Cholesterol is a type of fat. It’s found in all the cells in your body and forms part of their outer layer. Cholesterol is also an essential part of many important hormones, including oestrogen, progesterone and testosterone.
There are two main types of cholesterol.
- Low-density lipoprotein (LDL) cholesterol is also known as ‘bad’ cholesterol. High levels of LDL cholesterol can lead to atherosclerosis – a process in which fatty deposits build up on the walls of your arteries. This can reduce or block the blood flow in your arteries and lead to heart disease or a stroke.
- High-density lipoprotein (HDL) cholesterol is also known as ‘good’ cholesterol. It carries excess cholesterol out of your blood to your liver, where it’s processed and removed from your body.
Your risk of heart disease and stroke is particularly high if you have high levels of LDL cholesterol and low levels of HDL cholesterol.
There are two different sources of cholesterol – some comes from the food you eat, but most of it is made within your body.
Cholesterol that comes from the food you eat is called dietary cholesterol. Not many foods actually contain cholesterol. Examples of some that do are:
If you eat foods that are high in cholesterol, it won’t usually raise your blood cholesterol level much. Most cholesterol is made within your body, in your liver. Your liver can produce all of the cholesterol your body needs so dietary cholesterol isn’t an essential part of your diet. Your cholesterol levels are mainly influenced by the other fats that you eat.
The saturated fats you eat have the biggest impact on cholesterol levels in your body. Saturated fats cause levels of LDL cholesterol to rise in your blood, in proportion to HDL cholesterol. This can increase your risk of heart disease or stroke. It’s important to limit the amount of saturated fats you eat – most of us eat too many. Saturated fats are found in foods such as meat, cheese, butter, cream, cakes, biscuits and pastries.
Unsaturated fats actually reduce levels of LDL cholesterol in your blood. For this reason they can be a healthy choice, and it's a good idea to replace saturated fats in your diet with unsaturated fats. Unsaturated fats are found in vegetable oils, sunflower spreads, nuts and avocados.
Trans fats are artificially solidified vegetable oils. Similar to saturated fats, trans fats raise levels of LDL cholesterol, so try to save foods that contain these for an occasional treat. Trans fats are found in many types of processed foods, including biscuits, cakes and pastries.
Your GP can measure your cholesterol level with a blood test. The general target is to have a total cholesterol lower than 5 millimoles per litre (mmol/l) and a LDL cholesterol lower than 3mmol/l. However, when you get your result, your GP will also consider your personal circumstances, as it’s important to remember that as well as your cholesterol level, other factors such as smoking, your weight and high blood pressure increase your risk of heart disease and stroke.
If you have high cholesterol, you can help to lower it by changing your diet and maintaining a healthy weight. Your diet should be low in fat overall and particularly low in saturated fats. It's also important to eat plenty of fibre, especially soluble fibre, which is thought to lower cholesterol levels. Soluble fibre is found in fruit, beans and oats.
If you're overweight, try to lose excess weight as it may help to reduce your LDL cholesterol levels and increase your HDL levels. If you increase your physical activity, it may also help to raise your HDL levels.
If you already have heart disease or are at a high risk of getting it, your GP may prescribe cholesterol-lowering medicines, such as statins or fibrates.
There are some specially-designed food products (for example, some spreads and yoghurts) that are aimed at people who need to lower their cholesterol levels. These foods contain added ingredients, such as substances produced by plants called sterols and stanols, which may help lower your blood cholesterol levels. If you choose to use these products, always read the label and make sure that you don’t eat too much. If you don’t have high cholesterol levels, it’s best not to eat these products too often, particularly if you’re pregnant or breastfeeding. Also, don’t give them to children under the age of five.
There are also specific diets that can help to lower your cholesterol, such as the ultimate cholesterol lowering plan. This involves eating a diet that is low in saturated fat and high in plant-based foods that can lower cholesterol – examples include nuts (unsalted peanuts, cashews and almonds, for example) and soya protein. It’s important to ensure that you still eat a healthy balanced diet that incorporates all the major food groups – see the Healthy eating article for more information on a balanced diet. Ask your GP or a dietitian for more information on diets to help lower cholesterol.
- Cholesterol. British Dietetic Association. www.bda.uk.com, published October 2010
- Dietary cholesterol. Centers for Disease Control and Prevention. www.cdc.gov, published 23 February 2011
- Cholesterol – healthy eating tips. Better Health Channel. www.betterhealth.vic.gov.au, published May 2012
- Low HDL cholesterol (hypoalphalipoproteinemia). eMedicine. www.emedicine.medscape.com, published 29 December 2011
- High cholesterol. British Heart Foundation. www.bhf.org.uk, accessed 31 July 2012
- Fat and diabetes. American Diabetes Association. www.diabetes.org, accessed 31 July 2012
- Cholesterol. Food Standards Agency. www.eatwellscotland.org, accessed 31 July 2012
- Dietary guidelines for Americans. US Department of Agriculture US Department of Health and Human Services. www.cnpp.usda.gov, published December 2010
- Cholesterol test. Lab Tests Online UK. www.labtestsonline.org.uk, published 26 January 2009
- Joint British Societies. Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91(Suppl 5):v1–52. doi: 10.1136/hrt.2005.079988
- The UCLP: eating to our heart’s content, saving lives and money. Heart UK. www.heartuk.org.uk, published October 2011
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