The cholesterol problem: a guide to the best foods to improve those numbers

The lab results came back from your annual physical, and your numbers aren’t good. You have too much blood cholesterol and other blood fats, one of the main drivers of the artery-clogging disease atherosclerosis. What changes can you make in your diet to turn those numbers around?

That’s one of the most common questions we (Duke University School of Medicine internist Vishal Rao and Johns Hopkins Medicine cardiologist Erin Michos) hear from our patients. Here’s a guide on the best foods to improve your cholesterol numbers. It is important to know that physicians recommend certain individuals already with heart disease or at high risk for it to take a preventive medication, such as a statin, even if their blood cholesterol levels aren’t that high. Even those already taking a statin can maximize the drug’s benefit by choosing a healthier lifestyle, such as eating better and increasing physical activity.

What Is Coronary Artery Disease?

Coronary artery disease, the most common type of heart disease, is a condition with narrowing or blockages in the arteries that supply blood to the heart muscle. The reduced blood flow can occur due to a buildup of plaque within the walls of the arteries, known as atherosclerosis. One of the main substances that contributes to formation of plaques is cholesterol. With time, plaque buildup can lead to less oxygen and nutrients delivered to the heart muscle. Common symptoms that people may feel include chest pain, shortness of breath and, ultimately, major cardiovascular events, such heart attacks, strokes and heart failure.

[See: Best Exercises for Heart Disease Patients.]

What Is Cholesterol, and Why Is it Important?

Cholesterol is a fat-like substance that is essential in the human body for making hormones and bile acids, plus forming the walls of human cells. It’s produced by the liver and is also derived from what we eat, including animal fats, cheese, full-fat dairy products, egg yolks, poultry and fish. There are two main forms of cholesterol: “good cholesterol,” also known as HDL cholesterol, and “bad cholesterol,” also known as LDL cholesterol. Another closely related blood fat called triglycerides is also linked to atherosclerosis and elevated blood sugar levels. Coronary artery disease can progress from too much total blood cholesterol or by having an imbalance of the cholesterol types. For example, low levels of good cholesterol can raise the ratio between total cholesterol and HDL cholesterol, which is also risky even if the total cholesterol number isn’t excessively high.

One of the ways to reduce the progression or reverse coronary artery disease is by treating abnormal cholesterol levels in the blood. The American College of Cardiology and the American Heart Association recommend lowering blood cholesterol levels by using lifestyle modifications, such as consuming a heart-healthy diet, participating in regular exercise and maintaining a healthy weight. Cholesterol-lowering statin medications can significantly lower blood cholesterol levels as well as heart attack and stroke risk in people with high or abnormal blood cholesterol levels, people with moderate to high risk for heart attacks and strokes, or people who have both. In fact, some individuals who’ve already had a heart attack or stroke or are at high risk for these conditions may benefit from statins, even if their blood cholesterol levels are not that high. In these cases, statins should be thought of as prevention medications and not just cholesterol-lowering drugs. People can lower their blood cholesterol levels even further by altering their diet in addition to taking statins. Due to family history (genetics), some people are particularly prone to high cholesterol levels, but a healthy lifestyle has been shown to help reduce their risks too.

What Are Healthy Cholesterol Levels?

Ideally, total cholesterol should be less than 200 milligrams per deciliter. HDL cholesterol should be above 40 milligrams per deciliter for men and above 50 milligrams per deciliter for women. LDL cholesterol should be less than 100 milligrams per deciliter, and triglycerides ideally should be less than 150 milligrams per deciliter. Keep in mind that treatment goals can vary based on each individual. You should discuss your cholesterol levels with your physician.

What Kinds of Foods Should I Eat to Help Lower My Blood Cholesterol Levels?

People can improve their blood cholesterol levels through diet by adding specific nutritional components, such as nuts, soy protein, phytosterols and fiber. Alternatively, they can stick to a general healthy eating pattern, such as the Mediterranean diet, DASH diet or another diet rich in plant-based foods and low in saturated fats and processed foods.

Here are some healthy additions you can make to your diet to lower blood cholesterol levels:


Many tree nuts contain proteins, unsaturated fats, fiber and antioxidants. Certain nuts, like almonds, pecans, walnuts, pistachios and macadamia nuts, can reduce LDL cholesterol. Studies on nut consumption have shown that eating tree nuts can improve blood pressure and reduce inflammation, which are both factors that can contribute to heart disease. A review on tree nut consumption studies revealed that total and LDL cholesterol levels came down more among people who consumed more nuts rather than from which type of nut they ate. That being said, the expected lowering effect of nuts on total and LDL cholesterol is modest — about 5 to 7 percent lower for each. And nuts do pack a lot of calories, so they should be consumed in moderation, keeping total daily caloric intake in check.

[See: 10 Cheap Plant-Based Meals.]

Soy Protein

Soy may also serve as a useful addition to a diet to lower blood cholesterol levels. Soy is derived from soybeans and is a source of dietary fiber, minerals, vitamins and protein. Studies on soy consumption describe positive effects of soy products on heart health. In one study, partly replacing animal protein sources with soy protein in a moderately high-protein diet reduced total and LDL cholesterol levels by as much as 5 to 10 percent each. To achieve this reduction, participants consumed about 25 to 30 grams of soy each day, which can be in the form of about 10 ounces of tofu, 2.5 cups of soy milk or an equivalent of soy meat alternatives or soy nuts.


