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Cholesterol is a type of lipid or fat that is essential for human life.
It’s a component of cell membranes and is needed to produce vitamin D and sex hormones like testosterone and estrogen.
Your body also needs cholesterol to make bile salt, which helps with the digestion of fat and absorption of fat-soluble vitamins like A, D, E, and K.
However, high levels of cholesterol are unhealthy and can increase your risk of heart disease and stroke.
Diet is important for treating and preventing high cholesterol.
This article explains what to eat and avoid to lower your cholesterol levels and provides a sample high-cholesterol diet menu.
Causes and risk factors
About 38% of American adults have high cholesterol (1).
High cholesterol is closely tied to lifestyle factors such as poor diet, lack of exercise, and smoking (2).
While animal-based foods like meat, eggs, and dairy naturally contain cholesterol, consuming these foods has little effect on most people’s blood cholesterol levels (3).
This is because your body tightly balances its production of cholesterol with the amount you consume through your diet.
The higher your dietary intake of cholesterol, the less cholesterol your body produces. The less cholesterol you consume, the more cholesterol your body makes.
However, in some people, eating high-cholesterol foods raise cholesterol levels due to genetic factors (4).
Diagnosis and treatment
High cholesterol has no symptoms and therefore can go undiagnosed for years.
Your doctor can use a blood lipid test to measure your total cholesterol level, as well as your LDL (bad) cholesterol, HDL (good) cholesterol, and another type of fat called triglycerides.
You may be required to avoid eating or drinking anything 8–12 hours before the test.
Here are the desirable ranges for blood lipids (5):
- Total cholesterol: less than 200 mg/dL
- LDL cholesterol: less than 100 mg/dL
- HDL cholesterol: 60 mg/dL or higher
- Triglycerides: less than 150 mg/dL
LDL cholesterol is considered bad cholesterol because it transports cholesterol to your arteries, where it can build up and limit or block blood flow to the heart and brain, increasing your risk of heart disease, congestive heart failure, and stroke (5).
On the other hand, HDL cholesterol is considered good cholesterol because it transports cholesterol to your liver to be removed from your body. With healthy HDL cholesterol levels, you can decrease your risk of heart disease and stroke (5).
If your total cholesterol or LDL cholesterol is too high, your doctors will diagnose you with high cholesterol.
The good news is, you can lower high cholesterol with diet.
How to lower cholesterol with diet
Several diets, including the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet, have been shown to lower LDL high cholesterol by up to 15% and reduce the risk of heart disease, stroke, and other conditions like gout (5).
These diets share many similarities in that they emphasize fruits, vegetables, whole grains, lean proteins, nuts, seeds, and legumes, and limit processed and red meats, added sugars, and refined grains.
Other diets like the standard American diet or Western diet — which is low in the foods the Mediterranean diet and DASH diets emphasize and high in the foods they limit — have been shown to increase cholesterol (6).
Some evidence suggests the ketogenic diet or keto diet temporarily raises cholesterol levels in some people but decreases levels when followed long term, likely because the diet can promote weight loss in some people (7, 8).
Foods to avoid
You should limit processed meats and refined carbs, as eating them in excess can raise cholesterol.
Processed meats are high in saturated fat.
Examples of processed meats include:
- hot dogs
- deli meats
Higher intakes of refined carbs are associated with low HDL cholesterol and high LDL cholesterol (13).
There are two main types of refined carbs:
- Added sugars. These are sugars added during the manufacturing process to enhance flavor, preserve freshness, or provide texture.
- Refined grains. These are grains that have had their fibrous and nutritious parts removed.
Refined carbs contain few nutrients but lots of calories. Many refined carbs such as cakes, pastries, potato chips, and crackers also contain saturated fats.
Other sources of refined carbs include:
- regular soft drinks
- fruit drinks
- dairy desserts like ice cream
- syrups and toppings
- condiments like ketchup and barbeque sauce
The American Heart Association recommends a daily limit of 9 teaspoons (36 grams) of added sugar for men and 6 teaspoons (25 grams) for women (14).
Foods to eat
Foods emphasized by the Mediterranean diet and DASH diet contain nutrients like fiber and other plant compounds called phytosterols that block your body from absorbing cholesterol.
Fiber and phytosterols are naturally found in plant-based foods like fruits, vegetables, whole grains, beans, seeds, and nuts.
A review of 124 studies found that eating a diet rich in phytosterols led to a 6–12% reduction in LDL cholesterol (15).
The best sources of fiber and phytosterols to eat to lower cholesterol include (19):
- Fruits: apples, berries, bananas, cherries, oranges, pears, raspberries, etc.
- Vegetables: arugula, asparagus, beets, carrots, mushrooms, peppers, tomatoes, etc.
- Whole grains: amaranth, barley, buckwheat, brown rice, oats, quinoa
- Beans, seeds, and nuts: black beans, lima beans, soybeans, sunflower seeds, pistachios, almonds, walnuts
- Oils: extra virgin olive oil, canola oil, avocado oil
In addition to these foods, choose healthy proteins such as chicken, turkey, Greek yogurt, and fish.
One-day sample high cholesterol diet
Here is a 1-day sample high cholesterol diet that is rich in fiber and phytosterols:
- Breakfast: overnight oats topped with blueberries and chopped walnuts
- Snack: Greek yogurt hummus with sliced peppers, snap peas, and cucumbers for dipping
- Lunch: quinoa, avocado, and chickpea salad over mixed greens
- Snack: apple slices and almonds
- Dinner: sheet-pan salmon with sweet potatoes and broccoli
Supplements to lower cholesterol
In addition to diet, psyllium husk powder and red yeast rice supplements have been shown to lower cholesterol.
Psyllium husk powder
Psyllium husk powder is a form of soluble fiber sourced from husks of the psyllium (Plantago ovato) seed.
As a significant source of soluble fiber, psyllium binds to cholesterol in your digestive system before it can be absorbed and eliminates it from your body (20).
A review of 28 studies involving 1,924 people with and without high cholesterol demonstrated that supplementing with 10 grams of psyllium daily for three weeks or longer significantly reduced LDL cholesterol by 12.8 mg/dL (21).
Studies have even demonstrated that psyllium has cholesterol-lowering effects similar to statins — a class of medications commonly prescribed to treat high cholesterol (22).
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Red yeast rice
Red yeast rice is a type of fermented rice that is produced using a specific species of yeast.
It contains the same active ingredient (monacolin K) as the prescription cholesterol-lowering drug lovastatin, which reduces your body’s natural production of cholesterol (23).
An analysis of 20 studies involving more than 6,600 patients found that supplementing with an average of 10.8 mg of monacolin K from red yeast rice extract daily for at least four weeks significantly lowered LDL cholesterol by 38.7 mg/dL, a decrease similar to prescription statins (24).
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The bottom line
Cholesterol is essential for maintaining cell membrane structure, making vitamin D and sex hormones, and absorbing fat-soluble vitamins.
However, high cholesterol levels can damage and block blood flow to your heart and brain, increasing your risk for heart disease and stroke.
Eating a diet rich in fiber and phytosterols like fruits, vegetables, and whole grains while avoiding processed meats and refined carbs can lower high cholesterol.
Additionally, supplements like psyllium husk powder and red yeast extract can also lower cholesterol, with decreases similar to stains.