Dietary management of hypercholesterolemia, or a cholesterol diet, is a combination of a calorie-controlled eating plan incorporating foods that may help to reduce LDL cholesterol levels and/or increase HDL levels while avoiding foods that may increase LDL cholesterol and reduce HDL cholesterol. Low glycemic index (GI) foods should be the primary source of carbohydrates, especially if weight loss is a consideration or a person is a diabetic.
The management of high cholesterol levels (hypercholesterolemia) should involve both diet and medication in patients with LDL cholesterol levels of 100 mg/dL or more. A cholesterol diet should also be structured for weight loss in overweight or obese patients. For levels lower than 100 mg/dL, dietary management is still advisable to maintain the cholesterol levels, lose weight if necessary or prevent weight gain. A cholesterol diet also aims to keep the LDL cholesterol (LDL-C) within an acceptable range for life and should therefore not be viewed as a temporary measure.
The guidelines for a cholesterol diet should include the following changes in the daily food intake.
- Total daily calorie intake should be adjusted for weight loss or maintain a desirable body weight.
- Dietary cholesterol intake should be less than 200 mg/day.
- Saturated fats should be less than 7% of the total calories.
- Trans fats should be less than 1% of the total calories.
- Plant sterols and stanols should be approximately 2 grams per day. *
- Viscous (soluble) fiber should be increased to 10 to 25 grams per day.*
* The plant sterols and viscous fiber foods are known to lower the LDL-C levels.
Refer to the Triglyceride Diet in hyperlipidemia (high LDL cholesterol + high triglycerides).
Foods to Eat or Avoid for High Cholesterol
Most of the cholesterol in the blood is produced in the liver. Dietary management should not only aim to reduce the intake of dietary cholesterol but also increase the intake of foods that are known to lower cholesterol levels. Weight loss is an important consideration in a cholesterol diet as a 10 lb (pound) reduction in the adult body weight can lead to a 20% to 30% reduction in LDL cholesterol levels.
Foods to Eat
- Use vegetable oils like flaxseed and fish oils from salmon, herring, sardines and tuna which are high in omega-3 fatty acids.
- Select fat free (skim), 1% fat and low-fat dairy products.
- Cook with olive oil rather than butter.
- Use nuts in moderation. Although high in omega-3 fatty acids, it is also contains other fats and is high in calories if consumed in excess. Avoid salted, candy (sugar coated) and chocolate nuts.
- Eat 2 cups of fruit and 2.5 cups of vegetables per day for every 2000 calories.
- The following foods are high in soluble fiber :
- Cereal grains like barley, oatmeal, oat bran, psyllium seeds and ground seeds.
- Fruits like blackberries, plums, prunes, citrus fruits, peaches, apples, bananas, nectarines.
- Legumes like lima beans, lentils and peas.
- Vegetables like broccoli, brussels sprouts and carrots.
Refer to Cholesterol Diet for Vegetarians for more information on suitable foods.
Foods to Avoid
- Meats (red meat and poultry) are generally high in saturated fats and should be eaten in moderation. Always buy lean meat, trim visible fat and remove the skin. Fish is often a better choice even when compared to lean meat.
- Egg yolks are high in cholesterol (approximately 215mg per egg) and should be limited to no more than 2 egg yolks per week.
- Minimize intake of partially hydrogenated fats, which is found ins high quantities in shortenings, hard margarine, cakes, cookies, crackers, snack food, pastries and processed foods. Be careful when eating out, including take away (take out) foods as these are often prepared with hydrogenated fats.
- Alcohol should be consumed in moderation. Avoid drinking excessively, even if it is red wine, in an attempt to reduce cholesterol. Moderate consumption of no more than 1 drink per day for women and 2 drinks per day for men has been shown to help increase HDL cholesterol levels. Alcoholic beverages are high in calories and can therefore drastically increase the daily calorie intake despite consuming small amounts.