Cholesterol is mainly found in animal-based foods, but plants have their own cholesterol-like compounds, known as phytosterols. Phytosterols compete with the absorption of dietary cholesterol in the gut. Phytosterols can be found in seeds, nuts, whole grains, legumes, fruit, vegetables and certain oils. A study in the Netherlands showed that eating phytosterols can reduce LDL cholesterol levels, with more of an effect seen in people consuming higher levels per day. However, a review on phytosterol consumption didn’t find a benefit in heart disease risk if phytosterol levels varied in the diet, so it still remains unclear how much benefit phytosterols provide in reducing the risk of coronary artery disease.


Adding fiber to the diet may be beneficial in reducing total blood cholesterol levels. Fiber is a substance found in plants that is resistant to human digestion. When ingested, fiber proceeds through the gastrointestinal tract without significant modification, increasing stool bulk. Fiber can reduce the absorption of dietary cholesterol, effectively reducing the blood cholesterol level. An analysis that combined results from 67 studies that examined the benefit of dietary fiber intake on cholesterol levels found that consuming approximately 2 to 10 grams of soluble fiber (fiber that absorbs water) per day was effective in reducing total and LDL cholesterol, although the change was relatively modest. Other studies suggest that high-viscosity fiber — a type of fiber that forms a thicker consistency in water — provides greater benefit than compared to lower-viscosity fibers or quantity of fiber consumed. Another review estimated that fiber reduces total and LDL cholesterol between 5 and 10 percent, depending on fiber type, solubility and viscosity.

What Diets Reduce the Risk of Cardiovascular Disease?

Adding one of the foods mentioned above can lower cholesterol, although the effect of each varies. Adopting an overall healthy diet composed of one or more of these food groups may reduce coronary artery disease risk by further lowering cholesterol levels. The Seven Countries Study, which looked at lifestyle and diet, found that regional differences in diet correlated with a reduction in coronary artery disease risk. Diets low in saturated fats and high in antioxidants provided the most benefit in coronary artery disease risk across populations. Here are some specific diets to follow to reduce coronary artery disease risk:

Mediterranean Diet

The Mediterranean diet traditionally consists of lots of vegetables, fruits, nuts, grains, legumes and olive oil, along with reduced saturated fats and red meat, low to moderate servings of dairy, and low to moderate servings of fish and poultry. This balanced diet improves cholesterol levels and longevity. A study published in 2003 in The New England Journal of Medicine found that among people of Greek origin, those who stuck to the Mediterranean diet had fewer deaths from coronary artery disease than those not on the diet. A more recent clinical trial, known as the Primary Prevention of Cardiovascular Disease with a Mediterranean Diet study, was conducted in Spain and enrolled over 7,000 individuals. This study used the Mediterranean diet but also added either 1 liter of extra-virgin olive oil per week or 30 grams of mixed nuts per day, which may be a lot for some people to take in. PREDIMED found that people who hadn’t yet had a major heart attack or stroke but were at high risk for one ended up having fewer heart attacks or strokes if they followed this diet. People who consumed a low-fat diet alone had more heart attacks and strokes. By emphasizing fruits, vegetables and low saturated fats, the Mediterranean diet in conjunction with healthy fats can reduce one’s heart disease risk.

[See: Your Plant-Based Diet Needs These 10 Foods.]


The Dietary Approaches to Stop Hypertension diet, known as the DASH diet, was originally designed for the purpose of lowering blood pressure. The DASH diet includes vegetables, fruits, grains, lean meat, nuts, seeds, beans and low-fat dairy products, as well as reduced amounts of salt, fats and sugar-rich foods. People with high blood pressure who consumed the DASH diet had a reduction in their systolic blood pressure (the top number) by 11 millimeters of mercury and diastolic blood pressure (the bottom number) by 6 millimeters of mercury — an effect comparable to some blood pressure medications. Not only did the DASH diet improve blood pressure, but it also reduced total cholesterol by an average of 7 percent and LDL cholesterol by an average of 9 percent. By tackling blood pressure and high cholesterol, the DASH diet is an attractive option to try.

Take-Home Points

1. High or abnormal blood cholesterol levels can contribute to plaque forming in the arteries that supply blood to the heart. This process can lead to coronary artery disease and strokes.

2. Although some people may still require cholesterol-lowering medications for prevention, there are several ways you can modify your diet to further reduce your blood cholesterol levels.

3. Supplementing your diet with nuts, soy, fiber and oils low in saturated fat may reduce your total cholesterol levels, likely having a greater benefit in combination than alone.

4. The Mediterranean diet can lower your risk of developing heart disease and provides a variety of options between fruits, nuts, vegetables and olive oil while minimizing animal meats, which carry high amounts of saturated fats.

5. The DASH diet can also reduce your risk of developing heart disease by lowering blood pressure and blood cholesterol levels.

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The Cholesterol Problem: a Guide to the Best Foods to Improve Those Numbers originally appeared on

Update 06/06/19: This article was originally published on Feb. 13, 2017. It has been updated.

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