High cholesterol is now so common, it’s almost the norm. More than half UK adults are believed to have it and last year, the cholesterol-lowering drug atorvastatin (a type of statin) was the most dispensed chemical substance in England with 71 million items prescribed.
Our cholesterol, type of fat, is essential for cell growth and repair, the production of vitamin D and steroid hormones like oestrogen and testosterone. But when levels are too high, fatty deposits can build in the arteries causing them to narrow and stiffen. There may be no symptoms, but it’s a major cause of heart attacks and strokes.
The main culprit here is a cholesterol called LDL (low-density lipoprotein). While LDL can cross into the blood vessel lining and accumulate, HDL (high-density lipoprotein) carries LDL away and back to our liver. “We call LDL ‘bad cholesterol’ and HDL ‘good cholesterol’ for this reason,” says Dr Ali Khavandi, a consultant interventional cardiologist at Sulis Hospital.
According to NHS guidelines, total cholesterol levels should be below 5mmol/L. LDL levels should be below 4mmol/L while HDL levels should be above 1.0mmol/L for men and 1.2 mmol/L for women. (Women have on average higher HDL levels than men.)
When it comes to deciding if you should take medication like statins, Dr Khavandi believes these measurements alone are a blunt tool. “As cardiologists, we are calculating risks,” he says.
“In the modern world though, high cholesterol is most commonly lifestyle-related and you can smash that through dietary and lifestyle changes.”
In Dr Khavandi’s experience, you can expect to reduce your cholesterol by 20 per cent – and those numbers can start dropping in weeks, not months. His key advice is to stick to meals made with single whole-food ingredients and avoid ultra-processed foods.
So what else can we do to lower our cholesterol in as little as a month?
Eat good fats, rather than ‘low fat’
It’s widely known that reducing cholesterol usually requires reducing our intake of saturated fats – butter, processed meats, pies, cookies. “If you want to eat healthy fats, stick to single-ingredient foods like oily fish, nuts, seeds, olives and avocados,” says Khavandi.
“Don’t make the mistake of filling the gap with carbs and items marked ‘low fat’. A lot of my patients think the healthy option is to buy anything branded ‘low calorie’, ‘low fat’, ‘light’, ‘lighter’. They are usually ultra-processed foods with added sugar.” They’re low in cholesterol-fighting fibre, they cause sugar spikes and all the additives and emulsifiers can trigger inflammation and disrupt the balance of gut bacteria, ultimately contributing to higher cholesterol.
A daily glass of tomato juice
Some studies have found that a high tomato diet can reduce LDL and increase HDL – possibly because of it contains the powerful antioxidant lycopene which can attach to LDL and help prevent its oxidation. One study from Japan which gave participants access to unlimited amounts of unsalted tomato recorded significant drops in LDL as well as blood pressure. Having tomato juice or tinned tomatoes may increase the availability of lycopene , with another study revealing that just nine days of drinking freshly-made pure tomato juice significantly impacted cholesterol levels.
Have porridge for breakfast
Oats have a type of soluble fibre called beta glucan that almost turns into a gel in your stomach and that binds onto the cholesterol, limiting the amount that can be absorbed into the bloodstream. One study from King’s College London in conjunction with the late Dr Michael Mosley for his programme Trust Me, I’m a Doctor recruited 42 people with raised cholesterol and asked them to make one change to their diet. After one month, the group that had been instructed to add in 75g of oats a day had reduced their LDL by an average of 10.2 per cent. (Dr Mosley himself believed that consuming oats helped lower his own LDL by nearly 25 per cent in four weeks.)
Get your plant sterols naturally
“Plant sterols and stanols are molecules that are similar in size and shape to cholesterol, so they almost ‘compete’ with it,” says Dr Khavandi. When we eat them and they are absorbed from the intestine into the blood, they will be preventing some of the cholesterol from being absorbed instead. Broccoli, cauliflower and avocado are all rich in sterols, while stanols are found in peanuts, almonds and sunflower seeds.
“When you eat a plant-rich diet, you’re getting all the cholesterol-lowering fibre and the nutrition that comes with it,” says Khavandi. When you eat a food product fortified with sterols, however, all that added nutrition is missing. “They are processed products,” says Khavandi. “All the added ingredients might not result in an overall positive impact on health.” According to the British Heart Foundation, although products fortified with sterols and stanols may lower cholesterol, no clinical trials have shown they reduce the risk of heart attack or stroke.
Add more beans
We normally associate high cholesterol with high-fat foods, but eating too many refined carbohydrates can also pose a risk to your heart health. “Don’t base meals around starchy carbohydrates like pasta, sugary cereal, baked potatoes and white bread,” says Dr Khavandi. Refined carbs can lead to blood sugar spikes and an increase in LDL and triglycerides (another form of “bad” cholesterol). Instead substitute with pulses like beans, chickpeas and lentils. They’re low in saturated fat and an excellent source of fibre, including ‘soluble fibre’ which slows down digestion, traps cholesterol and helps eliminate it from the body.
Skip the snacks....
In an ideal world, we wouldn’t snack at all. “The body likes breaks from eating,” Dr Khavandi. Although the evidence is mixed, there are studies that have found that intermittent fasting can lower cholesterol, possibly because of changes in metabolism. One study, for example, found that eating within a ten hour window each day, with consistent eating times, decreased LDL. An umbrella review of 23 studies found good evidence that it can lower waist circumference, LDL and triglycerides.
...but if you do snack, swap crisps for nuts
However, if you are a snacker, there’s also evidence that a few weeks of snacking on nuts instead of crisps can lower cholesterol. A study by Dr Sarah Berry from King’s College, London and chief scientist at health app Zoe, found that snacking on almonds rather than typical snacks led to both a drop in levels of LDL and a significant improvement in blood vessel function.
Only have wine at the weekends
“Unfortunately it sounds boring but it really is the low hanging fruit, the first change you need to make if you want to get your cholesterol under control,” says Dr Khavandi. “Habitual home drinking in the UK – half a bottle of wine every day after work - seems to be the problem and once you go over a couple of drinks a week regularly, the graph of risk rises rapidly.” Alcohol is broken down in the liver and converted into triglycerides and cholesterol, a lethal combination. The more you drink, the more levels will rise. In addition, high levels of triglycerides can lead to a fatty liver, making it less efficient at clearing cholesterol from the blood.
Switch butter for extra virgin olive oil
“The term ‘superfood’ is overused, but extra virgin olive oil really is a superstar,” says Khavandri. The primary fat in extra virgin olive oil – monounsaturated fats – has been shown to lower LDL and increase HDL. It also contains antioxidants and anti-inflammatories which help protect against build-up in arteries. One study which tracked around 90,000 people over 28 years found that those who consumed the most olive oil (more than half a tablespoon a day) had a 19 per cent lower risk of dying from cardiovascular disease (not to mention a 29 per cent lower risk of neurodegenerative disease deaths.)
