Can Vegans Have High Cholesterol?

Movies like The Sixth Sense, The Usual Suspects, and Planet of the Apes leave viewers gasping in disbelief at their shocking revelations. 

But what about a vegan who goes in for a routine blood test and discovers that they have high cholesterol? Is that just another fanciful Hollywood invention, or could that actually happen?

Many vegans assume that their diet eliminates the risk of high cholesterol. After all, plants don’t contain cholesterol. 

But is that the whole story? (Spoiler alert: no.)

In this article, we’ll explore the science of high cholesterol. You’ll see that while diet is a huge factor, it’s not the only one. And you’ll get practical tips and steps for supporting healthy cholesterol levels that go beyond what you include and exclude from your plate.

What Is Cholesterol and What Does It Do?

Cholesterol is a fatty substance that performs a number of vital functions in your body. It’s needed for the construction and repair of cell membranes, and to make important hormones, including:

• Sex hormones like estrogen, progesterone, and testosterone
• Stress hormones such as cortisol
• Water and electrolyte-balance hormones like aldosterone
• Vitamin D, which your skin starts making from cholesterol when exposed to sunlight

Cholesterol is so vital that your body doesn’t take any chances; your liver produces all the cholesterol you need. You don’t need to get any cholesterol from food.

Cholesterol isn’t water soluble, which means that it can’t dissolve in your bloodstream by itself. Your body deals with this by binding cholesterol to protein molecules that can travel through the blood. These combinations of fats and proteins are known as apolipoproteins (fun tongue-twister!). 

Simplifying a bit for our discussion, there are two apolipoproteins of note. One is apolipoprotein B (ApoB), which is the main protein in LDL cholesterol. This is the “delivery” form, responsible for getting cholesterol to the cells where it’s needed.

The second is apolipoprotein A1 (ApoA1), the main protein in HDL cholesterol. It’s the “waste management” form, and its job is to help remove excess cholesterol from your bloodstream.

The difference in those two functions is why LDL is considered the “bad” cholesterol while HDL is thought of as the “good” one. Both are necessary for life, so “bad” and “good” are simplistic assessments. But because our modern diet and lifestyle make us prone to high LDL cholesterol, and this condition is a known precursor to cardiovascular disease, it’s a useful way to think about it.

How bad is “bad” LDL cholesterol? It’s a major risk factor for some of our most common and deadly chronic diseases, including atherosclerosis (plaque buildup in arteries), coronary artery disease, peripheral artery disease, and stroke.

What are Healthy Cholesterol Levels?

So, what is considered “high” cholesterol? And what are normal levels? The answers come from decades of studies correlating cholesterol with health outcomes. 

For total cholesterol, a level below 200 mg/dL (that’s “milligrams per deciliter”; cholesterol researchers are fans of the metric system, apparently) has long been considered desirable. More recent research has found that, in addition to that total number, the ratio of LDL to HDL is also a risk factor for disease.

That’s one reason why total cholesterol can be a misleading number. It lumps together different types of cholesterol, including LDL and HDL. Someone with high total cholesterol might have excellent cardiovascular health if their HDL level is especially high. It’s kind of like labeling someone “obese” based on their body weight, even if their weight is coming from lean muscle, not fat. Without knowing the breakdown, the total number doesn’t tell the full story.

LDL cholesterol should ideally be less than 100 mg/dL. That said, if you’re below 130, that’s pretty good. Between 130 and 160 is borderline high, while anything above 160 is considered high. 

In contrast, higher HDL cholesterol levels are associated with better health. So HDL at 60 mg/dL or higher is considered optimal, as it offers protection against heart disease. For men, anything below 40 is considered a risk factor, while for women, that number rises to 50. 

There’s another blood lipid, triglycerides, that’s not part of the cholesterol family, but is also important when assessing risk. For optimal health, your fasting triglycerides should be below 150 mg/dL.  

