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11 foods that lower cholesterol

Foods that make up a low cholesterol diet can help reduce high levels

Updated: February 6, 2019Published: October, 2009

Changing what foods you eat can lower your cholesterol and improve the armada of fats floating through your bloodstream. Adding foods that lower LDL, the harmful cholesterol-carrying particle that contributes to artery-clogging atherosclerosis, is the best way to achieve a low cholesterol diet.

Add these foods to lower LDL cholesterol

Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol.

1. Oats. An easy first step to lowering your cholesterol is having a bowl of oatmeal or cold oat-based cereal like Cheerios for breakfast. It gives you 1 to 2 grams of soluble fiber. Add a banana or some strawberries for another half-gram. Current nutrition guidelines recommend getting 20 to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber. (The average American gets about half that amount.)

2. Barley and other whole grains. Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease, mainly via the soluble fiber they deliver.

3. Beans. Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal. That’s one reason beans are a useful food for folks trying to lose weight. With so many choices — from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond — and so many ways to prepare them, beans are a very versatile food.

4. Eggplant and okra. These two low-calorie vegetables are good sources of soluble fiber.

5. Nuts. A bushel of studies shows that eating almonds, walnuts, peanuts, and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL, on the order of 5%. Nuts have additional nutrients that protect the heart in other ways.

6. Vegetable oils. Using liquid vegetable oils such as canola, sunflower, safflower, and others in place of butter, lard, or shortening when cooking or at the table helps lower LDL.

7. Apples, grapes, strawberries, citrus fruits. These fruits are rich in pectin, a type of soluble fiber that lowers LDL.

8. Foods fortified with sterols and stanols. Sterols and stanols extracted from plants gum up the body’s ability to absorb cholesterol from food. Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They’re also available as supplements. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%.

9. Soy. Eating soybeans and foods made from them, like tofu and soy milk, was once touted as a powerful way to lower cholesterol. Analyses show that the effect is more modest — consuming 25 grams of soy protein a day (10 ounces of tofu or 2 1/2 cups of soy milk) can lower LDL by 5% to 6%.

10. Fatty fish. Eating fish two or three times a week can lower LDL in two ways: by replacing meat, which has LDL-boosting saturated fats, and by delivering LDL-lowering omega-3 fats. Omega-3s reduce triglycerides in the bloodstream and also protect the heart by helping prevent the onset of abnormal heart rhythms.

11. Fiber supplements. Supplements offer the least appealing way to get soluble fiber. Two teaspoons a day of psyllium, which is found in Metamucil and other bulk-forming laxatives, provide about 4 grams of soluble fiber.

Putting together a low cholesterol diet

When it comes to investing money, experts recommend creating a portfolio of diverse investments instead of putting all your eggs in one basket. The same holds true for eating your way to lower cholesterol. Adding several foods to lower cholesterol in different ways should work better than focusing on one or two.

A largely vegetarian “dietary portfolio of cholesterol-lowering foods” substantially lowers LDL, triglycerides, and blood pressure. The key dietary components are plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants. Add margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.

Of course, shifting to a cholesterol-lowering diet takes more attention than popping a daily statin. It means expanding the variety of foods you usually put in your shopping cart and getting used to new textures and flavors. But it’s a “natural” way to lower cholesterol, and it avoids the risk of muscle problems and other side effects that plague some people who take statins.

Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay flexible and responsive. It’s good for bones and digestive health, for vision and mental health.

For more information, read “How to lower your cholesterol without drugs.”

image: Giovanni Boscherino | Dreamstime.com

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How to Lower Cholesterol with Diet

Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol travels through the blood on proteins called lipoproteins. One type, LDL, is sometimes called the “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the “good” cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

The treatments for high cholesterol are heart-healthy lifestyle changes and medicines. The lifestyle changes include healthy eating, weight management, and regular physical activity.

How can I lower cholesterol with diet?

Heart-healthy lifestyle changes include a diet to lower your cholesterol. The DASH eating plan is one example. Another is the Therapeutic Lifestyle Changes diet, which recommends that you

Choose healthier fats.You should limit both total fat and saturated fat. No more than 25 to 35 percent of your daily calories should come from dietary fats, and less than 7 percent of your daily calories should come from saturated fat. Depending upon how many calories you eat per day, here are the maximum amounts of fats that you should eat:

Calories per Day Total Fat Saturated Fat
1,500 42-58 grams 10 grams
2,000 56-78 grams 13 grams
2,500 69-97 grams 17 grams

Saturated fat is a bad fat because it raises your LDL (bad cholesterol) level more than anything else in your diet. It is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Trans fat is another bad fat; it can raise your LDL and lower you HDL (good cholesterol). Trans fat is mostly in foods made with hydrogenated oils and fats, such as stick margarine, crackers, and french fries.

Instead of these bad fats, try healthier fats, such as lean meat, nuts, and unsaturated oils like canola, olive, and safflower oils.

Limit foods with cholesterol. If you are trying to lower your cholesterol, you should have less than 200 mg a day of cholesterol. Cholesterol is in foods of animal origin, such as liver and other organ meats, egg yolks, shrimp, and whole milk dairy products.

Eat plenty of soluble fiber. Foods high in soluble fiber help prevent your digestive tract from absorbing cholesterol. These foods include

  • Whole-grain cereals such as oatmeal and oat bran
  • Fruits such as apples, bananas, oranges, pears, and prunes
  • Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

Eat lots of fruits and vegetables. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

Eat fish that are high in omega-3 fatty acids. These acids won’t lower your LDL level, but they may help raise your HDL level. They may also protect your heart from blood clots and inflammation and reduce your risk of heart attack. Fish that are a good source of omega-3 fatty acids include salmon, tuna (canned or fresh), and mackerel. Try to eat these fish two times a week.

Limit salt. You should try to limit the amount of sodium (salt) that you eat to no more than 2,300 milligrams (about 1 teaspoon of salt) a day. That includes all the sodium you eat, whether it was added in cooking or at the table, or already present in food products. Limiting salt won’t lower your cholesterol, but it can lower your risk of heart diseases by helping to lower your blood pressure. You can reduce your sodium by instead choosing low-salt and “no added salt” foods and seasonings at the table or while cooking.

Limit alcohol. Alcohol adds extra calories, which can lead to weight gain. Being overweight can raise your LDL level and lower your HDL level. Too much alcohol can also increase your risk of heart diseases because it can raise your blood pressure and triglyceride level. One drink is a glass of wine, beer, or a small amount of hard liquor, and the recommendation is that

  • Men should have no more than two drinks containing alcohol a day
  • Women should have no more than one drink containing alcohol a day

Nutrition labels can help you figure out how much fat, saturated fat, cholesterol, fiber, and sodium is in the foods that you buy.

NIH: National Heart, Lung, and Blood Institute

Cholesterol clarified

Before we get to the details, let’s be clear on what we’re talking about. For years, cholesterol has had a bad rep that it doesn’t really deserve. The truth is, we need cholesterol to function. Your body makes most of the cholesterol it needs. The rest comes from foods you eat.

Here’s the important thing: Dietary cholesterol – found in meat, poultry, eggs and dairy products – has less impact on increasing your blood cholesterol level. Foods that contain lots of saturated and trans fat are the true culprits.

Now here’s how to make nutritious choices to lower your blood cholesterol.

Keep eating simple.

In the last 20 years, the rules on healthy eating have shifted. Super restrictive diets aren’t sustainable or the healthiest choice. Rather than zeroing in on a single nutrient, nutrition research shows the quality of your diet matters more. A diet filled with the right portions of whole, unprocessed foods can help decrease heart disease and stroke. What does that look like? For a healthy, balanced eating plan:

Choose whole grains. Look for whole grain breads, barley, oats (including oatmeal) quinoa, brown rice, bulgur, farro etc.

Add more vegetarian options like beans, lentils, tofu and nuts to your weekly meal plans. And opt for lean cuts of meat, poultry and fish.

Choose lower-fat dairy products with no added sugar. Pick 1% or skim milk, plain yogurt and lower fat cheeses.

As a rule of thumb, steer clear of highly processed foods, even if they are lower in fat content. Low-fat or diet foods are often loaded with calories, sodium and added sugar.

Read Nutrition Facts panels and choose foods that contain no trans fat. Avoid foods that contain partially hydrogenated fat or vegetable shortening.

Cook at home.

Home-cooking is usually more nutritious and wallet-friendly than eating out. By choosing your ingredients, you’re in control of the flavour and can avoid excess sugar, salt and fat. Need a break from the kitchen? Choose restaurants that serve freshly made dishes, use natural, minimally-processed ingredients and provide nutrition information, for healthy, informed choices.

Sneak more fibre into your diet.

Studies show eating fibre, especially the soluble type that’s found in oats, barley, oranges and eggplant, can help lower unhealthy cholesterol levels. However, to obtain those heart-healthy benefits, adults would need to consume between 21 to 38 g every day. Most of us get about half that amount. The good news is there are easy – and tasty – ways to fix that.

