Over a quarter of the adults aged 50 and over in Ireland are living with high cholesterol.  With a cholesterol-lowering diet, it’s about adding cholesterol-lowering foods to your diet rather than removing cholesterol-increasing foods. Or, to put it another way, it’s about what you’re not eating. For example, increasing plant stanols/ sterols, tree nuts, plant fibres and soya protein could reduce your cholesterol by a whopping 33%. 

What is cholesterol?

Cholesterol is a type of fat in our blood which is produced by the liver. Everyone has cholesterol. Some of this cholesterol comes from the food that we eat. Our bodies need a certain amount of cholesterol for normal cell function, to help digestion and produce certain hormones. So not all cholesterol is bad.

Why is healthy cholesterol important?

If your total cholesterol is high, it can mean that you have a lot of LDL (bad) cholesterol in your blood. Too much LDL cholesterol can be harmful because it sticks to the inside walls of your arteries. This can lead to fatty material building up – in a process called atherosclerosis.  It makes it harder for blood to flow through, which can lead to a stroke or heart attack.

Having high cholesterol affects people of all ages. Making small changes now can make a big difference to your life now and in the future, especially if you already have heart disease or a family history of it.

 What are the types of cholesterol?

There are two main types of cholesterol: HDL and LDL

HDL (high-density lipoprotein) is known as ‘good’ cholesterol because it can help keep bad cholesterol in check by transporting it away from the arteries to the liver, where it is broken down and removed from the body. HDL cholesterol has been associated with a reduced risk of coronary heart disease.

LDL (Low density lipoproteins) is known as ‘bad’ cholesterol because it sticks to the artery walls forming a fatty plaque and causes narrowing of the arteries. This narrowing reduces the blood supply to your heart and brain. If the arteries that carry blood to your heart get damaged and blocked, it can lead to a heart attack. If this happens in the arteries that carry blood to your brain it can lead to a stroke.

Triglyceride is another type of fat in our blood and it is also affected by what we eat and drink (e.g. eating a lot of sugary processed foods can make you more likely to have a high triglyceride level). Triglycerides can be raised in diabetes, obesity, kidney disease, with an underactive thyroid and too much alcohol. Triglycerides can also contribute to the narrowing of the artery walls, increasing your risk of heart disease.

What causes high cholesterol?

Anyone can get high cholesterol, and it can be caused by many different things. Some things you can control like lifestyle habits, others you can’t. As long as you take care of the things you can control, you’ll help lower your risk.

 Things that can cause high cholesterol

  • An unhealthy diet
  • Not being active enough
  • Smoking can lead to the build-up of tar in your arteries which makes it easier for cholesterol to stick to your artery walls
  • Having a higher weight, holding weight around your middle area or having diabetes increase your risk of having high cholesterol.
  • A number of other things which you have no control over can cause high cholesterol. These include getting older, gender, ethnic background, familial hypercholesterolaemia (a genetic condition meaning that you are born with a high level of cholesterol in your blood and have no control over it), having an underactive thyroid or kidney or liver disease.

 

What steps can you take to keep your cholesterol at a healthy level?

A cardio-protective Mediterranean diet is the first line dietary approach for the  prevention of heart disease and stroke.  Research around the Mediterranean diet has shown that people following this approach have a reduced risk of developing conditions such as diabetes, high blood pressure and raised cholesterol, all of which are all risk factors for heart disease.

However, it must be remembered that the Mediterranean diet is not just a diet, it also includes a number of lifestyle factors such as, increased physical activity and smoking cessation, all of which have also been shown to be important to reduce the risk of heart disease. At its core, the Mediterranean diet is an entire dietary pattern rich in fruits and vegetables, wholegrains, olive oils, beans, nuts, seeds, and legumes in addition to oily fish. It also contains moderate amounts of low fat dairy while consumption of red and processed meats along with sweets and treats, is low. The Mediterranean diet is high in good fats (mostly monounsaturated fats that have been shown to lower cholesterol levels) which come from nuts, seeds and olive oils.

The Mediterranean diet can be used in conjunction with specific dietary and lifestyle advice related to individual risk factors which are present such as high cholesterol, diabetes, high blood pressure, weight.

