After fainting and experiencing a scary fall, my patient, a 43-year-old father of two, was diagnosed with a variety of cardiovascular conditions, including high cholesterol. Although he couldn’t change his genetic risk for these conditions, with support from health care professionals and loved ones, he focused on factors he could control. As his dietitian, I helped him establish consistent, practical changes to his lifestyle, including fiber-forward, plant-rich meals, consistent exercise and reducing saturated fat intake. After six months of applying these lifestyle changes, his cardiologist was amazed when his total cholesterol decreased by nearly 40 points (from 197 to 158), and his low-density lipoprotein (LDL) cholesterol dropped by over 30 points (from 135 to 104). What once seemed daunting turned out to be manageable; as he put it, “It isn’t hard. You just need education, love, and support.”

Read on to learn more about the strategies we used to improve his cholesterol panel as well as other ways to support healthy cholesterol levels.

Fiber & Plant Focused Meals

Fiber, the indigestible part of carbohydrates, is associated with various health benefits. Adequate fiber intake helps increase feelings of fullness and slow digestion, which supports weight loss and blood glucose management. Soluble fiber specifically plays a crucial role in managing healthy lipid panels. The soluble fiber that you find in plant foods “binds to cholesterol and bile acids in the gut and helps remove them from the body. This forces the liver to use more circulating LDL to make new bile acids, lowering blood cholesterol,” says Maria Elena Fraga, RD, CDCES, director of the Diabetes Alliance at the Mount Sinai Health System in New York City.

Before working together, my patient had “no clue about the power of fiber” when it came to heart health. In fact, he never paid much attention to fiber at all. But he is not alone. Nearly 95% of Americans do not meet the recommended daily intake of fiber, set at 14 grams per 1,000 calories. Because he was not accustomed to a high-fiber diet, we decided to gradually increase his fiber intake alongside his water intake to prevent unpleasant side effects like constipation.

He increased his fiber intake through the following simple interventions:

• Adding chia seeds, nuts and berries to whole-grain oats for breakfast


• Eating a salad for lunch with vegetables, whole grains like quinoa and high-fiber lentils


• Snacking on fiber-rich foods like bananas, dates with peanut butter and a few chocolate chips, and high-fiber crackers and carrots with hummus


• Filling half of his dinner plate with vegetables

Prioritizing fiber in his meals and snacks meant incorporating a variety of plant foods. Fruits, vegetables, nuts, seeds, legumes and whole grains are sources of fiber as well as essential vitamins, minerals and phytonutrients. Some of these foods, like fruits and vegetables, contain plant stanols. Plant stanols are molecules that can inhibit the absorption of cholesterol. We focused on increasing intake of these foods at work to help him stay full and energized throughout his busiest days. By eating salads with beans like lentils and chickpeas, he was able to consume higher volume meals that were nutrient-rich without being overly calorie-dense.

Reduced Saturated Fat Intake

Diets rich in saturated fat are associated with an increased risk of high LDL cholesterol. “Foods that are high in saturated fat are generally bad for our cholesterol levels. These include common breakfast items such as bacon, sausage, hash browns, butter, cheese and donuts,” says Chen.

It’s recommended to reduce saturated fat to less than 10% of your total calorie intake. For someone consuming a 2,000-calorie diet, which equates to less than 22 grams per day. By focusing on foods that have lower saturated fat content and higher unsaturated fat content, my patient was able to achieve a healthy balance. We focused on healthy additions to his diet, such as 3 to 4 cups of vegetables and 2 to 2 1/2 cups of fruits daily, and 1 1/2 cups of legumes per week. We also made sure to limit sources of saturated fat, like red meat. Red meat intake was reduced to once or twice a month and, when he did eat it, he made sure to mix it with a fiber-rich food to reduce the serving size while still providing satiating nutrients. For example, his family enjoys taco salads and, as a recipe makeover, included beans and quinoa as new high-fiber ingredients.

Convenient Whole Foods

As a working parent with two young kids, my patient’s time was limited and valuable. In order to make sustainable changes to his eating patterns, we needed to find convenient food items that met his nutrition goals.