The next time you’re feeling hungry, snack on fruit – with the skin on – for a sweet treat. And ditch the juice; you won’t find fibre there. Raw veggies are another awesome source of fibre, among other good things, and low calorie to boot. You can get creative by sneaking kale, spinach or arugula into your next meal.

Each of these options will provide you with two grams:

  • ½ ripe avocado
  • ¼ cup dried figs
  • 1 large orange
  • ½ cup sweet potato
  • ¾ cup broccoli
  • ¾ cup oat bran
  • ¼ cup bran buds
  • ¾ cup chickpeas
  • 2 tbsp flax seeds
  • 3/4 cup eggplant

Filling up on fibre isn’t always easy. If you’re still not getting enough fibre through food, a supplement like psyllium fibre can help make up what you’re missing.

Foods that may improve your cholesterol level

Cholesterol

Cholesterol is a waxy, fat-like substance suspended in your blood. It is made by your liver and is also found in some foods you eat. Your total cholesterol blood test value includes three parts:

  • LDL, low density lipoprotein, cholesterol (the “bad” cholesterol)
  • HDL, high density lipoprotein, cholesterol (the “good” cholesterol)
  • triglycerides. This is a fat digested from food that is released into your bloodstream. It either gives your body energy or it is stored as fat. Triglycerides come from dietary fat, high-sugar foods, too much alcohol or too many calories.

When too much LDL builds up on your artery walls, plaque forms and blocks blood flow. This can cause heart disease, peripheral vascular disease and stroke.

HDL helps to get rid of extra cholesterol from your blood vessels. This may prevent or reverse problems by taking the cholesterol from the plaque.

You can lower your LDL cholesterol and triglycerides and raise your HDL cholesterol by taking cholesterol-lowering medicine, getting regular exercise, making changes to your eating or doing all three. The following tips can help you get started.

  • Read the nutrition facts label.
    • Eat less saturated fat (found in animal products and some vegetable oils). Saturated fat raises your LDL. If you are eating 2,000 calories a day, limit saturated fat to less than 22 grams a day.
    • Look for foods with unsaturated (“good”) fats. Good fats include heart-healthful monounsaturated and polyunsaturated fats.
    • Choose foods with 0 grams of trans fats. Trans fats raise your LDL (“bad” cholesterol) and lower your HDL (“good” cholesterol). Also read the ingredients list to see if the food contains hydrogenated oils.
  • Lose weight if you need to. Decrease your daily calories and increase exercise to lose weight, lower your cholesterol and lower your LDL.
  • Do 40 minutes of moderate to vigorous physical activity 3 to 4 times a week. Examples of activities you could do include brisk walking, jogging, biking, aerobics or yard work.

What is cholesterol?

Cholesterol is a fat-like substance suspended in your blood. It is made by your liver and is also found in some foods you eat.

Your total cholesterol blood test value includes three parts:

LDL (low density lipoprotein) cholesterol is “bad” cholesterol. When too much LDL builds up on your artery walls, plaque forms and blocks blood flow. This can cause heart disease, peripheral artery disease and stroke.

HDL (high density lipoprotein) cholesterol is the “good” cholesterol. HDL helps to get rid of extra cholesterol from your blood and tissue. This may prevent or reverse blood vessel problems by taking the cholesterol from the plaque.

Triglycerides is a fat digested from food that is released into your bloodstream. It either gives your body energy or it is stored as fat. Triglycerides come from dietary fat, high sugar foods, too much alcohol or too many calories.

Meats

Eat no more than four to seven ounces of fish, poultry or lean meat a day. Try to include some meatless meals in your weekly eating plan.

Dairy products

Eat three servings of fat-free or low-fat dairy products every day.

  • Choose fat-free or low-fat dairy products such as milk or yogurt, cheese with less than six grams of fat per ounce.
  • Limit 2% or whole milk, cheese with more than six grams of fat per ounce, ice cream, half-and-half, whipped cream.

Fats and oils

Eat no more than three to six teaspoons of fats and oils a day (one serving is equal to five grams of fat or one teaspoon). Saturated fats and trans fats promote plaque formation.

  • Choose olive oil, canola oil, peanut oil, flaxseed oil, low-fat condiments, soft tub margarines or peanut butter without hydrogenated oils (0 grams trans fat), avocados, nuts, seeds.
  • Limit butter, lard, bacon fat, coconut, coconut oil, palm kernel oil.
  • Eliminate trans fats or products made with hydrogenated oils.

Eggs

Eat no more than two eggs yolks a day. Use egg substitute or egg whites if you are eating more than eight egg yolks a week.

Fruits and vegetables

Eat four and a half cups of fruit and vegetables every day.

  • Choose fresh or frozen vegetables and fruits, no-salt-added canned vegetables, canned fruits in juice (not syrup), dried fruits (in moderation unless your health care provider or dietitian gives you other instructions).
  • Limit fried vegetables or vegetables made in butter, cream or other sauces; fruits with sugar, butter, cream or other sauces.

Starches, grains (breads) and legumes

Make half of your grains whole grains. The amount you need each day depends on your age, gender and calorie needs.

Heart Healthy Eating to Help Lower Cholesterol Levels

Paying close attention to what you eat can help you reduce your risk of developing atherosclerosis. Atherosclerosis is the narrowing of arteries caused by plaque build-up inside the arteries. As the arteries narrow, blood can’t flow properly through the arteries. This can lead to a heart attack or stroke. If the artery-clogging process has already begun, you may be able to slow it down by making changes in your lifestyle, including your diet.

It is important to lower your levels of total cholesterol and low-density lipoprotein (LDL/”bad”) cholesterol. Follow the guidelines in this handout to help lower these levels.

Limit bad fats and cholesterol

Research shows that there isn’t really a link between how much fat you eat and your risk of disease. The biggest influence on your risk is the type of fat you eat. Two unhealthy fats, including saturated and trans fats, increase the amount of cholesterol in your blood cholesterol and increase your risk of developing heart disease. However, two very different types of fat — monounsaturated and polyunsaturated fats — do just the opposite. In fact, research shows that cutting back on saturated fat and replacing it with mono and polyunsaturated fats can help lower the level of LDL cholesterol in your blood.

What are saturated fats?

Saturated fats are generally solid or waxy at room temperature and are most often found in animal products and tropical oils. The following foods contain saturated fats:

  • Fatty cuts of beef, pork, lamb, veal, and the skin of poultry.
  • Hot dogs, bacon and high-fat luncheon meats, such as salami and bologna.
  • Full fat and processed cheeses, cream cheese.
  • High-fat dairy products, such as whole milk, cream, half and half, butter and sour cream.
  • Lard, bacon fat, sauces and gravies made from animal fat.
  • Most fried foods and fast foods.
  • Tropical oils – palm, palm kernel and coconut.
  • Baked goods made with lard, butter or tropical oils.

How much is too much saturated fats?

Most foods you choose should contain no more than 2 grams (g) of saturated fat per serving. To help lower your LDL cholesterol, no more than 5 to 6 percent of your daily calorie intake should come from saturated fats. Use the list below to figure out the maximum amount of saturated fat you can have each day.

What are trans fatty acids?

Trans fatty acids are formed when a liquid fat is changed into a solid fat through a process called hydrogenation. Many manufacturers use hydrogenated fats in their ingredients because it creates a product with an extended shelf life and better consistency.

Trans fatty acids are especially bad for you. They raise the levels of LDL cholesterol in your blood and lower the levels of high-density lipoprotein (HDL/”good”) cholesterol.

There are currently no safe levels of trans fat to consume each day, so avoid them completely or eat them as little as possible.

Many manufacturers have stopped using or greatly reduced the amount of trans fats in their foods. But, check the label and avoid:

  • Partially hydrogenated oils. This means the product contains at least a small amount of trans fat, even if the label states “trans-fat-free.” Foods can contain up to 0.49 grams of trans fat per serving and claim to be “trans-fat-free.”
  • Margarine: Stick margarine contains more partially hydrogenated oil (trans fat) than tub margarine does, and tub margarine contains more than liquid margarine. Choose margarine that does not contain any partially hydrogenated oil.
  • Shortening is an example of trans fat in its purest form. Some shortenings claim to be trans-fat-free, but remember that such foods can still contain small amounts of trans fat in each serving. Also, the fat used to substitute the trans fat in shortening is high in saturated fat, so it’s still not a healthy choice.
  • Fast foods and fried foods. Almost all are high in trans fats.
  • Convenience foods. Some brands of chocolate or yogurt-coated granola/energy bars; liquid, flavored coffee creamers; powdered coffee creamers; and pre-packaged baked goods contain trans fat.

Cholesterol is made by the liver and is only found in animal-based foods. Our bodies need some cholesterol to work properly, but we make enough and do not need extra cholesterol in our diet. However, there is not enough scientific evidence to show that eating cholesterol affects cholesterol levels in your blood.

