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Elevated Cholesterol 3: What foods and nutrients are good for healthy cholesterol levels?

This section contains an overview of some of the most important foods and nutrients that can help promote healthy cholesterol levels, please see the section Recent Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.


Foods for Healthy Cholesterol Levels
Nutrient Foods Benefits
Soluble fiber* Whole grains, oat bran, barley, peas, beans (all types, especially soy), nuts Lowers LDL and improves ratio of LDL to HDL
Niacin* (if LDL levels are already high, supplements may be necessary to reduce levels) Salmon, tuna, chicken, calf liver, halibut, asparagus, crimini mushrooms Helps decrease the body's production and increase its elimination of cholesterol, prevents oxidation of LDL and can increase levels of HDL cholesterol
Vitamin E* Swiss chard, sunflower seeds, spinach, kale, mustard greens, almonds, walnuts Helps prevent prevent the oxidation of LDL cholesterol
Vitamin C* Citrus fruits, broccoli, red bell peppers, kale, Brussels sprouts, kiwifruit Helps prevent the oxidation of cholesterol
Flavonoids, including naringenin
Citrus fruits, especially grapefruit Lowers LDL and triglycerides
Beta carotene* Carrots, sweet potatoes, winter squash, kale Helps prevent the oxidation of LDL cholesterol
Polyphenols, including pterostilbene
Cranberries, grapes, blueberries,
olive oil
Help prevent oxidation of cholesterol and increase levels of HDL cholesterol
Sesame, pumpkin, sunflower seeds
Help lower cholesterol
Brown rice
Lowers LDL cholesterol
Probiotic bacteria
Lowers LDL, increases HDL cholesterol
Foods rich in taurine and omega 3 fatty acids (e.g., cold water fish), monounsaturated fats (e.g.,
olive oil
, avocado, walnuts, almonds) and the allium family of vegetables (e.g., garlic, onions) can also be helpful. These foods' cholesterol-lowering benefits are discussed below under "How Foods Help Lower Cholesterol".

Soluble Fiber:

Soluble fiber significantly reduces blood cholesterol levels by several different mechanisms:

First, soluble fiber in the intestines binds to bile from the liver, so the bile is carried out of the body as waste instead of being reabsorbed. In order for the body to make more bile, which is necessary for digestion, it must break down more cholesterol, removing it from the bloodstream. In addition, because bile is needed for the absorption of cholesterol from food, binding the bile makes it less able to assist in cholesterol absorption, so less dietary cholesterol is absorbed from food as well.

Secondly, when normal levels of bacteria are present in the colon, they are able to break down some of the soluble fiber into what are called short-chain fatty acids. In addition to being the preferred fuel of colon cells and thus essential for good colon and digestive health, some short-chain fatty acids are absorbed into the bloodstream, where they travel to the liver and decrease the action of HMG Co-A reductase, one of the main enzymes involved in the production of cholesterol.

Diets high in soluble fiber have been shown in some studies to lower total cholesterol and LDL cholesterol as much as 20-30%. The soluble fiber used in these studies was the naturally-occurring fiber found in oat bran, beans, and other food sources. In these same studies, the use of cooked soy beans, a rich source of both soy protein and naturally occurring soluble fiber, led to a decrease in total cholesterol of 30% and a decrease in LDL cholesterol of 35-40%.

(For more information, see below: Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Cultures in which soy foods constitute a major portion of the diet typically have much lower rates of heart disease than cultures with a low consumption of soy. In addition to this epidemiological data, clinical studies have shown that soy foods are protective against the development of heart disease and its associated mortality. The beneficial effects found in these studies are due to an intake of whole soy foods and not the isolated soy components that are currently available in supplement form.

Soybeans and foods made from them have been found to significantly decrease the risk of heart disease and heart attack via several mechanisms. Soy can help prevent the oxidation of LDL cholesterol and soy foods have been shown to decrease LDL by 35-40% and total cholesterol levels by 30%, to decrease triglyceride levels, and to decrease platelet aggregation reducing the risk of blood clots. Soy foods may also increase levels of HDL (beneficial) cholesterol.

