What fish can you eat when you have high cholesterol?

October 27, 2025 •

4 min read

According to the American Heart Association, eating fatty fish twice per week can help manage cholesterol levels and support heart health. This is because the right fish can be a powerful ally in your diet, providing beneficial omega-3 fatty acids that counter bad cholesterol. Understanding what fish can you eat when you have high cholesterol is key to making heart-smart food choices.

Quick Summary

Several types of fish, particularly fatty varieties, are rich in omega-3 fatty acids, which can lower triglycerides and improve cholesterol ratios. Choosing fish low in saturated fat and opting for healthy cooking methods are also important for managing high cholesterol.

Key Points

Prioritize Omega-3 Rich Fish: Fatty fish like salmon, mackerel, and sardines are high in omega-3 fatty acids (EPA and DHA), which are excellent for managing cholesterol.
Omega-3s Lower Triglycerides: The omega-3s in fish help to lower triglycerides, a type of fat in the blood, and may also improve HDL ("good") cholesterol levels.
Choose Leaner Fish for Variety: Lower-fat options such as cod, haddock, and tilapia are also good choices, offering lean protein without significant saturated fat.
Focus on Healthy Cooking: Baking, grilling, and steaming are the best cooking methods. Avoid deep-frying, which adds unhealthy fats that can negatively impact cholesterol.
Moderate Shellfish Intake: While some shellfish like mussels are low in cholesterol, others like shrimp and squid are higher. Eat these in moderation and consider how they're prepared.
Watch for High-Mercury Fish: Be aware of fish with high mercury levels, such as shark and swordfish, and opt for lower-mercury alternatives like salmon and trout for regular consumption.
Incorporate into Regular Diet: Aim to eat at least two servings of fatty fish per week to reap the heart-health benefits, as recommended by the American Heart Association.

The Cholesterol-Fighting Power of Omega-3s

Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are polyunsaturated fats known for their powerful effects on cardiovascular health. Unlike saturated and trans fats, which raise harmful LDL ("bad") cholesterol levels, omega-3s primarily work to lower triglycerides in the bloodstream. While their impact on LDL can vary, they often help to raise beneficial HDL ("good") cholesterol. This dual action of lowering triglycerides and potentially improving cholesterol balance is why fatty fish is a cornerstone of a heart-healthy diet.

Omega-3 Rich Fatty Fish

For those managing high cholesterol, the focus should be on fatty, cold-water fish, which are the best dietary sources of EPA and DHA. Here are some of the top choices:

Salmon: A versatile and popular choice, salmon is celebrated for its high omega-3 content. It's also an excellent source of protein and essential vitamins. Choose wild-caught over farmed when possible, and prepare it by baking, grilling, or poaching to avoid adding unhealthy fats.
Mackerel: Small but mighty, mackerel is an affordable and accessible source of omega-3 fatty acids. It can be found fresh, smoked, or canned and adds a rich flavor to meals.
Sardines: These small, oily fish are often sold canned and are bursting with omega-3s. They are also rich in calcium and vitamin D. Canned sardines in water or olive oil are best; if canned in oil, draining it helps reduce overall fat content.
Herring: Similar in size and nutrient profile to sardines, herring is another fatty fish packed with heart-healthy omega-3s. It's a great option for salads or as a protein source in various dishes.
Trout: Freshwater trout is a solid option that offers a good amount of omega-3s with lower mercury levels than some other fish. Baking or pan-searing with a small amount of healthy oil are excellent cooking methods.

Low-Mercury, Leaner Fish Options

For variety or for those concerned about mercury, several leaner fish options are also beneficial. While they contain less omega-3, they are low in saturated fat and still provide high-quality protein. Good choices include:

Cod: A flaky, white fish that is extremely low in fat and calories. Cod is a great base for a healthy meal, absorbing flavors well from herbs and spices.
Haddock: Similar to cod, haddock is a lean fish that can be baked or broiled. It's a low-calorie, low-fat source of protein.
Tilapia: Another very lean, mild-flavored fish that works well for a variety of healthy recipes.
Flounder: A flatfish that is also low in fat and calories, making it a healthy protein choice.

