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Everything you need to know about your cholesterol

Cholesterol: How to Reduce Your Cholesterol Levels & Avoid Heart Problems

By Alex R. Nutritionist Advisor | 16th October 2017

Cholesterol has developed a bad reputation over the years, but this may not be entirely deserved. Whilst many of us know that unhealthy cholesterol levels can be bad for us, fewer people realize that cholesterol is actually essential to maintaining a healthy body. 

In this guide, we’ll break down the often complex topic of cholesterol, helping you to understand both the good and the bad. You’ll learn what a healthy cholesterol level looks like, why some people see their cholesterol level rising, and we’ll look at some simple steps you can take to protect your health. 

What is Cholesterol?

Cholesterol is a type of lipid or fatty substance that is essential for many functions in the human body, including:

●    Forming part of the membranes of our cells.
●    Creating steroid and sex hormones such as cortisol and testosterone.
●    Insulating nerves and aiding in chemical signaling throughout the body.
●    Being converted into bile in the liver, which is important for digesting fat and absorbing the fat-soluble vitamins A, D, E and K.

Cholesterol is an entirely natural substance that is produced by the liver. It binds to proteins and is then transporting around the body in your blood stream. Excess cholesterol is easily removed from the body when it completes its journey and arrives back at the liver. So long as this system remains in balance no issues arise; the problems occur when cholesterol levels get too high.

Cholesterol can also be obtained from our diets, particularly foods containing animal fats such as meat, dairy products like cheese and butter, and eggs. Consuming the wrong foods or not exercising regularly can lead to increasing cholesterol, and the potential health risks this brings.

LDL Vs. HDL: What is Good Cholesterol?

As we have discussed, cholesterol normally travels around the body, starting and finishing its journey in the liver. No doubt, however, you have heard of “good cholesterol” and “bad cholesterol” - so where do these come into the picture?

Cholesterol is transported around the body inside lipoproteins, which contain varying amounts of lipids like cholesterol in addition to protein. The more protein they contain the higher their density, and also the lower their cholesterol content.

LDL (low-density lipoprotein) cholesterol: Also referred to as ‘bad’ cholesterol, LDL contains a relatively low amount of protein and a high percentage of cholesterol. LDL transports cholesterol to the blood vessels from the liver.

HDL (high-density lipoprotein) cholesterol: Also referred to as ‘good’ cholesterol, HDL contains a greater amount of protein and lower amount of cholesterol than LDL and is involved in transporting cholesterol away from artery walls and towards the liver, where it can be broken down or removed from the body. 

In plain English, LDL cholesterol (often referred to as LDL-C) is bad because if it exists in high volumes it can begin to clog arteries. In contrast, HDL-C has the opposite effect, and safely transports excess LDL-C away to be removed from the body.

There are two important lessons to understand. The first is that LDL cholesterol levels should not be allowed to get too high, or health risks may ensue. At the same time, the balance between LDL and HDL is also critically important; if there isn’t enough HDL to carry excess LDL away then similar problems can arise. The reverse is also true, in that higher levels of HDL to LDL cholesterol can offer a protective effect.

Triglycerides: The main type of fat found in the blood, triglycerides can be either saturated or unsaturated. High levels have been linked to an increased risk of heart disease so your doctor will likely measure these alongside cholesterol levels. 

 Pencils laid across a piece of paper
 

Signs of High Cholesterol 

One of the reasons why cholesterol has become such a focus for doctors in recent years is precisely because high levels of cholesterol often have no obvious physical signs or symptoms. Sufferers may continue on for years, unaware of the risks they are taking. The plaque that builds up in arteries may take years to reach dangerous levels. 

Most commonly, sufferers of high cholesterol only become aware of their condition either through routine testing or when serious health issues arise.  

Health Risks of High Cholesterol

The most common health problem associated with high cholesterol levels is coronary heart disease. An extensive 25 year study concluded that cholesterol is an “important determinant” in death from coronary heart disease. Another group of scientists claim that “total cholesterol levels are related to development of coronary heart disease in both men and women”. Interestingly, it seems that the risk of high cholesterol levels may be noticeably higher in men than women.

Of course, coronary heart disease is only one potential issue arising from narrowed arteries. Other potential health complications can include strokes, heart attacks and peripheral arterial disease (PAD). Angina may also occur in less extreme cases, though this should be seen as a warning to resolve high cholesterol levels before more serious complications arise. 

