We are at the tail-end of National Cholesterol Month (UK) , where the focus is on understanding to taking action for a healthier heart. So, let’s talk cholesterol.
Cholesterol is a fat-like substance found in your blood. While some cholesterol is needed for good health, too much of it in your blood can damage your arteries and increase your risk of heart disease (1). Your liver makes cholesterol, and you can also find cholesterol in some foods.
There are different types of cholesterol. The key ones are:
- HDL (high density lipoprotein) cholesterol– known as ‘good’ cholesterol. This type of cholesterol helps to keep levels in your blood from building up.
- Non-HDL (high density lipoprotein) cholesterol – known as ‘bad’ cholesterol. When levels of non-HDL cholesterol are high, they can clog up your arteries.
If you have been diagnosed with high cholesterol, this probably means that you have too much non-HDL cholesterol in your blood (1). Having too much of this ‘bad’ cholesterol can increase your risk of cardiovascular diseases such as heart attack, stroke and dementia (2).
Causes of high cholesterol
High cholesterol can be caused by a number of different things (3). These include:
- eating too much saturated fat
- leading a sedentary lifestyle (with little or no exercise)
- being overweight, particularly when you carry fat round your middle
- smoking
Sometimes having high cholesterol is the result of your genetics and because you have a strong family history of the condition, meaning that you are at a higher risk regardless of your lifestyle (4). Being older or having health conditions such as diabetes or kidney problems can also mean that you are at risk of having high cholesterol.
How to reduce your cholesterol
You can reduce your cholesterol by making some dietary and lifestyle changes (5), these include:
- Eating a healthy balanced diet, low in saturated fat
- Getting active
- Quitting smoking
You may also need medication to help lower your cholesterol. Your GP will discuss this with you if necessary.
Eating well to reduce cholesterol
Eating a healthy diet can help to reduce cholesterol. A healthy diet is one which consists mainly of fruits, vegetables ,mono-unsaturated fats such as olive or rapeseed oil, oily fish, wholegrains, pulses, nuts and seeds with modest amounts of lean meats, and reduced fat dairy products.
To reduce cholesterol, you should:
Reduce the amount of saturated fat in your diet
The type of fat you include in your diet can impact your cholesterol levels. The main types of dietary fat are saturated and unsaturated. When you have high cholesterol, it is important to reduce the amount of saturated fat you eat, choosing instead to eat foods containing unsaturated fats(6).
| Saturated fat – can be found in animal products (e.g. fatty meat/chicken, lard, ghee, butter, cream, processed meats such as bacon and sausages full, full-fat dairy foods), some plant products (coconut oil, palm oil) and processed foods such as pasties and cakes. |
| Unsaturated fat – can be found mostly in foods from plants, such as vegetable oils, nuts, and seeds. The two main types of unsaturated fats are polyunsaturated and monounsaturated. Polyunsaturated fats:omega-3 fats which are found in fish, especially oily fishomega-6 fats which are found in some oils such as sunflower, safflower and soybean oil, along with some nuts, including Brazil nuts and walnuts. Monounsaturated fats: found in olive and rapeseed oil, avocados and some nuts, such as cashews, macadamias, and almonds. |
| Instead of this | Choose this |
| Fatty meats and processed meats such as sausages, bacon, salami, pork chops | Eat fish twice a week (at least one portion oily fish) Small amounts lean trimmed meat, reduced fat mince, low fat sausages, turkey bacon |
| Full fat dairy products (milk, cheese, yoghurt, ice cream) | Reduced fat (semi skimmed or skimmed) milk, cheese, yoghurt, ice cream |
| Cream | Reduced fat crème fraiche, Reduced fat squirty cream |
| Crisps | Seeds (e.g. pumpkin, sunflower), unsalted nuts (e.g. walnut, almond, Brazil, macadamia)Air popped popcorn, Fruit, Hummus and vegetable sticks |
| Biscuits, cakes | Dark chocolate, fruit based cakes, oat bakes, chocolate rice cakes |
| Butter | Avocado, reduced fat spread |
| Lard | Rapeseed or olive oil |
| Creamy dressings | Vinegar based dressings, reduced fat versions, light coconut milk |
| Sugary, crunchy cereals | Oats, Oat based cereals |
Checking labels for fat
You can use the traffic light system to help show you which foods should be avoided as they are too high in saturated fat. Labels in the UK will display how much fat a product contains in total and then specifically how much saturated fat will be listed below this. Check labels for foods low/labelled green in saturated fat (less than 1.5g) and avoid high in saturated fat/labelled red (more than 5.0g) (7). Also try to avoid fried food and takeaways as these are often full of saturated fat and calories, which is not helpful when trying to lose weight.