To control cholesterol in your diet, try these tips:

  • Eat egg yolks in moderation.
  • Do not eat the skin of poultry.
  • Trim extra fat from red meat before eating.
  • Limit servings of poultry and red meat to 3-4 ounces (the size of a deck of cards).
  • Choose reduced-fat, part-skim cheese or cheese made with 2% milk instead of full fat.
  • Avoid cream-based soups. Choose broth-based soups instead.
  • Use nonfat or low-fat dairy products instead of high-fat varieties of cream cheese, sour cream, cottage cheese (4%) and yogurt.

What are unsaturated fats (“Healthy Fats”)?

Unsaturated fats are considered the healthiest fats because they improve cholesterol, help reduce inflammation (a risk factor for heart disease), and help decrease the overall risk of developing heart disease. The main source of unsaturated fats are plant-based foods. These fats are usually liquid at room temperature. There are two types of unsaturated fat: monounsaturated and polyunsaturated.

Monounsaturated fats are considered one of the healthiest sources of fat in the diet. These fats should make up most of your daily fat intake. Good sources of monounsaturated fats include:

  • Olive, canola and peanut oils.
  • Most nuts, nut oils and nut butters (eg, natural peanut butter or almond butter).
  • Olives.
  • Avocados.

Good sources of Polyunsaturated Fats include:

  • Safflower oil.
  • Flax oil and flax seeds.
  • Sunflower oil.
  • Walnuts.
  • Fish.

Omega-3 fats are a type of polyunsaturated fat. Omega-3 fats help protect against heart disease by lowering triglyceride levels, protecting against irregular heartbeats, decreasing the risk of a heart attack and lowering blood pressure. To get the most protective benefits of these foods, eat them several times per week.

The body cannot make omega-3 fats, so they must come from your diet. The best food source of omega-3 fats is cold-water fish such as:

  • Salmon.
  • Tuna.
  • Mackerel.
  • Herring.
  • Sardines.

Other food sources that contain smaller amounts of omega-3 fats are:

  • Flaxseeds.
  • Chia seeds (salvia).
  • Walnuts.
  • Hemp seeds.
  • Soybeans (edamame).
  • Canola Oil.

Increase the Amount of Fiber in Your Diet

Most of us do not get enough fiber in our diet. The recommended amount is 25-35 grams of dietary fiber per day. Dietary fiber is a type of carbohydrate that the body cannot digest. As fiber passes through the body, it affects the way the body digests foods and absorbs nutrients. Fiber can help reduce your LDL cholesterol level. A fiber-rich diet can also help control blood sugar, promote regularity, prevent gastrointestinal disease and help you manage your weight.

There are two types of dietary fiber: soluble (viscous) and insoluble. To receive the greatest health benefit, eat a wide variety of all high-fiber foods. Refined foods, like white bread, white pasta and enriched cereals are low in fiber. The refining process strips the outer coat (bran) from the grain, which reduces the amount of fiber that’s left.

The best sources of fiber are whole grains, fruits, vegtables and legumes (dried beans, lentils, split peas).

What is soluble fiber?

Soluble fiber provides the greatest heart-health benefits. It helps lower total and LDL cholesterol levels by binding to bile in the gut and removing it with the body’s waste. Bile is made up of cholesterol. Good sources of soluble fiber include:

What is insoluble fiber?

Insoluble fiber is generally referred to as “roughage.” Insoluble fiber promotes regularity, adds bulk and softness to stools, helps with weight regulation and helps prevent many gastrointestinal disorders. Good sources on insoluble fiber include:

  • Wheat bran and whole wheat or grain bread/bread products, pasta, cereal and crackers.
  • Vegtables.
  • Nuts.

Reading a food Label

The Nutrition Facts panel on a food label gives you information about the nutritional values in foods. It breaks down the values by serving and also tells you how a serving fits into your daily diet amounts. The example below breaks down each part of the label. If you have questions, please talk to your healthcare provider or registered dietitian.

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Foods with high cholesterol to avoid and include

Aim to eat a diet that promotes low levels of bad cholesterol and high levels of good cholesterol. Fat intake affects this balance because fatty acids bind to liver cells and regulate the production of cholesterol.

Pay attention not only to quantities of fat in the diet, but also to which types are entering the body. Each form of fat influences cholesterol levels differently:

  • Saturated fats: These mostly occur in meat and dairy products. They instruct the liver to produce more bad cholesterol.
  • Unsaturated fats: These are more common in fish, plants, nuts, seeds, beans, and vegetable oils. Certain unsaturated fats can help increase the rate at which the liver reabsorbs and breaks down bad cholesterol.
  • Trans fats: These are solidified vegetable oils. Manufacturers normally use an artificial process called hydrogenation to produce them. Fried food, baked goods, and packaged foods often contain trans fats.

While avoiding foods with high cholesterol content may be beneficial for some, the American Heart Association (AHA), National Heart, Lung, and Blood Institute (NHLBI), and Centers for Disease Control and Prevention (CDC) agree that the most effective dietary approach to cutting blood cholesterol is choosing foods that contain unsaturated fats over those that contain saturated or trans fats.

Trans fats

Trans fats not only increase levels of bad cholesterol, but they also lower levels of good cholesterol. For this reason, they are the most harmful fats.

A study paper that appears in The American Journal of Clinical Nutrition followed 344,696 participants for 4–10 years after they changed which types of fats they ate.

Share on PinterestProcessed food often contains harmful trans fats.

The participants who cut their saturated fat intake by 5 percent and replaced it with polyunsaturated fats had significantly fewer incidences of coronary illness or coronary-related death.

It is best to cut trans fats out of the diet completely. In 2013, the United States Food and Drug Administration (FDA) announced that they no longer recognize partially hydrogenated oils, the major commercial source of trans fats, as safe because of their strong links to coronary heart disease.

In 2018, the U.S. will undergo a national ban on trans fats, and several cities have already banned them from use in restaurants.

While nationwide cardiovascular disease incidences have recently fallen, the results of a recent study that appears in JAMA Cardiology revealed an additional 6.2 percent decrease of heart attack and stroke in the New York counties where trans fats are banned.

Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study

ABSTRACT

Background: An elevated LDL-cholesterol concentration is associated with an increased risk of cardiovascular disease. The association between fruit and vegetable consumption and LDL has been inconsistent.

Objective: The objective was to determine whether a high intake of fruit and vegetables is inversely associated with LDL concentrations.

Design: We used data collected from 4466 subjects in the National Heart, Lung, and Blood Institute Family Heart Study to study the association between fruit and vegetable consumption and serum LDL. We used a food-frequency questionnaire to assess fruit and vegetable intakes and regression models to estimate adjusted mean LDL according to fruit and vegetable consumption.

Conclusion: Consumption of fruit and vegetables is inversely related to LDL in men and women.

INTRODUCTION

An elevated LDL-cholesterol concentration is a risk factor for coronary artery disease (1–5). Plasma concentrations of LDL are influenced by both genetic and environmental factors. Although it is difficult to alter genetic factors, modifiable environmental factors such as smoking or dietary patterns could be targeted in preventive interventions aimed at lowering LDL. The usual guidelines recommend a reduction in dietary saturated fat and cholesterol intakes as a way to prevent hypercholesterolemia; however, only limited data are available on the benefits of fruit and vegetable consumption on plasma concentrations of LDL in a community-based population. Data on the effects of fruit and vegetable intakes on LDL are inconsistent. In the Dietary Approaches to Stop Hypertension (DASH) trial (6), a diet high in fruit and vegetables was not associated with a significant reduction in LDL compared with the control diet, although the trend suggests a decrease in plasma LDL concentrations. In contrast, in the Indian Diet Heart Study (7), fruit and vegetable consumption decreased LDL concentrations by ≈7%. In a randomized trial, fruit and vegetable intake was associated with a reduction in LDL among patients with acute myocardial infarction after 12 wk of intervention (8). Fruit and vegetables are rich in dietary fiber, which has been shown to decrease LDL concentrations (9–11).

In the current study we used data from 4466 adult participants of the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study to evaluate whether higher intakes of fruit and vegetables is inversely related to LDL concentrations in men and women, independent of other risk factors.

SUBJECTS AND METHODS

Study population

The NHLBI Family Heart Study is a multicenter, population-based study designed to identify and evaluate genetic and nongenetic determinants of cardiovascular disease. A detailed description of the methods and design was published previously (12). Subjects in this study are members of families from previously established population-based cohort studies: The Framingham Heart Study in Framingham, MA; the Atherosclerosis Risk in Communities Study cohorts in North Carolina and Minnesota; and the Utah Health Family Tree Study in Salt Lake City. Briefly, in 1993–1995, participants (probands) in each of the 4 studies were selected at random and invited to furnish an updated family health history that contained information on their parents, children, and siblings. Of the families who furnished data, 588 were chosen at random and 657 were chosen because of higher than expected coronary artery disease rates among their family members. All members of these families, including the spouses of the probands, were invited to 1 of the 4 study clinics for evaluation. The evaluation included a detailed medical and lifestyle history that was obtained through an interview. Informed consent was obtained from each participant, and the study protocol was reviewed and approved by the institutional review boards of each of the participating institutions.

