Cholesterol, a fat chemical (lipid), is a waxy substance found naturally in the blood.
Many different cells make cholesterol but cells in the liver make about a quarter of the total. It is an essential part of every cell in our body and has many important functions. For example, it is used as a building block to make hormones such cortisol, testosterone and progesterone. It is used to make bile acids, which help to digest fat. And it is a component of vitamin D. We all need some cholesterol in our blood to stay healthy, but too much can lead to serious health problems in the future, including heart attacks and strokes.
How does cholesterol work?
In a similar way that we use roads to get from one place to another, cholesterol uses the blood as its transport system. It can’t travel on its own though, so it attaches itself to ‘vehicles’ made up of proteins. These combos of cholesterol and proteins are called lipoproteins (lipo comes from the Greek word for fat).
In this way, cholesterol is transported around the body and deposited at various points where it’s needed.
There are two main groups of lipoproteins:
1. Non-high density lipoproteins (non-HDL) – or ‘bad’ cholesterol mainly LDL.
2. High-density lipoproteins (HDL) – often called ‘good’ cholesterol.
LDL or ‘bad’ cholesterol
LDL lipoproteins transport cholesterol from the liver to destinations that need it, such as cells and tissues. However, if the smooth surface of the transport system – the arteries – are damaged, LDL can lose some of its cholesterol along the way. When LDL levels are raised, there’s a greater chance that cholesterol will be deposited in the arteries. Over time, this cholesterol can start to build up in the arteries and combine with other substances to form a fatty plaque known as an atheroma in the artery walls. This causes the arteries to narrow and harden – a process known as atherosclerosis. This means blood flows less easily around the body and our heart has to work harder to pump it around. That’s why LDL is called ‘bad’ cholesterol.
HDL or ‘good’ cholesterol
HDL lipoproteins carry excess cholesterol away from the arteries and takes it to the liver. Here, cholesterol is broken down and then eliminated from the body. Higher HDL levels mean there’s more traffic available to pick up cholesterol from cells and take it back to base, removing it from the transport system before it has a chance to build up in the arteries. As a result, high HDL levels are good news for overall blood cholesterol, and coronary heart disease risk and the reason why HDL is called ‘good’ cholesterol.
Checking your cholesterol levels
High cholesterol doesn’t normally have any signs or symptoms, so to find out what your cholesterol level is usually involves a simple blood test.
Total cholesterol
This is sometimes written as ‘serum cholesterol’ or ‘TC’ and refers to the overall level of cholesterol, but it’s not just the total cholesterol that’s important.
Non-HDL cholesterol
Your non-HDL cholesterol is your total cholesterol minus your HDL cholesterol. It’s the LDL and all the other ‘bad’ cholesterol added together, and ideally should be as low as possible.
TC:HDL ratio
You might be given a ratio of HDL compared to the total cholesterol, written as TC:HDL ratio. You can work it out from your HDL and total cholesterol numbers.
This should be as low as possible. Above 6 is considered high.
HDL cholesterol
Your HDL cholesterol (high density lipoprotein, or ‘good’ cholesterol) helps clear the cholesterol out of your arteries, while your LDL cholesterol (low density lipoprotein, or ‘bad’ cholesterol) can clog them up. So your HDL cholesterol should be above 1mmol/L in men and above 1.2mmol/L in women, ideally around 1.4mmol/L. Currently specialists believe that levels above this may not provide additional protection.
What are the causes of high cholesterol?
A number of things can lead to high cholesterol:
• Eating too much saturated fat.
• Smoking.
• Drinking more alcohol than is recommended.
• Not being physically active.
Your overall health and other health problems can have an effect, for example:
• Being overweight.
• An underactive thyroid gland.
• Type 2 diabetes.
• Liver disease.
• Kidney disease.
• Certain medications.
High cholesterol can be genetic, meaning you inherit it from your parents:
• Familial hypercholesterolaemia (FH for short) can cause very high cholesterol, even if you have a healthy lifestyle.
• There are other genetic causes of high cholesterol too.
Who can be affected?
Anyone can have high cholesterol – even if you are young, slim, eat well and exercise. It’s true that as we move through the decades towards retirement age, the more likely we are to have raised total cholesterol. However, after the age of 65 years, the percentage of people with high total cholesterol starts to drop.
Added to this, the latest figures show that more than one in six young adults aged between 16 and 24 years have high total cholesterol. This increases to more than a third – 35% – of 25 to 34 year olds.
Interpreting your results
Your cholesterol results should be interpreted in relation to any other risk factors you may have
and any other health conditions (such as diabetes). Because of other risk factors or medical conditions, your Health Care Professional may recommend making changes in your diet or lifestyle to lower your cholesterol level.
The good news is that even the small steps you take to lower your cholesterol all add up. You’ll also lower your risk of other illnesses or stop them from getting worse.
Lowering your cholesterol can typically be done through a combination of regular exercise and healthy habits in your lifestyle, however some people will need medication to manage their cholesterol.