What is a Normal, Healthy Cholesterol Level?

Cholesterol levels are most typically measured using a simple blood test, and it is recommended that individuals over 40, and those related to high cholesterol sufferers should be tested regularly.  

According to the NHS, healthy cholesterol levels are as follows:

●    Total Cholesterol: 5mmol/L or less
●    HDL (“good”) Cholesterol: 1mmol/L or higher
●    LDL (“bad”) Cholesterol:  3mmol/L or less
●    Triglycerides: 1.7mmol/L or less

Remember this is just one of many factors considered when determining your risk for cardiovascular disease, so speak to your doctor about what your specific results actually mean overall for you as an individual.

What Can Raise Your Cholesterol Level?

There is no single cause of high cholesterol levels in the body; instead a range of factors may have an impact. Some of the most important of these are:

Smoking

A group of scientists from the University of Minnesota investigated the link between cigarette smoking and high cholesterol levels. They found that not only did smoking reduce the levels of healthy cholesterol, but that the differences were stark. Smokers with high cholesterol levels were found to have a death rate from coronary heart disease up to twenty times greater than for non-smokers. 

Inactivity

Regular exercise has been found to increase the body’s production of healthy cholesterol, which helps to fight the risks of cardiovascular diseases associated with narrowed arteries. Furthermore, inactivity is frequently linked to excess body weight, which itself can raise cholesterol levels. 

Being Overweight

A high Body Mass Index (BMI) is associated with reductions in good cholesterol levels. Shedding weight can therefore be a fantastic way of battling high levels of LDL in the body.

Genetics

There is some evidence to suggest that some people may be naturally more prone to high cholesterol levels. If either of your parents have suffered from cholesterol-related problems in the past it is well worth informing your doctor and having regular blood tests.

Poor Diet

The food that we eat can have a huge impact on cholesterol levels. Possibly the greatest impact on cholesterol level comes from the consumption of fats. In contrast to past thinking, however, health experts now believe that not all fats are bad... 

Unsaturated Fats

These are both the mono- and polyunsaturated fats found in foods such as olives, vegetable oils, nuts and seeds, avocados and oily fish. These have been found to lower LDL cholesterol while raising HDL cholesterol, supporting a potential beneficial effect from these types of fat on heart health.

Saturated Fats

Saturated fats are commonly found in animal products such as meat and dairy and some plant foods such as coconut. Initially, saturated fat was considered to have negative effects on cholesterol levels, due to findings that it raises LDL cholesterol. However, it also raises HDL cholesterol levels, meaning the balance of ‘good’ to ‘bad’ cholesterol doesn’t change much and the overall effect on cardiovascular risk appears to be neutral.

Trans Fats 

These artificial fats are found in some processed foods such as biscuits, cakes, fried and fast foods. These have been shown to largely increase LDL cholesterol while not affecting HDL cholesterol, and are associated with an increased risk for cardiovascular disease. It is recommended to considerably reduce this type of fat in the diet. Check the label for partially hydrogenated vegetable oils or trans-fat and avoid if possible (though in the UK trans-fat levels now tend to be low in most foods already).

Dietary Cholesterol

Cholesterol obtained from foods such as eggs and shellfish doesn’t appear to have much of an effect on our blood cholesterol levels, especially relative to the other fats consumed in the diet. Only reduce your intake of dietary cholesterol if advised to by your doctor/dietitian and otherwise focus on the levels of saturated, unsaturated and trans-fats you’re consuming. 
  

olives for heart health
 

What Not to Eat When You Have High Cholesterol

Foods that are high in trans-fats and some saturated fats should be avoided for sufferers of high cholesterol. Heart UK, the cholesterol charity, recommends that many high-fat foods from animal sources are best consumed only in moderation. These include butter, lard, full fat cheese, cream and milk. Also, food items which contain large volumes of these fatty substances are also best eliminated from the diet. This means that sausages, cake, pastries and pies are all off the menu. 

Whilst this may sound rather limiting, the good news is that the body generally responds very positively to a change to more healthy dietary practices. There are still a wealth of foods that may support healthy cholesterol levels (discussed later on) which can offer variety and flavour. It’s a relatively painless way to improve cholesterol levels in the body and reduce your risks of cardiac events. 

How Do You Lower Your Cholesterol Level?

