How to Lower Cholesterol With Diet: Fats, Fiber, Plant Sterols, Omega-3s, Salt and Alcohol

Cholesterol is a waxy, fat-like substance found in every cell of the body, which needs some to work properly. Too much in the blood can stick to artery walls and narrow or block them, raising the risk of coronary artery disease and other heart diseases.

The liver makes cholesterol, and it travels in the blood on proteins called lipoproteins:

• LDL — "bad" cholesterol: high levels lead to buildup in the arteries;
• HDL — "good" cholesterol: carries cholesterol back to the liver, which removes it from the body.

The main treatments for high cholesterol are heart-healthy lifestyle changes — healthy eating, weight management, regular physical activity — and medicines.

Eating to lower cholesterol

The DASH eating plan is one heart-healthy diet. Another, the Therapeutic Lifestyle Changes (TLC) diet, recommends:

1. Choose healthier fats. Keep total fat to no more than 25–35% of daily calories, and saturated fat under 7%.

Saturated fat raises LDL more than anything else you eat. It is in some meats, dairy, chocolate, baked goods, and deep-fried and processed foods. Swap in lean meat, nuts, and unsaturated oils such as canola, olive and safflower.

2. Limit dietary cholesterol to under 200 mg a day. It is found in animal foods — liver and other organ meats, egg yolks, shrimp, whole-milk dairy.

3. Eat plenty of soluble fiber — 10 to 25 g a day — which helps keep the gut from absorbing cholesterol:

• whole-grain cereals such as oatmeal and oat bran;
• fruits such as apples, bananas, oranges, pears and prunes;
• legumes such as kidney beans, lentils, chickpeas, black-eyed peas and lima beans.

4. Eat lots of fruits and vegetables, for vitamins, fiber and other nutrients.

5. Get more plant stanols and sterols — about 2 g a day — which also block cholesterol absorption. They are in whole grains, nuts, legumes and oils such as olive and avocado, and added to some orange juice, margarine and bread.

Also good for the heart

• Omega-3 fatty acids can lower LDL and triglycerides, help control blood pressure, may lower the risk of heart rhythm problems, and — for people with heart disease — of heart attack. Sources: fish such as salmon, tuna and mackerel (most people should eat them twice a week; if pregnant or breastfeeding, avoid high-mercury fish such as mackerel); walnuts, flaxseed, chia seeds, canola and soybean oils (with less omega-3 than fish); and fortified eggs, yogurt, juices, milk, soy drinks and infant formulas.
• Salt: keep sodium to 2,300 mg (about 1 teaspoon of salt) a day, from all sources. It won't lower cholesterol, but it helps blood pressure and so heart risk. Choose low-salt and "no added salt" foods and seasonings.
• Alcohol adds calories; extra weight can raise LDL and lower HDL, and too much alcohol can raise blood pressure and triglycerides. It's best not to drink; if you do, no more than 2 drinks a day for men and 1 for women.

Nutrition labels show a food's fat, saturated fat, cholesterol, fiber and sodium — a practical way to put all this into practice.

Sources

Based on "How to Lower Cholesterol with Diet," MedlinePlus, National Library of Medicine, drawing on the National Heart, Lung, and Blood Institute; a work of the United States government in the public domain.