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Cumulative Effects of Nutritional Strategies on Cholesterol Management

Cholesterol
Chronic diseases
• Nov 21, 2025
A person is holding a bowl of vegetables and other healthy ingredients for cholesterol management

After the age of 40, over 50% of Canadians develop dyslipidemia, a rate which climbs to over 60% by age 65 and above (1).

Numerous nutritional interventions (see table below), both for prevention and as adjuncts to pharmacotherapy, demonstrate clinically significant efficacy by directly targeting LDL‑cholesterol and other cardiometabolic markers (2-9).


Expected benefits from nutritional interventions

Nutritional 

Intervention (2-9)

Primary effect

 on LDL‑C (2-9)

Other notable benefits

(2-9)

Reduction of saturated fat (< 7% of total energy)

↓ 5–10 %

↓ cardiovascular mortality

Polyunsaturated fats: omega‑3 & omega‑6 (10‑15% of total energy)

↓ 10–15 %

↓ TG, ↓ BP,  ↓ inflammation,  

↓ cardiovascular events

 

Dietary cholesterol intake (< 200 mg/day)

↓ 10–16 %

Variable effect depending on responders vs non‑responders

Plant sterols (≈ 2 g/day)

↓ 7–10 %

↑ HDL‑C, ↓ TG, ↓ total cholesterol

Soluble fibres (5–15 g/day)

↓ 2–20 %

↓ total cholesterol, dose‑dependent effect

Plant proteins (especially soy, 25‑50 g/day)

↓ 3–9 %

↓ TG, ↓ total cholesterol

Nuts (30–60 g/day)

↓ 5–7 %

↓ TG

Weight loss (5‑10% of body weight)

↓ ~10 %

↓ TG ~20 %, ↑ HDL-C, ↓ BP, ↓ HbA1c

TG = triglycerides; BP = blood pressure; LDL‑C = low‑density lipoprotein cholesterol; HbA1c = glycated hemoglobin.

Cumulative effects of the Portfolio Diet

A nutrition‑therapy approach (without pharmacological treatment) combining:

  • Replacement of ~5% of total energy from saturated fats with unsaturated fats;
  • Daily addition of ~7 – 8 g of viscous (soluble) fibre;
  • Intake of ~2 g/day of plant sterols;
  • Daily addition of ~30 g plant proteins;
  • Weight loss of ~5% in the context of overweight or obesity.

This approach may result in substantial reductions in LDL‑C ranging from ~22% to ~37% (8).

 

More specifically, the Portfolio Diet relies on this principle of synergistic effects from four nutritional components in order to lower blood cholesterol (10):

  • Nuts: 25–50 g/day
  • Plant proteins (especially soy): 35–50 g/day
  • Soluble fibre: 15–25 g/day
  • Plant sterols: 2–3 g/day

 

In a controlled experimental context with provided meals (isocaloric food intake, no weight loss), this approach achieved LDL‑C reductions up to ~30%—an effect comparable to a low‑dose statin (11). 

 

In real‑world conditions, where participants receive only dietary advice, reductions are more modest (~10–15%), primarily due to limited adherence (~43%). However, the effect remains significant and sustained over time (12). 

 

Compared with a low‑fat control diet (<7% saturated fat and < 200 mg/day dietary cholesterol), the Portfolio Diet also induced significant reductions in total cholesterol (–12%), triglycerides (–16%), non‑HDL cholesterol (–14%) and apolipoprotein B (–15%), while lowering the estimated 10‑year risk of coronary heart disease by 13% independent of weight loss (10).

Sample 1850‑kcal menu based on the Portfolio Diet

Meals

Foods

Estimated Nutritional Intake

Breakfast

Overnight oats : 

  • ½ cup rolled oats

  • 1  tbsp chia seeds

  • 1  tsp psyllium

  • ⅔  cup enriched soy beverage

  • ½  cup berries

  • ½  cup 0‑2% fat Greek yogurt or 1 tbsp (15 g) nut butter

  • 2 g phytosterol supplement

 

~ 7 g soluble fibre

~ 10 g plant protein

~ 2 g plant sterols

 

 

 

 

Lunch

Bean and/or barley soup or salad:

  • ¾ cup cooked chickpeas

  • ½  cup barley

  • Mixed vegetables (peppers, spinach, carrots)

  • 1  tbsp your choice of seeds (pumpkin seeds etc.)

  • 1–2 tsp olive oil (cooking or dressing)

  • 1 orange

~ 4-5 g soluble fibre

~ 18 g plant protein

 

 

 

Afternoon Snack 

  • ⅓ cup of nuts, to taste

  • 1 whole apple

 

~ 2 g soluble fibre

~ 7 g plant protein

 

 

Dinner 

  • 150 g extra‑firm tofu or tempeh 

  • ¾ cup cooked quinoa 

OR

  • 125  g grilled salmon (or chicken breast)

  • ¾ cup cooked brown rice mixed with edamame

 

  • Roasted vegetables: eggplant and asparagus

  • 1–2 tsp olive oil (cooking)

~2-3 g soluble fibre

~10 to 27 g plant protein

 

What about dairy products?

Recent evidence suggests that type of dairy product may have a more determinant impact than fat‑content per se. Fermented products such as yogurt, kefir and cheese are associated with neutral or favourable effects on LDL‑cholesterol and overall cardiovascular risk (15, 16). 

 

In contrast, high‑fat non‑fermented dairy products (e.g., butter, cream) consistently increase LDL‑cholesterol—even when their saturated‑fat content is comparable to fermented products (17).

