You may have heard that pizza is an unhealthy fast food high in saturated fats and sodium (1).

So, you might be wondering whether it’s OK to eat pizza if you’re watching your cholesterol levels.

A key point to consider is that there are many types of pizzas to choose from, with a variety of toppings. These may improve or worsen the pizza’s nutritional quality and, consequently, your cholesterol levels.

This article explains whether it’s safe to enjoy pizza if you have high cholesterol levels.

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Your body needs cholesterol, an essential fatty molecule, to survive.

It requires cholesterol for many healthy cell functions, including (2, 3):

  • giving your cells structure
  • producing hormones and vitamin D
  • absorbing vitamins A, D, E, and K
  • aiding digestion

However, if cholesterol — particularly LDL (bad) cholesterol — reaches especially high blood levels, it may increase your risk of heart disease (2).

High LDL (bad) cholesterol levels may increase your risk of plaque buildup inside your veins, leading to an increased risk of heart attack and stroke (2, 4).

Your liver produces some cholesterol, and you may also consume cholesterol from animal sources. As a result, a pizza’s cholesterol content depends mostly on its animal-based ingredients — pepperoni, sausage, ham, and other popular meat toppings.

Summary

Dietary cholesterol comes from animal food sources. So, your pizza’s cholesterol level may vary depending on its animal-based toppings, including meats like pepperoni, sausage, and ham.

It’s safe to eat pizza if you have high cholesterol levels as long as you keep in mind that not all pizzas are the same.

For example, you may divide pizzas into two categories: ultra-processed pizza and authentic Italian-style pizza that is made with fresh ingredients.

Ultra-processed foods are defined as multi-ingredient industrial formulations. These include frozen and fast-food pizzas made with other processed foods, such as cured meats and cheese (5).

Research shows that high intakes of ultra-processed foods are associated with increases in total cholesterol, LDL (bad) cholesterol, and heart disease risk (6, 7).

Additionally, fast food tends to be higher in calories, higher in saturated fat and salt, and larger in portion sizes than other foods (8).

This increases your overall fat intake.

On the other hand, authentic Italian-style pizza is prepared with higher-quality ingredients.

For instance, pizza Napoletana is characterized by a soft, thin dough made of wheat flour, yeast, salt, and water; prepared with fresh tomato sauce and mozzarella cheese; and topped with oregano, basil, and garlic.

When made with higher-quality ingredients such as fresh tomato sauce, pizza may be a source of antioxidants such as lycopene. Lycopene is a pigment present in tomatoes that fights harmful free radicals and may even lower the risk of heart disease (9).

Free radicals are unstable molecules that may cause damage to your cells. Antioxidants help stabilize free radicals to prevent this damage.

Mind the toppings

Your choice of toppings may quickly turn a nutritious pizza into a greasy, high cholesterol pie.

Some of the most popular animal-based pizza toppings are processed meats. Studies have linked processed meat intake with increased heart disease risk due to the high saturated fat and cholesterol content of these meats (10, 11).

For instance, a meta-analysis in 614,062 people found that those who had a daily intake of 50 grams of processed meat had a 42% higher risk of heart disease (12).

Most people consider cheese to be an essential ingredient in pizza. But because this dairy product contains fat and dietary cholesterol, you may wonder whether it will increase your cholesterol levels.

Research suggests that while cheese is a source of saturated fat and dietary cholesterol, it has little to no effect on your cholesterol levels (13, 14).

One 12-week study in 164 people with two or more risk factors for heart disease found that eating regular-fat cheese didn’t increase LDL (bad) cholesterol levels any more than eating reduced-fat cheese did (15).

Moreover, a study that compared the effect of eating cheese or butter on blood cholesterol levels found that cheese lowered LDL (bad) cholesterol levels (16).

Summary

You may enjoy some pizza even if you have high cholesterol levels. Just make sure to opt for high quality ingredients and cut back on processed meat toppings.

People adore pizza in all its forms, which is why countless alternatives and variations are available that enable almost everyone to enjoy a slice or two, regardless of dietary needs.

Lowering your pizza’s cholesterol content is quite easy.

Here are some tips you could try the next time you crave pizza:

  • Swap toppings. Trading processed meats for vegetables will lower a pizza’s cholesterol content while increasing fiber content. Increasing your intake of fiber — especially soluble fiber — may help lower your blood cholesterol levels (17).
  • Try a different base. Adding more veggies to your pizza doesn’t have to be limited to toppings. Try swapping the flour-based pizza crust for a veggie-based crust. Some popular recipes call for cauliflower, broccoli, squash, or zucchini.
  • Avoid stuffed-crust pizza. One slice of a stuffed-crust pizza may contain up to 13 grams of fat and 35 mg of cholesterol, while one slice of a regular-crust pizza contains 10 grams of fat and 18 mg of cholesterol (18, 19).
  • Make your own pizza. Fast foods and some restaurant meals are high in processed meats, fat, cholesterol, and sodium and low in fiber and other essential nutrients. Switching to homemade pizza may increase dietary diversity (20, 21).
  • Stick to oven-baked pizzas. Cooking methods may significantly affect your meal’s nutritional quality. Baking your pizza doesn’t add any fat, but deep-frying forms trans fats, which increase LDL (bad) cholesterol levels and heart disease risk (22).
  • Opt for traditional Italian-style pizza. Authentic Italian-style pizzas are more nutritious than the fast-food alternative.
Summary

Swap processed meats for veggies, try a veggie-based crust, avoid stuffed-crust and deep-fried pizzas, and opt for an Italian-style or homemade pizza if trying to lower your pizza’s cholesterol content.

You can make pizza as nutritious as you wish with the ingredients you choose.

You can still enjoy pizza if you’re watching your cholesterol levels. It mainly depends on the type of pizza you consume, which toppings you choose, and the cooking method used to prepare it.

Try some of the tips mentioned above for a lower-cholesterol pizza.