Research presented at the 2004 annual meeting of the North American Menopause Society held October 6-9, 2004 in Washington, D.C., and a study published in the November 2004 issuye of the American Journal of Clinical Nutrition suggest that soy offers special cholesterol-lowering benefits for premenopausal women: the isoflavones in soy appear to work with a woman's own estrogen to decrease cholesterol and increase bone mass. For a summary of this research, see below: Research Studies Confirm the Importance of eating Healthy Foods on Healthy Cholesterol Levels.)

For more information about soy, click Soybeans.; on fiber, click Dietary Fiber.


Niacin, also known as vitamin B3, has been shown to decrease the activity of HMG Co-A reductase, a primary rate-limiting enzyme involved in the production of cholesterol, thus causing a decrease in the body¡¯s production of cholesterol. Niacin also helps increase the breakdown of cholesterol to bile, decreases the proliferation of smooth muscle cells, helps to prevent LDL oxidation, reduces platelet clumping, lowers lipoprotein(a) levels, and can increase levels of HDL by as much as 15-40%. Increasing HDL levels, particularly through diet, can significantly decrease atherosclerosis progression.

Niacin has been shown to decrease cholesterol levels by 10-26% and to decrease heart attack recurrence by 29%. Niacin given to patients after a heart attack reduced non-fatal heart attack recurrence by 27% and decreased long-term overall mortality by 11%.

For more information, click Niacin.

Vitamin E:

Vitamin E prevents oxidation of LDL cholesterol, prevents the growth of blood vessel plaques, and has been shown to reduce the risk of heart attack and deaths related to heart disease.

The primary fat-soluble antioxidant in the body, Vitamin E is the antioxidant found in highest quantities in LDL cholesterol particles, which it protects from oxidation. As the main antioxidant defender of lipids (fats) in the body, Vitamin E is responsible for putting a halt to chain reactions of lipid peroxidation anywhere in the body.

Vitamin E has also been shown to decrease platelet clumping, prevent the rupture of existing atheromas, decrease the migration of macrophages to atheromas, prevent the inhibition of nitric oxide production, and to decrease the expression of adhesion molecules on the surfaces of endothelial cells (which form the outermost layer of blood vessel walls), thereby reducing the amount of binding that can occur with monocytes and other immune cells.

(For more information, see below: Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Why whole foods are better than vitamin E supplements:

The potential downside of taking vitamin E as a supplement is that large amounts have been associated with a possible increase in oxidation. This is because, in order to prevent the oxidation of fats, the vitamin E itself must become oxidized. If all of the vitamin E in an LDL particle becomes oxidized, it is then able to cause oxidation of the LDL cholesterol. A way to prevent this from happening is to make sure that enough of the antioxidant vitamin C is available. Vitamin C is very effective at restoring oxidized vitamin E back to its non-oxidized, antioxidant form. For this reason, studies recommend that an increase in vitamin E intake be accompanied by an increase in vitamin C intake.

One more caution for those interested in taking supplemental vitamin E. Because of its ability to decrease platelet clumping and clot formation, supplemental vitamin E should not be used by those taking blood thinners unless they are being closely monitored by their doctor. Getting your vitamin E from foods, however, is highly unlikely to cause such problems. Just remember to include foods rich in vitamin C (discussed next) in your meals as well.

Vitamin C:

The body's primary water-soluble antioxidant, vitamin C is needed for the proper function of blood vessels, regenerates vitamin E, and can help decrease cholesterol levels through several mechanisms. Although vitamin C is not found in LDL cholesterol particles because it is not fat-soluble, it does play a large role in the prevention of LDL oxidation. In addition to restoring antioxidant function to vitamin E, vitamin C also eliminates many free radicals produced by normal body metabolism, thus preventing them from damaging cholesterol.

