High cholesterol in vegetarians


Benefits of a Vegetarian Diet When You Have High Cholesterol

Cutting meat and dairy from your diet is one way to lower your high cholesterol levels, since the saturated fats that raise blood cholesterol come primarily from animal products. And even better, a vegetarian diet may lower your risk for chronic health conditions like obesity, high blood pressure, heart disease, diabetes, and some types of cancer. Here’s how to do it right.

Is a Vegetarian Diet Safe and Nutritious?

A well-rounded vegetarian diet can be healthy and nutritionally sound with some careful planning. Here are tips to make sure you’re getting enough essential nutrients:

  • Protein You can get all the protein you need from a vegetarian diet. Pulses (beans and peas), legumes, and soy are all rich sources of protein. Good sources of plant protein include whole grains, seeds, nuts, and some vegetables.
  • Iron A vegetarian diet may put you at higher risk for iron deficiency. Make sure to get enough good plant-based sources of iron, like dried beans, spinach, dried fruits, and yeast in your diet.
  • Vitamin B12 This vitamin is important for reducing the risk of heart disease, and vegetarians often don’t get enough B12, which could put them at risk. You can make sure to get enough vitamin B12 by including a type of seaweed called dried purple laver (nori) in your diet, eating fortified products such as B12-fortified soy milk or cereal, or taking a B12 supplement.
  • Zinc This mineral is important for growth and development. Grains, nuts, and legumes are good sources of zinc.
  • Vitamin D If you don’t include dairy in your vegetarian diet and you don’t spend much time outdoors in the sun, you might not get the vitamin D you need. You may want to supplement your diet with vitamin D and calcium.

Vegetarian Cooking Tips to Lower Cholesterol

Even though a vegetarian diet eliminates animal foods as a source of saturated fat, if you have high cholesterol, you’ll still need to watch out for sources of fat and cooking methods that can affect your cholesterol levels.

  • Avoid trans fats. Many vegetable oils have hydrogen added to them. Called hydrogenated oils, these are high in trans fats, which can raise your cholesterol levels. Read the labels of any butter substitute or cooking oil you’re choosing in order to avoid trans fats when you cook.
  • Limit saturated fats. These fats can raise your cholesterol levels and are primarily found in meat and full-fat dairy products. But beware that coconut, palm, and palm kernel oils do contain saturated fats. Consider substitutes like the heart-healthy oils below.
  • Add heart-healthy oils. Cook with healthier unsaturated fats, found in heart-healthy oils like safflower, corn, olive, canola, and peanut oils, to help lower your cholesterol levels.
  • Try low-fat cooking. You can sauté in water instead of oil, or use just a very small amount of canola or olive oil to sauté instead of frying. Broiling, steaming, poaching, and boiling are better than frying when you’re watching the amount of fat and calories in your diet. When baking, you can cut back on the amount of oil or margarine and replace it with water, juice, or applesauce.

Vegetarian Diet: Eating Out

Eating out and sticking to your vegetarian diet can be a challenge. Here are some tips to help you:

  • Plan in advance. Think about what kind of restaurant you want to go to so you’ll have more plant-based options. In addition to vegetarian spots, international choices, such as Italian, Chinese, Mexican, Thai, and Japanese restaurants, tend to have more vegetarian diet selections.
  • Call ahead. Inquire about the menu when you make reservations.
  • Talk to your server. Don’t assume that your server knows that food prepared in chicken stock isn’t vegetarian, or that lard and gelatin are animal products. Be specific about your dietary requirements to avoid surprises in your meal.
  • Ask for a substitution. Many restaurants will gladly substitute meatless pasta or exchange a baked potato for a fried side order. You can also request that your meal be prepared with unsaturated oil to help with your cholesterol levels.

RELATED: Why I Went Vegan for a Healthier Heart

Talk About Your Vegetarian Diet Choice

Family members and friends who are unfamiliar with a vegetarian diet may try to discourage you because they think a diet without animal foods isn’t safe or nutritious. Here are ways to get their support:

  • Educate yourself. Be ready to explain the benefits of a vegetarian diet. Assure family members and friends that a balanced vegetarian diet isn’t missing any nutrients compared with one that includes animal products.
  • Don’t preach. You’ve decided to pursue a vegetarian diet because you think it’s a healthier choice, but don’t expect to change someone else’s diet.
  • Be patient. A vegetarian diet can seem like a radical idea to people who aren’t familiar with it.
  • Be responsible. Don’t expect your family to change their cooking and eating habits and start making meals just for you. Be prepared to do your own cooking and shopping, and have the plant-based ingredients you need on hand.
  • Share your food. Once you’ve convinced your family that a vegetarian diet is healthy, prepare a vegetarian meal once a week to share with them. Show them that a vegetarian diet can also be appetizing and filling.

If you’re worried about cholesterol, adopting a vegetarian diet is a good option to consider. Vegetarian diets are low in total fat and saturated fat, and high in fiber, all of which can help you lower your cholesterol. A carefully planned vegetarian diet is good for your heart and can include all the important nutrients you need.

How do vegans get cholesterol? Whether diet or genetics, here’s all you need to know about cholesterol on a plant-based diet.

According to MedlinePlus, an online service launched by the U.S. United States National Library of Medicine, cholesterol is a waxy, fat-like substance present in all of the body’s cells. It’s needed in order to make steroid hormones, vitamin D, and bile acids, which aid in the digestion of dietary fats and oils. The human body is capable of making all of the cholesterol it needs, but it is also present in animal-based foods, including meat, cheese, and eggs.

What Is Cholesterol?

There are three different types of cholesterol. HDL, or high-density lipoprotein, is known as “good” cholesterol. HDL carries cholesterol throughout your body to your liver, which then “recycles” it in bile form into the digestive tract. About 50 percent of this is absorbed back into the body via the small intestine.

LDL, or low-density lipoprotein, is what’s known as “bad” cholesterol. High levels of LDL has been linked to the buildup of plaque in arteries as well as other health issues.

VLDL, or very low-density lipoprotein, is also considered a “bad” cholesterol, but while LDL carries cholesterol, VLDL carries triglycerides. Triglycerides are the most common type of fat found in the human body. When you eat too many calories for your body, VLDL cholesterol particles carry triglycerides to your tissues, where it is stored in body fat. Your body then releases triglycerides when energy is needed.

Where Does ‘Bad’ Cholesterol Come From?

According to Dr. Michael Greger, founder of NutritionFacts.org, LDL cholesterol is found in trans fats, which is found in processed foods and naturally in meat and dairy. The Mayo Clinic notes that this trans fats are “double trouble” for heart health due to the fact that it raises LDL levels while lowering “good” HDL levels.

