What are the Mediterranean diet and exercise recommendations for managing hypercholesterolemia (high cholesterol)?

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Last updated: April 23, 2025View editorial policy

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From the Guidelines

The Mediterranean diet and regular exercise are effective strategies for managing high cholesterol, as recommended by the most recent and highest quality study 1. For diet, focus on consuming:

  • Olive oil as your primary fat source
  • Plenty of fruits, vegetables, and whole grains daily
  • Legumes like beans and lentils several times weekly
  • Fatty fish such as salmon or mackerel at least twice weekly for omega-3 fatty acids
  • Moderate amounts of poultry and eggs
  • Limited red meat (only a few times monthly)
  • Nuts and seeds in moderation
  • Herbs and spices instead of salt for flavoring
  • Dairy products like yogurt and cheese in moderation For exercise, aim for:
  • At least 150 minutes of moderate-intensity aerobic activity weekly, such as brisk walking, swimming, or cycling
  • Resistance training twice weekly to build muscle mass, which helps improve metabolism
  • High-intensity interval training can be particularly effective for cholesterol management
  • Daily activities like taking stairs or walking short distances add to your overall activity level This combination works because the Mediterranean diet is rich in monounsaturated fats, fiber, and antioxidants that help lower LDL (bad) cholesterol while raising HDL (good) cholesterol, while exercise increases HDL cholesterol and improves overall cardiovascular health, as supported by studies such as 1, 1, and 1.

From the Research

Mediterranean Diet for High Cholesterol

  • The Mediterranean diet has been shown to decrease LDL atherogenicity in high cardiovascular risk individuals, with a focus on virgin olive oil and nuts 2
  • Key components of the Mediterranean diet include:
    • High consumption of fruits, vegetables, and whole grains
    • High intake of monounsaturated fats from olive oil
    • Low intake of saturated fats and refined carbohydrates
    • Moderate consumption of wine, particularly red wine
  • The Mediterranean diet has been associated with a reduction in inflammatory and oxidative stress markers, improvement in lipid profile, insulin sensitivity, and endothelial function 3, 4

Exercise for High Cholesterol

  • There is no direct evidence in the provided studies on the specific exercise recommendations for high cholesterol
  • However, a healthy lifestyle, including regular physical activity, is often recommended in conjunction with a Mediterranean diet to reduce cardiovascular risk 5, 4

Key Foods for High Cholesterol

  • Virgin olive oil: rich in monounsaturated fats and polyphenols, which have been shown to have beneficial effects on lipid profile and cardiovascular health 2, 3, 6
  • Nuts: may have beneficial effects on LDL traits, although the evidence is limited 2
  • Fruits and vegetables: high in fiber, vitamins, and minerals, and low in saturated fats and refined carbohydrates
  • Whole grains: rich in fiber, vitamins, and minerals, and low in saturated fats and refined carbohydrates
  • Red wine: may have beneficial effects on cardiovascular health when consumed in moderation, due to its high polyphenol content 3

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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