There are two main types of cholesterol circulating in the blood:
- low-density lipoprotein (LDL), or bad cholesterol
- high-density lipoprotein (HDL), or good cholesterol
In this article, we examine the idea of a cholesterol-free diet and whether it is effective. We also explain the benefits of the Mediterranean diet and other diets for managing cholesterol.
A completely cholesterol-free diet is not a healthful option. However, a low cholesterol or cholesterol-reducing diet may be part of an effective plan to manage blood cholesterol in those who have high levels.
Cholesterol levels also depend on genetics, body weight, diet quality, and exercise levels. A person's dietary intake of cholesterol is just one consideration.
According to the U.S. Department of Health and Human Services guideline, the ideal amount of LDL cholesterol in the blood is less than 100 milligrams per deciliter (mg/dL).
However, the American Heart Association (AHA) currently indicate that the total cardiovascular risk is more important than a person's cholesterol test scores.
If a person's LDL level is higher than this, they may wish to consider trying lifestyle changes such as a cholesterol-lowering diet. This is especially true if a person is at high risk for heart disease due to other causes, such as obesity, diabetes, genetics, or lifestyle factors.
The body needs cholesterol for full function, so it is vital to consume some cholesterol in the diet.
For people interested in lowering their cholesterol through diet, they should consider reducing saturated fat, trans fat, and added sugar and increase the amount of fiber and whole, nutrient-dense foods.
Some diets claim to lower LDL levels. The nutritional plans that work best share similar elements, such as:
- reducing intake of saturated fat
- cutting out trans fat
- avoiding added sugar
- increasing dietary fiber
The foods in a person's diet may help them reduce LDL levels and increase heart protective HDL cholesterol. Regardless of the specific diet, people looking to reduce their cholesterol levels should consider adding the following nutrients:
- Unsaturated fats: According to the AHA, unsaturated fats can help lower cholesterol levels in the blood.
- Soluble fiber: The National Lipid Association suggest that adding 5–10 grams (g) of soluble fiber from plants and whole grains to your diet per day may lower total and LDL cholesterol readings by 5–11 points or more.
- Stanols and sterols: These are cholesterol-like chemicals found in plants. A 2018 review of studies found that consuming 1.5–3 g of these compounds per day can lower LDL-C concentrations by 7.5–12%.
Popular diets that many people use to reduce cholesterol levels include:
- The Therapeutic Lifestyle Changes (TLC) diet, an initiative from the National Institutes of Health (NIH)
A vegan diet plan involves eliminating all animal-based foods. A vegan diet prohibits the consumption of animal products, such as:
- dairy products
- honey, for some following a vegan diet
A vegan diet significantly reduces saturated fat intake. Since saturated fat may be a contributing factor to higher LDL cholesterol levels, a person who eats a vegan diet is reducing some risk of high cholesterol.
A person interested in following a vegan diet should follow the advice of a reputable dietitian or a knowledgeable healthcare provider. Eating no meat or animal products does not guarantee a person will make healthful food choices since many vegan foods contain lots of calories and little nutrition.
Those who choose to follow a vegan diet need to pay special attention to specific nutrients plant-based food sources typically lack, including:
People should add these nutrients to vegan diets through supplementation or by consuming fortified foods.
For people interested in a vegan diet, the Vegetarian Resource Group also offer a variety of vegan meal ideas on their website, as well as a directory of vegan and vegetarian-friendly restaurants.
Some people may find giving up animal-based foods difficult, so following a Mediterranean diet may be a better option for reducing cholesterol. While the Mediterranean eating pattern is low in red meat, people following the Mediterranean diet can eat low-to-moderate amounts of dairy products, poultry, and fish.
The AHA explain that while there are many different versions of the Mediterranean diet, each relies on the same basic nutrients:
olive oil, in place of saturated fats
a high volume of fruits and vegetables
high fiber starches, such as potatoes, beans, bread, and whole grain cereals
- nuts and seeds
- fish and poultry
- consuming eggs up to four times a week
- drinking small to moderate amounts of wine
The Mediterranean diet is high in fiber and healthful fats, and decades of scientific research has shown that this dietary pattern is effective at promoting weight loss and improving heart health.
The National Heart, Lung, and Blood Institute (NHLBI) created the TLC diet.
The TLC eating plan combines dietary adjustments with lifestyle changes to reduce a person's risk of heart disease. It has fewer restrictions than a vegan diet but follows a much stricter, more scientific structure.
According to the TLC handbook, a person should consume the following each day:
- less than 7% of calories from saturated fat
- 25–35% percent of daily calories from total fat
- less than 200 milligrams (mg) of cholesterol
- a low but healthy number of calories, which a doctor can help a person plan
- an optional 2 g per day of plant stanols or sterols
- an optional 10 to 25 g per day of soluble fiber
While a person can follow the original plan, which the NHLBI created in 2005, there have been no updates since. The recommendations to reduce saturated fat intake, lower caloric intake, and increase physical activity are still similar to current standards.
The TLC handbook offers recipes, menu plans, and tips on improving the taste of vegetables tastier. The AHA also provide an online collection of heart-healthy recipes that are compatible with the TLC diet.
Before making any dietary or lifestyle changes, a person should check with their doctor or dietitian.
Though cutting out red and processed meats, reducing calories, and increasing physical activity are generally considered healthful choices, an individual's circumstances can make the transition more complicated.
A cholesterol-lowering diet should be a part of a person's plan to keep their heart healthy.
In addition to maintaining a healthy body weight and regular exercise, diet plans that focus on fiber, fruits, vegetables, and lean proteins can help a person reduce their risk of developing heart disease or stroke.
Is a diet containing all fats and proteins, such as a keto diet, also good for cholesterol levels?
This answer is complicated, as are the reasons why someone may have high cholesterol levels. Although dietary cholesterol has little impact on most people’s blood lipid levels, some people are highly sensitive to dietary cholesterol.
Individuals who are sensitive to dietary cholesterol — meaning their blood cholesterol levels rise significantly after eating cholesterol-rich foods — are known as cholesterol hyper-responders or non-compensators.
For people who are sensitive to dietary cholesterol, a very high fat diet such as the ketogenic diet is likely to raise cholesterol levels further. However, some research has shown that low carbohydrate, high fat diets may effectively improve cholesterol and triglyceride levels.
For example, a 2019 review of eight randomized control trials found that low carb, higher fat diets were more effective at improving blood lipid levels than low fat diets. Keep in mind that the relationship between cholesterol levels, dietary cholesterol, heart disease, and overall health is complicated and ongoing.
The best way to ensure you are keeping your cholesterol levels in check and your heart healthy is to follow a diet rich in whole, nutrient-dense foods, especially high fiber foods, such as vegetables and fruits.Jillian Kubala, MS, RD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.