Trans fat is added to processed foods through an industrial process where hydrogen is added to vegetable oil, which allows the oil to be solid at room temperature. On ingredients labels, it’s called “partially hydrogenated vegetable oil,” and it is used to give many packaged foods a longer shelf life. It is also used for deep-frying by some restaurants because partially hydrogenated oil does not need to be changed as often.

Foods that typically contain trans fats include commercial baked goods, snacks like chips and crackers, refrigerated dough such as cinnamon rolls and pizza crusts, fried foods, and margarine. Cheese, butter, and processed meat like bacon, breakfast sausages, ham, and hot dogs are also high in “bad” cholesterol.

What Is the Ideal Cholesterol Ratio?

Measuring your cholesterol levels is considered an effective way of determining your risk of heart disease and stroke. According to the American Heart Association (AHA), all adults over the age of 20 should have their cholesterol checked every four to six years.

When it comes to measuring your cholesterol, there are two things to keeIsp in mind. The first is your total cholesterol level, which is measured by a health professional via a blood test. This number is calculated from your HDL, LDL, and 20 percent of your triglycerides. Typically, you want this number to be below 200.

However, many health professionals stand by measuring your cholesterol ratio. According to the AHA, this is obtained by dividing the HDL cholesterol level into your total cholesterol.“For example, if a person has a total cholesterol of 200 and an HDL cholesterol level of 50, the ratio would be 4:1,” the organization writes.

The ideal level of cholesterol varies from person to person and can also be determined by genetics. The Framingham Heart Study says that a cholesterol ratio of five indicates an average heart attack risk for men and the risk doubles if the ratio reaches 9.6.

Women, meanwhile, are more likely to have higher levels of good cholesterol. A ratio of 4.4 is average heart attack risk for women and it doubles if that number reaches seven.

What Are the Health Risks of High Cholesterol?

High cholesterol comes with a number of health risks. If you have too much in your blood, cholesterol can combine with other substances such as calcium and fat to form plaque, which sticks to the walls of your arteries. This can lead to a condition known as atherosclerosis, a disease marked by the hardening or narrowing of arteries. If left untreated, atherosclerosis can lead to coronary artery disease, carotid artery disease, peripheral artery disease, heart attack, stroke, chronic kidney disease, or premature death.

What Raises the Risk of High Cholesterol?

Beyond diet, there are a number of lifestyle factors that can contribute to high cholesterol levels. Smoking is known to lower good cholesterol levels and also damages your arteries and blood vessels, raisin the risk of plaque buildup. Those who are more sedentary may also have a greater risk of having high cholesterol.

Your risk can also be affected by your family history. Those with a family history of heart disease may need to take extra care in monitoring their cholesterol ratio because arteries harden with plaque buildup, meaning the body needs to work harder to pump blood. Diabetics may also have a greater risk, as their LDL particles tend to stick to arteries. Glucose also attaches to lippoproteins, which remains in the bloodstream longer and may lead to the formation of plaque.

Saturated Fat and Cholesterol

Eating foods that are high in saturated fat can also raise your “bad” cholesterol levels, thus raising your heart attack risk.

The American Heart Association states that foods high in saturated fat include meat like beef, lamb, poultry, and pork. Dairy products include butter, cream, and cheese made from 2 percent or whole milk. Some plant-based foods include saturated fat: coconut, coconut oil and cocoa butter, palm oil, and palm kernel oil.

A recent study published in the Journal of Internal Cardiology revealed that eating less meat and more plant-based foods lowers your risk of heart attack.

“We found that eating relatively little of the longer chained saturated fatty acids and consuming plant-based proteins instead was associated with a lowered risk. Substitution of those saturated fats with other energy sources such as carbohydrates did not affect the risk to develop myocardial infarction,” said study lead investigator, Dr. Ivonne Sluijs of Utrecht University in the Netherlands.

Do Vegans Need to Worry About Cholesterol?

Those who follow a plant-based diet are known to have lower cholesterol levels compared to those who consume animal products. According to Livestrong, for a food item to contain dietary cholesterol, it must come from an animal-based source. Cholesterol is still important to certain bodily functions, but your body is typically able to produce everything it needs.

If you are looking to lower your cholesterol, consult with your doctor about introducing more plant-based meals into your diet.

Which Foods Lower Bad Cholesterol?

If you have high cholesterol, there are a number of plant-based foods that can help lower your levels, according to Harvard Health.

1. Oats, Barley, and Other Whole Grains

Oats, or whole grain, oat-based cereal like One Degree Organics Sprouted Oat O’s or Cascadian Farms Purely O’s, which is made from oats and barley, can help get your cholesterol levels where they’re supposed to be. Try having steelcut or overnight oatmeal for breakfast or use rolled oats to make vegan pancakes and healthy baked treats like plant-based muffins or oatmeal breakfast cookies.

You can also incorporate more whole grains into your diet by swapping enriched pasta and bread for whole wheat, like Bionature Whole Wheat Spaghetti or Dave’s Killer Bread.

2. Beans and Legumes

Beans of all kinds are rich in soluble fiber, meaning they take the body longer to digest and help you feel fuller, longer. Harvard Health recommends eating a wide variety of beans, including chickpeas, lentils, black-eyed peas, navy beans, and kidney beans. Try whipping up a delicious chickpea curry for your weeknight meal, or make a vegan lentil loaf.

If you don’t like beans or lentils, try using legume-based pasta from brands like Banza Chickpea Pasta Shells or Explore Organics Edamame and Mung Bean Fettuccini.

Soybean and soy-derived foods like tofu, tempeh, and Silk Organic Soymilk are also effective in lowering cholesterol.

3. Nuts

Eating two ounces of nuts daily, including walnuts, almonds, peanuts, and other varieties can lower your LDL cholesterol by as much as 5 percent. They’re also packed with other heart-healthy nutrients. You can eat nuts whole, or try a nut-based milk like walnut milk, peanut milk, or good old-fashioned almond milk.

4. Vegetables and Vegetable Oil

Healthline recommends incorporating soluble fiber-rich vegetables like eggplant, okra, carrots, and potatoes into your diet to help lower cholesterol. This also includes dark, leafy greens such as kale, spinach, and collard greens.

According to Harvard Health, swapping dairy butter for liquid vegetable oils such as canola, sunflower, and safflower can help lower LDL.

5. Fruit

Pectin-rich fruit such as apples, grapes, citrus fruit, and strawberries can help lower LDL. Avocados are a rich source of monounsaturated fats and fiber, both of which two help your body lower “bad” LDL and raise “good” HDL cholesterol (5).

According to Dr. Greger, eating dried apple rings can also lower bad cholesterol levels, while dates despite their high sugar content, can lower your triglycerides.

