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How to reduce cholesterol with diet, based on your biomarkers

High (total) cholesterol can greatly endanger your health, as it increases the risk of heart attack, stroke, and atherosclerosis. However, what you choose to eat can mitigate some of these risks and even reverse numbers. From oats to walnuts and fatty fish, here are the best foods (and subsequent diets) to reduce cholesterol.

As we age, many health-related topics surrounding heart health and longevity move to the forefront of our minds. Heart disease remains the leading cause of death in the United States, accounting for 1 out of every 4 deaths [32]. Lifestyle choices, high cholesterol, or elevated blood pressure are just some of many factors that contribute to heart disease. But what are some actions you can take to improve heart health and reduce the risk of becoming another statistic? 
Before we discuss how to reduce cholesterol with diet, let’s understand what exactly this biomarker is, how you can measure it, and what impact it has on heart health.

What is cholesterol?

Cholesterol is a waxy substance in your blood that is used to create new cells, hormones, and vitamin D. While your liver produces all the cholesterol your body needs, you can also get cholesterol from animal foods you eat [1].
There are two different types of cholesterol: low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL is often referred to as “bad” cholesterol, as it accumulates in your blood vessels and increases the risk of cardiovascular disease, stroke, and atherosclerosis. 
Conversely, HDL is considered “good” cholesterol because it picks up cholesterol and carries it back to the liver to be disposed of. Therefore,  higher HDL levels are considered to be cardioprotective in most cases.
Biomarkers such as total cholesterol, HDL and LDL provide important insights about your cardiovascular health and subsequent nutrition status.
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What do cholesterol levels mean?

Your total cholesterol score can be determined with this equation (HDL level + LDL level + 20% of triglyceride level) and should be evaluated as such [2,3]:
  • <200 mg/dL: Optimal for adults age 20 years old and above
  • 200–239 mg/dL: Borderline high
  • >240 mg/dL: High
LDL levels should be evaluated with the following measurements [4]:
  • <100 mg/dL: Optimal
  • 100-160 mg/dL: Elevated
  • >160 mg/dL: High
If you are at risk for cardiovascular disease, it’s recommended to have your LDL levels be below 70 mg/dL [5]. These should be checked every four to six years; however, if you have heart disease, diabetes, or a family history of high cholesterol, it’s recommended to get levels checked more frequently.
Learn how to reduce LDL cholesterol without medication with these expert tips.
Lastly, HDL cholesterol should be evaluated with the following measurements [6]: 
  • >60 mg/dL: Desirable
  • 40-60 mg/dL: Low
  • <40 mg/dL: At risk
Wondering how to increase HDL levels? Here’s how you can do it without medication.

Science-based dietary eating patterns to reduce cholesterol 

While weight management, physical activity, and positive lifestyle choices can lessen the risk of cardiovascular disease, you can also reduce cholesterol levels through the foods you choose to eat. There are some eating styles which have been shown to reduce cholesterol levels. 
Here’s how you can reduce cholesterol with diet.

Mediterranean diet

The Mediterranean diet is a well-known eating style that focuses on whole foods and a limited amount of high-sugar processed foods to help extend your lifespan and prevent chronic disease. Filled with fruits, vegetables, omega-3 fatty acids, red wine, and whole grains, this eating pattern emphasizes less dairy, red meat, and saturated fat than a typical Western diet. Due to the high emphasis on plant foods, the Mediterranean diet has a myriad of benefits, including a reduced risk of stroke, type 2 diabetes, and cognitive decline. But can the Mediterranean diet also lower cholesterol?
Research says yes! It’s been found that those who follow a Mediterranean diet experience a 10% decrease in LDL and a 5% increase in HDL levels, thus lowering the risk of developing cardiovascular disease [7,8]. This is likely due to nutrients such as soluble fiber, monounsaturated fatty acids, and omega-3s present in this dietary eating style.  

