What (Not) to Eat to Lower Your Cholesterol
Is shrimp high in cholesterol? How much cholesterol is in an egg?
If you're aiming for a low cholesterol diet, you've likely found yourself asking these sorts of questions. We'll throw out a better question: Does it matter?
To be clear, preventing and lowering high cholesterol is important. There's no doubt about that.
High cholesterol leads to the formation of fatty deposits (called plaque) in the arteries — causing them to harden and narrow, affecting blood flow. This is called atherosclerosis, which, over time, contributes to a range of health issues, including heart disease, peripheral artery disease, heart attacks, strokes and more.
But in terms of how to lower your cholesterol, there's more to it than avoiding high-cholesterol foods. A lot more.
"Dietary cholesterol makes up far less of an important role in what your blood cholesterol will be than you might think," says Dr. Joshua Septimus, associate professor of clinical medicine and medical director of Houston Methodist Primary Care Group Same Day Clinics.
But wait, isn't dietary cholesterol bad ... ?
You're not alone if you think dietary cholesterol is the problem. High-cholesterol foods have been villainized since the 1960s, when they were assumed to be the primary driver of developing high cholesterol.
"We've known for quite some time that the cholesterol hypothesis — that cholesterol in the blood triggers heart disease — is true," says Dr. Septimus. "But the specifics of how cholesterol levels are affected by diet is a much less mature discussion."
Why did dietary cholesterol take all the blame initially? That's a history lesson for a different day.
Right now, there's a more important point to be made anyway.
What we know can drive up cholesterol in the blood are:
- Making poor food choices
- Being overweight
- Living a sedentary lifestyle
In terms of poor food choices, certain types of dietary fat and the sheer amount of processed food many of us consume are important factors to consider.
"We also need to understand that it's not just how much fat you consume, it's what type of fats," adds Dr. Septimus. "For instance, someone who eats a diet rich in nuts and olive oil or has salmon every day may have very normal cholesterol levels. While someone who eats the typical American diet, which is highly processed, could have high cholesterol."
There are three main types of dietary fat — unsaturated fats, saturated fats and trans fats — each of which falls in a different place on the health spectrum. Unsaturated fats are healthy. Trans fats might as well be called trash fats. And saturated fats fall somewhere in between.
There's also more nuance we need to understand.
"Within the unsaturated category, monounsaturated fats — the ones that olive oil is high in — are generally considered to be the healthiest," says Dr. Septimus. "Then you have the polyunsaturated fats that come from plant and seafood sources, which are also healthy."
Saturated fats, on the other hand, are typically considered unhealthy and it's recommended that they make up as little as 5% to 6% of your daily calories, but that can be somewhat of an oversimplification at times as well.
"The yolk of an egg has a lot of saturated fat in it. That's bad, right? Well, not necessarily," says Dr. Septimus. "That egg also has a bunch of other nutrients that may have natural anti-inflammatory properties and be beneficial to you."
Diet and cholesterol levels: What not to eat
When it comes to how to lower your cholesterol — or prevent it from rising in the first place — Dr. Septimus recommends the following:
Avoid trans fats at all costs
The one type of fat that doesn't come with an asterisk or a footnote is trans fats. Dr. Septimus describes to them as simply horrendous.
"Most trans fats are artificial, partially hydrogenated oils that we know to be uniformly atherogenic, meaning they're pro-inflammatory, they significantly increase the amount of cholesterol in the bloodstream and they absolutely trigger heart disease," explains Dr. Septimus. "Around the same time as the cholesterol hypothesis was proven true, trans fats were on the rise and being added to all sorts of foods. So the term dietary cholesterol almost became wrapped up in the harm of trans fats."
Artificial trans fats aren't commonly found in the processed foods available to us today thanks to the FDA taking steps to remove them. But beware — they're still out there, frequently in foods like frozen pizza, microwave popcorn, non-dairy coffee creamer and many baked goods, among other products.
"The No. 1 thing I'd say is to avoid trans fats," adds Dr. Septimus. "They're horrible. If you're going to eat a processed food item, turn it over first and look at the ingredients. If you see 'partially hydrogenated' or 'hydrogenated' in the list, throw it out."
