Here, dietitians share their insights on what they want you to know if you — or someone you love — has high cholesterol.
1. Saturated Fat and Trans Fat Have a Big Influence on Blood Cholesterol
We use the same word for the cholesterol in foods as for the cholesterol that gets measured at the doctor’s office in our blood tests — but there are important differences between the two. According to the American Heart Association (AHA), your liver naturally produces all the cholesterol your body needs to build cells. But eating certain foods can raise these natural levels and produce too much LDL cholesterol (or “bad”) blood cholesterol. Cholesterol usually isn’t the biggest culprit, however. A large body of research shows that eating foods that contain cholesterol doesn’t affect the amount of cholesterol in the blood of most people as much as doctors once thought, says Lisa Dierks, RDN, dietitian and regional director for the University of Minnesota Extension Program in Wanamingo, Minnesota. Instead, saturated fat and trans fat raise LDL cholesterol levels more than dietary cholesterol does, according to the American Heart Association (AHA). But that doesn’t mean a high-cholesterol diet is a good choice. While limiting cholesterol is no longer listed in the most recent USDA Dietary Guidelines for Americans, a study of 30,000 people, published in March 2019 in JAMA, found that cholesterol did appear to impact blood cholesterol levels and in turn, risk for cardiovascular disease (CVD). According to the Harvard University T.H. Chan School of Public Health, the combination of fats and carbohydrates a person regularly eats has the largest impact on blood cholesterol levels — not the amount of cholesterol you get from food –– but it’s still important to limit the amount of cholesterol in your diet, especially if you have diabetes. As it turns out, a lot of high-cholesterol foods are also high in saturated fat. And according to USDA guidelines, it’s particularly important to limit saturated fats, which are found in animal products like meat and full-fat dairy, and trans fats, also known as partially hydrogenated oils, which are found in many fried foods and processed baked goods such as cookies, cakes, and crackers. Specifically, saturated fatty acids shouldn’t account for more than 10 percent of your daily calories. There has been tons of back and forth over whether or not eggs contribute to high cholesterol, so if you’re trying to lower your LDL levels, Francisco Lopez-Jimenez, M.D. of the Mayo Clinic recommends eating egg whites, which are rich in protein but not cholesterol. The jury is out on shrimp as well, another food that is high in cholesterol, but low in saturated fat and rich in other nutrients like protein. According to the AHA, shrimp is a healthier choice than cuts of meat that are high in saturated fat, as long as you don’t fry it.
2. Not All Blood Cholesterol Is Bad
Being diagnosed with high cholesterol can be alarming, and the three numbers you’re given for your cholesterol levels can also be confusing. However, not all cholesterol is bad. The three numbers that you usually see are so-called “good” HDL (high-density lipoprotein) cholesterol, “bad” LDL (low-density lipoprotein) cholesterol, and total cholesterol. A higher HDL cholesterol number is good for heart health since it flushes bad cholesterol from the bloodstream. But a high level of LDL cholesterol increases your risk for heart disease and stroke since LDL cholesterol’s structure allows it to stick to the walls of arteries where the deposits are known as plaque buildup, according to the Harvard University T.H. Chan School of Public Health.
3. The Same Things That Lower Bad Cholesterol Raise Good Cholesterol
You also have some control over your so-called “good” HDL cholesterol. According to the Mayo Clinic, people who have metabolic syndrome — a group of conditions that include obesity, high blood pressure, elevated triglycerides, and high blood sugar –– typically have low HDL cholesterol levels. So losing weight with diet and exercise could help increase your HDL cholesterol levels. Also, following the same diet guidelines that can lower LDL cholesterol can raise HDL cholesterol levels at the same time. Research has shown that high doses of niacin supplements can increase HDL cholesterol levels by as much as 35 percent, according to a study published in July 2018, in the journal Advances in Preventive Medicine, though according to the Mayo Clinic, medications that increase HDL do not reduce the rate of heart attacks.
4. One Food Alone Will Not Lower Cholesterol
In the same way that no single food will cause you to have high cholesterol, there’s no one food that can save the day, either. “There are no magic foods. You have to look at the overall diet,” says Judith Wylie-Rosett, RDN, doctor of education, professor of epidemiology and population health at the Albert Einstein College of Medicine in the Bronx, New York. The key to lowering cholesterol levels is to eat a generally healthy diet of lean protein, fruit, vegetables, whole grains, and fat-free or low-fat dairy, and to limit saturated and trans fat. Research has shown that adopting a plant-based diet can be a powerful way to lower LDL cholesterol. A meta-analysis of 96 studies on the health impacts of vegan and vegetarian diets, published in November 2017, in Critical Reviews in Food Science and Nutrition, found that a plant-based diet significantly reduced both total cholesterol and LDL-cholesterol numbers. In another study, published in August 2019, in the Journal of the American Heart Association, researchers compared their own findings to what previous research on heart disease and diet found. Just as previous research suggested, the new study also found that people who ate less meat and whose diet most resembled a vegetarian way of eating had lower overall risk of heart disease.
5. Fruits, Vegetables, and Whole Grains Are Key to a Cholesterol-Controlling Diet
Choosing foods that contain healthy unsaturated fats, like olive oil or avocado, and limiting those with unhealthy saturated and trans fat is key to lowering high LDL cholesterol levels. But it’s only part of building a healthier diet. “While fat tends to be the thing we focus on first, other components of the diet can help too,” says Dierks. “Are you eating enough fruits, vegetables, and whole grains?” The fiber in these foods can contribute to bringing down your cholesterol levels. According to the Mayo Clinic, just 10 grams of soluble fiber or more a day can reduce LDL cholesterol levels. Reducing added sugar can also positively impact your cholesterol levels. A prospective study published in February 2020, in the Journal of the American Heart Association, found that adults who drank 12 ounces of sugary drinks –– sodas, fruit-flavored drinks, sports drinks, and presweetened coffees and teas –– more than once a day had lower levels of HDL cholesterol and raised triglycerides, which are both linked to heart disease. Take a look at your diet as a whole and decide where you may need to make changes. RELATED: 9 Best and Worst Milks for Your Heart
6. Lifestyle Changes Can Improve Cholesterol Numbers
In addition to diet, other healthy lifestyle changes can also make a big difference in cholesterol levels. “Diet is very important, but it isn’t the only piece of the cholesterol puzzle,” says Despina Hyde, RDN, CDE, registered dietitian and certified diabetes educator at Shannan Carter Nutrition, LLC in New York City. For instance, being physically active on most days of the week can lower your cholesterol levels. The American Heart Association (AHA) recommends getting at least 150 minutes (2.5 hours) of moderate exercise — or 75 minutes (1.25 hours) of vigorous exercise — per week as an important part of cholesterol management. Hyde also says that quitting smoking, losing weight, and limiting how much alcohol you drink can all contribute to lower cholesterol levels (and lower your blood pressure also — another important risk factor for cardiovascular disease). According to the Centers for Disease Control and Prevention (CDC), smoking is associated with lower HDL cholesterol levels and increased plaque buildup in blood vessels. Pair these lifestyle changes with a healthy diet and you’ll likely be on the road to better cholesterol levels in no time.
7. Family History of High Cholesterol Puts You at Higher Risk
If members of your family have high cholesterol, you’re more likely to have it as well. This doesn’t mean that your destiny is sealed, but you may have to pay more attention than the average person to your diet and lifestyle choices. “If you have a family history of high cholesterol, have your blood cholesterol levels checked every year and focus on a healthy diet to minimize the risk of developing high cholesterol yourself,” recommends Hyde.
8. High Triglyceride Levels Are Bad, Too
Triglycerides are another type of blood lipid that can be dangerous if levels get too high, and a blood lipid panel will screen for them as well. “On average, your diet can influence a modest percentage of your cholesterol values. Triglycerides, though, are highly influenced by diet,” says Julia Zumpano, RD, a registered dietitian at the Cleveland Clinic in Ohio. “Cholesterol is only one piece of the pie,” says Zumpano. Having high levels of triglycerides, a type of fat in your blood, increases your risk of heart attack and stroke. According to the National Heart, Blood and Lung Institute, high blood triglycerides can be a separate condition, or be compounded by high LDL cholesterol or low HDL cholesterol. Thyroid disease, diabetes, liver and kidney diseases, and being overweight are medical conditions that can cause high blood triglycerides. But lifestyle habits and genetics can also impact triglyceride levels. As is the case with LDL cholesterol, not getting enough exercise, eating foods that are high in fat and sugar, and drinking too much alcohol can all raise blood triglycerides. On the contrary, omega-3 fatty acids, like the kind found in salmon, olive oil, and avocado, can help keep triglycerides in check.
9. Some People Will Still Need Medication
Make the changes and work closely with your doctor to monitor your levels. Wiley-Rosett says, “There are ways to bring down cholesterol levels through healthy changes, but in the end, you may need medication as well.” Diet and exercise can go a long way toward improving high cholesterol and, in many cases, can alleviate the problem entirely, but this isn’t the case for everyone. Some people will need to take cholesterol-lowering medication in addition to maintaining a healthy lifestyle. Work with your doctor to figure out what’s best for you. Because other factors — including, sometimes, the medication you take — contribute to cholesterol levels in addition to your diet, hitting your health targets can be complicated. If you’re not sure where to start, pick one or two changes that you know you can stick with. Small adjustments to your diet, more physical activity, or other lifestyle changes can go a long way to lowering cholesterol levels. Additional reporting by Kaitlin Sullivan
