Cholesterol: Plant-based diets may reduce the risk of strokes, heart attacks

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Eating a more plant-based diet can help lower cholesterol levels. Maria Korneeva/Getty Images
  • A vegetarian or vegan diet may help reduce cholesterol levels in the body, while also helping fight climate change, says a new meta-study.
  • In particular, plant-based diets lower levels of a lipoprotein that is gaining interest as a better predictor of heart health than bad cholesterol, according to the study.
  • Because the body makes most of its own cholesterol, and it doesn\’t come from diet drugs like statins that control cholesterol production, they remain important.

A new study indicates that a vegetarian or vegan diet can reduce dietary cholesterol levels in the body. Specifically, the study shows that such diets reduce levels of lipoproteins which may be a better predictor of cardiovascular disease than low-density lipoprotein (LDL) or bad cholesterol.

The study finds that plant-based diets are associated with a 7% reduction in total cholesterol and a 14% reduction in all artery-blocking lipoproteins, thereby reducing the risk of cardiovascular disease for people who maintain such a diet. diet for at least five years.

Lipoproteins are particles composed of fats, or lipids, and proteins. The lipids they contain include cholesterol and triglycerides. Some cholesterol lipids, such as high-density lipoprotein (HDL), or good cholesterol, protect against heart disease. An excess of low-density lipoprotein (LDL) increases the risk of cardiovascular disease.

The risk reduction from plant-based diets was roughly equivalent to about a third of the cholesterol-lowering effect of drugs such as statins.

The study authors also noted the benefits of climate change that wider adoption of plant-based foods would provide.

The study is a meta-study or study of studies that analyzed the results of 30 different randomized trials published between 1980 and 2022 investigating the effect of plant-based diets on cholesterol.

The results are published in European Heart Journalaccompanied by an editorial.

The study\’s senior researcher, Dr. Ruth Frikke-Schmidt, emphasized the importance of cholesterol, even though it is often discussed in a negative light:

Cholesterol is a cornerstone for, for example, cell membranes, bile and hormones, said Dr. Frikke-Schmidt.

However, a traditional Western diet contains much more cholesterol than necessary, which results in plasma levels that are too high and [a] risk of atherosclerosis and heart attacks. A plant-based diet with less cholesterol is still enough to meet the body\’s needs.

Dr. Frikke-Schmidt also pointed out that vegetarian and vegan diets appear to encourage the liver to produce more LDL receptors, therefore, [the body] it can more efficiently capture cholesterol from the bloodstream.


Perhaps the most interesting finding of the study, according to Dr. Yu-Ming Ni, a cardiologist who was not involved in the study, was that while overall cholesterol levels did not drop spectacularly, what was most interesting was the decrease in apoB cholesterol [apolipoprotein B].

It reflects a trend towards a reduction in the effective counts of the particles themselves, which in research has potentially be a more accurate risk factor to predict cardiovascular risk in some patients, he said.

One of the main findings of the study is that vegetarian and vegan diets not only promote health but also benefit the environment. Dr Frikke-Schmidt said:

The Institute of Nutrition at the Technical University of Copenhagen estimates that 20-35% of the climate impact can be reduced by limiting the amount of meat products and reduced by 45-50% if only diets are produced and used vegan.

These estimates are based on all available scientific literature in the field and incorporate land use, water use and other resources. You can also get more information on this topic from the EAT Lancet commission report, he explained.

Most cholesterol is not based on diet, explained Dr. Devin Kehl, a noninvasive cardiologist who was not involved in this study.

The body makes about 80 percent of its cholesterol and the rest is ingested through the diet, she said.

However, he added, reducing animal fat in one\’s diet, as demonstrated in this dataset, leads to reductions in blood cholesterol concentrations.

Dr. Kehl cautioned, however, [plant-based diets] it should not be viewed as a substitute for cholesterol-lowering medications when these are deemed appropriate by your cardiologist.

The liver produces the body\’s cholesterol, and drugs such as statins inhibit this production. Cholesterol is stored in the gallbladder as bile.

Bile is a kind of soap for the body, Dr. Ni said.

When a person eats, hormones cause the gallbladder to expel bile into the intestinal tract.

[It] it basically collects the fats in food, helps digest them, and helps gather those all-important fat-soluble vitamins that are important for our daily functioning, among other things, Dr. Ni said.

These are then reabsorbed in the intestinal tract, along with some cholesterol. The rest leaves the body in feces.

We recycle a very significant portion of our cholesterol every day, Dr. Ni added.

Dr. Kehl said the study, while in line with existing research, adds to our body of evidence supporting that reducing dietary saturated fat promotes improvements in the serum cholesterol profile.

The key to cardiovascular health and cholesterol control, according to Dr. Ni, is living in the American Heart Associations essential 8.

First of all, diet, stress management and sleep. For me, that\’s always the focus, and I spend a lot of my time with my patients talking about those basics of cardiovascular health.
Dr. Yu-Ming Ni

Dr. Frikke-Schmidts\’ personal point of view is:

An important message from me is that plant-based diets are a key tool in shifting food production towards more environmentally sustainable forms, while also reducing the growing burden of cardiovascular disease globally.

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