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Dr. Thomas Johnson reviews Lower LDL Cholesterol Naturally with Food: Simple Ways to Add Proven LDL Reducers to Your Everyday Routine, a new book by Dr. Michael Greger and Dr. Christine Dennis. Dr. Johnson also draws from his own professional experience to explain why physicians rarely prescribe a plant-based diet to their patients and how a vegan diet combined with proper stress management can benefit heart health.

Lower LDL Cholesterol Naturally with Food: Simple Ways to Add Proven LDL Reducers to Your Everyday Routine
From Dr. Thomas Johnson, NCSP, CPQ - Health Psychologist
November 2025

Images from Canva

Lower LDL Cholesterol Naturally with Food: Simple Ways to Add Proven LDL Reducers to Your Everyday Routine
Paperback – September 30, 2025
By Dr. Michael Greger & Dr. Christine Dennis
Reviewed by Dr. Thomas Johnson

The authors of this well-written and researched book introduce the readers with the following:

LDL cholesterol is the primary driver of our primary killer, atherosclerotic cardiovascular disease. When it comes to LDL, the lower, the better. No threshold appears to exist below which further LDL-lowering won't further reduce our risk of heart attacks, strokes, or sudden death.

The reason more people aren't prescribed cholesterol-lowering statin drugs is there are associated drawbacks (such as increased diabetes risk), so the drugs are limited to those for whom the benefits outweigh the risks. But what if there were safe, simple, side-effect-free steps we could take to lower our cholesterol, like eating certain foods every day? With no downsides, everyone should be eating them to get their LDL as low as possible, regardless of whether they are already on medications or not.

—Page 1, Lower LDL Cholesterol Naturally with Food

Dr. Greger introduced the Portfolio Diet in an earlier book—How Not to Die. The starting point is to recognize that the main factors in the SAD that raise LDL include dietary cholesterol, trans fat, and saturated fat. These are primarily from animal flesh, eggs and dairy. These should be avoided or minimized.

Eating a healthy plant-based diet subtracts all the major foods that increase our LDL cholesterol. The Portfolio Diet is plant-based with a bonus—a portfolio of foods we can add to our diet to actively pull cholesterol out of our system[.]

—Page 17, Lower LDL Cholesterol Naturally with Food

Nuts. Eat one and a half ounces of nuts a day. According to Greger, Brazil Nuts are particularly effective in lowering LDL. Also, Healthline.com has this to say online:

Brazil nuts are nutritional powerhouses providing healthy fats, antioxidants, vitamins, and minerals. They’re exceptionally high in selenium, a mineral with potent antioxidant properties that’s also good for thyroid, brain, and heart health.

Taking too much selenium may lead to toxicity, though. To avoid consuming too much selenium, limit your intake to one to three medium-sized Brazil nuts daily. If you take any medications, consult a healthcare professional before incorporating Brazil nuts into your routine.

—7 Proven Health Benefits of Brazil Nuts, Healthline.com, accessed November 14, 2025

Plant protein: legumes, including soy, other beans, split peas, peas or lentils

Viscous fiber: Emphasize foods with lots of sticky fiber, like oats, eggplants, barley, and flax meal.

Plant sterols: Eat with meals. Eat a total of 2 grams of plant sterols each day.

In my experience, physicians, nurse practitioners and other health care providers will make referrals to psychologists when there are issues related to stress control as stress factors often affect the decision making of their patients. These healthcare providers can often benefit from psychologists who have a broad range of knowledge and experience looking at what affects patient decision making when it involves healthy versus unhealthy choices. What patients put into their bodies (e.g. tobacco, alcohol, pot, etc.) naturally affects whether or not they're making good decisions that will help resolve the stress-related conditions that brought them to their healthcare providers in the first place. For example, a lot of patients will eat the wrong foods and drink the wrong beverages as far as enhancing the abilities of their bodies to make progress with respect to health stress control as well as anything related to heart or brain health. A good example is as follows. I was talking with a heart patient last month about his reasons for retiring and he indicated that he had recently suffered his second heart attack, and this led to his deciding to retire. His cardiologist put him on statins but apparently did not give him specific guidance on how to change his diet to a heart healthy plant-based diet. When asked about whether or not he was planning to switch from his Standard American Diet (SAD) meals to a plant based diet and he indicated that he did not plan to make the switch and even said the same thing when it was explained that the only evidence demonstrating that reversal of diet related heart disease can only be reversed by eating a vegetarian or vegan diet. He stated that he still would not give up his SAD diet. Ongoing counseling with a well-informed therapist could make a difference as it does with addicted tobacco smokers.

The reader may wonder if physicians in general might be reluctant to follow the guidance that is offered here for lowering LDL cholesterol in the ways recommended by these medical scientists. As a health psychologist and health educator I have worked for several decades conducting comprehensive psychological evaluations for other health care providers like nurse practitioners, physicians and others who are not trained in psychological assessments. I have been conducting these assessments ever since my early training in psychological assessments at Harvard University. The health care providers making referrals are often looking for guidance on what should be included in their treatment plans—including in what drugs to prescribe.

