From Lipitor commercials on TV, health discussions with your grandparents and even that blood test from your doctor, cholesterol talk is everywhere and it’s often negative or unsettling. Although your cholesterol levels are, in large part, genetically determined, the right diet can improve your cholesterol while the wrong diet can make it worse. Furthermore, diet can decrease your risk of heart disease even if it does not decrease your total cholesterol. To jump right to the foods that will improve your lipid profile, see the "effects of food on your lipid profile" section below.

The lipid profile is total cholesterol broken down to its components: HDL, LDL, and triglycerides (TG for short). The lipid profile is one predictor of your risk of heart disease; other factors play a role as well. Thus, a diet that decreases the overall risk of heart disease will do more for health and risk reduction than a diet that is focused solely on improving the lipid profile. Furthermore, there is only so much that diet can do to improve the lipid profile. So don’t go crazy over which foods do what to the lipid profile. Diet can do a lot more to decrease your overall risk of disease, which is the ultimate goal. Nevertheless, this section will give you the basics on cholesterol, a diet that yields a healthy lipid profile, and will dispel some common myths along the way. Enjoy!
[ Scroll down after clicking links ]
Cholesterol Basics

Cholesterol itself is made by your body and is only in animal products (meat, poultry, seafood, eggs, dairy products). Cholesterol often gets a bad rap, but it’s in every living cell in the body and serves many important functions.

When you go to the doctor and get a blood test, odds are they measure your cholesterol, that is, they take your lipid profile. The lipid profile measures HDL, LDL, and triglycerides which are carried by VLDL. HDL, LDL, and VLDL are lipoproteins that carry cholesterol (HDL= high density lipoprotein, LDL=low density lipoprotein, VLDL=very low density lipoprotein) and triglycerides. VLDL is the lipoprotein that carries fasting triglycerides (TG).

HDL is the healthy way to carry lipids (cholesterol and fat), while LDL and VLDL are less healthy ways to carry lipids. However, health really depends on the levels. At lower levels, LDL and VLDL perform useful functions and are fine. At high levels, LDL and VLDL are risk factors for heart disease. HDL is the healthy/protective cholesterol. High levels of HDL have been associated with decreased risk for heart disease and osteoporosis, while low levels of HDL are unhealthy.

A healthy lipid profile consists of a high HDL and a low LDL and VLDL.

There are several factors that determine your cholesterol levels. Genetics play a big role. Diet also plays a role for VLDL and HDL. Exercise can increase your HDL and decrease triglycerides (VLDL) to a small extent, but won’t necessarily. To read about the diet that will improve your lipid profile click here.

Bottom Line Cholesterol Recommendations

In terms of the lipid profile, the ideal foods will increase high density lipoproteins (HDL) and decrease or not increase low density lipoprotein (LDL) and triglycerides (TG). Consuming monounsaturated fat as the principal fat in the diet will do exactly this. This does not make all monounsaturated fats healthy. The case-in-point is red meat which has monounsaturated fat but is one of the worst foods you can eat. For more on this click here. On the other hand, 3 tablespoons or more of extra virgin olive oil (evoo) per day will yield this benefit and improve health. Evoo is your go-to fat not just because of its effects on cholesterol but also because of numerous other health benefits. For more on this click here.

A low fat diet will increase triglycerides and decrease HDL (both bad) and thus a low fat diet should be avoided. For more on why a low fat diet should be avoided click here.

Consuming eggs changes your lipid profile very minimally, and furthermore egg consumption has not been shown to increase the risk of heart disease.

Vegetable oils contain high quantities of polyunsaturated fats which cause LDL to oxidize. This increases your risk for heart disease so stay away.

Cholesterol Myths

Overall, eggs are a neutral food. They are the healthiest animal source of protein and are used in many of the Healthy Low Cost Recipes. But let’s take a closer look:

Eggs do contain cholesterol, but for most people, this will change your HDL, LDL, and VLDL very little. While some cholesterol containing foods, like red meat, are terrible for you, the scientific literature does not show that eggs are related to heart disease.

In a study of over 100,000 participants by Hu et al., egg consumption was not associated with an increased risk of heart disease or stroke among healthy individuals.1

Eggs have been associated with a decreased risk of breast cancer. In a study by Frazier et al., egg consumption during adolescence was associated with a decreased risk of breast cancer, with greater egg consumption reducing breast cancer risk even more.2 In a study by Shannon et al., egg consumption was inversely related to breast cancer in a graded fashion. Women who ate six or more eggs per week had a 50% lower risk of breast cancer than women who ate 2 eggs or fewer per week. The purported mechanism is that the sphingolipids, a bioactive compound in eggs, inhibit cancer cell growth and thus help reduce the risk for breast cancer.3 Eggs also contain vitamin E, folate and the carotenoid, lutein, which could also play a role in this risk reduction.

Exercise with some weight loss can increase your HDL but won’t necessarily. HDL is by and large genetically determined. Nevertheless, increasing your consumption of certain foods will increase your HDL. Click here to learn about the foods that will give you the healthiest lipid profile.

By the numbers, what is a healthy lipid profile?

