Short answer
Diet changes have the best evidence, and combining them works best. In a six-month JAMA trial, a Portfolio diet of plant sterols, soy protein, viscous fiber and nuts cut LDL by about 13 to 14%. Single changes do less: plant sterols 6 to 12%, psyllium about 13 mg/dL, oat fiber about 7 mg/dL. Aerobic exercise alone did not lower LDL in pooled trials.
1. Stack the foods: the Portfolio diet
The largest effect from food alone comes from combining several cholesterol-lowering foods. In a 2011 JAMA trial, 351 Canadians with high cholesterol got advice for six months on either a low-saturated-fat diet or a Portfolio diet built on plant sterols, soy protein, viscous fibers and nuts.
From an average starting LDL of 171 mg/dL, the two Portfolio groups dropped 13.8% and 13.1%, or 26 and 24 mg/dL. The low-saturated-fat control group dropped 3.0%. Results tracked with how closely people followed the diet.
2. Plant sterols and viscous fiber
Plant sterols and stanols: a 2014 meta-analysis of 124 studies found intakes of 0.6 to 3.3 g a day lowered LDL by 6 to 12% on average, with the effect leveling off around 3 g a day.
Psyllium: a 2018 meta-analysis of 28 trials found a median of about 10.2 g a day lowered LDL by 0.33 mmol/L, roughly 13 mg/dL.
Oat beta-glucan: a 2016 meta-analysis of 58 trials found a median of 3.5 g a day lowered LDL by 0.19 mmol/L, roughly 7 mg/dL. Both fibers also lowered ApoB.
3. Saturated fat, weight loss and exercise
Saturated fat: a 2016 World Health Organization analysis of 84 controlled feeding studies found that each 1% of daily calories moved from saturated to polyunsaturated fat lowered LDL by 0.055 mmol/L, about 2 mg/dL. Swapping to monounsaturated fat gave 0.042 mmol/L. The total depends on how much you replace.
Weight loss: a 2020 meta-analysis of 73 trials found LDL fell 1.28 mg/dL per kilogram lost through lifestyle change.
Exercise: in a 2012 meta-analysis of six trials, aerobic exercise alone lowered triglycerides but not LDL. Diet did. Exercise is still worth doing for your heart.
When lifestyle is not enough
These are averages, and your own response can differ. The 2018 AHA/ACC cholesterol guideline calls a heart-healthy lifestyle the foundation at every age, but it does not treat diet as a substitute for medication in higher-risk groups.
It recommends statin therapy for people with existing cardiovascular disease and for LDL of 190 mg/dL or higher, where a 13% drop still leaves LDL high. For adults 40 to 75 it calls for a risk discussion with a clinician. Talk to your prescriber before stopping or declining a medication.
Related questions
How fast does LDL respond to diet?
The fiber trials pooled in the meta-analyses ran for at least 3 weeks, and the Portfolio trial measured its 13 to 14% drop at 6 months. The 2018 guideline suggests repeating a lipid test 4 to 12 weeks after a change in statin therapy.
Does exercise lower LDL?
Not much on its own. In a 2012 meta-analysis, aerobic exercise alone reduced triglycerides only, while diet lowered LDL.
Do these changes lower ApoB too?
Psyllium and oat beta-glucan did in meta-analyses, by 0.05 g/L and 0.03 g/L. Replacing saturated with polyunsaturated fat also lowered ApoB in the WHO analysis.
Read next
Sources
- Jenkins et al., JAMA: Effect of a dietary portfolio of cholesterol-lowering foods on serum lipids in hyperlipidemia, randomized trial (2011)
- Ras et al., Br J Nutr: LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges, meta-analysis (2014)
- Jovanovski et al., Am J Clin Nutr: Effect of psyllium fiber on LDL cholesterol, non-HDL cholesterol and apolipoprotein B, meta-analysis (2018)
- World Health Organization (Mensink): Effects of saturated fatty acids on serum lipids and lipoproteins, systematic review and regression analysis (2016)
- Grundy et al., AHA/ACC: Guideline on the Management of Blood Cholesterol (2018)
Published 2026-10-04 · Last checked 2026-10-04
Educational content, not medical advice. Made for the United States.