Following This Eating Plan Could Lower Your Cholesterol, Study Finds
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New research finds that people who follow a vegetarian or vegan diet have lower levels of LDL (bad) cholesterol than those who eat meat.
People who followed a plant-based diet had 10% lower levels of LDL cholesterol than those who ate meat.
Experts say the reasoning is complicated.
About 86 million people in the U.S. have elevated cholesterol levels, putting them at risk for serious complications like heart disease and stroke. High cholesterol is treatable with some lifestyle changes and certain medications, but new research suggests two diets, in particular, may help lower high cholesterol levels: a vegan and vegetarian diet.
That’s the major takeaway from the scientific analysis, which was published in the European Heart Journal. For the study, researchers analyzed data from 30 studies that looked at the impact of vegetarian or vegan diets vs. a meat-eating diet on cholesterol in adults. The researchers found that levels of low-density lipoproteins (LDL, or “bad” cholesterol), decreased 10% in people who followed a plant-based diet compared to people who ate meat, while total cholesterol dropped by 7%.
The study also found that a plant-based diet was linked with a 14% drop in apolipoprotein B (apoB), a protein found in blood that measures how much a certain type of fat and cholesterol is in the body.
“Cardiovascular disease is increasing worldwide,” says study co-author Ruth Frikke-Schmidt, M.D., Ph.D., deputy head of the Department of Clinical Medicine at the University of Copenhagen. “Timely prevention of getting high cholesterol is paramount because high cholesterol is a direct cause of cardiovascular disease.”
But why is a vegetarian or vegan diet linked to lower cholesterol? Here’s the deal.
Why might a vegetarian or vegan diet lower cholesterol?
The researchers didn’t explore this in the study—they simply found an association. However, there are a few theories.
On a basic level, “plant-based diets contain less cholesterol,” Dr. Frikke-Schmidt says. “Saturated fat is a major contributor to raising LDL cholesterol, and the main source of that is from animal products like meat and butter,” says Ali Haider, M.D., an interventional cardiologist at NewYork-Presbyterian Queens. “Eliminating that dietary source will naturally reduce dietary cholesterol.”
But it’s a little more complicated than that. “It often goes beyond that,” says Yu-Ming Ni, M.D., a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif.
Diets that include animal fats not only tend to be higher in saturated fat, but they may also raise bodily inflammation that can contribute to higher cholesterol, he says. Plant-based diets may also contribute to a healthier body weight, which has also been linked to lower cholesterol levels, he says.
Plant-based diets are high in fiber, too, points out Jessica Cording, R.D., author of The Little Book of Game-Changers. “A plant-forward diet includes a lot of vegetables, legumes, whole grains, nuts, seeds, and fruit—and they all have a lot of fiber,” she says. “Fiber, specifically soluble fiber, has been shown to reduce LDL cholesterol.”
Many foods that are rich in dietary fiber also contain plant sterols, says Scott Keatley, R.D., co-owner of Keatley Medical Nutrition Therapy. “These are plant compounds that are structurally similar to cholesterol and can help block cholesterol absorption in your gut, which can further reduce LDL cholesterol levels,” he explains.
The fiber in plant-based diets may also help you feel fuller longer, says M. Wesley Milks, M.D., a preventive cardiologist and clinical assistant professor of internal medicine in the division of Cardiovascular Medicine at The Ohio State University Wexner Medical Center. “The increased fiber may also help promote satiety with a greater bulk of ingested food per calorie as compared with meat, thereby filling the stomach and curbing appetite more efficiently, although the study was not focused on weight loss,” he explains.
But a plant-based diet can do more than just lower your cholesterol. “I always recommend plant-based diets regardless of cholesterol levels as they not only lower cardiovascular risk but also decrease the risk of cancer, diabetes, high blood pressure, and dementia,” says Thomas Boyden, M.D., medical director for preventive cardiology and cardiac rehabilitation at Corewell Health in Grand Rapids, Mich.
What else can lower your cholesterol?
Dr. Ni points out that there are a lot of factors that go into your cholesterol levels. “Diet is just one part of the foundation of health,” he says. He notes that the American Heart Association (AHA) lists eight different factors that can help promote a healthy heart. Those include:
Eating a healthy diet that includes whole foods, lots of fruits and vegetables, lean protein, nuts, seeds, and cooking in non-tropical oils such as olive and canola.
Strive to get 2.5 hours of moderate or 75 minutes of vigorous physical activity a week.
Avoid tobacco products.
Aim to get seven to nine hours of sleep a night.
Maintain a healthy body weight.
Control high cholesterol.
Manage your blood sugar.
Manage your blood pressure.
“Anyone with high cholesterol should understand their individual cardiovascular risk and focus on improving their diet, getting moderate physical activity routinely, and taking medications to lower their cholesterol based on their individual risk,” Dr. Boyden says.
Can a plant-based diet replace medications?
Dr. Frikke-Schmidt cautions against interpreting these findings as saying a plant-based diet can do the same work as cholesterol-lowering medications. “Cholesterol-lowering drugs are much more efficient in lowering your cholesterol levels than plant-based diets,” she says. “If your doctor has prescribed a cholesterol-lowering drug to you, it is very important to maintain the drug treatment.”
Dr. Ni agrees. “There are many people with high cholesterol where changes in diet don’t influence that much,” he says. “In some cases, you need to take medications.”
However, Dr. Frikke-Schmidt says that a vegan or vegetarian diet could be one factor in lowering cholesterol. “Healthy, plant-based foods are a supplement on top of drug treatment for patients,” she says.
But Dr. Ni says that “every case is different” with high cholesterol. “Some people are able to get their cholesterol down with diet alone and others require certain medications,” he says. It ultimately involves careful collaboration with your doctor to see which treatment method is best for you, he says.
How to add more plant-based foods to your diet
Dr. Ni says you don’t necessarily have to go full-on vegetarian or vegan to help lower your cholesterol—and many people with high cholesterol don’t want to anyway. “Some of my patients are motivated to eat a fully vegetarian or vegan diet, but most struggle to do that,” he says. “I tell them to just try to limit the amount of animal products they have more than anything else.”
Dr. Ni recommends having red meat no more than once a week and having leaner animal proteins like chicken and fish, along with some meals that are entirely plant-based.
Dr. Milks also says a strictly vegetarian or vegan diet can be “difficult” for many of his patients. “I usually tell them to focus on a Mediterranean-style eating pattern that emphasizes vegetable intake, whole grains rather than processed carbohydrates, and fat and protein sources that ideally come from plants or seafood, and less from (particularly red) meats,” he says.
“Every patient is different and I tailor my recommendations based on individual habits, culture, and realistic expectations,” Dr. Haider says. “Patients need to understand and believe the concepts to make true change.”
Keatley points out that “there are many ways to be a vegetarian.” “I would recommend going no further than a lacto-ovo-pescatarian, meaning you still consume dairy, eggs, and fish/shellfish,” he says. “This will allow you to have a varied diet, consume high-quality protein, and minimize fat intake.”
Cording recommends trying to increase your fiber intake to the recommended 25 to 30 g a day. Just do it gradually, Keatley says. “Adding too much fiber to the diet too quickly can lead to digestive discomfort like bloating, gas, and cramps,” he says.
And, if you’re concerned about your cholesterol, Dr. Frikke-Schmidt recommends talking to your doctor. They should be able to help you come up with a personalized plan that works for you.
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