Vegetarian diet lower cholesterol

How Low Will Your Cholesterol Go on a Vegetarian Diet?

In my clinical cardiology practice, approximately 30 percent of people I see have coronary artery disease, a condition where diet and exercise could make a big difference for prevention.

Coronary artery disease symptoms include shortness of breath, chest pain, activity intolerance, nausea, dizziness, and loss of energy. But over time, you may have a heart attack due to blockage of blood flow in a coronary artery. Your heart tissue can become damaged, weaken, and stiffen. This process can result in heart failure. It also leads to an increased risk for developing abnormally fast electrical rhythms from the upper and lower heart chambers. In some cases, coronary artery disease treatment includes cardiac stents, or, when the disease is very severe, coronary artery bypass surgery.

What if this could be prevented?

Our Enormous High Cholesterol Problem

Coronary artery disease is often the consequence of many other diseases, problems, or lifestyles termed risk factors:

  • High cholesterol
  • Diabetes
  • High blood pressure
  • High levels of body inflammation
  • Obesity
  • Physical inactivity
  • Smoking

Most of these are preventable.

If you have a genetic tendency towards coronary artery disease, with parents or siblings who developed it early in life, the disease can occur without many risk factors. But even in these cases, it accelerates quickly in the presence of risk factors.

Of all the coronary artery disease risk factors, high cholesterol is a particularly big problem in the United States. The Center for Disease Control and Prevention (CDC) estimates that 71 million U.S. adults have high cholesterol. That’s one third of our adult population.

Yet less than half of people with high cholesterol seek treatment for it, the CDC notes. What’s more, when treatment is pursued, only one in three adults have their cholesterol adequately treated.

High Cholesterol Treatment

The most common treatment for high cholesterol, particularly after heart disease has developed, is a statin. This type of drug comes with benefits and risks. Statins inhibit HMG-CoA reductase, an enzyme in our bodies that is used to make cholesterol. Some examples of statin drugs are Zocor (simvastatin), Lipitor (atorvastatin), Crestor (rosuvastatin), and Pravachol (pravastatin). These drugs have side effects that include muscle pain, joint pain, headache, and nausea. You can also have rare severe sides effects such as inflammation and injury of the liver and muscles.

Most of the time, when I see patients in clinic, joint and muscle pain leads them to stop their statin medication and try to lower their cholesterol by other means. Some of the most common questions I hear are:

“What will happen to my cholesterol if I change my diet?”

“Can I work on my lifestyle, exercise more and eat better, and recheck my cholesterol in 6 months?”

“I gained weight this year. If I lose weight and eat better will I still need my statin?”

If you have high cholesterol or have needed a statin drug you may have asked these same questions to yourself or your physician. A new study tells us just how much of a benefit we can expect when our diets are greatly improved.

Cholesterol Benefits of Vegetarian Diets

An October 2015 analysis in the Journal of the American Heart Association examined how a strict vegetarian diet affects cholesterol levels in people with heart disease or risk factors of heart disease. This report summarized 11 prior studies in what is called a meta-analysis. The studies included were from the United States, Finland, Sweden, Czech Republic, and Australia. In all the studies, people were randomized to receive a vegetarian diet versus a diet that included meat. The average age of the people in these studies ranged from 28 to 54. In three studies, people had already tried a medication to lower their cholesterol.

The most commonly studied vegetarian diet was a vegan diet in which both meat and diary products are avoided. The second most common diet studied was a lacto-ovo vegetarian diet that primarily avoids meats (but can include dairy products). In all studies these diets were compared to an omnivorous diet of plant and animal products. The cholesterol levels in these patients were studied up to 74 months.

Here is a summary of what the researchers found about people’s cholesterol on a vegetarian diet:

  • Total cholesterol was reduced by 13.9 mg/dL
  • LDL (bad cholesterol) was reduced by 13.1 mg/dL
  • HDL (good cholesterol) was reduced by 3.9 mg/dL
  • Triglycerides levels were similar in nearly all studies regardless of diet

In addition, people on a vegetarian diet were more likely to lose weight by an average of 2.9 kg (about 6.35 pounds).

What Else Can Help Control High Cholesterol?