Our conversations sparked his curiosity around food shopping, and he found himself taking more time to look at new products while walking the aisles. We discussed some key factors to consider when reading product labels. Did the product have at least 3 grams of fiber in a serving? Was the daily value percentage for saturated fat content below 10%? Were any of the main ingredients nutrient-dense foods like whole grains, nuts, seeds or legumes? Asking himself these questions as he scanned nutrition labels made it easier to make informed choices that aligned with his nutrition goals.

Some convenient, high-fiber, nutrient-dense foods that were added to his grocery list included:

• Ready-to-eat steamed lentils


• Pre-cut beets, butternut squash and other colorful veggies


• Frozen fruits and vegetables


• Unsalted nuts


• Chia and hemp seeds


• Hummus


• High-fiber bread

He noted that these changes weren’t just for him—they were for the entire family. He shared that “The support of my spouse was huge. I could not have succeeded without her.”

Consistent Physical Activity

Establishing an exercise routine that is both enjoyable and compatible with your schedule is an effective strategy for maintaining regular physical activity. “Regular physical activity helps increase HDL cholesterol, ‘healthy cholesterol,’ improve insulin sensitivity and lower cholesterol production. Recommendations include 150 minutes per week of moderate activity plus strength training twice weekly,” says Fraga. My patient chose an online program with a combination of cardio and resistance exercise that he could do before work. Early morning workouts were ideal for his schedule, as his newborn daughter would be awake and accompany him during his exercise sessions.

Now that he was focusing on “food as fuel and nourishment,” he also had more energy than ever before. His increased energy made it easier to exercise consistently in the morning before work, often at 5 a.m.

Continued Weight Loss

Eating in a moderate calorie deficit helps with weight loss, which can have a significant impact on cholesterol. “Excess body fat, especially abdominal fat, raises LDL and total cholesterol. Losing 5-10% of body weight can significantly lower LDL and triglycerides while improving HDL. Weight loss improves how the liver processes fats, leading to less LDL production,” says Fraga.

While my patient had already lost some weight, he hit a plateau and needed extra support. We didn’t talk about restrictions; rather, we framed the discussion around the foods he could “add” into his eating pattern to increase feelings of fullness and increase energy. One adjustment that made a significant difference was adding 8 to 10 grams of fiber per meal, which helped him feel more satiated by his mid-day meals. “Adding a tablespoon of chia seeds to my oats in the morning and having salads at lunch helped me realize how fiber keeps me full. Before these changes, I’d be starving way before lunch time. Now I eat lunch later and don’t always need a mid-afternoon snack,” he said.

After one week of making small adjustments to his eating patterns, he lost two pounds. “The biggest thing was learning what to eat to keep me sustained throughout the day,” he said. After six months, his total weight loss is 18 pounds, 8.5% of his starting body weight.

Other Tips for Supporting Healthy Cholesterol

• Avoid Smoking. Smoking has been shown to increase LDL cholesterol, so if you do smoke, quitting can help support healthy cholesterol and overall cardiovascular health.


• Manage Your Stress. Chronic stress can increase a hormone called cortisol. When you have consistently high cortisol levels, this is associated with elevated cholesterol levels.


• Get Good Sleep. “Getting 7-9 hours of good quality sleep every night will also help to lower cholesterol levels,” says Chen. Research shows that inadequate sleep is associated with insulin resistance, and insulin resistance is associated with elevated LDL cholesterol levels.

Our Expert Take

Start with one aspect of your health, and try making small, sustainable changes. It’s not about perfection, but consistency. Working with a health care professional, like a registered dietitian, provides you with individual recommendations that support your nutrition and health- goals. For my busy and motivated patient, we dialed in on improving his cholesterol panel through fiber-rich meals that were full of nutrient-dense and convenient foods, reducing saturated fat intake and prioritizing consistent movement that he enjoyed. At the end of the six months, not only was my client able to improve his physical health goals, but his mental health too. He shared that “For the first time, I feel more confident, empowered, and in control of my health. Simple meal prep strategies and recipes that fit my busy schedule gave me the roadmap I needed to take control of my health and eating habits.”