Pages in other languages are translated automatically from English.
For education only, not medical advice. Ask your doctor before you change your diet or any medication.
Cholesterol on a plant based diet: what the doctors say
Cholesterol on a plant based diet: what McDougall, Esselstyn, Barnard, Ornish and other doctors say about targets, LDL, HDL and food, with sources.
Updated . For education only, not medical advice.
Our view
The body builds every bit of cholesterol it uses, so Ornish puts the amount we need from food at zero, and Barnard points out that plant foods hold none at all12. McDougall reads the blood level as a signal of how healthy the arteries are rather than as an illness in itself, and he blames the rich Western diet for pushing it up together with blood pressure and triglycerides34.
We give most weight to the low-fat clinicians who have watched this in thousands of patients, and their reports point the same way: on a diet of starches and vegetables with no animal foods, cholesterol comes down within days or weeks567. They all put food first; how hard to chase a number, and what place drugs have, is where they part8910.
The target numbers on this page are each doctor’s own, from a total under 150 for McDougall and Rogers to an LDL near 80 for Esselstyn111213. Several of them also warn that a good reading does not protect someone who keeps eating badly, and that some healthy people simply run higher than others1415.
Where they agree
Every doctor here holds that diet moves blood cholesterol and that the typical rich Western diet drives it up41617. Animal foods are the common thread: Barnard notes that plants carry no cholesterol and that less animal fat means the body makes less, Willett says feeding trials show saturated fat lifting LDL, and Novick argued in 2015 for keeping the limit on dietary cholesterol21718.
They also agree that fiber helps clear it: Barnard says fiber helps the body get rid of cholesterol it already has, Jenkins credits the sticky fiber of oats and barley, and Goldhamer singles out oats too21920.
And the low-fat clinicians agree that food comes before pills: McDougall calls the diet step one and drugs step two, Ornish says larger lifestyle changes cut cholesterol nearly as much as drugs, and Esselstyn’s FAQ notes that statins played no part in many of his best results869.
Where they differ
They split on the target, on how much the number itself tells you, on HDL, on what in food raises it, on added foods like nuts, on how big a drop diet brings, and on drugs112122232425.
Target numbers
In 2022 McDougall named 150 mg/dL total or less as ideal, resting on the Framingham study and his own look at its data about 40 years before, and in 2026 Rogers cited Framingham for the same line1112. Esselstyn said in 2009 that he asked his first patients for a total under 150 and an LDL under 80, as in rural China, while his FAQ, read in 2026, aims for an LDL of about 80 to 85 or lower yet says people holding near 95 to 105 on plant food without statins seem to fare well2613. Barnard in 2021 put the point of concern at an LDL above 10027. In notes to a 1998 piece, Novick gave the Pritikin center’s ideal total as 100 plus your age, never above 16028. Campbell in 2003 put the rural Chinese average near 12729. Goldhamer said in 2025 that some people never get to 150 because levels spread on a bell curve, and that this alone does not mark them as at risk15.
How much the number matters
McDougall said in 2022 that people die from damaged arteries rather than from a lab figure, although heart attacks and strokes usually rise as cholesterol rises34. Campbell said in 2018 that population studies tie blood cholesterol only loosely to heart disease, and faulted drug research for chasing single markers30. Goldhamer called cholesterol in 2022 a limited guide for any one person, and in 2025 a possible marker rather than a cause, with inflammation tests such as CRP more telling312132. Nelson in 2026 called LDL a stand-in and said he would rather see data on heart attacks and deaths10. Esselstyn urged audiences in 2009 to know their numbers, but in 2011 used the journalist Tim Russert, whose LDL of 70 came from a heavy statin dose, as proof that numbers are not the whole story3314. On the other side, Novick in 2015 cited a 2014 genetic study where LDL about 12 mg/dl lower came with roughly half the heart disease risk, and Kahleova in 2024 estimated that a 20% LDL cut would mean about 20% less cardiovascular risk1834.
What raises it
Novick defended the dietary cholesterol limit in 2015 with a 1972 controlled feeding trial, where every extra 100 mg per 1,000 calories lifted blood cholesterol by about 12 mg/dl18. Willett in 2020 pointed to saturated fat, whose effect on LDL he called clear in feeding trials17. Campbell puts animal protein first: in 2003 he dated its cholesterol-raising effect to 1909, and in 2021 cited a 1926 Michigan summary that blamed animal protein rather than dietary cholesterol or fat3523. Pritikin told McDougall in 1982 that his level climbed from 100 to 140 within a month of eating animal protein again, then fell back to 10036. McDougall said in 2024 that a lot of simple sugar, fruit included, raises triglycerides and with them cholesterol, and that coffee lifts it by about 10%3738. Ornish in 2011 put the differences between people down to genes, saying those with heart disease tend to clear fat and cholesterol poorly39.
