Gastroenterologist Dr. Raj tells you what you want to know about diet and cholesterol.

By Dr. Roshini Raj
August 08, 2019

My cholesterol is a little high. What lifestyle changes should I make to bring it down?

We know that diet can make a big difference for cholesterol. For starters, cut back on saturated fats (such as red meat) and avoid trans fats as best you can. Remember that any food that has the words partially hydrogenated in the ingredient list contains trans fats. (As of June 18, 2018, manufacturers are no longer allowed to use trans fats. But foods produced prior to that date are still permitted on store shelves until January 2020.)

Eating more whey protein, the kind in cow’s milk, and soluble fiber will help your numbers too. Soluble fiber—found in foods like oats, brussels sprouts, and black beans—actually reduces the absorption of cholesterol into your bloodstream. Shoot to get 5 to 10 grams per day.

RELATED: 4 Diet Mistakes That Are Killing People Around the World

Omega-3 fatty acids may be beneficial as well. They don’t have a direct effect on LDL (or “bad”) cholesterol, but they do have other heart-healthy perks.

As for lifestyle tweaks, losing weight, even just a few pounds, can make a dent in your LDL, while a consistent exercise routine (30 minutes, five days a week) can raise your HDL (or “good”) cholesterol.

Sometimes, though, diet and lifestyle changes alone aren’t enough to do the trick. Talk to your doctor, who can help you determine if you need medication.

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Should I try to eat super healthy right before I get my cholesterol tested?

Here’s the thing about cholesterol tests: They usually reflect what you’ve been eating over the past two weeks. While it’s natural to want to clean up your act before seeing your doctor, you should stick to your regular eating habits. Being extra “good” for the few weeks before the test won’t do you any favors. Instead, it might lead to a falsely reassuring lipid profile rather than one that shows the effects of your true diet, meaning you could miss out on the advice or treatment that’s right for you. So come as you are. This is one test you should not try to game.

RELATED: Eating to Control Your Cholesterol: Everyday Diet Strategies to Lower LDL

I make two scrambled eggs for breakfast every day. Is that bad for my cholesterol?

Though eggs used to have a bad rap as a top source of dietary cholesterol, experts are no longer as concerned about the type of cholesterol found in food. We know now that most blood cholesterol is produced by the liver, and that foods high in saturated fat and trans fat (think bacon and doughnuts) are far worse than egg yolks because they stimulate the liver to make more cholesterol than your body needs.

If you like eating eggs, there are plenty of reasons to enjoy them scrambled, hard-boiled, or however you prefer. They are packed with vitamins (including D), minerals, and almost 6 grams of protein. That said, you might want to cut back to one egg at your morning meal: Studies have shown that for most people, up to one egg per day does not raise the risk of heart attack, stroke, or any other type of heart disease. But there isn’t as much research on eating more than that. In other words, one egg a day is a safe bet, while two is less charted territory.

RELATED: Are Eggs Actually Good for You?

Another caveat: A daily egg may not be safe if you have diabetes or you’re already at high risk of cardiovascular disease. If you’re concerned, consider mixing up your breakfast routine with a bowl of heart-healthy steel-cut oats, sprinkled with nuts and berries.

I know fiber can help with things like cholesterol levels and losing weight—but it gives me gas. Is it really that important?

Yes, fiber is extremely important—and not only for your gastrointestinal system. As you mentioned, it can help with cholesterol and weight management, too.

A study published in the Archives of Internal Medicine found that women who ate the most fiber (around 25 grams a day) were 22 percent less likely to die from any cause, compared with women who ate just 10 grams.

RELATED: Exactly How Much Fiber You Should Be Eating Every Day, According to Science

But some people do develop gas and bloating when they up their fiber intake. One trick is to start slowly: Let your body get used to increased fiber in small amounts, rather than loading up on the stuff all at once.

As your digestive system adjusts, it may be helpful to keep in mind that foods with soluble fiber (such as fruit, oats, beans and peas, and nuts and seeds) tend to produce more gas than foods with insoluble fiber (a.k.a. roughage, including whole grains and veggies).

But don’t give up on fiber! Your body needs both types. With time and experimentation, you will find high-fiber foods that agree with you.

Until you hit your fiber mark (the daily value is 25 grams), taking a probiotic may help with regularity. Sticking to an exercise routine and drinking more water should make a difference.

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Is spirulina really a miracle food? I read it can boost brain function and lower cholesterol.

Spirulina, a type of blue-green algae, is what lends so many smoothie bowls on Instagram their sea-colored hue. It’s an excellent source of protein, iron, and beta-carotene, a pigment that your body converts into vitamin A. Some studies suggest spirulina has anti-inflammatory properties and that it may reduce high cholesterol, heart disease, and liver disease.

RELATED: Spirulina is the Latest High Protein Superfood—Here's Why It's So Good for You

Not bad for pond scum. But there are safety concerns linked to this buzzy ingredient. Spirulina, which grows in both salt and fresh water, can become contaminated with toxins produced by other species of algae, and those toxins can cause severe side effects, including liver damage.

As with other supplements, spirulina isn’t regulated by the FDA. Before you buy a product (in powder or pill form), do some research to find a brand you like. And if you’re pregnant or breast-feeding, or taking any prescription meds, check with your doctor first.

Health’s medical editor, Roshini Rajapaksa, MD, is an associate professor of medicine at the NYU School of Medicine and a cofounder of TULA Skincare.

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