Looking at the vegetarian diet analysis you may be thinking the cholesterol levels did not lower all that much. If you consider most people in these studies started with a total cholesterol over 200 mg/dL, the dietary changes only reduced cholesterol by 5 to 10 percent. Unfortunately, good cholesterol levels did not improve but actually slightly declined with a vegetarian diet. Raising good cholesterol levels can be hard. In fact, good cholesterol levels also don’t improve with statin drugs.

Fortunately, if you are serious about lowering your cholesterol without medications, you can do more.

First, remember that certain food types can actually lower cholesterol more significantly when added to an already heart-healthy diet:

  • Nuts
  • Avocados
  • Healthy oils

Second, to tackle high cholesterol you have to take on all the different lifestyle choices that raise it, in particular sedentary lifestyles, obesity, and lack of exercise.

Exercise Lowers Bad Cholesterol and Raises Good Cholesterol

A 2002 study in the New England Journal of Medicine from researchers at Duke University examined the value of exercise to lower cholesterol. Here, 111 patients were randomized to three exercise programs, one was exercise equivalent to jogging 20 miles per week, another to jogging 12 miles per week, and the final group to walking 12 miles per week.

Here is a summary of the impact of exercise on people’s cholesterol levels:

  • LDL (bad cholesterol) was reduced by 1 mg/dL in the walking group and down 3 mg/dL in the jogging 20 miles per week group
  • HDL (good cholesterol) was increased by 1 mg/dL in the walking group and up to 4 mg/dL in the jogging 20 miles per week group

If exercise is a good thing, how much should be done? I get this question almost every time I see patients in clinic.

First, exercise should be moderate in intensity for most people. For most people this is jogging, walking quickly, swimming, or using an exercise machine at a low to a low-medium level. If you exercise to a level that makes you breathless this is beyond moderate intensity. Find a moderate exercise level that will allow you to do it continuously for at least 10 minutes and up to 20 to 30 minutes.

Second, the American Heart Association recommends that you exercise from 30 to 60 minutes per day. Sixty minutes should be targeted if you want to lose weight. This exercise quantity can be done at once, or by breaking things up in 10-minute intervals.

Third, I am often asked what the best exercise is. The truthful answer is that I don’t know. What I do know is that you should find an exercise that you can enjoy doing on a daily basis. This exercise should over time allow your body and mind to heal. For me, this exercise is jogging. For many of my patients it’s aerobics or yoga classes. For others, it’s cycling, weight lifting, interval training, or swimming.

What Are Healthy Cholesterol Levels?

If you are an adult, you should get your cholesterol checked through a simple fasting blood test at minimum every 5 years, to see if it’s healthy. If you have not developed heart disease or you have risk factors associated with coronary artery disease, the following cholesterol levels are consider ideal:

  • Total cholesterol less than 200 milligrams (mg) per deciliter (dL)
  • LDL (bad cholesterol) less than 100 mg/dL
  • HDL (good cholesterol) more than 60 mg/dL
  • Triglycerides less than 150 mg/dL

If heart disease has developed, your doctor will try to more aggressively reduce your cholesterol to minimize plaque build up in your coronary arteries, and your target numbers will be different. For example, the ideal goal LDL in people who have had a heart attack or received a heart stent or bypass surgery is less than 70 mg/dL.

Time to Get Serious About High Cholesterol

Diet and exercise can significantly improve cholesterol in as little as a few months. The benefits of diet and exercise extend beyond the cholesterol levels themselves to improving the type and function of the cholesterol particles. Some people still need medication despite all they do, but most people can achieve their cholesterol level goals if they adopt healthy lifestyle changes early.

PHOTO CREDIT: Madeline Jia Lu/Offset.com

by Jack Norris, RD

Contents

  • Introduction
  • Blood Lipids
    • Cholesterol in EPIC-Oxford
    • Cholesterol in Western Vegans
    • Cholesterol in USA Vegans
    • Triglycerides
    • Summary
  • Blood Pressure
    • Vegetarians and Blood Pressure Meta-Analysis
    • Why Do Vegans Have Lower Blood Pressure?
  • Body Mass Index
    • 2013 Report From Adventist Health Study-2
    • 2003 Report From EPIC-Oxford
    • Body Mass Index Over Time as a Vegan
  • Body Fat
  • Homocysteine
  • Conclusion

Introduction

Numerous studies have measured cholesterol levels, blood pressure, obesity, and other markers of disease in vegans. Most of these studies included information on lacto-ovo vegetarians (lacto-ovo), fish-eaters (pesco), and non-vegetarians (non-veg). This article surveys those published since 1980. Not much was published on vegans before that time.

