Foods that lower LDL cholesterol, and foods that raise it

David Jenkins and colleagues at the University of Toronto designed it to stack small effects. In the 2003 trial, participants ate per 1,000 kcal about 1.0 g plant sterols, 21.4 g soy protein, 9.8 g viscous fiber and 14 g almonds [1]. After a month LDL-C fell by 28.6% on the diet, 30.9% on lovastatin 20 mg and 8.0% on a low saturated fat control diet.

In daily life the result was smaller. Across four Canadian centers, six months of advice lowered LDL-C by 13.1% to 13.8%, against 3.0% for standard advice, and people who stuck to it more closely saw larger drops [8].

The whole-food plant-based and Mediterranean diet protocols cover most Portfolio foods.

• Oats and barley. Their beta-glucan is a viscous soluble fiber. A median 3.5 g a day lowered LDL-C by about 7 mg/dL (0.19 mmol/L)0.19 mmol/L (about 7 mg/dL) [2]. About three servings of oatmeal provide 3 g of soluble fiber [9].
• Beans, lentils, chickpeas and peas. About one serving (130 g) a day lowered LDL-C by about 7 mg/dL (0.17 mmol/L)0.17 mmol/L (about 7 mg/dL) [3].
• Nuts. 67 g a day lowered LDL-C by 10.2 mg/dL (7.4%), with similar effects across nut types [4].
• Soy foods. About 25 g of soy protein a day from foods such as tofu and soy milk lowered LDL-C by 3% to 4% [10].
• Plant sterols and stanols. Fortified spreads, yogurt drinks or capsules giving 0.6 to 3.3 g a day lowered LDL-C by 6% to 12% [11].
• Liquid vegetable oils. Olive, canola and sunflower oil in place of butter lower LDL by replacing saturated fat [12].

In metabolic ward studies, saturated fat was the main dietary driver of LDL-C. Replacing 10% of calories from saturated fat with complex carbohydrate lowered LDL-C by about 14 mg/dL (0.36 mmol/L)0.36 mmol/L (about 14 mg/dL); polyunsaturated fat in place of carbohydrate lowered it a little more [5].

What replaces saturated fat matters for risk too. Unsaturated fats improve the total to HDL ratio, while refined carbohydrates do not [12]. Over at least two years, cutting saturated fat reduced combined cardiovascular events by 21% [13].

The keto and carnivore protocols are high in saturated fat by design, which is why they recommend checking LDL after the switch.

A 2015 meta-analysis found dietary cholesterol raised LDL-C by 6.7 mg/dL in 14 trials, with heterogeneous results [14]. Avoiding 200 mg a day of dietary cholesterol lowered LDL-C by about 4 mg/dL (0.10 mmol/L)0.10 mmol/L (about 4 mg/dL) in metabolic ward studies [5].

The American Heart Association advises focusing on eating patterns, such as Mediterranean or DASH, that are naturally modest in cholesterol rather than counting eggs [7]. Responses vary between people, so your own repeated panels are the best guide.

Coffee beans contain oils that raise cholesterol, and a paper filter traps most of them. A meta-analysis of 14 trials found that unfiltered and boiled coffee raised total and LDL cholesterol in a dose-dependent way, while filtered coffee barely did [6]. A later meta-analysis of 12 trials found an average LDL-C rise of 5.4 mg/dL over about 45 days, larger with unfiltered coffee and in people with high cholesterol [15].

The trials we cite did not report espresso separately.

In 44 studies, alcohol raised HDL cholesterol by about 3.6 mg/dL (0.094 mmol/L)0.094 mmol/L (3.6 mg/dL) and lowered fibrinogen, but did not change triglycerides [16]. Raising HDL has not proven to protect the heart on its own, and alcohol has other harms.

If you are trying to lower LDL, alcohol does not help. For its effect on other blood fats, see the triglycerides hub.