Vegan diet

A vegan diet is a dietary pattern that is completely void of animal products (including animal derived products, like honey) and instead focuses on plants, alternative protein sources, and healthful fats to provide nutrition needs. A vegan diet falls under the realm of plant-based eating.  This eating style has continued to gain popularity due to its eco-friendly nature, unique food products, and sustainability mantra.  
These dietary choices can lead to many heart-healthy benefits, as studies have found that plant-based diets are associated with lower levels of total and LDL cholesterol levels, BMI, triglycerides, blood sugar, and blood pressure when compared to omnivores [9,10]. 

Keto diet

A ketogenic diet (or keto for short) is a high-fat, moderate protein, low carbohydrate diet consisting of 70-80% calories from fat, 20-25% calories from protein, and a scant 10-40 grams of carbohydrates per day. This dramatic reduction in carbohydrate intake is what puts you into ketosis, which improves your body’s efficiency at burning fat. With subsequent health benefits like weight loss, lowered blood pressure and improved memory, it’s easy to see why this eating style has become so popular. However, it begs the question: is the keto diet good for high cholesterol?
The answer may vary depending on a few caveats. Some evidence suggests that those who are on the keto diet experience a reduction in triglycerides, as well as total and LDL cholesterol levels, while seeing an increase in HDL cholesterol levels, which all can improve heart health [13,14,15]. This could be attributed to the lack of carbohydrates; since the liver produces fewer triglycerides, HDL cholesterol levels may increase. However, other studies report spikes in LDL cholesterol, dyslipidemia, heart problems, and hypoglycemia, so it’s recommended to consult a healthcare professional to see if the keto diet is right for you [16].
It’s also important to note that due to the complex nature of this eating style, the keto diet is also hard to adhere to and is one of the most restrictive eating approaches out there. Since this eating style is high in fat, it’s important to adjust the structure of your keto diet to prevent it from further raising cholesterol levels. For example, while keto doesn’t have any fat restrictions, it’s suggested that you avoid artificial trans fats, processed meats, and fried foods, as these can increase the risk of heart disease and have a negative impact on cholesterol [17,18]. Instead, reach for monounsaturated fatty acids (such as olive oil, avocados, and nuts) to lower your cholesterol levels and healthfully stay within the keto guidelines. 
Does going keto affect your cycling performance? Get the details here
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Foods to eat to reduce cholesterol

You don’t have to follow the Mediterranean, vegan, or extreme keto diets to see cardiovascular benefits. While each dietary eating style has  pros and cons which may or may not work for your overall lifestyle, there are some common foods between them. 
Here are the best foods to eat to reduce cholesterol, based on your biomarkers.
whole grain oats in wooden spoons

Whole grains. 

Studies have found that a diet rich in whole grains can help lower total cholesterol and LDL levels [19]. This can be attributed to the soluble fiber present in whole grain products, which reduces the absorption of cholesterol into your bloodstream. Foods such as oats, barley, quinoa, and popcorn are good sources of whole grains, and can be enjoyed with a variety of dietary eating styles [11,12].
lentils, chickpeas, and other beans and legumes separated into bowls

Beans and legumes. 

These little gems are packed full of heart-healthy nutrition, as research shows that eating a 1/2 cup (or one serving) of beans, peas, chickpeas, or lentils per day significantly lowers LDL cholesterol levels and reduces the risk of heart disease [20,21]. These can be enjoyed with many different dietary eating patterns, although since they are higher in carbohydrates, they may not fit into a keto eating style. 
avocado sliced in half on a cutting board

Healthy fats. 

Monounsaturated fat sources (such as avocados, flax seeds, walnuts, olive oil, and fatty fish) have long been touted for their heart-healthy benefits, as they help to lower triglycerides and increase HDL cholesterol [22]. A 2015 randomized controlled trial among overweight and obese adults found that those who ate one avocado daily lowered their LDL levels and particle size more than those who didn’t eat avocados [23]. 
assortment of nuts in a bowl

Nuts. 

