Cholesterol and longevity: foods, supplements and healthspan research

What is cholesterol and what does it do?

Cholesterol is a fat-like substance that is part of every cell membrane. Your body uses it to make hormones such as oestrogen, testosterone and cortisol, as the starting point for vitamin D in the skin and to make bile acids for fat digestion.

Most of the cholesterol in your blood is not from your food: your body makes it itself, mainly in the liver. An important step in that production is the enzyme HMG-CoA reductase, which is also the enzyme that statins inhibit.

Because cholesterol does not dissolve in blood, it is transported in lipoproteins. LDL carries cholesterol to the tissues and HDL carries it back to the liver. That is why LDL is often called “bad” and HDL “good” cholesterol, although the reality is more nuanced, as you will read below.

Does cholesterol from food raise your blood cholesterol?

Less than many people think. Observational studies generally do not find a clear link between dietary cholesterol and cardiovascular disease. Intervention studies are less uniform: most link intakes above the current average with somewhat higher total or LDL cholesterol.¹ Guidelines therefore focus less on cholesterol in individual foods and more on the overall dietary pattern.

Does high cholesterol cause symptoms?

Usually not. High cholesterol does not cause complaints and only shows up in a blood test. Only in some inherited forms can fatty deposits appear in the skin or tendons. LDL cholesterol also tends to rise with age, in women especially after the menopause.

Cholesterol and longevity: what does science show?

The clearest link concerns the heart and blood vessels. A consensus statement from the European Atherosclerosis Society brought together genetic studies, cohort studies and randomised trials with more than two million participants. The conclusion: LDL causes atherosclerotic cardiovascular disease, and the risk increases with both the level and the duration of exposure.²

View the research

That duration matters. In a long-term American study, the risk of cardiovascular disease depended on cumulative exposure to LDL over the years, and the same exposure at a younger age weighed more heavily than later in life.³ Researchers therefore increasingly look at cholesterol over a lifetime rather than at a single measurement.

The brain is also part of the picture. The brain makes its own cholesterol, but the 2024 report of the Lancet Commission on dementia lists high LDL cholesterol in midlife as one of the modifiable risk factors for dementia.⁴

What did the Swedish study on cholesterol and centenarians find?

In the Swedish AMORIS cohort, researchers followed people whose blood had been tested between 1985 and 1996 for up to 35 years. Of them, 1,224 reached the age of 100. Already from the age of 65, those who later became centenarians had more favourable values for markers such as glucose, creatinine and uric acid.⁵

In the media, the study was sometimes presented as “high cholesterol helps you reach 100”. The authors later published a correction: low total cholesterol was associated with a lower likelihood of reaching 100, but high cholesterol neither increased nor decreased that likelihood.⁶

Is high cholesterol protective in older people?

A systematic review of cohort studies in people over 60 found an inverse association between LDL cholesterol and mortality in more than half of the cohorts, and no association in the rest.⁷ That sounds surprising, but observational research cannot separate cause and effect here. Illness, frailty and weight loss can lower cholesterol in the years before death, which makes low cholesterol a possible marker of poor health rather than its cause. There is also no single target value by age: European guidelines base cholesterol targets on someone’s overall cardiovascular risk.⁸

Is high HDL cholesterol always better?

Not necessarily. In two large Danish cohorts with more than 116,000 adults, the association between HDL cholesterol and mortality was U-shaped: both very low and very high HDL were associated with higher mortality.⁹ This is observational research as well, so it shows an association and not a cause.

Beyond LDL: what ApoB and Lp(a) add

LDL cholesterol measures how much cholesterol the LDL particles carry. ApoB reflects the number of LDL and other cholesterol-carrying particles that can enter the artery wall, because each of them carries one apoB molecule, and European guidelines mention it as an additional marker of cardiovascular risk.⁸

Lp(a) is an LDL-like particle whose level is largely determined by your genes. A consensus statement from the European Atherosclerosis Society recommends measuring it at least once in adulthood, because a high level is a risk factor for cardiovascular disease that a standard cholesterol test does not show.¹⁰

Cholesterol-lowering foods: what to add and what to limit

For cholesterol, the overall dietary pattern matters more than one superfood. Several foods have been studied separately in randomised trials.

• Oats and barley. They contain beta-glucan, a soluble fibre. A meta-analysis of 58 trials found lower LDL cholesterol and apoB with a median of 3.5 g of oat beta-glucan a day.¹¹
• Nuts. In a meta-analysis of 61 trials, eating tree nuts lowered total cholesterol, LDL and apoB, with stronger effects at higher amounts.¹²
• Legumes, soy and fibre-rich foods. These are part of the Portfolio diet, which combines nuts, plant protein, viscous fibre and plant sterols. In controlled trials in people with high cholesterol, it led to clinically meaningful changes in LDL.¹³
• Green tea. A meta-analysis of 14 randomised trials found small decreases in total and LDL cholesterol with green tea or green tea extract.¹⁴

Do avocados raise your cholesterol?

No. In a meta-analysis of avocado studies, total and LDL cholesterol did not differ from the control groups, while HDL rose slightly.¹⁵ Avocados contain fat, but mostly unsaturated fat and no cholesterol.

Which foods should you limit or avoid for cholesterol?

No single food is forbidden, but some raise LDL more than others. It helps to distinguish between foods to limit and foods that are better avoided.

• Limit. Foods rich in saturated fat, such as fatty meat, butter, cheese, cream, coconut oil and palm oil, can be part of a varied diet in moderate amounts. European guidelines recommend replacing part of them with unsaturated fats, such as olive oil, nuts and seeds.⁸
• Eat only occasionally. Processed meat such as sausages, salami and bacon, and pastries, biscuits and deep-fried snacks often combine saturated fat with a lot of salt or sugar.⁸
• Avoid where you can. Industrial trans fats from partially hydrogenated oils raise LDL. Since 2021, the EU limits them to 2 g per 100 g of fat in foods, so they have become much less common in Europe.¹⁶

Which foods are high in cholesterol, and what about eggs?

Egg yolks, shellfish, organ meats and butter contain a relatively large amount of cholesterol. Eggs are the main source of dietary cholesterol for many people; as described above, their effect on blood cholesterol is smaller than often thought, but intakes well above average can raise LDL somewhat.¹ For blood cholesterol, saturated fat usually matters more. Plant foods contain no cholesterol at all, so legumes, tofu, nuts and seeds are protein sources without any cholesterol.

What does a cholesterol-friendly meal look like?

Think of oatmeal with nuts and fruit for breakfast, a lentil or bean dish with vegetables and olive oil, or fish with whole grains and vegetables. Simple swaps, such as olive oil instead of butter, add up over months and years.

Cholesterol and exercise

Exercise has a smaller effect on LDL than diet, but it does affect HDL. A meta-analysis of 25 randomised studies found a modest increase in HDL with regular aerobic exercise. There appeared to be a minimum of around 120 minutes of exercise a week, and the duration per session mattered most.¹⁷

Exercise also influences blood pressure, blood sugar, body weight and fitness. For longevity, that combination is probably more important than the effect on cholesterol alone.

Read more about exercises for longevity

Do cholesterol-lowering supplements work?

Many supplements are marketed for cholesterol, but the evidence differs considerably. Only a few food components have an authorised EU health claim for maintaining normal blood cholesterol levels.

Plant sterols and stanols

Plant sterols and stanols occur naturally in nuts, seeds and vegetable oils and are added to some margarines and yoghurt drinks. They have an authorised EU claim from an intake of 0.8 g a day. In a meta-analysis of 124 studies, the effect on LDL increased with the dose up to about 3 g a day.¹⁸

Beta-glucan and other soluble fibre

Beta-glucan from oats and barley also has an authorised EU claim, at 3 g a day. In practice you can get that from food, for example from oatmeal and oat bran, as well as from supplements.

Red yeast rice and statins: what is the link?

Red yeast rice contains monacolin K, which is chemically identical to the statin lovastatin. That also means it can cause the same kind of side effects as statins. Because of concerns about side effects, the EU has limited supplements since 2022 to less than 3 mg of monacolins per daily portion, with a warning on the label.¹⁹ In 2025, the European Food Safety Authority could not identify any daily intake of monacolins that does not give rise to safety concerns.²⁰ In 2026, EU Member States approved a proposal to prohibit monacolins from red yeast rice in foods and supplements altogether; at the time of writing, that regulation had not yet been published.

Berberine and policosanol

Berberine is widely studied in relation to cholesterol. A systematic review of twelve randomised studies, some testing berberine alone and some in combination with other ingredients, found decreases in LDL and triglycerides in most of them. The reviewers noted that many trials reported their methods incompletely.²¹ Policosanol from sugar cane looked promising in studies from one research institute, but an independent randomised trial in Germany found no effect on blood lipids beyond placebo.²²

Read more about berberine

Vitamins for cholesterol: niacin or niacinamide?

In trials, niacin (nicotinic acid) in doses of grams per day lowers LDL and raises HDL. In the large HPS2-THRIVE trial with more than 25,000 high-risk patients, however, niacin combined with laropiprant did not lead to fewer heart attacks or strokes, while serious side effects such as disturbed blood sugar control became more common.²³ Niacinamide (nicotinamide), the other form of vitamin B3, does not have this effect on cholesterol.

Read more about niacin, nicotinamide and niacinamide

Do inositol, glycine or NMN affect cholesterol?

Inositol is studied mainly in people with metabolic conditions such as PCOS. A meta-analysis of 14 randomised trials in this group found decreases in triglycerides, total and LDL cholesterol.²⁴ For glycine, research on cholesterol comes mainly from animal studies, and NMN has not been studied as a cholesterol-lowering compound: human trials so far mainly looked at NAD+ levels.

Points to consider

Supplement studies usually run for weeks to months, so any change takes time to show in a blood test. Supplements do not replace medication, even if you do not tolerate a statin: discuss the options with your doctor. Do you use a statin or other cholesterol medication, blood thinners or medication for blood sugar or blood pressure? Then discuss supplements with your doctor or pharmacist first, and never stop or change your medication on your own.