Blood Lipids

Lipids are fat-soluble substances, including cholesterol and fatty acids. Blood lipid measurements generally include total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Total cholesterol is a measure of all the various types of cholesterol in the blood. Cholesterol can be separated according to the lipoprotein that carries it in the blood. Cholesterol carried by low-density lipoproteins (LDL) is considered “bad” because it tends to be deposited on the artery walls, causing heart disease. Cholesterol carried by high-density lipoproteins (HDL) is considered “good” because it tends to be taken to the liver where it is then broken down or excreted into the digestive tract in the form of bile. Dietary fiber (especially soluble) can then bind to some and it will be excreted in the stool.

There are also other lipoproteins, such as very low density lipoproteins (VLDL). They will not be examined here as they have not been measured in many vegans.

Cholesterol in EPIC-Oxford (2013)

The most recent report of cholesterol in vegans is from the EPIC-Oxford study in which vegetarians were compared to meat-eaters with healthy lifestyles (41). The results are in Table 1 and show vegans to have a 34 mg/dl and 23 mg/dl lower cholesterol level than meat-eaters for men and women respectively. Most of this difference was in the non-HDL cholesterol. Adjusting the results for body mass index reduced the difference by 13% for men and 17% for women.

Vegans also had a significantly lower amount of apolipoprotein B which is thought to promote fat deposits in the arteries.

The authors of the study suggest that vegans have lower cholesterol levels due to a lower body mass index, replacement of saturated fats with polyunsaturated fats, and higher fiber intakes.

Table 1. Cholesterol Levels in EPIC-Oxford (2013) in mg/dl41
Vegans Lacto-ovo Pesco Non-veg P-value
Men
Number 167 168 168 168
Total Cholesterol 170 188 196 204 < .001
HDL 44 44 47 45
Non-HDL 126 143 149 159 < .001
Apolipoprotein B 82 89 93 100 < .001
Women
Number 255 255 257 256
Total Cholesterol 172 184 188 195 < .001
HDL 53 55 56 57
Non-HDL 119 129 131 137 < .001
Apolipoprotein B 76 81 82 87 < .001
Results adjusted for age, alcohol, and physical activity.

Cholesterol in Western Vegans (1980 – 2002)

Between 1980 and 2002, cholesterol levels of vegans living in Western countries was measured in 17 studies. The average cholesterol level of vegans was 160 compared to 202 mg/dl for non-vegetarians. Table 2 shows the results.

Cholesterol in USA Vegans

Of the 17 studies in Table 2, five were of vegans living in the USA. Of those studies, the lowest average finding for total cholesterol for vegans was 135 mg/dl. The data from all 5 studies is compiled in Table 3. The total cholesterol of the 135 vegans averaged out to 146 mg/dl.

Table 3. Cholesterol in USA Vegans2, 4, 5, 11, 13

Triglycerides

Elevated triglycerides are generally thought to increase the risk for heart disease. However, there is a debate as to whether moderately high triglycerides are merely associated with other risk factors for heart disease, while not being a cause in themselves. Normal triglycerides for adults is 40-160 mg/dl for men and 35-135 mg/dl for women (20). Triglyceride levels above 250 mg/dl are more of a concern (20).

Some people are concerned that, although a vegan diet can lower cholesterol levels, it may increase triglyceride levels. As can be seen from Table 4, in the 11 studies that measured triglycerides, vegans were shown to have lower levels than lacto-ovo and non-veg.

Table 4. Triglycerides in Western Vegans2–5, 9–11, 13–15, 17

Vegan Lacto-ovo Non-veg
Triglycerides (mg/dl) 86.5
(310)a
107.6
(253)a
107.5
(281)a
aNumber of people measured

Summary

The total cholesterol of Western vegans averages out to 160 mg/dl. This is 40 points lower than the non-vegetarians in these studies and well below the “desirable” level of less than 200 mg/dl according to the National Heart Lung and Blood Institute. It is possible to eat a vegan diet that is high in fat and hydrogentaed oils and is highly processed with little fiber. This sort of diet might not provide the benefits seen in the studies compiled above. Additionally, some people have a strong genetic predisposition to high cholesterol. The American Heart Association recommends that people over the age of 20 have their cholesterol levels checked every 4 to 6 years (18).

