Doctor's Note

This is the third of a five-part video series on the cholesterol-lowering effects of nuts and seeds. In Nuts and Bolts of Cholesterol Lowering, I reviewed the data showing that nuts decrease cholesterol levels, and heart disease mortality. How Fiber Lowers Cholesterol attempts to explain the fiber mechanism, and the final two videos wrap up on a more practical note, discussing the Optimal Phytosterol Dose as well as the Optimal Phytosterol Source. The role played by phytoestrogens can be found in Soy & Breast Cancer Survival, and Soy Hormones & Male Infertility. Not all molecular mimics are good, though; check out Poultry and Paralysis

For more context, check out my associated blog posts: Stool Size and Breast Cancer Risk and Optimal Phytosterol Dose and Source.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

To post comments or questions into our discussion board, first log into Disqus with your account or with one of the accepted social media logins. Click on Login to choose a login method. Click here for help.

  • Michael Greger M.D.

    This is the third video of five-part series on the cholesterol-lowering effects of nuts and seeds. In Friday’s video-of-the-day Nuts and Bolts of Cholesterol Lowering, I reviewed the data showing nuts decrease cholesterol levels and heart disease mortality. Yesterday’s video-of-the-day How Fiber Lowers Cholesterol attempted to explain the fiber mechanism and the final two will wrap up on a more practical note, discussing optimal phytosterol doses and sources. The role played by phytoestrogens can be found in Soy & Breast Cancer Survival and Soy Hormones & Male Fertility. Not all molecular mimics are good, though. Check out Poultry and Paralysis. If you haven’t yet, feel free to subscribe to my videos for free by clicking here.

    • URwhatUeat

      Are phytosterol suplements of any value?

  • Pkzerbe

    I listened to this three times and will keep listening to it hoping I will understand it better.  It’s just the terminology that throws me.  Can you put this in lay language what the impact of eating the nuts and seeds are as to unhealthy cholesterol intake?  Are you saying that nuts and seeds are harmful in this way?  I need more on the nuts, etc. to know how to use them in my diet.  I am trying to eat vegan but still am having difficulty understanding how I can incorporate nuts, etc. in the diet.  I do have a predisposition to high cholesterol and the vegan lifestyle has helped me keep this somewhat at bay but not low enough yet.  Thank you for explaining this to me in as simple terms as possible.

    • Veganrunner

      Message: when you eat a phytosterols rich diet more cholesterol is excreted.

      • Pkzerbe

        Thank you.

    • Always remember it’s not just being vegan or eating vegan that lowers your risk of disease or high cholesterol but NOT being a junk food vegan. Whole grains, legumes, vegetables/leafy greens and fruits. If it has more than 2-3 ingredients in it, it’s probably not worth your time. I always seem to hear or read that if your weight is an issue to limit nuts, seeds and avocados until you are at your desired weight then go back to them sparingly??? Anyway I hope you have a fantastic day!

    • Rathatcher

      I think the general recommendation is to eat handful of nuts or seeds a day. The problem is when the vending machine only offers a jumbo, five-serving, highly salted bag. It’s easy to go overboard as with any high-fat food.

      • Valnaples

        I actually prefer a *palmful* of nuts / seeds each day…that way, I know I’m not eating too many of them. (Handful just sound like more to me…and certainly a fist-full is NOT what we want)  

        • Sue Hull

          But, a thimbleful is certainly not enough! :-)

  • Elderberry

    I am a strict vegan who eats seeds and nuts at least twice daily. If I understand correctly, it is the excess cholesterol from food that gets dumped when one consumes enough seeds and nuts (or phytosterols), is that right? Cholesterol is produced by the body itself and there is no need to consume food containing cholesterol, is that right?  

    • SJ M.D.

      No need to eat food containing cholesterol, unless you want to increase your risk of getting a heart attack or stroke.

      Cholesterol is synthesized by the liver, some of it is excreted in the bile. Some of the biliary cholesterol is reabsorbed from the gut. Plantsterols interfere with this absorption, so I guess that it lowers your bloodcholesterol even further by excreting the cholesterol you produce in your liver.

      Get some nuts in your guts………..

