According to the Centers for Disease Control and Prevention, nearly 94 million Americans ages 20 years and older are dealing with cholesterol levels over the healthy range of 200 milligrams per deciliter (mg/dL), while 28 million present with numbers over 240 mg/dL. Having high cholesterol numbers means having a higher risk of developing cardiovascular disease—and while genetics and hormonal changes can play a role in your levels, the blog for the T.H. Chan School of Public Health at Harvard University points out that what you eat tends to be the biggest influence.
Norman E. Lepor, MD, FACC, FAHA, FSCAI, is an attending cardiologist at Cedars-Sinai Heart Institute and a professor at the David Geffen School of Medicine at the University of California in Los Angeles. Lepor says, “As a cardiologist, my first point of discussion with a patient … is lifestyle modification, [and] that includes dietary issues as well as exercise.”
So, adjusting diet is one of Dr. Lepor’s first recommendations. Getting on a good track with nutrition is one major key to lowering cholesterol (and heart disease risk) for the long-term. So what’s a cholesterol-healthy diet…and what isn’t? Get your grocery list handy—here, Dr. Lepor gets very specific about what’s worth adding to your cart.
The best diet for healthy cholesterol
Dr. Lepor says the best diet for cholesterol is pretty simple advice for most patients: follow a Mediterranean-style diet. “We all like traveling,” this cardiologist says. “We go to Greece and Italy and these countries where there is a Mediterranean diet prevalent, but when we come back to our native land we end up with diets that are high in carbs and fat sources [that] aren’t particularly healthy.”
Continually ranked the best diet for your overall health by U.S. News & World Report, the Mediterranean diet focuses on consuming a variety of fruits, vegetables, whole grains, nuts, legumes, and healthy fats, like olive oil. Fish and seafood are incorporated around twice a week, while other protein sources like eggs, poultry, and dairy are eaten in moderation. Red meat is eaten sparingly. That’s because, as the American Heart Association points out, research shows eating red meat regularly increases cardiovascular disease risk by 22% on average.
Dr. Lepor says incorporating more sources of monounsaturated fats (found in avocados, olive oil and seeds) and polyunsaturated fats (walnuts, flaxseeds, fish) is a good place to start. “We recommend using oils that are not tropical oils, but using canola or high-quality olive oil instead,” Dr. Lepor says. “Eat lots of nuts. And we love blue fruits, like blueberries and blackberries, because they have lots of antioxidants. So those are the kinds of advice that we give patients, along with regular exercise.”
The worst diet for cholesterol, says this cardiologist
“People tend to say they can lose weight fast on the keto diet, and they eat the types of foods that reduce their appetite, but you’re really increasing the intake of those saturated fats,” he says. “If you’re able to do the keto diet and have your protein intake come from healthier sources, well that’s a different story.”
Even outside of the keto diet, Americans are regularly consuming a diet high in saturated fats, trans fats, added sugars, sodium and overall calories. These increase cardiovascular disease risk as well as type 2 diabetes, obesity and some types of cancer, says the 2020-2025 Dietary Guidelines for Americans, as published by the US Department of Agriculture in collaboration with he US Department of Health & Human Services. “We are getting a lot of saturated fat intake, we are eating lots of meat and pork products as sources of our protein and we’re eating lots of bread and starches,” Dr. Lepor adds.
It’s not all about losing weight
While losing excess weight is important for improved cardiovascular health, Dr. Lepor says it’s not the only solution to reducing cholesterol levels and cardiovascular disease risk. “Oftentimes people will lose weight as part of my recommendations—they’ll lose five or 10 or 15 pounds—and then we do their cholesterol levels and their cholesterol levels may not have budged much,” he says. “It’s not just about the loss of pounds, it’s about how you achieve it. There is no strict relationship between pounds lost and cholesterol reduction.”
In order to truly take care of your cholesterol levels, Dr. Lepor recommends consuming healthier sources of fats and proteins. While weight loss can come with these dietary changes (and can benefit other weight-related issues like diabetes risk and heart failure), losing weight isn’t the only solution. He says even slender people can be at significant risk of developing coronary vascular disease. “I have patients who are thin who are very active and you know something? They have heart attacks and strokes as well.”
Dr. Lepor says focusing on eating a diet with sources of monounsaturated and polyunsaturated fats, as well as lean proteins like chicken, seafood and plant-based options such as legumes, can benefit those cholesterol numbers—and your overall health—over time.