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Cholesterol


Cholesterol is a type of fat that’s made in your liver. It’s in all of the cells in your body and forms part of their outer membrane.

Your body needs cholesterol to make hormones and vitamin D. It’s also needed to make bile acids, which help your gut to digest the food you eat. Although your body needs cholesterol to work properly, too much of some types of cholesterol can be harmful.

Types of cholesterol

Cholesterol travels around your bloodstream attached to proteins, in a combination called a lipoprotein. There are two main types of cholesterol and protein combination.

  • Low-density lipoprotein (LDL) cholesterol. This is sometimes called ‘bad’ cholesterol, because having high levels of it can make you more likely to develop heart disease or have a stroke. This is because large amounts of LDL cholesterol in your blood can cause fatty deposits to build up in your blood vessels (atherosclerosis). This can lead to heart disease and stroke. 
  • High-density lipoprotein (HDL) cholesterol. This is sometimes called ‘good’ cholesterol because it helps to remove LDL cholesterol. If you have too much LDL cholesterol in your body, HDL cholesterol takes it to your liver, where it can then be removed from your body.

Saturated fats and trans fats

Most of the cholesterol in your body is made by your liver from saturated fat. Saturated fat comes from certain foods that you eat, for example, cream, butter, cheese, palm oil and fatty meat.

Eating a lot of saturated fat is likely to increase the amount of LDL (bad) cholesterol in your blood. This is then thought to increase your chances of developing heart disease or having a stroke.

Trans fats are another type of fat that can also increase the amount of LDL cholesterol in your blood. Trans fats are found in lots of processed foods, such as biscuits, cakes and pastry.

Cholesterol from food

Some foods naturally contain small amounts of cholesterol, such as eggs, shellfish and offal (liver, kidney, etc.). But eating these foods has much less effect on your cholesterol levels than eating foods that contain saturated and trans fats.

If you want to reduce your cholesterol levels, it’s more effective to eat less saturated and trans fat than to eat fewer foods that contain cholesterol. It’s fine to keep eating foods that contain cholesterol, unless your doctor or dietitian has told you otherwise.

Measuring cholesterol

Your GP can measure your cholesterol levels with a blood test called a lipid profile. The test measures the different types of cholesterol as well as the total amount of cholesterol in your blood. Occasionally, you may be asked not to eat anything for about 12 hours before having the blood test. However, you won’t normally need to fast.

Your GP will discuss the results of the test with you and may suggest some ways that you can reduce your cholesterol levels. Your lifestyle and factors such as your blood pressure and weight also affect how likely you are to develop heart disease or have a stroke in the future.

Healthy cholesterol levels

It’s important for everyone to aim for healthy blood cholesterol levels. This means a low level of LDL cholesterol, a high level of HDL cholesterol, and a low total cholesterol. Your GP or practice nurse can tell you the exact levels you should be aiming for. There are a number of ways to keep your cholesterol levels healthy.

Your diet

Eating less saturated fat and trans fat can help to keep your cholesterol levels healthy. The following tips may help.

  • Go for lower-fat options when you can. For example, choose lean meat or alternatives to meat, such as beans, tofu or lentils, rather than fatty meat. If you do have fatty meat, cut off any fat you can see. Choosing low-fat dairy products such as skimmed milk and reduced-fat cheese can also help you to cut down on fat.
  • Eat only small amounts of foods that are high in saturated fats, such as processed meats and full-fat cheese.
  • Choose low-fat ways of cooking, such as grilling, steaming or baking foods.
  • When you do cook with fat, use an unsaturated fat, such as olive oil, sunflower oil or rapeseed oil.
  • Eat only small amounts of foods that contain trans fats, such as cakes, biscuits and pastries.

The current guidelines in the UK are that men should have no more than 30g of saturated fat and women no more than 20g of saturated fat a day. It’s recommended to replace saturated fats with unsaturated fats where you can.

A 30g portion of cheddar cheese has about 7g saturated fat in it, a beef burger and a croissant both have about 11g. So, it can be easy to reach your daily limits in just one or two meals.

Reading the labels on food can help you to work out whether or not the food is high in saturated fat. Foods are said to be high in saturated fat if they have more than 5g of saturated fat in each 100g of food. Foods that have 1.5g or less of saturated fat in each 100g are low in saturated fat.

Eating more fibre and more complex carbohydrates can also help to lower LDL cholesterol. This means eating more foods like fruit and vegetables, oats, beans and pulses (for example, lentils and soya).

Lifestyle

If you're overweight, losing excess weight can help to reduce your LDL cholesterol level. Being physically active can also help to keep your cholesterol levels healthy. Aim to do 150 minutes (two and a half hours) of moderate activity spread across each week. Moderate activity is anything which causes you to breathe faster and feel warmer, and which increases your heart rate.

If you already have heart disease or have had a stroke, or your GP tells you you’ve got a high risk of developing these conditions, they may prescribe cholesterol-lowering medicines, such as a statin.

Cholesterol-lowering products

Plant stanols and sterols are substances found naturally in foods like fruits, vegetables, nuts and wholegrains. They can also be added artificially to some food and drink, such as mini-drinks, yoghurts and spreads. It’s possible that these substances may help to reduce your LDL cholesterol and increase your HDL cholesterol levels. However, if you’re at risk of heart disease and stroke, you shouldn’t use these products as a way to prevent these conditions.


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Related information

    • Cardiology and vascular disease. Oxford handbook of general practice. Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
    • Overview of lipid metabolism. The MSD Manuals. www.msdmanuals.com, published August 2015
    • Cholesterol. The Association of UK Dietitians. www.bda.uk.com, published October 2014
    • Lipid modification CVD prevention. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2015
    • Hypercholesterolaemia. BMJ Best Practice. bestpractice.bmj.com, last updated January 2016
    • Cardiovascular disease prevention. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Fat facts. The Association of UK Dietitians. www.bda.uk.com, published January 2015
    • JBS3 Board. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 2014; 100:ii1–ii67. doi:10.1136/heartjnl-2014-305693 
    • Healthy diet. World Health Organization. www.who.int, published January 2015
    • Physical activity: brief advice for adults in primary care. National Institute for Health and Care Excellence (NICE), 2013. www.nice.org.uk
    • CVD risk assessment. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2014
    • Cardiovascular disease: risk assessment and reduction, including lipid modification. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
  • Reviewed by Pippa Coulter, Bupa Health Content Team, April 2016.



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