Blood collection and assays

Fasting blood samples for lipid measurements were collected into evacuated tubes containing no additives. Blood samples were then spun at 3000 × g for 10 min at 4 °C. Sera were stored at −70 °C until shipped periodically to a central laboratory at the Fairview–University Medical Center in Minneapolis for processing. LDL was estimated by using the method of Friedewald et al (13), except for subjects with triacylglycerol concentrations >400 mg/dL, whose LDL concentrations were measured by ultracentrifugation.

Assessment of fruit and vegetable intakes

Trained interviewers obtained information on usual consumption of fruit and vegetables with the use of a 100-item food-frequency questionnaire (FFQ) modified from the FFQ developed by Willett et al (14, 15). The reproducibility and validity of the FFQ was documented elsewhere (16). For fruit consumption, each participant was asked about how often, on average, he or she consumed fruit during the previous year (items 9 through 14 on the FFQ). For vegetable consumption, subjects were asked about their average consumption of vegetables such as beans, broccoli, cabbage, cauliflower, carrots, corn, spinach, squash, and tomatoes (items 15 through 25 on the FFQ). Response categories ranged from almost never, 1–3/mo, 1/wk, 2–4/wk, 5–6/wk, 1/d, 2–3/d, 4–6/d, to >6/d. The portion size of each fruit and vegetable was specified to facilitate determination of the number of typical servings and nutrient content.

Other variables

Information on the dietary consumption of total fat, saturated fat, and cholesterol was obtained by using the same FFQ. Intake of specific nutrients was computed by multiplying the frequency of consumption of an item by the nutrient content of specified portions. Nutrient composition was obtained from the Harvard University FOOD COMPOSITION DATABASE, derived from US Department of Agriculture sources (17), and from manufacturer information.

Anthropometric data were collected while the subjects were wearing scrub suits. A balance scale was used to measure body weight, and height was measured with a wall-mounted vertical ruler. Demographic data and information on alcohol intake, cigarette smoking, and physical activity (minutes per day of leisure activity) were obtained by interview.

Statistical analysis

Because eating habits differ between men and women, we initially analyzed the data stratified by sex and created the following categories of fruit and vegetable consumption: 0–1.9, 2.0–2.9, 3.0–3.9, and ≥4 servings/d. Because the subjects were not independent in this study, we used a general linear model (PROC MIXED; SAS Institute, Cary, NC) to estimate adjusted mean LDL concentrations across categories of fruit and vegetable intake. This method corrects the variance of the point estimates for familial clustering. Adjustment was made for age, age squared, study center, risk group (high risk compared with random), body mass index, energy intake (quintiles), smoking status (never, former, and current smokers), dietary cholesterol (quintiles), history of coronary artery disease, and diabetes mellitus. Additional adjustment for education (high school graduate or less, vocational school, and college or more), physical activity (minutes per day of leisure activity), use of vitamin supplements, consumption of breakfast cereals, and total fat (quintiles), saturated fat (quintiles), and polyunsaturated fat (quintiles) intakes did not alter the results significantly. All sex-specific analyses were initially conducted within the random and high-risk groups separately, but, because the results were similar, we combined the high-risk and random groups.

Subjects with higher intakes of fruit and vegetables were older and had different lifestyle habits and lower Keys score than did those who consumed fewer servings of fruit and vegetables per day. The Keys score correlates changes in fatty acid intake with changes in serum cholesterol and is computed as follows: Keys score=1.35×(2S−P)+1.5×C (1) where S and P are percentages of energy from saturated fat and polyunsaturated fat, respectively, and C is dietary cholesterol in mg/1000 kcal. Therefore, in secondary analyses, we conducted stratified analyses according to age (25–39, 40–59, and ≥60 y), tertiles of Keys score, education (high school graduate or less, vocational school, and college or more), smoking status (current nonsmokers and current smokers), physical activity (with the median of total minutes of daily exercise as the cutoff), and use of vitamin supplements. Furthermore, we repeated the analyses after excluding 751 subjects (n = 276 with diabetes mellitus, n = 366 with coronary artery disease, and n = 109 with both diseases). All analyses were performed with the use of SAS software (18).

RESULTS

TABLE 1

Baseline characteristics of male participants in the National Heart, Lung, and Blood Institute Family Heart Study according to fruit and vegetable intakes

1

Values obtained from a general linear model (PROC MIXED in SAS) for continuous variables and from generalized estimating equations (PROC GENMOD in SAS) for categorical variables.

2

x̄ ± SD.

3

Calculated as 1.35 × (2S − P) + 1.5 × C⁠, where S is the percentage of energy from saturated fat, P is the percentage of energy from polyunsaturated fat, and C is dietary cholesterol in mg/1000 kcal.

TABLE 1

Baseline characteristics of male participants in the National Heart, Lung, and Blood Institute Family Heart Study according to fruit and vegetable intakes

1

Values obtained from a general linear model (PROC MIXED in SAS) for continuous variables and from generalized estimating equations (PROC GENMOD in SAS) for categorical variables.

2

x̄ ± SD.

3

Calculated as 1.35 × (2S − P) + 1.5 × C⁠, where S is the percentage of energy from saturated fat, P is the percentage of energy from polyunsaturated fat, and C is dietary cholesterol in mg/1000 kcal.

TABLE 2

Baseline characteristics of female participants in the National Heart, Lung, and Blood Institute Family Heart Study according to fruit and vegetable intakes

1

Values obtained from a general linear model (PROC MIXED in SAS) for continuous variables and from generalized estimating equations (PROC GENMOD in SAS) for categorical variables.

2

x̄ ± SD.

3

Calculated as 1.35 × (2S − P) + 1.5 × C⁠, where S is the percentage of energy from saturated fat, P is the percentage of energy from polyunsaturated fat, and C is dietary cholesterol in mg/1000 kcal.

TABLE 2

Baseline characteristics of female participants in the National Heart, Lung, and Blood Institute Family Heart Study according to fruit and vegetable intakes

1

Values obtained from a general linear model (PROC MIXED in SAS) for continuous variables and from generalized estimating equations (PROC GENMOD in SAS) for categorical variables.

2

x̄ ± SD.

3

Calculated as 1.35 × (2S − P) + 1.5 × C⁠, where S is the percentage of energy from saturated fat, P is the percentage of energy from polyunsaturated fat, and C is dietary cholesterol in mg/1000 kcal.

In the categories 0–1.9, 2.0–2.9, 3.0–3.9, and ≥4 servings of fruit and vegetables per day, adjusted mean (±SE) LDL concentrations were 3.36 ± 0.04, 3.35 ± 0.04, 3.26 ± 0.04, and 3.17 ± 0.06 mmol/L, respectively, in men (P for trend < 0.0001) and 3.35 ± 0.05, 3.22 ± 0.04, 3.21 ± 0.04, and 3.11 ± 0.04 mmol/L, respectively, in women (P for trend < 0.0001) in a model that adjusted for age, age squared, field center, risk group, body mass index, energy intake, smoking status, dietary cholesterol, and prevalence of diabetes mellitus and coronary artery disease (Table 3). Additional adjustment for education, physical activity, and saturated, polyunsaturated, and total fat intakes did not alter the results significantly. Furthermore, exclusion of 751 subjects with diabetes mellitus, coronary artery disease, or both did not change the results (data not shown). We also looked at HDL, LDL:HDL, and triacylglycerol as endpoints. Although the consumption of fruit and vegetables was not associated with HDL (P for trend = 0.57 for men and 0.97 for women) or triacylglycerol (P for trend = 0.83 for men and 0.60 for women) concentrations, fruit and vegetables consumption was inversely related to LDL:HDL. From the lowest to the highest category of fruit and vegetable consumption, multivariate-adjusted mean LDL:HDL values were 3.21 ± 0.05, 3.19 ± 0.05, 3.16 ± 0.05, and 3.03 ± 0.05, respectively, for men (P for trend = 0.006). Corresponding values for women were 2.52 ± 0.05, 2.40 ± 0.04, 2.42 ± 0.04, and 2.36 ± 0.04 (P for trend = 0.020). Because the intake of fruit and vegetables was inversely related to the intake of energy from saturated fat, we conducted subanalyses that were restricted to subjects above the 75th percentile of energy intake from saturated fat; we found an inverse relation between fruit and vegetable consumption and LDL cholesterol concentration (P for trend < 0.0001; data not shown).

TABLE 3

Adjusted LDL cholesterol according to fruit and vegetable intakes in the National Heart, Lung, and Blood Institute Family Heart Study1

1

x̄ ± SE.