Eat more fibre, particularly soluble fibre
Fibre is an important part of your diet as it supports digestion and helps keep you fuller for longer, which in turn can help with weight loss. There are different types of fibre (soluble, insoluble and resistant starch). Soluble fibre in particular can help lower cholesterol levels by reducing the absorption of cholesterol into the bloodstream.
Ways to ensure you are getting enough fibre include:
- Eating soluble fibre (good sources include oats, oat bran, linseed, chia seeds, barley, beans and pulses, lentils, peas, citrus fruits, apples)
- Include 30g unsalted nuts each day as a snack
- Eating a wide range of fruits and vegetables (aim for at least 5 a day)
- Including wholegrains (e.g. swapping to wholegrain versions of pasta, rice and bread)
Cut down on alcohol
Drinking too much alcohol is linked to a variety of illnesses and can impact your cholesterol level (8). If you regularly drink more than 14 units of alcohol per week, you should consider cutting down. Aim to have several alcohol free days per week and avoid binge drinking.
Other lifestyle recommendations
Exercising regularly can help reduce your cholesterol. Adults should aim to do at least 150 minutes of moderate intensity exercise per week, such as walking, swimming and cycling.
Quitting smoking can significantly help to improve your overall health. Smoking raises your cholesterol making you at increased risk for developing more serious illnesses such as heart disease. If you are wanting help to quit, speak with your GP who can support you with this.
FAQ
Q. I’ve heard that other foods like seafood and eggs are high in cholesterol, do I need to cut down on these as well?
There are some foods which naturally contain dietary cholesterol, such as eggs, prawns, crab, liver and liver pate. These foods are excellent sources of protein and other nutrients and you do not need to avoid them unless you have been told to by a healthcare professional. This is because the amount of cholesterol they contain does not have any significant impact on your cholesterol level, it is more important to focus on reducing your saturated fat intake (9).
Q. What are plant stanols and sterol products?
Plant stanols and sterols are naturally occurring substances found in foods that may help to reduce cholesterol. You will find foods fortified with stanols and sterols in the supermarket (e.g. mini drinks, yoghurt, and spreads). You need to eat 1.5-3g of plant stanols or sterols, in combination with a healthy diet, to see a reduction in cholesterol. Eating more than the recommended amount does not appear to help lower cholesterol further. (10, 11, 12).
Q. Should I switch to a plant-based diet?
A plant-based diet can be beneficial for overall health as it is rich in fruits, vegetables, plant-based proteins and high fibre foods such as nuts and grains. A lot of these foods also naturally contain plant sterols and stanols. (12) However, there is no need to completely avoid animal sources of protein, especially oily fish. There is good evidence to suggest that oily fish is helpful in reducing cholesterol levels, and has a supportive role in various other cardiovascular illnesses (13).
Q. I have a healthy diet and I am not overweight; can I still be diagnosed with high cholesterol?
Yes you can, even if you have no other risk factors you can still develop high cholesterol if you have this condition. Familial hypercholesterolaemia is a genetic disorder that means your liver cannot remove the ‘bad’ cholesterol from your blood and you are more at risk of complications at a much earlier age if left untreated (4).