HDL
Esselstyn’s FAQ says HDL commonly drops on plant food and that nobody should be alarmed by it22. A 2014 Ornish column compares HDL to trucks that carry cholesterol away, so a rich diet can push it up and a low-fat diet bring it down without harm40. Barnard said in 2021 that doctors have stopped treating a high HDL as the protection they once took it for, and that LDL is the figure to follow27.
Nuts and the portfolio diet
Jenkins built his portfolio diet, he said in 2026, by combining plant foods that supply fat, protein and carbohydrate into one diet aimed at lowering LDL, with no cholesterol in it41. Barnard cited it in 2023 for a cholesterol fall of roughly 30% within a month, near what drugs achieve, and Kahleova co-authored a 2018 meta-analysis of it4243. Nelson in 2026 called the portfolio diet a sound food route for healthy people who want lower cholesterol44. Yet he noted that across 113 nut trials LDL fell only about 5 mg/dL, mostly where nuts were added to diets with meat, dairy and oil, so those trials say little about adding nuts to a low-fat whole food diet2445.
How big a drop
The reported drops vary in size, and so does the way each was measured546. McDougall’s figure, an average fall of 22 mg/dL in seven days across close to 2,000 of his program’s guests, had no comparison group, and in 2024 he said the drop lasts a year for those who stay with it547. Novick wrote in 2015 that total and LDL cholesterol both fell by about 23% on average when people spent three weeks eating plant based in a program, with the biggest falls, 50% or more, in some who began highest7. Rip Esselstyn said in a talk posted 2018 that 65 people on his diet for four weeks cut total cholesterol by 40% and LDL by 30% on average, a group result with no comparison group4849. Ornish in 2008 tied his figure of about 40% to a randomized trial in which patients ate 10% of calories as fat and took no cholesterol drugs50. Barnard’s 2021 crossover trial put 62 people through a vegan and a Mediterranean diet for 16 weeks each; on the vegan diet total cholesterol dropped almost 19 points and LDL 15, against 3 points and about half a point on the Mediterranean diet4651. Kahleova’s 2024 trial randomly assigned 58 adults with type 1 diabetes to one of two diets for 12 weeks, and LDL fell only in the low-fat vegan group, not in the portion control group525354. Kempner reported in 1950 that cholesterol fell in 96% of 511 of his rice diet patients, with the average going from 279 to 205 mg/dl over roughly 100 days, a report on his own patients55. In fasting patients Goldhamer described further drops, such as from 280 to 220 after a fast and toward 200 a year later15.
Rises after a change
Goldhamer said in 2022 that cholesterol often goes up for a while during fast weight loss, as stored fat and plaque break down into the blood, and that readings mean more once weight is near its goal5631. McDougall said in 2024 that a high result can be a lab error, so he would rely on more than one test before judging57.
Drugs
The doctors here see cholesterol drugs very differently; we only report what each said, and Nelson, like us, leaves that decision to patients and their own doctors10. In 2009 Esselstyn asked why the large statin trials of the 1990s, which cut heart attacks by about 30%, counted as a success when most events still happened25. His FAQ, read in 2026, rates statins of modest value for prevention and of some help once disease is present, and on a 2026 panel he granted that they lower cholesterol but leave the artery lining exposed when people keep the Western diet958. McDougall in 2022 placed drugs after food and warned that driving levels very low may starve the body of what it needs to build vitamin D and sex hormones8. Ornish said in 2019 that he prescribes statins to patients who do not want to change how they eat59. Goldhamer said in 2025 that statins clearly lower cholesterol, but that their net effect on deaths from all causes is uncertain, above all for people on healthy diets6061. Rogers in 2026 called statins mitochondrial inhibitors that may raise diabetes risk62. Jenkins in 2026 spoke of diet and drugs used together, noting that people often do not stay on drugs for life6364. Rip Esselstyn’s PLANTSTRONG site wrote in 2026 that a newly approved cholesterol pill is meant to add to diet and exercise, not replace them65.
