You need cholesterol. It’s a crucial material your body uses to build the hormones, cells, and vitamins that keep you alive and healthy. But many people—including 94 million American adults—have high cholesterol levels, which puts them at an increased risk of heart disease and stroke.
Romit Bhattacharya, MD, is a Mass General Brigham cardiologist. He is also the associate director of the Cardiac Lifestyle Program at Massachusetts General Hospital.
In this article, Dr. Bhattacharya explains what it really means to have unhealthy cholesterol levels. He shares tips about the worst and best foods to eat when you have high cholesterol.
Many people are familiar with the term “cholesterol,” and have heard that high cholesterol is dangerous. But to truly grasp the value of healthy cholesterol levels, it’s important to understand what the word means.
“Cholesterol is a particle in the blood that all humans and animals need to live,” says Dr. Bhattacharya. “But in today’s day and age, we end up with too much of it. Its primary role is to create a membrane—like a bubble—around molecules in the body and help them travel from place to place.”
According to Dr. Bhattacharya, the concept of high cholesterol is not as cut and dry as it seems. That’s because when doctors talk about cholesterol levels, they’re referring to average levels in a world where most people get more than they need. Dr. Bhattacharya recommends thinking about this more as a concept of “unhealthy levels of cholesterol” in your body.
Here’s why: “Imagine you live near a factory that gives off dangerous fumes. You might not have asthma or be coughing day in and day out, but in the back of your mind, you’re wondering if it’s healthy to inhale these fumes every day. That’s how I’d think about cholesterol: We’re all living in a world where we’re exposed to higher levels of it than we should be.”
When your body has more cholesterol than it needs, problems arise. Dr. Bhattacharya explains cholesterol begins to build up on the walls of your arteries, increasing your chance of developing heart disease and other serious problems.
One tricky thing about high cholesterol is that unlike some medical concerns, unhealthy cholesterol levels may not create noticeable symptoms. “It’s a game of trust,” explains Dr. Bhattacharya. “If your doctor tells you your cholesterol is too high, you need to act on it—even if you’re feeling well.”
Although high cholesterol doesn’t usually cause symptoms, Dr. Bhattacharya says there is one sign that can often go unnoticed: erectile dysfunction.
“We used to think erectile dysfunction in men over 40 was happening because people were getting older. But it’s a problem of blood flow. The blood vessels in the penis are like the blood vessels in the heart. When enough cholesterol cakes the walls of the blood vessels, blood and nutrients can’t get to those organs.”
Otherwise, the first symptoms are often a heart attack, stroke, or chest pain (called angina). Because the first symptoms of high cholesterol are often debilitating events like heart attack and stroke, it is especially important to get your cholesterol levels measured regularly by your doctor and make sure you are maintaining healthy levels.
“Heart attack and stroke are the most common problems caused by a very high cholesterol level,” says Dr. Bhattacharya. “When cholesterol builds up along artery walls, that’s called atherosclerosis—and heart attack and stroke are both typical diseases atherosclerosis can cause. When we think about the ways that we can prevent cardiovascular disease, which is the number-one cause of death in the world, controlling your cholesterol and blood pressure are key.”
“Plants basically don’t make cholesterol,” explains Dr. Bhattacharya. “So, if you’re worried about cholesterol, eating plants is going to help. And among plants, high fiber content is important. It cleans out your gut, it allows you to detoxify, it feeds your gut microbiome in a healthy way, and it can help prevent cholesterol from absorbing into your bloodstream.”
A heart-healthy low-cholesterol diet may include foods like:
For those truly looking to lower their cholesterol, Dr. Bhattacharya adds that it’s important to think not just in terms of quick results, but in terms of a consistent lifestyle.
“Fad diets don’t work as well. They can get you down briefly, but then—boom—you’re back up. Maintaining healthy cholesterol is really about consistency of effort. If you’re doing 80% of the right things 80% of the time, that’s a great start.”
When it comes to the worst foods for high cholesterol, Dr. Bhattacharya says it’s important to look out for animal products—particularly red meat and dairy.
“High-fat dairy is for growing calves,” Dr. Bhattacharya explains. “It’s for growing infants who need cholesterol and fat in their diet to build their brains, their nerves, their bodies. When we’re eating full-fat dairy and meat, we’re ingesting a whole lot of dietary cholesterol—particularly saturated fat, which has consistently proven to increase cholesterol levels. So, message number one is this: Decrease your saturated fat intake to at least less than 10% of your daily calories.”
The worst foods for high cholesterol, given their high saturated fat content, include: