New Cholesterol Guidelines (2026) - Part 2: Lowering cholesterol with Diet

In my experience, it is difficult for patients to improve their cholesterol with diet alone. However, the new ACC/AHA cholesterol guidelines offer some info that I think will prove useful for patients who would like to improve their cholesterol levels but don't yet require medication.

The guidelines recommend a diet low in saturated fat (you know: butter, red meat, high-fat dairy, etc) and higher in polyunsaturated and monounsaturated fats (e.g., fish, nuts, seeds, legumes, olive oil, avocados). Trading saturated fat for unsaturated fats will lower the "bad" LDL cholesterol. Specific diets the guidelines mention for doing so are the DASH diet and the Mediterranean diet. This is advice I've provided patients for years. In general, the guidelines mentioned that strict vegetarian and vegan diets lower cholesterol more than simply changing to a heart-healthy diet like the Mediterranean diet.

However, one diet I was not familiar with is seemingly more powerful than the diets above for lowering LDL ("bad") cholesterol. This is called the Portfolio diet. It consists of four components: nuts and seeds (almonds, walnuts, or peanuts, for example), soy/plant-based protein (tofu, soy milk, soy burgers), soluble fiber (oats, barley, psyllium/Metamucil, eggplant, berries), and plant sterol supplements (e.g., plant-sterol fortified margarine/spreads or supplements). The guidelines mention this diet lowers LDL by about 26 mg/dL. Pretty impressive!

The guidelines also mention how to improve triglycerides with diet. This is done by lowering sugar and refined carbohydrate intake, as well as by lowering or eliminating alcohol intake. In general 5 to 10% weight loss and regular exercise are also beneficial for lowering triglycerides.

Stay posted for more content on cholesterol in the coming days and week. These ACC/AHA 2026 cholesterol guidelines are chalk full of great information! Also, see my first post concerning these cholesterol guidelines for other useful information.