You’ve probably heard that eating a diet high in cholesterol-rich foods isn’t the best practice for heart health, but this may leave you wondering about foods like fish. Does fish have cholesterol? Yes, but that doesn’t mean it needs to be avoided in a heart-healthy diet. 

While it contains cholesterol, fish also has plenty of nutritional benefits that work in favor of your cardiovascular health. Understanding the association between fish and your heart can help you design a healthy diet, without ditching your favorite seafood.

Does Fish Contain Cholesterol?

Yes, all animal products contain cholesterol, and this includes fish. However, if you enjoy eating fish, just because it has cholesterol doesn’t make it bad for your heart. Including fish in your diet has heart health benefits. 

What the Research Says

In a 2004 study published in Circulation involving 4815 adults ≥ aged 65 years, researchers examined their fish consumption and incidence of atrial fibrillation (AF) over 12 years. (AF is one of the leading causes of strokes, so prevention is important.) 

Their conclusion? Eating tuna, or other broiled and baked fish, was associated with a lower risk of developing AF. Specifically, those who ate fish had a 28% lower risk when consumed 1-4 times per week, and a 31% lower risk with an intake of at least 5 times per week.

A 2020 meta-analysis of 22 studies published in Nutrients found that fish consumption is associated with a lower risk for coronary heart disease. The authors found that for every 20 grams per day increase in fish consumption, there was a 4% lower risk of coronary heart disease incidence and mortality.

Finally, in a 2020 cohort study published in JAMA Internal Medicine, researchers examined how eating unprocessed red meat, poultry, or fish affected cardiovascular disease risk and all-cause mortality. 

The authors found that “…higher intake of processed meat, unprocessed red meat, or poultry— but not fish—was significantly associated with a small increased risk of incident coronary vascular disease.” Remember that all of these foods contain cholesterol, but fish was the only one found not to have negative heart health effects.

https://youtu.be/o6rs7icwfJ8

Why Dietary Fats Matter 

They’ve been misunderstood for decades, but dietary fats are essential for long-term health and everyday functioning. You need fats to absorb nutrients like vitamins A, D, E, and K, plus specific antioxidants and carotenoids. 

Fat helps produce hormones, protects your organs, regulates body temperature, and acts as an energy source. Your body makes its own cholesterol for some of these purposes. 

These are the main types of dietary fats and what they do in your body: 

• Saturated fat. Predominantly found in animal products as well as palm oil and coconut oil. A high intake has been associated with increased cholesterol, especially LDL “bad” cholesterol, atherogenic lipoproteins, and reduced HDL “good” cholesterol.
• Trans fat. Manmade trans fats have been banned in the US because of their strong link to heart disease, but they are still naturally occurring in some animal products. 
• Unsaturated fat. Monounsaturated and polyunsaturated fats (omega-3s) found primarily in plant foods and have a protective effect on heart health.
• Cholesterol. Made by your body and found in animal products. Too much dietary cholesterol may contribute to a higher risk for heart disease, as cholesterol-rich foods tend to also be high in saturated and trans fats. 

Remember that one single food or nutrient isn’t going to have the ultimate effect on your heart health—it’s about the overall quality of your diet and other lifestyle habits. 

For a detailed explanation of what these and other cardiovascular biomarkers mean for your health, see this blog post. 

Can You Eat Fish if You Have High Cholesterol?

In most people, when you eat dietary cholesterol, your liver just makes less. However, when you eat a lot of saturated fat, it can accumulate over time.

While it’s true that fish contains dietary cholesterol, it’s also low in saturated fat—the type of fat that has a much bigger impact on raising apoB and LDL cholesterol levels in your blood. 

Many types of fish, especially fatty varieties like salmon, sardines, and mackerel, are rich in heart-healthy omega-3 fatty acids. These fats can help lower triglycerides, reduce inflammation, and support overall cardiovascular health.

Read more in my blog post about omega-3 fatty acids and your heart.

If you have high cholesterol, fish can be a smart protein choice compared to red or processed meats. That said, preparation matters. Fried fish or seafood doused in heavy sauces can pack in unhealthy fats that offset the benefits. Instead, opt for grilled, baked, or steamed fish to keep your meals both delicious and heart-friendly.

How Much Fish Should I Eat?

Eating omega-3-rich fish is recommended at least twice per week. The American Heart Association suggests a 3.5-ounce serving at a time or at least 8 ounces of non-fried fish per week.

