Diets · Metabolic & Cardiometabolic
plant-based diet decreases LDL cholesterol
In plain terms: Does a low-fat vegan/plant-based diet lower LDL cholesterol?
Strong support Diets 🔬 Includes disconfirming
Part of: 🥗 plant-based diet
RefutedContestedStrong support
consensus score 0.79
Yes — this is one of Barnard's best-supported claims; independent RCT meta-analyses confirm plant-based diets modestly lower LDL and ApoB.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
10 support 0 contradict 1 tested null 2 mixed · 13 sources, 10 independent groups
What the evidence shows
Randomised trials and their meta-analyses agree that plant-based diets modestly lower LDL cholesterol and ApoB, with an identical-twin trial isolating the diet from genetics and shared environment. The mechanism matters for interpretation: the reduction tracks replacing saturated with unsaturated fat rather than avoiding animal foods as such.
The evidence (18)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Hantikainen E, Berger S, Barbieri G, Pramstaller PP, Garcia-Larsen V, Gögele M, Pattaro C, Lundin R, Domingues FS 2026 · European journal of nutrition | observational | supports | moderate | Cross-sectional CHRIS study (n=8066): highest vs lowest quartile of a healthy plant-based dietary index was associated with lower LDL/total cholesterol (beta ~ -5.0 mg/dL, p<0.001). |
| Glenn AJ, Tessier AJ, Kavanagh ME, Morgan GA, Clish CB, Salas-Salvado J, Malik VS, Hanley AJ, Bazinet RP, Comelli EM, El-Sohemy A, Liu S, Boucher BA, Kendall CWC, Jenkins DJA, Hu FB, Sievenpiper JL 2025 · Eur J Clin Nutr 79(9):863-875 | RCT | supports | moderate | Secondary plasma-metabolomics analysis of two portfolio-diet feeding RCTs. OFF-SCOPE for the plant-based-lowers-LDL claim on two counts. (1) Outcome: only metabolites were analysed — 'Of 496 known metabolites, 145 and 63 metabolites significantly changed within the portfolio diet interventions in the first and second RCT, respectively' — and no LDL-C result is reported; the only cholesterol language is the authors' interpretation that the metabolites 'likely reflect the plant-based nature, low saturated fat content, and cholesterol-lowering effects of the diet'. (2) Contrast: the control arm is itself plant-based — the portfolio diet was 'compared to a control vegetarian diet and the same control diet with a statin' — so nothing here isolates plant-based versus omnivorous eating. Abstract-only basis; full text paywalled. The prior extract ('feeding trials confirm LDL-C lowering via metabolomic biomarkers') asserted a result the paper does not report. |
| Marrero-Fernández P, Fresán U, Nicaudie S, Huecas NR, Abusaada M, Bertotti G, Roldán-Ruiz A, López-Moreno M 2026 · Nutrition (Burbank, Los Angeles County, Calif.) | RCT | supports | low | FIBROVEG RCT in women with fibromyalgia (n=22, 6 weeks): vegan Mediterranean diet produced greater LDL-C reduction than a traditional Mediterranean diet (mean difference -21.2 mg/dL, 95% CI -38.3 to -4.08). |
| Prater MC, Cogan BR, Cooper JA 2026 · Am J Clin Nutr | meta-analysis | mixed | moderate | LDL lowering is driven by swapping saturated for unsaturated fat, not veganism per se. |
| Csölle I, Cseh V, Veres G, Czina L, Kuellenberg de Gaudry D, Nagy DU, Georgi A, Lohner S 2026 · Nutrients | meta-analysis | supports | moderate | Meta-analysis of 10 RCTs in overweight/obese adults: plant-based diets may slightly reduce LDL cholesterol vs omnivorous diets, with greater LDL reductions in longer (>=14 week) interventions; GRADE certainty rated very low for most outcome |
| Landry MJ, Ward CP, Cunanan KM, Durand LR, Perelman D, Robinson JL, Hennings T, Koh L, Dant C, Zeitlin A, Ebel ER, Sonnenburg ED, Sonnenburg JL, Gardner CD 2023 · JAMA Netw Open | RCT | supports | high | Randomized identical-twin trial showed the vegan arm significantly lowered LDL-C versus the omnivorous arm over 8 weeks, controlling for genetics. |