      • June Crow

        HI, I met you in Austin, TX during the Veggie Fest last year.  I am a strict vegan (have been for 20 years), not overweight, active…and yet my cholesterol is 266. triglycerides 258, HDL 45, HDL 169 (ration 3/76)  I am also celiac (and I only found out this at age 50, 10 years ago…so I am trying to figure out the cholesterol conundrum.  I know that gluten can cause changes in the liver…so maybe something happened before I went off gluten 10 years ago?  I am strictly off gluten as well).  I am not even sure that these numbers are bad–but I do wonder why so much cholesterol on a vegan diet.  I eat nuts and seeds, do the green smoothie with kale thing, etc.  Any thoughts?
        thanks so much for all that you do!  BTW, my syblings have high cholesterol as well (although they are not vegan), so I am told there may be a genetic component…..thanks.  June

        • Rathatcher

          June, I’ve had a bit of the same issue, hitting a brick wall at 200, after bringing my numbers down from 312 with plants. Are you cutting out vegetable oils? I think Drs. Gregor and McDougall mention that unfilter coffee can raise cholesterol. I’ve heard limiting alcohol and simple sugars will help lower triglycerides.

        • Thea

           June: I don’t have the answer for you, but I have a thought.  It sounds like you are eating very healthy, period.  However, I wonder if you could tweak your diet to still be healthy, but to specifically work on the lowering cholesterol.

          For example, this video talks about using nuts to lower cholesterol.  I don’t have the links off the top of my head, but I remember several other videos on this site that also mention specific foods known for lowering cholesterol.  Maybe you could find those videos and start taking in more foods like the ones listed???  Just a thought.

          FYI: I know of two people in my inner circle with dangerously high cholesterol.  One was able to go from 260 something down to 131 total cholesterol simply by changing his diet.  My other friend, who has a family history of high cholesterol, was able to loose a lot of weight on a vegan diet, but did not lower (much) her cholesterol.   You are clearly not alone.

          I hope some more knowledgeable people answer your question, because I too would like some ideas to share with my friend.

        • Mupdyke1

          Your cholesterol levels can be affected by things other than dietary cholesterol. Saturated fat and carbohydrates can raise your cholesterol levels. Someone made a good point in a previous post about being a junk food vegan…if someone is only doing carbohydrates all day…especially simple carbs and sugar it can absolutely affect your cholesterol levels. Whatever carbohydrates your body doesn’t need for energy or storage in the muscle will turn to fat, and then that fat can turn into cholesterol. You mentioned a genetic factor…there is Apolipoprotein E genotype. That can actually indicate if someone is not as efficient from clearing cholesterol from the body. It can also indicate if someone needs to follow a more low fat diet. There is also testing done to see if someone is a hyperabsorber and/or hypersynthesizer of cholesterol. Advanced testing can always be helpful! 

          • Lincat13

            Lots of great points.  Totally agree.  I think it should also be mentioned that there are some medications that raise cholesterol levels through various mechanisms (one being constipation) and as you alluded to some people are predisposed to the problem. 

    • Toxins

       Indeed, there is no dietary need of saturated fat, cholesterol, monounsaturated fat or trans fat. The only essential fat is omega 3 and omega 6.

  • NutAddict

    I came into this dietary style about 10 years ago by reading Dr. McDougal’s books and website. He advised that nuts be consumed rarely, perhaps just on holidays. After being exposed to the information on this website however, I began to feel that Dr McDougall was out of step with the science and so, I started enjoying a couple of ounces of nuts and seeds daily. So, has it improved my health? Well, I weigh 5 pounds more than when I was McDougalling, and my total cholesterol is up some 15 points from then- although it could be that it’s up because I’m 10 years older. But, I’m wondering…

    The other day I read a couple of articles on vegsource about nuts, see below, and I’m wondering if I shouldn’t again revise, or more accurately, revert my eating habits regarding nuts and seeds. The first one, although lengthy, is very good. It agrees with what Dr. Greger said a couple of day ago that if you’re already on a healthy plant-based diet, eating nuts isn’t really going to do much-if anything- to improve your lipid scores and health. But, in addition, it pointed out that the assurances the studies give that nuts won’t cause weight gain are actually false, misinterpretations of the facts and that nuts in the diet may be the source of weight gain.

    I don’t mean to be controversial or contradictory and I don’t want to give false advise, but it does seem to me that  for the person on an already healthy, plant-based diet, that nuts and seed get no better than mixed reviews and that there is room for discussion on this issue. I’d be glad to hear anyone’s thoughts after you read the two articles below. Thanks.

