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Cholesterol Lowering in a Nut Shell

Though official recommendations are to first treat high cholesterol with dietary change, many physicians jump right to cholesterol-lowering medications such as statins like Lipitor that can have an array of side effects. As described in my 1-min. video Diet Versus Drugs for High Cholesterol, up to a third of patients prescribed cholesterol-lowering drugs experience adverse reactions. Side effects include liver, muscle, and kidney dysfunction, skin disorders, abdominal pain, nausea, constipation, dizziness, flushing, neurological disorders, and cognitive impairment.

Dietary and lifestyle changes, on the other hand, tend to carry positive side effects. That’s why they are the cornerstones of the American Heart Association guidelines. Recommendations include reduced intake of saturated fat and cholesterol with increased physical activity and intake of dietary fiber. Basically we need to eat fewer animal foods, the only source of cholesterol, and more plants, the only source of fiber. One plant food that may be particularly protective is nuts. See Nuts and Bolts of Cholesterol Lowering for a pooled analysis of studies on nut consumption, cholesterol levels, and risk of death from heart disease.

For more on reducing cholesterol, the #1 risk factor for our #1 cause of death, see:

 For preventing our other top killers, see Uprooting the Leading Causes of Death.

For more on nuts, see:

Michael Greger, M.D.

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


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

6 responses to “Cholesterol Lowering in a Nut Shell

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  1. I was wondering if an historical source of fibre for man has been dirt on food. most animals eat some soil with food, this acts to help digestion with birds. For example if you don’t give budgies shell grit to eat with seeds they will often die of blockages in their digestion. grain would usually have had some dirt mixed with it along with some remaining chaff. As food became cleaner maybe this missed dirt in food led to problems with a lack of fibre like with birds. Also dirt would have some minerals to absorb, maybe bacteria or some source of B12 for vegetarians.

    1. Dirt has no fiber unless there is plant material in it. It can as you mention be a source of Vit B12 from the bacteria in the dirt. It is important to make sure you have an adequate Vit B12 intake. Deficiencies are more common in vegans see… Read more about the history see… It is relatively easy to get adequate minerals from plants see additional videos on iodine while also avoiding excess exposure to minerals such as iron and aluminum.

  2. While nuts don’t seem to contain any trans-fats or cholesterol, many do seem to be high in saturated fat. Should this be a concern if one eats a good deal of different nuts, or is the saturated fats in nuts not problematic for some reason? Thanks.

    1. Great question totally depends! How are you cholesterol numbers and how many do you eat? ​Here is a great video by Dr. Greger that explains the research between nut intake and body weight. Make sure to checkout the bottom of the video’s “Doctors Note” to see more links and information. Lastly, a follow-up to that video is solving the mystery of the missing calories, so it seems nuts are super healthful but if folks have high cholesterol and it’s not coming down I would limit nuts and seeds (1 ounce per day). If still a problem, maybe avoid and see if it helps?

  3. I have been vegetarian, and mostly vegan, for two decades now and eat absolutely no animal flesh or secretions, with the occasional exception of a square of cheese once a quarter at a party or something. On diet alone my cholesterol won’t go below 217 with bad ratios. As well, I have a genetic disposition. But on a statin it drops to 150 with good ratios. Does Dr. Greger ever recommend a patient like me go on statins?

    1. Hi Cole, I would make a couple of points in your situation.
      1) Are you eating large amounts of plant based saturated fats like nuts, avocado, or coconut oil or even unsaturated oils like olive oil or nut oil like sunflower oil. Take inventory and get a good sense for how much and how often you are eating those substances and if it’s substantial, cut back and see if that helps.
      2) You said you have a genetic predisposition. Some people’s genetics make them “over-producers” and some people are “over-absorbers” of cholesterol. There is a blood test that can tell you which you are, based on the types of cholesterol that predominate in your blood. The lab I use is Boston Heart Lab and the test is called the Cholesterol Balance test
      This test can be helpful because if for instance you are an over-absorber then that tells you that the majority of your cholesterol numbers are coming from absorption from your diet. If you are an over producer then you may have high numbers even with relatively low dietary intake and you may benefit from a statin if your numbers are dangerously high. This test is only available through a health care provider so you would have to work with your doctor to be tested but it’s worth looking into if your not able to bring it down on your own.
      3) High numbers especially in the range of total cholesterol you mention do not necessarily translate into high cardiovascular risk. You said you had “bad ratios” but without seeing the actual numbers I’d just say there are many other factors that contribute to cardiovascular risk beside cholesterol number. Healthy vegan and vegetarian diets mitigate most if not all of those other risks so with all other risks eliminated you could essentially “tolerate” a higher cholesterol number without the same consequence as someone not on a healthy diet.
      Hopefully these points will give you some further insight into your numbers and how much risk they represent.


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