Q. What are triglycerides?
Triglycerides are another type of fat in our body which may have been part of your blood tests showing your high cholesterol. If this is too high, your GP will discuss this with you as it is more likely if you are overweight and it can contribute to your risk of cardiovascular problems. You can manage your triglyceride levels by increasing your physical activity and making some dietary changes such as consuming more sources of unsaturated fat, particularly omega 3, and cutting down on processed foods (14). You should also aim to limit your alcohol intake, especially if you are a heavy drinker (8) and limit sugary foods as these can impact your triglycerides and cholesterol regardless of body weight (15).
Q. Will I have to take any medication to lower my cholesterol?
Your GP will discuss with you if medication is needed in addition to dietary and lifestyle changes. This will depend on how high your cholesterol is, your age, any dietary changes you feel like you are able to make (14) and any other factors which are individual to you. You should still follow a cholesterol lowering diet if you have been prescribed medication.
Q. Can eating soya reduce my cholesterol?
There have been some claims that soya beans can help lower cholesterol, however the evidence is not strong enough to recommend this at this point. Soya and soya products are still a good addition to your diet as it is a great source of protein, fibre and unsaturated fats, all of which can contribute to a healthy balanced diet and lead to lower cholesterol levels (16).
Conclusion
High cholesterol is a serious health concern, but with the right lifestyle and dietary adjustments, you can reduce your levels and lower your risk of cardiovascular diseases. Focus on a diet rich in unsaturated fats, fibre, and heart-healthy foods, and make regular physical activity a priority. Always consult with your healthcare provider before making any drastic changes, and follow any prescribed medication plans for optimal results.
References
1. Huff T, Boyd B, Jialal I. Physiology, Cholesterol. [Updated 2022 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470561/
2. British Heart Foundation, High cholesterol – causes, symptoms and treatments [Online] Available at: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol
3. British Dietetic Association (BDA), 2021, Cholesterol: Food Fact Sheet [Online] Available at: https://www.bda.uk.com/resource/cholesterol.html
4. British Heart Foundation, Familial Hypercholesterolaemia [Online] available at: https://www.bhf.org.uk/informationsupport/conditions/familial-hypercholesterolaemia
5. NHS, 2019 How to lower your cholesterol [Online] available at: https://www.nhs.uk/conditions/high-cholesterol/how-to-lower-your-cholesterol/
6. Cardiovascular disease: risk assessment and reduction, including lipid modification CG 18 NICE 2014 https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations#lifestyle-modifications-for-the-primary-and-secondary-prevention-of-cvd
7. British Nutrition Foundation, 2022, Looking at Labels [Online] Available at: https://www.nutrition.org.uk/putting-it-into-practice/food-labelling/looking-at-labels/
8. Minzer S, Losno RA, Casas R. The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information?. Nutrients. 2020;12(4):912.
9. Soliman GA. Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients. 2018;10(6):780.
10. British Dietetic Association (BDA), 2021, Stanols and Sterols: Food Fact Sheet [Online] Available at: https://www.bda.uk.com/resource/food-facts-plant-stanols-and-sterols.html
11. Trautwein EA, Vermeer MA, Hiemstra H, Ras RT. LDL-Cholesterol Lowering of Plant Sterols and Stanols-Which Factors Influence Their Efficacy?. Nutrients. 2018;10(9):1262.
12. Han, S., Jiao, J., Xu, J. et al. Effects of plant stanol or sterol-enriched diets on lipid profiles in patients treated with statins: systematic review and meta-analysis. Sci Rep 6, 31337 (2016).
13. Brinson BE, Miller S. Fish oil: what is the role in cardiovascular health? J Pharm Pract. 2012 Feb;25(1):69-74.
14. Oh RC, Trivette ET, Westerfield KL. Management of Hypertriglyceridemia: Common Questions and Answers. Am Fam Physician. 2020 Sep 15;102(6):347-354
15. Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomised controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014 Jul;100(1):65-79.
16. British Heart Foundation, Should I be eating soya to lower my cholesterol? [Online] Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/ask-the-expert/does-soya-lower-cholesterol.
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