Type of Cholesterol	Desirable	Borderline High	High	Very High
Total Cholesterol	< 200	200–239	≥ 240	> 300
LDL (Bad Cholesterol)	< 100	130–159	160–189	≥ 190
HDL (Good Cholesterol)	≥ 60	40–59	< 40 (men), < 50 (women)	N/A
Triglycerides	< 150	150–199	200–499	≥ 500

High LDL cholesterol and triglycerides are a problem. They’re strongly associated with increased risk of heart disease, stroke, and other forms of cardiovascular disease, which are the world’s leading killers. According to large-scale studies, every 39 mg/dL (1 mmol/L) decrease in LDL cholesterol is associated with about a 22% lower risk of cardiovascular events. Elevated triglycerides, especially when paired with low HDL, have also been linked to a significantly increased risk of cardiovascular events and all-cause mortality.

But what about when your cholesterol gets really low? Is there a point where that becomes dangerous?

Technically, yes. Extremely low LDL or total cholesterol levels (like, below 40 mg/dL for LDL and 120 mg/dL for total cholesterol) have been linked in some studies to hormonal imbalances, increased cancer risk, and hemorrhagic stroke. 

What about low HDL cholesterol? If it’s the good kind, don’t we want it to be as high as possible?

Not exactly. Remember, the job of HDL is to clear cholesterol from your bloodstream. If you’re eating a fully plant-based diet that’s low in saturated fats and devoid of cholesterol, you may very well have low LDL and total cholesterol. In that case, you don’t need so much HDL. 

Joel Fuhrman, MD, puts it this way in his book Cholesterol Protection for Life: “Populations with the highest HDL levels have the highest rates of heart disease. In other words, when you do not have an atherosclerosis burden, you do not need a high HDL to remove stored lipids within the plaque. If there is no plaque, more HDL is not needed, and the body then keeps the levels low.”

So HDL is kind of like a city’s sanitation department. You want enough garbage trucks to pick up all the trash on a timely basis, but no more. And the less garbage you produce, the fewer trucks you need. 

There’s evidence for this. The EPIC-Oxford study found that vegans had lower total and LDL cholesterol levels compared to meat-eaters, with HDL levels being slightly lower as well. However, the favorable LDL-to-HDL ratio in vegans was associated with a reduced risk of cardiovascular disease. 

What Factors Influence Cholesterol Levels?

So let’s get back to our original question: Can vegans have high cholesterol even if they don’t eat any foods that contain it?

The answer is yes, because your body makes its own cholesterol, and because diet is just one of several factors that affect cholesterol levels. 

Let’s start by looking at food, and then consider other factors that could undermine even the cleanest diet.

1. How Diet Influences Cholesterol Levels

Your daily food choices directly influence your body’s cholesterol production and absorption. Every meal is an opportunity to either support healthy cholesterol levels or work against them. Here’s how to make your plate work in your favor.

Foods that Lower LDL Cholesterol 

Some foods do heavy lifting in lowering LDL cholesterol.

Oats and barley contain beta-glucan, a soluble fiber that acts like a sponge, binding to cholesterol in your digestive system and escorting it out of your body. Just one bowl of oatmeal daily may reduce LDL by 5–10%.

Legumes (beans, lentils, chickpeas) are fiber powerhouses. Their combination of soluble fiber and plant protein makes them particularly effective in lowering LDL cholesterol. Aim for at least one serving daily.

Flaxseeds deserve special attention. Consuming a few tablespoons of ground flaxseeds has been shown to reduce LDL cholesterol. The key is to eat them whole or ground, rather than as oil, so that their fiber and lignans work together. Interestingly, a 2012 study found that adding flaxseeds to drinks lowered cholesterol more than when the seeds were incorporated into baked goods. 

Plant sterols and stanols are especially plentiful in nuts, such as almonds, walnuts, and pistachios, and are also present in legumes, some fruits and vegetables, unrefined olive oil, and whole grains. They have similar molecular structures to cholesterol and compete for the same intestinal transport proteins, physically blocking some cholesterol absorption sites and reducing the amount of cholesterol that enters your bloodstream.

Colorful fruits and vegetables provide antioxidants that prevent LDL oxidation, a process that makes cholesterol more harmful to arteries. Berries, apples, and leafy greens are especially rich in protective compounds.

Soy Foods like tofu, tempeh, and edamame contain isoflavones that modestly reduce cholesterol production. Include them a few times weekly for best results.