6. Dark Chocolate

It might sound too good to be true, but studies have shown that dark chocolate can help lower bad cholesterol, too. In one study involving adults who drank a cocoa beverage twice daily for a month, participants experienced lower LDL levels and increased HDL. When choosing dark chocolate, look for a fair trade brand that contains at least 75-85 percent cocoa.

How to Get Good Cholesterol on a Plant-Based Diet

Many of the foods that lower LDL will promote the production of HDL cholesterol. This includes avocado, soy-based foods, vegetable oil, whole grains, fruit, beans, and legumes. Healthline advises incorporating a few other foods into your diet in order to raise HDL levels.

1. Nuts and Seeds

Nuts such as almonds, pistachios, peanuts, and Brazil nuts contain a substance called plant sterols, which block the absorption of LDL cholesterol and promote HDL. Seeds like chia and flax are both rich sources of heart-healthy omega-3 fatty acids – but nutritionists recommend grinding both in order to make all of the nutrients bioavailable.

Mix ground flax or chia into oatmeal or smoothies, make a chia pudding, or use it to replace chicken eggs in traditional baking.

2. Use Extra-Virgin Olive Oil and Coconut Oil

Swap other oils for extra-virgin olive oil and coconut oil to promote HDL cholesterol levels. Studies have attributed the presence of antioxidants known as polyphenols in olive oil to healthy cholesterol. Meanwhile, evidence shows that coconut oil tends to raise HDL levels more than other types of fat. Use these instead of dairy butter or other oils in cooking or baking.

3. Purple Fruits and Veggies

Opt for antioxidant-rich purple produce like eggplant, purple corn, red cabbage, blueberries, blackberries and black raspberries. They’re rich in an antioxidant called anthocyanin, which has been shown to increase good cholesterol.

4. Red Wine

Like dark chocolate, it might sound too good to be true, but drinking a moderate amount of red wine daily (that’s one glass for women and two for men) has been shown to improve good cholesterol levels. Be sure to check your red wine on a site like Barnivore to ensure that it’s free from any hidden animal ingredients.

5. Exercise Regularly and Stop Smoking

If you’re a smoker, studies have shown that smoking can inhibit the production of HDL cholesterol. In one study of more than 1,500 people, those who quit smoking experienced twice the increase in HDL as those who resumed smoking within the year.

Being physically active is another way to maintain healthy cholesterol levels, particularly for strength training, aerobics, and high-intensity exercise such as HIIT (high-intensity interval training) and HICT (high-intensity circuit training). However, even low-intensity exercise has been shown to increase HDL’s anti-inflammatory and antioxidant capabilities.

6. Plan Your Meals

One of the best ways to ensure that you’re avoiding certain foods while making sure to get enough of the heart-healthy foods you need is to plan your meals. Planning your meals has been shown to have a multitude of benefits from losing weight, helping you stick to a healthier diet, saving money, and reducing food waste. Not only can you ensure that you”re eating what you should, meal planning can also keep you from caving in and buying things you’re trying to avoid, like last-minute fast-food dinners.

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Summary Article Name How Do Vegans Get Cholesterol? Description How do vegans get cholesterol? Everything you need to know about what causes cholesterol and why there’s some good kinds you need in your diet. Author Kat Smith Publisher Name LIVEKINDLY Publisher Logo

Healthy vegetarian diet

What is a healthy vegetarian diet?

Healthy vegetarian diets are thought to be easy – just fill your plate with vegetables and you’ll be fine. However, the situation is a little more complicated than this. There are definitely vegetarians with high cholesterol. That’s because high levels of (bad) cholesterol can be partly due to the type of fats consumed in your diet, and it’s still possible to eat a diet high in saturated and trans fat even if you’re not eating meat. Cheeses, creams, butter, pastries, biscuits, cake and some processed foods are all vegetarian sources of saturated fat.

Vegans with high cholesterol: What to eat

If vegetarians can have high cholesterol, how about vegans? A lot of the foods that when eaten in large amounts across your diet are likely to increase your (bad) cholesterol levels are eradicated in a vegan diet, but not all. Coconut oil is an example of a plant-based food thought to be healthy, but which actually contains high levels of saturated fat. Also, some people who eat only plant-based foods will be genetically pre-disposed to high cholesterol levels. That means it’s still important to eat a healthy, balanced diet whatever your choices. If you’re wondering about vegan diet and cholesterol, it’s still important to follow the same advice as everyone else: eat a balanced diet with lots of fruit and veg, lean protein, and wholegrains. Check the ingredients list when you purchase food and avoid partially hydrogenated fat or oils (trans fatty acids). Check the labels on food and limit high saturated fat products.

Indeed, as a vegan it’s easy to miss out on vital nutrients, so it’s important to plan your diet well to stay feeling healthy and strong.

It’s also important for vegetarians and vegans (along with everyone else!) to maintain a healthy weight and keep physically active.

Can vegetarians have high cholesterol?

So it’s clear that vegetarians and vegans can have high cholesterol and that just like meat eaters this can often be improved with a healthy, balanced diet. One important thing to consider if you’re worried about cholesterol is fat swaps. Reducing your bad cholesterol and increasing your good cholesterol can be done by swapping out saturated fats for unsaturated ones. That means reducing foods like biscuits, cakes, butter and pastries and opting instead for things like nuts, avocados, spreads made from vegetable oils and lower fat milk.

If you’ve decided to go vegetarian or vegan, it’s easy to feel like you’re allowed to eat anything else you like, but that’s not the case. The trick however to remaining healthy is to still eat a balanced diet whatever your choices. For vegans and vegetarians looking to control their cholesterol levels try some of Flora ProActiv’s healthy range* that can help keep levels down as part of a healthy diet, and if you need a bit of extra support download the Cholesterol Lowering Starter Kit.

New meta-analysis finds a plant-based vegetarian diet is associated with lower cholesterol

Space-filling model of the Cholesterol molecule. Credit: RedAndr/Wikipedia

A new dietary review of 49 observational and controlled studies finds plant-based vegetarian diets, especially vegan diets, are associated with lower levels of total cholesterol, including lower levels of HDL and LDL cholesterol, compared to omnivorous diets. The meta-analysis appears as an online advance in Nutrition Reviews.

A plant-based vegetarian diet is associated with total cholesterol that’s 29.2 mg/dL lower in observational studies. In clinical trials, a plant-based diet lowers total cholesterol by 12.5 mg/dL.

  • In observational studies, a plant-based vegetarian diet is associated with a 22.9 mg/dL reduction in LDL cholesterol and a 3.6 mg/dL reduction in HDL cholesterol, compared to control groups following an omnivorous diet.
  • In clinical trials, a plant-based vegetarian diet lowers LDL cholesterol by 12.2 mg/dL and reduces HDL cholesterol by 3.4 mg/dL, compared to control groups following an omnivorous, low-fat, calorie-restricted, or a conventional diabetes diet.
  • A plant-based vegetarian diet is not associated with statistically significant changes in triglyceride levels in observational studies or in clinical trials.

