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Cholesterol is a fatty substance known as a lipid and is vital for the normal functioning of the body. It is mainly made by the liver but can also be found in some foods.
Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health. High cholesterol itself does not cause any symptoms, but it increases your risk of serious health conditions. For more information about diet and to download two diet sheets and guidance please click here:
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Cholesterol is carried in your blood by proteins, and when the two combine they are called lipoproteins. There are harmful and protective lipoproteins known as LDL and HDL, or 'bad' and 'good' cholesterol.
- Low-density lipoprotein (LDL): LDL carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as "bad cholesterol".
- High-density lipoprotein (HDL): HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed out of the body as a waste product. For this reason, it is referred to as "good cholesterol" and higher levels are better.
The amount of cholesterol in the blood (both LDL and HDL) can be measured with a blood test. The recommended cholesterol levels in the blood vary between those with a higher or lower risk of developing arterial disease.
Why should I lower my cholesterol?
Evidence strongly indicates that high cholesterol can increase the risk of:
This is because cholesterol can build up in the artery wall, restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing somewhere.
Your risk of coronary heart disease (when your heart's blood supply is blocked or disrupted) also rises as your blood's cholesterol level increases and this can cause pain in the front of the chest or arm (angina) during stress or physical activity.
What causes high cholesterol?
There are many factors that can increase your chance of having heart problems or stroke if you have high cholesterol, including the following:
- an unhealthy diet: some foods already contain cholesterol (known as dietary cholesterol) but it is the amount of saturated fat in your diet which is more important
- smoking: a chemical found in cigarettes called acrolein stops HDL transporting fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis)
- having diabetes or high blood pressure (hypertension)
- having a family history of stroke or heart disease
There is also an inherited condition known as familial hypercholesterolaemia (FH). This can cause high cholesterol even in someone who eats healthily.
Read more about the causes of high cholesterol.
When should I test my cholesterol levels?
Your GP may recommend that you have your blood cholesterol levels tested if you:
- have been diagnosed with coronary heart disease, stroke or mini-stroke (TIA) or peripheral arterial disease (PAD)
- have a family history of early cardiovascular disease
- have a close family member who has a cholesterol-related condition
- are overweight
- have high blood pressure, diabetes or a health condition that can increase cholesterol levels
Read more about how high cholesterol is tested.
How to Lower your Cholesterol
Eating a healthy diet and regular exercise can help lower the level of cholesterol in your blood.
Adopting healthy habits, such as eating a healthy balanced diet and exercising, will also help prevent your cholesterol levels from becoming high in the first place.
It's important to keep cholesterol in check because high cholesterol levels increase your risk of heart disease and stroke.
The first step in reducing cholesterol is to maintain a healthy, balanced diet. It is important to keep your diet low in fatty food. Try to swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help to prevent high cholesterol from returning.
Other lifestyle changes can also make a big difference. It will help to lower your cholesterol if you:
If these measures don't reduce your cholesterol and you continue to be at a high risk of heart disease, your GP may prescribe a cholesterol-lowering medication such as statins. Your GP will take into account the risk of any side effects from statins and the benefit of lowering your cholesterol must outweigh any risks.
Read more about how high cholesterol is treated.
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Foods containing cholesterol
Some foods contain cholesterol. This type of cholesterol is called dietary cholesterol. Foods such as kidneys, eggs and prawns are higher in dietary cholesterol than other foods.
The cholesterol found in food has much less of an effect on the level of cholesterol in your blood than the amount of saturated fat that you eat.
If your GP has advised you to change your diet to reduce your blood cholesterol, the most important thing to do is to cut down on saturated fat. It's also a good idea to increase your intake of fruit, vegetables and fibre.
Fats and cholesterol
There are two main types of fat – saturated and unsaturated. Eating foods that are high in saturated fat can raise cholesterol levels in the blood. Most people in the UK eat too much saturated fat.
Foods high in saturated fat include:
- meat pies
- sausages and fatty cuts of meat
- hard cheese
- cakes and biscuits
- foods containing coconut or palm oil
Eating foods that contain unsaturated fat instead of saturated fat can actually help reduce cholesterol levels.
Try to replace foods containing saturated fats with foods that are high in unsaturated fats, such as:
- oily fish (such as mackerel and salmon)
- nuts (such as almonds and cashews)
- seeds (such as sunflower and pumpkin)
- vegetable oils and spreads (such as sunflower, olive, corn, walnut and rapeseed oils)
Trans fats can also raise cholesterol levels. Trans fats can be found naturally at low levels in some foods, such as those from animals, including meat and dairy products.
Artificial trans fats can be found in hydrogenated fat, so some processed foods such as biscuits and cakes will contain trans fats.
As part of a healthy diet, try to cut down on foods containing trans fats or saturated fats and replace them with foods containing unsaturated fats.
You should also reduce the total amount of fat in your diet. Try microwaving, steaming, poaching, boiling or grilling instead of roasting or frying. Choose lean cuts of meat and go for low-fat varieties of dairy products and spreads, or eat just a small amount of full-fat varieties.
Fibre and cholesterol
There are two different types of fibre – soluble fibre and insoluble fibre. Most foods contain a mixture of both.
Soluble fibre can be digested by your body (insoluble fibre cannot), and it may help reduce the amount of cholesterol in your blood.
Good sources of soluble fibre include:
- fruit and vegetables
Try to include more of these foods in your diet. Aim to eat at least five portions of fruit and vegetables each day. Find out more about eating 5 A DAY.
There's evidence that foods containing certain added ingredients, such as plant sterols and stanols, can reduce levels of cholesterol in the blood.
Sterols and stanols can be found in specially developed products, such as some spreads and yoghurts.
These foods are aimed at people who need to lower their cholesterol levels. People who don't have high cholesterol shouldn't eat these products regularly, particularly children and pregnant or breastfeeding women.
If your doctor has told you that you have high cholesterol, you can lower it by changing your diet without having to eat special products.
If you do eat foods that are designed to lower cholesterol, read the label carefully to avoid eating too much.
An active lifestyle can also help lower cholesterol levels. Activities can range from walking and cycling to more vigorous exercise, such as running and dancing.
Doing 150 minutes of moderate-intensity aerobic activity every week can improve your cholesterol levels.
Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat.
One way to tell whether you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.
Find out more about getting more active and achieving your recommended activity levels.