A healthy lipid profile consists of the following:

HDL of 50 or more for women

HDL of 40 or more for men

Triglycerides less than 100 is healthy. Clinically, less than 150 is considered “normal.”

LDL less than 125

Side note: VLDL is the lipoprotein that carries fasting triglycerides (TG). VLDL= TG/6. Having a high VLDL is a risk factor for heart disease and thus high triglycerides are a risk factor as well.

Is it bad to have a high total cholesterol?

Total cholesterol does not tell you if you are healthy or unhealthy. With cholesterol, it’s all about the breakdown into HDL, LDL and VLDL. On a lab report you usually see triglycerides, denoted TG, instead of VLDL, and the following example is consistent with this. Remember, TG/6=VLDL

Total Cholesterol = HDL + LDL + TG/6

Let’s say Joe’s total cholesterol is 205. It’s a common mistake to call this unhealthy without even looking at the breakdown. However, if Joe’s (a male) total cholesterol is 205, he could be very healthy with an HDL of 95, LDL 95 and VLDL 15 (thus TG=90).

205= total cholesterol: 95= HDL (megahealthy), 95= LDL (good), 90=TG (good)

This is an awesome lipid profile; Joe’s LDL and TG are low and his HDL is very high, which is great because HDL is protective.

In contrast, Joe could be unhealthy with a total cholesterol of 205 if his HDL is 38, LDL 140, and TG 162. Here Joe’s TG is unhealthy, his HDL is below 40 and his LDL is above 100. All of these are health concerns.

The take home message is that you always have to look at HDL, LDL, and TG individually to determine the health of your lipid profile.

The effect of food on your lipid profile

The type of fats you eat will directly affect your lipid profile. The following shows the effects of fat and cholesterol from foods in the diet on your lipid profile. Remember: higher HDL and lower LDL and triglycerides are healthy while the opposite is unhealthy. Consuming more butter, whole milk, palm oil, red meat: Increases LDL, Increases HDL, Triglycerides stay the same

Remember: red meat is unhealthy even though it can increase HDL. This is a good example which highlights the fact that the overall effect of the food is more important than its effects on lipid profile.

Consuming more extra virgin olive oil, avocados:

Decreases LDL, Increases HDL, Triglycerides stay the same

Consuming more soybean oil, corn oil, cottonseed oil, safflower oil, and other vegetable oils:

Decreases LDL more than monounsaturated fat* but will oxidize the particle (this is bad), HDL stays the same or decreases, triglycerides stay same

Consuming more trans fat from partially hydrogenated oils:

Increases LDL, Decreases HDL, triglycerides stay same

Consuming more eggs:

Increases LDL very little (1-2 points), increases HDL very little, triglycerides stay same

Consuming less fat and following a low fat diet:

Decreases LDL, decreases HDL, increases triglycerides

As you’ve probably deduced, monounsaturated fat has the best effect on the lipid profile and is the clear winner, while trans fat has the worst effect on the lipid profile. This is the reason why monounsaturated fats are considered healthy and part of the reason why trans fats are unhealthy. For more on trans fat and why you should stay away click here.

*Polyunsaturated fat will decrease LDL more than monounsaturated fat. This is why vegetable oils were once considered good. However, vegetable oils are not healthy because polyunsaturated fat causes LDL to oxidize, which increases your risk for heart disease.

Is it okay to get no cholesterol in the diet, like if I’m a vegan?

Yes. The body already makes most of the cholesterol it needs. If you get no cholesterol from food, the body will make all the cholesterol it needs.

Is canola oil preferable to evoo since it decreases LDL more?

The better question to ask is which oil will better decrease the risk for chronic disease such as heart disease? Lipid profiles (HDL, LDL, TG) are just one marker for disease; they aren’t the be all and end all determinants for whether or not you’ll get heart disease. Thus, it’s best to consume foods that yield a favorable lipid profile and have other health benefits.

Both canola and olive oils will increase HDL and decrease LDL, which is ideal. Canola oil will decrease LDL a little bit more than extra virgin olive oil. Extra virgin olive oil can greatly increase HDL. However, the phytonutrients in evoo provide many more health benefits, which are not taken into account in the lipid profile and which far outweigh canola oil’s small edge in the lipid profile. Overall, evoo is a much healthier oil than canola and thus evoo should be the go-to oil. For more on what makes evoo so healthy click here.

1Hu FB, Stampfer MJ, Rimm EB, et al.: A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999; Vol. 281, pp. 1387-94.

2A Lindsay Frazier, Catherine Tomeo Ryan, Helaine Rockett, Walter C Willett, and Graham A Colditz: Adolescent diet and risk of breast cancer. Breast Cancer Res 2003, Vol. 5, R59-R64.

3Jackilen Shannon, Roberta Ray, Chenyuan Wu, Zakia Nelson, Dao Li Gao, Wenjin Li, Wei Hu, Johanna Lampe, Neilann Horner, Jessie Satia, Ruth Patterson, Dawn Fitzgibbons, Peggy Porter, and David Thomas: Food and Botanical Groupings and Risk of Breast Cancer: A Case-Control Study in Shanghai, China.  Cancer Epidemiology, Biomarkers & Prevention 2005, 14(1), pp. 81-90.