The authors predict the strong correlation between vegetarian diets and lower cholesterol levels may be due to the association a plant-based diet has with a lower body weight, a reduced intake of saturated fat, and an increased intake of plant foods, like vegetables, fruits, legumes, nuts, and whole grains, which are naturally rich in components such as soluble fiber, soy protein, and plant sterols.

The study authors hypothesize that the greater risk reduction for total, HDL, and LDL cholesterol levels observed in the longitudinal studies is likely due to long-term adherence to plant-based eating patterns and changes in body composition.

“The immediate health benefits of a plant-based diet, like weight loss, lower blood pressure, and improved cholesterol, are well documented in controlled studies,” says study author Susan Levin, M.S., R.D., C.S.S.D. “Our goal with studying plasma lipids throughout the lifespan is to capture the net risk reduction of using a vegetarian diet to control lipid levels. We hope to empower patients with new research about the long-term cardiovascular health benefits of a vegetarian diet, which include a reduced risk of a heart attack, stroke, and premature death.”

Charles Ross, D.O., a member of the nonprofit Physicians Committee and a former emergency department physician, has firsthand experience with putting a plant-based diet into practice.

Dr. Ross is in his late 60s, takes no medications, and lowered his previously high total cholesterol from 230 mg/dL to a healthy 135 mg/dL after adopting a whole-food, plant-based diet in 2012. Within the first month of making the dietary change, he effortlessly lost 10 pounds. Within a year, Dr. Ross traded a 34-year career of practicing emergency medicine for a new career path: lifestyle medicine. After 5.5 years of making the career switch, he continues to host free biweekly nutrition classes for his primary care patients and the community. More than 700 people have enrolled to learn how to lose weight, eliminate the need for medications to treat type 2 diabetes, hypertension, and elevated cholesterol, and to simply feel better. His former hometown of Roseburg, Ore., is now a Blue Zones community. He is a part-time instructor at the College of Osteopathic Medicine of the Pacific Northwest and hopes to set an example for future physicians.

“I no longer work for a living,” notes Dr. Ross, who now resides in Westfir, Ore. “I wake up every day eager to hear about how a plant-based diet and a healthful lifestyle is changing and saving lives in our community. What I’ve found is that if you want your patients to make significant health changes, you have to make them yourself. The prescription started to spread soon after my family, co-workers, neighbors, and friends heard about my experience.”

For clinicians concerned about spending extra time in and outside of the exam room, the study authors encourage time-strapped health care providers to refer patients to registered dietitians who can help with the transition to a plant-based vegetarian diet. The 2015 Dietary Guidelines for Americans highlights a healthy vegetarian diet as one of three healthful eating plans to follow.

The study authors also note hyperlipidemia, or elevated cholesterol and triglycerides, is often underdiagnosed and undertreated. A 10 percent increase in the prevalence of treatment for hyperlipidemia can prevent 8,000 deaths each year. Taking small steps, like those proposed by the National Cholesterol Education Program Adult Treatment Panel 3, which include assessing heart disease risk, making lifestyle and dietary recommendations, and assessing the need for future follow-up appointments and pharmaceutical interventions, could prevent approximately 20,000 heart attacks, 10,000 cases of coronary heart disease, and save almost $3 billion in medical costs each year.

“To make any form of health care work and to truly power economic mobility, we have to get healthy,” says Levin. “The first place to start is by building meals around nutrient-packed, plant-based foods, which fit into nearly every cultural template, taste preference, and budget.”

Explore further

Not all plant-based diets are created equal More information: Yoko Yokoyama et al, Association between plant-based diets and plasma lipids: a systematic review and meta-analysis, Nutrition Reviews (2017). DOI: 10.1093/nutrit/nux030 Provided by Physicians Committee for Responsible Medicine Citation: New meta-analysis finds a plant-based vegetarian diet is associated with lower cholesterol (2017, August 22) retrieved 2 February 2020 from https://medicalxpress.com/news/2017-08-meta-analysis-plant-based-vegetarian-diet-cholesterol.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Examples: Raw Food Diet, Neal Barnard, T Colin Campbell, John McDougall, Caldwell Esselstyn. Among the reasons one might choose to become a vegan, is the belief that a diet free of animal foods is best for the body. Take a closer look at the health effects of this way of eating.

STRATEGY: Elimination of all animal foods, including dairy products, eggs, gelatin, and honey.

FOODS: All foods except animal foods are allowed.


Lower cholesterol levels
Lower IGF-1 levels (see below)
Lower body weight
People with dairy, egg, or specific meat/seafood sensitivities will feel better on a vegan diet.


Vitamin B6 deficiency
Vitamin B12 deficiency
Iron and other mineral deficiencies
Omega-3 fatty acid deficiency

Watch my 20-minute video presentation entitled “Little Shop of Horrors: The Risks and Benefits of Eating Vegetables” given at the 2012 Ancestral Health Symposium at Harvard University.

Approximately 1% of Americans report eating a vegan diet, and the popularity of this diet is rising. A vegan diet is very different from a lacto-ovo-vegetarian diet in that it contains no animal foods of any kind. While we know from thousands of years of recorded history that people can thrive for many decades eating anything from a lacto-ovo-vegetarian diet to a nearly 100% carnivorous diet, I am not aware of any examples in human history of a culture which has subsisted on a vegan diet from childhood through death.

Are vegan diets healthier?

Vegan diets, like all diets, can vary widely in quality, depending on food choices. However, it is certainly more challenging to eat junk food as a vegan, because so many junk foods contains dairy, egg, gelatin, or other ingredients that are derived from animals. For example, most fast food, many candies, and most commercially available brands of white bread are not suitable for vegans.

A vegan whose diet is based on whole foods and is careful to get enough protein, vitamins, minerals, and omega-3 fatty acids, is eating a much healthier diet than an omnivore who eats junk food all day long and doesn’t pay attention to the composition of his or her diet. However, just because a particular food contains no meat, dairy, or eggs, doesn’t necessarily mean that it is healthy. Vegan-friendly candies, cakes, cookies, chips, and ice cream substitutes, are available, which are loaded with refined carbohydrates and are very poor in nutritional value. Some varieties of these types of foods may be high in artificial ingredients, as well.

