Tips for Eating Well With High Cholesterol
A Delicious Road to Better Health: Todd’s Story.
Eating well and managing high cholesterol don’t have to be mutually exclusive.
By Jacqueline Raposo for Epicurious
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Image description: A colorful illustration of food and a person holding their heart by Morgane Fadanelli
For most of his adult life, Minnesota newspaper executive Todd Heroff had kept his borderline high cholesterol in check by watching his weight. When the scales crept up, he’d jump on the Atkins diet, eschew lasagna and potatoes at Sunday family dinners, and drop 30 pounds. For a few months, his suits would fit better. “But it was always hard to keep that up,” Heroff says of the diet’s restrictions. Eventually, the weight would sneak back on. “I’d do it again. Over and over,” he admits.
That was until a lipid panel test at age 57 showed his cholesterol had jumped dangerously high.
Heroff has familial hypercholesterolemia, a gene mutation that elevates unhealthy LDL cholesterol levels and runs in families. Heroff’s two brothers and mother are on statins that help lower theirs. But he’d taken great pride in the efficacy of his approach. “My personality is that you take care of stuff and don’t let things like that happen. I felt like I failed myself in letting that cholesterol jump,” he says of the statins he’s recently started.
Familial hypercholesterolemia affects one in 250 people. But about 38% of Americans have high cholesterol overall, meaning that total blood cholesterol sits above 240 mg/dL. While high cholesterol asserts no obvious symptoms, it increases the risk of developing coronary artery disease or having a heart attack. It can be diagnosed at any age through a simple blood test.
Heroff’s primary care physician had been ambivalent about his use of the Atkins diet to manage his weight. But when his cholesterol levels spiked, she referred him to Donald Hensrud, MD, MS, Medical Director of The Mayo Clinic Healthy Living Program and author of The Mayo Clinic Diet books.
Hensrud understands resistance to managing cholesterol through long-term food shifts. “But eating well and eating healthy are not mutually exclusive,” he promises. “By focusing on wonderful foods, it can be an enjoyable experience. People underestimate that.”
If you’re also battling high cholesterol, here’s how to join Heroff on a delicious road to better health.
Count servings, not calories
Heroff was used to the significant restrictions of a short-term diet. But Hensrud explained that heart-healthy eating isn’t about abstaining from favorite foods entirely or about meticulously counting calories. “Following a plant-based diet with minimally processed foods will help lower cholesterol. Don’t get too caught in the details,” he warns. When people do, they are more likely to get overwhelmed and quit entirely.
Registered dietitian and heart health specialist Heather Shasa points out obvious items to reduce in order to lower your LDL levels. “It’s excess fat—particularly saturated fat—added sugar, and sodium,” she says. Then increase fruits, vegetables, whole grains, and fiber. “It’s quality and quantity.”
The Mayo Clinic Diet Book offers guidance on how to estimate serving sizes of various food groups depending on health goals. But for Heroff, generalizations included reducing his intake of red meat—he and his wife now have Meatless Mondays—and only eating eggs once a week. Whereas it was once believed that the cholesterol level in individual foods increases blood cholesterol levels, it’s now better understood that it’s the associated saturated fat found in many high-cholesterol foods that does the damage. And while eggs alone can be part of a heart-healthy diet, reducing the fried potatoes and bacon often served alongside them can have an impact.
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Heroff has also drastically increased his daily consumption of fruits and vegetables, which had been negligible before the shift. “It becomes a practical limit—you’re not going to overdose on green beans and broccoli,” his doctor says. Hensrud points out that overall daily intake is more important than combining food groups in every meal. “That’s a way to combine things practically,” he says.
Reconsider the rut
Like many, Heroff is a creature of habit: His Midwestern meal-prep historically involved taking meat out of the freezer and adding starch and vegetables around it. Hensrud suggested he reconsider meal planning with five goals: “It should be practical—we can’t spend two hours every night in the kitchen, although it’s fun to cook like that now and then. It should taste good. It should be healthy. It should fill you up. And it should be low in calories.” Planning delicious, satisfying, and cholesterol-friendly dishes—not reaching for what’s nearest when you’re already hungry—is the way to progressively reach health goals.
