Five high-cholesterol foods you should eat (and what to avoid)

Telegraph

16-04-2025

Thankfully, having high cholesterol doesn't necessarily mean you should avoid all cholesterol-rich foods.
Recent research has found that specific cholesterol-rich foods, such as full-fat milk, yogurt and aged cheese, might actually improve blood lipid (fat) profiles, and therefore cholesterol levels.
First, you must understand why your cholesterol levels are raised in the first place, as Dr Ali Khavandi, a Bath-based consultant interventional cardiologist, explains.
'If you have a genetic predisposition to high blood cholesterol levels, diet has very little influence so medication, such as statins, is usually required,' he says. 'Even for an 'average' person with raised cholesterol who is otherwise healthy, eating low-cholesterol foods is likely to have a limited effect.
'But if you are overweight and have some level of insulin resistance or other associated conditions, you can absolutely impact your cholesterol through dietary intervention, but usually, it comes down to adopting a healthy dietary pattern rather than avoiding certain high cholesterol foods.'
Let's break it down. Which high cholesterol foods should you include in your diet – and which are best avoided?
Five foods high in dietary cholesterol to include in your diet
1. Cheese
Dr Khavandi is clear on this one: 'Everyone thinks that cheese is a disaster. I often hear people say 'my cholesterol is high, so I shouldn't eat cheese', but there's good data that long-fermented cheeses [such as aged cheddar] are beneficial'. While cheese is high in cholesterol, it is also a rich source of vitamins (A, K, B12), minerals (calcium, phosphorus, magnesium), and gut-friendly probiotics. Indeed, a study published in the Journal of Clinical Investigation found that participants with metabolic syndrome who followed a low-carbohydrate, high-fat diet that included 200g of cheese per day had improved blood lipid profiles after four weeks.
2. Eggs
Good news for egg lovers: if you have high cholesterol, there's no need to order the egg white omelette. A review of the evidence by Harvard Medical School found that rates of heart attacks, strokes, or other cardiovascular diseases were no higher in people who ate up to one egg per day.
The effects of any cholesterol that eggs contain may also be mitigated by the other heart-healthy nutrients, such as selenium and omega-3 fatty acids, they contain, as Dr Khavandi explains: 'I think if you ate lots of eggs then your total cholesterol would probably go up but whether or not that would result in any prognostic problems further down the line is arguable. If you're otherwise healthy then it's unlikely to be an issue.'
3. Red meat
This is a slightly more contentious one because red meat is high in saturated fat, which has been shown to increase LDL cholesterol (the 'bad' kind) in the blood, but Dr Khavandi believes this is over-simplifying the issue. 'The received wisdom is that LDL cholesterol is bad, there's a linear relationship with cardiovascular disease and the best thing you can do is reduce it by cutting out saturated fats from your diet, but that model is now outdated,' he says. 'If your cholesterol is high because you are part of that 'metabolic' group, then changing your dietary pattern from high sugar/high carbohydrate to eating minimally processed, satiating foods is far more beneficial.
'Eating a good-quality steak, which is high in protein, improves appetite regulation, which can help bring metabolic disorders under control. It's very similar to what the GLP-1 medications like Ozempic do; they shut off your hunger.'
4. Shellfish
Although historically shellfish were a 'watch' food because of their relatively high cholesterol levels, where they differ from most other cholesterol-rich foods is their low fat content. Specifically, the fat they do have is of the heart-healthy omega-3 variety, which is known to protect against the risk of heart disease. The American Heart Association has reversed their advice and now says they can be eaten as part of a heart-friendly diet that is 'more plant-based, including whole grains, fresh fruits and vegetables'.
5. Liver
For most, avoiding liver is no great hardship, but it is a cheap, nutrient-dense source of protein and several key micronutrients providing a wide range of health benefits, including vitamins A, B12, D, E, K, iron, and copper. In a similar vein to shellfish, even though liver is high in cholesterol, it is low in fat. Heart UK, the cholesterol charity, advises that most people don't need to cut down on the cholesterol that's found in these foods if they're eaten as part of an overall healthy, balanced diet.
