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Dear Dietitian – Can cholesterol be controlled with just diet and exercise?

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PICT Leanne McCrate Dear Dietitian
Leanne McCrate, RDN, LD, CNSC

Dear Dietitian,

My cholesterol level has slowly been creeping up, and now it’s up to 275! My doctor says I have to get it down, but I don’t want to take medication yet. Do you think I could get my cholesterol down with diet and exercise?


Dear Charles, 

There are several healthy diets that will help lower your cholesterol, and you are wise to try diet and exercise before medication. A healthy cholesterol level is 200 mg/dL or lower. The low-density lipoprotein (LDL) level has been dubbed “bad cholesterol” because it contributes to the buildup of plaque in the arteries, increasing the risk of heart attack and stroke. The high-density lipoprotein level (HDL) holds the title of “good cholesterol” because it transports some LDL back to the liver for disposal.

The Ornish diet was created by Dean Ornish, MD, a clinical professor of medicine at the University of California, San Francisco. This diet is plant-based and emphasizes fruits, vegetables, and whole grains. It is very low in fat, with only 10% of calories coming from fat, and only a small amount of that is saturated fat. Only 12 mg of cholesterol is allowed each day, and plant oils are prohibited. Exercise and stress management are also a part of the program.

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In a study of forty-eight participants, those who followed the Ornish plan for one year had a 37% reduction in LDL cholesterol. HDL remained the same. More important, there was a reversal in heart disease in these participants. A drawback of the Ornish diet is that it is strict and difficult to follow for some. Critics also point out that the study size was small, and more extensive research is needed (1).

Another diet that has gained global recognition is the Mediterranean diet. It consists of fruits, vegetables, whole grains, nuts, legumes, fatty fish, and poultry. The oils permitted are canola and olive oil, and moderate amounts of dairy and eggs are included. Red meat is allowed occasionally, and alcohol, particularly red wine, is enjoyed with meals.

In the Lyons study, those who followed the Mediterranean diet only produced a 6% reduction in LDL levels. However, the same group saw a 70% decrease in death from any cause and 70% fewer nonfatal heart attacks after four years. Numerous theories have been proposed on how this diet decreases heart disease despite the modest reduction in LDL. One theory is that a diet high in fruits and vegetables has a high amount of folic acid, which reduces the risk of heart disease. Another factor is that moderate alcohol intake is associated with less risk for heart disease (2).

If you like to do things your way, you can lower your cholesterol with your own diet and exercise plan. In a fifteen-week study of 350 volunteers with an average body mass index (BMI) of 35.1, those who lost between 5-10% of total body weight saw impressive results. Men had a 22-point decrease in total cholesterol, while women saw a 15-point decline. Both parties enjoyed healthier LDL levels. Men had a 5-point reduction; whereas, women had a 10-point decline. The study participants were put on a calorie-restricted diet and were expected to engage in 150 minutes of moderate-intensity exercise each week. This study was limited by its short duration (3).

If lowering your cholesterol is a goal, these three very different diet plans will produce results. Choose the plan that works for you. It is important to note that some of these studies are small, and the results may not be the same for everyone. All things considered, each diet will likely improve your health.

Until next time, be healthy!

Dear Dietitian


  1. Rosenthal R. Effectiveness of altering serum cholesterol levels without drugs. Proc (Bayl Univ Med Cent) 2000 Oct; 13(4): 351-355. doi: 10.1080/08998280.2000.11927704
  2. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–785.
  3. Brown J, Buscemi J, Milson V, Malcolm R, O’Neil P. Effects on cardiovascular risk factors of weight losses limited to 5-10%. Transl Behav Med. 2016 Sep; 6(3): 339-346. 

doi: 10.1007/s13142-015-0353-9

Leanne McCrate, RDN, LD, CNSC, is an award-winning dietitian based in St. Louis, Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at Dear Dietitian does not endorse any products, health programs, or diet plans.