In order to understand whether vegan diets are healthier than diets that contain animal foods, we would need to compare 100% plant food diets to similar diets containing animal foods. Ideally, both diets would contain roughly the same amount of calories, fat, protein and carbohydrate, so that the main difference between the two diets would be the presence or absence of animal foods. Ideally, both groups of people would have similar lifestyles with respect to things like smoking and exercise. Unfortunately, I am not aware of any studies of vegan diets which have been designed that way. Studies of vegan diets suffer from the same confusing limitations that studies of most diets do:

1) Most studies have been epidemiological studies, and therefore cannot prove that the reason why vegan diets are healthier is because they are free of animal foods;

2) Vegans, as a group, in most studies, not only avoid animal foods; they also tend to drink less alcohol, eat fewer calories, eat less fat, eat more fiber, and weigh less than omnivores. Most studies do not properly control for these variables. Therefore, while vegans appear healthier in some respects than omnivores, it may or may not be due to their avoidance of animal foods.

3) Epidemiological studies of vegans have not taken refined carbohydrate consumption into consideration as a potential risk factor for disease, therefore we do not know if vegans eat less refined carbohydrate than other people do.

4) The clinical trials (experiments) that have been conducted comparing the health effects of a plant-based diet to an omnivorous diet not only removed animal foods from the diet; they also removed most fat and refined carbohydrate, as well, comparing a low-fat, low-refined-carbohydrate vegan diet to an omnivore diet higher in fat and refined carbohydrate. Therefore there is no way to know whether the vegan study groups improved because they avoided animal foods, ate less fat, or ate less refined carbohydrate.

Can vegan diets help with weight loss?

Clinical studies have shown that vegan diets containing the same number of calories as meat-based diets do not lead to more weight loss, therefore simply avoiding meat, if you are eating the same number of calories as an omnivore, is unlikely to help you lose weight..

However, many epidemiological studies of vegans do find that they tend to weigh less than the general population. We can only speculate about why this is. Studies of vegans find that they tend to, on average, eat more fiber, less saturated fat, and fewer calories than omnivores. Whether any of these differences is responsible for the observation that vegans tend to weigh less than others is unknown. Other possibilities that have not been explored in research studies include:

  • differences in refined carbohydrate intake
  • differences in whole food vs. processed/junk food intake
  • differences in exercise habits and alcohol intake

Do vegan diets improve cholesterol levels?

On the whole, studies suggest that vegan diets can lower cholesterol levels by between 10 and 35 percent.

Since cholesterol comes only from animal foods, vegan diets are, by definition, cholesterol-free. Even though cholesterol is a vital component of every human cell, vegans do not need to worry about not getting enough cholesterol, because the body can make all the cholesterol it needs from non-animal foods. In fact, it is even possible for strict vegans to to develop high cholesterol levels, because cholesterol is primarily created in the liver, not absorbed from the diet (see cholesterol).

There are numerous epidemiological studies demonstrating that vegans tend to have lower total cholesterol levels and lower LDL (so-called “bad cholesterol”) levels. However, they also tend to have lower HDL (so-called “good cholesterol”) levels. In epidemiological studies it is impossible to be certain that levels were lower because of vegan diet, as opposed to some other lifestyle difference, however, the trend is very clear.

There have also been a number of human clinical trials that show a vegan diet can lower cholesterol levels, unfortunately most of them were designed in such a way that factors other than animal food avoidance (avoidance of refined carbohydrate, or reduction in fat, for example) could have been responsible for the reduction.

Do vegan diets treat or prevent heart disease?

Vegans tend to eat more fiber, have lower LDL cholesterol levels, and weigh less than omnivores, and these factors are all associated with lower risk for heart disease. However, vegans also tend to have lower HDL cholesterol levels, higher levels of homocysteine, and may have higher triglyceride levels in some cases, and these are all associated with higher risk for heart disease. While numerous studies find that vegetarians are at lower risk for heart disease than the general population, there is no data I am aware of that answers the question of whether vegans are at lower or higher risk than the general population.

Former President Clinton credits the nutritional advice of Professor T Colin Campbell for his successful weight loss and improved heart health. Prof Campbell is a very well known proponent of a vegan diet. As is the case with other plant-based diet advocates, Professor Campbell does not simply recommend the elimination of animal foods; he also recommends limiting fat to 10% of calories, avoiding all processed foods, and avoiding refined carbohydrates. Therefore, it is impossible to know whether the potential health benefits of his approach are due to the lack of animal foods, the lack of refined carbohydrates, the lack of processed foods, and/or the reduction in fat.

Do vegan diets improve blood sugar control?

Blood sugar control is primarily about dietary carbohydrate, not about meat, so if a vegan eats a diet low in refined and high glycemic index carbohydrate, or eats a low carbohydrate diet, his or her blood sugar control will improve.

Dr. Neal Barnard has authored numerous scientific articles about the benefits of low-fat, plant-based diets for controlling diabetes or for losing weight. In a study published in 2009, he compared diabetics eating a low-fat vegan diet to patients eating the standard diet recommended by the American Diabetes Association (ADA). The vegan group lost the same amount of weight as the ADA diet group did, but the vegan group had lower cholesterol and lower blood sugar values. However, the vegan group was also told to “favor low glycemic index foods”. Therefore, it is impossible to know whether the potential benefits of his diet were due to the fact that it was low-fat, that it was vegan, or that it had a low glycemic index.

Do vegan diets treat or prevent cancer?

The quality of evidence is generally poor on this topic. In practice, it would be very difficult to design a human experiment that could answer this question. The majority of epidemiological studies find no difference in cancer rates between vegans and omnivores. However, vegans do tend to have lower levels of IGF-1, a growth hormone that is associated with cancer. The two dietary factors most closely linked to IGF-1 levels are dairy products and refined carbohydrates. Since vegans do not eat dairy products, (and may also eat less refined carbohydrate?), the fact that vegans enrolled in these studies tend to have lower levels of this growth factor makes sense.

Do vegan diets improve digestive health?

Constipation and the general health of the digestive tract are primarily about digestibility. When foods are easily broken down and absorbed, they tend not to cause constipation. Dairy products, and all plant foods except for fruits, are somewhat difficult to digest and absorb, whereas meat and fat are relatively easy to digest and absorb. Since vegan diets are based on plant foods, and since most omnivores also eat lots of plant foods, digestive issues can be problematic for both groups. In my clinical experience I have worked with vegetarian and vegan patients who have severe constipation as well as with meat-eaters who have severe constipation. However, some people do notice that they have less trouble with constipation if they eat a high-fiber diet. Fiber does not necessarily help with constipation (see: fiber) —it depends on your individual chemistry and on what else you are eating. Vegan diets may or may not be higher in fiber than meat-based diets—it depends on food choices.

Do vegans live longer?

All we have are epidemiological observations to attempt to answer this question, but these do not show any difference in mortality between vegans and omnivores.

Do vegans get enough protein?

