How going vegan and eating a plant-based diet can lower your cholesterol levels

We can’t live without it, but too much can be deadly. Here’s all you need to know about cholesterol and your health, and how to lower it with a vegan diet.

What is cholesterol and what role does it play in the body?

Cholesterol is a type of fat and has a soft, waxy consistency. It’s a crucial component of your cell membranes, bile, vitamin D and several hormones.

Small cholesterol particles float in your blood as they are transported either from or to the liver for processing.

Generally, cholesterol is recycled in the digestive system. The liver uses it to make bile, which is stored in the gallbladder. It then travels into the small intestine to help the digestive process. About 50% of this bile is then reabsorbed through the gut back into the bloodstream.

Your body produces its own cholesterol according to its needs so you don’t need it in your diet.

The trouble is, your body makes cholesterol from saturated and hydrogenated fats you eat and there’s no limit. So long as you keep supplying these fats, your body keeps making cholesterol from them.

High cholesterol levels are a major risk for heart disease^1,2.

What are healthy cholesterol levels?

Your cholesterol levels can be measured from a blood sample in a routine test. Levels under 5 mmol/L or less are considered good and desirable.

Higher figures mean you are at risk of artery narrowing, heart disease and stroke.

What problems can high cholesterol cause?

High cholesterol levels mean that you have many small, sticky cholesterol particles floating in your blood.

These tiny blobs can stick to your blood vessel walls, in particular to the walls of arteries (blood vessels carrying blood away from the heart). Gradually they will form fatty layers called cholesterol plaques.

This leads to the narrowing and hardening of the arteries – atherosclerosis.

Inevitably, narrowing of the arteries increases blood pressure because the same volume of blood has to squeeze through a smaller tube.

It is also a big risk factor for heart disease and stroke because there’s a risk that one of the plaques will tear off and block an important blood vessel.

What’s the difference between good cholesterol and bad cholesterol?

Cholesterol swims in your blood bound to proteins called lipoproteins. These come in two versions – LDL ‘bad’ cholesterol and HDL ‘good’ cholesterol.

LDL is the bad type of cholesterol because its high levels in the blood can form plaques in your arteries.

HDL is the good type because it carries cholesterol back to the liver where it’s broken down.

Cholesterol tests show the results for both.

Ideally, the HDL levels should be above 1mmol/L and the LDL levels under 3 mmol/L.

What causes high cholesterol levels?

Many different factors can contribute to high cholesterol, including genetics, age, gender and diseases such as type 2 diabetes, liver or kidney disease.

However, the biggest contributors to high cholesterol levels by far are diet and lifestyle.

Eating too much saturated fat greatly contributes to high cholesterol levels. This is found mostly in meat, eggs, butter, cheese, pies, pastries, processed foods, fatty spreads, coconut oil and palm fat.

High intake of animal protein, which usually goes hand in hand with excessive saturated fat intake, and too much sugar in the diet also increase cholesterol levels³.

When you eat animal products, there’s one more substance making things worse – a compound called trimethylamine-N-oxide (TMAO).

Human gut bacteria produce TMAO parent molecule from foods rich in L-carnitine (meat) and choline (eggs) and the liver then finishes the last step in TMAO formation^3,4.

This compound increases the stickiness of cholesterol particles, contributing to atherosclerosis. That’s why it’s a substantial risk factor for heart disease and stroke⁵.

Trans fats

Trans fats, also called hydrogenated, are another problem. They raise your levels even more than saturated fats.

Low levels are found in meat and dairy products. Higher amounts are used in some processed foods, such as biscuits, cakes, pastries, spreads and shortening.

Always read the ingredients and when you see that a product contains hydrogenated fat, put it back and walk away.

Margarine used to contain hydrogenated fats, which is why some people think it’s bad. However, most margarine producers have now removed these from their products.

Smoking, drinking alcohol and a lack of physical activity can increase your cholesterol, too.

If these lifestyle habits are combined with a poor diet, you’ve got a recipe for a cholesterol disaster.

How does a vegan diet help to lower cholesterol?

A vegan diet means a healthier fat intake because most plants contain very little saturated fat, more fibre and antioxidants. It usually also contains more fruit and vegetables, pulses, wholegrains, nuts and seeds compared to an animal-based diet⁶.

All these characteristics help to keep your blood vessels healthy, prevent high cholesterol and plaque formation, and help to maintain a healthy blood pressure.

It’s why people who eat vegan or mostly plant-based diets have lower cholesterol levels than all other diet groups and a 25-57 per cent lower risk of heart disease^{7,8,9,10,11,12,13,14}.

If you already have heart disease, atherosclerosis or high cholesterol, a vegan diet can work better than any drug or treatment. Dr Esselstyn¹⁵ says: “it is unconscionable not to inform the cardiovascular disease patient of this option for disease resolution. To begin to eliminate chronic illness, the public needs to be made aware that a pathway to this goal is through WFPBN [wholefood plant-based nutrition].”

And another expert review¹² agrees: “Plant-based diets are the only dietary pattern to have shown reversal of CHD [coronary heart disease].”

Unsaturated fats

When you suffer from high cholesterol levels, a low-fat, wholefood vegan diet is recommended to bring them down and clear away cholesterol plaques³.

However, it’s been shown that simply reducing all fat is not the key to success. It’s crucial to strictly cut down on saturated fat but ensure a healthy supply of essential unsaturated fats¹⁶.

In particular, omega-3 fats are important. You can get your daily dose from two tablespoons of ground flaxseed or chia seeds, two teaspoons of flaxseed oil, one tablespoon of hempseed oil or 10 walnut halves.

And there’s more to a vegan diet – many plant foods contain phytosterols, compounds similar in structure to cholesterol.

