Vegan diets are sometimes promoted for cholesterol management. This article reviews the role of cholesterol in the body, dietary components that impact cholesterol levels and the effect of different plant-based dietary patterns on cholesterol and cardiovascular outcomes.
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What is Cholesterol?
Cholesterol is a type of lipid (fat). It plays a vital role in the body, serving as a component of cell membranes and acts as a precursor for vitamin D, steroid hormones, reproductive hormones, and bile salts 1.
While the body can make cholesterol, we can also consume it in foods. Since the body can produce enough cholesterol, it is not an essential nutrient. People do not need to consume cholesterol from food to survive or be healthy.
Cholesterol in the Body
The body is composed of water and fat, which don’t mix. Fats need to be moved around the body via the bloodstream which is mainly water.
To do this, the body uses lipoproteins. Cholesterol, being a type of fat, is transported through the bloodstream via these lipoproteins.
Low density lipoproteins (LDL) transport much of the cholesterol in the body and typically bring cholesterol from the liver to other cells. High density lipoproteins (HDL) usually carry cholesterol from cells in the body to the liver, where it’s often eliminated from the body 1.
High LDL levels are considered problematic whereas higher HDL levels are considered favorable.
Why Is High Cholesterol a Problem?
High LDL levels are concerning because they are a major factor that contributes to the development of plaques in artery walls. The formation of these plaques, referred to as atherosclerosis, is associated with increased risk for many cardiovascular diseases 1.
Atherosclerotic plaques can build up over time and narrow the diameter of the artery. This makes it difficult for blood to flow through sections of the artery that have plaque build-up.
Plaques are not stable and can rupture. If they do, it can form a blood clot which can either grow in size and block blood flow at the rupture site, or break off and get caught in the artery elsewhere, causing a blockage there.
Either way, a blocked artery limits blood flow to whatever organ or tissue it was flowing to, cutting off oxygen supply and causing damage to that organ or tissue.
If blood flow to the heart muscle is blocked, it’s called a heart attack (myocardial infarction). Alternatively, if blood flow is blocked to the brain, it’s called a stroke.
What Diet Increases Risk of High Cholesterol?
There are numerous dietary factors that have been shown to increase and decrease cholesterol levels in humans. The two main factors shown to increase cholesterol levels are trans fats and saturated fats 2, 3, 4, 5.
A diet that increases risk of high cholesterol is generally one that contains high levels of trans fats and/or saturated fats as well as lower levels of the nutrients and foods that are found to decrease risk of high cholesterol.
Trans Fats and Cholesterol Levels
This is a double insult to the body and is likely the reason why trans fats have consistently been shown to increase heart disease risk, and death from cardiovascular disease. They are also thought to cause systemic inflammation, which can lead to other chronic illnesses 3.
Due to their adverse health impacts, many countries have either banned their use in the food supply or are in the process of phasing out their use.
Saturated Fats and Cholesterol Levels
Research consistently shows that increased consumption of saturated fats increases cholesterol levels in the blood, particularly LDL levels 4, 5. Changing intake of saturated fats is expected to change LDL levels 5.
Saturated fat intake is a hotly debated topic, largely due research that fails to find an association between saturated fat intake and cardiovascular disease events 6. Other research does find this association 7.
This led many people to suggest that saturated fat intake isn’t a concern, and limiting saturated fat intake is unnecessary. However, to date, research still supports the idea that lowering saturated fat intake is related to a lower risk of cardiovascular disease events 4, 7.
Furthermore, it appears that greater reductions in saturated fat intake result in greater reductions in risk of cardiovascular disease events 4.
Additional Saturated Fat Considerations
A main area of confusion in this research is what nutrient to replace saturated fats with. Research shows that replacing saturated fats with refined carbohydrates or protein from meat is associated with higher risk of cardiovascular disease 8.
Conversely, replacing saturated fats with plant-based proteins, unsaturated fats or complex carbohydrates is associated with a reduced or neutral risk of cardiovascular disease 8.
Finally, saturated fats aren’t all considered equal. They vary in size, also called chain length, and the length of the saturated fat appears to relate to its health outcomes.
Longer chain saturated fats are more strongly associated with an increased risk of cardiovascular disease whereas short or medium chain saturated fats show a neutral association 8.
What Diet Decreases Risk of High Cholesterol?
Research shows that certain dietary patterns can help lower cholesterol. One diet in particular, the Portfolio diet, was pitted against a low saturated fat diet with cholesterol lowering medication and was found to be almost just as effective 9, 10.
Direct comparison of a low-saturated fat diet and the Portfolio diet showed a greater reduction in LDL cholesterol with the Portfolio diet 11.
Another diet that may be beneficial in lowering cholesterol is the DASH diet (Dietary Approaches to Stop Hypertension). The DASH diet was designed to lower blood pressure and to improve cardiovascular health. Some evidence suggests DASH is also helpful for lowering cholesterol 12.
A third dietary pattern that can improve cardiovascular health is the Mediterranean diet. Quality evidence shows that the Mediterranean diet can decrease risk of heart disease; one of the ways it does this is through improving cholesterol levels 13.
All these dietary patterns have a common focus towards plant-based foods. Plant-based diets, vegetarian, and vegan diets are all associated with lower cholesterol levels and improved cardiovascular health 14, 15.
What Foods Decrease Risk of High Cholesterol?
Randomized clinical trials have shown specific foods lower cholesterol levels. The Portfolio diet combined four of these foods, each with a different mechanism of action, to get maximum cholesterol lowering results.
The four cholesterol-lowering components of the Portfolio diet are: 9
- Soluble fiber
- Soy protein
- Nuts (specifically almonds)
- Plant sterols
A fifth food, legumes, are not specifically included in the Portfolio diet but have been shown to help lower cholesterol levels 18.
Can a Vegan Diet Prevent High Cholesterol?
There is extensive research that suggests plant-based dietary patterns lower LDL cholesterol levels. These dietary patterns include the Portfolio diet 9, Mediterranean diet 13, DASH diet 12 as well as Nordic dietary patterns 19, vegetarian and vegan diets 14.
The research examining dietary patterns and cholesterol levels are typically randomized controlled trials, which can help to assess causation. In these trials, it’s found that various plant-based dietary patterns can lower cholesterol.
While lowering cholesterol is considered beneficial, the reason to do so is for improved cardiovascular health and to prevent cardiovascular diseases.
In addition to their cholesterol-lowering effects, plant-based dietary patterns are also generally associated with lower risk of cardiovascular disease outcomes 19. These studies examine correlations which cannot assess causation but help support the idea that a diet that results in lower cholesterol levels can also reduce risk of cardiovascular disease.
Regardless, for some people, high cholesterol is genetic. This group of people likely require medications to manage cholesterol levels. Always speak with your doctor before making any changes to your diet and/or medications.
Summary: Cholesterol for Vegans
Research supports the notion that dietary choices can greatly influence cholesterol levels. Opting for a balanced diet rich in soluble fiber, soy protein, nuts, plant sterols, and legumes can support healthful cholesterol levels.
Embracing plant-based dietary patterns, such as vegetarian or vegan diets, is generally found to benefit cholesterol levels and is associated with decreased risk of cardiovascular diseases.
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About Nicole Stevens
Nicole is a vegan Registered Dietitian (RD) and founder of Lettuce Veg Out.
She helps people thrive on a vegan diet with balanced recipes and easy-to-understand nutrition science.