Low levels of vitamin C have also been associated with higher levels of total cholesterol and LDL cholesterol, and lower levels of HDL cholesterol. Vitamin C is required for the breakdown of cholesterol to bile in the liver and also for the uptake of LDL cholesterol into cells for normal use. Vitamin C use is therefore associated with a decrease in total and LDL cholesterol levels as well as an increase in HDL levels. These effects seem to be most pronounced in men and tend to take about six months of increased vitamin C intake to be significant.

Low vitamin C levels are associated with an increase in cholesterol deposition in the aorta, the main artery leaving the heart. Vitamin C has been shown to decrease the binding of monocytes to atheroma lesions, thereby reducing the rate of atheroma growth. It is especially beneficial in preventing the negative effects of smoking on the blood vessels and heart. Vitamin C also reduces the deactivation of nitric oxide (a chemical messenger that tells blood vessels to dilate) and actually increases its production, leading to decreased vessel spasm and increased vasodilation.

For more information, click Vitamin C and see below, Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Beta Carotene:

Beta-carotene is another antioxidant found in foods. Although it is not found in high quantities in LDL cholesterol particles, it has been shown to prevent the oxidation of LDL cholesterol. Beta-carotene, like vitamin C, is also able to increase vessel dilation and reduce vessel spasm. One study has shown that patients with the lowest level of beta-carotene intake had almost twice the risk of having a heart attack compared to those with the highest intake. The group of patients taking the highest intake of beta-carotene had about 1/3 the risk of fatal heart attack and about 1/2 the risk of cardiovascular death as those in the group with the lowest intake.

For more information, click beta-carotene and see below LDL Cholesterol Protected by Beta-Carotene.)


Fish are the best sources of taurine. Cold-water fish such as salmon and cod are recommended as these are also rich in beneficial omega-3 essential fatty acids.

Taurine is an amino acid component of protein particularly common in fish protein. It has been shown to decrease elevated cholesterol levels by decreasing the absorption of cholesterol in the intestines in addition to increasing the conversion of cholesterol into bile, thereby removing it from the body. Studies have shown that individuals with higher intakes of taurine have a lower risk of death from ischemic heart disease. To gain the maximum protective benefit, eat a serving of fish at least 5 days a week. For more information about fish, serving ideas and recipes, click cod, halibut, salmon, scallops, shrimp, snapper, yellowfin tuna

Foods Rich in Omega-3 Fatty Acids

Best Food Sources of Omega-3 Fats: cold-water fish such as salmon and cod and their oils, flaxseed and its oil, walnuts, and purslane.

Frequent consumption of fish, especially cold water fish since these contain the most omega-3s, is associated with a decreased risk of heart attack. A high intake of omega-3 fats, when part of a diet low in saturated fat, has also been found to help decrease cholesterol. Foods rich in omega-3s should be used to replace foods high in saturated fats such as meat and dairy products.

Monounsaturated Fats:

Best Food Sources of Monounsaturated Fats include: olive oil, high oleic sunflower oil, avocado, almonds, cashews, peanuts, sesame seeds, pumpkin seeds and walnuts.

Monounsaturated fats are a unique type of fat found in particularly high quantities in olive oil. These stable fats decrease the oxidation of LDL cholesterol, help reduce cholesterol levels, and may partly explain why the ¡°Mediterranean Diet,¡± which is high in monounsaturated fats as well as whole foods, is protective against heart disease.

Studies have revealed that populations that follow the ¡°Mediterranean¡± diet, which is high in vegetables and whole grains, and low in saturated fats, but relatively high in total fat due to a high intake of olive oil, tend to have fairly low rates of cardiovascular disease and its associated mortality. Based on studies of fat intake and heart disease in many countries, it would be expected that these populations would have high rates of heart disease because of the level of fat in their diets. However, the opposite is true.

Recent studies have shown that LDL cholesterol particles that contain monounsaturated fats, such as from olive oil, are much more resistant to oxidation that those that contain high levels of polyunsaturated fats, such as from other vegetable oils like corn or safflower oil. In addition, the substitution of monounsaturated fats for saturated fats in the diet has been shown to decrease total cholesterol by 13.4% and to decrease LDL cholesterol by 18%.