2

Adjusted for age, age squared, field center, risk group (random compared with high risk of coronary artery disease), BMI, energy intake (quintiles), smoking status (never, former, and current smokers), dietary cholesterol (quintiles), and history of coronary artery disease and diabetes mellitus with the use of a general linear model (PROC MIXED in SAS).

3

Adjusted for variables controlled for in model 1 and for education (high school graduate or less, vocational school, and college or more), physical activity, and saturated fat (quintiles), polyunsaturated fat (quintiles), and total fat (quintiles) intakes.

TABLE 3

Adjusted LDL cholesterol according to fruit and vegetable intakes in the National Heart, Lung, and Blood Institute Family Heart Study1

1

x̄ ± SE.

2

Adjusted for age, age squared, field center, risk group (random compared with high risk of coronary artery disease), BMI, energy intake (quintiles), smoking status (never, former, and current smokers), dietary cholesterol (quintiles), and history of coronary artery disease and diabetes mellitus with the use of a general linear model (PROC MIXED in SAS).

3

Adjusted for variables controlled for in model 1 and for education (high school graduate or less, vocational school, and college or more), physical activity, and saturated fat (quintiles), polyunsaturated fat (quintiles), and total fat (quintiles) intakes.

DISCUSSION

In this cross-sectional study, we found that consumption of fruit and vegetables was inversely related to LDL-cholesterol concentrations in men and women, independent of age, Keys score, smoking status, exercise, educational attainment, and use of vitamin supplements. Subjects in the highest fruit and vegetable intake groups had LDL concentrations that were ≈6–7% lower than those in the lowest fruit and vegetable intake groups. Although several clinical trials and observational studies have assessed the effects of dietary fat on LDL concentrations, limited data are available on the association between the consumption of fruit and vegetables and LDL concentrations in a community-based population. In the DASH trial, LDL-cholesterol concentrations in 146 subjects assigned to consume a fruit and vegetable diet—a diet increased in fruit, vegetables, and whole grains and lower in sweets—were not significantly lower than concentrations in the control group after an 8-wk intervention period (6). In that study, although the DASH diet—which is rich in fruit, vegetables, and low-fat dairy products and low in saturated fat, total fat, and cholesterol—resulted in a reduction in LDL cholesterol (mmol/L) in men and in women , a diet high in fruit and vegetables indicated a nonsignificant reduction in LDL cholesterol (mmol/L) in men and no effect in women . In contrast, the Indian Diet Heart Study showed that fruit and vegetable consumption was associated with a 7.3% decrease in LDL after 12 wk of intervention (7). However, this study did not analyze the data stratified by sex; of the 621 participants, only 14% were women. Neither the DASH trial (6) nor the Indian Diet Heart Study (7) assessed a dose-response effect between fruit and vegetable consumption and LDL-cholesterol concentrations. Fornes et al (19) reported in a cross-sectional study that the intake of fruit and vegetables was inversely correlated with LDL-cholesterol concentrations, and other investigators reported beneficial effects of fruit and vegetable intakes on LDL-cholesterol concentrations (20, 21). Our findings are consistent with these reports.

Diets rich in fruit and vegetables are good sources of dietary fiber. In a randomized trial, a fiber-multivitamin combination resulted in a reduction in LDL cholesterol of ≈8% from baseline after 8 wk (22). Other epidemiologic studies (9, 11) and a meta-analysis (23) showed LDL-cholesterol lowering effects of dietary fiber.

Our study has some limitations. Given the cross-sectional design, we cannot infer causality between fruit and vegetable consumption and lower concentrations of LDL cholesterol. However, dietary patterns in adults are relatively stable, and the exclusion of those with prevalent coronary artery disease and diabetes mellitus did not alter the results significantly, making it more likely that dietary intakes reported over the past year may reflect the subjects’ usual diets. Frequencies of fruit and vegetable consumption were self-reported; thus, reporting bias might have affected our estimates of the effect.

Could the observed inverse association between fruit and vegetable consumption and LDL-cholesterol concentrations simply be attributed to a lower intake of saturated fat and dietary cholesterol in subjects with higher fruit and vegetable intakes? Our data indicate that a higher intake of fruit and vegetables was associated with lower Keys score and a lower percentage of energy from saturated fat, especially in men. This suggests that residual confounding by saturated fat could have biased our estimates. However, dietary cholesterol did not differ across categories of fruit and vegetable intakes in men and was in the opposite direction in women, because a higher intake of fruit and vegetables was related to higher dietary cholesterol in women (Table 2). In addition, the inverse association between fruit and vegetable consumption and LDL-cholesterol concentrations was observed across all tertiles of Keys score and among subjects whose energy intake from saturated fat was above the 75th percentile of the total population. This finding is not consistent with the fact that subjects with a higher intake of fruit and vegetables were more likely to eat less saturated fat and dietary cholesterol. Thus, our findings are less likely to be attributable to the effect of substituting saturated fat and dietary cholesterol with fruit and vegetables. The wide age range, the availability of data across many centers, and the large sample size are strengths of the study. In conclusion, our data show that the consumption of fruit and vegetables is associated with lower concentrations of LDL cholesterol in a dose-response manner.

This paper is presented on behalf of the investigators of the NHLBI Family Heart Study. The participating institutions and principal staff of the study are as follows. Forsyth County, University of North Carolina, and Wake Forest University Field Center: Gerardo Heiss, Stephen Rich, Greg Evans, James Pankow, HA Tyroler, Jeannette T Bensen, Catherine Paton, Delilah Posey, and Amy Haire; University of Minnesota Field Center: Donna K Arnett, Aaron R Folsom, Larry Atwood, James Peacock, and Greg Feitl; Boston University, Framingham Field Center: R Curtis Ellison, Richard H Myers, Yuqing Zhang, Andrew G Bostom, Luc Djoussé, Jemma B Wilk, and Greta Lee Splansky; University of Utah Field Center: Steven C Hunt, Roger R Williams (deceased), Paul N Hopkins, Hilary Coon, and Jan Skuppin; Coordinating Center, Washington University, St Louis: Michael A Province, DC Rao, Ingrid B Borecki, Yuling Hong, Mary Feitosa, Jeanne Cashman, and Avril Adelman; Central Biochemistry Laboratory, University of Minnesota, Minneapolis: John H Eckfeldt, Catherine Leiendecker-Foster, Michael Y Tsai, and Greg Rynders; Central Molecular Laboratory, University of Utah, Salt Lake City: Mark F Leppert, Jean-Marc Lalouel, Tena Varvil, and Lisa Baird; NHLBI Project Office: Phyliss Sholinsky, Millicent Higgins (retired), Jacob Keller (retired), Sarah Knox, and Lorraine Silsbee.

LD designed the project, completed the data analyses, and drafted the manuscript. DKA and MAP participated in the study design, the data collection, and the critical review of the manuscript. HC and LLM participated in the data analyses and the critical review of the manuscript. RCE participated in the study design, the data collection, the data analyses, and the critical review of the manuscript. None of the authors had a conflict of interest to disclose.