Protein deficiency is actually uncommon, and is easily avoided by counting protein grams. We used to think that vegans had to eat special combinations of plant foods at every meal to make sure they were getting all nine essential amino acids their bodies needed. We now know that the body can hold on to amino acids for several hours, so, as long as vegans are getting all nine essential amino acids in their diet at some point every day, they don’t have to worry about eating them simultaneously at every meal. However, vegans must be careful to eat a variety of plant protein sources in order to obtain all necessary amino acids. If rice, corn, wheat, or cassava is the SOLE source of dietary protein, essential amino acid requirements will not be satisfied.

Some sources indicate that vegans may require 25% more protein per day than vegetarians and carnivores, because plant proteins are more difficult to digest and absorb than animal proteins.

There is concern that vegans may not get enough sulfur in their diet due to lower levels of certain amino acids which provide sulfur to the body. Sulfur is necessary for a variety of important cellular functions, including antioxidant activity and vitamin function. However, there are plant foods that are high in sulfur, including the cruciferous vegetables and vegetables in the onion/garlic family; therefore, eating more of these (if you can tolerate them) may be helpful.

Vitamin deficiencies in vegans

Vitamin B12 is only found in animal foods, therefore B12 deficiency may occur, and is more common in vegans than vegetarians. Potential consequences of B12 deficiency include anemia, fatigue, difficulty concentrating, and depression. B12 deficiency is easily remedied with supplements.

The form of Vitamin B6 that is found in most plant foods (pyridoxine) is less bioavailable than the forms found in animal foods, therefore vegans may have lower than normal levels of B6. Severe deficiencies are uncommon, but symptoms of significant B6 deficiency include mouth ulcers and neurological symptoms, including irritability and depression. Unfortunately standard B6 supplements are also in the pyridoxine form, so it probably makes more sense to simply increase the amount of B6-rich plant foods, such as bananas and spinach.

Vitamin D deficiency is more common in vegans than vegetarians, because the only other dietary source of Vitamin D other than sunlight exposure is animal foods. Vitamin D is available in supplement form. Potential consequences of vitamin D deficiency include rickets (soft bones) and muscle weakness.

Mineral deficiencies in vegans

Deficiencies of minerals occur more often in vegans.

Plant foods are naturally high in “anti-nutrients”, like cellulose, phytates and tannins that interfere with the absorption of minerals. Iron, zinc and calcium deficiencies are most common. Omnivores who eat lots of plant foods are also at risk for these deficiencies.

Iron deficiency is best known for causing mild anemia and fatigue, but iron is also required for proper function of the brain, and deficiency can cause memory and other cognitive problems, particularly in the very young.

Iron deficiency is common in vegans; probably because plant sources of iron are harder to absorb. Vegetable iron (or “non-heme” iron), is 8 times less available to the body than “heme” iron, the form of iron found in meat. Heme iron is available in supplement form, but it comes from animal sources.

Taking iron supplements to correct the deficiency is not always as helpful as we wish it were. Traditional (non-heme) iron supplements are just as hard to absorb as plant food sources of iron, and in addition, can be irritating to the gastrointestinal tract (constipation is a common side effect). If you do take non-heme iron supplements, you may experience few gastrointestinal side effects if you take them less often. You actually only need to take them 2-3 times per week, because intestinal cells can only absorb so much before they become saturated with iron and stop taking any more in. Avoid taking calcium supplements with iron supplements because calcium interferes with iron absorption. Taking vitamin C supplements can improve iron absorption from supplements as well as from plant foods.

Zinc deficiency can increase susceptibility to infection and skin problems. If you need supplemental zinc, use small doses, as zinc cannot only cause nausea, it can also cause copper deficiency.

Vegans also seem to be at higher risk for bone fractures than vegetarians and omnivores, perhaps because their intake of bioavailable protein, Vitamin D and calcium is lower than in others. If you need supplemental calcium, choose calcium citrate over other forms, as it is easier to absorb.

How do vegans get omega-3 fatty acids?

Most fats that are naturally found in plant foods tend to be very high in omega-6 fatty acids and are essentially devoid of omega-3 fatty acids. This can lead to an unhealthy imbalance in the omega-3 to omega-6 ratio.

To lower omega-6 levels, it may be helpful for vegans to emphasize fats from coconut (only about 2% of the fat in coconut is omega-6), and olive oil (about 10% omega-6) and limit oils from seeds, nuts, legumes, and grains, which tend to be high in omega-6 (usually 50% or higher).

Essential omega-3 fatty acid levels can be low in vegans. Of the three essential omega-3 polyunsaturated fatty acids—ALA, DHA, and EPA, only ALA is found in traditional plant foods, such a flaxseed and walnuts. Unfortunately, only a very small amount of ALA (about 5%) can be converted to DHA, so dietary deficiencies of DHA can occur. Omega-3 fatty acid supplements are now available from (vegan) microalgae sources. The health consequences of low omega-3 fatty acid status are poorly understood.


While many vegans tend to weigh less and have lower cholesterol levels (including lower levels of HDL, the so-called “good cholesterol”) than others, it is unclear if these trends are due to the lack of animal foods in their diet or due to other lifestyle factors, such as lower fat intake, lower caloric intake, lower protein intake, and/or lower intake of processed foods.

A vegan diet must be very carefully planned to avoid vital nutrient deficiencies.

Vegans are at significantly higher risk for a variety of vitamin deficiencies, including vitamins B6, B12, and D, therefore supplementation may be necessary.

Vegans are at higher risk for mineral deficiencies, including iron, calcium, and zinc, therefore supplementation may be necessary.

Vegans are at higher risk for omega-3 fatty acid deficiencies, therefore supplementation may be necessary.

To read a complete, detailed article about how vegan diets affect the brain and mental health, including a full description of all potential deficiencies, please see my post Your Brain On Plants: Micronutrients and Mental Health.

To read about other popular diets, visit the Diets page.

Appleby P et al. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford European Journal of Clinical Nutrition 2007; 61: 1400–1406.

Barnard ND et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial1–4 Am J Clin Nutr 2009; 89(suppl):1588S–96S.

Barnard ND et al. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol 2000; 85:969–972.

Barnard ND et al. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. The American Journal of Medicine 2005; 118: 991–997.

Craig WJ. Health effects of vegan diets. Am J Clin Nutr 2009; 89 (suppl): 1627S–33S.

De Biase SG et al. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol 2007; 88(1): 35-39.

Ho-Pham LT et al. Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans. European Journal of Clinical Nutrition 2012; 66: 75–82.

Jenkins DJA et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009;169(11):1046-1054.

Key TJ et al. Health effects of vegetarian and vegan diets. Proceedings of the Nutrition Society 2006; 65: 35–41.

Madry E et al. The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study. Acta Sci Pol Technol Aliment 2012; 11(2): 209-12.

Majchrzak D et al. B-vitamin status and concentrations of homocysteine in Austrian omnivores, vegetarians and vegans. Ann Nutr Metab 2006; 50: 485-491.

