What diet is recommended for managing high cholesterol?

Diet for Managing High Cholesterol

The most effective diet for managing high cholesterol is one that limits saturated fat to less than 7% of total calories, trans fat to less than 1% of energy, and dietary cholesterol to less than 300 mg per day, while emphasizing fruits, vegetables, whole grains, and plant proteins. 1

Key Dietary Components

Fats

• Saturated fat: Limit to <7% of total daily calories 1
  • Major sources: Full-fat dairy products, fatty meats, tropical oils
  • Saturated fat has a stronger impact on raising LDL cholesterol than dietary cholesterol itself 2
• Trans fat: Limit to <1% of total daily calories 1
  • Major sources: Partially hydrogenated oils in commercially prepared foods, some margarines, fried foods
  • Trans fats increase LDL cholesterol and reduce HDL cholesterol 1
• Unsaturated fats: Increase consumption
  • Monounsaturated fats: Olive oil, canola oil, avocados, nuts
  • Polyunsaturated fats: Sunflower oil, corn oil, fatty fish
  • Both types of unsaturated fats help lower LDL cholesterol when substituted for saturated fats 3, 4

Cholesterol

• Limit dietary cholesterol to <300 mg/day 1
• For those with LDL cholesterol ≥100 mg/dL, further restrict to <200 mg/day 1, 2
• Foods high in both cholesterol AND saturated fat have the greatest impact on blood cholesterol 2

Protein Sources

• Choose lean meats, poultry without skin, and plant proteins 1
• Increase consumption of plant proteins (legumes, nuts, seeds) 2
• Fish: Consume at least twice weekly, especially oily fish rich in omega-3 fatty acids 1, 5
• Egg whites can be consumed liberally as they contain protein without cholesterol 2
• Limit whole eggs with yolk to 0-1 per week if LDL is >130 mg/dL 2

Carbohydrates

• Choose whole grains and high-fiber foods 1
• Include foods rich in soluble fiber (oats, psyllium, legumes) to reduce cholesterol absorption 2
  • Each gram increase in soluble fiber can decrease LDL cholesterol by approximately 2.2 mg/dL 2
• Limit intake of added sugars to <10% of total energy 1
• Minimize consumption of refined carbohydrates, which can increase triglycerides 5

Beneficial Additions

• Plant sterols/stanols: Consider foods enriched with phytosterols (1-2 g/day) for individuals with elevated cholesterol 1, 2

  • These compete with cholesterol for absorption in the intestine
  • Found naturally in nuts, seeds, legumes, and vegetable oils

• Mediterranean diet pattern: Strongly recommended for reducing cardiovascular disease risk 5

  • Rich in fruits, vegetables, whole grains, legumes, nuts, olive oil, and fish
  • Limited in red meat, processed foods, and added sugars

Common Pitfalls to Avoid

1. Focusing only on dietary cholesterol while ignoring saturated fat intake

   • Saturated fat has a stronger impact on raising LDL cholesterol than dietary cholesterol 2, 4

2. Eliminating all high-cholesterol foods without consideration of their saturated fat content

   • Some cholesterol-rich foods that are low in saturated fat (e.g., shellfish) have smaller effects on LDL cholesterol 1, 6

3. Replacing saturated fats with refined carbohydrates

   • This can increase triglycerides and lower beneficial HDL cholesterol 1, 5

4. Overlooking the importance of overall dietary pattern

   • A single food is less important than your overall eating pattern 2

5. Neglecting weight management

   • Excess weight contributes to dyslipidemia; even modest weight loss improves lipid profiles 1

By following these dietary recommendations and avoiding common pitfalls, most individuals can significantly improve their cholesterol levels and reduce cardiovascular disease risk. For those who cannot achieve target cholesterol levels through diet alone, medication may be necessary in addition to these dietary changes 7.