If you have high cholesterol you are not alone. In Australia and New Zealand around 50% of adults have high blood cholesterol and/or triglycerides levels. You may be wondering if so many people have high cholesterol, then what is the problem?

Why do we need cholesterol?
Cholesterol is the most common type of steroid in the human body. Cholesterol is vital for normal function and structure of all cell membranes, and for making bile acids (which aid in the digestion of fats) hormones such as oestrogens, progesterone, and androgens; mineralocorticoid hormones (aldosterone) and glucocorticoid hormones (cortisol).  

Triglycerides (TG) are a different class of fats made up of glycerol and 3 fatty acids. These are the major class of dietary fats and body fat storage molecules.  About 30% of your cholesterol comes from your diet and you make the other 70 % mostly in your liver. If we need cholesterol for several normal bodily functions, and we make most of it, then why is high cholesterol a problem?

Why is high cholesterol bad news?
Elevated levels of blood lipids, especially triglycerides and low-density lipoprotein (LDL) cholesterol are risk factors for cardiovascular disease. Cardiovascular disease (CVD) is the number one cause of death in Western countries. High levels of cholesterol and triglycerides are thought to be atherogenic, as they can cause a build-up of fatty deposits (sometimes referred as plaque) in the wall of blood vessels. As plaques builds up it causes a narrowing of the blood vessels making it harder for blood to get through. This can increase blood pressure and if the blood vessels become totally blocked it can cause a stroke of heart attack.


Cholesterol levels are influenced by your genes, age and your environment. Increases in cholesterol related to your genes tends to occur at an earlier age and affect family members. Whereas elevated cholesterol that is related to ageing and the environment tends to occur at an older age.  

Cholesterol and triglycerides are transported in the blood stream packaged into chylomicrons or lipoproteins of which there are a few different types. The types often referred to are VLDL (very low density lipoprotein), IDL (intermediate density lipoproteins), LDL (low density lipoproteins), HDL high density lipoproteins).

The VLDLs, LDLs and IDLs deliver cholesterol and triglycerides to the tissues, whilst HDLs remove cholesterol from the tissues and take it to the liver for breaking down and excretion. The LDL cholesterol is usually thought of as the “bad” and HDL is thought of as the good cholesterol as it helps to remove cholesterol from cells for elimination via the liver.

Most strategies aim to lower LDL cholesterol because elevated LDL levels are associated with an increased risk of coronary artery (heart) disease. Conversely, high-density lipoprotein (HDL) cholesterol is the “good” cholesterol since high HDL levels are associated with less coronary disease.

VLDL is the lowest density lipoprotein as it has the highest fat content. It is the major transporter of liver derived triglycerides, which they deliver to the various tissues (primarily muscle and fat tissue) for storage or the production of energy through oxidation.

IDLs are an intermediate lipoprotein between VLDL and LDL. They also deliver triglycerides to tissues.

LDL particles are the major plasma carriers of cholesterol. Elevated LDL particles concentrations may be the consequence of elevated production or a decrease in the breakdown. Diets high in saturated fat, trans fatty acids, and cholesterol appear to cause a reduction in LDL receptors in the liver, thus retarding LDL breakdown and elevating circulating LDLs.  

Small dense (sd) LDLs, formed by the removal of triglycerides from VLDLs are more atherogenic. Factors that increase the risk of sdLDLs being produced include: body composition (higher with increased abdominal adiposity); diet (increased by low fat, high carbohydrate diet); metabolic health (increased by insulin resistance and type 2 diabetes); and medications (increased by the oral contraceptive pill).

Higher HDLs levels decrease cardiovascular risk. They are antioxidant, anti-inflammatory and antithrombotic. Total cholesterol (TC) to HDL ratio is a strong risk marker for CVD. HDL levels increase with weight loss, smoking cessation, moderate alcohol consumption, exercise, and some types of dietary fat. Low HDL is associated with diabetes and metabolic syndrome.

Apolipoproteins are present in all these lipid transport particles. They provide structure and act as receptor for binding to different tissues to release their cargo of cholesterol. Important apolipoproteins are:

  • ApoA, essential for HDL formation.
  • ApoB*, present in VLDL, IDL and LDL particles; essential for LDL receptor activation.
  • ApoE, essential for LDL receptor activation.

Blood test for cholesterol

Dietary fats are absorbed and packaged into chylomicrons, which are produced in the absorbent cells lining the small intestine. Chylomicrons are stable droplets containing triglycerides, cholesterol, phospholipids, and protein. They are formed in the intestinal walls and are found in blood and the lymphatics during and after meals. They transport dietary fat to the liver for processing into lipoproteins.

Triglycerides are transported in chylomicrons and VLDLs. Elevated triglycerides are an independent risk factor for cardiovascular disease as they are associated with the formation of atherogenic small, dense LDLs (sdLDLs) and decreased HDLs. Dietary TGs are transported in chylomicrons from the gut to the liver, where they are hydrolysed to glycerol and free fatty acids and reformed into VLDL particles. As these particles circulate around the body, they are progressively hydrolysed to remove triglycerides for transfer into the tissues, leaving sdLDLs

How to lower your cholesterol?