To keep your overall cholesterol profile healthy, in addition to a healthy diet, the evidence recommends regular physical activity, alcohol intake limited to moderation, achieving and maintaining a healthy weight and if you smoke looking at supports to help you quit . Your dietitian or GP will be able to provide you with further tailored dietary advice dependent on your cholesterol profile.

Is it possible to increase your good cholesterol?

When it comes to specific lifestyle advice for increasing your good (HDL) cholesterol the evidence supports:

  • Increasing physical activity – Aim for 150 minutes/week of moderate intensity (brisk walking, slow cycling) or 75 minutes/week of vigorous intensity (jogging, running) physical activity
  • Reducing trans fats – found in processed foods such as cakes, biscuits, pastries and deep-fried foods. In addition to avoiding foods with ‘hydrogenated fat’ or ‘partially hydrogenated oils’ listed in their ingredients. Trans fats not only decrease your good cholesterol but increase your bad cholesterol.
  • Achieving and maintaining a healthy body weight

 

Signs and symptoms of high cholesterol

People with high cholesterol often have no noticeable symptoms. The only way to know if you have high cholesterol is to go to your doctor and have a blood test. Your blood is then checked for levels of good (HDL) cholesterol, bad (LDL) cholesterol and triglycerides, as well as getting a total cholesterol result. If you have been told you have a high cholesterol level, you have too much ‘bad’ cholesterol in your bloodstream which increases your risk of having a heart attack or stroke. But a high level of ‘good’ (HDL) cholesterol can help keep that ‘bad’ (LDL) cholesterol in check.

How often should I have my cholesterol checked?

The frequency you should have your cholesterol checked would vary for individuals, based on their family history, on whether they have a pre-existing illness or condition, on their age and other factors.  Assessments should be individualised.  However, we would recommend that for individuals with no pre-existing condition or family history of heart disease and stroke that individuals over 40 years should also have a cholesterol check and then every 4 to 5 years after that.  This is just a guide as other factors would need to be taken into consideration such as physical activity levels, alcohol intake, weight and whether the person smokes.

 Getting your cholesterol checked

Your cholesterol can be measured by your doctor, who knows your family history. If a family member has high cholesterol, heart disease or has had a stroke, it’s really important you ask your doctor to do a cholesterol test. You can ask for this on any visit.

If your results show a blood cholesterol level greater than five mmol/l, or if your doctor is concerned about your HDL (good) or LDL (bad) cholesterol, they will arrange for another test. You will need to fast for 12 hours to get more information on your HDL and LDL cholesterol.

As well as HDL and LDL levels, the more detailed test will show triglyceride levels – another type of fat. Anyone can have high levels of triglyceride, but it is more likely if you have a higher weight, a high intake of alcohol; eat a lot of sugary foods; or are not very active.

 The numbers to watch out for

If you have previously had a heart attack, bypass surgery or angioplasty, it’s also very important that you keep your LDL at or below 2.5 mmol/l. Your doctor will most likely suggest medication together with healthy eating and other lifestyle changes.

Cholesterol And Triglycerides Healthy levels:

  • Total cholesterol:  No more than 5 mmol/l

  • LDL cholesterol:  No more than 3 mmol/l

  • HDL cholesterol:  More than 1 mmol/l

  • Triglycerides:  No more than 2 mmol/l

For people with heart disease or diabetes

  • Total cholesterol:  No more than 4.5 mmol/l

  • LDL cholesterol:  No more than 1.8 mmol/l

If you need to change any aspects of your cholesterol or triglyceride levels, your doctor will advise you on changes in lifestyle and may recommend medication. If you are prescribed medication, please make sure you follow the instructions carefully.

Diet

If your diet is high in fat, fatty plaques are much more likely to build up in your arteries. This is because fatty foods contain cholesterol. There are 2 types of fat: saturated and unsaturated. Avoid foods containing saturated fats. They will increase the levels of “bad cholesterol”  in your blood.

Foods high in saturated fat include:

  • sausages and fatty cuts of meat

  • butter

  • lard

  • cream

  • hard cheese

  • cakes and biscuits

  • food that contains coconut or palm oil

It’s not healthy to completely cut out all types of fat from your diet. It’s important to replace saturated fats with unsaturated fats. They increase levels of “good cholesterol”  and reduce any blockage in your arteries. Foods that are high in unsaturated fat include:

  • oily fish – such as mackerel, salmon and tuna

  • avocados

  • nuts and seeds

  • sunflower, rapeseed and olive oil

A low-fat diet including lots of fibre and plenty of fruit and vegetables has also been shown to help lower cholesterol. Fruit and vegetables are full of vitamins, minerals and fibre. They help keep your body in good condition. Aim to eat five 80g portions of fruit and vegetables every day.

What Foods Help to Lower Cholesterol?

  • Oats: Eating porridge is a great way to help to lower cholesterol. If you don’t like porridge, try adding dry oats to muesli or other cereals or look for oatcakes.

  • Beans and lentils: These high fibre foods can help keep cholesterol levels healthy. Try to have beans or lentils 3-4 times a week. Try baked beans chickpeas or kidney beans in salads, soups made with lentils and chilli-con-carne.

  • Barley: Barley is rich in a type of fibre called beta-glucan which can also help to lower cholesterol. Try adding some traditional ‘soup-mix’ to soups, stews and casseroles.

  • Fish: Although fish will not help to lower cholesterol, it has lots of benefits for your heart. Omega-3 fats, which are found in oil-rich fish such as salmon, trout, mackerel, herring and sardines, are very beneficial for your heart. Did you know that eating fish once a week can cut your chances of a fatal heart attack by over 30%? Omega-3 fats are found in fresh, frozen, tinned, fried and smoked fish. Tuna is the one exception – fresh tuna has omega-3s but tinned tuna generally doesn’t. However, tinned salmon, tinned mackerel and tinned sardines are all good sources of omega-3s.

Eggs

Much of the confusion around eggs comes from the fact that egg yolks are rich in cholesterol. But we now know that cholesterol in eggs generally has little impact on our blood cholesterol levels – it’s too much saturated fat that’s the problem! Only familial Hypercholesterolaemia (FH) sufferers, who have an inherited condition that results in extremely high blood cholesterol levels, need to be careful about the number of eggs they eat.

So, if you have high cholesterol, you can still enjoy eating eggs, as part of a healthy diet that’s low in saturated fat. And with eggs back on the menu, you’ll be able to enjoy all of their nutritious benefits, too. Eggs are not only low in calories (fewer than 70 kcals in a medium-sized egg) and fairly low in saturated fat (at 1.3g) but they’re also a good source of protein and contain many essential vitamins and minerals, such as riboflavin, vitamin B12, vitamin D, selenium and iodine.

What else can I do? 

  • Exercise: Being physically active is one of the most important things you can do for your heart. Exercise helps to increase your HDL (good) cholesterol, lower blood pressure and strengthen your heart muscle.

Did you know that if you walk for 30 minutes per day that you reduce your chances of having heart disease by 30%? If you increase this to 1 hour a day, you reduce your chances of having heart disease by 50%. Any exercise is good as long as you are breathing a little faster- you should be able to talk but not sing! – and you should be getting warmer. Walking is excellent exercise but cycling, swimming, running, aerobics, skipping, anything will help. Check with your doctor before you start any new intense exercise and stop immediately if you get any chest pain.

  •  Stop Smoking: If you smoke, stop. There is lots of help available now to anyone who wants to quit. Talk to your GP for advice and help.

  • Get to a Healthy Weight: Being overweight can put more pressure on your heart. If you are overweight, then losing weight, even if it is just a few pounds can make a difference. If you struggle to get your weight under control ask to be referred to your local dietitian or check out our ‘find a dietitian’ list to find someone in your local area who can help.

My Top Cholesterol Tips

  1. Enjoy fatty foods occasionally… Just not too much

  2. Choose the right fats

  3. Reduce saturates (rather than cholesterol in food) 

  4. Enjoy more fish

  5. Add plant stanols to your daily diet

  6. Take 5-a-day

  7. Keep the carbs – but choose the high-fibre ones

  8. Eat more plant-based protein

  9. Enjoy sugary and salty foods in moderation

  10. Enjoy a tipple… but in moderation

This information is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. I encourage you to discuss any questions or concerns you may have with your provider

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