Integrative Approach to High Cholesterol

As a family medicine PA, a lot of my job is discussing and managing chronic disease. High cholesterol is a big one!

With all counseling sessions, I would say the majority of them is brainstorming what gets in the way of making healthful choices – ie stress, work, grief, anxiety, depression, poor sleep, child care to name just a few.

From a nutrition counseling standpoint, I typically ask about access to nutrient dense foods, take a 24 hour nutrition recall, inquire about sources of refined/processed foods.

I’ll also aim to remove any guilt or shame from a diagnosis. There are SO many different factors that influence health and health behaviors beyond individual decisions. Policy making, genetics/family history and other predisposing factors, access to medical care, access to nutrient dense foods and/or transportation, environment, social circumstances are all incredibly important factors.

I will spend some time discussing the diagnosis of high cholesterol, particularly debunking the fact that dietary cholesterol does not equate to serum cholesterol, and discussing the difference between LDL and HDL cholesterol. Eating egg yolks will not cause you to have high cholesterol!! So ditch the egg white and reach for the whole egg instead.

  • High Density Lipoprotein (HDL): Helps remove “bad” cholesterol, and therefore higher levels of HDL cholesterol can lower your risk for heart disease or stroke.
  • Low-density Lipoprotein (LDL):  associated with higher risk for heart disease or stroke.
I always like to emphasize that no food is ever off limits. Noting a food as inherently “bad” often leads to a pattern of restriction and binging. Instead, all foods are okay and healthy. We aren’t robots and food is much more than simply input and output. Instead, it’s sustenance, nourishment, emotion, culture, community, joy, and so much more! And speaking of shame, sometimes medications are necessary to act as a bridge, or necessary for much longer term. Each individual person is different and has different healthcare needs!
Including my general recommendations for hypercholesterolemia care below.
General recommandations: 


  • Focus on unsaturated fats – These are mono and poly unsaturated fats that come from sources such as fatty
    fish, nuts and seeds, and oils such as olive oil. These foods are rich in omega-3 fatty acids which are a type of fat
    that doesn’t affect LDL cholesterol.
  • Be mindful of fast/processed foods, as these often contain trans fats, which raise  cholesterol levels. Also take care to cook with olive/avocado oils instead of vegetable oils. Vegetable and other refined industrial seed oils are quite inflammatory and lead to elevated LDL cholesterol values.
  • Be mindful of added/refined sugars!! This is especially important with elevated triglycerides.
  • Increase soluble fiber (think: brown rice, oatmeal, beans, lentils, fruits, and veg) as these can help reduce the absorption and enhance elimination of cholesterol in your bloodstream.
  • Eat LOTS of non-starchy vegetables (cauliflower, broccoli, onions, zucchini, tomatoes, kale, spinach, lettuce, for example)
  • Think about gut health! The microbiome is extremely important for managing chronic disease.
  • If possible, keep a period of 12 hours of not eating between your last meal (dinner) and next meal (breakfast). Time restricted feeding can be really helpful for cardio-metabolic health in some patients.
  • Be mindful of excessive alcohol consumption. Decrease alcohol consumption – alcohol lowers HDL cholesterol and increases LDL cholesterol which can lead to higher risk for heart disease or stroke.
  • Apply mindful eating at each meal, eating slowly and paying attention to hunger cues.



  • Focus on getting enough restful sleep, ~7-9 hours per night.
  • Do something every day that brings you joy! This will help manage stress, which alone has a profound impact on cholesterol.  There are also apps available like Calm and Headspace. Yoga, tai chi, therapy, journaling,
    meditation, and deep breathing are all excellent ways to manage stress sustainably.
  • Move your body in a way you find enjoyable and that gets your heart rate up 3-5 times per week. Moderate physical activity can help raise HDL cholesterol.
  • Consider smoking cessation if you haven’t done so already.  Smoking increases LDL and lowers HDL cholesterol, which can lead to higher risk for heart disease or stroke.
  • Try to go for a walk a few times throughout the day. Walking can be a powerful form of movement for blood pressure regulation!
  • Ask friends, family, peers, colleagues or your healthcare team for support!

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