Blood Pressure

In 2009, preliminary cross-sectional date from Adventist Health Study-2 was reported. Relative rates for having high blood pressure are show in Table 11. Vegans had a considerably lower rate of high blood pressure. Results were not adjusted for smoking.

In 2012, a more thorough, cross-sectional report was published from Adventist Health Study-2. It included only white people, and results didn’t appear to be adjusted for anything. Rates for having high blood pressure are shown in Table 12; vegans had considerably lower rates of blood pressure.

In 2002, a study was published in which 11,004 participants of the EPIC-Oxford study were asked if they had high blood pressure (22). Results are shown in Table 5.

The lower percentage of vegans with high blood pressure was statistically significant. This is the only study that has compared the percentage of vegans with high blood pressure to other diet groups.

Blood pressure was then measured in 8,663 participants who did not have high blood pressure. Those results are in Table 6. Results from the 4 other studies measuring blood pressure in vegans since 1980 are also in Table 6. Finally, the combined results of all 5 studies are listed in Table 6.

Table 6. Blood Pressure in Vegans (mm Hg)

The results show that vegans have slightly lower blood pressures than those in other diet groups. If the data from Epic-Oxford had included all the participants, rather than only those without high blood pressure, the differences between the vegans and non-veg in Table 6 would have been larger. The difference also might have been larger if the participants in one study (7) had randomly chosen non-vegetarians to participate, rather than choosing non-vegetarians with a similar BMI to the vegans in the study.

Vegetarians and Blood Pressure Meta-Analysis

In 2014, researchers from Japan published a meta-analysis of clinical trials and cross-sectional observational studies of a vegetarian diet and blood pressure (42). Many of these vegetarians were actually semi-vegetarians.

Among seven clinical trials, a vegetarian diet was found to reduce systolic and diastolic blood pressure by an average of 4.8 and 2.2 mm Hg, respectively. Among the 32 cross-sectional studies, vegetarians were found to have a lower systolic and diastolic blood pressure of 6.9 and 4.7 mm Hg respectively.

These findings were statistically significant. The authors said, “According to Whelton et al, a reduction in systolic BP of 5 mm Hg would be expected to result in a 7%, 9%, and 14% overall reduction in mortality due to all causes, coronary heart disease, and stroke, respectively.”

Why Do Vegans Have Lower Blood Pressure?

EPIC-Oxford (22) and Adventist Health Study-2 (40) found lower body mass index explained most of the differences in blood pressure among the diet groups. Other contributory factors could be higher consumption of potassium, lower consumption of sodium, modulation of baroreceptor sensitivity, direct vasodilatory effects, changes in catecholamine and renin–angiotensin–aldosterone metabolism, improvement of glucose tolerance with lower insulin levels, and lower blood viscosity in vegetarians (40).

Body Mass Index

Body mass index (BMI) is measured by taking one’s weight in kilograms and dividing it by their height in meters squared (i.e., kg/m2). It is a way of measuring weight while taking into consideration differences in height. A healthy BMI is considered to be between 20 and 25. Generally, a BMI of 30 or higher is considered obese (32).

Recent research has shown that a BMI of 22.5 to 25.0 is associated with the lowest mortality rate. It has been known for some time that a lower BMI has been associated with an increased risk of death, but that was thought to be due mostly to smoking-related diseases. A 2009 meta-analysis of 900,000 people found that even in those who never smoked, there is a slight increase in mortality below a BMI of 22.5 (37). The excess mortality below 22.5 has not been explained. One theory is that the excess mortality might be due to lower fat-free mass, which would most likely be lower muscle mass (though could also technically be bones, or even some organs) (37, 38). Studies on BMI and mortality to date have not differentiated between fat and fat-free body mass.

2013 Report from Adventist Health Study-2

In 2013, cross-sectional data on BMI were released from the Adventist health Study-2 (43).

In AHS-2, vegans had a lower BMI than all other diet groups. The study wasn’t focused on BMI, and the report didn’t mention testing for statistical significance.

2003 Report From EPIC-Oxford

A report on BMI from EPIC-Oxford was published in 2003. Results are in Table 8.

The differences between the vegans and meat-eaters was accounted for mostly by differences in protein, polyunsaturated fat, and fiber intake. The authors note that protein intake’s influence on weight has not been reported often in the literature, but there is some mention of it altering hormones in a way that increases abdominal fat. They also note that low fiber intakes have been previously associated with higher body weight and this is thought to be via making people feel full on less calories, insulin control, and reducing fat absorption.

