Cholesterol is a hotly debated topic especially when talking about high cholesterol levels and diet. There remains a lot of confusion about the dietary factors that raise or lower cholesterol levels. Some people turn to vegan or plant-based diets as a way to manage cholesterol levels.
This page covers:
- What is Cholesterol?
- Why is High Cholesterol a Problem?
- What Diet Increases Risk of High Cholesterol?
- What Diet Decreases Risk of High Cholesterol?
- Lifestyle Changes vs Medication for Cholesterol Management
- Can a Vegan Diet Prevent High Cholesterol?
- Can a Vegan Diet Help to Manage High Cholesterol?
- Recipes for High Cholesterol from Lettuce Veg Out
Please note: This is a broad overview of the topic and the details about physiology/ pathophysiology have been simplified for easy reading and understanding. Always speak to a doctor before making any changes to your diet and/ or medications.
What is Cholesterol?
Cholesterol is a term that represents a group of molecules in the lipid (fats) category, meaning cholesterol is a type of fat. Cholesterol is an essential component of the body’s cells and is a precursor for vitamin D and steroid hormones (including estrogen, progesterone and testosterone).
The liver makes cholesterol molecules, but we can also consume cholesterol from foods. Since the liver can produce adequate amounts of cholesterol, cholesterol is not an essential nutrient. People do not need to consume cholesterol from food to survive or be healthy.
Why is High Cholesterol a Problem?
The blood is primarily water but fat and water don’t mix so the body needs a way to transport fat (and cholesterol) molecules around. It does this by using transporting molecules called lipoproteins.
There are different types of lipoprotein molecules but when talking about cholesterol levels, the focus is put on two types called HDL and LDL. HDL is considered a healthy type of cholesterol whereas LDL is considered "lousy" or unhealthy.
A diagnosis of “high cholesterol” typically refers to high LDL levels but always ask your doctor for clarification.
High LDL levels are considered a problem because they can “dump” free cholesterol molecules into the blood stream. This cholesterol can migrate into the artery walls. Over time, with prolonged high cholesterol levels, cholesterol deposits in the artery walls grow and form plaques 1.
Plaques build over time and narrow the diameter of the artery 1. This makes it difficult for blood to flow through sections of the artery that have plaque build-up. Plaques can build in different areas of the arteries and this disease process is called atherosclerosis 1.
How Atherosclerosis Plaque Build-up Can Lead to Artery Blockage
The plaques that form in artery walls are not stable. They can rupture, and if they do, a blood clot forms to heal the rupture (just like a scab heals cuts) 1. This clot could grow in size and block blood flow at the rupture site, or break off from the rupture site and get caught in an area of plaque build-up further along the artery, causing a blockage there 1.
Either way, artery blockage stops blood flow to whatever organ or tissue the artery flows to. The event of having a blocked artery is called many different things, and depends on the organ that the blood flow was going to. The two most common organs this happens to are the heart and brain; we call these events heart attacks and strokes respectively.
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
In Canada, industrially processed trans fats are being phased out of the food supply. Therefore they shouldn’t be a huge concern as food manufacturers won’t be allow to use this type of fat anymore.
Trans fats have consistently been shown to increase LDL cholesterol levels and lower HDL cholesterol levels 4. 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.
I am very careful with my wording around nutrition recommendations especially when talking about removing a food from the diet. However, if ever I were to say that something should be avoided completely, it would be trans fats.
Saturated Fats and Cholesterol Levels
Saturated fats are found in animal products and tropical oils (palm oil, coconut oil). Increased consumption of saturated fats increases cholesterol levels in the blood, particularly LDL levels 2. The key word here is increased: if someone changes the amount of saturated fat they eat, we expect cholesterol levels to change with it.
Experimental research studies have been done to demonstrate the relationship between saturated fat intake and cholesterol levels. A meta-analysis of these experimental studies shows that when someone increases their intake of saturated fat, cholesterol levels increase 2. If someone decreased saturated fat intake, cholesterol levels decrease 2.
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 6. The Portfolio diet’s name comes from the fact that it contains a portfolio of foods, each of which have been shown to decrease cholesterol, and together can have an even more powerful effect 6, 7, 8.
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 9, 10.
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 11.
All these dietary patterns have a common focus towards plant-based foods. Plant-based diets are often associated with lower cholesterol levels 12, 13.
What Foods Decrease Risk of High Cholesterol?
Randomized clinical trials have shown specific foods that lower cholesterol levels. The Portfolio diet combined four of these foods, each with a different mechanism of action, to get maximum cholesterol lowering results 7. The four cholesterol-lowering food components of the Portfolio diet are:
- Soluble fibre
- Soy protein
- Nuts (specifically almonds)
- Plant sterols
A fifth food, legumes, are not specifically included in the Portfolio diet but legumes have been shown to help lower cholesterol levels 14.
