Cholesterol is one of the most familiar compounds in our bodies. Your doctor has probably tested your blood levels of total cholesterol and LDL (a cholesterol-containing substance). Both blood markers show your heart disease risk. If either is elevated, your risk of developing heart disease is higher. 

We used to be very concerned that high-cholesterol foods would raise cholesterol. We now know that only part of the population is sensitive to dietary cholesterol. For those who are cholesterol-sensitive, dietary cholesterol is important to limit. On the other hand, non-sensitive people can eat high-cholesterol foods with very little change in blood cholesterol. 

Cholesterol-sensitive people will likely benefit from a low-cholesterol diet.

Your doctor and a nutrition professional will help determine if you’re cholesterol sensitive by using a low-cholesterol diet. During that time, your doctor will monitor your cholesterol levels over a few months.

Pharmaceuticals can be very effective at lowering cholesterol levels, which is excellent, but many people want to do more. Here are six dietary changes to lower total cholesterol and LDL aside from avoiding dietary cholesterol.

An infographic for six ways to reduce cholesterol.

Eat Plant Sterols

Many animals produce cholesterol, but did you know that plants make their version of cholesterol? It’s called plant sterols and stanols. There are many different plant sterol molecules, and they all look like cholesterol.

We absorb cholesterol from our food in our intestines. However, plant sterols and stanols compete for absorption against cholesterol. So, some cholesterol won’t be absorbed when plant sterols are present. Therefore, eating a lot of plant sterols can significantly lower cholesterol absorption and cholesterol levels.

A diet high in plant sterols seems to lower cholesterol more than any other dietary factor (1). For many, consuming plant sterols is even better than avoiding dietary cholesterol! Moreover, some evidence shows that the effect may be even better for those with Type 2 diabetes.

Which foods contain plant sterols? Lots of food contain sterols but mature soybeans and peas are particularly excellent sources. Beans, lentils, nuts, seeds, and whole grains are typically the most dense in plant sterols. However, vegetables and fruits contain them as well. Although not a whole food, our vegetable oils like sesame oil and corn oil are very dense in sterols. That’s one reason olive oil is better for our hearts than butter.

Sometimes, food manufacturers add sterols to their foods. Cheese, milk, margarine, orange juice, and bread are typical targets for sterol fortification. Find the fortified versions by searching for the word “sterol” (like phytosterol) in the ingredients list. The product will likely state that it “lowers cholesterol,” too.

The goal is two grams of plant sterols daily, up to five grams, but that’s hard to measure. Most food labels don’t mention the sterol content of the food. A more straightforward approach is to shoot for ten servings of vegetables and fruits daily, ideally with more fruits than vegetables.

Plant-based foods contain many more heart-healthy nutrients than sterols, including fiber, antioxidants, and anti-inflammatory phytonutrients. As a result, they are a powerhouse for heart health. Eating a variety of plant based foods daily will ensure that you’re getting plenty of sterols as well as all the other heart-healthy nutrients.

Limit Saturated Fat Consumption

We produce most of the cholesterol in our bodies and use it for healthy processes. Cholesterol travels through the blood in LDL (and other substances) to be deposited in our cells. The LDL ensures that all the cells that need cholesterol will receive them. Afterwards, LDL will be picked up by the liver to be dismantled or recycled.

Unfortunately, high saturated fat diets reduce the liver’s ability to uptake LDL from the blood. When saturated fat blocks LDL clearance, LDL builds up in the blood and increases our heart disease risk. Clearly, eating a high saturated fat diet leads to high total cholesterol and high LDL.

For most people, limiting saturated fat to 10% of their calories is the goal for general health. However, the American Heart Association recommends restricting saturated fat to 5-6% of your daily calories if you have high cholesterol. For a 2,000-calorie diet, 5-6% would equal only 11-13 grams of saturated fat daily. To give you an idea of how much that is, one tablespoon of unsalted butter has about 7.2 grams of saturated fat.

If it takes some time to adapt to the diet, that’s ok. Even a slight reduction in saturated fat intake could be helpful. And as tempting as it may be, don’t avoid all saturated fat. Limiting saturated fat to less than 5% might not benefit you. It might even have negative consequences. A professional evaluation would help determine what’s safest for you.

