Nutrition and Cholesterol: Evidence-Based Ways to Lower LDL Naturally

What Is Cholesterol and Why Does It Matter?

Cholesterol is one of the most debated topics in nutrition. It has long been labelled as “good” or “bad”, with advice often focused on avoiding specific foods. However, cholesterol is essential for life, and cardiovascular risk depends on more than a single cholesterol number.

Cholesterol is a waxy, fat-like substance found in every cell of the body. It is essential for hormone production, including oestrogen, progesterone and testosterone, for bile acid formation needed for fat digestion, for vitamin D synthesis, and for maintaining healthy cell membranes.

Around 70–80% of cholesterol is produced by the liver. Only a small proportion comes from food, mainly animal-derived foods such as egg yolks, shellfish and organ meats. Large studies consistently show that dietary cholesterol has little impact on blood cholesterol levels for most people.

Cholesterol Transport and Lipoproteins

Cholesterol travels in the bloodstream packaged inside lipoproteins.

Low-density lipoprotein

Low-density lipoprotein (LDL cholesterol) transports cholesterol from the liver to tissues. When present in excess, LDL particles can enter the artery wall and contribute to plaque formation (atherosclerosis). Raised LDL cholesterol is associated with an increased risk of heart disease and stroke. LDL cholesterol also tends to rise with age, particularly after menopause.

LDL cholesterol measures how much cholesterol is being carried in the blood, but it does not show how many cholesterol-carrying particles are present. Each LDL particle is capable of entering the artery wall, so cardiovascular risk is driven more by the number of atherogenic particles and how long they circulate, rather than cholesterol concentration alone. Someone can therefore have a “normal” LDL cholesterol result but still have a high number of LDL and related particles, increasing their risk of atherosclerosis. Markers such as non-HDL cholesterol and apolipoprotein B (ApoB) better reflect this particle burden and can give a clearer picture of risk, particularly in people with insulin resistance, metabolic syndrome or a strong family history of heart disease. I often refer clients for additional testing to investigate these and other markers.

High-density lipoprotein

High-density lipoprotein (HDL cholesterol) helps transport cholesterol back to the liver for recycling or excretion. Higher HDL levels are associated with lower cardiovascular risk, although raising HDL alone does not appear to reduce risk unless LDL is also well controlled.

Triglycerides

Triglycerides are another type of blood fat. Raised triglycerides often reflect insulin resistance and are associated with increased cardiovascular risk, particularly when HDL cholesterol is low.

UK Cholesterol Guidelines

Current NHS and Nice guidelines recommend the following targets. For most adults, total cholesterol target is below 5 mmol/L, LDL cholesterol below 3 mmol/L, non-HDL cholesterol below 4 mmol/L, HDL cholesterol above 1.0 mmol/L for men and 1.2 mmol/L for women, and triglycerides below 1.7 mmol/L.

For people at higher risk, including those with existing cardiovascular disease, diabetes or a strong family history, LDL cholesterol is typically targeted closer to 2.0 mmol/L or below, and non-HDL cholesterol around 2.6 mmol/L or below. Targets should always be interpreted alongside blood pressure, smoking status, metabolic health and family history.

Why LDL Builds Up

Most raised cholesterol is not caused by eating cholesterol, but by reduced clearance from the bloodstream. The liver removes LDL particles using LDL receptors. When these receptors work efficiently, LDL is cleared quickly. When receptor activity is reduced, LDL remains in circulation longer, increasing the likelihood that particles enter artery walls.

Diet plays an important role in influencing LDL receptor activity, which is why cholesterol levels can change meaningfully within weeks of dietary change.

What to Eat to Lower Cholesterol

Soluble Fibre

Soluble fibre binds bile acids in the gut, increasing cholesterol excretion and prompting the liver to remove LDL from circulation. The following fibre-rich foods have consistently been shown to lower LDL cholesterol.

1. Oats contain beta-glucans, a soluble fibre shown to lower LDL cholesterol when consumed regularly. An intake of around 3 g of beta-glucans per day is effective, typically achieved with 70–80 g of dry oats such as porridge or overnight oats.

2. Flaxseeds provide soluble fibre, lignans and alpha-linolenic acid, which together reduce cholesterol absorption and increase excretion. Studies support an intake of around 20 g of ground flaxseed daily.

3. Pulses such as lentils, chickpeas and beans provide a combination of soluble and insoluble fibre that reduces cholesterol absorption and supports gut bacteria involved in cholesterol metabolism. Consuming around 100–150 g of cooked legumes daily is associated with meaningful reductions in LDL cholesterol.