1 Castelli WP . Cholesterol and lipids in the risk of coronary artery disease—the Framingham Heart Study. Can J Cardiol 1988;4(suppl):5A–10A. 2 Castelli WP , Anderson KM , Wilson PWF , Levy D . Lipids and risk of coronary heart disease. The Framingham Study. Ann Epidemiol 1992;2:23–8. 3 Castelli WP . The role of plasma lipids as predictors of risk for coronary heart disease. Drugs 1990;40(suppl):1–6. 4 Laakso M . Lipids and lipoproteins as risk factors for coronary heart disease in non-insulin-dependent diabetes mellitus. Ann Med 1996;28:341–5. 5 Lehto S , Ronnemaa T , Haffner SM , Pyorala K , Kallio V , Laakso M . Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with type 2 diabetes. Diabetes 1997;46:1354–9. 6 Obarzanek E , Sacks FM , Vollmer WM , et al. Effects on blood lipids of a blood pressure–lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Clin Nutr 2001;74:80–9. 7 Singh RB , Rastogi SS , Niaz MA , Ghosh S , Singh R , Gupta S . Effect of fat-modified and fruit- and vegetable-enriched diets on blood lipids in the Indian Diet Heart Study. Am J Cardiol 1992;70:869–74. 8 Singh RB , Ghosh S , Singh R . Effects on serum lipids of adding fruits and vegetables to prudent diet in the Indian Experiment of Infarct Survival (IEIS). Cardiology 1992;80:283–93. 9 Ballesteros MN , Cabrera RM , Saucedo MS , Yepiz-Plascencia GM , Ortega MI , Valencia ME . Dietary fiber and lifestyle influence serum lipids in free living adult men. J Am Coll Nutr 2001;20:649–55. 10 Stone NJ . Lowering low-density cholesterol with diet: the important role of functional foods as adjuncts. Coron Artery Dis 2001;12:547–52. 11 Hagander B , Asp NG , Efendic S , Nilsson-Ehle P , Schersten B . Dietary fiber decreases fasting blood glucose levels and plasma LDL concentrations in noninsulin-dependent diabetes mellitus patients. Am J Clin Nutr 1988;47:852–8. 12 Higgins M , Province M , Heiss G , et al. NHLBI Family Heart Study: objectives and design. Am J Epidemiol 1996;143:1219–28. 13 Friedewald WT , Levy RI , Fredrickson DS . Estimation of the concentration of LDL cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502. 14 Rimm EB , Giovannucci EL , Stampfer MJ , Colditz GA , Litin LB , Willett WC . Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 1992;135:1114–26. 15 Stein AD , Shea S , Basch CE , Contento IR , Zybert P . Consistency of the Willett semiquantitative food frequency questionnaire and 24-h dietary recalls in estimating nutrient intakes of preschool children. Am J Epidemiol 1992;135:667–77. 16 Willett WC , Sampson L , Stampfer MJ , et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985;122:51–65. 17 US Department of Agriculture. Composition of foods: raw, processed, and prepared, 1963–1988. Agriculture handbook no. 8. Washington, DC: US Government Printing Office, 1989. 18 SAS Institute. SAS/STAT user’s guide, version 6. 4th ed. Vol 2. Cary, NC: SAS Institute, 1989:1071–126. 19 Fornes NS , Martins IS , Hernan M , Velasquez-Melendez G , Ascherio A . Frequency of food consumption and lipoprotein serum levels in the population of an urban area, Brazil. Rev Saude Publica 2000;34:380–7. 20 Singh RB , Rastogi V , Rastogi SS , Niaz MA , Beegom R . Effect of diet and moderate exercise on central obesity and associated disturbances, myocardial infarction and mortality in patients with and without coronary artery disease. J Am Coll Nutr 1996;15:592–601. 21 Bruce B , Spiller GA , Klevay LM , Gallagher SK . A diet high in whole and unrefined foods favorably alters lipids, antioxidant defenses, and colon function. J Am Coll Nutr 2000;19:61–7. 22 Sprecher DL , Pearce GL . Fiber-multivitamin combination therapy: a beneficial influence on LDL and homocysteine. Metabolism 2002;51:1166–70. 23 Brown L , Rosner B , Willett WW , Sacks FM . Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30–42.

FOOTNOTES

2 Supported in part by the National Heart, Lung, and Blood Institute (cooperative agreement grants U01 HL56563, U01 HL56564, U01 HL56565, U01 HL56566, U01 HL56567, U01 HL56568, and U01 HL56569). © 2004 American Society for Clinical Nutrition

A recipe for better heart health

A heart-healthy eating plan can help you manage your blood cholesterol level and reduce your risk of heart disease and stroke. The simple cooking tips below will help you prepare tasty, heart-healthy meals that could help improve your cholesterol levels by reducing excess saturated fat and trans fat.

Reduce saturated fat in meat and poultry

The American Heart Association recommends a diet that emphasizes poultry and limits red meat. The amount of saturated fat in meats can vary widely, depending on the cut and how it’s prepared.

Here are some ways to reduce the saturated fat in meat:

  • Select lean cuts of meat with minimal visible fat. Lean beef cuts include the round, chuck, sirloin or loin. Lean pork cuts include the tenderloin or loin chop. Lean lamb cuts come from the leg, arm and loin.
  • Buy “choice” or “select” grades rather than “prime.” Select lean or extra lean ground beef.
  • Trim all visible fat from meat before cooking.
  • Broil rather than pan-fry meats such as hamburger, lamb chops, pork chops and steak.
  • Use a rack to drain off fat when broiling, roasting or baking. Instead of basting with drippings, keep meat moist with wine, fruit juices or a heart-healthy oil-based marinade.
  • Cook a day ahead of time. Stews, boiled meat, soup stock or other dishes in which fat cooks into the liquid can be refrigerated. Later, remove the hardened fat from the top.
  • When a recipe calls for browning the meat first, try browning it under the broiler instead of in a pan.
  • Eat chicken and turkey rather than duck and goose, which are higher in fat. Choose white meat most often when eating poultry.
  • Remove the skin from chicken or turkey before cooking. If your poultry dries out too much, first try basting with wine, fruit juices or a heart-healthy oil-based marinade. Or, leave the skin on for cooking and then remove it before eating.
  • Limit processed meats such as sausage, bologna, salami and hot dogs. Many processed meats – even those with “reduced fat” labels – are high in calories and saturated fat. Such foods are often high in sodium, too. Read labels carefully and choose to eat processed meats only occasionally.

Eat more fish

Fish can be fatty or lean, but it’s still low in saturated fat. Eat at least 8 ounces of non-fried fish each week, which may be divided over two 3.5- to 4-ounce servings. Choose oily fish such as salmon, trout and herring, which are high in omega-3 fatty acids. Prepare fish baked, broiled, grilled or boiled rather than breaded and fried, and without added salt, saturated fat or trans fat. Non-fried fish and shellfish, such as shrimp, crab and lobster, are low in saturated fat and are a healthy alternative to many cuts of meat and poultry.

Research has shown the health benefits of eating seafood rich in omega-3 fatty acids, especially when it replaces less healthy proteins that are high in saturated fat and low in unsaturated fat. Including seafood high in omega-3 fatty acids as part of a heart-healthy diet can help reduce the risk of heart failure, coronary heart disease, cardiac arrest and the most common type of stroke (ischemic).

Eat less meat

Try meatless meals featuring vegetables or beans. For example, think eggplant lasagna, or, instead of a burger, consider a big grilled portobello mushroom on a bun. Maybe substitute low-sodium beans for beans-n-franks. Or, treat meat as a sparingly used ingredient, added mainly for flavor in casseroles, stews, low-sodium soups and spaghetti.

Cook fresh vegetables the heart-healthy way

Try cooking vegetables in a tiny bit of vegetable oil and add a little water during cooking, if needed. (Or use a vegetable oil spray.) Just one or two teaspoons of oil is enough for a package of plain frozen vegetables that serves four. Place the vegetables in a skillet with a tight cover and cook them over very low heat until done.

Add herbs and spices to make vegetables even tastier. (It’s a healthier choice than opting for pre-packaged vegetables with heavy sauce or seasonings.) For example, these combinations add subtle and surprising flavors:

  • Rosemary with peas, cauliflower and squash
  • Oregano with zucchini
  • Dill with green beans
  • Marjoram with Brussels sprouts, carrots and spinach
  • Basil with tomatoes

Start with a small quantity of herbs and spices (1/8 to 1/2 teaspoon for a package of frozen vegetables), then let your family’s feedback be your guide. Chopped parsley and chives, sprinkled on just before serving, can also enhance the flavor of many vegetables.

Use liquid vegetable oils in place of solid fats

Liquid vegetable oils such as canola, safflower, sunflower, soybean and olive oil can often be used instead of solid fats, such as butter, lard or shortening. If you must use margarine, try the soft or liquid kind. Use a little liquid oil to:

  • Pan-fry fish and poultry
  • Sauté vegetables
  • Make cream sauces and soups using low-fat or fat-free milk
  • Add to whipped or scalloped potatoes using low-fat or fat-free milk
  • Brown rice for Spanish, curried or stir-fried rice
  • Cook dehydrated potatoes and other prepared foods that call for fat to be added.
  • Make pancakes or waffles

Puree fruits and veggies for baking

Pureed fruits or vegetables can be used in place of oil in muffin, cookie, cake and snack bar recipes to give your treats an extra healthy boost. For many recipes, use the specified amount of puree instead of oil. Check the mix’s package or your cookbook’s substitutions page for other conversions. You can:

  • Use applesauce in spice muffins or oatmeal cookies
  • Include bananas in breads and muffins
  • Try zucchini in brownies

Lower dairy fats

When it comes to cheeses used in recipes, you can substitute low-fat, low-sodium cottage cheese, part-skim milk mozzarella (or ricotta) cheese, and other low-fat, low-sodium cheeses with little or no change in consistency.

Sauces and gravies

Let your cooking liquid cool, then remove the hardened fat before making gravy. Or, use a fat separator to pour off the good liquid from cooking stock, leaving the fat behind.

Increase fiber and whole grains

Consider these heart-smart choices:

  • Toast and crush (or cube) fiber-rich whole-grain bread to make breadcrumbs, stuffing or croutons
  • Replace the breadcrumbs in your meatloaf with uncooked oatmeal
  • Serve whole fruit at breakfast in place of juice
  • Use brown rice instead of white rice and try whole grain pasta
  • Add lots of colorful veggies to your salad – carrots, broccoli and cauliflower are high in fiber and give your salad a delicious crunch

Have high cholesterol? You’re not alone. The problem affects some 95 million Americans, according to Centers for Disease Control and Prevention, and has been linked to serious health conditions, from heart disease to diabetes.

