Cholesterol - healthy eating tips

Cholesterol is used for many different things in your body, but it can become a problem when there is too much of it in your blood. High levels of blood cholesterol are mainly caused by eating foods that aren’t part of a heart-healthy eating pattern. By following a heart-healthy eating pattern, you eat in a way that is naturally low in unhealthy fats and high in healthy fats.

Types of cholesterol#

The two main types of cholesterol are:

• Low-density lipoprotein (LDL) – also known as ‘bad’ cholesterol, because it can add to the build-up of plaque (fatty deposits) in your arteries and increase your risk of coronary heart disease.
• High-density lipoprotein (HDL) – also known as ‘good’ cholesterol, because it can help protect you against coronary heart disease.

How is cholesterol measured?#

Most people with high cholesterol feel perfectly well and often have no symptoms. Visit your doctor to find out your cholesterol level (with a blood test) and to learn what you need to do if your levels of bad cholesterol are high. For most people, cholesterol can be checked from age 45 years, but speak to your doctor about checking earlier if you have other risk factors or a family history.

What causes high cholesterol?#

Some causes of high cholesterol include:

• A high intake of foods containing unhealthy fats (saturated fats and trans fats) – such as fatty meats, deli-style meats, butter, cream, ice cream, coconut oil, palm oil, most deep-fried takeaway foods, and commercially baked products (such as pies, biscuits, buns and pastries).
• A low intake of foods containing healthy fats – healthy fats tend to increase the good (HDL) cholesterol. Foods containing healthy fats include avocado, nuts, seeds, olives, cooking oils made from plants or seeds, and fish.
• A low intake of foods containing fiber – foods high in dietary fiber, particularly soluble fiber, can reduce the amount of bad (LDL) cholesterol in your blood. Include fiber by choosing vegetables, fruits, wholegrains, legumes, nuts and seeds every day.
• Low levels of physical activity and exercise.
• Being overweight or obese, and having too much body fat around your middle.
• Smoking, which can lead to high cholesterol levels.

In some families, several people might be diagnosed with high cholesterol or heart disease at a relatively young age (men below age 55 years and women below 65 years). This pattern can be caused by genetics, including a genetic condition called familial hypercholesterolaemia. It’s best to speak to your doctor as soon as possible if you think you might be affected.

Drinking too much alcohol can increase your cholesterol and triglyceride levels. Some medical conditions can also cause high cholesterol, including kidney and liver disease and an underactive thyroid gland (hypothyroidism). People with type 2 diabetes and high blood pressure often have high cholesterol. Some medicines taken for other health problems can increase cholesterol levels as well.

Cholesterol and healthy eating#

What we eat has an impact on our cholesterol levels and can help reduce our risk of disease. A heart-healthy eating pattern means eating a wide variety of fresh and unprocessed foods and limiting highly processed foods, including takeaway, baked goods, chocolate, chips, lollies and sugary drinks. This helps maintain a healthy and interesting diet while providing essential nutrients.

A heart-healthy eating pattern includes:

• plenty of vegetables, fruit and wholegrains
• a variety of healthy protein-rich foods, especially fish and seafood, and legumes (such as beans and lentils), nuts and seeds
• smaller amounts of eggs and lean poultry
• unflavoured milk, yoghurt and cheese (people with high cholesterol should choose reduced-fat varieties)
• healthy fats and oils – choose nuts, seeds, avocados, olives and their oils for cooking
• herbs and spices to flavor foods, instead of adding salt

If choosing red meat, make sure it is lean and limit it to one to three times a week. This way of eating is also naturally high in fiber, which is good news, because a high intake of dietary fiber can reduce levels of bad cholesterol in the blood.

Be mindful of how much you are eating. Portion sizes have increased over time, and many of us eat more than we need, which can increase our cholesterol and risk of heart disease. Serving size can vary depending on age, sex and specific nutrition needs.

Healthy eating tips to lower cholesterol#

As well as sticking to a varied and healthy diet, try these tips to help manage your cholesterol:

• Eat mostly plant-based foods like vegetables, legumes, fruit, wholegrains, nuts and seeds.
• Include legumes or pulses (such as chickpeas, lentils, split peas) and beans (such as haricot beans, kidney beans, baked beans and bean mixes) in at least two meals a week. Beans make a great alternative to meat in tacos; snack on hummus with vegetable sticks; or add legumes to soups, pasta sauces, curries and stews. Use tofu or lentils instead of meat in stir fries or curries.
• Choose wholegrain breads, cereals, pasta, rice and noodles.
• Snack on plain, unsalted nuts and fresh fruit (ideally two serves of fruit every day).
• Use avocado, nut butters, tahini or spreads made from healthy unsaturated fats (such as canola, sunflower or extra virgin olive oil) instead of those made with saturated fat (such as butter, coconut oil and cream).
• Use healthy oils for cooking, such as canola, sunflower, soybean, olive (extra virgin is a good choice), sesame and peanut oils.
• For people at high risk of heart disease, eat 2–3 grams of plant sterol-enriched foods every day (for example, plant sterol-enriched margarine, yoghurt, milk and cereals).
• Enjoy fish two to three times a week (150 grams fresh or 100 g tinned).
• Most people don’t need to limit the number of eggs they eat each week. However, a maximum of seven eggs each week is recommended for people with high cholesterol, type 2 diabetes and heart disease.
• Select lean meat (trimmed of fat, and poultry without skin) and limit unprocessed red meat to less than 350 g per week.
• Choose unflavoured milk, yoghurt and cheese. People with high cholesterol or heart disease should opt for reduced-fat options. Check labels to make sure there’s no added sugar. Non-dairy milks and yoghurts are fine too; choose versions with no added sugar that have had calcium added.
• Limit or avoid processed meats including sausages and deli meats (such as ham, bacon and salami).
• Check food labels and choose the lowest-sodium (salt) products.

