Heart disease is the number one killer in Ireland, accounting for 36% of all deaths. As an indicator of heart disease risk, cholesterol screening is one of the most important tests your doctor can give you. But what should you do if you’ve tested high and want to avoid taking cholesterol-lowering medication for the rest of your life? Luckily, there’s quite a lot you can do!

What Is Cholesterol?

Cholesterol is a fat present in all of our body cells and circulating in our blood. It is necessary for many functions and 80% of the cholesterol in the body is actually made in the liver. However, an excessive amount increases your risk of heart attack and stroke. Cholesterol is carried through the body by molecules called lipoproteins, of which there are three main types:

Low density lipoprotein (LDL). Often called ‘bad’ cholesterol – it carries cholesterol from the liver to the body cells. LDL is the main ingredient of atherosclerotic plaque, and therefore it is commonly measured to determine your risk of heart attack. The liver increases it’s production of LDL cholesterol if the diet is rich in saturated fat, dietary cholesterol and trans fats. LDL level is also influenced by genetic factors.

High density lipoprotein (HDL). The ‘good’ cholesterol – it is thought to prevent arterial disease. It takes 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. Level is determined largely by genes, but can be influenced by diet and lifestyle.

Triglycerides. Triglycerides are also produced by the liver. People who are overweight, physically inactive, eat a diet high in fatty or sugary foods (including simple carbohydrates such as white bread and rice), smoke or drink a large amount of alcohol have an increased risk of a high triglyceride level.

Cholesterol & heart disease

High cholesterol usually has no symptoms, but is a risk factor for heart disease. Current thinking is that total cholesterol levels are a poor indicator of heart disease risk. More important is the ratio of LDL/ HDL. Current UK guidelines are:

TOTAL CHOLESTEROL: Less than 5 mmol/ litre

LDL CHOLESTEROL: Less than 3 mmol/ litre

HDL CHOLESTEROL: Greater than 1 mmol/ litre

These are guidelines, and there’s a lot more that goes into your risk of heart disease than any of these numbers.

Factors that contribute to high cholesterol

Dietary cholesterol comes from animal-based foods only and is not present in plant-based foods. However dietary cholesterol is poorly absorbed and up to 80% of the cholesterol in the body is actually manufactured in the liver. The body’s production of cholesterol is influenced by diet and lifestyle factors, as well as genetic predisposition. Factors that contribute to high cholesterol include:

• A diet rich in saturated fat (meat, full fat dairy products) and trans fats (labelled as hydrogenated and partially hydrogenated fat) raises LDL cholesterol
• Cholesterol binds to fibre to be removed from the body, so a low intake of soluble fibre (legumes, oats, fruit and vegetables) can contribute to high cholesterol by causing regular constipation.
• A high-carbohydrate diet, sedentary lifestyle, diabetes and smoking all reduce HDL levels and can increase triglycerides
• Being overweight increases your LDL and decreases your HDL
• Drinking more than the recommended daily amount and binge drinking
• Underlying problems like an underactive thyroid or digestive problems can also influence your ability to clear cholesterol from the body. These can be explored and supported through nutritional therapy.

Managing your cholesterol

Diet and lifestyle changes can be very effective in managing cholesterol levels. Allow 3-6 months before retesting:

• Adopt a heart-healthy Mediterranean diet: High in fruit, vegetables, legumes, nuts, seeds, wholegrains; Low red meat, olive oil as the primary fat source; Dairy, fish and poultry in low-moderate amounts (not daily); 0-4 eggs/ week; Moderate alcohol, mostly red wine.
• Avoid high glycaemic-load foods, like white bread, white rice and foods high in sugars. These foods get converted into triglycerides (a form of fat) in the body, and triglycerides have a seesaw relationship with HDL (good) cholesterol – as triglycerides goes up, HDL goes down.
• Mono and poly-unsaturated fats (olive oil, oily fish, nuts and seeds) can help lower LDL cholesterol. The plant sterols found in raw nuts and seeds can further help to lower LDL cholesterol. As a snack, eat a handful of mixed almonds, pumpkin and sunflower seeds.
• Limit your intake of saturated fat. Reduce meat and dairy products to 2-3 times a week. Enjoy oily fish (salmon, mackerel, sardines, fresh tuna), legumes (beans, lentils) and soy foods (tofu, tempeh) as alternative sources of protein. Eliminate trans fats (which are found in processed foods, commercial pastries and baked goods, chips, fried food etc.).
• Increase your intake of soluble-fibre from fruits, vegetables, oats and legumes, which can help remove cholesterol from the body. Ensure you drink 6-8 glasses water per day.
• Niacin (vitamin B3) lowers LDL and triglycerides and increases HDL levels. Increase your intake of foods high in niacin – tuna, salmon, mushrooms, mackerel, wholegrains, or take a supplement.
• Regular exercise can help raise your HDL levels – aim for 30 minutes of aerobic exercise 5-6 days a week and 10-30 minutes of strength training 3 days a week. If you are overweight, weight loss of 5-10% can improve cholesterol, as well as blood pressure and blood glucose.
• Probiotics can reduce high cholesterol up to 30%.
• You can raise your HDL cholesterol level by quitting smoking.
• People taking statins should supplement 100-200mg/ day of Coenzyme Q10, because production of this important nutrient is blocked by statins.
• Keep your alcohol intake at the recommended total – women: 14 units/week; men: 21.
• Promote bile synthesis and flow with dandelion tea, artichoke or milk thistle. Cholesterol is used to make bile, and is subsequently eliminated from the body. Increasing bile flow also supports fat digestion, and may aid weight loss.

Beyond cholesterol – other considerations for a healthy heart

• As well as improving LDL/HDL ratios, eat plenty of oily fish, nuts and seeds to reduce inflammation, and prevent the progression of atherosclerosis.
• Increase your intake of brightly-colored fruit and vegetables, which are loaded with heart-healthy antioxidants.
• Avoid hydrogenated or trans fats (baked or deep fried goods, crisps, chips etc.), which increase LDL, reduce HDL cholesterol, make the cell membranes rigid (which increases blood pressure) and are pro-inflammatory
• Eat magnesium rich foods (green leafy veg, pumpkin seeds, beans and legumes) to relax artery walls, which helps to prevent high blood pressure.
• Reduce salt consumption and make sure you drink about 2 litres water per day to prevent high blood pressure.
• Replace refined grains with whole grains, which are a better source of B vitamins, to lower homocysteine, and plant sterols to help reduce cholesterol).