Cholesterol is a waxy, fatty substance found in your cells. Your liver makes it naturally, but it’s also found in animal foods like meat and dairy products. Your body needs some cholesterol to function, but getting more than you need, which can happen from eating too many cholesterol-rich foods, causes plaque to form in the arteries that could lead to dangerous blood-flow blockages.

“High cholesterol is a top risk factor for heart attacks, strokes, and poor circulation,” says Omar Ali, MD, intervention cardiologist at Detroit Medical Center Harper University Hospital. Ideally, this is what healthy cholesterol numbers look like, according to the National Institues of Health:

Adult women (age 20+)

  • Total cholesterol: 125 to 200 mg/dL
  • LDL cholesterol: Less than 100 mg/dL
  • HDL cholesterol: 50 mg/dL or higher

Adult men (age 20+)

  • Total cholesterol: 125 to 200 mg/dL
  • LDL cholesterol: Less than 100 mg/dL
  • HDL cholesterol: 40 mg/dL or higher

Medications like statins can help you get there, though most experts recommend trying to make healthy lifestyle changes first. “I always advise people to try and lower their cholesterol through diet and exercise,” says Jennifer Haythe, MD, co-director of the Women’s Center for Cardiovascular Health at New York-Presbyterian.

Cutting back on high-cholesterol foods—like fried foods, sugary desserts, and fatty meats—is a start, but you also need to eat more of the fare that can help lower your cholesterol naturally. Here, 10 picks to add to your grocery list.

Oats

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Getting 5 to 10 grams of soluble fiber daily could help lower LDL cholesterol (the “bad” cholesterol that can build up in your arteries) by as much as 11 points, according to the National Lipid Association. The roughage isn’t well absorbed by your intestine, so it binds to cholesterol in the blood and helps remove it from the body, Dr. Haythe explains. And oats are a top source, delivering around 2 grams of soluble fiber per half-cup cooked.

Try it: These tasty overnight oats recipes will save you tons of time during busy mornings. Simply prep them the night before and enjoy a fiber-rich breakfast the next day.

Fatty fish

Christopher Testani

Aim to eat at least two 3.5-ounce servings of fatty fish like salmon, mackerel, tuna, trout, or herring per week, recommends the American Heart Association. The omega-3 fatty acids found in these swimmers can help improve your triglycerides—a type of cholesterol-like fat found in the blood that can cause your arteries to become hard or thick.

Try it: This honey-spiced salmon with quinoa is loaded with protein and fiber—and takes just 35 minutes to make! If tuna is your go-to, try this tuna salad recipe that subs out mayo for protein-rich Greek yogurt.

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Regular consumption of tree nuts like walnuts, almonds, and pistachios is tied to lower levels of total cholesterol, LDL cholesterol and triglycerides, found an American Journal of Clinical Nutrition review of 61 studies. “This is likely because they contain unsaturated fats, omega-3 fatty acids, fiber, vitamin E, and plant sterols,” Dr. Haythe explains. Just watch your portions, since nuts are high in calories. A small handful or two tablespoons of nut butter is all you need, says Dr. Haythe.

Try it: Top your salads, oatmeal, and stir-fry with nuts for extra crunch.

Green tea

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A Japanese study of more than 40,000 adults found that those who drank more than five cups of green tea daily were 26 percent less likely to die from a heart attack or stroke compared to folks who rarely sipped the stuff. Experts suspect that’s because the grassy brew is rich in catechins, a family of flavonoids that have been shown to thwart the production of cholesterol as well as block it from being absorbed.

Try it: Drink it straight—or amp up the flavor of your brew with this iced lemon and ginger green tea recipe.

Beans and legumes

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Having a daily half-cup serving of beans or legumes could lower your LDL cholesterol by an average of 5 percent in just six weeks, according to a review of 26 studies. Like oats, beans are packed with soluble fiber that helps sweep cholesterol out of the bloodstream, Dr. Ali explains. Hummus, anyone?

Try it: Add beans to your tacos, salads, and soups for extra plant-based protein and fiber. You can add your favorites to this vegetable chili for a hearty dinner.

Dark chocolate

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Who says treats can’t also be good for you? In a British study, participants who sipped a cocoa drink twice daily for a month lowered their LDL cholesterol and raised their HDL cholesterol (the “good” cholesterol that helps prevent plaque from building up in your arteries). Chalk it up to dark chocolate’s flavonoids, beneficial compounds that have an antioxidant effect. Just stick with chocolate that’s 70 percent cocoa or higher—it contains more antioxidants and less sugar than the lower percentage stuff.

Try it: Sprinkle a serving of dark chocolate over your oats or eat on its own with a cup of tea as a post-dinner sweet treat.

Safflower oil

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This neutral-flavored oil is rich in phytosterols—cholesterol-blocking plant compounds that could lower your LDL cholesterol by as much as 14 percent, according to the Cleveland Clinic. In fact, regular consumption of safflower oil is tied to lower total cholesterol and LDL cholesterol compared to regular consumption of olive oil, according to a recent Journal of Lipid Research review.

Try it: Safflower oil has a mild flavor and high smoke point, making it easy to cook with. Drizzle over your favorite veggies before roasting or use it in a DIY salad dressing.

Kale

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The leafy veggie (along with cousins collard and mustard greens) has been shown to bind to bile acid. What good does that do, exactly? “That helps the liver burn more fat, which in turn lowers cholesterol,” Dr. Ali says. For the biggest benefit, opt for lightly cooked greens over raw ones. Steaming in particular seems to boost bile acid binding, research shows.

Try it: Beyond using kale as a salad base, you can throw it into your stir-fry, sauté with eggs, or add into soup.

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Thanks to their fiber and monounsaturated fat, avocados could help lower your total cholesterol by 18 points, your LDL cholesterol by 16 points, and your triglycerides by 27 points, suggests an analysis of 10 studies. The key is using them in place of foods containing less healthy fats, like saturated fat. Think sliced avocado instead of mayo on a sandwich, or diced avocado rather than cheese in a burrito bowl.

Try it: We all love avocado toast and guacamole, but if you want to get creative, they make a creamy (and satiating) base for smoothies.

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Having one every day really might help keep the (heart) doctor away. Apples are one of the best sources of pectin, a type of fiber that’s been shown to lower levels of LDL cholesterol. They’re also chock-full of antioxidants like polyphenols, which an Ohio State University study found can help keep LDL cholesterol from oxidizing, which can cause arteries to become inflamed and clogged.

Try it: Enjoy as a snack or whip up a batch of these apple oatmeal muffins for a grab-and-go breakfast in the morning.

Marygrace Taylor Marygrace Taylor is a health and wellness writer for Prevention, Parade, Women’s Health, Redbook, and others.

10 Foods That Lower Cholesterol

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Pictured Recipe: Walnut-Rosemary Crusted Salmon

There’s no magical food to keep your heart healthy, but there are a lot of foods that can help-including these foods that help lower your cholesterol. In addition to cutting back on foods that can raise total cholesterol and getting enough exercise, make sure to eat more of these foods that improve your cholesterol profile by raising “good” HDL and/or lowering “bad” LDL cholesterol. These foods include some old standbys, such as oatmeal and fruit, plus a few surprising foods that can help lower cholesterol to reduce your risk of heart attack and stroke.

Watch: 4 Heart-Healthy Foods to Eat

Red Wine

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Pictured recipe: Red Sangria

Raise your glass for heart health! In moderation, alcohol is known to raise HDL, or “good,” cholesterol. Drinking a daily glass of red wine increased “good” HDL cholesterol and also decreased “bad” LDL cholesterol after a few months, found one study. Red wine also contains antioxidants called polyphenols that help keep your blood vessels healthy and strong. Remember that moderation means one drink for women or two for men daily and, in this case, more is not better.

Read Up: 5 Heart-Healthy Diet Rules Everyone Should Follow

Salmon

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Pictured Recipe: Miso-Maple Salmon

Salmon is rich in omega-3 fatty acids, which are healthy fats that can help reduce blood pressure. Eating salmon can improve your “good” HDL cholesterol, but it won’t lower your “bad” LDL cholesterol. HDL cholesterol helps sweep cholesterol off your artery walls, preventing dangerous plaque from forming. The American Heart Association recommends eating fatty fish like salmon at least twice per week for heart-healthy benefits. Other fish that contain omega-3s, such as mackerel, tuna and sardines, can also help.

Don’t Miss: Healthiest Fish to Eat

Oatmeal

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Pictured Recipe: Fig & Ricotta Oatmeal

Oatmeal is one of the best cholesterol-fighting foods because it is so high in beta-glucans, the soluble fibers that cause oats to bulk up in liquid when you make oatmeal. Soluble fiber lowers your LDL, or “bad,” cholesterol by forming a sticky layer in the small intestine that blocks cholesterol from entering your bloodstream. Make oatmeal and skip the instant packs with lots of added sugar. (In a rush? See our picks for best instant oatmeals.) Add fruit to your oatmeal to naturally sweeten it and boost the soluble fiber content even more.