• Oats, barley, and other whole grains
• Legumes (lentils, chickpeas, black beans)
• Nuts (almonds, walnuts, pistachios)
• Seeds (chia, flax, hemp)
• Avocados
• Leafy greens and cruciferous vegetables
• Berries and apples (rich in pectin)

Foods That Increase LDL Cholesterol

Refined carbohydrates and added sugars trigger your liver to produce more cholesterol. These include white bread, pastries, and sugary drinks.

Saturated fat makes it harder for your liver to remove LDL cholesterol from your blood by reducing the number of “receptors” in your liver that normally help clear it out. Some types of saturated fat can also increase the amount of fat your liver sends into your bloodstream. 

These fats are packaged into particles called VLDL (very-low-density lipoproteins), which get converted into LDL cholesterol. The result? More LDL cholesterol stays in your blood, especially the small, dense type. And these are the particles most closely linked to clogged arteries and heart disease. 

While meat and dairy are the main sources of saturated fat in the modern diet, there are vegan sources as well. Tropical oils like coconut and palm oil are often added to packaged vegan items — such as vegan butters and margarines, non-dairy creamers and cheeses, and baked goods like cookies and cakes — for texture and mouthfeel.

Trans fats, found in some processed foods, raise LDL while lowering HDL. Check labels for partially hydrogenated oils. Although the US Food and Drug Administration deemed them “unsafe to eat” in 2015, there are still loopholes to watch out for.

What About Dietary Cholesterol?

Dietary cholesterol is only found in animal products. There is none in any vegan foods. And many vegans think this makes them immune to concern about blood cholesterol levels. But the truth turns out to be more complicated.

For most people, eating cholesterol in food has only a modest impact on blood cholesterol levels, if any at all. That’s because your liver adjusts its cholesterol production based on how much you’re getting from food. That’s why foods like eggs or shrimp (which are high in cholesterol but low in saturated fat) don’t typically raise heart disease risk for most people, especially when they’re part of a healthy, plant-rich diet. That said, the story might be different for people who are hyper-responders or who already have metabolic or cardiovascular disease.

Cholesterol-Lowering Diets

Plant-based approaches consistently produce lower cholesterol levels, with vegans doing better than vegetarians. A 2023 meta-analysis of 30 trials found that plant-based diets reduce LDL cholesterol by 10% and total cholesterol by 7%. Vegans show a 26% lower risk of heart disease compared to meat-eaters, and significantly lower cholesterol levels. But being vegan just means you don’t eat meat, dairy, or eggs. It doesn’t indicate what you DO eat. And unsurprisingly, that matters, too.

Two evidence-based approaches stand out for cholesterol management.

The Portfolio Diet combines consumption of four classes of cholesterol-lowering components (soluble fiber, soy protein, plant sterols, and nuts) with avoidance of foods high in saturated fat. A 2003 study found that people who followed it closely reduced their LDL cholesterol levels by up to 30%, which is comparable to the effect of some older cholesterol-lowering medications. More significantly, adherents to the Portfolio Diet had about a 16% lower risk of dying from heart problems compared to those who followed it the least.

Joel Furhman’s Nutritarian Diet is a plant-rich, nutrient-dense eating plan focused on maximizing health and longevity by prioritizing foods with the highest nutrient-to-calorie ratio. It was designed to support weight loss, reverse chronic disease, and reduce dependence on medication, especially for conditions like heart disease, diabetes, and high blood pressure.

In a study published in the American Journal of Lifestyle Medicine, more than 2,200 people who adopted a nutritarian eating pattern saw dramatic health improvements. Among 328 participants not using cholesterol-lowering medications, LDL cholesterol dropped by an average of 42 points (from about 171 to 128 mg/dL) in just 1 year. Those who were also taking statins saw an even greater average drop of 48 points in LDL, indicating that the diet and medication may work synergistically. Many also experienced significant weight loss, lower blood pressure, and reduced triglycerides. Some even reversed symptoms of advanced heart disease, without drugs or surgery. While this was a survey-based study rather than a randomized trial, the findings add powerful evidence that a whole food, plant-forward diet can profoundly improve cardiovascular health.

2. Genetic Factors

Some people are born with conditions that lead to high cholesterol levels, regardless of diet. 