The essential support of dietitians

According to a meta‑analysis of randomized controlled trials published in 2024, dietetic nutritional counselling by a registered dietitian alone or within a multidisciplinary team involving 2 – 12 encounters significantly improved lipid profiles in individuals with dyslipidemia (with or without diabetes or overweight) (13):

  • ↓ LDL‑C by –0.30 mmol/L
  • ↓ total cholesterol by –0.54 mmol/L
  • ↓ triglycerides by –0.37 mmol/L

 

These results hold whether or not pharmacotherapy was already present prior to the individualized nutritional intervention. 

 

Moreover, prior data suggest that dietitian‑led nutritional counselling in dyslipidemia could generate cost savings of  $638-1456 per patient per year by reducing medication use—and allow a mean gain of 10.75 quality‑adjusted life years (14). 

 

Dyslipidemia is a modifiable condition for which nutrition represents a major therapeutic lever. In addition to reducing LDL‑cholesterol, nutritional interventions improve blood pressure, triglycerides, inflammation and overall metabolic health.

 

For professional nutrition support tailored to dyslipidemia, individual consultations with a TeamNutrition dietitian offers a personalized, evidence-based approach. We can help your patients adopt effective nutrition habits to improve cholesterol levels and support overall health. Contact us today to learn more about our clinical nutrition services.

 

References

  1. Spohn, O., Morkem, R., Singer, A. G., & Barber, D. (2024). Prevalence and management of dyslipidemia in primary care practices in Canada. Canadian Family Physician, 70(3), 187-196.
  2. Rosa, C. D. O. B., Dos Santos, C. A., Leite, J. I. A., Caldas, A. P. S., & Bressan, J. (2015). Impact of nutrients and food components on dyslipidemias: what is the evidence?. Advances in Nutrition, 6(6), 703-711.
  3. Blanco Mejia, S., Messina, M., Li, S. S., Viguiliouk, E., Chiavaroli, L., Khan, T. A., Srichaikul, K., Mirrahimi, A., Sievenpiper, J. L., Kris-Etherton, P., & Jenkins, D. J. A. (2021). Effect of plant protein on blood lipids: A systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association, 10(21), e021693.
  4. Chiavaroli, L., Nishi, S. K., Khan, T. A., Braunstein, C. R., Glenn, A. J., Mejia, S. B., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Jenkins, D. J. A., Kendall, C. W. C., & Sievenpiper, J. L. (2018). Portfolio dietary pattern and cardiovascular disease: A systematic review and meta-analysis of controlled trials. Progress in Cardiovascular Diseases, 61(1), 43–53.
  5. Trautwein, E. A., & McKay, S. (2020). The role of specific components of a plant-based diet in management of dyslipidemia and the impact on cardiovascular risk. Nutrients, 12(9), Article 2671.
  6. Ryan, D. H., & Yockey, S. R. (2017). Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Current obesity reports, 6, 187-194.
  7. Ras, R. T., Geleijnse, J. M., & Trautwein, E. A. (2014). LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. British Journal of Nutrition, 112(2), 214-219
  8. Kirkpatrick, C. F., Sikand, G., Petersen, K. S., Anderson, C. A., Aspry, K. E., Bolick, J. P., ... & Maki, K. C. (2023). Nutrition interventions for adults with dyslipidemia: a clinical perspective from the National Lipid Association. Journal of clinical lipidology, 17(4), 428-451.
  9. Carson, J. A. S., Lichtenstein, A. H., Anderson, C. A., Appel, L. J., Kris-Etherton, P. M., Meyer, K. A., ... & Van Horn, L. (2020). Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation, 141(3), e39-e53.
  10. Chiavaroli, L., Nishi, S. K., Khan, T. A., Braunstein, C. R., Glenn, A. J., Mejia, S. B., ... & Sievenpiper, J. L. (2018). Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Progress in cardiovascular diseases, 61(1), 43-53.
  11. Jenkins, D. J., Kendall, C. W., Marchie, A., Faulkner, D. A., Wong, J. M., de Souza, R., ... & Connelly, P. W. (2003). Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. Jama, 290(4), 502-510.
  12. Jenkins, D. J., Jones, P. J., Lamarche, B., Kendall, C. W., Faulkner, D., Cermakova, L., ... & Frohlich, J. (2011). Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. Jama, 306(8), 831-839.
  13. Mohr, A. E., Hatem, C., Sikand, G., Rozga, M., Moloney, L., Sullivan, J., ... & Handu, D. (2022). Effectiveness of medical nutrition therapy in the management of adult dyslipidemia: A systematic review and meta-analysis. Journal of Clinical Lipidology, 16(5), 547-561.
  14. Sikand, G., Cole, R. E., Handu, D., deWaal, D., Christaldi, J., Johnson, E. Q., ... & Ekvall, S. M. (2018). Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: a systematic review and meta-analysis. Journal of clinical lipidology, 12(5), 1113-1122.
  15. Kiesswetter, E., Stadelmaier, J., Petropoulou, M., Morze, J., Grummich, K., Roux, I., Lay, R., Himmelsbach, L.,Kussmann, M., Roeger, C., Rubach, M., Hauner, H., & Schwingshackl, L. (2023). Effects of Dairy Intake on Markers of Cardiometabolic Health in Adults: A Systematic Review with Network Meta-Analysis. Advances in Nutrition, 14, 438 - 450.
  16. Savaiano, D., & Hutkins, R. (2020). Yogurt, cultured fermented milk, and health: a systematic review. Nutrition Reviews, 79, 599 - 614.
  17. Giosuè, A., Calabrese, I., Vitale, M., Riccardi, G., & Vaccaro, O. (2022). Consumption of Dairy Foods and Cardiovascular Disease: A Systematic Review. Nutrients, 14.
Chloé Fleurent-Grégoire – Nutritionniste Diététiste à Montréal