  • Elvin

     The question that appears to me to be in need of being posed is this:
    calorie per calorie (not gram per gram), what is better at lowering
    cholesterol? Is it nuts and seeds? Or is it beans, oatmeal and yams

    • WholeFoodChomper

      I believe the key is variety and a diverse plant-based diet.

  • LumLum2500

    My total cholesterol last December was 193.  After being on a vegan diet for a month, it is now 128.  My LDL went from 105 to 64.  I am so grateful to this website for transforming my life.  I just wish I had found it sooner.

  • Thinkabouddit

    Dr. Greger,

    I saw this morning this post at Natural

    $tatin Nation is the first film to publicly question the Big Pharma narrative on statin drugs. It explores these three shocking facts that are now emerging in the medical literature:

    1) People with high cholesterol tend to live longer

    2) People with heart disease tend to have low levels of cholesterol

    3) Cholesterol-lowering on a population level does not reduce the rate of heart disease

    Huh? But your doctor told you exactly the opposite, right? That’s because your doctor has been brainwashed or bribed by the drug companies that now generate $29 billion dollars a year from selling statin drugs.

    Learn more:

  • sf_jeff

    I don’t understand how the endogenous cholesterol could be so much greater than the dietary cholesterol in either group. Does this mean the cholesterol isn’t really the biggest problem on the source side, but rather cholesterol precursors or catalysts? Or does “cholesterol eaten, but not today” get counted as endogenous (eg. lacking today’s radioactive markers)?

    • Joseph Gonzales R.D.

      Not sure I follow. The study was to test the hypothesis that intrinsic phytosterols present in unmodified foods alter whole-body cholesterol metabolism.The graph is showing how much cholesterol is excreted in the feces and more endogenous cholesterol was excreted in comparison to dietary cholesterol. The body makes tons of cholesterol daily, way more than typical folks eat so it would make sense that more is endogenously excreted than dietary sources. Dietary cholesterol is still very much a concern in excess.

      • sf_jeff

        Thanks for the response. I wasn’t aware that the body made so much. It makes me wonder if cholesterol precursor consumption could be a big factor.

        The graph at the end is pretty suggestive. I guess this sort of complexity is exactly why we like test tube studies and longitudinal studies to confirm each other.

  • Jennifer Heath

    Hello! I have run across some conflicting data about phytosterols. Apparently this article claims that high amounts of these plant sterols can actually be detrimental to cardiac health. I am a nurse practitioner who treats many patients who have heart disease. Please advise!

    Phytosterols: Perspectives in Human Nutrition and Clinical Therapy

    Author(s): S. P. Choudhary and L. S. Tran

    Affiliation: Signaling Pathway Research Unit, RIKEN Plant Science Center, 1-7-22, Suehiro-cho, Tsurumi, Yokohama 230-0045, Japan.


    Phytosterols (PSs) are a group of plant derived steroid alcohols, with wide occurrence in vegetables and fruits. They are integral components of plant cell membranes, having stabilizing effects on phospholipids bilayer, just like cholesterol in animal cell membranes. Structural resemblance of PSs with cholesterol enables them to displace low-density lipoprotein (LDL) cholesterol in the human intestine. Protective effects of PSs against cardiovascular diseases (CVDs), colon and breast cancer developments have been widely documented. Several reports have been published on the potential dietary intake of common PSs, such as β-sitosterol, stigmasterol and campesterol, and their safety concerns. Ability of PSs to reduce cholesterol levels and risks associated with heart problems has made them a class of favorite food supplements. Nowadays functional foods supplemented with PSs have become an alternative and healthy tool to lower LDL-cholesterol levels in a natural way. However, excessive use of PSs has been observed to develop premature coronary artery disease in phytosterolemic patients, high risk of atherosclerotic CVDs, myocardial infarction and even impaired endothelial functions. This manuscript will highlight the recent developments in PSs with particular focus on their role as dietary supplements and in treatment of various heart- and cholesterol-related ailments. Recently explored side effects of PSs will also be discussed.

    Article Details

    VOLUME: 18
    ISSUE: 29
    Page: [4557 – 4567]
    Pages: 11
    DOI: 10.2174/092986711797287593
    Price: $58