Cholesterol

This fact sheet explains what cholesterol is and how eating better can help to lower your cholesterol if it is too high.

What is cholesterol?

Cholesterol is a fatty substance found in your blood. It is produced naturally in your liver and is also in some of the foods you eat. It is used to make certain hormones and vitamin D, as well as bile acids, which help to digest and absorb fat from the food you eat.

Your blood carries cholesterol around your body. There are two main types:

• High-density lipoproteins (HDL cholesterol) take cholesterol you don’t need back to your liver to be broken down and passed out of your body. It is often known as ‘good’ cholesterol, as it removes cholesterol from your blood. Cholesterol is measured in millimoles per litre or mmol/l for short. HDL cholesterol should be higher than 1mmol/l for men and higher than 1.2mmol/l for women.
• Non-high-density lipoproteins (non-HDL cholesterol) take cholesterol from your liver to the cells around your body. It is often known as ‘bad’ cholesterol because when there is too much, it can build up inside the walls of your blood vessels (arteries). This can cause them to become narrowed or blocked, increasing your risk of having a heart attack or stroke. Non-HDL cholesterol should be less than 4mmol/l.
• Total cholesterol is the total amount of cholesterol in your blood. For healthy people, it should be less than 5mmol/l.

Recommended total and non-HDL cholesterol levels are lower than those for people who have coronary heart disease.

What causes high cholesterol?

High cholesterol is mainly caused by:

• Eating too many foods high in saturated fat (a type of fat that gives your body energy, mainly found in animal products)
• Not being active enough
• Smoking
• Having too much body fat, especially around your middle

It can also run in families. Changing what you eat, being more active and stopping smoking can help get your cholesterol back to a healthy level.

Lowering your cholesterol with diet

A few small changes to your diet can make a big difference to your cholesterol level.

1. Choose healthier fats

To help lower your cholesterol, you don’t need to avoid fats altogether. You should cut down on foods high in saturated fat and replace them with foods high in unsaturated fat like vegetable oils (olive, rapeseed and sunflower oil), nuts, seeds, avocado and oily fish (see Table 1). Reducing your overall fat intake can reduce calorie intake and be beneficial if you are managing your weight.

Swap saturated fats for unsaturated fats

Try these smart swaps to help cut back on saturated fat (Table 2):

2. Look at food labels

Compare labels and choose foods that are labelled green or amber for ‘saturates’. Foods are high (red) in saturated fat if they contain more than 5g of saturates per 100g. Foods containing 1.5g or less per 100g are low (green) in saturated fat. Some healthy foods that are high in fat like oily fish, nuts and oils may be red for saturated fat. This is okay as they contain more of the healthy unsaturated fat.

3. Eat more high-fibre foods

Eating plenty of fibre helps lower your risk of heart disease and some high-fibre foods can help lower your cholesterol. To make sure you get enough fibre:

• Aim for at least five portions of fruit and vegetables a day
• Switch to wholegrain varieties of bread, cereals, pasta and rice
• Choose other high-fibre foods such as pulses (lentils, beans, chickpeas), oats, unsalted nuts and seeds

What about plant stanols or sterols products?

If you have high cholesterol, using foods with added plant stanols and sterols (natural substances found in plants, which stop some cholesterol from getting into your blood ) has been shown to help to lower cholesterol levels. However, there is insufficient long-term evidence to show that they reduce the risk of heart attacks or strokes. Therefore, UK guidelines do not recommend them for preventing cardiovascular disease and a healthy, balanced diet is still the best advice. So, if you don’t have high cholesterol, these products are not recommended for you.

If you decide to use these products, you need to eat 1.5 - 3g of plant stanols or sterols, in combination with a healthy diet, to see a reduction in cholesterol. You can get this amount from fortified foods such as mini drinks, spreads, milk and yoghurts from both branded and supermarket-own label products. Follow guidelines on the packet to get the right amount. However, they are not a substitute for a healthy diet or a replacement for cholesterol-lowering medication.

Dietary cholesterol – don’t get confused!

Some foods naturally contain dietary cholesterol, but they don’t make a big difference to the cholesterol in your blood. These are foods like eggs, some shellfish such as prawns and crab and offal such as liver, liver pâté and kidney. They are low in saturated fat so are fine to eat as part of a healthy diet. Only cut down on these foods if you have been advised to by your doctor or a dietitian. To lower cholesterol, it’s more important to cut down on the amount of saturated fat you eat.

Top tips

• Cholesterol is a fatty substance found in your blood. There are two main types: HDL cholesterol or ‘good’ cholesterol and non-HDL cholesterol or ‘bad’ cholesterol.
• Too much non-HDL cholesterol can cause your arteries to become blocked. This increases your risk of having a heart attack or stroke.
• A healthy balanced diet, being physically active, stopping smoking and maintaining a healthy weight can all help to lower your cholesterol.
• Replace foods containing saturated fats with those that contain polyunsaturated and monounsaturated fats. You can do this by choosing healthy fats such as olive or rapeseed oil, nuts, seeds, fish and avocado.
• Increase your fibre by choosing vegetables, fruits, wholegrains, pulses, nuts and seeds every day.