Now we have established that high levels of cholesterol are to be avoided, the obvious question is what we can do to reduce bad cholesterol levels…

Exercise

Regular exercise may be one of the most important aspects of reducing bad cholesterol levels. Whilst diet can have a significant impact (as outlined below) the results are considerably greater when exercise is combined with a suitable diet.  

Quit Smoking

Just as smoking may increase cholesterol levels, quitting smoking is associated with healthier cholesterol levels in the body. 

Eat Fish

The omega 3 fatty acids found in oily fish have been shown to help combat excess cholesterol in the bloodstream. They may also have a preventative effect on heart troubles, by helping to reduce chronic inflammation in the body. Omega 3 supplements can pose as an easy alternative to the government-recommended intake of two portions of fish per week. 

Red Wine (Resveratrol)

Resveratrol, the active ingredient in red wine, has been shown to benefit the heart and reduce levels of bad cholesterol when consumed in moderation. Only small amounts are required to offer this benefit, and sadly excessive intake won’t offer any more protection. 

Supplements

There is evidence to suggest that some dietary supplements may also help to lower cholesterol levels. Possibly the best-known of these is red yeast rice (RYR), which according to the European Food Safety Authority (EFSA) contributes to the maintenance of normal blood cholesterol levels.  

Eating for Healthy Cholesterol Levels

There can be little doubt that diet can make a huge impact on cholesterol levels in the body. Numerous studies have confirmed the link between poor diet and an increased risk of heart disease. One group of scientists, for example, has claimed that a “cholesterol-lowering diet was associated with considerably and significantly reduced mortality” from cardiac problems. So, what should we be eating to help lower cholesterol levels?

The overall dietary pattern is important for maintaining healthy cholesterol levels. Aim to include a variety of unprocessed whole foods, such as plenty of fruit and vegetables, starchy carbohydrates, healthy fats and lean sources of protein. 

Regarding fat intake, aim to get most of the fat in your diet from unsaturated sources, such as olive and other vegetable oils, oily fish such as salmon, nuts and seeds. Include some from saturated fat sources like animal products and coconut, and try to reduce your intake of trans fats. If you’re aiming to reduce trans or saturated fats in your diet, replace them with foods containing unsaturated fats.

Dietary fibre has been associated with lower cholesterol levels, particularly soluble fibre found in foods such as oats, beans, lentils, chickpeas, fruit and vegetables. Soluble fibres, such as the beta-glucan found in oats, form a gel with water in the stomach and intestine. This gel is then able to bind with fats such as cholesterol in the digestive tract and carry it out of the body. This leads to less cholesterol being absorbed, potentially decreasing total and LDL cholesterol levels in the blood.

Plant sterols are another way in which less cholesterol can be absorbed from food. These are naturally found in small amounts in foods such as vegetable oils, nuts and cereals. In addition to eating a healthy diet, those with high cholesterol levels may be recommended to also obtain plant sterols from fortified foods such as yoghurt or a spread, or a plant sterols supplement. 

Plant sterols help lower cholesterol as they have a similar structure, leading the cholesterol and plant sterols to compete for absorption, so less cholesterol ends up being absorbed and is instead removed from the body. Adding plant sterols into your diet from fortified sources is likely only beneficial for those with high cholesterol levels, and is not recommended for children or pregnant women as cholesterol is essential for growth. 

Overall for healthy cholesterol levels, eat a balanced diet with fats coming predominantly from unsaturated sources, plus include adequate fibre and a variety of fruit and vegetables; exercise regularly, and aim to maintain a healthy weight. 


Sources:

http://www.ncbi.nlm.nih.gov/pubmed/22208554 
http://www.ncbi.nlm.nih.gov/pubmed/12716665 
https://heartuk.org.uk/cholesterol-and-diet/low-cholesterol-diets-and-foods
http://jamanetwork.com/journals/jama/article-abstract/363237
http://www.sciencedirect.com/science/article/pii/S0140673672922088
http://europepmc.org/abstract/med/3042201
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/615878
http://www.nhs.uk/conditions/Cholesterol/Pages/Introduction.aspx
http://jn.nutrition.org/content/135/9/2075.full 
http://www.nejm.org/doi/full/10.1056/NEJM199807023390103#t=abstract

Article by Alex R. Nutritionist Advisor

Alex Rood is a Nutritionist Advisor with a Masters in Nutritional Sciences and a genuine love of all things food and nutrition. Alex enjoys providing advice on how to make healthy choices as part of a balanced lifestyle so that individuals can benefit from good nutrition. 

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