cholesterol levels. When soluble fiber is digested, it dissolves into a gel-like substance that helps block the absorption of fat and cholesterol into the bloodstream.

Soluble fiber is found in foods such as oatmeal, oat bran, barley, soy products, legumes (eg, dried beans and peas), apples, and strawberries. On a cholesterol-lowering diet you should consume at least 5-10 grams of soluble fiber per day, and ideally 10-25 grams. For more information, see Lipid Disorders and Fiber.

Stanols and Sterols

Stanols and sterols are substances found in certain plants. Plant stanols and sterols can lower LDL cholesterol levels in a similar way to soluble fiber, by blocking their absorption from the digestive tract. Certain foods—including margarines and orange juice—are now being fortified with these cholesterol-lowering substances. Research shows that consuming at least 2 grams of plant stanols or sterols a day can reduce LDL cholesterol by more than 10%. For more information, see Lipid Disorders and Stanols/Sterols.

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