Image credit: Getty/fcafotodigital
Cholesterol is a waxy, fat-like substance that our cells need for strengthening their membranes, making vital hormones and supporting digestion. But too much of the wrong sort can increase the risk of heart attack and stroke.
One in two UK adults has high cholesterol – and the risk rises with age. The good news is that small lifestyle tweaks can make a real difference.
“Cholesterol is packaged up into particles which travel around the bloodstream to the cells a bit like delivery vans carrying parcels,” explains leading blood fats expert, Dr Dermot Neely.
There are two types:
The “good” cholesterol that picks up excess cholesterol and delivers it back to the liver, where it is removed from the blood stream and recycled or disposed of.
The “bad” cholesterol that can accumulate in the arteries together with other types of cholesterol called VLDL (very low-density lipoprotein) and cholesterol remnants (CR).
All this together is what scientists call non-HDL cholesterol.
However, as Dr Neely explains, “Cholesterol only becomes bad if it stays around in the circulation for too long.”
When things are working properly a slippery coating surrounding the particles helps them glide easily through the arteries without sticking. It’s only if that becomes damaged that cholesterol can stick to the artery walls, increasing the risk of cardiovascular disease (CVD).
“A healthy diet and lifestyle can help the particles retain a nice, healthy, long-lasting, slippery coating that enables them to do their job and get recycled without sticking to the blood-vessel lining,” says Dr Neely.
“Diet can lower cholesterol by up to a fifth (20%), though results vary between individuals,” says dietitian Lynne Garton at the cholesterol charity Heart UK.
Low-dose statins – the drugs prescribed to lower cholesterol and cut heart disease risk – can lower LDL cholesterol by up to 30%. High-dose statins can lower it by more than 40% according to the British Heart Foundation.
But it doesn’t have to be either/or. “Diet and statins work hand in hand,” explains Garton. Every little helps to bring those numbers down.
A humble bowl of porridge or muesli makes a good start to your cholesterol-lowering day. “Oats and pearl barley are rich in beta-glucan, a soluble fibre than ‘binds’ cholesterol in the gut,” explains Garton.
You need around three grams a day, the equivalent of all these three things taken together:
“Rich in fibre and protein, and low in saturated fat, pulses such as beans, lentils, chickpeas and so on at least four times a week can help keep cholesterol in check,” Garton says.
“All count, including canned and baked beans. Add to stews, salads and dips or swap for meat in recipes.” A serving is half a large can or a small can.
According to a 2019 US analysis of 46 studies, soya protein lowered cholesterol by around 3-4%.i Find it in soya-derived foods including soya beans, tofu, tempeh, edamame beans, unsweetened soya drinks and soya mince.
These naturally occurring compounds found in nuts, seeds, vegetable and seed oils and fortified foods reduce the amount of cholesterol absorbed from the gut into the bloodstream.
A daily 1.5-2.4g can lower “bad” cholesterol] by 7-10%, while 2.5-3g daily can reduce it by 10-12.5%. Benefits can be seen within two to four weeks.
“Choose fortified foods such as yogurts, mini-shot drinks and fat spreads and have them with a main meal for best effect,” advises Garton. “Intakes beyond 3g show little extra benefit.”
Your daily quota equals:
A recent US study found that 57g of pecans a day lowered bad cholesterol and harmful blood fats in 12 weeks. And it’s not just pecans.
“All nuts – including peanuts, walnuts, almonds, hazelnuts – contain fibre, minerals and heart-healthy unsaturated fats,” says Garton. “A small handful (38g) of nuts daily, preferably unsalted and unsweetened, is enough. Contrary to popular opinion nut eaters have a healthier weight than non-nut eaters.”
Too much saturated fat, which is found in butter, cream, coconut oil and foods of animal origin, interferes with the action of receptors in the liver that usually remove bad cholesterol from the bloodstream.
“That means more bad cholesterol stays in the bloodstream where over time it can build up in the arteries,” explains Garton. When it comes lowering cholesterol, eat more of the unsaturated fats found in olive, rapeseed or sunflower oil, plus oily fish, nuts and avocados.
Physical activity lowers cholesterol and other harmful blood fats and boosts good HDL cholesterol. A recent review of 487 studies concluded that all types of aerobic exercise help. Swimming topped the list for lowering total cholesterol, LDL and other harmful blood fats.
Dancing boosted HDL the most. A recent small study meanwhile found that morning activity seems better for a healthy blood fat profile in older adults.
For over 65s, NHS England recommends:
While egg yolks are high in cholesterol, eating them in typical amounts has little impact on blood cholesterol for most people. “The priority is to limit saturated fat, include more unsaturated fats, and focus on a varied, heart-healthy diet,” says Garton.
The exception is people with familial hypercholesterolaemia, an inherited condition that causes very high cholesterol from birth, who may need tailored advice.
Aim for the following recommended targets:
Total cholesterol – Below 5.0 mmol/L
Non-HDL cholesterol – Below 4.0 mmol/L
LDL cholesterol – Below 3.0 mmol/L
HDL cholesterol – Men: above 1.0 mmol/L. Women: above 1.2 mmol/L (around 1.4 mmol/L gives the best protection, though very high levels don’t add extra benefit)
Aim to lower non-HDL cholesterol by more than 40% from your starting level.
HEART UK’s Cholesterol SMART programme offers personalised guidance with small, achievable steps.
Be the Boss of Your Cholesterol is the theme of October’s National Cholesterol Month.
Health insurance for people over 50 that provides a quicker route to diagnosis and planned medical treatment in a private facility.
Underwritten by Bupa Insurance Limited.
The simple exercise that could help you stay independent for longer.
Facial weakness, a sudden headache and dizziness can all be signs of a stroke, we've got the facts from an expert.
Knee pain is more common as we age: to help we've got the best advice from 3 leading experts with easy ways to make a difference.
Do you know the symptoms of a heart attack? Here’s what to look out for, and how to prevent one.
Front, back or side? Which sleeping position is best for you as you get older, and which ones you should avoid