What each expert says
JMJohn McDougall
In a 2022 video McDougall described blood cholesterol as a sign of artery health rather than a disease, and gave 150 mg/dL or less as ideal311. He reported that close to 2,000 of his program guests saw cholesterol fall by 22 mg/dL on average within a week, and called food the first step and drugs the second58. In 2024 he added that one high result may be a lab error and that sugar and coffee both raise the level573738.
In 2009 Esselstyn set strict goals of a total under 150 and an LDL under 80, recalling a 2000 paper of his whose message was that “moderation kills”2666. His FAQ, read in 2026, is looser on LDL and treats a falling HDL as no cause for worry1322. He holds that what people eat counts for more than a number reached with drugs1458.
Campbell traces the cholesterol-raising effect of animal protein back to 1909 and to a 1926 Michigan summary, and in 2003 put the rural Chinese average near 127 mg/dL352329. In 2018 he called the population link between blood cholesterol and heart disease a loose one30.
Barnard’s 2021 crossover trial found total and LDL cholesterol fell on a vegan diet while hardly moving on a Mediterranean one51. He follows LDL rather than HDL, with concern above 100, and in 2022 explained that plant foods have no cholesterol and that fiber helps remove it272. In 2023 he cited the portfolio diet’s drop of about 30% in four weeks42.
Ornish said in 2012 that our bodies produce whatever cholesterol they require, and that people who make bigger changes lower it by close to 40% on average16. He sees a lower HDL on a low-fat diet as harmless, and said in 2019 that he prescribes statins for patients unwilling to change their diet4059.
Goldhamer treats cholesterol as an imperfect guide for any one person, notes that levels spread on a bell curve, and also looks at inflammation markers such as CRP211532. He said in 2022 that fast weight loss can lift readings for a while, and in 2025 that the all-cause benefit of statins for people on healthy diets is in doubt5661.
In a 2026 lecture Rogers said LDL is among the molecules that make red blood cells pile up, so the blood gets thicker, and called it backwards to claim that saturated fat and cholesterol play no part in clogged arteries6716. He watches total cholesterol, citing Framingham for a line of 150, and sees giving up fatty food as a better route than statins1262.
In 2015 Novick argued that the limit on dietary cholesterol should stay, citing a 1972 feeding trial and a 2014 genetic study, and called dietary cholesterol both harmful in itself and a sign of an animal based diet187. His notes to a 1998 piece give the Pritikin ideal of 100 plus age, capped at 16028.
In 2026 Nelson questioned adding nuts to a low-fat diet for LDL, called the portfolio diet a sound food route for healthy people, and treated LDL as a stand-in for heart attacks and deaths244410. He also noted that a cardiologist who left plant based eating for keto saw her LDL climb from 80 to 21068.
In a talk posted 2018 Rip Esselstyn reported that 65 people on his diet for four weeks cut total cholesterol by 40% and LDL by 30% on average4849. In 2026 his PLANTSTRONG site presented a new cholesterol pill as an addition to diet and exercise65.
On a 2020 panel Willett said feeding studies show plainly that saturated fat pushes LDL up, and that red meat raises LDL in trials when set against nuts, legumes and soy1769. In trials, he added, replacing dairy with such plant proteins gives better blood fat readings70.
On a 2026 podcast Jenkins said he designed the portfolio diet as an all plant menu, with no cholesterol, meant to bring LDL down41. He said the sticky fibers of oats and barley lower cholesterol by holding bile acids in the gut, and that diet and drugs can work together197163.
In her 2024 trial of 58 people with type 1 diabetes, LDL fell only on the low-fat vegan diet, and she estimated its roughly 20% drop as about 20% less cardiovascular risk535434. Her 2021 trial against the Mediterranean diet showed the same pattern, with no significant cholesterol change on the Mediterranean side72.
Pritikin told McDougall in 1982 that doctors had called his cholesterol of about 300 in the early 1950s high normal, and that his diet later brought it to 1007336. He also linked cholesterol to gallstones, and said two patients in his program saw their stones go away74.
Kempner reported in 1950 that his rice diet lowered cholesterol in 96% of 511 patients, from 279 to 205 mg/dl on average, and in 1954 wrote that modest reductions of dietary fat and cholesterol tended to fall short where the rice diet succeeded55. A 1975 paper on his obesity patients found no significant change, which the authors linked partly to fairly normal starting values75.
Like the low-fat clinicians above, we put food first and a number second81421. Which number to aim for, how often to test, and anything about a medicine you take are questions for your own doctor, and no medicine should be changed without them. This page is education, not medical advice.
Each small number links to its reference below: the video at the exact second, or the page where it was said.