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What Actually Lowers Your LDL Cholesterol?

Inside this episode

The video’s narration, chapter by chapter, with stills from the video and every source at the end.

The short version

Prescription medicine can lower LDL the most, and statins have the strongest trial proof of fewer heart attacks and strokes. Food changes lower LDL too, more when combined. Psyllium and plant sterols lower LDL modestly; most other drug-free supplements don't. Whether medicine makes sense depends on the whole risk picture, not just the LDL number.

How much does each lower LDL?

On average, a moderate statin dose lowers LDL by about 30 to 49 percent; a high dose, by half or more. A combined portfolio diet lowered LDL about 30 percent in a month when most food was supplied, but about 13 percent over six months of advice alone.

From the video: AVERAGE LDL DROPS, 0%, 10%, 20%, 30%, 40%, 50%, 60%, Statin, high dose, about 50% or more, Statin, moderate dose, about 30–49%, Portfolio diet, most food supplied, about 30% (4 weeks)
Average LDL drops. food-industry funds; SPORT 2023 (~25 per arm, 4 weeks, AstraZeneca-funded)

In statin trials of about 170,000 people, each 39-point LDL drop cut major heart and stroke events by about a fifth. In people without heart disease but with risk factors, statins meant a little under one fewer heart attack per 100 over a few years. In trials of two years or more, cutting saturated fat cut heart and circulation problems by about a sixth, without clearly changing deaths. For plant sterols, oats, beans and soy, the trials we found measured LDL, not heart attacks.

From the video: LDL VS HEART ATTACKS, LDL is a lab number. What counts: heart attacks and strokes., CTT, Lancet 2010 (26 trials). Europe PMC record, Statins: tested on events, each 1 mmol/L lower LDL, (~39 mg/dL, our arithmetic):, about 1/5 fewer, major heart and stroke events, incl., artery-opening procedures (relativ
LDL vs heart attacks. CTT, Lancet 2010; Chou et al., JAMA 2022 (22 trials); Hooper et al., Cochrane 2020 (12 trials, moderate certainty);

Which food changes work best?

The changes with the best LDL evidence: swap saturated fat, from butter, fatty meat and coconut oil, for unsaturated oils and nuts. Add oats, barley and beans. In trials, foods with added plant sterols, about 2 grams a day, lowered LDL about 8 percent. Keto-style diets tend to leave LDL higher than low-fat diets do.

From the video: FOOD CHANGES WITH THE BEST LDL EVIDENCE, Swap saturated fat, for unsaturated oils, nuts, Oats, barley, beans, soluble, viscous fibre, (oats, barley), Plant-sterol foods, ~2 g/day in short trials:, about 8% lower, Soy protein, nuts, a little each*, (drawings), *FDA proposed dropping soy’s heart claim (82
Food changes with the best LDL evidence. Mansoor 2016; Ras 2014 (2 of 3 authors from Unilever, a sterol seller); mostly short trials, several industry-linked

Stacking food changes is the hard part. In that six-month trial of 351 adults, about a fifth dropped out, as many as with standard advice, and people who stuck more closely to the diet tended to get bigger LDL drops.

From the video: MAKING IT STICK, Stacking food changes: the hard part, Six-month trial, 351 adults (Canada); LDL drop from starting level:, Portfolio advice, about 13%, Standard advice, about 3%, (food supplied for one month in an earlier trial: about 30%), About 1 in 5 dropped out, similar in every group (18–26%; 6 mo
Making it stick. Jenkins et al., JAMA 2011 (NCT00438425) and AJCN 2005; Mohr et al., J Clin Lipidol 2022; Ross et al., Nutr Diet 2019

Which supplements work?

The opening trial had 199 adults, about 25 per supplement, one product each, for four weeks, and the statin's maker funded it. So it can't prove the supplements are useless, but none came close to the statin.

From the video: THE HEAD-TO-HEAD TRIAL, Laffin et al., J Am Coll Cardiol 2023 (SPORT). Europe PMC record, 199 US adults, aged 40–75, average 64; no heart disease; raised risk score, ~25 on each supplement, one product each, 4 weeks, LDL only, not heart events, Funded by AstraZeneca, the statin’s maker; one author worke
The head-to-head trial. Laffin et al., J Am Coll Cardiol 2023 (SPORT). Europe PMC record

Psyllium fibre, about 10 grams a day, lowered LDL about 13 points more than comparison groups in trials. Red yeast rice can contain the same compound as the statin lovastatin; across 28 US brands, the daily amount varied over 120-fold, and two had none detectable.

From the video: SUPPLEMENTS: WHAT THE EVIDENCE SAYS, Psyllium (fibre), ~10 g/day, (median studied; 28 trials; LDL only, no heart-attack trials found), LDL ~13 mg/dL lower vs control, (our arithmetic, from 0.33 mmol/L), US labels: take with a full glass of liquid, Red yeast rice, can contain monacolin K = lovastatin, 28
Supplements: what the evidence says. Jovanovski et al., Am J Clin Nutr 2018 (psyllium, 28 trials); NCCIH; Cohen et al., Eur J Prev Cardiol 2017;

When is medicine considered?

