Cholesterol Explained: What Your Results Mean and What You Can Do About Them
Cholesterol is one of the most talked-about, yet often misunderstood topics in health. So, in this blog, we’re going to unpack what cholesterol actually is, why your body needs it, what your results really mean, and how to support healthy levels through diet and lifestyle.
What Is Cholesterol, And Do You Need It?
Yes, you need it!
Cholesterol is a waxy, fat-like substance, and your liver makes the majority of it. Your body uses it every day to:
• Build cell membranes, so every cell in your body holds its shape
• Make hormones, including oestrogen, testosterone and cortisol
• Make vitamin D when sunlight hits your skin
• Make bile acids, which helps you digest fat (if you have read my posts on bile flow, this is where cholesterol comes in)
High cholesterol doesn't usually cause symptoms, which is why checking your levels is important. And the causes often go far beyond simply eating foods that contain cholesterol.
Saturated fat can raise LDL cholesterol in many people, while low fibre intake and a diet high in ultra-processed foods can also contribute to a less favourable cholesterol profile. Other factors can include excess weight, low physical activity, smoking, alcohol intake, insulin resistance, certain medical conditions such as an underactive thyroid, and some medications.
Genetics also matter. Some people naturally have higher cholesterol levels, while others have an inherited condition such as familial hypercholesterolaemia (FH), which affects the body's ability to remove LDL cholesterol from the blood.
Cholesterol cannot travel through your blood on its own, so your body packs it into "delivery vans" called lipoproteins. LDL vans carry cholesterol out to your cells. HDL vans collect the spare and take it back to the liver.
Over time, LDL particles can become trapped in the walls of arteries, where they may become oxidised and contribute to inflammation and plaque formation. As plaque builds up, arteries can become narrowed and the risk of heart attack and stroke increases.
Standard Cholesterol Testing
A standard cholesterol test gives you the following:
• Total cholesterol: the overall amount in your blood
• LDL cholesterol: the amount carried in the LDL vans
• HDL cholesterol: the amount carried in the HDL vans
• Non-HDL cholesterol: everything that is not in the HDL vans, which is a useful catch-all
• Triglycerides: another type of blood fat, tied to how you handle carbohydrates and sugar
• Cholesterol Ratio: This shows how much good cholesterol you have compared to total cholesterol.
Those numbers tell you how much cholesterol the "vans" are carrying. They do not tell you how many vans there are or what size they are. It is important to look at all of your cholesterol results together rather than just your total cholesterol level or LDL for example.
You can find more information about what your cholesterol levels should be on this link from the British Heart Foundation: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol/understanding-your-cholesterol-levels
What Is The Typical GP Approach To High Cholesterol?
If you are in England and aged 40–74, you may be eligible for an NHS Health Check. As part of assessing your cardiovascular health, your cholesterol results are considered alongside other risk factors such as your age, blood pressure, smoking status, family history and certain health conditions. These can be used to calculate a QRISK3 score, which estimates your risk of developing cardiovascular disease, such as a heart attack or stroke, over the next 10 years.
Under current NICE guidance:
If your 10-year QRISK3 score is 10% or higher, you should be offered a statin for primary prevention. The usual first choice is atorvastatin 20 mg.
Diet and lifestyle changes are an important part of reducing cardiovascular risk and may be recommended before, or alongside, medication.
If your cholesterol is particularly high, or there is a strong family history of premature heart disease, your GP may consider familial hypercholesterolaemia (FH).
One limitation of standard cardiovascular risk assessment is that it is designed to estimate your overall risk, rather than provide a detailed picture of all the factors that may be contributing to that risk. Tests such as Lp(a), ApoB, LDL particle number or size, insulin and inflammatory markers are not routinely included in a standard NHS Health Check.
If your results sit in a grey area, you have a strong family history, or you are unsure about starting a statin, it can be helpful to discuss whether any additional information would help you and your GP make a more informed decision.
Please do not stop or change any prescribed medication without discussing it with your GP.
The diet and lifestyle information in this blog is intended to work alongside your medical care, not replace it.
Additional Testing
For my clients, where appropriate I recommend additional blood testing which includes running an advanced lipid profile investigating LDL particles in more detail.
I will often recommend also to include:
• hs-CRP for inflammation
• Fasting insulin and HbA1c to see how you handle blood sugar
• Thyroid markers, because a sluggish thyroid can push LDL up
• Triglycerides to HDL ratio, a handy pointer to insulin resistance
It can be useful if:
• Early heart disease runs in your family
• Your standard results look normal, but you have other risk factors
• Your QRISK score sits near the threshold, and you are weighing up your options
• You are in perimenopause or menopause. Falling oestrogen can nudge LDL up, and the first you might notice this is in your 40s.
Supporting Healthy Cholesterol Levels Through Diet And Nutrition
Good news: this is where you hold a lot of the power.
Load up on soluble fibre. Think oats, barley, beans, lentils, apples and ground flaxseed. Soluble fibre forms a gel in your gut that grabs bile (which is made from cholesterol) and carries it out of your body. Your liver then pulls more cholesterol out of your blood to make fresh bile. A generous bowl of porridge each day is a good place to start. Add chia seeds and flaxseeds for an extra boost.
Reduce saturated fat and increase healthy fats. Cut back on processed meat and saturated fat. You do not need to banish butter for life, it is about the overall balance. Increase extra virgin olive olive (for example drizzled on a salad), avocado and nuts such as walnuts.
Eat oily fish twice a week. Salmon, mackerel, sardines and trout bring omega-3 fats, which help bring triglycerides down.
Go easy on refined carbs and sugar. These push triglycerides up and steer your LDL towards the small, dense type. Wholegrains, plenty of veg and some protein at every meal keep your blood sugar steadier.
Antioxidant rich vegetables and fruit.
Keep alcohol modest. Alcohol raises triglycerides for many people.
Then there is life beyond the plate. Regular movement (a brisk walk or strength work for example), decent sleep, stress management, not smoking and a healthy waistline all shape your cholesterol picture.
Where To Go From Here
Your cholesterol result is not a report card you have failed. It is a piece of information, and with the right context it becomes a starting point, not a verdict.
If you would like help making sense of your results, working out whether deeper testing makes sense for you, or building a food plan that fits your real life, I would love to hear from you. I support clients on statin therapy and those wishing to address their cholesterol through diet and lifestyle.
Book a free, no-obligation chat with me here:
We can talk through where you are and what feels doable.
The content provided is not intended to treat, diagnose, cure or prevent any disease. All material on laurabealesnutrition.co.uk is provided for information and educational purposes only. Always seek the advice of your doctor and/ or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, supplement, exercise or other health-related programs.
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