Cholesterol is naturally produced by your body and is essential to its function throughout your everyday life. However, excessively high levels of cholesterol, specifically LDL cholesterol, can lead to serious health problems.

The main causes of elevated LDL cholesterol are poor diet and lifestyle, and in some cases genetics. A healthy diet and exercise program that leads to an ideal weight can reduce the risk of lots of common problems such as the development of heart disease, diabetes, high blood pressure, and even some cancers.

Talk to your doctor if you are concerned about your cholesterol levels or have a history of heart attacks in family members, especially if you have family members who experienced heart attacks at a young age. Your doctor will be able to advise you on the best way to minimize your risk of heart problems.

Lowering LDL with a Heart Healthy Diet

When it comes to diet, there is not one perfect diet. The best diet is a healthy one that a person can stick with. One exception to this for many people with genetic cholesterol disorders is the currently popular ketogenic “keto” diet. The ketogenic diet high in saturated fat can lead to dramatic increases in LDL-C. In general, this diet should be avoided by persons with genetically elevated LDL-C.

A general rule of thumb is to fill 1/2 your dinner plate with healthy vegetables, ¼ of the plate can be comprised of foods from the healthy protein category and the other ¼ of the plate should consist of healthy whole grains or starchy vegetables. Let's take a look at healthy choices, and what foods should be avoided.


Foods you should eat

  • Fiber, grains & seeds (good examples are: steel cut oats, quinoa, farro, barley, bulgur, brown rice, sunflower seeds, whole wheat bread)
  • Fruits & vegetables (ex. Blueberries, blackberries, strawberries, raspberries, peaches, plums, prunes, grapefruit, oranges, bananas, apples, brussel sprouts, tomatoes, carrots, green beans, beets, mushrooms, colored bell peppers, broccoli, asparagus)
  • Healthy proteins (ex. Grilled or baked fish, poultry with the skin off, soy products like tofu or soy burgers, legumes like lentils, black, kidney and white beans, edamame, chickpeas, low fat cheese, and nuts in moderation like almonds or walnuts)
  • Healthy fats ( ex. Omega 3 fatty acids found in fatty fish such as salmon, tuna, and sardines, other healthy fats include monounsaturated fats such as olive oil, canola oil, peanut oil avocado and polyunsaturated fats such as sunflower oil, corn oil and safflower oil. It is important to remember that while certain fats are considered healthy, they still have calories so should be used in moderation)
  • Healthy beverages (ex. water, tea and coffee in moderation, fat free or 1% milk, seltzer water)

Read more cholesterol-lowering diet suggestions and get recipes here.

Foods to Avoid

  • Full fat dairy products (ex. whole or 2% milk, ice cream, full fat yogurt, full fat cheese, half and half, butter)
  • Red meatlimit to one serving a week (ex. steak, burger, lamb)
  • Organ meats like liver and kidney
  • Creamy Salad Dressings (blue cheese, ranch dressing)
  • Poultry with skin
  • Pork
  • Palm oil and palm kernel oil
  • Coconut oil
  • Commercially prepared baked goods


Exercise to lower your cholesterol

The American Heart Association recommends getting 150 minutes or more of moderate-intensity physical activity or 75 minutes of vigorous activity each week. You can even get the same health benefits if you break up your workout time into 10 or 15 minute sessions each day throughout the week. Combining aerobic activities like walking, jogging, or swimming with strength training and stretching exercises will strengthen your heart, lower your blood pressure, increase muscle mass and boost your circulation.

People with genetically elevated LDL will absolutely benefit from diet and exercise but almost universally require cholesterol lowering medications to normalize their cholesterol.  Sometimes people with FH hope that they will be able to correct their cholesterol level with diet and exercise alone. What is FH?


When diet and exercise is not enough

If you have a family history of heart disease and very high cholesterol, you may have familial hypercholesterolemia, or FH. FH is a genetic disorder that causes dangerously high levels of LDL cholesterol. FH does not respond to diet and exercise alone, and requires diagnosis and treatment. Click here to learn more about FH.

Page reviewed by Mary McGowan, MD