One of these is familial hypercholesterolemia (FH), which is a fancy way of saying “high cholesterol that runs in families.” It’s a genetic disorder that causes high LDL cholesterol levels from birth, more than 400–500 mg/dL in children and 300 mg/dL in adults.

And that’s if only one parent bequeathed the gene. If both of them did (what genetics calls “homozygous,” which isn’t much of a tongue twister but would be amazing in Scrabble), LDL levels can reach 600–1000 mg/dL. These numbers significantly raise the risk of early-onset heart disease, even in childhood or adolescence.

FH affects about 1 in 200–500 people and greatly increases the risk of early cardiovascular disease. If you think you may have this condition, there are several ways to find out, including blood tests, family history, and possibly genetic testing. 

Elevated lipoprotein(a) —  Lp(a) to its friends — is another genetically determined condition that increases heart disease risk and is not directly influenced by diet. Studies show that 20–30% of people with FH also have elevated Lp(a), which compounds their risk.

Lp(a) levels are measured in either milligrams per deciliter (mg/dL) or nanomoles per liter (nmol/L). Unfortunately, these units are not directly interchangeable, for reasons that would require that both of us have PhDs in molecular biochemistry to explain and understand fully. 

Fortunately, I can provide a table of commonly accepted thresholds.

Lp(a) Level	mg/dL	nmol/L	Risk Assessment
Low to Normal	< 30 mg/dL	< 75 nmol/L	Low risk
Elevated	30–50 mg/dL	75–125 nmol/L	Moderately increased risk
High	> 50 mg/dL	> 125 nmol/L	Increased cardiovascular risk
Very High	> 100 mg/dL	> 200 nmol/L	High to very high risk

While FH is treatable with lifestyle changes and medication, there is currently no specific medication approved to reduce Lp(a). If your Lp(a) is elevated, your best bet is to focus on lowering your overall cardiovascular risk through lifestyle management. 

3. Lifestyle

In addition to what you put into your mouth, the way you live your day-to-day life can have a significant impact on your cholesterol levels. For example, physical inactivity, stress, poor sleep, smoking, and alcohol consumption can all raise LDL cholesterol. 

Exercise

Exercise is one of the most powerful levers you can pull to improve your cholesterol levels. Especially when combined with weight loss, physical activity can lead to reductions in LDL cholesterol and can also support healthy HDL levels. 

Stress

Stress can ramp up cholesterol in your body in a number of ways. First, there are direct links, which are primarily hormonal. When you’re stressed, your body releases cortisol. Chronically high levels of this stress hormone can signal your liver to increase its production of LDL cholesterol and triglycerides.

Another stress hormone, adrenaline, floods your bloodstream with triglycerides and fatty acids, mobilizing them as a source of quick energy. If they don’t get used up by running away or fighting (the original purpose of the stress response), they stick around and raise circulating lipid levels.

Stress can also undermine other lifestyle strategies, like diet and exercise. Let’s put it this way: It’s more common to stress-eat cake than salad. And stress also predisposes you to sit on the couch and doomscroll through an infinite feed of posts rather than hit the gym, the mat, or the garden.

Fortunately, various forms of stress management, including yoga and meditation, can positively affect cholesterol levels. A 2022 meta-analysis of over 50 randomized controlled trials, including more than 13,000 participants, found that yoga lowered LDL cholesterol and triglycerides by an average of 9 mg/dL and 13 mg/dL, respectively. And practicing yoga boosted HDL cholesterol slightly, so win-win-win-win.

Meditation may be even more powerful. A 2024 meta-analysis of 16 clinical studies, including more than 1,000 participants, found that various forms of sitting meditation lowered cholesterol by an average of about 14 mg/dL and triglycerides by about 33 mg/dL.

Sleep

We’ve known for a while that poor sleep is a risk factor for cardiovascular disease, and recently, researchers have been identifying how they’re connected. Sleep deprivation has been shown to cause imbalances in cholesterol levels, which suppresses the conversion of cholesterol into other compounds. This leads to excess cholesterol accumulating in the body.

Smoking

Smoking is linked to many chronic diseases, including those of the cardiovascular system. One of the paradoxes of smoking is that people often gain weight after they quit, which you would think would predispose them to more cardiovascular risk.

