Lowering Cholesterol Levels
Written by Julia Monteiro (ANutr) on May 1st 2024
A few weeks ago a client asked for some advice around cholesterol levels and said:
“My doctor told me to fix my diet because my bad cholesterol is too high. But I don’t know where to start, and I have no idea what bad cholesterol is!”
Is this you?
Well, you’re not alone. Understanding cholesterol, the good and bad ones, the impact on our health and how to make effective dietary changes to lower cholesterol levels can be confusing.
But changing your diet doesn’t have to be difficult to positively change your cholesterol levels. I’ve summarised a few easy nutrition hacks that I share with my clients to help make sense of cholesterol and know how to keep levels in check.
What is cholesterol?
Cholesterol is a crucial fat that circulates in your bloodstream. It is synthesised naturally in the liver and is vital for maintaining overall health. For example, our body requires cholesterol to produce essential hormones (such as oestrogen, testosterone and adrenal hormones), vitamin D, and bile acids that facilitate the digestion and absorption of dietary fat.
Lipoproteins
Lipoproteins are the proteins that transport cholesterol throughout the body. There are two primary types of lipoproteins: high-density lipoproteins (HDL cholesterol) and low-density lipoproteins (LDL cholesterol or non-HDL cholesterol):
HDL cholesterol takes the cholesterol you don't need back to the liver for breakdown and excretion. It’s often called 'good' cholesterol since it removes excess cholesterol from the bloodstream.
Non-HDL cholesterol transports cholesterol from the liver to cells throughout the body. Excess non-HDL cholesterol can accumulate in the arteries, resulting in atherosclerotic plaques, leading to narrowing or blockages that increase the risk of heart attacks or strokes. This is why non-HDL cholesterol is often considered 'bad' cholesterol.
What are the recommended cholesterol levels?
A cholesterol test can measure total cholesterol, HDL cholesterol, and non-HDL cholesterol. Below are the NHS-recommended healthy levels for cholesterol:
NHS recommended cholesterol levels (1)
It is important to discuss with your healthcare practitioner what your healthy cholesterol range is, as this really depends on factors such as age, sex, risk of cardiovascular disease, and more.
What causes high cholesterol?
High cholesterol is mainly caused by eating foods that are high in saturated fat, not being active enough, smoking, having too much body fat (especially around your middle), genetics (it can run in families) and menopause (2).
3 Top Tips to Lower Cholesterol Level with Nutrition
Here are 3 evidence-based tips I share with my clients to help lower cholesterol levels through diet and are easy to implement in your daily eating routine.
1. Heart-Healthy Fats Swap
You don’t need to avoid fats altogether. As mentioned before, cholesterol and fat is crucial for our body. So choose healthy fats such as monounsaturated fats (MUFA) and polyunsaturated fats (PUFA) as they are known to help reduce cholesterol (3). Aim to reduce your intake of saturated fats by replacing with unsaturated fats:
Saturated fats are mainly found in fatty animal products (butter, full-fat dairy products, fatty meats, processed meat like salami and sausages), pastries, cakes biscuits and chocolate, lard ghee, coconut and palm fats.
Unsaturated fats are found in plant foods, oils and spreads such as rapeseed, peanut, olive, avocado and oil-rich fish.
Include oily fish - mackerel, salmon, pilchards, sardines, and trout contain long-chain omega-3 oils, which can help maintain a healthy heart as part of a balanced diet. One to two 140g serving/s of oil-rich fish per week is recommended.
2. Add NOFSS:
Nuts, Oats, Stanols/Sterols, and Soya
Nuts
All nuts (including peanuts) are naturally high in unsaturated fats (the good fats). Have a daily serving of a handful of nuts (almonds, walnuts, peanuts, cashews or my favourite pistachios) as a snack or part of a meal. Make sure these are unsweetened/unsalted, plain nuts.
Oats and Barley
Oats and barley contain beta-glucan fibre that can reduce cholesterol levels (4). Eating three servings of oat-rich and/or barley foods per day as part of a healthy diet and lifestyle can help you get the recommended 3g of beta-glucan. Here are some examples of 3 servings:
a bowl of porridge (using 30g oats)
bowl of oat-based breakfast cereal flakes
1 oat breakfast biscuit
1-2 tbsp oat bran
3 oatcakes
60g cooked barley (used in stews, casseroles or salads).
Sterols and Stanols fortified foods
Foods with added plant Stanols and Sterols have been proven to help lower cholesterol (5). You need to eat 1.5-3g of plant Stanols or Sterols, in combination with a healthy diet, to see a reduction in cholesterol.
