What Should I Eat to Lower My Cholesterol?
A Cardiologist’s Guide to Dropping Apolipoprotein B, Triglycerides, and Low-Density Lipoprotein Cholesterol Without a Prescription
You don’t need to go vegan.
You don’t need to count every gram of fat.
But if your Apolipoprotein B (ApoB) is elevated, your low-density lipoprotein cholesterol (LDL-C) is creeping up, or your coronary calcium score just delivered a wake-up call, your plate is the first—and best—place to start.
Over the past 20 years, I’ve counseled thousands of patients with rising cholesterol and early plaque. Most thought they were genetically doomed. A few blamed butter in their bulletproof coffee. Nearly all were confused by the online noise:
“Seed oils are toxic!”
“Keto cures everything!”
“You just need more red meat!”
The truth is simpler—and far less click-worthy. The best dietary changes for lipids are boring. But they’re also free, sustainable, and powerful. Done well, they can match or beat low-dose statins in clinical trials.
Let’s walk through what the science says. Then I’ll show you what I actually recommend.
The Clinical Bottom Line: Diet Works
Low-density lipoprotein cholesterol isn’t just a marker of risk. It’s causal in atherosclerosis.
The more ApoB-containing particles circulating in your bloodstream, the more likely they are to get trapped in your artery walls—especially when inflammation, oxidative stress, or insulin resistance are also present.
Here’s the good news:
Diet alone can lower LDL-C, ApoB, and triglycerides by 10–35% in just 4 to 12 weeks.
No pills. No side effects. Just better food.
The Big 4 Dietary Wins for Lipids
1. Cut Saturated Fat (<7% of Calories)
What to change: Replace fatty red meats, processed meats, butter, cream, coconut oil, and palm oil with fish, olive oil, nuts, seeds, and avocado.
LDL-C drop: 8–15%
Timeline: 4–8 weeks
Why: Randomized controlled trials (RCTs) and metabolic studies of real people on research hospital wards consistently show LDL-C drops when saturated fat is replaced with unsaturated fats or fiber-rich carbohydrates¹.
2. Add Soluble Fiber (25–40g/day)
What to eat: Oats, barley, lentils, beans, apples, pears, flax, chia, leafy greens.
LDL-C drop: 5–10% (independent of fat intake)
Timeline: 3–6 weeks
Bonus: Also lowers triglycerides, improves glycemic control, and reduces appetite.
Reality check: 95% of Americans fall short of the minimum fiber intake².
3. Focus on More Plants in Your Diet
What works:
Portfolio Diet → LDL-C ↓ up to 35%3
Vegetarian/Vegan → LDL-C ↓ 13–23 mg/dL4,5
Dietary Approaches to Stop Hypertension (DASH) → LDL-C ↓ ~11 mg/dL6
Mediterranean (plant-forward) → Variable LDL-C drop, strong cardiovascular outcome data⁷
Why: These diets naturally lower saturated fat while increasing fiber, polyphenols, plant sterols, and unsaturated fats.
Timeline: 4–12 weeks for lipid changes; longer for plaque regression.
4. Swap in Unsaturated Fats (Polyunsaturated and Monounsaturated)
What to use: Olive oil, avocado, canola oil, walnuts, sunflower, soy, fish
LDL-C drop: 5–12%
Bonus: Polyunsaturated fats may reduce liver fat and systemic inflammation (C-reactive protein, interleukin-6).
Ignore the noise: Clinical trials show that seed oils—when replacing saturated fats—reduce LDL-C and cardiovascular events8,9.
My Go-To Protocol for Patients
I don’t give people “meal plans.” I give them movement targets, food swaps, and fiber goals they can actually follow.
Here’s the real-world checklist I use:
- Oatmeal + berries + flax every morning
- Beans or lentils daily (soups, salads, tacos, hummus)
- A handful of nuts most days
- Olive oil as your primary cooking fat
- Swap red meat → fish or tofu 3–4x/week
- Hit 30g+ of fiber per day (track for 1 week to see where you really are)
- Minimize processed snacks, especially those with palm or coconut oil
Bonus tip: Make meat a side dish. Flip the plate: 70% plants, 30% protein.
Should You Still Consider a Statin?
Maybe.
But in many cases, dietary change alone can delay—or eliminate—the need for medication. If your LDL-C is under 160 mg/dL, you don’t have established atherosclerotic cardiovascular disease (ASCVD), and you’re willing to put in the work, nutrition should be your first move.
I reassess lipids 8–12 weeks after a focused dietary push.
If we’re not where we need to be, we talk about medication options:
Statins (pravastatin, atorvastatin, rosuvastatin) – reduce LDL-C by inhibiting HMG-CoA reductase, the enzyme responsible for cholesterol synthesis in the liver.
Ezetimibe – lowers LDL-C by blocking cholesterol absorption in the small intestine via selective inhibition of the NPC1L1 protein on the intestinal brush border.
Adenosine triphosphate–citrate lyase (ACL) inhibitors (bempedoic acid) – reduce cholesterol synthesis upstream of HMG-CoA reductase.
PCSK9 inhibitors – monoclonal antibodies that increase LDL receptor recycling, allowing the liver to clear more LDL particles from the blood.
Small interfering RNA (siRNA) therapies – silence the PCSK9 gene to sustain lower LDL-C production over time.
But now, we’re building on a strong foundation—not relying on a pill to do all the work.
Final Thought
You don’t need to eat perfectly.
You don’t need to go vegan.
You don’t need to fear oils, carbs, or food itself.
But you do need to understand this:
Your daily diet—more than your genes—is the first and best lever to pull for cardiovascular risk.
And just like maximal oxygen uptake (VO₂ max), your lipid profile is visible, measurable, and changeable.
Let’s use that to our advantage.
Coming Next on Train for Life
Case Study: How one patient dropped LDL-C from 160 → 88 mg/dL in 4 months, combining lifestyle and medications.
GLP-1 Deep Dive: Who should (and shouldn’t) use these weight-loss and metabolic health medications.
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I love that you put the timeline for change! Many folks expect nutrition to work overnight. Also - looking forward to your GLP dive! 🤙
Very well put