What dietary recommendations can help lower Low-Density Lipoprotein (LDL) cholesterol?

From the Guidelines

To lower LDL cholesterol through diet, focus on reducing saturated and trans fats while increasing soluble fiber and plant sterols, as recommended by the most recent and highest quality studies 1. The key dietary recommendations to achieve this include:

• Limiting saturated fat to 7% of total calories, as suggested by the American Diabetes Association 1
• Minimizing trans fat intake by avoiding processed foods with "partially hydrogenated oils" 1
• Increasing soluble fiber intake to 5-10 grams daily through whole-grain products, fruits, and vegetables, which can modestly reduce LDL cholesterol levels beyond those achieved by a diet low in saturated and trans fats 1
• Adding plant sterols/stanols (2 grams daily) through fortified foods or supplements to block cholesterol absorption 1
• Limiting dietary cholesterol to under 200mg daily by reducing egg yolks and organ meats 1
• Maintaining a healthy weight through portion control and regular physical activity, as excess weight contributes to higher LDL levels 1 These dietary changes work by reducing cholesterol intake, blocking its absorption, and enhancing its elimination, potentially lowering LDL by 10-15% when consistently followed. Some of the key foods to include in the diet are:
• Whole-grain products, such as oats, barley, and whole-wheat bread
• Fruits and vegetables, such as beans, apples, and berries
• Nuts and seeds, such as almonds and chia seeds
• Fatty fish, such as salmon and sardines
• Fortified foods, such as plant sterol-enriched margarines and soy milk
• Lean protein sources, such as poultry, fish, and legumes It is also important to limit or avoid foods that are high in saturated and trans fats, such as:
• Red meat and full-fat dairy products
• Processed meats, such as hot dogs and sausages
• Fried foods and baked goods
• Partially hydrogenated oils and trans fat-containing products.

From the FDA Drug Label

In combination with a statin, or alone when additional low-density lipoprotein cholesterol (LDL-C) lowering therapy is not possible, as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH) In combination with a statin as an adjunct to diet to reduce elevated LDL-C in pediatric patients 10 years of age and older with HeFH. In combination with fenofibrate as an adjunct to diet to reduce elevated LDL-C in adults with mixed hyperlipidemia As an adjunct to diet for the reduction of elevated sitosterol and campesterol levels in adults and in pediatric patients 9 years of age and older with homozygous familial sitosterolemia

The recommended dietary approach to lower LDL cholesterol is to use ezetimibe as an adjunct to diet. The key points are:

• Diet is a crucial component of the treatment plan
• Ezetimibe is used in combination with diet to reduce elevated LDL-C levels
• The specific dietary recommendations are not explicitly stated in the label, but it is implied that a diet aimed at reducing LDL-C levels is necessary 2

From the Research

Dietary Recommendations to Lower LDL Cholesterol

To lower LDL cholesterol, the following dietary recommendations can be considered:

• A healthy diet rich in vegetables, fruits, whole-grain, high-fiber foods, and fish, with a small amount of saturated and trans fats 3
• Increased dietary fiber intake, which is associated with significantly lower prevalence of cardiovascular disease and lower LDL-cholesterol concentration of about 5-10% 3
• Inclusion of food ingredients such as plant sterol/stanol, soy protein, and isoflavones, which may help reduce cholesterol levels 3
• Minimizing saturated fats and refined carbohydrates, eliminating trans-fat, and increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 4
• Adhering to a Mediterranean diet, which is strongly recommended for lowering CVD and total mortality 4

Specific Dietary Components

Some specific dietary components that can help lower LDL cholesterol include:

• Plant sterols/stanols, which can lower LDL cholesterol by 10% 3
• Nuts, which can lower LDL cholesterol by 8% 3
• Soy protein, which can lower LDL cholesterol by 3-10% 3
• Omega-3 fatty acids, which can lower triglyceride and reduce CVD events 4
• Dietary fibers, which can lower LDL cholesterol by 5-10% 3

Lifestyle Approaches

In addition to dietary recommendations, lifestyle approaches such as maintaining a healthy weight, exercising regularly, and not smoking can also help lower LDL cholesterol and reduce the risk of cardiovascular disease 5