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Cholesterol-Lowering Diet

( Low-Density Lipoprotein [LDL] Lowering Diet)

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.

Your Cholesterol Levels

A cholesterol test should be done after a 9- to12-hour fast. The results that you want to focus on are the total, LDL, and HDL levels.
  • Total cholesterol—Your total cholesterol should be less than 200 milligrams per deciliter (mg/dL [11.1 mmol/L]). However, what is even more important is the breakdown of LDL and HDL cholesterol.
  • Low-density lipoprotein (LDL) cholesterol—Also known as bad cholesterol, tends to build up along your arteries. Bad cholesterol levels are increased by eating fats that are saturated or hydrogenated. This level should be less than 100 mg/dL (5.6 mmol/L).
  • High-density lipoprotein (HDL) cholesterol—Also known as good cholesterol. It actually carries bad cholesterol away from your arteries and may, therefore, help lower your risk of having a heart attack. This level should be 60 mg/dL (3.3 mmol/L) or above.

Diet and Cholesterol

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.

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. Fat can be broken down into four main types:
Fats that increase LDL levels and should be avoided or limited:
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
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:
Monounsaturated fat
Found in oils such as olive and canola; can decrease total cholesterol level while keeping levels of HDL high
Polyunsaturated fat
Found in oils such as safflower, sunflower, soybean, corn, and sesame; can decrease total cholesterol
Saturated fat raises your blood cholesterol more than any of the other types of fat or cholesterol. For this reason, less than 10% of calories should come from saturated fat on a cholesterol-lowering diet.
On an 1,800 calorie diet, this translates into less than 20 grams of saturated fat per day, leaving 40 grams to come from mono- and polyunsaturated fats.

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, 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.

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%.

Eating Guide for a Cholesterol-Lowering Diet

Food Category Foods Recommended Foods to Avoid
Grains
  • Whole grain breads and cereals, pasta, rice, potatoes, low-fat crackers
  • High-fat baked goods like muffins, donuts, and pastries
  • Crackers made with trans fat
Fruits
  • All; choose whole fruit over juice for added fiber
  • None
Vegetables
  • All
  • Vegetables with added fat or sauce
Milk
  • Nonfat or low-fat (1%) milk
  • Nonfat or low-fat yogurt, sour cream, buttermilk
  • Cottage cheese, low-fat cheeses
  • Whole milk
  • Reduced-fat (2%) milk
  • Malted and chocolate milk
  • Most cheeses
Meat and beans
  • Lean cuts of beef, pork, veal, or lamb (look for the word loin or round; trim visible fat before cooking
  • Poultry without the skin
  • Fish and most shellfish; limit your intake of shrimp
  • Egg whites and egg substitutes; limit whole eggs to two per week
  • Tofu
  • Seeds, nuts; peanut butter should be eaten in moderation due to high calorie content
  • Dried peas, beans, and lentils
  • Fatty cuts of meat
  • Organ meats like brain, liver, and kidneys
  • Poultry skin
  • Breaded fish or meats
  • More than two egg yolks per week, including those found in baked goods, cooked foods, or processed foods
Fats and oil
  • Vegetable oils high in unsaturated fat like olive, canola, corn, safflower, or soybean
  • Trans fat-free soft or liquid margarines; the first ingredient should be unsaturated liquid vegetable oil
  • Stanol/sterol-containing margarine
  • Low-fat salad dressings and mayonnaise
  • Butter, stick margarine, coconut and palm oils, bacon fat
  • Salad dressings made with egg yolk
Snacks, sweets, and 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 like hard candy or jelly beans
  • High-fat desserts; baked goods made with butter, lard, shortening, egg yolks, or whole milk

Suggestions

Food Selection

  • Make whole grains, fruits, and vegetables the base of your diet.
  • 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 no grams trans fat, even on the label, but still have a small amount. Be sure to look for partially hydrogenated oil. 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. These include fatty fish such as salmon, mackerel, and tuna; flaxseed; walnuts; canola oil. Eating fish at least 2 times a week is more effective than omega-3 fatty acid supplements. In fact, evidence about the benefits of supplements is not conclusive.

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.

Other

  • Engage in at least 30 minutes of physical activity every day.
  • Lose weight if you are overweight.
  • Talk to a registered dietitian for individualized diet advice.

RESOURCES

Academy of Nutrition and Dietetics http://www.eatright.org

National Cholesterol Education Program http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Dietitians of Canada http://www.dietitians.ca

Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca

References

About cholesterol. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol%5FUCM%5F001220%5FArticle.jsp. Updated October 11, 2012. Accessed February 13, 2013.

Dietary guidelines for Americans 2010. US Department of Agriculture and US Department of Health and Human Services. Available at: http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf. Accessed February 13, 2013.

Dietary recommendations for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 9, 2013. Accessed February 13, 2013.

Harland JI. Food combinations for cholesterol lowering. Nutr Res Rev. 2012;25(2):249-266.

Hypercholesterolemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 11, 2013. Accessed February 13, 2013.

Lowering your cholesterol with TLC. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/chol/chol%5Ftlc.pdf. From December 2005. Accessed February 13, 2013.

What your cholesterol levels mean. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean%5FUCM%5F305562%5FArticle.jsp. Updated February 8, 2013. Accessed February 13, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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