So how do you know how much saturated fat you should consume? You’ll first have to determine your daily calorie needs. Online calculators or a professional can help you do this. Then, calculate 5% and 6% of total daily calories. Next, divide each of those numbers by nine (the number of calories in a gram of saturated fat). The resulting numbers are the minimum grams and maximum grams of saturated fat you can eat daily.

Eat for your Needs (or the needs for your healthy body weight)

Weight management is an essential part of our heart health. Both overeating and the extra fat tissue itself play a role in raising cholesterol. Let’s start with the excess fat tissue.

Our fat tissue stores extra energy in the form of fat, but it’s not just storage. Fat tissue is necessary for good health. It helps reduce hunger, manage inflammation, produce and retain heat, and release hormones. But when we have too much, it begins to cause problems.

Fat molecules and cholesterol are transported to and from fat tissue constantly. LDL, HDL, and other similar substances do the transporting. Having more fat tissue means there are more fat molecules to transport. As a result, LDL cholesterol levels rise to transport all those fat molecules. But not all fat is the same. It’s the fat around the belly that is most likely to increase LDL levels.

Excess fat tissue will cause insulin resistance too. When insulin-resistant, the carbohydrates we eat cannot get into the cells. As a result, the liver converts the excess sugar into fat and other molecules. That triggers a rise in LDL and a gain in weight, an unfortunate downward cycle when left unaddressed.

Overeating leads to excess fat tissue, but that is not the only way it raises cholesterol. LDL cholesterol can rise right after overeating a high carbohydrate or high-fat meal, especially if that meal is high in saturated fat. The effect is temporary, lasting a few hours. But regularly overeating carbohydrates, fats, or saturated fats means LDL stays high.

Losing only 10 lbs. can reduce LDL for overweight people (1). Attaining a healthy body fat percentage will help most people manage LDL cholesterol. What is the right body percentage? For males, <25% body fat is acceptable. Females do best when <32% body fat. Unfortunately, it can be difficult to get an accurate body fat percentage, espcecially in an affordable way. An easier alternative is waist circumference. The guidelines for the typical male is <41 inches and for females is <36 inches.

Manage Your Sugars

Our blood sugar rises as we absorb the sugars from our carbohydrate-rich foods. These variations in blood sugar levels are normal and natural. Our bodies use the sugars in the blood for energy and storage (glycogen), but the liver converts some into fat. The liver packages that fat with proteins in a globule that eventually becomes LDL cholesterol. The liver converts more sugar into fat during a blood sugar spike. And as we know, more fats in the blood are a problem.

So how do we prevent these blood sugar spikes? It mostly depends on what we eat.

The glycemic load is a valuable metric to evaluate foods for blood sugar balance. It tells us how much one serving of a specific food will increase blood sugar. A higher number indicates a higher blood sugar spike. Some foods with high glycemic loads are pancakes, potatoes (especially baked), white rice, Kraft Macaroni and cheese, apple juice, instant oatmeal, raisins, dried dates, and white bagels. It’s important to remember that overeating a low glycemic load food can spike blood sugar too.

Another metric that measures the impact on blood sugar is the glycemic index. However, this measurement is less helpful than glycemic load because it doesn’t consider serving size. Instead, it analyzes whatever amount of a food item contains the target carbohydrate content (usually 50 grams). So, for example, the amount of watermelon that has 50 grams of carbohydrates is four and a half cups. One serving is only one cup. Eating four and a half cups of watermelon gives it a high glycemic index rating (about 75). But even though watermelon has a high glycemic index, it has a low glycemic load. What does this mean?

For watermelon, the high glycemic index indicates that its sugars/carbohydrates absorb quickly. The low glycemic load suggests that one serving of watermelon contains minimal amounts of sugar/carbohydrate. It doesn’t matter how fast we absorb sugars when our food contains only a small amount of sugar/carbohydrate. Many foods are like this, especially fresh fruits with high water content, but some foods have the opposite classification: a low glycemic index but a high glycemic load. It’s dried fruits that typically fit this classification.

If you stick with the serving size, the glycemic load will tell you all you need to know.

