Cholesterol is one type of lipid or fat in the body. It is synthesized predominately in the liver and used to make steroid hormones and is required for bile acid which aids in digestion and absorption of dietary fats. Cholesterol is also found in our diet, with a vast majority consumed from animal products. When animal products and processed foods rich in saturated and trans fats are consumed in excess amounts, high cholesterol, along with the inflammation produced from eating a low nutrient diet, will result in cholesterol plaques leading to cardiovascular disease.

  • Overview
  • Action Plan
  • Ask The Doctor
  • Related Info
  • Success Stories


An estimated 31.9 million adults (>/= 20 years of age) have a total serum cholesterol greater than 240, with a prevalence rate of 13.8%. The prevalence of abnormal lipids in youths ages 12 to 19 was 20.3%.1 As the dietary habits found in the Standard American Diet continue, prevalence rates will continue to increase among adults and children.

A cholesterol panel includes total cholesterol, LDL (low density lipoprotein), and HDL (high density lipoprotein) levels. LDL is referred to as “bad cholesterol” and HDL as “good cholesterol.” Cholesterol is packaged into lipoproteins when circulating in the blood; LDL carries cholesterol to the cells, and HDL delivers the excess back to the liver where it is broken down. Specialized lipid blood tests are able to evaluate the size and particle number of LDL. Having elevated numbers of small dense LDL particles increases CV risk. As these particles interact with and are degraded by white blood cells in an inflammatory environment that can arise from eating a SAD diet, foam cells form, and LDL can now easily accumulate as plaque build-up. Cholesterol plaque that covers the inner lining of arteries can cause obstruction and block blood flow to various organs. Ruptured cholesterol plaque can quickly form clots in arteries, leading to blockages.

  • In the heart, this can lead to chest pain, progressing to heart attacks.
  • In the kidneys, this can lead to renal disease and failure.
  • In the legs, this can lead to peripheral vascular disease with symptoms like numbness, pain or tingling.
  • In the eyes, this can lead to poor vision and blindness.
  • In men, this can manifest as erectile dysfunction.

Medications used to treat high cholesterol include those that stop the production of cholesterol in the liver or those that inhibit absorption of dietary cholesterol in the intestines. Statins like Lipitor and Crestor have been shown to increase the risk of myalgias, liver dysfunction, renal disease, macular degeneration, and diabetes.2 Not only is treating high cholesterol with a Nutritarian diet safer but it has been found to be even more effective at lowering LDL levels than medications.3

  1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014, 129:e28-e292.
  2. Naci H, Brugts J, Ades T. Comparative tolerability and harms of individual statins: a study-level network meta-analysis of 246 955 participants from 135 randomized, controlled trials. Circ Cardiovasc Qual Outcomes 2013, 6:390-399.
  3. Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism 2001, 50:494-503.

Action Plan


  • A Nutritarian diet with an array of cruciferous vegetables, other vegetables, legumes, fruits, nuts, and seeds can lower cholesterol levels and dissolve cholesterol plaque in arteries. It is high in antioxidants, anti-inflammatory phytochemicals, and fiber and low in saturated and trans fat. While lowering cholesterol levels is desirable, this eating style will, most importantly, lower the risk of cardiovascular disease.
  • Plant foods contain dietary phytostanols and phytosterols which help lower blood cholesterol levels as well as cut down on cancer risk.1 These stanols and sterols can be found in supplement form, helping patients as they titrate off their cholesterol medications.
  • Consuming nuts daily can help lower cholesterol levels. The micronutrients, fatty acids, and fiber can help lower LDL levels. The effects of nuts were greater in individuals with lower BMI, meaning that those who were overweight or obese saw less cholesterol-lowering benefit than healthy weight individuals.2 Because of their caloric density, limit to one ounce of nuts daily if overweight.


Consuming a Nutritarian diet, which provides a substantial amount of plant sterols and stanols, works synergistically with exercise regimens to lower cholesterol levels. It changes the way cholesterol is absorbed, transported, and metabolized.3

  1. Woyengo TA, Ramprasath VR, Jones PJ. Anticancer effects of phytosterols. Eur J Clin Nutr 2009, 63:813-820.
  2. Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med 2010, 170:821-827.
  3. Marinangeli CP, Varady KA, Jones PJ. Plant sterols combined with exercise for the treatment of hypercholesterolemia: overview of independent and synergistic mechanisms of action. J Nutr Biochem 2006, 17:217-224.