And don't fall for labels claiming that a product has "0 grams of trans fats." There's a reason manufacturers choose this language instead of simply saying "No Trans Fats." The FDA allows foods that contain 0.5 grams of trans fat per serving or less to be labeled as having zero grams of trans fats. That may not sound like much at first, but how many servings are in the bag? How many servings are you going to eat?
Limit processed foods
"The next layer of protection I recommend is limiting processed foods, which ultimately means don't eat a standard American diet," says Dr. Septimus. "What it really all boils down to is that you shouldn't eat fake food — things that don't rot, packaged items full of added sugar and foods with ingredients you can't pronounce."
This includes sugar-sweetened beverages, fast food, fried foods, frozen meals and commercially baked goods and snacks. Full of added, artificial ingredients, these foods affect metabolic pathways and significantly contribute to high cholesterol levels. They're also typically devoid of nutrients and full of empty calories, contributing to weight gain, inflammation and blood sugar spikes — all of which can indirectly lead to high cholesterol.
"I think a lot of people don't realize that insulin resistance and high cholesterol are linked," adds Dr. Septimus. "If you eat a lot of processed foods, particularly sugar-sweetened beverages, that will drive your cholesterol up."
Reduce saturated fat, but weigh a food's saturated fat content against its overall healthfulness
Since saturated fats aren't as healthy as their unsaturated counterparts, Dr. Septimus says it's a good idea to reduce the amount you eat, particularly if you're not already eating saturated fats in moderation.
But keep in mind that certain foods containing saturated fat provide health benefits, so eating them is still worthwhile. Eggs, dairy products, avocados and nuts are a few examples.
For instance, full-fat, plain Greek yogurt is a source of saturated fat, but it's not processed and doesn't have added sugars. It also contains live, active cultures that have a lot of potential gut health benefits.
"Back to the eggs we talked about, yolks come with minerals and vitamins and have anti-inflammatory effects," says Dr. Septimus. "But what else do you get when you eat beef, pork or other types of red meat? In addition to saturated fat, red meat — particularly processed options, like bacon, salami, sausage — contains potentially toxic compounds. Some evidence also suggests that red meat consumption promotes insulin resistance."
All of which is to say, it's important to look at all of what a food product has to offer. Reducing your saturated fat intake is important but when you eat foods containing it, choose ones that offer health benefit over those that instead have additional drawbacks.
What to eat to lower your cholesterol
So, what should you eat to help manage your cholesterol levels? For starters, Dr. Septimus notes that there's no single perfect diet.
"There are cultures all around the world thriving on various diets," says Dr. Septimus. "Even though they can be fundamentally different, there are a few key commonalities with these diets that help the people who eat them thrive."
Almost all emphasize whole foods packed with nutrients, eating a mix of plants, fish and meat. He adds that they eat a lot more fiber than the average American, and most of their carbohydrates come from vegetables and starchy plants that have a low glycemic index — meaning ones less likely to cause blood sugar spikes.
"It sounds simple, but we've drastically moved away from these basic principles in America," says Dr. Septimus. "Most people get their fruit from fruit juice and their vegetables on top of their pizza. Refined, starchy carbohydrates are a staple of most meals, and we are getting nowhere near the amount of fiber we once used to."
When framing what to eat to help prevent and lower high cholesterol, Dr. Septimus quotes Michael Pollan, who's been writing on the intersection of nutrition and culture for more than 30 years. He thinks about diet very simply, saying that everything he's learned can be summed up in seven words: "Eat food, not too much, mostly plants."
"The first two are probably the most important," adds Dr. Septimus. "'Eat food' means real food — vegetables, fruits, whole grains and, yes, fish and meat."
It also means avoiding what Pollan calls "edible food-like substances" — those processed foods Dr. Septimus warned us about. And moderation is key to any healthy eating pattern.
"The concept of increasing the amount of plants in our diet is good because if we can get the plate in front of us to have more broccoli, cauliflower or beans, it naturally helps us cut down on the saturated fat," says Dr. Septimus.
The bottom line: The best foods to eat to help keep your cholesterol levels in check are the whole foods you find on the perimeter of the grocery store — not the processed, packaged foods full of unhealthy additives that you find at a gas station or in a store's inner aisles.