DIY Oatmeal: Recipes for Apple Oatmeal, Oat Muffins and More

Apples

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Pictured Recipe: Apple-Onion Relish

Many fruits contain soluble fiber, which is important for lowering cholesterol, but apples have a leg up on other fruits. Apples (especially the skins) contain pectin, a type of soluble fiber that latches onto the “bad” cholesterol and guides it through your digestive system and out of your body, effectively lowering your LDL-cholesterol levels. Citrus fruits are also high in pectin, but since it’s mostly in the pulp, you’ll have to eat your fruits to get the benefits, rather than juice them. Luckily, apples are a little easier to pucker up to than lemons. Apples are also high in polyphenols, powerful antioxidants that help reduce inflammation.

Crunch on This: Sweet & Savory Apple Recipes

Beans

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Pictured recipe: White Bean & Veggie Salad

How does that song go? “Beans, beans, they’re good for your heart”? Well…those lyrics get it right! Beans are packed with cholesterol-busting soluble fiber, but that’s not their only benefit. Beans are high in protein, which makes them a heart-healthy replacement for some animal protein sources, such as meat. For the biggest cholesterol-lowering benefits, add beans to chili, tacos and burritos (either in place of or in addition to meat). They’re also great in soups and salads.

Eat Your Beans: Budget-Friendly Bean Suppers

Nuts

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Pictured recipe: Cranberry-Almond Granola Bars

Tree nuts, such as walnuts, pistachios and pecans, have been shown to lower both total cholesterol and “bad” LDL cholesterol. Nuts are high in heart-healthy monounsaturated fat, fiber and several vitamins and minerals that are good for heart health. Nuts also contain plant sterols, which are natural compounds that block the cholesterol you eat from entering your bloodstream. While nuts are awesome to eat, don’t go crazy. Portion control is still important-there are 163 calories in just 1 ounce of almonds. Add a small handful to oatmeal, top toast with nut butter or make a DIY trail mix with dried fruit and nuts.

More Recipes: Cook with Nuts-Salads, Sides and More!

Avocado

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Pictured recipe: West Coast Avocado Toast

Who doesn’t love avocados? They not only taste amazing but also can help lower your cholesterol. Avocados are high in healthy monounsaturated fat, which helps lower “bad” LDL cholesterol. They also contain fiber, antioxidants and phytosterols, such as beta-sitosterol, which have also been shown to lower cholesterol. Don’t hog the entire bowl of guacamole, though! One serving is just a quarter of a Hass avocado, which delivers 57 calories. Spread a few slices of avocado on your sandwich instead of mayo, or dip some veggies into a bowl of fresh guacamole.

Watch: How to Make Cuban Pineapple & Avocado Salad

Dark Chocolate

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Pictured recipe: Chocolate Nut Bark

Chocolate fans rejoice! You might have heard that chocolate is good for you, and it’s true. Dark chocolate and cocoa powder contain powerful antioxidant compounds called flavonoids, which help lower cholesterol. Milk chocolate has less cocoa solids, and thus lower flavonoid levels, and white chocolate is even lower in the good stuff. Reach for small portions of dark chocolate, preferably with a high cocoa content. Or try a sprinkle of cocoa powder in your smoothie or on yogurt to reap chocolate’s cholesterol-lowering benefits.

Watch & Learn: DIY Chocolate Bark

Kimchi

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Pictured recipe: Kimchi Shrimp Cup of Noodles

Kimchi, a Korean fermented side dish commonly made from cabbage, radish or cucumber, is quickly gaining a following for its many health benefits. Kimchi is high in fiber and-because it’s fermented-is loaded with good bacteria that help keep your gut healthy. Kimchi contains bioactive compounds that lower cholesterol by blocking cholesterol from being absorbed into the bloodstream. The good bacteria produced during fermentation also help lower cholesterol. Kimchi and sauerkraut are usually pretty high in sodium, so watch your portions if you’re watching your salt intake.

Related: 7 Must-Eat Fermented Foods

Garlic

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Pictured recipe: Garlic Chicken for Two

Garlic packs a serious health punch. Some people love the flavor and others have been using it as a kitchen cure to boost immunity and promote heart health for years. Recent research has backed garlic’s health benefits, especially for your heart. Garlic, along with garlic extract, has been shown to lower cholesterol, possibly by preventing cholesterol from being made in the liver. Plus, eating garlic may also help lower blood pressure. Give your heart a boost and add garlic to your sauces, salad dressings and stir-fries.

Get Your Garlic On: Healthy Recipes with Garlic

EatingWell.com May 2016

How to lower cholesterol with the right diet and exercise regimens

  • The best way to lower cholesterol is with a heart-healthy diet and regular exercise.
  • Foods that can lower cholesterol include nuts, avocados, whole grains, fruits, vegetables, and healthy oils.
  • It generally takes at least three months to lower cholesterol and you will still need to maintain a healthy lifestyle afterward for any change to be effective.
  • This article was reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine.
  • Visit Insider’s homepage for more stories.

If you’re one of the 95 million US adults with a total cholesterol level higher than 200 mg/dL, you might be wondering what measures you can take to lower your cholesterol.

Medication isn’t right for everybody, and making changes to your lifestyle, such as eating a heart-healthy diet and getting regular exercise, may be more important for you. Here’s what you need to know.

The best ways to lower cholesterol

According to Steven Reisman, MD, a cardiologist and director of the New York Cardiac Diagnostic Center, the best way to lower cholesterol is with lifestyle modification through diet and exercise.

Reducing saturated and trans fats, while introducing soluble fiber and healthier fats, is key to adopting a heart-healthy diet. As far as exercise, aim for at least 30 minutes of aerobic activity five times each week — walking, biking, jogging, or exercise classes should work.

If you’re a smoker, giving up the habit can also get your numbers under control. That’s because smoking lowers HDL, which is considered good cholesterol. You’ll want higher levels of HDL to remove LDL from the arteries, which is considered bad cholesterol.

Foods to eat to lower cholesterol

To lower LDL cholesterol, Reisman says to reduce your consumption of saturated fats, such as red meat and full-fat dairy products. You’ll also want to minimize trans fat and partially hydrogenated oil in your diet, especially fried foods.

The next step is to eat foods that are considered heart-healthy. “Foods with monounsaturated fats are beneficial because they can decrease bad cholesterol (LDL) and increase good cholesterol (HDL),” says Reisman. Foods with monounsaturated fats include:

  • Avocados
  • Nuts like almonds, cashews, and pecans
  • Cooking with canola, olive, or peanut oil

Including polyunsaturated fats may also reduce the risk of heart disease and help lower your LDL cholesterol, says Reisman. Look for foods that contain an important type of polyunsaturated fat — omega-3 fatty acids. These include:

  • Walnuts
  • Sunflower seeds
  • Fish like salmon, herring, and tuna

Finally, Reisman says soluble fiber can also reduce LDL cholesterol. Some of the best foods to eat for added soluble fiber are:

  • Whole grains and oats
  • Beans and lentils
  • Apples, pears, and peas

How long it takes to reduce cholesterol levels

Sasan Massachi, MD, a primary care physician specializing in internal medicine, says that patients are typically advised to adopt a lifestyle modification program for three months, focusing on a healthier diet and regular exercise. This is followed up with cholesterol tests after three months to gauge results.

“If patients reduce their cholesterol adequately and are not in any danger of cardiovascular diseases, and they commit to maintaining a healthy diet and exercise regimen, we have them follow up in three to six months for additional cholesterol tests,” he says.

Overall, how quickly you can reduce cholesterol will depend on your total cholesterol level, your family history, any pre-existing health conditions like diabetes, and the type of diet and exercise program.

If your levels are already closer to a healthy range, and you don’t have any pre-existing conditions, it may take less time.

When a doctor will recommend medication

“For some patients who don’t respond well to lifestyle changes, it is necessary to take medication,” says Massachi. This may include those with a family history of high cholesterol and those who also have cardiovascular diseases or diabetes.

In these cases, Massachi says taking cholesterol medication can lower your cholesterol levels, and also help manage other pre-existing conditions. You should talk with your doctor if you think this might be the right option for you.

Related stories about heart health:

  • A cardiologist is begging patients to avoid the high-fat keto diet because their cholesterol levels could skyrocket
  • Eating 2 apples a day may lower cholesterol, helping ward off heart attacks and strokes
  • An avocado a day could lower your ‘bad’ cholesterol levels and reduce your risk of heart disease
  • Burnout may lead to an irregular heartbeat decades later, according to a first-of-its kind new study
  • 7 of the most dangerous things that put you at risk of a heart attack
  • A cardiologist revealed the truth behind red wine’s health benefits

Foods that lowers cholesterol

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