Body Mass Index Over Time as a Vegan

A 1996 letter to the editor of the British Medical Journal from the authors of the EPIC-Oxford study (31) reported BMI according to the time on current diet (less than or greater than 5 years). The number in each group were:

  • 1,652 Vegan
  • 8,827 Lacto-ovo
  • 3,776 Pesco
  • 6,850 Non-veg

The actual BMIs were not given, but a graph was provided (which can be viewed at bmj.com/cgi/content/full/313 /7060/816/F1). The graph shows that those on a vegan diet for more than 5 years had the lowest BMI, followed by those on a vegan diet for less than 5 years, for both men and women. This is impressive, as most weight loss is not sustained for more than one year. Of course, weight loss can sometimes be difficult even for vegans, and some people actually gain weight after becoming vegan. But, on average, the evidence supports the notion that becoming vegan is conducive to permanent weight loss.

In 2006, a report from EPIC-Oxford (35) showed that over a 5 year period, vegans had the lowest weight-gain compared to meat-eaters, fish-eaters, and lacto-ovo vegetarians. The group who had switched to a diet of eating less animal products had the lowest weight gain of all. The group of people who reverted to a diet of more animal products had the most weight-gain, but this was not statistically significant. All groups had some weight gain over the 5 year period.

Body Fat

What does it matter if vegans weigh less if they simply have less muscle mass? Above (Table 9) we saw that vegans have an average BMI of about 22.2 to 22.5, which is right in the middle of the healthy range of 20 to 25. So, vegans are not too thin. But what if a lower percentage of their body weight is muscle (which would mean that a higher percentage of their body weight is fat)?

Table 10 lists the studies that measured percentage of body fat or skinfold thickness (an indicator of body fat) in vegans. Determining the percentage of body fat can vary greatly from method to method, so averaging the results would not be appropriate. Instead, we should look at the general trend. In the 5 comparisons made, the vegans had lower body fat in all five. In three of those comparisons, the differences were statistically significant.

Table 10. Percentage of Body Fat in Vegans
Year Country Vegan Lacto-ovo Non-veg Adjustments SS
Body Fat
199610 UK 21.9%
21 M & 17 F
22.5%
6 M & 5 F
24.0%
20 M & 19 F
None. Vegans had more men. Not SSa
199528 Canada 23.7%
8 F
24.1%
15 F
27.4%
22 F
Vegans slightly older. P < .05a
199026 USA 8.0%
15 M
8.6%
20 M
14.0%
18 M
Vegans were older. P < .05a
Tricep Skinfold Thickness
19877 UK 8.8 mm
11 M13.5 mm
11 F
10.7 mm
11 M17.3 mm
11 F
Matched for age, body build. Energy intake did not differ. NR
Sum of skinfold measurements
19781 UK 43 mm
12 M & 10 F
76 mm
12M & 10 F
Matched for age, height, ethnic, socio economic status. P < .01a
F—female • M—male • NR—not reported • SS—statistical significance • P—the % chance that the finding was due to random chance • aStatistically significant between vegans and non-veg

So, we now know that vegans have lower BMIs and they also tend to have lower body fat percentage (though the numbers measured are small).

Homocysteine

There is one marker of cardiovascular disease for which some vegan are at a disadvantage: homocysteine levels. Elevated homocysteine levels are associated with heart disease, stroke, and early death. Numerous studies have looked at homocysteine in vegans and indicated that if vegans are not taking vitamin B12, they probably have high homocysteine levels. For more information, please read the chapter B12 and Chronic Disease: Homocysteine in Vitamin B12: Are You Getting It?

Conclusion

In summary, the evidence shows:

  • Vegans have lower total cholesterol, LDL cholesterol, and triglycerides, while having about the same HDL cholesterol as
    lacto-ovo and non-veg.
  • Vegans have lower rates of high blood pressure than lacto-ovo and non-veg.
  • Vegans have a lower BMI and body fat percentage than lacto-ovo and non-veg. People who have been vegan for more than
    5 years have the lowest BMI of all diet groups studied here.

Last updated September 2018
1. Sanders TA, Ellis FR, Dickerson JW. Studies of vegans: the fatty acid composition of plasma choline phosphoglycerides, erythrocytes, adipose tissue, and breast milk, and some indicators of susceptibility to ischemic heart disease in vegans and omnivore controls. Am J Clin Nutr. 1978 May;31(5):805-13.

