Dietary Recommendations for Lowering LDL Cholesterol

Primary Recommendation: Plant Sterols/Stanols

The American Heart Association recommends consuming 2-3 grams daily of plant sterols/stanols with meals for 9-20% LDL reduction 1, 2, 3
The American College of Cardiology recommends plant sterols/stanols as the single most effective dietary supplement for LDL reduction 1, 2, 3
Dose: 2-3 grams daily, with a maximum effective dose, and higher amounts providing no additional benefit 1, 2, 3
Timing: Divide into two doses with meals, such as 1-1.5 grams at breakfast and dinner 3
Expected LDL reduction: 9-20% at optimal dosing 2, 3, 4

Add 10 grams daily of viscous (soluble) fiber for an additional 5-10% LDL reduction 1, 2
Sources include oat bran, psyllium, beans, and certain fruits 1
Fiber should come primarily from whole foods, as fiber supplements are not specifically recommended by the American Heart Association for heart disease risk reduction 5, 6

The American Heart Association states that soy protein has minimal LDL-lowering effect and is not recommended as a primary supplement for cholesterol management 7, 8, 2
Earlier guidelines recommended 25 grams daily of soy protein, but the most recent 2006 American Heart Association Science Advisory reversed this recommendation 5, 6, 9
Very large amounts of soy protein (more than half daily protein intake) may lower LDL by only a few percentage points 7, 8

Omega-3 fatty acids do not lower LDL cholesterol and should not be used for this purpose 2, 4
For documented coronary heart disease, 1 gram EPA+DHA daily (preferably from oily fish) is recommended 1, 5, 2

Reduce saturated fat to <7% of calories and cholesterol to <200 mg/day 1, 2
Add 2-3 grams daily of plant sterols/stanols with meals for 9-20% additional LDL reduction 1, 2, 3
Target 10 grams daily of soluble fiber through whole foods for 5-10% additional LDL reduction 1, 2
Incorporate 1-2 ounces of nuts daily for 8% additional LDL reduction 2
Reassess LDL levels after 6-12 weeks of dietary changes 2, 4
If LDL goals are not achieved, escalate to prescription statin therapy while continuing dietary modifications 1, 2