At times it has felt like an awesome responsibility to be in this position and that is why I insist on conducting thorough assessments whether I am paid for all my professional time or not. I usually allocate 10 or more hours to conduct these assessments which includes interviews, cognitive tests, personality tests, research, scoring and report writing. In contrast, those medical providers making the referrals are often limited to 15 to 30 minutes of patient contact to make their preliminary diagnostic impressions and offer treatment plans which often include what drugs to prescribe.

These referral sources would sometimes ask me to recommend an appropriate drug(s). Since I don’t see that as an appropriate recommendation for psychologists to make, I would explain that psychopharmacology is not my area of appropriate practice or where I make recommendations, I will often explain this and typically will move to the area of stress control including what constitutes the elements in the Harvard Medical Schools Stress Control model (my training in this comes from CEUs through the medical school)—those elements include sleep hygiene, meditation, plant-based nutrition, exercise and counseling. These are areas of my post-doctoral training. Lack of training in lifestyle medicine as well as lack of time allowed by insurance companies to bill for this more comprehensive assessment and treatment practice are offered by referral sources as to why they defer to me for guidance.

Despite the proven health benefits of plant-based diets, physicians may not prescribe them to patients for several additional reasons according to multiple sources. Many medical doctors often have limited training in nutrition, and some express negative opinions about plant-based diets. This lack of knowledge and skepticism can lead to hesitation in recommending such diets. Secondly, there are economic factors at play; the healthcare system is financially motivated, and providing lifestyle counseling is not very profitable. Physicians may also fear losing patients if they promote lifestyle changes over writing prescriptions. Additionally, the financial interests of the pharmaceutical and food industries can influence healthcare practices and public health policies. Time constraints in medical appointments also contribute to the challenge, as counseling patients on dietary changes requires time and multiple visits.

Finally, I found the following in my literature search. One study found that many patients had better knowledge about nutrition than their doctors. This may not be altogether surprising given that only one-fifth of US medical schools require students to take a nutrition course. Even in those schools, students receive less than 25 hours of nutrition studies over four years. As a result, many practicing physicians rate their nutrition knowledge and counselling skills as inadequate. While working on this article I looked for well-trained cardiologists’ views on this subject and found the following testimonial from Doctor Kim Williams Sr.—former president of the American College of Cardiology. He stated in Good Nutrition: The Power of a Plant-Based Diet

I became a vegan in 2003 because I was concerned that my LDL “bad” cholesterol was too high. As a cardiologist and former president of the American College of Cardiology, I let my patients know that plant-based diets lead to better outcomes, reduce health risks, and have a much more favorable effect on obesity, compared with the standard American diet. They say knowledge is power. In this case, being aware of risk factors helps motivate people to make a difference.

—Page 23, Good Nutrition: The Power of a Plant-Based Diet

Before concluding this article, I would like to credit Dr. Dean Ornish and his team with their pioneering work which is covered in the following book—Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery. I have taken courses with members of his team including his psychologist and nutritionist. His nutritionist Deborh Kesten facilitated one of the most meaningful courses I have taken in this area over the course of a weekend workshop at the Esalen Institute in Monterey County, California. In addition to a vegan diet, they include stress management—meditation, exercise, and opening your heart support groups.

Photo from Dr. Thomas Johnson

In conclusion and summary, Doctors Greger and Dennis make the case very effectively that

LDL cholesterol is the primary driver of our primary killer, atherosclerotic cardiovascular disease. When it comes to LDL, the lower, the better. No threshold appears to exist below which further LDL-lowering won't further reduce our risk of heart attacks, strokes, or sudden death.

[...] With no downsides, everyone should be eating them to get their LDL as low as possible, regardless of whether they are already on medications or not.

—Page 1, Lower LDL Cholesterol Naturally with Food

Additionally, I think supplementing the vegan diet with Dr. Ornish’s stress management components approach can enhance the effectiveness of lowering cholesterol levels. I strongly recommend this combination to health care providers and patients alike!

Biographical Notes

Dr. Thomas B. Johnson completed his graduate studies at Brown University (US Public Health Fellowship in social psychiatry and medical sociology), Harvard University (master’s degree in counseling psychology), UC-Berkeley (doctor’s degree in counseling psychology) and Duke University (doctoral internship in psychological services). He has taken many post-doctoral courses at the Harvard Medical School and the Institute of Natural Resources in Nutritional Psychiatry and Stress Management. He is a licensed psychologist, nationally certified school psychologist and a health psychologist and certified by the National Register of Health Services Psychologists. He has served as a faculty member at Bates College, Rutgers University and the University of Southern Maine. He was a contributing editor of the NASP Communique for 10 years as their editor for alternative and complimentary approaches to health and learning. He has been providing a full range of psychological services over many years including assessments, consultations, education, psychotherapy, supervision and research. He now serves as a consulting psychologist and is a major contributor to All-Creatures.org.

Learn more about Dr. Thomas Johnson and see his other contributions to All-Creatures here!

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Posted on All-Creatures: November 14, 2025
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We began this archive as a means of assisting our visitors in answering many of their health and diet questions, and in encouraging them to take a proactive part in their own health. We believe the articles and information contained herein are true, but are not presenting them as advice. We, personally, have found that a whole food vegan diet has helped our own health, and simply wish to share with others the things we have found. Each of us must make our own decisions, for it's our own body. If you have a health problem, see your own physician.