However, it turns out that the risks of weight gain are more than offset by improvements in cholesterol levels, particularly the increases in two different forms of HDL.

Alcohol

Heavy or frequent alcohol use raises triglycerides and may raise LDL cholesterol in some people, especially if they also indulge in diets high in fat or sugar. Chronic alcohol use can harm the liver, impairing how your body handles fat and cholesterol.

Consuming alcohol in moderation, on the other hand, may be neutral or even slightly protective for heart disease. A 2011 meta-analysis found that moderate drinking (defined as one drink per day for women and up to two for men) increased HDL cholesterol and one of its key components, apolipoprotein A1.

A  couple of words of caution before you go on a beer run. The same meta-analysis found that moderate drinking may elevate triglycerides. The outcome measures in these studies were all laboratory test results, rather than long-term health outcomes. 

In fact, the American Heart Association acknowledges that while moderate alcohol intake) may increase HDL, the risks of alcohol outweigh the potential benefits for most people.

4. Metabolic and Hormonal Factors

If you’ve never touched an animal product in your life, your cholesterol levels could still be off the charts, thanks to the cholesterol factory in your liver. Certain metabolic conditions disrupt this assembly line.

Take diabetes, for instance. When insulin resistance sets in, your liver goes into overdrive, pumping out more cholesterol-rich particles while simultaneously struggling to clear them from your bloodstream. It’s like having a factory that’s ramped up production, but the loading docks aren’t working, so packages just keep piling up.

Thyroid dysfunction can also dramatically alter this delicate balance. An underactive thyroid essentially slows down your body’s cholesterol recycling program, leading to a build-up even if you’re eating a squeaky-clean diet.

Then there’s non-alcoholic fatty liver disease. When your liver accumulates excess fat, it disrupts the dance of cholesterol production and metabolism, often resulting in elevated levels regardless of dietary choices.

We’ve seen that cholesterol is a building block for hormones. In turn, those hormones affect how cholesterol is processed in the body.

Estrogen increases HDL and lowers LDL cholesterol. That’s why LDL levels typically rise following menopause. 

Diet can come to the rescue here, at least partially. A 2021 study found that a low-fat vegan diet, which included soybeans, significantly reduced severe hot flashes and improved lipid profiles in menopausal women.

Low levels of testosterone correlate with higher cholesterol, which is why testosterone therapy has been found to lower total cholesterol, too. 

(For more on how to balance hormones with diet and lifestyle, see our article here.)

5. Environmental Factors

Many chemicals in our air, soil, and water can also raise cholesterol levels. Research shows that prolonged exposure to air pollution can negatively affect your cholesterol balance.

The worst offenders are the tiniest particles, the ones smaller than 2.5 micrometers in diameter. Known as PM_2.5, these particles are generated by combustion from car engines, fossil-fuel-burning power plants, industrial facilities, and wood-burning sources, as well as natural sources such as wildfires, dust storms, and volcanic eruptions. 

Breathing in PM_2.5 particles has been linked to higher levels of total and LDL cholesterol, as well as triglycerides, and lower levels of protective HDL cholesterol. This is yet another reason that an indoor air filter could be helpful if you can afford it. (For more on indoor air pollution and filtration options, see our article here.)

Similarly, exposure to per- and polyfluoroalkyl substances (also known as PFAS) can also impact your cholesterol. They’re ominously called “forever chemicals” because they don’t break down naturally in the environment or the human body.  Instead, they persist for years, decades, even centuries, accumulating in soil, water, animals, and people.

A 2023 study found that, among its many potential harms, PFAS exposure can notably increase cholesterol in certain lipoprotein particles. 

Statins: Helpful or Harmful?

Statins are the main class of cholesterol-lowering drugs. Among the most well-known are Lipitor (atorvastatin), Crestor (rosuvastatin), and Pravachol (pravastatin).

Say you’ve been eating a healthy vegan diet for many years and are physically active, but your cholesterol remains high. Should you take a statin?

On average, they work well, typically lowering LDL cholesterol by 30–50%, which can result in a significant reduction in the risk of cardiovascular events.