Healthy Lifestyle Choices
For many people, a few simple lifestyle changes are often the first – and only – line of treatment needed to lower cholesterol. Making some simple changes to your lifestyle can keep your cholesterol levels in check and your heart healthier.
Better still, many of these lifestyle changes can have many other benefits that help to keep our heart – and other parts of our body – healthy, too, including lowering high blood pressure and helping us lose weight.
Exercise
Being active is a major part of looking after your cholesterol levels, keeping your heart healthy and preventing heart disease.
Regular physical activity also helps to control weight and ease stress.
Ideally, you should aim for at least 30 minutes of moderate-intensity physical activity on at least five days of the week but even 10 minutes is better than nothing.
You should aim to do at least a couple of sessions of muscle-strengthening activities per week as week as well.
Regular exercise can:
• Raise your HDL cholesterol levels – the good cholesterol which removes fat from your arteries.
• Lower your LDL cholesterol – the kind that builds up in your arteries.
• Help you to lose weight or stay a healthy weight.
• Lower your blood pressure.
• Lower the risk of diabetes and help control diabetes.
Changes to your diet
To an extent your blood cholesterol level can vary depending on your diet. However, different people who eat the same diet can have different blood cholesterol levels.
In general, however, if you eat less fatty food in your diet your cholesterol level is likely to go down. A combination of diet and lifestyle changes are key to reducing cholesterol.
For some, dietary changes alone can have a big impact.
The degree to which cholesterol is lowered depends on a number of factors such as the quality of the baseline diet, the number and magnitude of dietary changes made and how long these changes are maintained. For some people this might be enough, but for others extra help from medication might be needed. This can be discussed with your Health Care Professional.
To see significant changes in cholesterol levels, it's important to take a whole-diet approach. It's about eating more of certain foods and less of others.
It has been shown that gradually changing what you eat with small swaps and adding in foods which actively lower cholesterol, rather than reforming it overnight, can transform your diet and make it more likely that you'll stick to it long-term.
To achieve a balanced diet it is recommend that you:
- Cut down on foods high in saturated fat and replace these with foods rich in healthy unsaturated fats, including vegetable and nut oils (excluding palm and coconut oils), spreads made from vegetable oils, oily fish, avocado, nuts and seeds.
- Eat plenty of plant-based foods such as fruit, vegetables, pulses, wholegrains, nuts and seeds.
- Include two portions of fish a week, one of which should be oily (mackerel, sardines, salmon).
Once you've created your balanced base diet, it is recommended that you add foods from each of four key groups with additional cholesterol-lowering effects.
Plant stanols and sterols
Sterols and stanols are plant compounds which have a similar size and shape to cholesterol. They work by blocking the absorption of cholesterol in the gut, so reducing the amount of cholesterol getting into the bloodstream.
Tiny amounts of sterols and stanols can be found in a range of plant-based foods but eating fortified foods like milk, yoghurt drinks and spreads can help you to eat enough.
Eating 1.5 to 2.4 g of plant sterol or stanols daily can reduce blood cholesterol by between 7 and 10% over the course of two to three weeks. It's important to note that they need to be eaten on a regular basis and as part of a meal because they only work by mixing with the food you have eaten.
Oats and barley
Whole grains are key to a balanced diet plus they are particularly effective in the fight against high cholesterol because they contain a particular type of fibre called beta-glucan which has been shown to lower cholesterol.
Beta glucan works by forming a gel which binds to cholesterol and bile (which is made from cholesterol) in the intestines. This helps limit the amount of cholesterol that is absorbed from the gut into your blood. Your liver has to take more cholesterol out of your blood to make more bile, which also lowers your blood cholesterol.
Eating 3 g of beta-glucan a day over three to twelve weeks can reduce LDL-cholesterol by around 7%.
To achieve this:
- Eat a bowl of porridge oats.
- Opt for bread made with some oat flour.
- Sprinkle oat bran in soup.
- Include pearl barley in casseroles.
- Choose oat cakes as a snack.
Nuts
It has been shown that eating just a handful of nuts a day (approximately 28-30 g) can reduce LDL cholesterol by around 7%. And that's not the only benefit of eating nuts.
As well as a cholesterol-lowering effect, eating this amount of nuts a day has been associated with a significant reduction in heart disease and improved vascular function as they are rich in unsaturated fat, fibre, plant proteins, vitamin E, natural plant sterols, and minerals like magnesium and potassium.
All nuts count but choose unsalted nuts and opt for nuts with their skins still intact and unroasted varieties as these contain additional nutrients.
Soya foods
Eating 25 g of soya protein every day also helps to lower cholesterol. Soya protein can be found in products like tofu, soya mince, edamame beans, soya nuts and soya alternatives to dairy.
Choosing soya foods instead of foods high in saturated fats can help regulate cholesterol levels.
If you would like to discuss this or any other health concern you may have,
please contact Claudia Carrillo your Health Care Professional at BioMed Natural Health.