In summaries of the 2026 US guideline, an LDL of 160 to 189 can be a reason to consider a statin, even when short-term risk is low: a conversation, not an automatic prescription. Statins slightly raise the chance of a diabetes diagnosis, mostly in people already near the line; trial researchers judged the heart benefit much bigger.

From the video: WHEN MEDICINE COMES UP, Guidelines weigh overall risk, not just one number, Age, Blood pressure, Diabetes, Smoking, Cholesterol, Kidney function, 2026 US guideline, as published summaries describe it:, 100, 130, 160, 190, mg/dL LDL
When medicine comes up. lead author); guideline text not reviewed by us. CTT Collaboration, Lancet Diabetes Endocrinol 2024

In tightly controlled diet trials, LDL dropped within two to four weeks, and the 2018 US guideline, since replaced, suggested re-testing 4 to 12 weeks after starting a statin.

From the video: HOW SOON WILL A TEST CHANGE?, 0, 2, 4, 6, 8, 10, 12, weeks, Controlled diet trials: LDL down within 2–4 weeks, 2018 US guideline (now replaced): re-check 4–12 weeks after starting or changing a statin, One result moves on its own, natural variation within one person: about 9.5%, (≈15 mg/dL either way at
How soon will a test change? ); Smith et al., Clin Chem 1993 (30 studies; biological variation only)

Before you go: check with your clinician or pharmacist before taking any supplement; some can interact with medicines. Red yeast rice can contain a statin's chemical and isn't recommended in pregnancy or breastfeeding. With it or a statin, unexplained muscle pain or weakness, dark urine, or yellowing skin or eyes: call your clinician right away.

Sources

29 sources cited in the video, in the order they come up.

  1. SPORT trial, low-dose statin vs six supplements (4 weeks): Laffin LJ et al., J Am Coll Cardiol 2023 [link 2]
  2. 2018 AHA/ACC multisociety cholesterol guideline (replaced in 2026): Grundy SM et al., Circulation 2019
  3. Portfolio diet vs lovastatin (1 month): Jenkins DJA et al., JAMA 2003
  4. Portfolio diet vs statin, food supplied (1 month): Jenkins DJA et al., Am J Clin Nutr 2005
  5. Portfolio diet advice, 6 months: Jenkins DJA et al., JAMA 2011. (NCT00438425)
  6. Statin trials, about 170,000 people: Cholesterol Treatment Trialists' Collaboration, Lancet 2010
  7. Statins in people without heart disease: Chou R et al., JAMA 2022
  8. Cutting saturated fat: Hooper L et al., Cochrane Database Syst Rev 2020
  9. A dissenting 2025 review: Yamada S et al., JMA J 2025
  10. Dietary fats and LDL (metabolic ward studies): Clarke R et al., BMJ 1997
  11. Coconut oil: Neelakantan N et al., Circulation 2020
  12. Oat beta-glucan: Ho HV et al., Br J Nutr 2016
  13. Beans, lentils and other pulses: Ha V et al., CMAJ 2014
  14. Tree nuts: Del Gobbo LC et al., Am J Clin Nutr 2015
  15. Soy protein: Blanco Mejia S et al., J Nutr 2019
  16. Very-low-carbohydrate vs low-fat diets: Bueno NB et al., Br J Nutr 2013. and Mansoor N et al., Br J Nutr 2016 [link 2]
  17. Plant sterols and stanols, dose-response: Ras RT et al., Br J Nutr 2014
  18. Dietitian-led nutrition therapy: Mohr AE et al., J Clin Lipidol 2022. and Ross LJ et al., Nutr Diet 2019 [link 2]
  19. Psyllium: Jovanovski E et al., Am J Clin Nutr 2018
  20. Red yeast rice product testing (28 US brands): Cohen PA et al., Eur J Prev Cardiol 2017
  21. Fish oil (omega-3): Abdelhamid AS et al., Cochrane Database Syst Rev 2020
  22. Garlic: Gardner CD et al., Arch Intern Med 2007
  23. Cinnamon: Maierean SM et al., J Clin Lipidol 2017
  24. Turmeric/curcumin: Dehzad MJ et al., Complement Ther Med 2023
  25. FDA, Questions and Answers on Dietary Supplements
  26. 2026 ACC/AHA multisociety dyslipidemia guideline (described from published summaries; we did not review its full text)
  27. Summaries of the 2026 guideline: Essa M et al., Am J Prev Cardiol 2026. Spitz JA et al., Am J Prev Cardiol 2026. Goren LR et al., Am J Prev Cardiol 2026 (co-written by the guideline's lead author) [link 2] [link 3]
  28. Statins and new diabetes diagnoses: Cholesterol Treatment Trialists' Collaboration, Lancet Diabetes Endocrinol 2024
  29. Natural variation in LDL within one person: Smith SJ et al., Clin Chem 1993

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