Ask The Doctor

The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)


I work for a company where we have a significant financial incentive to score well on our BMI, cholesterol, and blood pressure. I have read several threads from those who are eating a Nutritarian diet, yet still scoring high on their blood tests, but you have stated that as long as they are eating predominantly high-nutrient foods and exercising, that high cholesterol number is not important. Then why do certain companies/doctors focus on these numbers?

I have followed a Nutritarian diet and practiced a very healthy lifestyle for years. I am at my optimal weight, (and have high cholesterol) so I will not be rewarded, however, my co-worker, who eats fast food but is on a statin, will!

I feel this encourages us to take the easy route (prescription drugs), rather than do what is best for our health (Nutritarian diet). Any comments? I have done everything you have suggested to bring my numbers down. My blood pressure is good, BMI great, triglycerides fine. Should I take a supplement?


I agree with you that a healthy diet with higher cholesterol is much healthier than a less healthy diet with lower cholesterol or medicated lower cholesterol. Plus, total cholesterol is not a good measurement of risk. One needs to consider the LDL particle number and size. The LDL particle size on a Nutritarian diet is much more favorable too, as are other markers demonstrating low inflammation. In conclusion, you are in phenomenal health, even if your LDL cholesterol does not drop below 100 as favored on those guidelines, whether it is recognized by your company’s standards or not.


After following a Nutritarian diet for several years now, I still struggle with less than ideal cholesterol. After the first year, my cholesterol went down below 200 (like 175). It has steadily crept up over the years. Last week, I had blood drawn for my annual physical and was shocked that the cholesterol number was 227. My LDL was 141. I’m 53, female, 5’7" and weigh 126 (this is my lowest weight in years).

My disappointment stems from me doubling my efforts to follow a Nutritarian diet. I have been making smoothies with spinach in the AM, salads for lunch, and salads and veggies for dinner. I have lost 5 pounds in the last 6 weeks alone!

One thing I have not done is keep up with my LDL protect supplements. I have not taken them for a few months. Could lack of the LDL Protect for a few months have caused such a difference when I am eating so well? Also, can stress cause a higher cholesterol level in the absence of bad eating? I recently lost my job.


Stopping the LDL and the increased stress can play a role, but most likely, this is caused by the recent weight loss and burning off more body fat (full of cholesterol). You must consider that you had plenty of stored saturated fats on your body that you autolysized, contributing to your continued utilization of those fats for cholesterol metabolism. In other words, you burned body fat for energy. Remember, you lost weight. The fat that was burned was animal fat (you are an animal). That fat was highly saturated and contributes to your high cholesterol production. Once that fat is off your body completely the picture will be different. In other words, once your weight has stabilized at this lower level, you will see an improvement in your cholesterol results, including a better LDL particle size and number.


I am a thin female, age 60, 5’ 7", weight 119-120. I eat a very strict Nutritarian diet and exercise 3-4 days per week. How much fat (percentage) is allowable and will not elevate my cholesterol level or clog my arteries? I really love nuts/seeds and avocados but just am never sure how much fat is safe. I went to a local health lecture by Dr. Caldwell Esselstyn, who states all fat is detrimental and causes damage to arterial walls. He recommends only 8-10%, but I know from reading your books that fat is necessary for brain health and heart health. I just get very confused. If I have a percentage to go by, like 20% or 25% of total calories from fat, I can better gauge how much is healthy. I tend to lose weight easily and really don’t like getting too thin.


There is no level of fat that is detrimental to the body if you are thin and utilizing the fat for energy, and it is from healthy food sources such as seeds and nuts. In fact, higher intake of seeds and nuts lower LDL cholesterol even more than lower amounts. Plus, seeds and nuts enlarge the LDL molecule (fluffy) reducing risk further, so the number does not even represent the degree of protection. Nevertheless, a small difference in cholesterol would not make much difference when every other parameter of risk improves, including less risk of arrhythmia and sudden cardiac death, as well as lower risk of cancer with the inclusion of seeds and nuts.

Did you ask the doctor making that claim to show the studies that determine that conclusion, and what type of fats were used in those studies? If you did, you would find no evidence for that conclusion. That was only from processed oil; in fact when they tried to reproduce inflammatory markers with nuts and seeds they found the opposite, that it decreased inflammation. There are more than one hundred studies documenting that nuts and seeds are favorable foods for the heart and blood vessels and none demonstrating unfavorable effects, so excluding them has no basis in science.