4. Soya protein and isoflavones improve LDL receptor activity in the liver, enhancing cholesterol clearance. An intake of around 25 g of soya protein per day has been shown to be effective. This can be achieved through a combination of soya foods, for example 200–300 g firm or extra-firm tofu depending on brand, 600–800 ml soya milk, or a combination such as tofu with soya yoghurt or edamame.

5. Regular consumption of a handful of nuts, around 30 g per day, such as almonds, walnuts or pistachios, is consistently associated with lower LDL cholesterol and reduced cardiovascular risk. This effect is likely due to their fibre, unsaturated fats, natural plant sterols and antioxidants.

Unsaturated Fats

Replacing saturated fats with unsaturated fats consistently improves LDL cholesterol and reduces cardiovascular risk. Key sources include extra virgin olive oil, rapeseed oil, avocados, nuts and seeds, and oily fish. Extra virgin olive oil also provides polyphenols that reduce LDL oxidation and improve endothelial function, offering cardiovascular protection beyond lipid lowering alone.

Oily fish does not significantly lower LDL cholesterol, but it reduces triglycerides, improves LDL particle characteristics and lowers cardiovascular event risk, making it an important part of a heart-healthy diet.

What to Reduce to Lower Cholesterol

Ultra-processed foods

High intakes of ultra-processed foods are consistently associated with higher LDL cholesterol, higher ApoB and increased cardiovascular risk. These foods are typically high in saturated and trans fats, refined carbohydrates and added sugars, while being low in fibre and protective nutrients. Ultra-processed foods can worsen cholesterol through several pathways simultaneously, including raising LDL cholesterol, increasing triglycerides, impairing gut microbiota involved in bile acid metabolism, and promoting liver fat accumulation.

Common examples include pastries, biscuits, crisps, processed meats, sugary cereals, sweetened drinks, ready meals and takeaways. Reducing ultra-processed foods improves cholesterol not only by removing harmful components, but by creating space for fibre-rich whole foods, healthy fats and plant proteins.

Saturated fats

Saturated fats reduce LDL receptor activity, slowing cholesterol clearance. The LDL-raising effect is most consistent when saturated fat comes from refined or ultra-processed foods such as pastries and processed meats.

Coconut oil deserves separate mention because it is often marketed as heart-healthy. Despite containing some medium-chain fatty acids, coconut oil is around 85–90% saturated fat, largely lauric acid, which reliably raises LDL cholesterol. Controlled trials show coconut oil increases LDL cholesterol more than unsaturated plant oils such as olive or rapeseed oil. While it raises HDL cholesterol, this does not offset the increase in LDL or non-HDL cholesterol. From a cardiovascular perspective, coconut oil should not be used as a main cooking fat by those aiming to lower cholesterol.

Some whole foods containing saturated fat, such as yoghurt or cheese, show neutral cardiovascular associations in population studies. However, these foods can still raise LDL cholesterol in many individuals, particularly at higher intakes. For people with raised LDL or ApoB, reducing saturated fat intake remains an important strategy.

I am often asked about whether eggs raise cholesterol. For most people, moderate egg consumption has little impact on blood cholesterol levels, as dietary cholesterol contributes relatively little compared with cholesterol produced by the liver. However, individual responses vary, and a minority of people are considered “hyper-responders”, meaning that higher intakes of dietary cholesterol can raise LDL cholesterol and ApoB. Estimates suggest this affects a small proportion of the population. For most healthy adults in the UK, an intake of up to one egg per day is unlikely to have a meaningful effect on cholesterol levels.

Refined carbohydrates

Refined carbohydrates do not raise LDL cholesterol directly, but they worsen lipid profiles indirectly, particularly in people with insulin resistance. High intakes can increase triglycerides, lower HDL cholesterol, increase production of small, dense LDL particles, and raise ApoB even when LDL cholesterol appears normal. Foods to limit include white bread and refined grains, sugary cereals, cakes, sweets and sweetened drinks. This is especially important if triglycerides are elevated or metabolic syndrome is present.

Key takeaways

• LDL and ApoB matter more than total cholesterol alone when assessing cardiovascular risk

• Fibre-rich foods such as oats, pulses, flaxseeds and nuts help lower LDL cholesterol

• Replacing saturated fats with unsaturated fats improves cholesterol profiles

• Ultra-processed foods and refined carbohydrates worsen lipid risk

• Most people can include eggs in moderation, but individual response varies

If you would like personalised advise on reducing your cholesterol please feel free to get in touch.