Harvard University Health Services

Cholesterol Management

Cholesterol Info
Cholesterol is a type of fat that is a building block for every cell in your body, and plays a role in the production of hormones. The liver manufactures cholesterol in the body.  It converts dietary fats and cholesterol, into the different types of cholesterol, such as low density lipoprotein (LDL), and high-density lipoprotein (HDL) that can be measured in the blood.  The dietary component that raises blood cholesterol the most, more than dietary cholesterol is the type of fat we eat.

Lifestyle Strategies

Modify Dietary Fat intake:
Not all fats are created equal! All fats are high in calories, however, there are some fats in the diet that have been correlated with lower risk for heart disease and cancer. Including heart-healthy sources of fat, those fats that are derived from vegetable sources, can help you to feel more satisfied at meals and aid in the absorption of fat-soluble vitamins (A, D, E, K).

Increase intake of Omega-3 Fats (EPA/DHA):
Aim for a fish meal 2-3 times per week. Omega-3 fats appear to lower triglycerides, thin the blood, and reduce the risk of sudden cardiac death.
  • Enjoy a fish meal at least 2-3 times per week. Fatty fish, such as salmon, halibut, tuna, bluefish, sardines, herring) are good sources.
  • Avoid fried fish. Broil, poach or grill fish to limit intake of other fats. Watch portion sizes! Buy tuna packed in water. The oil added to canned tuna is not fish oil.
  • Cod liver oil is NOT an appropriate substitute as it can contain high levels of vitamin A.
  • If you are a vegetarian, enjoy small amounts of ground flaxseeds, walnuts, canola oil, and soybean products. While these foods are good sources of alpha-linolenic acid (ALA), a precursor to omega-3 fatty acids, the conversion of these to EPA/DHA in the body is limited.
  • Marine algae is a vegan alternative that is a rich source of EPA/DHA.
  • Consider taking a fish oil supplement, look for EPA and DHA to add up to 1,000 mg or 1 gram. Typically, you need to take 2-3 pills per day. *Fish oil pills do not contain lead or mercury. Check the HUHS pharmacy for fish oil supplements in stock.   

Limit saturated fat: Aim for less than 13 – 20 grams per day.
  • Choose lower-fat dairy products. Select nonfat skim milk or try one of the “Smart” fat-free milks.
  • Reduce the intake of cheese, sour cream, ice cream, cream soups/sauces and butter.
  • Avoid high fat meats such as hamburgers, hotdogs, sausage, bacon, ribs, salami, bologna, pastrami, and marbled cuts of beef, pork, and lamb.
  • Remove the skin from poultry before eating. Trim visible fat off red meat.
  • Reduce the frequency of desserts, milk chocolate, cake, pastries, cookies. Beware of fat-free desserts as many are higher in sugar content or have partially hydrogenated oils.

Avoid trans fats:
These hidden fats are labeled as partially hydrogenated oils and can raise LDL cholesterol and increase cardiovascular risk. Most processed foods contain trans fats (chips, cookies, cakes, candy, etc.) As of January 2006, transfatty acids now appear on all Nutrition Facts labels.  You can also look for these terms in the  ingredients list on the package to identify foods that contain amounts too small to report in the Nutrition Facts section.
  • Avoid stick margarine. Choose “trans-free” tub margarines that contains “stanol esters.” Foods containing at least 0.65 grams per serving of plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.
  • Avoid non-dairy creamer for coffee.
  • Limit products such as Cool Whip that are labeled as “Fat-Free” but are made from partially hydrogenated oils. *The servings size is 2 TB and by law, anything with less than .5 % of a specific nutrient, like fat, is not required to be labeled as having fat. Consider what your typical serving size is compared to the label. Opt for a spray whip cream and use sparingly.
  • Some foods like red meat and other animal products, naturally have trans fats. Choose lean cuts of meat and trim all visible fat.

