What foods to eat and avoid

A low sodium, low saturated fat diet can reduce the amount of low-density lipoprotein (LDL), or “bad” cholesterol, in the blood and reduce the risk of high blood pressure.

Contrary to the previous belief, recent research shows that the cholesterol in food has very little effect on blood cholesterol. This is why the 2015–2020 Dietary Guidelines for Americans removed the recommendation of limiting dietary cholesterol to no more than 300 milligrams (mg) per day.

The guidelines now focus on limiting saturated fats and trans fats. The AHA recommends limiting saturated fats to less than 6% of total calories, while the 2020–2025 Dietary Guidelines for Americans recommends 10%.

Eating a diet high in saturated fats and trans fats may result in high LDL cholesterol levels. LDL cholesterol can build up in the arteries, causing them to narrow and harden and increasing a person’s risk of blood clots, high blood pressure, and heart disease.

Doctors use a complete cholesterol test, also known as a lipid panel test, to check a person’s blood cholesterol levels.

High total cholesterol is a reading of 240 milligrams per deciliter (240 mg/dL) or higher. Doctors consider total cholesterol of 200–239 mg/dL borderline high. These results are usually due to underlying health conditions or lifestyle factors.

To maintain a healthy total cholesterol level under 200 mg/dL, doctors usually recommend a diet low in saturated fat and cholesterol.

The American Heart Association (AHA) recommends that people consume no more than 2,300 mg of salt per day, which is equivalent to 1 teaspoon. This includes all the sodium a person eats, whether they add it to foods or it is already present in the food they buy. Most people consume at least twice this amount.

Learn more about what causes high cholesterol here.

As a general rule, the less processing a food undergoes before reaching the plate, the healthier it will be. To follow a heart-healthy diet, choose whole foods with as few added ingredients as possible.

The nutrition facts label on packaged foods shows serving sizes and the nutrients each serving contains as a percentage of the recommended daily intake. People can compare nutrition fact labels and choose options with lower sodium, saturated fat, and added sugar.

The ingredient list on packaged foods also provides valuable information. Some experts recommend avoiding packaged foods with more than five ingredients, but others think this is too restrictive. Avoid trans fats, which may feature as “hydrogenated” or “partially hydrogenated” oil in ingredient lists.

Look out for alternative names for sodium too. It may feature on ingredient lists as “sodium benzoate,” “disodium,” or “monosodium glutamate (MSG).”

Preparing meals and snacks at home is often the most reliable way for a person to control their salt and saturated fat intake. Instead of adding a lot of salt for flavor, people can experiment with alternative seasonings, such as spices, citrus, and herbs.

Below is a list of foods to avoid on a low sodium, low cholesterol diet.

• fatty cuts of red meat, such as beef, lamb, pork, and poultry
• organ meat, such as kidney and liver
• processed meat, such as bacon, sausages, and hot dogs
• full-fat dairy, including butter, whole milk, cheese, and full-fat yogurt
• fried foods, such as french fries, potato chips, and fried chicken
• baked food products, such as cakes, cookies, crackers, pastries, and donuts
• desserts, such as ice cream, pudding, and pies
• saturated vegetable oils, such as palm oil, coconut oil, and palm kernel oil

Learn more about high cholesterol foods to avoid here.

Diet is not the only factor that contributes to high cholesterol. Healthcare professionals also recommend lifestyle modifications and therapies to manage cholesterol levels. They include:

• Increasing physical activity: Regular exercise can help reduce “bad” cholesterol and increase the levels of “good” HDL cholesterol in the body. The AHA recommends that people aim for a minimum of 150 minutes of moderate-intensity exercise per week to lower LDL cholesterol levels.
• Getting adequate sleep: Animal research from 2020 suggests that prolonged sleep deprivation can increase blood LDL levels. The American Academy of Sleep Medicine recommends that adults aged 18–60 years have at least 7 hours of sleep each night to promote health and well-being.
• Stopping smoking: According to the Centers for Disease Control and Prevention (CDC), the chemicals from smoking can increase bad cholesterol, lower good cholesterol, thicken blood vessels, and cause a buildup of plaque in the arteries. Stopping smoking can yield long-term benefits for a person’s cholesterol levels and lower their risk of heart disease.
• Reducing alcohol consumption: Reducing alcohol intake can help improve heart health and lower cholesterol levels.
• Taking medications: If a person’s cholesterol does not reduce after following doctor-approved lifestyle modifications or they have a high risk of stroke, the doctor may prescribe medications to lower their cholesterol. They include:
  • statins, such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), and pravastatin (Pravachol)
  • ezetimibe (Zetia)
  • PCSK9 monoclonal antibodies, such as alirocumab (Praluent), evolocumab (Repatha)
  • bempedoic acid (Nexletol)
  • bile acid sequestrants, including cholestyramine (Questran), colesevelam (Welchol), and colestipol (Colestid)

According to the AHA, about 38% of adults in the United States have high cholesterol. Elevated cholesterol levels can increase a person’s risk of stroke and heart disease, which are leading causes of global deaths.

The British Heart Foundation notes that high cholesterol can be asymptomatic. This means it has no signs or symptoms, so a person can only know their cholesterol status through a blood test.

The AHA recommends that all adults 20 years or older with low cardiovascular risks have their cholesterol and other traditional risk factors checked every 4–6 years. They note that people with cardiovascular disease and those at elevated risk may need their cholesterol and other risk factors assessed more often.

Learn what to expect from a cholesterol test.

People can reduce their risk of high cholesterol by including certain foods in their diets and avoiding others.

If a person is at risk of high cholesterol or high blood pressure, the doctor will recommend that they eat foods low in saturated fats, trans fats, and sodium.

People can check the nutrition facts labels and ingredient lists on packaged foods to help make informed choices about what they eat. Choosing whole, minimally processed foods can help people lower their cholesterol levels.

Doctors may also recommend lifestyle modifications to lower cholesterol, such as being more active and stopping smoking.