2. Lock DR, Varhol A, Grimes S, Patsch W, Schonfeld G. Apolipoprotein E levels in vegetarians. Metabolism. 1982 Sep;31(9):917-21.

3. Roshanai F, Sanders TA. Assessment of fatty acid intakes in vegans and omnivores. Hum Nutr Appl Nutr. 1984 Oct;38(5):345-54.

4. Kritchevsky D, Tepper SA, Goodman G. Diet, nutrition intake, and metabolism in populations at high and low risk for colon cancer. Relationship of diet to serum lipids. Am J Clin Nutr. 1984 Oct;40(4 Suppl):921-6.

6. Thorogood M, Carter R, Benfield L, McPherson K, Mann JI. Plasma lipids and lipoprotein cholesterol concentrations in people with different diets in Britain. Br Med J (Clin Res Ed). 1987 Aug 8;295(6594):351-3.

7. Sanders TA, Key TJ. Blood pressure, plasma renin activity and aldosterone concentrations in vegans and omnivore controls. Hum Nutr Appl Nutr. 1987 Jun;41(3):204-11.

9. Sanders TA, Roshanai F. Platelet phospholipid fatty acid composition and function in vegans compared with age- and sex-matched omnivore controls. Eur J Clin Nutr. 1992 Nov;46(11):823-31.

10. Thomas EL, Frost G, Barnard ML, Bryant DJ, Taylor-Robinson SD, Simbrunner J, Coutts GA, Burl M, Bloom SR, Sales KD, Bell JD. An in vivo 13C magnetic resonance spectroscopic study of the relationship between diet and adipose tissue composition. Lipids. 1996 Feb;31(2):145-51.

13. Haddad EH, Berk LS, Kettering JD, Hubbard RW, Peters WR. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr. 1999 Sep;70(3 Suppl):586S-593S.

14. Krajcovicová-Kudlácková M, Blazícek P, Babinská K, Kopcová J, Klvanová J, Béderová A, Magálová T. Traditional and alternative nutrition–levels of homocysteine and lipid parameters in adults. Scand J Clin Lab Invest. 2000 Dec;60(8):657-64.

15. Fokkema MR, Brouwer DA, Hasperhoven MB, Martini IA, Muskiet FA. Short-term supplementation of low-dose gamma-linolenic acid (GLA), alpha-linolenic acid (ALA), or GLA plus ALA does not augment LCP omega 3 status of Dutch vegans to an appreciable extent. Prostaglandins Leukot Essent Fatty Acids. 2000 Nov;63(5):287-92.

18. American Heart Association. What Your Cholesterol Levels Mean. Updated May 3, 2018. Accessed June 17, 2018.

20. Fischbach F. A Manual of Laboratory & Diagnostic Tests, 6th Ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

26. Ross JK, Pusateri DJ, Shultz TD. Dietary and hormonal evaluation of men at different risks for prostate cancer: fiber intake, excretion, and composition, with in vitro evidence for an association between steroid hormones and specific fiber components. Am J Clin Nutr. 1990 Mar;51(3):365-70.

31. Key T, Davey G. Prevalence of obesity is low in people who do not eat meat. BMJ. 1996 Sep 28;313(7060):816–817.

32. Mahan LK, Escott-Stump S. Krause’s Food, Nutrition, & Diet Therapy, 10th Ed. Philadelphia, PA: W.B. Saunders, Co. 2000.

33. Personal communication with Paul Appleby. February 17, 2003.

37. Prospective Studies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009 Mar 28;373(9669):1083-96.

42. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y. Vegetarian Diets and Blood Pressure: A Meta-analysis. JAMA Intern Med. 2014 Feb 24.

How Long Does It Take to Lower Cholesterol?

Making healthy lifestyle changes is one of the most important ways to lower your cholesterol and improve overall health.

According to Dr. Eugenia Gianos, cardiologist at NYU Langone Medical Center, you can lower your cholesterol levels by up to 20 percent through dietary and lifestyle changes alone, but that can vary depending on the person. “We give patients three months to see what effects occur with dietary changes,” she says.