| Hoes LLF, Geleijnse JM, Bemelmans RHH, Muller AF, de Ranitz-Greven WL, van Sloten T, Visseren FLJ, Koopal C 2026 · American heart journal | RCT | supports | moderate | RCT in type 2 diabetes (n=48, 12 weeks): predominantly plant-based online dietary intervention lowered LDL-c by 0.3 mmol/L (~11.6 mg/dL, 95% CI -0.6 to -0.0) vs usual diet, alongside reduced saturated fat intake and weight loss. |
| Sayadi M, Azami P, Zibaeenezhad MJ, Motazedian N, Khademian F, Hasanzadeh M, Zibaeenejad F, Mohammadi SS, Mousavinezhad H, Daneshvar Z, Parsa N, Razeghian-Jahromi I 2026 · PloS one | observational | tested-null | low | Cross-sectional study (n=1675, Iran): high adherence to a vegan dietary pattern was associated with lower atherogenic index of plasma (AIP, a triglyceride/HDL-C ratio) vs low adherence (adjusted beta -0.047, p<0.001); LDL-C itself not direc |
| Ferreira JP, Marques P, Zhang G, Possik E, Mavrakanas TA, Tsoukas MA, Sharma A 2026 · Scientific reports | RCT | supports | moderate | FOOD-1 randomized cross-over trial (n=41, 6 days/arm): plant-based meat-supplemented diet lowered LDL cholesterol by 6.0 mg/dL (95% CI -10.0 to -1.9) vs red-meat supplemented diet, alongside lower TMAO. |
| Inankur A, O'Hare D, Arevalo E, Dursus-Élisée R, P Schwartz L, Sterling SR 2026 · Nutrients | observational | supports | low | Prospective chart review of a residential plant-based lifestyle medicine program (NEWSTART, n=109): LDL cholesterol fell 11.0 mg/dL (p<0.01) from baseline to end of program, alongside reduced meat intake and total cholesterol. |
| Chatzi CA, Basios A, Markozannes G, Ntzani EE, Tsilidis KK, Kazakos K, Agouridis AP, Barkas F, Pappa M, Katsiki N, Rizos EC 2024 · Nutrients | meta-analysis | mixed | moderate | Umbrella review of '25 meta-analyses': vegetarian diets 'failed to show any strong or even highly suggestive evidence for a clear benefit' across CV risk factors; LDL-c reduction was probable only for the Portfolio diet. Units are meta-analyses — review, zero weight. |
| Yokoyama Y, Levin SM, Barnard ND 2017 · Nutr Rev | meta-analysis | supports | moderate | Barnard-authored MA: vegetarian diets lowered total and LDL cholesterol. |
| Selinger E, Neuenschwander M, Koller A, Gojda J, Kühn T, Schwingshackl L, Barbaresko J, Schlesinger S 2023 · Crit Rev Food Sci Nutr | meta-analysis | supports | high | Umbrella review of syntheses: 'we conducted an umbrella review of systematic reviews and meta-analyses'; in diabetes/high-CVD-risk 'a vegan diet reduced measures of adiposity, total cholesterol, LDL' (CoE moderate to low). Review — zero weight. |
| Durrington PN, Bashir B, Soran H 2025 · Antioxidants | mechanism | tested-null | low | Off-scope: mechanistic review of HDL in atherogenesis — 'The mechanism for this that has received the most attention is the antioxidant activity of HDL, which is due in large part to the presence of paraoxonase 1 (PON1).' No plant-based diet content (0 mentions in full text); also a review, zero weight either way. |
| Rosendahl-Riise H, Gravrok EO, Rung SL, Dierkes J, Aakre I 2026 · Nutrition journal | RCT | supports | moderate | 4-week open-label RCT in healthy young women (n=32): replacing cow's milk with oat drink (a plant-based drink) reduced LDL-cholesterol by 0.4 mmol/L (~15.5 mg/dL, 95% CI -0.6 to -0.2, p=0.002) vs cow's milk. |
| Rees K, Al-Khudairy L, Takeda A, Stranges S 2021 · Cochrane Database Syst Rev | meta-analysis | mixed | moderate | Cochrane review of vegan-diet RCTs found reductions in total/LDL cholesterol but evidence graded low-to-moderate certainty with few hard-endpoint trials. |
| Koch CA, Kjeldsen EW, Frikke-Schmidt R 2023 · Eur Heart J | meta-analysis | supports | high | Meta-analysis of 30 RCTs: vegetarian/vegan diets lowered total cholesterol, LDL-C (~-0.30 mmol/L) and ApoB vs comparison diets. |
| Mazzola G, Rondanelli M, Cabrini C, Perna S 2026 · Nutrition (Burbank, Los Angeles County, Calif.) | meta-analysis | supports | moderate | Systematic review of 7 RCTs (n=976, 4-52 weeks): plant-based low-carbohydrate and ketogenic diets significantly reduced LDL-cholesterol (with weight and HbA1c) vs control diets, GRADE certainty moderate for lipid parameters. |
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