The most important aspect of the use of monounsaturated fats is that they be used in place of saturated fats. Adding olive oil to a diet that is already high in saturated and/or trans fats can have negative effects on heart disease progression and risk. Olive oil should instead be used to replace animal sources of fat and other vegetable oils. Even though olive oil is a relatively stable fat, it is important not to use olive oil when cooking foods as high temperatures. Exposing even this more stable oil to high temperatures may cause it to oxidize.

Instead, use our Healthy Sauté or Healthy Stir Fry to cook the food, then after removing it from the heat, add the olive oil. You'll add all its delicious flavor and health-giving benefits to your food, without potentially adding damaged fats that might cause damage to the fats, including cholesterol, in your own body.

Polyphenols, including Pterostilbene

Pterostilbene, a powerful antioxidant compound found in cranberries, grapes and blueberries, activates a type of cell receptor involved in absorbing lipids, including cholesterol, into cells for use in energy production. A study published in the July 2004 issue of the Journal of Agricultural and Food Chemistry found that pterostilbene was as effective as the lipid-lowering drug ciprofibrate in activating this cell receptor, called PPAR-alpha. (For more on this research see below: Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.

Olive Oil Polyphenols Primarily Responsible for Olive Oil's Cardiovascular Benefits

Researchers now believe the abundance of polyphenols in extra virgin olive oil, rather than its monounsaturated fatty acids, are largely responsible for the oil's well known cardiovascular benefits.

And its rich supply of polyphenols, which are known to have anti-inflammatory, antioxidant and anticoagulant actions, may also be central to emerging evidence that olive oil's protective effects extend to colon cancer and osteoporosis.

Research conducted by Dr. Juan Reno and colleagues at the Reina Sofia University Hospital, Cordoba, Spain, and published in the November 2005 issue of the Journal of the American College of Cardiology, investigated the effects of virgin olive oil on endothelial function in 21 volunteers with high cholesterol levels.

The endothelium, although just a one-cell thick layer of flat cells that lines the inner wall of all blood vessels, may be the critical player in cardiovascular health. Among its many functions, the endothelium orchestrates the mechanics of blood flow, and regulates blood clot formation and the adhesion of immune cells to the blood vessel wall (one of the first steps in the formation of plaque).

Normally, after a meal, endothelial function is impaired for several hours. Blood vessels become less elastic, and blood levels of free radicals potentially harmful to cholesterol (lipoperoxides and 8-epi prostaglandin-F2) rise.

But when the subjects in this study ate a breakfast containing virgin olive oil with its normal high phenolic content (400 ppm), their endothelial function actually improved, blood levels of nitric oxide (a blood vessel-relaxing compound produced by the endothelium) increased significantly, and far fewer free radicals were present than would normally be seen after a meal.

When they ate the same breakfast containing the same type of virgin olive oil with its phenolic content reduced to 80 ppm, the beneficial effects were virtually absent, and concentrations of cholesterol-damaging free radicals increased. The results of this study underscore the importance of knowing how to select, store and serve your olive oil to maximize its polyphenol content. For all the information you need, see our How to Select and Store section in Olive oil.


Phytosterols are compounds found in plants that have a chemical structure very similar to cholesterol, and when present in the diet in sufficient amounts, are believed to reduce blood levels of cholesterol, enhance the immune response and decrease risk of certain cancers.

Phytosterols beneficial effects are so dramatic that they have been extracted from soybean, corn, and pine tree oil and added to processed foods, such as "butter"-replacement spreads, which are then touted as cholesterol-lowering "foods." But why settle for an imitation "butter" when these spreads contain hydrogenated fat (see "A word of caution about plant-sterol enriched margarines" above) and Mother Nature's nuts and seeds are a naturally rich source of hydrogenated fat-free phytosterols-plus cardio-protective fiber, minerals and healthy fats as well?

In a study in the November 2005 issue of the Journal of Agricultural and Food Chemistry, researchers published the amounts of phytosterols present in nuts and seeds commonly eaten in the United States.