Finally, if your meal or snack contains protein, it will likely minimize the blood sugar spike. Fat and fiber may also reduce blood sugar spikes. The interactions of all the nutrients make it challenging to predict the glycemic load of a meal/snack. No matter what, a balanced, whole foods meal will be better than a high-carbohydrate meal with processed carbs.

Eat NO Trans Fats . . . Well, No Artificial Trans Fats.

Trans fats are like saturated fats in that they increase LDL. However, they also decrease HDL, a beneficial substance that lowers heart disease risk. They have such a profound effect that it’s recommended that we eat no trans fats, especially artificial trans fats.

Interestingly, eating foods with natural trans fats has the opposite effect. They can increase HDL and lower LDL cholesterol. That effect on our cholesterol levels makes natural trans fats helpful. We typically find these natural trans fats in meat and dairy products and some eggs. Choosing meats, milk, and eggs from grass-fed animals is more likely to contain beneficial, natural trans fats.

Most food producers and restaurants have cut down on trans-fat ingredients. However, you’ll still find trans fats in small amounts, usually in highly processed foods. Using the nutrition label, you can determine how much trans fats are in a food serving. If you want to avoid all trans fats, you’ll need to read the ingredients.

The nutrition label can report zero trans fats per serving if the number is less than 0.5 grams. To find out if your food contains any trans fats, search the ingredients for the words trans, hydrogenated, and partially hydrogenated. Any ingredient with these words in its name will be an artificial trans fat.

The more you know about your foods from outside the home, the easier it will be to make educated decisions. Large restaurant chains often have nutrition information online, and all packaged food must have a nutrition label.

Eat More Fiber

Fiber is the indigestible part of plant-based foods, so we don’t break fiber into smaller pieces. We classify fiber as soluble or insoluble. Soluble will attract water and become gelatinous, while insoluble will not. The specific type of soluble fiber will determine how thick the fiber becomes. Denser soluble fibers are most helpful for cholesterol management.

The cholesterol in our digestive system comes from our food and our bile. When the soluble fiber in our food forms a gel in our digestive system, it traps some dietary cholesterol (and bile salts) in the gel. Instead of being absorbed, the gel and the trapped cholesterol combine with solid waste (poop) and are excreted. The body must replace the lost bile salts, so it uses cholesterol already in the blood to do so. This eventually lowers cholesterol levels.

Consuming as little as 5 grams of soluble fiber daily can be helpful, but consuming even more, up to 20 grams daily, is even better. But it is challenging to count soluble fiber in the diet. Most fiber foods contain a mix of soluble and insoluble, and our nutrition labels don’t separate the two; they only specify total fiber. So, if you aren’t using a food database and diet tracker, you could at least shoot for the adequate intake (AI) of total fiber.

Adequate fiber intake is 38 grams/day for men and 25 grams/day for women.

If you change your fiber intake, make slow changes. Rapid changes can cause digestive symptoms, including diarrhea and constipation for some people. Get your doctor’s opinion as well. Some conditions and medications are negatively affected by fiber.

Following these six factors can significantly reduce your cholesterol levels.

All of this can be overwhelming, but there is a trick. Without much thought, you can rely on already-established diet plans to lower your dietary cholesterol. Both the DASH and Mediterranean diet patterns follow these factors.

The DASH diet is short for Dietary Approaches to Stop Hypertension. People with high blood pressure use the DASH diet to help them naturally lower their blood pressure. Both high blood pressure and high cholesterol/LDL are risk factors for heart attacks and strokes. DASH focuses on ( vegetables, fruits, and whole-grain foods. DASH limits high saturated-fat foods, including fatty meats, full-fat dairy, and vegetable oils like coconut and palm oils.

The Mediterranean diet comes from the traditional diets of Greece, Italy, and other cultures along the Mediterranean Sea. The diet is associated with lower cholesterol levels, healthier hearts, and overall health. Like DASH, it focuses on vegetables, fruits, and whole grains but also includes legumes, nuts, and seeds. In addition, it recommends proteins such as fish, seafood, and poultry, but the diet eliminates red meats. Additionally, olive oil plays a central role in cooking and dressing foods.

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I’m Matt

I am a licensed, registered dietitian and nutritionist who helps people change their lives.

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