Phytosterols compete with cholesterol for absorption in the gut. The more phytosterols in your diet, the less cholesterol is absorbed.

Don’t forget, even if you don’t eat any cholesterol, your bile contains it. Phytosterols block the re-absorption of this cholesterol too.

So do vegans not have to worry about high cholesterol?

A vegan diet doesn’t automatically guarantee healthy cholesterol levels.

It’s true that vegans tend to have healthier diets in general. But if you mostly eat processed, fatty foods, white bread, potatoes and sweets, you can easily have high levels.

If, on the other hand, your diet consists of fruit and vegetables, wholegrains, pulses, nuts and seeds, your levels are probably super healthy and shouldn’t be an issue.

Some people may have a wholefood vegan diet, without coconut and palm oil, avoiding hydrogenated fats, doing everything ‘right’ and still have high cholesterol.

In those cases it’s often because there’s an underlying cause, such as a disease altering cholesterol metabolism, which requires medical attention.

Which foods lower cholesterol?

A healthy vegan diet low in saturated fats is excellent for lowering cholesterol in general. But there are a few foods that can be extra helpful:

• Oats – and other sources of beta-glucans, such as barley and mushrooms. Beta-glucans are a specific type of fibre that is very effective at lowering cholesterol levels¹⁶.
• Wholegrains – Wholemeal bread, whole-wheat pasta, brown rice, quinoa or muesli are excellent sources of fibre helping to keep your cholesterol in check.
• Fruit and vegetables – at least five portions a day. They provide essential vitamins, minerals and antioxidants important for healthy blood vessels, healthy energy and are also great sources of fibre.
• Nuts and seeds – especially those high in omega-3 fats, such as walnuts, hempseed, flaxseed, chia seeds.
• Soya – Soya protein actually helps to actively lower your cholesterol levels. The intake of around 25 grams of soya protein daily has been identified as an effective dose¹⁷. A couple of servings of soya foods is enough to provide this amount – tofu, tempeh, soya-based mock meats, soya milk or yoghurts, etc.
• Beans, lentils and chickpeas – These low-fat, high-fibre sources of protein are excellent for your heart. They take a while for the body to digest, preventing over-eating while providing healthy energy, fibre and a number of essential minerals.

Are statins the only way to treat high cholesterol?

Statins are drugs that interfere with cholesterol synthesis in your body – that way, they lower levels.

Statins also reduce the formation of cholesterol plaques in blood vessels. They are the go-to prescription drug for people with high levels and/or blood pressure.

There are a few other medications that can be used and they all target cholesterol metabolism in your body.

However, if you keep supplying material for excess cholesterol to be made in your body, taking medication is like dismantling a wall that you continue building.

It makes no sense! A diet change is what can make the most dramatic positive difference to your health.

Choosing a wholefood vegan diet is the best tool in preventing or treating high cholesterol levels.

Healthy lifestyle choices can help people to live well with osteoporosis, including vegans. 

Make sure you’re giving your body what it needs with our guide to vegan diets and osteoporosis.

References

1. Sacks FM, Lichtenstein AH, Wu JHY, et al., American Heart Association, 2017. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 136(3):e1-e23.
2. Korakas E, Dimitriadis G, Raptis A, Lambadiari V, 2018. Dietary Composition and Cardiovascular Risk: A Mediator or a Bystander? Nutrients. 10 (12): 1912.
3. Campbell T, 2017. A plant-based diet and stroke. Journal of Geriatric Cardiology. 14(5):321-326.
4. Spence JD, 2018. Diet for stroke prevention. Stroke and Vascular Neurology. 3(2):44-50.
5. Chiu THT, Chang HR, Wang LY, et al., 2020. Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan. Neurology. 94(11):e1112-e1121.
6. Miles FL, Lloren JIC, Haddad E, et al., 2019. Plasma, Urine, and Adipose Tissue Biomarkers of Dietary Intake Differ Between Vegetarian and Non-Vegetarian Diet Groups in the Adventist Health Study-2. Journal of Nutrition. 149 (4): 667-675.
7. Bradbury KE, Crowe FL, Appleby PN, et al., 2014. Serum concentrations of cholesterol, apolipoprotein A-I and apolipoprotein B in a total of 1694 meat-eaters, fish-eaters, vegetarians and vegans. European Journal of Clinical Nutrition. 68 (2): 178-183.
8. Le LT, Sabaté J. 2014. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 6(6) 2131-2147.
9. Appleby PN, Key TJ. 2016. The Long-Term Health of Vegetarians and Vegans. Proceedings of the Nutrition Society. 75 (3) 287-293.
10. Dinu M, Abbate R, Gensini GF, et al., 2017. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 57(17): 3640-3649.
11. Benatar JR, Stewart RAH, 2018. Cardiometabolic risk factors in vegans; A meta-analysis of observational studies. PLoS One. 13 (12): e0209086.
12. Kahleova H, Levin S, Barnard ND, 2018. Vegetarian Dietary Patterns and Cardiovascular Disease. Progress in Cardiovascular Diseases. 61 (1) 54–61.
13. Korakas E, Dimitriadis G, Raptis A, Lambadiari V, 2018. Dietary Composition and Cardiovascular Risk: A Mediator or a Bystander? Nutrients. 10 (12): 1912.
14. Matsumoto S, Beeson WL, Shavlik DJ, et al., 2019. Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health Study-2. Journal of  Nutrition Science. 8:e6.
15. Esselstyn CB, 2017. A plant-based diet and coronary artery disease: a mandate for effective therapy. Journal of Geriatric Cardiology. 14 (5): 317-320.
16. Trautwein EA, McKay S, 2020. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients. 12 (9): 2671.
17. Blanco Mejia S, Messina M, Li SS, et al., 2019. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr. 149 (6): 968-981.