Veggie Blog

The old version of this post said that high cholesterol is linked to a long list of diseases, that most people eat a diet high in saturated fat and “LDL,” and that a low-cholesterol diet plan should not be a fad. The advice to treat the diet as a long-term habit is good, but LDL is not a food, so I have rewritten the post to follow what health agencies actually recommend.

Why follow a low-cholesterol diet plan?

MedlinePlus explains that too much LDL (“bad”) cholesterol in the blood can build up on artery walls and raise your risk of coronary artery disease. The old post called heart disease the number one killer in the U.S., and that is still true: the CDC reports that heart disease was the leading cause of death in 2023. Food is one of the main things you can change. According to the National Heart, Lung, and Blood Institute, the Therapeutic Lifestyle Changes (TLC) and DASH eating plans can help you lower your LDL.

What does the TLC plan ask for?

The numbers from MedlinePlus are a good guide for a plan:

Get 25 to 35 percent of your daily calories from fat, with less than 7 percent from saturated fat (about 13 grams on a 2,000-calorie diet). Eat less than 200 milligrams of dietary cholesterol a day. Aim for 10 to 25 grams of soluble fiber. Include about 2 grams of plant stanols and sterols, omega-3 fish twice a week, and no more than 2,300 mg of sodium a day. Limiting salt will not lower cholesterol, but it lowers blood pressure and heart risk.

Which foods do the work?

The old post says that fiber “soaks up” cholesterol and carries it out of the body, and names apples, oranges, pears, oats and carrots. MedlinePlus describes it this way: soluble fiber helps prevent your digestive tract from absorbing cholesterol. Its list of high-fiber foods includes oatmeal and oat bran, apples, bananas, oranges, pears, prunes, kidney beans, lentils and chickpeas. Carrots are a healthy vegetable, but they are not on that list. Saturated fat, found in some meats, dairy products, baked goods and fried foods, raises LDL more than anything else in your diet, so swap it for unsaturated oils such as olive or canola oil. For specific meals, see how a good diet can lower cholesterol: one example day.

What could one week look like?

This is my own template, not a prescription, and portion sizes depend on your calorie needs. Start the day with oatmeal and fruit. For lunch, have lentil or bean soup with a salad. Eat fish such as salmon or canned tuna twice a week. Make vegetables half the dinner plate, and snack on an apple or a handful of nuts. Keep dessert occasional. The NHLBI recommends preparing foods with little or no salt and eating a variety of nuts. For a longer list of foods to choose, read how to lower cholesterol through diet.

Is diet enough?

Sometimes it is not. The NHLBI says that your provider may also recommend medicines, and that adults with overweight can lower LDL and raise HDL by losing 3 to 5 percent of their body weight. Genes, other conditions and some medicines also affect cholesterol. Ask for a test, and use understanding your cholesterol numbers to read the results. For more recipes and swaps, see MedlinePlus on lowering cholesterol with diet.

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Medicines and vitamins are often mentioned in the same breath when it comes to lowering cholesterol. They are very different. Prescription drugs have been tested in large trials, while many supplements have not. Here is what is known about each, so that you can ask better questions at your next appointment.

How do statins work?

Statins are the medicines most often used to treat high cholesterol. They reduce the amount of cholesterol made in the liver. The NHLBI says that studies have shown that statins lower the risk of heart attack and stroke in people with high LDL. The NHLBI adds that statins usually do not cause side effects, but they may raise the risk of diabetes, mainly in people who are already at high risk of it. Your doctor will weigh the benefits and risks for you. For more, see when lifestyle is enough and when medicine helps.

What are bile acid sequestrants?

These are another type of cholesterol medicine. They keep bile acids, which help digest fats and oils, from being absorbed into the body, and that lowers LDL cholesterol. They may be prescribed if you cannot take statins or if statins alone are not lowering your cholesterol enough. According to the NHLBI, they may cause diarrhea, make some other medicines less effective or raise triglyceride levels.

Does niacin lower cholesterol?

Niacin, also called vitamin B3, can do so, but only in very large doses. The NIH Office of Dietary Supplements says that doses more than 100 times the recommended daily amount, taken for months or years, can raise HDL by 10 to 30 percent and lower LDL by 10 to 25 percent. But in the largest trial to date, which included 25,673 adults with cardiovascular disease, adding extended-release niacin to statin treatment did not significantly reduce major vascular events, and the niacin group had more diabetes, digestive problems and skin rashes. Large doses can also cause flushing, itching, nausea, low blood pressure, raised blood sugar, blurred vision and, over months or years, liver damage. Experts do not agree on its value, and it is not something to start on your own. If a doctor prescribes it, the dose is supervised. For everyday amounts of vitamins, see getting the right amount of vitamins.

What about lecithin, vitamin C and vitamin E?

Lecithin is sold as a supplement that is said to help disperse fat and cholesterol in the body. The studies I could find on lecithin and cholesterol are small and mixed, and it is not a standard treatment, so it is not something to rely on. Vitamins C and E are antioxidants, and it was once hoped that they would protect LDL from damage and prevent heart disease. In practice, large trials have been disappointing. The Office of Dietary Supplements says that the HOPE and HOPE-TOO trials provide compelling evidence that moderately high doses of vitamin E do not reduce serious cardiovascular events, and that most trials have not found conclusive evidence that vitamin C supplements protect against heart disease. Fruits and vegetables, which contain these vitamins together with fiber and other nutrients, are associated with a lower risk of heart disease, and that is the reason to eat more of them.

What is the safest approach?

Start with food: more fiber, fewer saturated fats, regular activity and a healthy weight. Have your cholesterol measured and ask your doctor whether you need medicine, and if so, which type. Tell your doctor and pharmacist about every vitamin and supplement you take, because some can interact with medicines. Our guides to what you can do to lower your cholesterol and vitamin C are a good place to begin.