And they’re generally safe, though some people experience side effects like muscle pain, digestive issues, and changes in liver enzymes. 

The problem is that some people rely on statins as a “free pass” and skip over the lifestyle changes that address the root of the problem. While statins can effectively lower LDL cholesterol — which as we’ve seen is a key risk factor for heart disease — they only address part of the picture. 

They don’t address obesity, insulin resistance, high blood pressure, or the damage to blood vessels caused by a poor diet and sedentary lifestyle. And they won’t protect against other diet-related conditions like type 2 diabetes, non-alcoholic fatty liver disease, or certain cancers.

Whether or not to take a statin is a personal decision that should take into account your overall health, cholesterol levels, and individual risk of cardiovascular disease. Tools like the 10-year ASCVD risk calculator can help you and your healthcare provider make an informed choice.

Can Supplements Help?

There are several supplements suitable for vegans that can help keep high cholesterol in check. Psyllium husk is a soluble fiber that lowers LDL. Red yeast rice contains monacolin K, a compound structurally similar to the statin drugs used to treat high cholesterol.

Amla powder, from the fruit of the Indian gooseberry plant, contains tannins, vitamin C, flavonoids, phenolics, phytosterols, and saponins — all of which can help with cholesterol management. Supplementation with amla has been shown to significantly decrease LDL, total cholesterol, and triglycerides while increasing HDL. 

Chokeberries owe their cholesterol-lowering and cardioprotective effects to a whole bunch of phytochemicals, especially polyphenols. A 2020 meta-analysis found that daily chokeberry supplementation not only significantly reduced total cholesterol but also lowered systolic blood pressure.

Dr. Fuhman’s LDL Biotect contains a blend of plant sterols, including organic pomegranate extract, organic chokeberry (Aronia), and organic amla (Indian gooseberry). While each component has cholesterol-lowering and antioxidant effects, this exact formulation has not yet been tested in a clinical trial. But it stands to reason that it would be helpful.

Citrus bergamot appears to work as a natural statin, reducing the body’s cholesterol production. This makes it a promising option for people who can’t tolerate statins or want a natural alternative. 

Cholesterol-Friendly Recipes

Looking for delicious ways to support healthy cholesterol levels without sacrificing flavor? These cholesterol-friendly recipes are packed with fiber, plant-based protein, and heart-smart fats to help nourish your body naturally. From a vibrant breakfast bowl to a creamy slaw and a hearty lentil loaf, each dish is crafted with whole food ingredients that are as satisfying as they are supportive.

1. Banana Berry Breakfast Bowl

The Banana Berry Breakfast Bowl is a heart-smart way to start your morning, combining fiber-rich oats, crunchy walnuts, almonds, pecans, and pumpkin seeds, all gently sweetened with maple syrup and cinnamon. Layered with bananas, blueberries, and a splash of plant-based milk, this bowl offers a balanced mix of soluble fiber and healthy fats to help support healthy cholesterol levels and keep you feeling full and energized.

2. Easy Creamy Apple Slaw 

Fresh, tangy, and delightfully creamy, the Easy Creamy Apple Slaw combines crunchy red cabbage, crisp apples, carrots, and slivered almonds in a silky, silken tofu dressing. With apple cider vinegar, maple syrup, and mustard adding flavor without cholesterol or saturated fat, this slaw is a vibrant, nutrient-rich side that pairs beautifully with any plant-based meal.

3. Lentil Flax Loaf

The Lentil Flax Loaf is a satisfying, savory main dish made with lentils, oats, and flax for a triple boost of plant-based protein, fiber, and omega-3s. Packed with vegetables and seasoned with warming spices, it’s topped with a zesty tomato glaze for extra flavor. This loaf is a comforting and nourishing option for anyone looking to support heart health without compromising on taste.

Final Takeaway

Yes, vegans can have high cholesterol. But a fiber-rich, whole food, plant-based diet is still one of the most effective ways to support healthy cholesterol, especially when combined with regular movement, restful sleep, and stress relief.

If your numbers still need support, there are natural options and, when appropriate, medications that can help. The key is to stay curious and proactive, and remember that your daily choices always matter.

Tell us in the comments:

• What is your experience with diet and cholesterol?

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