Three foods to avoid
1. Sugar
Excessive sugar consumption, particularly added sugars in ultra-processed foods, is recognised as a major driver of metabolic disorders such as Type 2 diabetes. Metabolic patients often have high cholesterol due to factors such as insulin resistance, high blood sugar, and excess abdominal fat, which lead to increased levels of 'bad' LDL cholesterol and decreased levels of 'good' HDL cholesterol.
Unfortunately, hidden sugars are everywhere, and unless you are a food label sleuth, they are hard to avoid, Dr Khavandi urges vigilance: 'A lot of my patients, even with the best motivation, are being tricked by the food industry. They might have a low-fat fruit yogurt as a snack, thinking they are being healthy, but when you look at it, it has four teaspoons of sugar per serving. Moving to a predominantly whole food diet, like the Mediterranean diet, to include plenty of fruit, vegetables, olive oil, oily fish, nuts and seeds, is the best way to improve your lipid profile.'
2. UPFs
The unfortunate fallout of the standard NHS advice to avoid saturated fat if you have high cholesterol is that people switch to ultra-processed, low-fat alternatives. Dr Khavandi is not a fan, 'Anything that says light, lighter or low-fat at the supermarket is often a catastrophe for health. If you take the example of low-fat mayonnaise, it will have a whole host of ingredients, including emulsifiers, starch and sugar, and very little in the way of oil or eggs.'
Reducing your reliance on UPFs is key to a more integrated approach to health, which focusses on improving overall dietary pattern to combat a whole range of health risks, such as Type 2 diabetes, heart disease, stroke, cancer and dementia.
3. Alcohol
Not strictly a food group, but heavy drinking is consistently linked to raised blood lipid levels. Even moderate drinking can disrupt the body's normal metabolic processes, leading to increased fat production and storage and interfering with how the body processes sugar and fats. This contributes not only to elevated cholesterol levels but also to central obesity and high blood pressure, also risk factors for heart disease.
Other ways to lower your cholesterol
Stop smoking: There is a proven link between quitting smoking and increased beneficial HDL cholesterol levels. Indeed, it's estimated that within a year of quitting, your risk of heart disease is half that of a smoker.
Exercise. A study funded by the British Heart Foundation in 2024 found that the more active you are, the more saturated fat your muscles use for energy. This means less is circulating in the body, which lowers your non-HDL cholesterol levels.
Manage stress: A large Spanish study of 90,000 workers found that those with job stress were more likely to suffer from abnormally high levels of LDL cholesterol and low levels of HDL cholesterol. Whilst quitting your job may not be an option, practising yoga and doing regular breathing exercises are two excellent ways to reduce stress.
FAQs
What is cholesterol?
Cholesterol is a fat (or lipid) found in all cells. It's a key component of cell membranes, is used to make hormones, helps the body make vitamin D and is essential in the production of bile acids, which help digest dietary fats. Most of our cholesterol does not come from nutritional sources, it's produced by the liver, which also tightly regulates the types and amounts of cholesterol in the blood.
What are the different types of cholesterol, and which ones are unhealthy?
There is, in fact, only one type of cholesterol, but there are various types of cholesterol 'carriers', called lipoproteins, that transport it through the body. VLDL (very low-density lipoprotein) and LDL (low-density lipoprotein) are two carriers that can potentially deposit cholesterol in the arteries, increasing your risk of heart disease and stroke. HDL (high-density lipoprotein) is the 'good' type of lipoprotein as it collects up excess cholesterol and transports it back to the liver for conversion to bile acids or to be excreted.
Am I at risk of health issues if my blood cholesterol is raised?
High blood cholesterol is a risk factor for cardiovascular disease and is diagnosed via a blood test. If your lipid profile is deemed high risk, statin medication would usually be recommended, but Dr Khavandi says that it's now possible to offer a more personalised approach using modern screening and imaging, 'I'll often see patients with high cholesterol but when we scan them their arteries are perfect, so for that group I probably wouldn't recommend statins.'