What is cholesterol?

Cholesterol is a fat-like substance in the body. It is produced by the body and also found in food.

It's important to keep cholesterol in check because high cholesterol levels increase the risk of heart disease and stroke. If you are concerned about your cholesterol level, talk to your doctor.

There are different types of cholesterol:

• Low-density lipoprotein (LDL) — ‘bad’ cholesterol
• High-density lipoprotein (HDL) — ‘good’ cholesterol.

You can find out the levels of these in your blood and also your total cholesterol level with a cholesterol or lipid profile blood test.

If you have high LDL or total cholesterol, you can lower your risk of heart disease by:

• quitting if you smoke
• keeping your weight in a healthy range
• limiting your alcohol and salt intake
• aiming for at least 30 minutes of exercise on most days

Your doctor might suggest medication to help keep your cholesterol in the healthy range. If you are on such medication, you might need regular cholesterol tests to check that they are working well and that you are taking the right dose.

To lower your cholesterol levels, follow these tips.

Healthy diet

You can lower cholesterol over time by eating fewer of the foods that cause high cholesterol and more of the foods that lower cholesterol.

Eat plenty of vegetables, fruits and wholegrains

Eating foods high in fibre may help reduce the amount of cholesterol in the blood. These include:

• oats
• beans
• peas
• lentils
• chickpeas
• fruit and vegetables

Aim to eat at least five portions of fruit and vegetables each day.

Choose reduced fat dairy foods such as milk (preferably unflavoured), yoghurt (preferably unflavoured) and cheese.

Eat a variety of healthy proteins

The best choices of protein are fish and seafood, legumes (such as beans and lentils), nuts and seeds. You can eat smaller amounts of eggs and lean poultry but limit red meat to 1-3 times a week.

Flavour foods with herbs and spices rather than salt, and avoid processed foods as these contain a lot of salt too. Salt can lead to high blood pressure, which can increase your risk of heart disease.

Choose healthy fats

There are two main types of fat: saturated and unsaturated. Eating foods that are high in saturated fat can raise cholesterol levels in the blood.

Foods that are high in saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter
• lard
• cream
• hard cheese
• cakes and biscuits
• foods that contain coconut or palm oil

Try to replace foods containing saturated fats with foods that are high in unsaturated fats, such as:

• avocadoes or olives
• oily fish (for example, mackerel and salmon)
• nuts (for example, almonds and cashews)
• seeds (for example, sunflower and pumpkin)
• vegetable oils and spreads (for example, sunflower, olive, corn, walnut and rapeseed oils)

Trans fats can also raise cholesterol levels. These fats can be found naturally at low levels in some foods, such as animal products, including meat and dairy.

Artificial trans fats can be found in hydrogenated fat, so some processed foods such as biscuits and cakes will contain trans fats.

You should also reduce the total amount of fat in your diet. Try microwaving, steaming, poaching, boiling or grilling instead of roasting or frying. Choose lean cuts of meat and go for low-fat varieties of dairy products and spreads (or eat just a small amount of full-fat varieties).

ARE YOU AT RISK? — Are you at risk of type 2 diabetes, heart disease or kidney disease? Use the Risk Checker to find out.

Foods containing cholesterol

Some foods contain cholesterol. This type of cholesterol is called 'dietary cholesterol'. Foods such as eggs and prawns are higher in dietary cholesterol than other foods.

The cholesterol found in food has much less effect on the level of cholesterol in your blood than the saturated fat you eat. The Heart Foundation recommends that you should limit eggs to 7 a week if you need to lower your LDL cholesterol.

If your doctor has advised you to change your diet to reduce the level of cholesterol in your blood, the most important thing to do is to cut down on saturated fat. It's also a good idea to increase your intake of fruit, vegetables and fibre.

Cholesterol-lowering products

There is evidence that foods that contain certain added ingredients, such as plant sterols and stanols, can reduce levels of cholesterol in the blood. Plant sterols and stanols are found in nuts, seeds and legumes, vegetable oils, breads and cereals, and fruits and vegetables. You need to eat 2 to 3 grams a day of plant sterols and stanols to assist in reducing high cholesterol. Eating more is not harmful, but you won't get any additional benefits.

One way to boost your intake of plant sterols and stanols is to eat foods that have been enriched. In Australia, these enriched foods include some margarines, low-fat milks, low-fat yoghurts and breakfast cereals, lower fat cheese and processed cheese. People who do not have high cholesterol should not eat these products regularly, particularly children and pregnant or breastfeeding women.

If you do eat foods that are designed to lower cholesterol, read the label carefully to avoid eating too much.

You should not eat foods fortified with plant sterols as a substitute for medication. You can use plant sterol-enriched foods while taking cholesterol medication, but check with your doctor first.

Get active

An active lifestyle can help to lower cholesterol levels. Activities range from walking and cycling to more vigorous exercise such as running and dancing.

Doing 30 minutes of moderate-intensity aerobic activity on most days can improve your cholesterol levels.

Moderate-intensity aerobic activity means you work hard enough to raise your heart rate and break a sweat.

One way to tell whether you are working at moderate intensity is if you can still talk but you cannot sing the words to a song.

Quit smoking

Smoking lowers levels of HDL (‘good’) cholesterol. Quitting smoking is important to prevent your risk of heart disease or stroke, especially if you have high cholesterol.

Medication

To reduce your risk of a heart attack or stroke, your doctor may recommend you take medication to lower your cholesterol level.

The most common type of medications to lower cholesterol are called statins. These lower the level of LDL or ‘bad’ cholesterol in the blood and reduce your risk of heart attack or stroke.

It’s important to take your medication as recommended. Don’t stop just because you feel better.

The Royal Australian College of General Practitioners recommends that you regularly review any medications you are taking for high blood pressure or high cholesterol with your doctor or specialist. They will be able to assess, with you, the continuing benefits and risks. For further information, visit the Choosing Wisely Australia website.