Focusing on seasonal ingredients can be a fun place to start in warmer months. “Try setting a goal to try a new recipe every week that helps you embrace the fresh ingredients of the season,” Hensrud suggests.
Lean into what you love
Heroff is an active outdoorsman who hunts and fishes throughout the year. And so Hensrud encourages him to incorporate more wild game and fresh fish dishes into his meals—proteins that are naturally leaner than pork or beef. Heroff’s also become a master gardener in his recent retirement. But that doesn’t mean he should force himself to eat vegetables he doesn’t like. “I have to focus on the ones that I do like—the broccoli, cauliflower, salad greens, those types of things,” he says. Combing seed catalogs for varieties of those favorites has become a cool new pastime as a result. And when springtime asparagus rises from the garden, for example, folding it into a springy whole wheat pasta dish satisfies both hobby and health.
Shasa urges using favorite family dishes to your advantage too. “Instead of frying, maybe it’s baking or using the air fryer,” she says of lightening the cholesterol count. “Maybe it’s adapting certain ingredients in a heavy sauce or gravy to make it more nutritious.” Using flavorful herbs and spices can provide sensory satisfaction that distracts eaters from a craving for salt or fat. And those favorites are an excellent place to swap habitual proteins with those lower in fat, like trying fish in a taco recipe where you’d usually use pork. “When mixing something new with something familiar, you feel more inclined to try it,” she says.
Plan ahead for when you’re out
When eating with others, awareness is everything. “You don’t always have to make the best choice. Just try to make a better one,” Shasa says. If going to a coursed event, select a couple of appetizers and then step away from the table—a few mindless extra cheese cubes can quickly add up. Periodically put your utensils or plate down so that your body can signal how full it is. Be aware of serving sizes during the main meal. Stay hydrated with water, unsweetened beverages, and nonalcoholic cocktails.
Hensrud warns that entirely saying “no” doesn’t always work. At barbecues, fill up as much as you can with raw veggies or veggie-heavy salads. Add turkey burgers and some flavorful veggie kabobs to the grill. If you still desire meat, measure out moderate portion sizes—a three-ounce serving is around the size of a pack of cards. And be aware of how much coleslaw or potato salad you add to your plate. (Or bring a lighter version to the spread.)
A two-pronged approach
Heroff thought resetting his food approach meant he could eventually stop taking statins. But Hensrud encouraged him to reconsider their value. “That’s an insurance policy for the future,” he explains. But statins only lower bad cholesterol—they don’t help manage weight, blood pressure, or good cholesterol. “Studies have shown that combining lifestyle with medication treatment is far more effective than just medication treatment alone,” Hensrud warns.
Ask for help
Shasa recommends working with a therapist if your high cholesterol connects to anxiety, depression, or PTSD. “It’s not just diet that we’re focusing on—it’s your emotional, physical, and social well-being.” Food journaling can help identify whether stress or feeling overwhelmed triggers eating certain foods. “That can help raise awareness of a dietary pattern.” And working with a registered dietitian makes the whole process clearer and even more personal.
Hensrud acknowledges that many people take weight and health issues personally. “Nobody’s perfect. We all need a little help now nowadays, and reaching out is a positive thing,” he encourages. “It will only improve your health, the way you feel, and your long-term self-esteem.”
Keep the faith
Hensrud believes people underestimate their ability to change. He uses whole milk as an example: You can drink whole milk your entire life. But after a few weeks of drinking low-fat or skim, the richer stuff will start to taste like cream. “A lot of the work is in the planning, and the time it takes to get ideas and do things,” he encourages. Some new habits might stick. Others might not. But rolling wins into long-term plans promises a sustainable road to success.
Heroff was initially frustrated at this slow approach. “I go back to the ‘it’s got to get done today’ mindset,” he says. “But the more time I’ve had to think about it, the better I feel about it.”