Best Fish for Heart Health

Not all fish are good sources of the omega-3s EPA and DHA. For instance, tilapia, catfish, cod, pollock, and flounder are generally lean and low in overall fat, and therefore low in omega-3s. Better sources of omega-3s include salmon, mackerel, trout, arctic char, herring, striped bass, whitefish, and sardines.

EPA and DHA can reduce endothelial dysfunction, lower inflammation, and fight oxidative stress, all of which are accelerators of arterial plaque formation.

So if you’ve been wondering whether salmon is high in cholesterol, just remember that the perks of its omega-3 content outweigh its cholesterol content.   

Are there high-cholesterol fish to avoid? Not necessarily, as I’d recommend first focusing on choosing omega-3 rich varieties. To minimize your saturated fat and cholesterol intake from fish, though, cooking matters. Deep-frying or sauteing may add more of these unhealthy fats to your meal, depending on the type of oil used.

What about shellfish? Are shrimp high in cholesterol? Yes, shrimp is high in cholesterol, and it’s often recommended to minimize or avoid it if you already have high cholesterol levels.

Still, some older research suggests that while shrimp can raise LDL, it can raise HDL and lower triglycerides to a more significant degree. Whether eating shrimp aligns with your individual heart health needs is best determined by consulting your registered dietitian who specializes in heart disease.

Incorporating Fish Into Your Diet

Need inspiration for how to cook fish? Check out some of these healthy fish recipes:

• Mediterranean Bowl with Salmon: This recipe combines omega-3-rich salmon with other heart-healthy ingredients, like leafy greens, quinoa, and chickpeas, to make a nutrient-dense and craveable bowl. 
• Lemon Garlic Sardine Fettuccine: This is a satisfying pasta recipe topped with sardines in a flavorful sauce, which you can serve alongside bitter greens tossed in a light vinaigrette. 
• Trout with Skillet-Roasted Peppers: This is an easy skillet dish using trout fillets, tomatoes, peppers, and plenty of flavors. 

How Fish Compare

To put things side by side, here’s a comparison of fat and cholesterol content per serving, in some popular varieties of fish. 

Fish/Seafood	Cholesterol (mg/3oz)	Saturated Fat (mg/3oz)	Polyunsaturated Omega-3s (mg/3oz)
Salmon, Atlantic (farmed)	37	2.6	3.2
Mackerel (Atlantic)	60	2.8	2.8
Sardines (canned in oil)	120	1.2	1.5
Tuna (light, canned in water)	36	0.7	1.0
Tilapia, cooked	13	0.4	0.3
Cod, Atlantic	37	0.1	0.2
Shrimp, cooked	160	0.05	0.07
Halibut	42	0.3	0.3
Trout, Rainbow (farmed)	50	1.2	1.3

What if I Don’t Eat Fish?

While fish and seafood are the richest sources of omega-3 fats, there are also some plant-based sources, such as flax seeds, chia seeds, and walnuts. Plants primarily contain ALA (alpha-linolenic acid), some of which is converted into EPA and DHA in the body.

However, the conversion rate is low and inconsistent, so it’s not a 1:1 substitution. Some research suggests that the conversion rate is less than 5-10% for EPA and 2-5% for DHA. 

An omega-3 supplement that directly provides DHA and EPA could be a good idea if you don’t eat fish. However, the need for one (and the appropriate dosage for you) should be properly evaluated regarding any medical conditions, medications you use, and other individual health and lifestyle factors. 

Why? When it comes to fish oil supplements, which are a concentrated dose of omega-3s, more isn’t always better. 

One meta-analysis and systematic review of randomized controlled studies looking at 81,200 individuals found that omega-3 supplementation was associated with an increased risk of AF. This was more likely among people who supplemented with over 1000 grams per day.

If you think an omega-3 supplement would be beneficial for your heart health but don’t eat fish, some vegan omega-3 supplements are made using algae instead.

Please be sure to consult with your dietitian and physician before you add a supplement to your diet.

Fish and Cholesterol: The Takeaway

Whenever you’re unsure about whether a certain food is right for your health, it’s best to consult a cardiovascular registered dietitian for personalized recommendations. I’m available for 1:1 counseling to help you design an effective heart-healthy diet that you love—and loves you back. I also offer group coaching to help optimize heart health, which you can learn more about here. 

References

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Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of Long-Term Marine ɷ-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Circulation. 2021 Dec 21;144(25):1981-1990. doi: 10.1161/CIRCULATIONAHA.121.055654. Epub 2021 Oct 6. PMID: 34612056; PMCID: PMC9109217. https://pubmed.ncbi.nlm.nih.gov/34612056/