Fortified foods like mini drinks, spreads, milk, and yoghurts from branded and supermarket own-label products are available. Benecol is a recommended brand. However, make sure to follow the product guidelines. These foods do not replace a healthy diet or cholesterol-lowering medication. Also, these foods are not recommended if you don't have high cholesterol.
* products will provide anything from 0.54 to 2g sterols or stanols in a single serve. Always check the label - ensure you do not exceed 3g stanols or sterols in one day.
Important Note: This product is only recommended for individuals who need to lower their cholesterol levels. The recommended intake is 1.5-3g per day and should not be exceeded. Please consume it as part of a balanced and healthy diet. This product is not suitable for pregnant or breastfeeding women, or children.
Soya
Soya foods are naturally lower in saturated fat which helps maintain normal cholesterol levels. Soya products are also great plant-based alternatives to dairy and meat that contains adequate levels of protein - an added bonus!*
Examples include:
100g firm silken tofu (this contains fortified calcium and …… something else I can’t remember)
100g soya mince, ready to use
80g edamame beans, or 35g (handful) roasted edamame beans
Large glass (250ml) calcium-fortified soya drink. Add to tea, coffee, cereal, baking or smoothies
150g plain soya alternative to yoghurt or Greek soya alternative to yogurt.
*Ensure you opt for calcium-fortified soya products.
3. Fibre
Eating fibre helps lower the risk of heart disease, and some high-fibre foods can help lower your cholesterol (6). Here is how you can increase fibre:
Aim for 5 portions of fruit and vegetables daily
Switch to wholegrain varieties of bread, cereals, pasta, rice, chapatti’s, rolls, flatbreads, etc.
Choose other high-fibre foods such as pulses (lentils, beans, chickpeas), oats, unsalted nuts and seeds.
What about food labels?
Finally, when food shopping you may want to keep an eye out on food labels and what they mean in the ‘saturated fats’ bit.
Look for ‘green’ or ‘amber’ labels for 'saturates'. Foods with ‘red’ labels are high in saturated fats and contain more than 5g of saturated fats per 100g. On the other hand, foods with 1.5g or less of saturated fats per 100g are considered low in saturated fats and have ‘green’ labels. Some foods like oil, nuts, and fish may have red labels for saturated fats, but this is acceptable as they contain healthy unsaturated fats.
That sums up a few top tips that can help reduce your cholesterol levels. If you have found these tips helpful for yourself or someone else, save this article and maybe share it with someone you know. I’d also love to hear your thoughts on the tips and if you have any more tips that might be helpful, please share!
If you would like more tailored advice to suit your needs, I would love to hear from you -
juliam.nutrition | juliamnutrition@gmail.com
References
NHS (2022) High Cholesterol Levels. Available at: https://www.nhs.uk/conditions/high-cholesterol/cholesterol-levels/
British Heart Foundation (2023) High cholesterol - symptoms, causes and levels. Available at: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol?gad_source=1&gclid=Cj0KCQjw0MexBhD3ARIsAEI3WHI9fD9j2bKMQBKBzfbp67oSHAz9CenNZOzsdt4UKtOkaF_E99Lzb1IaAljJEALw_wcB&gclsrc=aw.ds
Hooper, L., Martin, N., Jimoh, O. F., Kirk, C., Foster, E., & Abdelhamid, A. S. (2020). Reduction in saturated fat intake for cardiovascular disease. The Cochrane database of systematic reviews, 5(5), CD011737. https://doi.org/10.1002/14651858.CD011737.pub2
Ho, H. V., Sievenpiper, J. L., Zurbau, A., Blanco Mejia, S., Jovanovski, E., Au-Yeung, F., Jenkins, A. L., & Vuksan, V. (2016). A systematic review and meta-analysis of randomized controlled trials of the effect of barley β-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reductioni-iv. European journal of clinical nutrition, 70(11), 1239–1245. https://doi.org/10.1038/ejcn.2016.89
Schoeneck, M., & Iggman, D. (2021). The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases : NMCD, 31(5), 1325–1338. https://doi.org/10.1016/j.numecd.2020.12.032
Reynolds, A. N., Akerman, A., Kumar, S., Diep Pham, H. T., Coffey, S., & Mann, J. (2022). Dietary fibre in hypertension and cardiovascular disease management: systematic review and meta-analyses. BMC medicine, 20(1), 139. https://doi.org/10.1186/s12916-022-02328-x