Moderate the quantity of fat in your diet:
Aim for 50-60 grams for the entire day (or up to 35% of total calories per day). Include at least 40 grams per day even if you are a small adult with modest caloric needs to support healthy, neurological functioning.
  • Limit fried foods, pastries (croissants, biscuits, pastries), cookies, and highly-processed snacks (tortilla, potato chips).    
  • Use low fat cooking methods such as baking, grilling, broiling, boiling, steaming, microwave.
  • Try to use less added fats in cooking and in foods. Use smaller quantities of salad dressing, mayonnaise, butter, sour cream, and spreads on breads.
Limit Dietary Cholesterol: Dietary cholesterol only has a minor effect on serum cholesterol, however, most cholesterol-containing foods also have saturated fat. Remember, any food that is derived from an animal, will have cholesterol. Don’t be deceived by vegetable oil packages touting “cholesterol free.” They never had any in the first place!

Increase Dietary Fiber Intake:
Fiber can help decrease blood cholesterol levels. The body eliminates cholesterol through the excretion of bile acids which are secreted by the gall bladder. Soluble fiber binds bile acids in the small intestine and prevents re-absorption and transport back to the liver, suggesting that a high-fiber diet may result in an increased excretion of cholesterol.

Aim for at least 25-35 grams of dietary fiber from a variety of food sources daily including:
  • whole grains
  • fruits
  • vegetables
  • beans
Increase water intake to avoid constipation. Aim for at least 10 grams of soluble fiber. Good sources of soluble fiber include:
  • oats barley
  • beans
  • fruits
  • eggplant and okra
  • Select a high-fiber (>5 grams) breakfast cereal made with whole grains.
  • Eat fruit as a snack. Add piece of fruit to breakfast. Make a trail mix with dried fruit.
  • Add fresh or frozen vegetables to meals, casseroles, sauces, add salsa (with beans even better!).
  • Make a meal out of salad – add kidney or black beans to add extra fiber.
  • Select whole grain breads – read the food label and aim for at least 2 grams of fiber per slice.
Increase Intake of Antioxidants and B Vitamins
Including a variety of colorful fruits and vegetables in your daily eating routine can help to increase your intake of vitamins, minerals, fiber and phytochemicals (plant chemicals) that your body uses to stay healthy, protect against the effects of aging, and reduce the risk of heart disease.
  • Enjoy 2-3 servings of fruit and 4-6 servings of vegetables every day. One serving equals 1 small piece of fruit (size of a tennis ball) 6 ounces of juice, 1⁄2 canned fruit or 1⁄4 c dried fruit.
  • Choose good sources of vitamin C: oranges, strawberries, tomatoes, mangoes, bell pepper.
  • Choose good sources of beta-carotene: carrots, apricots, cantaloupe, sweet potatoes, spinach.
  • Choose good sources of folic acid: spinach, broccoli, romaine lettuce, whole grains, beans & legumes, fortified breakfast cereals.
  • Choose good sources of vitamin E: nuts, vegetable oils, seeds, wheat germ, whole grains.
  • Consider a multivitamin supplement with 100% of the RDI for all vitamins and minerals. Avoid mega-dose (>100%) vitamins, especially fat-soluble vitamins (A, D, E, K). Select vitamin with beta carotene as the source of vitamin A (vs. Retinol).
Consider Soy Products
Consuming a diet with 25 grams of soy protein per day can help to reduce total cholesterol. Many soy products contain isoflavones, a group of phytonutrients that may help to lower blood cholesterol. Soy products are low in saturated fat, rich in protein, and in some cases provide dietary fiber.
  • Be creative with soy products including: tofu, tempeh, soy beans (edamame), soy milk, soy nuts.
  • Try drinking soy milk for a change. It does not taste EXACTLY like milk, but it can be a nice change. Try vanilla or other flavored soy milks. Consider a soy milk creamer.
  • Order edamame (green soybeans) at a Japanese restaurant as an appetizer.
  • Try adding soy milk to a smoothie. There are many vegetarian recipes for shakes, pies and other dessert products that are made with tofu. www.soyfoods.com

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