McEvoy CT et al. Vegetarian diets, low-meat diets and health: a review. Public Health Nutrition 2012; 15(12): 2287–2294.

Outila TA et al. Dietary intake of vitamin D in premenopausal, healthy vegans was insufficient to maintain concentrations of serum 25-hydroxyvitamin D and intact parathyroid hormone within normal ranges during the winter in Finland. J Am Diet Assoc 2000; 100(4): 434-41.

Pawlak R et al. How prevalent in vitamin B(12) deficiency among vegetarians? Nutrition Reviews 2013;71(2):110-7. .

Tantamango-Bartley et al. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev 2013; 22:286-294. .

Tonstad S et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. .

Toohey ML et al. Cardiovascular disease risk factors are lower in African-American vegans compared to lacto-ovo-vegetarians. Journal of the American College of Nutrition 1998; 17 (5): 425–434. .

Trapp CB and Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep 2010; 10:152–158.

Turner-McGrievy GM et al. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity 2007; 15(9): 2276-2281.

Waldmann A et al. German vegan study: diet, life-style factors, and cardiovascular risk profile. Ann Nutr Metab 2005; 49(6): 366-372.


Cholesterol is an important part of heart health to be aware of with each meal and snack you choose. Though it sounds like a complicated part of our health, it’s actually a pretty simple one. Cholesterol is produced in the liver, primarily by saturated fats, which is one reason a diet high in saturated fats (from animal-based foods and refined veggie oils) is said to be harmful for your heart health. Cholesterol travels through the blood via the arteries, which is why a high cholesterol diet can lead to clogged arteries that prevent proper blood flow to your heart, leading to heart disease and even diabetes. Your body can use fats from your diet to produce cholesterol on its own, which makes added (dietary) sources of cholesterol something you’ll want to avoid in order to lower bad cholesterol (LDL) and raise good cholesterol (HDL). This is one reason why a plant-based diet is now being advised as the best diet to eat for overall heart health and longevity. Plant-based foods also improve liver function, and also provide antioxidants to support the immune system. Most all plant-based foods provide a major boost for your cholesterol, but some have specific benefits not to miss out on.

1. Lutein-Rich Spinach

Source: Seasonal Sweet Autumn Salad


Lutein is a yellow pigmented antioxidant that is found abundantly in spinach, even more than other greens. It’s known to provide protection against macular degeneration for healthy eyes, but research also shows that it helps lower the bad cholesterol by preventing clogged arteries. Though egg yolks are known as the best source of dietary lutein, they’re also high in cholesterol and inflammatory animal-based saturated fats. Instead, use 2 cups of spinach in a smoothie or salad for lutein, 10 grams of protein, and a heart-healthy dose of vitamin E, stress reducing magnesium, and an abundance of B vitamins also needed for a healthy liver and metabolism.

2. Oats

Source: Matcha Porridge With Pomegranate Seeds

Oats and oat bran (the most fiber-rich part of the grain) are two of the best foods you can include each day to fight high cholesterol and reduce your risk of heart disease on an ongoing basis. Oats are full of beta-glucan fibers, an important type of soluble fiber that acts like a broom in the arteries (and digestive tract) to sweep out cholesterol and daily toxins. Enjoy 1/3 cup day to get the delicious benefits. If you like and eat barley, it also offers the same benefits as oats.

3. Walnuts

Source: Healthy Fats


Walnuts are a fantastic source of omega 3 fats. These fats lower cholesterol directly by reducing inflammation and raising good cholesterol (HDL). Though seafood is a natural source of omega 3 fats, it’s also very high in cholesterol to most people’s surprise. Walnuts, on the other hand, are not only free of cholesterol, but they also don’t come with the same health risks like mercury and toxin exposure that fish do. Enjoy 4-6 walnuts a day to reap the benefits. They go great on top of oatmeal, on a smoothie, or can be enjoyed as a snack or in an entrée.

4. Beans

Source: Tamale Inspired Bowls With Beans


If you love beans, then good news – they love you too! Beans are the highest fiber food aside from chia, coconut flour, and bran per serving. They help keep our bones strong, and are incredible sources of antioxidants, folate (a B vitamin), potassium, magnesium, protein, and iron. Beans’ fiber has been shown to improve heart health and directly lower high cholesterol in a short amount of time. Legumes (such as lentils and green peas) also come with the same benefits. Try some of our favorite bean recipes from burgers to chili, and everything in between!

5. Avocado

Source: Mexican Black Bean Soup


Okay avocado lovers, rejoice once more – these little babies are awesome for your heart health! They directly lower cholesterol due to a type of fat they have known as beta-sitosterols. These fats reduce bad cholesterol (LDL) and raise good cholesterol (HDL), helping to improve your heart health with every bite. They are high in fats, so no need to go overboard; just 1/4 a fruit each day or one or two a week is enough to get the benefits. Out of avocados? Go get yourself one at the store and use the pit to grow your own avocados in just weeks with this product!

6. Most All Nuts and Seeds

Source: Jules/Flickr

Aside from walnuts, most all nuts and seeds are also high in certain fats known as mono-unsaturated fats that lower bad cholesterol. They also provide anti-inflammatory support and contain antioxidants that support overall heart health. As a bonus, these foods are also good sources of plant-based protein and they support collagen production in the body to fight the effects of aging. A little goes a long way, so enjoy 1/4 cup a day to gain the benefits. Try them in some raw energy bars or toss a few into your next smoothie or breakfast bowl.

7. Natural Soy Foods

Source: Super Protein Kale Caesar Salad

Don’t go running if you hate soy – listen up! We’re not talking about highly processed forms of soy like chalky soy protein powders, we’re talking about cleaner, more whole food forms of soy. Think tempeh, tofu, and whole soy beans (edamame). Non-GMO soy milk and soy yogurt also make good choices if bought from a high-quality organic brand (choose unsweetened if possible). Soy contains higher amounts of isoflavones than most foods, which directly reduce high cholesterol in the body and improve overall heart health. Concerned about soy and cancer? Isoflavones from soy have actually shown to reduce cancer risks, despite the myth that soy causes breast cancer. Enjoy it a couple times a week and see how it works for you.

8. Berries

Source: Strawberry Mousse


Berries are packed with soluble fibers that reduce high cholesterol and assist with good digestion. They’re also a top source of antioxidants that fight immune system invaders to improve your overall health. No berry shows more benefits over another for cholesterol, so include blueberries, strawberries, goji berries, cranberries, blackberries, raspberries and others such as acai, golden berries and mulberries for even more benefits.

