Nutrition Expert Editorial Team February 11, 2016

With the topic of cholesterol never far from the headlines, Linda Main, Dietetic Adviser to Heart UK, answers your questions.

What is cholesterol?

Cholesterol is an essential fat (lipid) found in our blood stream. Most of our cholesterol is made by our liver, but it is also found in small amounts in foods like full-fat dairy products, egg yolks, shellfish, liver and kidney.

There are two types of cholesterol: ‘good’ HDL (high density lipoprotein) cholesterol, and ‘bad’ LDL (low density lipoprotein) cholesterol.

Why do we need cholesterol?

Cholesterol is essential to help your body to make hormones, build cells, make vitamin D and digest food.

What’s the difference between ‘good’ and ‘bad’ cholesterol?

Cholesterol travels around your blood wrapped up in protein particles called ‘lipoproteins’. Too much ‘bad’ cholesterol can build up in your arteries and restrict the blood flow to your heart, increasing your risk of heart disease.

‘Good’ cholesterol, meanwhile, carries the excess bad cholesterol from your cells and arteries back to your liver for removal. Your balance of ‘good’ and ‘bad’ cholesterol is one factor influencing your risk of heart disease.

Is it good to have low blood cholesterol?

Yes – but it’s slightly more complicated than that. There are two types of unhealthy blood fat profiles, both of which have been linked to a higher risk of heart disease.

The first type occurs if you have a high level of both ‘bad’ LDL cholesterol and total cholesterol. The second type occurs when you have a high level of ‘bad’ LDL cholesterol, combined with lower-than-normal levels of ‘good’ HDL cholesterol and higher-than-normal levels of other blood fats called triglycerides.

If you have the second type of low blood cholesterol, you will probably have an ‘apple shape’ body type, where your fat sits around your middle. ‘Apples’ have a higher risk of type 2 diabetes and pre-diabetes, which are both linked to heart disease.

What should I eat to keep my cholesterol level healthy?

Try to eat five portions of fruit and vegetables, and one of pulses such as lentils, chickpeas, kidney beans and black beans per day. Have wholegrains with as many meals as possible. Try to eat fish twice a week, too, but make sure one of these is an oily fish, like salmon, mackerel, sardines, herrings or tuna.

Swap foods high in saturated fat, such as butter, full-fat milk, cream and cheese, coconut and palm oil, for modest amounts of high unsaturated fat foods, like olive, rapeseed, sunflower and other plant oils and spreads, almond milk and cottage or other lower fat cheeses.

Are high-saturate foods like cream, butter and cheese bad for cholesterol?

Foods that are high in saturated fats raise your cholesterol levels, so they are still a risk factor for heart disease. However, the picture is more complicated than that.

There are many kinds of saturated fats (found mostly in animal products), but they don’t all have the same impact on cholesterol. Most foods contain a mixture of both saturated and unsaturated fats (found mainly in plant foods), so how healthy they are will depend on which type is dominant.

Even more complicated, the amount of saturated fat in cheese does not raise cholesterol levels in the same way it does in butter, for example. It is thought that this is because of other positive nutrients, such as proteins, or calcium in cheese, though scientists are still investigating why.

Which foods help to lower cholesterol?

The following four cholesterol-busters have proven benefits so put one or more on your menu:

• Nuts (unsweetened and unsalted)

• Soya foods (soya milk, tofu, tempeh (a kind of soya cake), natto (a fermented soya product), and miso).

• Plant sterols and plant stanols (found in plant foods), help lower ‘bad’ LDL cholesterol levels. Find them in wholegrains, plant oils, vegetables, nuts, fortified foods and supplements.

• Oats, oat bran and barley are rich in a soluble fibre and beta glucans that help soak up cholesterol and carry it out of the body.

How does exercise help lower cholesterol?

Exercising regularly will help you shed fat from your middle, which can help boost good cholesterol levels and lower levels of bad cholesterol and triglycerides.

Try brisk walking, running, dance, swimming, or anything that makes you slightly breathless and sweaty and aim for at least 30 minutes most days of the week. No time to exercise? Invest in a pedometer or activity monitoring device and aim for 10,000 steps a day.

Know your numbers

The following are healthy for most people:

Total cholesterol: 5 mmol/L or less

Non HDL-cholesterol: 4 mmol/L or less

LDL-cholesterol: 3 mmol/L or less

Fasting triglyceride: 2mmol/L or less

Non-fasting triglyceride: 4 mmol/L or less

*Mmol/L=millimoles per litre (source: Heart UK)

If you are at a higher risk of heart disease or already have heart disease you may need to further reduce cholesterol. Check with your GP.

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