Lifestyle Changes vs Medication for Cholesterol Management
Firstly, do not stop taking medications or make changes to your diet without consulting your doctor first. Cholesterol lowering medications can be life-saving.
Rather than questioning your doctor about the need for cholesterol medications, I think a better question would be to ask about the lifestyle changes that have been shown to improve cholesterol levels. In particular, a request to be referred to a Registered Dietitian could be a great way to go about safely implementing dietary changes.
Unfortunately doctors don’t have a lot of time to spend with patients. Lifestyle changes are hard and require specialized support. If possible, work with a Registered Dietitian to make sustainable lifestyle changes.
Again, let me be clear, while the lifestyle and dietary changes noted above are backed by research, they are not intended to replace cholesterol lowering medications unless you’ve explicitly discussed it with your doctor first.
Can a Vegan Diet Prevent High Cholesterol?
This article is about cholesterol levels and a vegan diet so it’s important to note that veganism isn’t about the health of an individual (it’s about animals). So, when talking about making dietary changes in relation to health, I prefer to use the term plant-based diet as that more accurately represents the fact that a plant-based diet is about the health of an individual.
It also helps clear up the fact that a vegan diet isn’t necessarily filled with health promoting foods whereas a plant-based diet is often focused around more whole foods.
Given what we know about plant-based diets and dietary factors related to increasing or decreasing cholesterol levels, it makes sense that a plant-based diet is one that could prevent high cholesterol.
However, for some people, high cholesterol is purely genetic and no amount of lifestyle changes can make an impact. This is one of the many reasons why it’s always recommended to listen to a doctor when making decisions about medications and dietary changes (if you are one of the people who has genetically high cholesterol, medications are likely to be recommended regardless of lifestyle).
Can a Vegan Diet Help Manage High Cholesterol?
What if you already have a diagnosis of high cholesterol? Would implementing lifestyle changes towards a more plant-based diet be helpful to manage high cholesterol?
Generally speaking, given the evidence above related to dietary factors that increase and decrease cholesterol, a plant-based diet (implemented under the supervision of a doctor and Registered Dietitian) could be a great option for managing high cholesterol levels.
Overall, limiting trans fats and saturated fats, while increasing intake of soluble fiber, nuts, soy protein, plant sterols and legumes is supported by research as the lifestyle changes to help lower cholesterol levels. Luckily, soy protein, legumes, nuts and fiber are easy to consume as a vegan or when following a plant-based diet.
Recipes for High Cholesterol from Lettuce Veg Out
Most of the recipes from Lettuce Veg Out include one or more ingredients listed above that could help with cholesterol management. The majority are high in fiber plus there are lots that include soy protein, legumes and nuts (although almond recipes are limited).
Some of my favorites include:
Summary: Cholesterol and a Vegan Diet
High cholesterol is both preventable and manageable through lifestyle changes (after speaking with a doctor). Medication may still be required for some people (always speak with a doctor before making any changes to medications). Lowering intake of trans fats and saturated fats while increasing intake of soluble fiber, soy protein, nuts, plant sterols and legumes is demonstrated in research studies to be effective in lowering cholesterol levels. Vegan diets are commonly high in these health-promoting foods and a transition to focusing on eating these plant-based foods could be helpful for cholesterol management.
Dietary changes are challenging so working with a Registered Dietitian can be extremely helpful in making and sustaining lifestyle changes for long-term health.
Join the Community for Vegan Recipes
- Silverthorn DU, Johnson BR, Ober WC, Garrison CW, Silverthorn AC. Human Physiology: An Integrated Approach. Glenview, IL: Peason Education Inc.; 2013. 612p
- Dietary lipids and blood cholesterol: Quantitative meta-analysis of metabolic ward studies
- The toxicity of dietary trans fats
- Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects
- Trans fatty acids and cardiovascular disease
- Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants
- Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial
- Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials
- Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial
- The Canadian Cardiovascular Society’s Dyslipidemia Guidelines 2016 Update
- “The Mediterranean Diet, its Components, and Cardiovascular Disease”
- Association between plant-based diets and plasma lipids: a systematic review and meta-analysis
- Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials
Please note that this is a curated list of references for the topics above and is not intended to be comprehensive.
Disclaimer: always speak with a doctor before changing your diet. Please read our full website disclaimer.
Author Profile: Nicole Stevens
Nicole is a vegan Registered Dietitian (RD) and founder of Lettuce Veg Out. She provides vegans with balanced meals and easy-to-understand nutrition science.
Having attained a Masters degree and passing a national registration exam, Nicole is a trusted source of nutrition information. She uses this knowledge to educate others about vegan diets and how to thrive as a vegan.