High Cholesterol: Which Diet Tips Actually Work?

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I do a lot of health checks in my family clinic here at BJU, and a large percentage have problems with their cholesterol tests. Since high cholesterol is one of the major risk factors for heart disease, I focus a lot of my time with them on proper diet. But what is a proper diet, exactly? We hear so many crazy diet tips from so many sources, but what are the proven high-yield foods that people should focus on?

First, most sources agree on the most high-yield foods: nuts; fish; fiber; olive oils; and plant sterols/stanols. How much does each group benefit? Find out in the graph below from the Natural Medicines Comprehensive Database, my perennial favorite website for evidence-based supplement research:

Summary of the Lipid Effects of Various Drugs on Hyperlipidemia
Summary of the Lipid Effects of Various Drugs on Hyperlipidemia

The NMCD has written a great free article on which natural products work to improve cholesterol. As you see below on their Recommendation Chart, their green area of “Likely Safe + Effective/Likely Effective” has quite a few products, including fish oil; barley, beta-glucans, blond psyllium, niacin, oat bran, and plant stanols and sterols:

Natural Medicines To Treat High Cholesterol
Natural Medicines To Treat High Cholesterol

My personal tips for anyone who has high cholesterol, even if they take medicines, are these:

  • Eat more nuts — a few servings a week can help more than you think. Look at the chart above: walnuts can lower total cholesterol by 8-16%
  • Eat fatty fish (salmon or sardines) at least twice a week, more if you can get it. Fish oil can lower triglycerides an amazing 20-50%, and most likely has overall benefit to your heart. I’m a big fan of fish oil for everyone in the family.
  • Fiber, fiber, fiber! Fiber can lower total cholesterol 5-26%. Fiber is especially important for breakfast: even the fiber from Cheerios can help, but oatmeal, muesli, or dark breads also are a better source. And don’t forget that fruits and vegetables also have a lot of fiber.
  • Improve your breakfast. The worst offenders usually have a very American breakfast of eggs and meat. A far healthier choice would be some fiber (dark bread, muesli, oatmeal) with a cup of yogurt and fruit. Want some sugar? Pour honey into non-sweetened yogurt. Did you know a yogurt a day also helps keep your weight down?
  • Think brown over white. If you must eat your pasta, rice and breads, at least try to switch from lily-white versions to the darker ones. Pick any, I don’t care — all brown grains have more fiber and nutrients than the ultra-processed white grains. This also has the added benefit of decreasing your risk of getting diabetes.
  • Switch to olive oil. We all need some fat in our diet, but there are good fats and bad fats, and it’s hard to beat olive oil for better health.
  • Avoid trans-fats. Trans-fat definitely tops the list of bad fats. This issue fortunately has received a lot of media exposure, but many cookies and snacks still contain a lot of this unnatural and artery-clogging fat. Take a look at your labels, which now require details about trans fats.

If you want more information, you can read a lot of healthy tips at the Mayoclinic website, as well as a patient handout from UpToDate.


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6 thoughts on “High Cholesterol: Which Diet Tips Actually Work?”

  1. There is this new pill with krill oil, how effective is this in its cholesterol lowering function in comparison to the fish oil?

    1. If you check the Natural Medicines Comprehensive Database, it mentions one study which showed krill oil helps with cholesterol. But there’s no consensus at all that it works better than fish oil — which is far cheaper and more developed as a safe product.

    2. If you check the Natural Medicines Comprehensive Database, it mentions one study which showed krill oil helps with cholesterol. But there’s no consensus at all that it works better than fish oil — which is far cheaper and more developed as a safe product.

    1. Thanks for the tip — and it’s good to hear from you, it’s been a while! I’m not surprised that beet root juice is helpful, but it’s good to know the underlying science why. It’s a strong flavor, of course, but sometimes we add it to our morning smoothies.

      1. Well what a warm welcome! Thanks! Well, I was researching something else entirely (supplements for dancers/athletes) and saw that it was good for cholesterol lowering, too. Remembered your blog already had some very helpful things listed, so I just thought I’d pop over here n add it to the list! best, Liora

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