What dietary recommendations should a patient with high cholesterol follow to manage their condition?

Managing High Cholesterol Through Diet: Patient Handout

If you have high cholesterol, you should limit saturated fat to less than 7% of your daily calories, dietary cholesterol to under 200 mg per day, and eliminate trans fats while increasing soluble fiber and plant sterols. 1, 2

Primary Dietary Changes to Lower Your Cholesterol

Limit These Fats (Most Important)

• Saturated fat should be less than 7% of your total daily calories (for the general population, this is 10%, but you need stricter limits) 1
• Dietary cholesterol should be under 200 mg per day (compared to 300 mg for healthy individuals) 1, 3
• Trans fats should be less than 1% of calories by avoiding partially hydrogenated oils in fried foods, baked goods, and processed snacks 1, 2
• Total fat intake should be 25-35% of calories, focusing on the type of fat rather than just the amount 1

Foods High in Cholesterol to Limit

High-cholesterol foods you should restrict include:

• Egg yolks (one large egg contains about 186 mg of cholesterol—nearly your entire daily limit) 3, 4
• Organ meats (liver, kidney, brain) 2
• Full-fat dairy products (whole milk, regular cheese, butter, cream) 2
• Fatty cuts of red meat and processed meats 2
• Shellfish (shrimp, lobster—though these are lower in saturated fat than other high-cholesterol foods) 3

Important distinction: Foods high in cholesterol but low in saturated fat (like eggs and shellfish) have less impact on your blood cholesterol than foods high in both cholesterol AND saturated fat (like fatty meats and full-fat dairy) 3

Foods to Add to Your Diet

Increase Soluble Fiber (Target: 10-25 grams daily)

• Oats and oat bran, barley, beans and lentils 2
• Vegetables (especially Brussels sprouts, carrots, sweet potatoes) 2
• Fruits (apples, pears, citrus fruits, berries) 1, 2
• Psyllium fiber supplements if needed 2
• Expected benefit: 5-10% reduction in LDL cholesterol 2

Add Plant Sterols/Stanols (Target: 2 grams daily)

• Fortified margarines, orange juice, or yogurt drinks 2
• Available as soft gel supplements 2
• Expected benefit: 10-15% reduction in LDL cholesterol 2

Choose Healthy Fats

• Replace saturated fats with polyunsaturated fats (corn oil, sunflower oil, soybean oil, walnuts) 1, 2
• Use monounsaturated fats (olive oil, canola oil, avocados, nuts) 1, 2
• Eat fish 2-3 times per week for omega-3 fatty acids 1
• Choose liquid vegetable oils over solid fats (butter, lard, shortening) 2

Practical Daily Food Choices

What to Choose:

• Fat-free or 1% milk instead of whole or 2% milk 2
• Lean cuts of meat with visible fat trimmed 2
• Skinless poultry (remove skin before eating) 2
• Whole grains instead of refined grains (brown rice, whole wheat bread, oatmeal) 1, 2
• At least 2 cups of fruit and 3 cups of vegetables daily 1
• Grilled, baked, or broiled foods instead of fried 2

Limit Sodium and Sugar:

• Keep sodium under 1,500-2,300 mg per day (about 1 teaspoon of salt) 1
• Limit added sugars to less than 10% of calories 1
• Avoid sugar-sweetened beverages 1

Expected Results and Timeline

• After 6 weeks of following this diet, have your cholesterol rechecked 2
• You can expect approximately 20% reduction in LDL cholesterol with comprehensive dietary changes 2
• Weight loss enhances all these dietary interventions—even modest weight loss (5-10% of body weight) improves cholesterol before reaching your ideal weight 2
• Your doctor should monitor your progress every 4-6 months 2

Mediterranean and Japanese Dietary Patterns

Both the Mediterranean diet and traditional Japanese diet are associated with excellent cardiovascular outcomes: 1

• Mediterranean diet emphasizes olive oil, fish, vegetables, fruits, whole grains, legumes, and nuts 1
• Japanese diet is low in saturated fat and high in complex carbohydrates from vegetables and whole grains 1
• Both patterns naturally limit saturated fat and cholesterol while providing beneficial nutrients 1

Common Pitfalls to Avoid

• Don't just reduce total fat—focus on replacing saturated fat with unsaturated fats 2
• If you have high triglycerides, avoid very low-fat/high-carbohydrate diets; instead use moderate fat with emphasis on monounsaturated fats 2
• Reducing portion sizes by 20-25% helps with weight management and cholesterol control 1
• Alcohol should be limited to 1 drink daily for women, 1-2 drinks for men (and avoided entirely if triglycerides are elevated) 1

When Diet Alone May Not Be Enough

Your doctor may recommend cholesterol-lowering medication if: 1

• Your LDL cholesterol remains above 100 mg/dL despite dietary changes and you have cardiovascular disease or diabetes 1
• Your 10-year cardiovascular risk is high (≥20%) 1
• You have multiple risk factors and LDL remains above 160 mg/dL 1

Diet and medication work together—continue dietary changes even if you start medication, as this provides additional benefit and may allow lower medication doses. 1, 2