For specific advice, you can also speak to an accredited dietitian.

Dietary fiber#

If you are trying to lower your cholesterol, aim to eat foods that are high in dietary fiber (particularly soluble fiber), because they can reduce the amount of LDL (bad) cholesterol in your blood. You can increase your fiber intake by eating:

• fruit
• vegetables
• legumes (such as chickpeas, lentils, soybeans and bean mixes)
• wholegrains (for example, oats and barley)
• nuts and seeds

Dietary fats#

Following a healthy, balanced diet that is low in saturated and trans fats can help lower your cholesterol. Aim to replace foods that contain unhealthy saturated and trans fats with foods that contain healthy fats.

Unhealthy fats are found in:

• processed or deli-style meats (such as ham, bacon and salami)
• fat on meat and skin on chicken
• deep-fried and fast foods, and takeaway foods (such as hamburgers and pizza)
• processed and baked goods (such as biscuits, pastries, pies and cakes)
• butter, ghee, lard and copha
• cream and ice cream
• coconut oil and palm oil (often called vegetable oil in products)

Healthy fats are found in:

• cooking oils made from plants or seeds, including olive, canola, peanut, sunflower, soybean, sesame and safflower, and spreads made from these oils
• unsalted nuts such as almonds, cashews, peanuts, walnuts and brazil nuts
• fish
• tahini (sesame seed spread)
• linseed (flaxseed) and chia seeds
• avocados and olives

Triglycerides in your blood#

In addition to cholesterol, your blood also contains a type of fat called triglycerides, which are stored in your body’s fat deposits. When you eat, your body converts any extra energy (kilojoules) into triglycerides, and hormones release them to make energy between meals. Like cholesterol, your body needs triglycerides to work properly.

However, there is evidence that some people with high triglycerides are at increased risk of heart disease and stroke. If you regularly eat more energy than you need, you may have high triglycerides. Some ways to reduce triglyceride levels include:

• sticking to a heart-healthy eating pattern
• limiting unhealthy fats and added sugar
• maintaining a healthy weight and reducing fat around your middle
• opting for water, tea and coffee (without added sugar) instead of sugar-sweetened drinks (such as soft drinks, cordial, energy drinks and sports drinks)
• including foods with healthy omega-3 fats (for example, fish such as salmon, sardines and tuna)
• reducing or limiting your alcohol intake

Treatment for high cholesterol#

Making lifestyle changes – especially changing some of the foods you eat – along with regular physical activity, is very important to help reduce high LDL (bad) cholesterol.

Regular physical activity is one of the best things you can do for your heart health. Increasing your physical activity from as little as 10 minutes a day to a recommended 30 to 45 minutes a day, five or more days of the week, can help manage your cholesterol levels and reduce your risk of heart disease.

Quitting smoking reduces the risk of heart disease and can help reduce cholesterol levels. The most effective way to stop smoking is with a combination of stop-smoking medicines (like nicotine replacement therapy) and support from a stop-smoking service. Speaking to your doctor is also a great first step.

Drinking alcohol doesn’t have any health benefits. Alcohol contributes unnecessary kilojoules (energy) and is of low nutritional value, and it is not a necessary or recommended part of a heart-healthy eating pattern. If you do drink, to reduce your risk of alcohol-related harm, a commonly recommended limit for healthy women and men is no more than 10 standard drinks a week and no more than four standard drinks on any one day.

You may also need to take cholesterol-lowering medicines (such as statins) to help manage your cholesterol and reduce your risk of having a heart attack or stroke. Talk to your doctor about finding the most appropriate treatment for you.

Key points#

• Most people with high cholesterol feel well and have no symptoms, so a blood test is the only way to know your levels.
• High cholesterol can run in families, including a genetic condition called familial hypercholesterolaemia.
• What we eat has a real impact on cholesterol and on our risk of disease.
• A heart-healthy eating pattern – rich in vegetables, fruit, wholegrains, legumes and healthy fats – provides essential nutrients and helps lower bad cholesterol.
• Regular physical activity, not smoking, limiting alcohol and, if needed, medicines all help reduce high LDL (bad) cholesterol.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).