Sesame seeds had the highest total phytosterol content (400-413 mg per 100 grams), and English walnuts and Brazil nuts the lowest (113 mg/100grams and 95 mg/100 grams). (100 grams is equivalent to 3.5 ounces.) Of the nuts and seeds typically consumed as snack foods, pistachios and sunflower seeds were richest in phytosterols (270-289 mg/100 g), followed by pumpkin seeds (265 mg/100 g).

Allium Family Vegetables:

Best Sources of Allium Vegetable Compounds: Fresh, raw garlic and onions contain the highest amounts of these beneficial compounds.

Allium family vegetables contain compounds that have been shown to modestly lower total cholesterol levels, lower blood pressure in cases of hypertension, and slow the rate of plaque growth. One of these compounds, S-propyl cysteine, has been shown to decrease the liver cells¡¯ secretion of apolipoprotein B100 (apo B-100). Apo B 100 is virtually the only protein component of LDL, which is composed of both protein and cholesterol. Apo B-100 is that portion of the LDL molecule that allows it to bind to receptors on other molecules, such as those that make up the lining of the blood vessels. Having a high level of apo B-100 in the blood is therefore a potent risk factor for developing cardiovascular disease.

Other S-Alk(en)yl cysteines found in garlic have been shown to inhibit cholesterol synthesis by lowering the activity of HMG-CoA reductase 30-40%. Garlic incorporated into high fat diets in animal studies has significantly decreased lipid peroxidation (damage to fats such as cholesterol) and the activity of a number of enzymes involved in cholesterol synthesis including HMG CoA reductase.

In a randomized, double-blind, placebo-controlled study involving men with high cholesterol, total cholesterol was lowered 7% and LDL cholesterol 10% among those given aged garlic extract, and in animals receiving garlic, blood levels of total cholesterol and triglycerides dropped by 15 and 30% respectively. In later test tube studies using cultured rat liver cells, garlic, specifically its water-soluble sulfur compounds, was found to inhibit cholesterol synthesis 44-87%. Of all these compounds, S-allylcysteine, was the most potent inhibitor of cholesterol synthesis. In other test tube studies, evidence has been presented that shows several garlic compounds can effectively suppress the oxidation of LDL, and in human subjects, short-term supplementation of garlic has been shown to increase their LDL's resistance to oxidation.

Yogurt Lowers LDL, Raises HDL Cholesterol

Daily consumption of 3 ounces (100 g) of probiotic yogurt (yogurt containing health-promoting bacteria) significantly improved the cholesterol profile, lowering LDL (bad) cholesterol while raising HDL (good) cholesterol, in women volunteers.

In this study, (Fabian E, Annals of Nutrition & Metabolism), one group of 17 women consumed 3 ounces (100 g) a day of probiotic yogurt, while a second group of 16 women were given 3 ounces of conventional yogurt daily for 2 weeks. Then both groups were given 6 ounces (200 g) of the type of yogurt they had been consuming for 2 more weeks. The study ended with a final 2 weeks during which both groups of women ate no yogurt.

In the women consuming probiotic yogurt, not only did levels of LDL (bad) cholesterol decrease significantly, but their HDL (good) cholesterol substantially increased. Women consuming conventional yogurt also experienced a significant drop in LDL cholesterol, although their HDL did not rise.

The take-home message: adding a daily cup of yogurt-preferably a yogurt with probiotic bacteria-to your healthy way of eating is an easy and delicious way to improve your cholesterol profile.

Here are just a few ways to enjoy yogurt:

  • Top your daily cup of yogurt with a quarter-cup of granola, a handful of nuts, and some frozen berries or dried fruit for a quick, delicious and sustaining breakfast.
  • Creamy yogurt, chives, and freshly ground sea salt and pepper make a great topping for baked potatoes, yams or other cooked vegetables.
  • For a creamy salad dressing or vegetable dip, just mix a cup of yogurt with a quarter cup of extra virgin olive oil and your favorite herbs and spices.

For more information on cholesterol see: