I do a lot of health checks in my family clinic here at BJU, and a large percentage have problems with their cholesterol tests. Since high cholesterol is one of the major risk factors for heart disease, I focus a lot of my time with them on proper diet. But what is a proper diet, exactly? We hear so many crazy diet tips from so many sources, but what are the proven high-yield foods that people should focus on?

First, most sources agree on the most high-yield foods: nuts; fish; fiber; olive oils; and plant sterols/stanols. How much does each group benefit? Find out in the graph below from the Natural Medicines Comprehensive Database, my perennial favorite website for evidence-based supplement research:

The NMCD has written a great free article on which natural products work to improve cholesterol. As you see below on their Recommendation Chart, their green area of “Likely Safe + Effective/Likely Effective” has quite a few products, including fish oil; barley, beta-glucans, blond psyllium, niacin, oat bran, and plant stanols and sterols:

My personal tips for anyone who has high cholesterol, even if they take medicines, are these:

• Eat more nuts — a few servings a week can help more than you think. Look at the chart above: walnuts can lower total cholesterol by 8-16%
• Eat fatty fish (salmon or sardines) at least twice a week, more if you can get it. Fish oil can lower triglycerides an amazing 20-50%, and most likely has overall benefit to your heart. I’m a big fan of fish oil for everyone in the family.
• Fiber, fiber, fiber! Fiber can lower total cholesterol 5-26%. Fiber is especially important for breakfast: even the fiber from Cheerios can help, but oatmeal, muesli, or dark breads also are a better source. And don’t forget that fruits and vegetables also have a lot of fiber.
• Improve your breakfast. The worst offenders usually have a very American breakfast of eggs and meat. A far healthier choice would be some fiber (dark bread, muesli, oatmeal) with a cup of yogurt and fruit. Want some sugar? Pour honey into non-sweetened yogurt. Did you know a yogurt a day also helps keep your weight down?
• Think brown over white. If you must eat your pasta, rice and breads, at least try to switch from lily-white versions to the darker ones. Pick any, I don’t care — all brown grains have more fiber and nutrients than the ultra-processed white grains. This also has the added benefit of decreasing your risk of getting diabetes.
• Switch to olive oil. We all need some fat in our diet, but there are good fats and bad fats, and it’s hard to beat olive oil for better health.
• Avoid trans-fats. Trans-fat definitely tops the list of bad fats. This issue fortunately has received a lot of media exposure, but many cookies and snacks still contain a lot of this unnatural and artery-clogging fat. Take a look at your labels, which now require details about trans fats.

If you want more information, you can read a lot of healthy tips at the Mayoclinic website, as well as a patient handout from UpToDate.