How to improve cholesterol profiles with diet

Registered dietitian, Annica Rust, explains why improving your cholesterol profile with diet is important.

What is blood cholesterol?

Many components in our body are sterols. For example: bile salts, sex hormones, cortisol, vitamin D and cholesterol. These components perform essential functions in our body.1,2

Cholesterol serves as a precursor to synthesise these components in our body and is also a structural compound of all cell membranes. Total blood cholesterol, which consist of low-density lipoproteins (LDL)(bad cholesterol), high-density lipoproteins (HDL) (good cholesterol)l and triglycerides, are used to assess a blood lipid profile. 1,2


An elevated blood lipid profile is dangerous as fat can accumulate in the arterial wall and will form a plaque/deposit. This hardening of arteries due to the formation of fatty deposits is known as atherosclerosis.1,2

The fatty deposits will restrict blood flow or can rupture which then causes blood clot formation in the artery which can cause a heart attack and a stroke.1,2

Atherosclerosis, high blood pressure and a heart attack can be classified under cardiovascular diseases (CVD).1,2 The risk for CVD in Type 2 diabetes is two to three times higher in men and three to five times higher in women when compared to people without diabetes.3

Dietary cholesterol

Dietary cholesterol is often confused with blood cholesterol levels. Blood cholesterol levels is not only influenced by dietary cholesterol alone but also by saturated fat and trans-fat.1,2

A diet high in saturated fat, trans fat and cholesterol may all increase the LDL-cholesterol levels in your blood. Studies have found that saturated fats have the biggest impact in increasing LDL-cholesterol. Saturated fat content of food items is thus more important than the cholesterol content of food.1,2

It has been found that a diet high in soluble fibre and omega-3 fatty acids may have cholesterol lowering effects. The replacement of saturated fats and trans fats with monounsaturated and polyunsaturated fats (as shown in the table below) can also lower LDL-cholesterol levels.1,2

Lifestyle factors, such as stress, sleep, smoking, alcohol and exercise, must be addressed in combination with a healthy balanced diet for the best results. Smoking increases inflammation and blood clotting which can also contribute to atherosclerosis. Regular physical activity can lower blood triglycerides, raise HDL levels and will lower blood pressure to lower CVD risk. Studies have proven that a 5-10% loss of body weight can be beneficial to reduce cholesterol and glucose levels as well as reduce your risk for heart disease.1,2

Types of fats

Saturated fat Trans-fatty acid Monounsaturated fatty acids (MUFAs) Polyunsaturated fatty acids (PUFAs)

Omega-3                         Omega-6

Visible fat on meat

Skin of  chicken



Chocolate (cocoa)


Cream cheese



Full cream milk products

Sour cream

Coconut, palm oil

Fried foods

Commercially baked foods (cakes, cookies)

Snack food (chips, crackers, microwave popcorn)

Margarine (hydrogenated)

Olive, canola, peanut oil


Nuts (cashews, almonds, peanuts, macadamia, pistachios)

Peanut butter

Sesame seeds

Fatty fish (tuna, salmon, herring, mackerel)



Pumpkin and sunflower seeds

Oils (corn, sunflower, cottonseed)


Margarine (nonhydrogenated)


Steps to improve your blood cholesterol levels:1,3

  1. Control energy intake: Adjust energy/kJ intake to achieve an ideal body weight.
  2. Increase omega 3 fatty acids: Aim for 2-3 servings of oily fish per week, such as tuna, sardines, salmon and trout.
  3. Choose healthy fats: Reduce saturated fat and trans-fat intake by eating less red and processed meats and refined foods. Remove all visible fat from meat before cooking. Total fat intake should also be limited to less than 30% of total energy. Reduce the amount of fat used for food preparation and use non-stick pans as an alternative to butter and/or oil. Consume more MUFAS and omegas 3 fatty acids.
  4. Increase soluble fibre intake: Most fruits and vegetables are high in soluble fibre.
  5. Increase plant stanols and sterols by consuming more fruits and vegetables. Switch out butter for margarine with added stanols and sterols.
  6. Improve beta glucan intake: Eat more oats which contains beta glucans or consider supplements with beta glucans in.
  7. Consume antioxidants by eating more fruits and vegetables.
  8. Cut back on sugar and sugar sweetened beverages.

Beneficial diets: Low-GI diet, Mediterranean diet and DASH diet. The above mentioned are general guidelines. Please contact a registered dietitian for individualised advice on how to practically implement the above-mentioned guidelines.


  1. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.
  2. Rolfes, S.R., Pinna, K., & Whitney, E. 2012. Normal and clinical nutrition. 9th edition. Wadsworth: Cengage Learning.
  3. SEMDSA Type 2 Diabetes Guidelines Expert Committee. JEMDSA 2017; 22(1)(Supplement 1): S1-S196.


Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston, Gauteng. She strives to provide individualised and practical nutritional care to improve the lifestyle and health of all of her patients.

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