Nuts (such as almonds, walnuts and peanuts) have been shown to be cardioprotective. Just 2 ounces (one serving) of nuts a day can slightly lower LDL levels [24]. However, research suggests that more is better, as three servings of nuts per day can significantly decrease LDL by 10.2 mg/dL [25]. 
salmon filets with garlic and pesto in a bowl

Fatty fish. 

Eating fish two or three times a week can improve heart health thanks to the omega-3 fatty acid content, which helps to lower triglyceride levels, increase HDL cholesterol, decrease platelet aggregation, and prevent the onset of abnormal heart rhythms [26]. Fatty fish like salmon, tuna, anchovies, and sardines are great additions to your diet, especially if you follow the keto diet. 
friends toasting with wine glasses

Red wine. 

The occasional alcoholic beverage has been shown to have positive health benefits (such as decreased blood pressure and reduced stress levels), but it can also be beneficial for your cholesterol. Studies have found that low alcohol consumption may raise HDL cholesterol between 5 and 15%, and may be associated with a decreased risk of coronary heart disease [27]. However, there are many negative side effects that come from drinking too much alcohol. Learn more about how alcohol affects weight gain and inflammation here.
Tofu bowl with tofu, avocado, mushrooms, carrot, and broccoli

Soy.

Despite some controversy, soy has been found to have a positive effect on heart health. Studies show that consuming 25 grams of soy protein per day can lower LDL by 5% [28]. While soy products (such as tofu, soy milk, and soybeans) can be enjoyed in many different dietary and plant-based eating styles, they should be avoided on a keto diet due to their high carb-to-fat ratio.
assorted berries in a white bowl

Berries.

Berries can potentially reduce the risk of cardiovascular diseases, as emerging evidence shows that berry consumption significantly reduces LDL cholesterol due to the high amounts of fiber and antioxidants present [29]. Fresh or frozen berries both offer the same benefits, and can be enjoyed with almost any dietary eating style; however, those following a keto diet will need to be more cautious due to many berries' high carbohydrate content.

How long does it take to reduce cholesterol?

While there is no predetermined amount of time recommended to reduce cholesterol, research suggests that it’s possible to see a decrease in cholesterol levels within three to six months of making positive lifestyle and dietary changes. However, one study found that those who ate a plant-based (vegan) diet lowered their LDL cholesterol by 30% in just four weeks [31]. 
If you have made positive lifestyle and dietary changes, but have not seen a difference in your cholesterol levels, it’s recommended to talk with your healthcare provider for further guidance.

Summary

High (total) cholesterol can greatly endanger your health, as it increases the risk of heart attack, stroke, and atherosclerosis. While certain medications and lifestyle changes can greatly improve heart health, you can also make a positive impact on cholesterol levels by what you choose to eat. Certain science-based eating styles (such as the Mediterranean, vegan, and keto diets) can help reduce total and LDL cholesterol, while incorporating a variety of nutrient-rich, cholesterol-lowering foods into your diet. Foods such as whole grains, fatty fish, red wine, and berries can be part of many dietary eating styles, and have been shown to improve HDL, reduce triglycerides, and positively impact heart health.
Disclaimer: The text, images, videos, and other media on this page are provided for informational purposes only and are not intended to treat, diagnose, or replace personalized medical care.

Key takeaways

  • Biomarkers such as total cholesterol, HDL and LDL provide important insights about your cardiovascular health and subsequent nutrition status.
  • High (total) cholesterol can greatly endanger health, as it increases the risk of heart attack, stroke, and atherosclerosis. However, what you choose to eat can mitigate some of these risks and even reverse numbers. 
  • The Mediterranean, vegan, and keto diets are a few science-based eating styles which have been shown to improve cholesterol levels in research.
  • Foods such as whole grains, fatty fish, red wine, and berries can be part of many dietary eating styles, and have been shown to improve HDL, reduce triglycerides, and positively impact heart health.
  • Research suggests that it’s possible to see a decrease in cholesterol levels within three to six months of making positive lifestyle and dietary changes.

References

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