What is cholesterol?
Cholesterol is a waxy substance like fat that travels around your body via your blood.
It is packaged in lipoproteins, of which there are 3 types:
- High Density Lipoprotein (HDL) (“good” cholesterol) — transports cholesterol to your liver where it is disposed of.
- Low Density Lipoprotein (LDL) (considered “bad” cholesterol) — carries cholesterol to your arteries and can contribute to atherosclerosis (hardening of the arteries).
- Very Low Density Lipoprotein (VLDL) — transports triglycerides (another type of fat) around your body. The higher the triglycerides, the higher the risk of atherosclerosis.
What are optimal cholesterol levels?
- LDL – below 3.00
- HDL – above 1.2 (women)
- Triglycerides – below 2.3
- Total cholesterol – below 5.0
- Non-HDL cholesterol – below 4.0
What about genetic predispositions to high cholesterol?
Familial hypercholesterolemia is an inherited condition leading to extremely high LDL cholesterol from birth. It affects around 1 in 250 people and can’t be treated by diet and lifestyle alone.
Polygenic hypercholesterolemia is due to multiple small genetic mutations which collectively raise LDL, but by less of an extent than familial hypercholesterolemia. Cholesterol may not be raised from birth but can be affected by diet, increasing age, and menopause. Around 1 in 20 to 1 in 100 people may be affected. Depending on their overall cardiovascular risk score, people with polygenic hypercholesterolemia may be able to reduce their LDL cholesterol with diet and lifestyle changes alone.
How do statins work?
Statins work by inhibiting the liver enzyme responsible for producing cholesterol, specifically targeting LDL cholesterol. The liver is then also able to draw more LDL cholesterol out of the bloodstream. Statins additionally have an anti-inflammatory effect, reducing plaque build-up in arterial walls. For some people, statins may be the only effective way to lower their LDL cholesterol levels.
Whether you need to take statins depends on your overall cardiovascular risk score. If this is moderate, you may be able to reduce your LDL levels by just altering your diet and lifestyle. However, if your score is high — meaning your risk of hardening and narrowing of your arteries is high, leading to cardiovascular disease — statins may be required. Remember, statins are designed to supplement, not replace, a healthy lifestyle!
What about the side effects of statins?
Common side effects of statins include:
- Muscle pain and weakness — due to a reduction in CoQ10, which is a vital component for energy production in muscle cells.
- Digestive issues — possibly due to changes in the gut microbiome.
- Headaches, dizziness, or sleep problems — due to lowering levels of CoQ10, vital for energy production in the brain.
- Tiredness and weakness — again due to reduced CoQ10.
It is important to discuss any side effects you experience with your doctor. Supplementing CoQ10 may be beneficial, but it is important to discuss taking any supplements with a healthcare practitioner.
What can I do to help reduce my LDL cholesterol?
- Reduce your saturated fat intake — such as fatty meats, lard, butter, cream, and ghee. Saturated fat suppresses the number and activity of receptors on liver cells, which then stops the liver from effectively clearing LDL cholesterol from the bloodstream.
- Keep your blood sugar stable — avoid high sugar and high starch foods, as the liver cannot process large amounts of dietary sugar and converts the excess into triglycerides, increasing LDL production.
- Work on reducing stress levels — which can lower cortisol and adrenaline, hormones that can promote LDL production.
- Prioritise sleep — this helps reduce cortisol, optimises metabolism, and helps you make better dietary choices.
- Work on your gut microbiome — a healthy gut microbiome can absorb cholesterol and/or turn it into coprostanol, which cannot be absorbed by the gut.
- Exercise regularly — both cardiovascular and resistance training can enhance liver function and increase enzyme activity that moves cholesterol from the blood to the liver.
- Eat lots of healthy fats — omega-3s (fish oils), avocado, nuts, and seeds can reduce triglycerides and may improve the size of LDL particles.
There is varying research on coconut oil — while it does contain high levels of saturated fat, some research suggests its structure makes it less likely to contribute to fat build-up in the body.
Fermented full-fat dairy, such as yoghurt and kefir, has been associated with neutral or beneficial effects on LDL cholesterol, although study results are variable.
Ideally, it is best to keep your saturated fat intake to a minimum.
Avoid trans fats — these are possibly the worst kind of fat to eat and are mainly found in processed foods containing partially hydrogenated fats.
Eat plenty of the following foods:
- Legumes
- Avocados
- Nuts
- Fatty fish
- Whole grains
- Fruits and berries (especially tomatoes) — being careful not to overeat very sweet fruits such as pineapple and mango
- Dark chocolate and cocoa (in moderation)
- Garlic
- Soy foods
- Vegetables
- Tea
- Dark leafy greens
- Extra virgin olive oil
(Healthline, 2023)
Should I increase my exercise?
Exercise has been shown to reduce cholesterol levels, as it enhances the body’s ability to utilise and transport lipids (fats), increasing the enzyme that converts LDL into energy. Aim for either 30 minutes of moderate intensity exercise 5 times a week, or 25 minutes of high intensity exercise 3 times a week.
Top exercises for reducing LDL cholesterol:
- Running or jogging
- Brisk walking
- Swimming
- Weight training
- HIIT
- Vinyasa yoga
To sum up
Increasing your exercise, reducing stress, and making dietary changes — such as eating less saturated fat and sugar and increasing fibre intake — can make a big difference to LDL cholesterol levels. However, if your cardiovascular risk score is high, you may additionally need to take statins to reduce your risk of cardiovascular disease.
If you have familial hypercholesterolemia, you will need to take medication. However, if you have polygenic hypercholesterolemia, you may be able to control your LDL cholesterol levels through lifestyle and dietary changes alone. Always discuss any changes to your medication with your doctor.
