9 Things Dietitians Wish You Knew About High Cholesterol

It's not just the cholesterol in your diet that matters when you're trying to lower your cholesterol levels.

Recently diagnosed with high cholesterol but not sure which foods help lower cholesterol and what’s off the table? A registered dietitian can be an invaluable resource, especially when it comes to managing your diet and high cholesterol. 

Here, dietitians share their insights on what they want you to know if you — or someone you love — has high cholesterol.

1. Dietary and Blood Cholesterol Aren't the Same

We use the same word for the cholesterol in foods as for the cholesterol that gets measured at the doctor’s office in our blood tests. “The most recent research shows that eating foods that contain cholesterol doesn’t directly affect the amount of cholesterol in the blood of most people,” says Lisa Dierks, RDN, dietitian and nutrition program manager for the Mayo Clinic Healthy Living Program in Rochester, Minnesota. Instead, it’s more important to limit saturated fats, which are found in animal products like meat and full-fat dairy, and trans fats, also known as partially hydrogenated oils and found in many baked and fried foods. Saturated and trans fats are the dietary fats that have the biggest impact on blood cholesterol levels, notes the American Heart Association (AHA).

2. Not All Blood Cholesterol Is Bad

Being diagnosed with high cholesterol can be alarming, and the three numbers you're given for your cholesterol levels can also be confusing. Keep in mind thatnot all cholesterol is bad. The three numbers that you may see are “good” HDL (high-density lipoprotein), “bad” LDL (low-density lipoprotein), and total cholesterol. HDL cholesterol helps to improve heart health (meaning a higher number is better) while too much LDL cholesterol increases your risk for heart disease and stroke. To raise your protective HDL cholesterol levels, focus on including foods such as legumes, fruit, whole grains, fatty fish, and olive oil in your diet.

3. Eggs Aren't Evil, and Neither Are Shellfish

Eggs have gotten an undeserved bad rap. While it’s true that a large egg yolk contains 186 milligrams (mg) of cholesterol, it’s been shown that dietary cholesterol doesn’t affect blood cholesterol levels in most people. “People think if they avoid eggs, it solves everything. In reality, dietary cholesterol isn’t the contributor,” says Judith Wylie-Rosett, RD, doctor of education, professor of medicine at the Albert Einstein College of Medicine in the Bronx, New York, and spokesperson for the AHA.

The same goes for shellfish. Shrimp and other shellfish are naturally high in cholesterol, but this doesn’t directly lead to high cholesterol levels in your blood. Eggs and shellfish are both considered lean sources of protein and can be a valuable part of a healthy diet.

4. No One Magic Food Will Lower Cholesterol

In the same way that eggs and shellfish will not cause you to have high cholesterol, there’s no one food that can save the day either. “There are no magic foods. You have to look at overall diet,” explains Dr. Wylie-Rosett. The key to lowering cholesterol levels is to eat a generally healthy diet of lean protein, fruit, vegetables, whole grains, and fat-free or low-fat dairy, and to limit saturated and trans fats.

5. Don't Just Focus on Fats and High Cholesterol

Choosing foods that contain healthy unsaturated fats, like olive oil or avocado, and limiting those with bad saturated and trans fats is key to bringing down high cholesterol levels, but it’s only part of building a healthier diet. “While fat tends to be the thing we focus on first, other components of the diet can help too,” says Dierks. “Are you eating enough fruits, vegetables, and whole grains?” The fiber in these foods can contribute to bringing down your cholesterol levels. Reducing added sugar can also positively impact your cholesterol levels. Take a look at your diet as a whole before deciding where to make changes.

6. Lifestyle Changes Can Improve Cholesterol Numbers

In addition to diet, other healthy lifestyle changes can also make a big difference in cholesterol levels. “Diet is very important, but it isn’t the only piece of the cholesterol puzzle,” says Despina Hyde, RDN, CDE, cofounder of Carey and Hyde Nutrition, and clinical dietitian at NYU Medical Center in New York City. For instance, being physically active on most days of the week,quitting smoking, losing weight, and limiting how much alcohol you drink can all contribute to lower cholesterol levels. Pair these lifestyle changes with a healthy diet and you’ll likely be on the road to better cholesterol levels in no time.

7. Family History of High Cholesterol Counts

If members of your family have high cholesterol, you’re more likely to have it as well. This doesn't mean that your destiny is sealed, but you may have to pay more attention than the average person to your diet and lifestyle choices. “If you have a family history of high cholesterol, have your blood cholesterol levels checked every year and focus on a healthy diet to minimize the risk of developing high cholesterol yourself,” recommends Hyde.

8. Cholesterol Isn't the Only Important Number 

“On average, your diet can influence a relatively small percentage of your cholesterol values. Triglycerides, though, are highly influenced by diet,” says Julia Zumpano, RD, dietitian at the Cleveland Clinic in Ohio. Having high levels of triglycerides, a type of fat in your blood, increases your risk of heart attack and stroke. “Cholesterol is only one piece of the pie,” says Zumpano.

9. Diet Can’t Always Fix High Cholesterol

If you’ve been diagnosed with high cholesterol, take a look at your lifestyle first. What changes could you make to bring your numbers down? Make the changes and work closely with your doctor to monitor your levels. Wiley-Rosett says, “There are ways to bring down cholesterol levels through healthy changes, but in the end, you may need medication as well.”

Diet and exercise can go a long way toward fixing a problem with high cholesterol and, in many cases, can alleviate the problem entirely, but this isn’t the case for everyone. Some people will need to take cholesterol medication in addition to maintaining a healthy lifestyle. Work with your doctor to figure out what’s right for you.

Because other factors — like exercise, and sometimes the medication you take— contribute to cholesterol levels in addition to your diet, hitting your health targets can be complicated. If you’re not sure where to start, pick one or two changes that you know you can stick with. Small adjustments to your diet, more physical activity, or other lifestyle changes can go a long way to lowering cholesterol levels.

Ask yourself: What can I do today to help improve my cholesterol levels?