What Decreases the Absorption of Cholesterol?

December 31, 2025 •

3 min read

Approximately 50% of the cholesterol reaching the small intestine is absorbed, while the rest is eliminated from the body. Several factors can decrease this intestinal absorption, offering a powerful way to lower LDL, or "bad," cholesterol and improve overall heart health.

Quick Summary

Learn how lifestyle adjustments and medications can significantly lower cholesterol absorption. Key strategies include consuming more soluble fiber and plant sterols, reducing saturated fat intake, and using specific prescription drugs.

Key Points

Increase Soluble Fiber: This binds to cholesterol and bile in the intestines, preventing absorption and promoting elimination from the body.
Consume Plant Sterols and Stanols: These plant-based compounds compete with cholesterol for absorption in the digestive system.
Limit Saturated and Trans Fats: A reduction in these unhealthy fats helps prevent the body from raising LDL cholesterol levels.
Ezetimibe (Zetia): This is a prescription medication that directly blocks the specific intestinal protein (NPC1L1) responsible for cholesterol absorption.
Use Bile Acid Sequestrants: These drugs bind to bile acids, causing the body to use more cholesterol from the bloodstream to produce new ones, thus lowering cholesterol levels.
Combine Strategies for Greater Effect: Combining diet, supplements, and medication can provide a more significant reduction in cholesterol absorption and overall LDL levels.

Dietary Strategies to Decrease Cholesterol Absorption

Your diet is a primary tool for managing cholesterol absorption. By incorporating specific foods and reducing others, you can create an environment in your gut that favors cholesterol excretion over absorption.

Incorporate Soluble Fiber

Soluble fiber is a key dietary component for decreasing cholesterol absorption. When it enters your digestive tract, it forms a viscous, gel-like substance that binds to cholesterol and bile acids, which are made from cholesterol. This process prevents them from being absorbed into the bloodstream and helps carry them out of the body. Foods rich in soluble fiber include:

Oats and oat bran
Legumes, such as beans, lentils, and chickpeas
Fruits, especially apples, pears, and citrus fruits
Vegetables, including carrots, Brussels sprouts, and okra
Psyllium supplements

Increase Intake of Plant Sterols and Stanols

Plant sterols and stanols are naturally occurring compounds found in small amounts in various plant foods. They are structurally similar to cholesterol and compete with it for absorption in the intestines. When you consume them, your body absorbs the plant sterols instead of cholesterol, leading to lower blood cholesterol levels. Since it is difficult to get enough from a typical diet, fortified foods or supplements are often recommended.

Fortified Foods: Many products like orange juice, milk, yogurt, and margarine spreads are enriched with plant sterols and stanols.
Natural Sources: Small amounts are present in nuts, seeds, whole grains, fruits, and vegetables.

Limit Saturated and Trans Fats

While cholesterol in food has a modest impact on blood cholesterol, saturated and trans fats can directly raise LDL cholesterol. By limiting your intake of these fats, you support a cholesterol-lowering diet. Foods to reduce include fatty meats, full-fat dairy, and many processed baked goods.

Medical and Supplemental Interventions

For some, lifestyle changes alone may not be enough to manage cholesterol. Fortunately, medical options and certain supplements can also effectively decrease cholesterol absorption.

Cholesterol Absorption Inhibitors

Medications like ezetimibe (Zetia) work by blocking a specific protein in the small intestine called Niemann-Pick C1-Like 1 (NPC1L1), which is responsible for transporting cholesterol from the intestine into the bloodstream. By inhibiting this transporter, ezetimibe significantly reduces the amount of cholesterol absorbed by the body. It is often prescribed in combination with a statin for enhanced effect.

Bile Acid Sequestrants

Bile acid sequestrants, also known as resins, are medications that bind to bile acids in the intestine. Since bile acids are made from cholesterol, removing them in the stool prompts the liver to pull more cholesterol from the bloodstream to produce new bile acids, thereby lowering blood cholesterol. Examples include cholestyramine and colestipol.

Comparison of Cholesterol-Lowering Strategies


Strategy	Mechanism	Key Advantage	Typical Reduction in LDL	Considerations
Dietary Fiber	Binds to bile acids and cholesterol in the gut.	Also provides broad health benefits, like improved digestion.	5–11 points with 5–10g soluble fiber/day.	Requires consistent, high intake; may cause bloating.
Plant Sterols/Stanols	Competes with cholesterol for absorption.	Effective and can be obtained through fortified foods.	Up to 10% reduction with 2g/day.	Needs consistent intake, often through specific products.
Ezetimibe (Zetia)	Directly blocks intestinal cholesterol transporter (NPC1L1).	Highly effective, especially when combined with a statin.	15–25% reduction with statin combination.	Prescription needed; potential side effects.
Bile Acid Sequestrants	Binds to bile acids, promoting cholesterol excretion.	Non-systemic action, suitable for those unable to tolerate statins.	15–30% reduction.	Potential for digestive side effects like constipation.

Conclusion

Decreasing cholesterol absorption is a multifaceted approach that can be achieved through a combination of lifestyle changes and, if necessary, medication. Dietary modifications, particularly increasing soluble fiber and incorporating plant sterols and stanols, provide a foundational method for managing cholesterol naturally. Medical options like ezetimibe and bile acid sequestrants offer more aggressive interventions for individuals who need further support or cannot tolerate statins. Working with a healthcare provider can help determine the most effective strategy for your individual health needs.

For more in-depth nutritional guidance, you may find the article on heart-healthy diets from the American Heart Association helpful: Cholesterol Medications | American Heart Association.

Frequently Asked Questions

Plant sterols and stanols have a similar molecular structure to cholesterol and compete with it for a spot within the micelles, which are necessary for cholesterol absorption. This competition displaces cholesterol, meaning less of it is absorbed by the body.

Foods rich in soluble fiber include oats, barley, legumes (like beans and lentils), and many fruits and vegetables such as apples, pears, carrots, and Brussels sprouts.

Medications like ezetimibe can directly and powerfully block cholesterol absorption, offering a more significant reduction than diet alone. For many people, a combination of lifestyle changes and medication is the most effective approach.

A daily intake of 5 to 10 grams of soluble fiber can help lower total and LDL-cholesterol. However, many Americans get only about half the recommended daily fiber intake, so increasing consumption through diet or supplements is often needed.

While both soluble and insoluble fiber are important for overall health, it is primarily soluble fiber that directly decreases cholesterol absorption by forming a gel that traps cholesterol in the gut.

Bile acid sequestrants are medications that bind to bile acids in the intestine. By preventing bile acid reabsorption, they force the liver to use more cholesterol to produce new bile acids, thereby reducing the amount of cholesterol in the blood.

Red yeast rice contains compounds similar to statins, which primarily inhibit cholesterol synthesis rather than absorption. While it can lower cholesterol, the potency and regulation of over-the-counter supplements can be inconsistent and potentially unsafe.