Comparison of Heart-Healthy Fish

To help you choose, here is a comparison of some popular heart-healthy fish options based on their nutritional profile per 100g serving.


Fish	Omega-3s (approx. mg)	Saturated Fat (approx. g)	Total Cholesterol (approx. mg)	Mercury Level	Best for...
Salmon (Atlantic)	1,700 - 2,000	2.4	63	Low	Optimal omega-3 intake and flavor.
Mackerel (Atlantic)	1,500 - 1,800	~2.5	~95	Moderate	Affordable, nutrient-dense option.
Sardines	1,400 - 1,600	1.5	142	Low	Convenient, high-calcium meals.
Trout	1,000 - 1,500	1.6	70	Low	Lower mercury concern.
Tuna (Canned in Water)	200 - 500	<1	42	Low	Lean protein for salads and sandwiches.
Cod	100 - 200	<1	43	Low	Very lean, mild flavor.

The Role of Cooking Methods and Fish to Limit

How you prepare your fish is just as important as the type you choose. Heart-healthy cooking methods include:

Baking or Broiling: A simple and effective method that requires little added fat. Using parchment paper or foil can make for easy cleanup.
Grilling: Grilling adds a smoky flavor without extra oils. Ensure the fish doesn't dry out by brushing with a healthy fat like olive oil.
Poaching or Steaming: These methods use moisture to cook the fish, resulting in a tender texture without any added fat.

It is crucial to avoid deep-frying fish, which adds unhealthy saturated and trans fats that negate the heart-healthy benefits. Additionally, be mindful of shellfish. While some shellfish like mussels are low in saturated fat and cholesterol, others like shrimp and squid are notoriously high in cholesterol. Despite this, moderate shrimp consumption might still be fine for some, as research suggests its effect on blood cholesterol levels is not always negative due to its low saturated fat content. As with any dietary change, consulting a doctor or registered dietitian is always recommended for personalized advice.

Conclusion: Making Heart-Healthy Fish Choices

Making the right fish choices is a delicious and effective part of managing high cholesterol. By focusing on fatty fish rich in omega-3s, such as salmon, mackerel, and sardines, you can significantly improve your heart health. Combining these choices with lean, low-mercury options like cod and flounder adds variety to your diet. Remember that preparation is key—always opt for baking, grilling, or steaming over frying. With these strategies, you can enjoy flavorful meals while actively working to improve your cholesterol profile and overall cardiovascular wellness. For more details and specific serving recommendations from health experts, the American Heart Association is a great resource.

: https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol/art-20045192

Frequently Asked Questions

No, eating the right kind of fish generally helps manage cholesterol. Most fish are low in saturated fat and high in beneficial omega-3 fatty acids, which can lower harmful triglycerides and improve cholesterol ratios. The key is choosing fatty fish and healthy cooking methods.

Yes, salmon is an excellent choice for high cholesterol. It is one of the richest sources of omega-3 fatty acids, which are known to lower triglycerides and may boost HDL cholesterol. Opt for wild-caught salmon and bake or grill it for maximum health benefits.

Shrimp is high in dietary cholesterol but very low in saturated fat. Research suggests that for most people, moderate consumption does not negatively impact blood cholesterol levels. The cooking method is crucial; steaming or boiling shrimp is much healthier than frying it.

The American Heart Association recommends eating at least two servings of fatty fish per week for optimal heart health. This helps ensure a consistent intake of beneficial omega-3 fatty acids.

The best cooking methods are baking, grilling, poaching, or steaming. These methods avoid adding unhealthy fats. Avoid deep-frying, which can add significant saturated and trans fats that are detrimental to cholesterol levels.

Yes, canned tuna, especially packed in water, is a good and convenient source of lean protein and some omega-3s. It is a healthier choice than red meat and can be included regularly in a heart-healthy diet. Draining oil-packed tuna is also an option, but water-packed retains more omega-3s.

Fatty fish (like salmon and mackerel) contain more omega-3 fatty acids, which actively benefit cholesterol levels. Lean fish (like cod and tilapia) are low in both total fat and saturated fat, making them a very low-cholesterol, high-protein option that's also good for heart health.