Diet

In order to help lower LDL cholesterol, reduce saturated fat in your diet and increase dietary fiber. Saturated fats increase your body’s production of LDL cholesterol. Dr. Gianos says to cut saturated fat to less than 10 grams per day, and to eat 30 grams of fiber per day, 10 grams of which should be insoluble fiber.

Both doctors say that plant-based diets can help lower cholesterol and improve your overall heart and body health. They recommend the DASH diet and the Mediterranean diet, because both emphasize high fiber levels and healthy fats.

The DASH diet includes:

  • plenty of fruits, vegetables, and whole grains
  • nonfat or low-fat dairy
  • lean proteins (such as fish, soy, poultry, beans)
  • healthy fats (for example, nuts, seeds, vegetable oils)
  • limited salt, sugar, processed foods, red meats

The Mediterranean diet includes:

  • plenty of fruits, vegetables, and whole grains
  • healthy fats like nuts and olive oil instead of unhealthy fats like butter
  • limited salt (substituting herbs and spices instead)
  • mainly fish and poultry for protein, with red meat in moderation (a few times a month)

Dr. Goldberg explains that she looks at the patient as an individual and tries to figure out why their cholesterol is high. She says a lot of her patients are busy and often eat quick meals out. In that case, Dr. Goldberg recommends that people focus on eliminating processed foods and refined sugars.

Exercise

Not being physically active can contribute to higher LDL levels and lower HDL levels. Aerobic exercise helps your body raise its HDL levels, which is important for protecting you against heart disease.

“Exercise is key. Exercise has cardiovascular benefits in addition to weight loss benefits. For weight loss, we recommend 60 minutes of moderate cardio per day,” says Dr. Gianos.

Activities like brisk walking, bicycling, dancing, gardening, swimming, jogging, and aerobics will all give you cardio benefits.

A longtime vegetarian gets a high cholesterol count

My blood test results arrived in the mail last year — and I was shocked. My report, with total cholesterol listed at 248, contained a handwritten note from my doctor in the margin: Come in to see me for medication.

How could I have high cholesterol?

I had been a vegetarian most of my life. I wasn’t overweight. I exercised several times a week on the treadmill.

And although high cholesterol can be genetic, I knew that my mother never had high cholesterol, and my father, who died in 1994, was never treated for cholesterol.

Then, weeks later, I discovered some of my father’s old medical records: His cholesterol at the time had been 270. Perhaps genetics was a factor after all.

A count of more than 200 for total cholesterol is considered high. Further, my “bad” cholesterol (LDL), which should have been below 130, was 174. The only good news I could salvage from the otherwise depressing report was that my “good” cholesterol (HDL) was 50, and higher than 40 is considered positive.

But medication seemed a drastic step. Before committing to a daily pill, I decided to try to reduce my cholesterol through diet. My meals often consisted of cold cereal, yogurt, a chocolate nutrition bar and several diet sodas — all processed foods. I couldn’t remember the last time that I had fruit or vegetables.

And so I embarked on a diet of raw food. I learned that cholesterol numbers don’t change much in less than five weeks, so I gave myself eight weeks to influence my count before trying a cholesterol-lowering medication. I hoped that raw food would keep me from taking cholesterol pills for the rest of my life.

Cholesterol is a major cause of heart disease, building up in the walls of the arteries, hardening them and preventing blood flow to the heart. I scoured the Internet for suggestions on lowering cholesterol through diet. Fresh fruit, vegetables, legumes and whole grains — those seemed to be the way to go.

On my new eating plan, breakfast is a bowl of oatmeal (the only non-raw food I eat) with blueberries when they’re in season or other fresh fruit, such as blackberries, strawberries, raspberries or apples.

Lunch is a smoothie made from orange juice or milk, plus fruit and ice. Dinner is a salad with a lettuce or broccoli base and condiments. Snacks include apples, grapes, carrots, celery and nuts.

No processed food, no sweets, no sodas, no fun.

After eight weeks I had another cholesterol test. I thought my eating plan would have some effect, but I never expected my total cholesterol to drop to 195, a 21% reduction. My “bad” cholesterol was borderline at 132 but still a 24% reduction and only three points over the optimal mark.

If I maintain my diet, perhaps my LDL will continue to drop and I won’t have to take pills to keep my cholesterol down after all.

The added benefit: What initially seemed like a sacrifice has become an enjoyable way of life.

Lewis is a marketing and communication consultant living in Sherman Oaks. [email protected] consulting.com

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *