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Fact File - Cholesterol

What is Cholesterol?

Cholesterol is a fatty substance made in the liver and is essential for the body. For example it helps produce hormones and Vitamin D. Cholesterol can also be found in some foods, but cholesterol in food has little influence on blood cholesterol levels. This fact sheet explores the reasons behind high cholesterol, looks at the two main types of cholesterol and how one can help lower cholesterol levels, focusing on diet and exercise.


Types of cholesterol

There are two main types of cholesterol which are carried by proteins in the blood, these are:

  1. High-density lipoprotein (HDL)  - This is often referred to as ‘good cholesterol’ because it carries cholesterol back to the liver where it is either broken down or passed out of the body. Higher levels of this cholesterol are better as it has a protective role in heart health.
  2. Low-density lipoprotein (LDL) – This is often referred to as ‘bad cholesterol’. Raised cholesterol (LDL) is a risk factor for heart disease and stroke. The main reason for this is because LDL cholesterol accumulates in the artery walls.

These two types of cholesterol can be measured with a simple blood test.


What Causes High Cholesterol Levels?

There are many factors, however, below are some of the most common risk factors:

  • An unhealthy diet, particularly diets high in saturated fat and low in fibre (fibre is found in fruit, vegetables, whole grains and pulses)
  • Lack of regular exercise
  • Being overweight or obese
  • Having a family history of heart disease
  • Having diabetes or high blood pressure
  • Smoking
  • Consuming excessive alcohol


There are some risk factors that cause high cholesterol that cannot be modified, these include:

  • A family history of early coronary heart disease or stroke
  • Age
  • Gender (males are more likely to have heart attacks than females)


What should my cholesterol levels be?

For healthy adults cholesterol levels should be:

(For people who are at risk, the level of total and LDL is lower)


A lower level of HDL can increase your risk of heart disease and therefore the ratio of total cholesterol to HDL is often calculated (total cholesterol level divided by HDL level). This ratio should be below 4. A higher ratio increases your risk of heart disease.


Preventing high cholesterol

High LDL can be lowered by a diet that is low in saturated fat and high in fibre, these are the basis of the UK healthy eating guidelines. In addition being a healthy weight, drinking sensibly, undertaking regular physical activity and not smoking will also significantly help.



An unhealthy diet is a major risk factor for raising cholesterol levels, but in particular too much of the wrong type of fat and too little fibre in the diet.



There are two types of fat in the diet, saturated and unsaturated. Saturated fats should be limited and in particular, trans fats should be avoided.

  • Trans fats – These are found mainly in highly processed, fast and takeaway foods and are associated with increased cholesterol (LDL). Know what you are eating by cooking from scratch to avoid these fats as much as possible.
  • Too much saturated fat in the diet can increase the amount of cholesterol (LDL) in the blood and should be limited. It is impossible to avoid saturated fats completely as these naturally occur in many foods, but by choosing lower fat varieties of dairy foods and avoiding fatty meats, including the skin from poultry can really help, as most saturated fats are from animal sources.


UK health guidelines recommend that:

  • The average man should eat no more than 30g of saturated fat a day
  • The average woman should eat no more than 20g of saturated fat a day
  • These figures can be used as a guide when you look at nutritional labels


Choose unsaturated fats

Unsaturated fats are monounsaturated (MUFA’s) and polyunsaturated fats (PUFA’s) which includes omega-3. Aim to replace saturated fats with these as much as possible, as follows:

  • MUFA’s are rich in olive and rapeseed oils and in almonds, walnuts and avocados. MUFA’s tend to be rich in the Mediterranean diet, which is heart friendly. These fats can help increase HDL cholesterol without raising LDL.
  • PUFA’s are rich in most nuts, particularly walnuts, seeds (particularly sunflower), corn and soya oils.
  • Omega-3 is a type of PUFA which appears to benefit the heart. Aim for at least two portions of fish a week, preferably those that are from sustainable sources and of which at least one portion which is oily (high in omega-3), for example salmon, mackerel, trout, sardines and fresh tuna (tinned is not oily). If you do not eat fish, green leafy vegetables and especially walnuts and flaxseed (including their oils) are alternative sources. There is no evidence that taking omega-3 fatty acid supplements has the same benefit.

However it is important not to have too much fat in the diet, as it is high in energy, particularly if you need to lose weight.



Not only do fruit and vegetables contribute to fibre intake but wholegrain varieties of starchy foods do too. Rich sources include, brown rice, whole-wheat pasta, rye bread, quinoa, buckwheat and corn as well as nuts, seeds, pulses (lentils, beans and chickpeas). Soya and oats are also fibre rich and may have additional benefits to heart health because they are high in soluble fibre which can help carry cholesterol out of the body via the gut. Aim to increase your fibre intake gradually to reduce the possibility of feeling bloated.



Exercising regularly will help increase the levels of HDL, which is heart protective, in your body by stimulating the body to move fatty deposits to the liver so they can be broken down. Exercise will also help with weight maintenance and weight loss if necessary. Being overweight or obese is a major risk factor for raised LDL cholesterol. The recommended minimum levels of physical activity is at least 150 minutes a week (2 ½ hours) of moderate intensity, for example brisk walking and cycling or half this amount as vigorous intensity, for example, running, circuit training. Also undertake weight-bearing exercises twice a week, for example, carrying groceries or exercising with weights.


This factsheet is intended for adults as a general guide only and not a substitute for professional advice or a diagnosis. If you are on certain medication or suffer from a medical condition, seek individual advice from your health care professional. Date produced October 2015


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