What is Cholesterol?
Cholesterol is a type of fat that is needed for digestion, cell structure, hormone production, and helps our body make vitamin D. Most of our cholesterol is made by the liver, and a small amount comes from food too (1).
Unchecked high cholesterol increases your risk of cardiovascular risk (CVD) (1). CVD risk is also associated with high blood pressure, a family history of CVD, age, gender, stress, alcohol, the impact of weight stigma, and psychosocial factors (also known as the social determinants of health, which are literally anything that relates to health) (2).
Cholesterol, and your relationship to food
Alongside stress management, medication (if you and your GP decide that’s right for you), nutrition can play a role in the management of cholesterol and heart health in general. But, before we get into that, a brief note on your relationship to food.
When you find out you’ve got high cholesterol, you understandably may have panicked, went into a spiral of “I can’t believe this, I have to fix this right now” and probably went straight onto Google and found a bunch of information there. Usually, this means you’ve been told to lose weight, never eat saturated fats again, eat less, move more… Which probably left you more stressed out than you were before. Which isn’t ideal especially since high cholesterol is linked to stress (2).
So, let’s start with these basics, which is just a tiny highlight reel into your relationship to food. This is to get the ball rolling, so you can understand some of the things you could work on.
Are you eating enough? I.e. 3 meals and 2-3 snacks per day? Are these (usually) balanced with carbs, protein, and fats?
Do you know how hunger feels? Can you tell when you’re very slightly hungry and do you eat before you’re overly hungry? Hint: your stomach growling is probably past the point you should be eating, which I know goes against what you’ve likely been told!
Do you skip meals, avoid certain food groups, think some foods are good and others are bad?
Are you saving calories or certain foods for night time or for weekends? Or hopping on a new diet or “healthy lifestyle kick” every other week?
These questions can really help you see if your relationship with food needs work. And for long-term sustainable changes to manage any condition, or for general health, this is step number 1. Which I know may be frustrating, because you just want to get going with all the nutrition tips.
But, think back to all the times you’ve attempted to kickstart a new lifestyle and you end up saying “stuff it” because it might be restrictive/not great for your mental health.
Nutrition to help cholesterol
There are 4 main food types which are linked to improving cholesterol, which I will outline below alongside some tips to add these foods into your diet.
1. Fortified foods
If you Google “heart health” or “cholesterol” you will come across a bunch of supplements and foods that are recommended but don’t have a lot of evidence to actually support the claims. But products with added plant sterols or stanols, such as yoghurt drinks, yoghurts, and spreads are likely to be effective in lowering cholesterol levels (3).
Products such as Flora Pro-active or Benecol are well-known brands that you might find easy to add to your daily intake. For most, replacing your usual food (e.g. butter) with a fortified butter is an easy swap. You can also opt for a yoghurt drink (e.g. Benecol) once per day which gives the recommended daily dose.
These products can be taken alongside statins (if prescribed by your GP) as they work as an additive effect (4).
2. Healthy fats
There are two main groups of unsaturated fats: monounsaturated and polyunsaturated. Unsaturated fats, especially polyunsaturated, are linked to improved heart health (5).
Monounsaturated fats are foods like nuts, seeds, vegetable oils, avocados: Try adding in a small handful of nuts every day and try cooking with rapeseed/canola/olive oil instead of butter or coconut oil.
Polyunsaturated fats (also known as omega 3s) are found in oily fish or some vegetable sources like walnuts, chia seeds, and flaxseed.
To meet your omega 3 needs, aim to eat one portion (around 120g) of oily fish per week (salmon, mackerel, anchovies, sardines, herring) as baked fish, fishcakes, frozen salmon or extra-omega 3 fish fingers, canned fish on toast. If you do eat fish, still add in nuts, seeds, vegetable oils daily.
If you don’t eat fish, aim to eat 1 tablespoon of chia or flaxseed every day, and if you can’t, consider taking an algae-based supplement.
3. Fibre-rich foods
Fibre is a part of carbohydrates that aren't easily digested and so reach the large intestine, and act as food for our gut bacteria. Eating at least 30g of fibre per day is associated with reduced CVD and a bunch of other health benefits (6). Carbohydrates made with the entire grain (wholegrains) are a higher fibre source than more simple carbohydrates like white rice.
You could try swapping white bread to 50/50 or wholemeal bread for toast and sandwiches. Eating wholegrain crackers or oatcakes with cheese or hummus for a snack. Swapping white pasta for whole grain pasta when you can. Remember, these swaps aren’t “rules'', you don’t need to do them all the time. You can still eat non-whole grain versions.
Fibre is also found in fruits and vegetables, nuts and seeds, beans and lentils. Try adding in a handful of snacks as a snack per day, adding in extra vegetables to lunch and dinner, or swapping out meat sometimes for beans or lentils.
4. Soya products
Foods like soya milk, tofu, edamame, meat alternatives, and miso are all common foods that are associated with improved heart health. Try swapping your usual dairy milk in cereal with soya milk, or adding in a portion of tofu to curries. You can also try using meat alternatives like soya mince in classic dishes like spaghetti Bolognese, plus adding some green lentils and whole-grain pasta will meet the other food groups too.
Foods that you might be mindful of
1. Saturated fats
Saturated fats usually come from animal foods, such as dairy foods like cream, cheese, ice cream, foods that use those ingredients like pastries, cakes, biscuits, and meat/meat products like burgers, meatballs, sausage, hot dogs, sausage rolls.
Saturated fats are well-established to be one of the top contributors in the diet to cholesterol levels (2), but this does not mean you can never eat foods containing it. Instead, you can focus on mindful eating. Which can be really difficult if you have a history of eating disorders or disordered eating, so 121 support would be super beneficial if you can.
If you are able to check-in with your saturated fat intake, you can take a look at your normal weekly diet and use the advice of what to eat more of, to see what you can swap
Berger, S. et al. (2015). Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clinic Nutr, 102(2): 276-94.
Alaa, A.M. et al. (2019) Cardiovascular disease risk prediction using automated machine learning: A prospective study of 423,604 UK Biobank participants. PLoS ONE, 14(5).
Trautwein, E.A. (2018) LDL-cholesterol lowering of plant sterols and stanols - which factors influence their efficacy? Nutrients,10(2).
Scholle, J.M. et al. (2009) The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: Systematic review and meta-analysis. Journal of American College of Nutrition, 28(5): 518-524.
Omega 3 fats - HEART UK (no date) Retrieved February 15th 2021. From https://www.heartuk.org.uk/low-cholesterol-foods/omega-3-fats
McRaw, M.P. (2017) Dietary fibre is beneficial for the prevention of cardiovascular disease: An umbrella review of meta-analyses. J Chriopr Med. 16(4): 289-299.