9. Cacao

Source: Raw Chocolate Energy Bites

What can’t this everyday superfood do? Cocoa and cacao boost arterial health by improving blood flow, reducing blood pressure, and they contain soluble and insoluble fibers that lower cholesterol and improve heart health. Cacao is also a good source of sulfur, a mineral that supports healthy liver function for daily detoxification. Try to enjoy it raw, though regular plain cocoa is also helpful if you don’t have access to raw cacao powder or nibs. Avoid highly sweetened and refined cocoa powders and bars however possible. Try cacao in some of our favorite healthy chocolate recipes!

10. Garlic

Source: Roasted Veggies With Buttery Garlic and Spinach Salad

A food you might think of as more of a flavoring option, is actually one of the best for lowering cholesterol and preventing blood clots. Now, keep in mind, this doesn’t count for garlic powder and garlic flavored foods, but the actual garlic cloves. Use one or two cloves a day in a savory entrée of your choice; just be sure to chop it finely, since the process releases the beneficial compounds found in garlic and makes them more readily available for absorption. You can also grow your own garlic at home so you always have some on hand! Other cholesterol supportive foods include all fruits and vegetables, whole grains of any kind, herbs, spices, and herbal and regular tea. Consume these foods liberally everyday, rotating which ones you buy and use, and you can be sure your heart health will improve as a result!

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Lead Image Source: ImpromptuKitchen/Flickr


As a cardiologist, patients often ask me for ways to lower their cholesterol without taking statins. They wonder how effective and viable alternatives can be and what strategies they can use to lower their cholesterol in other ways.

I often tell my patients at the Ohio State University Wexner Medical Center that diet is key. A focus on a plant-based diet, reducing saturated fat, and increasing fiber with vegetables and whole grains, has been shown to reduce cholesterol levels with or without the use of statins. Those levels can drop further by incorporating supplements like soluble fiber products or plant sterols and stanols.

So several months ago, when my own LDL cholesterol climbed above the optimal range (<100 mg/dL in primary atherosclerotic cardiovascular disease prevention), I decided to find out for myself.

I’m 34, and have few traditional risk factors for atherosclerotic disease, aside from a family history. But because LDL cholesterol levels are so tightly associated with heart disease risk, I wanted to take action and change the way I eat.

Major portions of my diet, growing up in Ohio, included the standard American fare of bacon, eggs, and toast for breakfast, a sandwich and chips at lunch, and then “meat and potatoes”-based dinners. I indulged in pork barbecue, complete with Southern-style fixings, during medical training in North Carolina. So, I feel equipped to commiserate with my patients by sharing my personal journey down a new path.

I cut back on steaks and burgers and replaced them with more greens and fish. At home, we switched to cooking with plant-based oils, such as grapeseed or sunflower. I began eating more vegetables and grains and added over-the-counter plant sterol/stanol as well as high-potency fish oil supplements.

I expected to see improvement due to my changes, but when I checked the results after 6 months, even I was surprised. I had reduced my LDL cholesterol by 29%, which is similar to the effect of low- or moderate-intensity statin treatment. Along the way, I learned it’s a plan my family and I can work into our normal routine, and one that I believe would potentially be effective for anyone who isn’t underweight or dealing with digestive diseases.

Here’s how I built a diet I would recommend to anyone trying to lower their cholesterol…

Predominantly Pescatarian: My Modified Mediterranean Diet

Benefits of the Mediterranean diet are generally well-accepted, despite some scrutiny of the scientific rigor of the PREDIMED trial, and it’s likely a good basis for many individuals. I appreciate the emphasis on fish and healthful oils, but I think putting olive oil on a health pedestal is extreme. Olive oil’s monounsaturated fatty acids are clearly more beneficial for health than saturated fat but likely not as metabolically helpful as certain polyunsaturated fats like alpha-linoleic acid or omega-3 polyunsaturated fatty acids.

I also appreciate the focus on limiting land-based meat, but I think the average American’s diet still includes more saturated fat than I aim for, particularly in preparations involving poultry skin. Low-fat vegetarian diets have long been touted as capable of reversing atherosclerotic plaque, but I often see that accompanied by increased carbohydrate intake, which can lead to weight gain and metabolic syndrome at the expense of potentially healthy fats.

Less Red Meat

Like many, I’m disappointed by the recent NutriRECS Consortium recommendation that people should “continue current processed meat and unprocessed red meat consumption” despite cited information that a reduction in such consumption likely has health benefits. An analysis of multiple studies involving hundreds of thousands of people concluded that diets with less red and/or processed meat were associated with a reduction of approximately 14% in cardiovascular mortality over a period of 4 to 26 years.

The Consortium suggested that these benefits of red/processed meat reduction “probably do not outweigh the undesirable effects (impact on quality of life, burden of modifying cultural and personal meal preparation and eating habits).” My own experience is a rebuttal to this argument. I have enjoyed challenging my historical dietary norms and have already realized significant cholesterol reduction and some weight loss as a result. Unfortunately, I can’t prove that I’m preventing a heart attack from occurring.

Not Quite Vegan

Though I do support reduced meat consumption on a societal level, I didn’t become fully vegan because I accept many dairy and seafood products, particularly fish, as part of a healthy diet, assuming one pays attention to dietary sources of cholesterol such as egg yolk and shrimp.

My family would describe me as adventurous with plant-based protein sources like tofu, quinoa, and chia seeds, but I still crave a protein-dense option that, I’ve found, can only be satisfied by fish. In addition, omega-3 polyunsaturated fatty acids in fatty fish such as salmon and sardines have proven health benefits. I have nothing against a vegan diet, but I personally don’t want to miss out on the dietary satisfaction and potential health benefits from fish.

Fewer Carbs, Not Zero Carbs

I appreciate the benefits of promoting carbohydrate reduction in individuals who are overweight, particularly if they have a cardiometabolic profile of prediabetes that includes hyperglycemia and hypertriglyceridemia. However, I don’t promote strict, very-low-carb diets in individuals of normal weight who have elevated cholesterol, given that many low-carb or “ketogenic” diets may actually raise LDL cholesterol.

One patient of mine adopted the ketogenic diet to lose weight and found that her LDL cholesterol tripled, likely because she replaced the carbohydrates with a lot of breakfast meat such as bacon and pork sausage. The choice of fats that replace carbs in the diet needs very special attention in people contemplating a ketogenic diet. These low-carb diets may severely restrict nutrient-dense foods that offer cardiovascular benefits and show mixed effects on LDL cholesterol levels.

I tell my patients that we celebrate small successes in change together, as something as fundamental to identity as dietary choices usually takes a long time to evolve.

M. Wesley Milks, MD, is a cardiologist and clinical assistant professor of medicine at Ohio State University Wexner Medical Center in Columbus. He has a focus in cardiovascular disease prevention, which includes management of lipid disorders and advanced cardiovascular risk prediction tools. Milks is a Diplomate of the American Board of Clinical Lipidology.

Milks disclosed no relevant relationships with companies or entities.


last updated 10.29.2019

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