There are a lot of information out there to help you understand how to lower cholesterol. So much so that is can be confusing to know what the best option is. This next section will outline some of the different treatment strategies, so you can decide what is right for you.

Strategies to lower cholesterol have been grouped into the following categories:  diet, lifestyle, nutrition therapy, and medications. Coming from a preventative health perspective the smart treatment options for long term health is to address the underlying drivers of high cholesterol which ultimately comes down to diet and lifestyle. When this is not enough you can add some nutrition therapy and medications if necessary to get things moving while you work on lifestyle and diet for longer term results.

Dietary changes you can make to improve cholesterol.

  • The right balance of macro nutrients (protein, fats, and carbohydrates) for your age and activity levels is the first step to stopping the drivers of high cholesterol
  • Plant based diet particularly high in soluble fibre to improve gut flora and reduce inflammation and LDL cholesterol.

Mediterranean style diet

  • Increase your intakes of omega 3 fats, (marine sources are better absorbed) to improve the ration of omega 3:6 fats to lower inflammation and decrease triglycerides.
  • Add some plant sterols to lower cholesterol levels. They work by reducing the re-use of gut bile acids, as cholesterol is used to make bile acids.
  • Add some soya protein to decrease LDL (bad cholesterol) and increase HDL (good cholesterol)
  • Tree nuts have also been shown to increase HDL’s

Lifestyle changes to lower cholesterol

  • Physical activity levels can reduce LDL cholesterol and triglycerides and increase HDL cholesterol. If you have limited mobility (disabled, elderly populations, etc.) you can still use physical activity to reduce LDL cholesterol and triglycerides and increase HDL cholesterol.

The aim for you is to increase physical activity as much as is feasible, and to include resistance training of majormuscle groups progressing to more intensity as you get fitter. If you are more mobile with less disability you can increase physical activity to 5 days per week for 30 minutes and include prolonged moderate-intensity aerobic exercise and moderate to high-intensity resistance training. If you are not used to physical activity it is better to start off gentle and build slowly to prevent injuries.

Strength build exercise

  • Smoking, has the effect of increasing LDL cholesterol and triglycerides and also decreases HDL (good cholesterol)

Saying no to smoking

  • Stress levels: Stress is a big one, because it can contribute to other risk factors such as smoking, obesity, hypertension and diabetes. Stress can have a much greater impact on cholesterol than fatty foods.
  • Stress can cause vascular changes and increased stickiness and clumping of blood cells and constriction of the coronary vessels.
  • Stress increases other risk factors or markers for coronary heart disease such as homocysteine, fibrinogen, and C-reactive protein (a marker of inflammation)

Stressed to breaking point

  • Stress causes increased internal fat deposits around your organs that can contribute tometabolic syndrome, insulin resistance which can also lead to poor cardiovascular health.
  • Other stressful psychological behaviours of excessive anger, hostility, anxiety, depression and stressful life events can also increase cholesterol and cardiovascular disease.


  • Excess weight – SOMETIMES, but not always. It is the excess weight that is stored as fat around the internal organs that affects your cholesterol more than fat deposited on your hips and legs. Excess fat stored within and around the liver can decrease HDL (good cholesterol) and increase VLDL (bad cholesterol), leading to a higher risk of coronary (heart) disease.

Abdominal fat deposits

Healthy sleep

  • Reduced sleep and disordered sleeping patterns can increase LDL and decrease HDL by an induced decrease in expression of genes in pathways related to reverse cholesterol transport and in the regulation of your immune cells (macrophages). Along with activation of inflammatorymolecules can damage blood vessel walls. Which in turn canincreased riskfor cardiovascular diseases from insufficient sleep.

Nutrition therapy to lower cholesterol

As discussed above around 70% of the body’s cholesterol is produced by the liver, with the other 30% from dietary sources. Attempts to control blood cholesterol levels have centred around a few different mechanisms for cholesterol reduction. Natural medicines of antioxidant properties that support cholesterol have been developed by combining novel natural medicines for blood lipid reductions:

  • Plant Sterols consuming 2-3 g of phytosterols per day from fortified food products (currently margarine, milk, yoghurt and breakfast cereals) have been shown to reduce cholesterol. Eating more than 3 grams per day does not reduce your LDL cholesterol any further.

Plant sterol oil

  • Fibre, and in particular therapeutic doses of beta-glucan found in oats and barley reduces your LDL cholesterol and blood glucose levels after meals, when eaten daily. Daily dose of 3 grams of beta-glucan is the amount proven to reduce cholestero

Oats- source of beta-glucans

  • Polymethoxyflavones(PMFs) from citrus fruitsextract, are a type of natural compound found in the peel of citrus fruits with antioxidant and anti-inflammatory effects. These phytochemicals have been shown to reduce cardiovascular disease risk. Many epidemiological studies show consumption of flavonoid-rich fruits and vegetables can reduce the risk of cardiovascular diseases. The way PMFs reduce cholesterol is by reducing apolipoprotein B (apoB) secretion (see above), this reduces the LDL synthesis in the liver. They also increase the syntheses of the LDL-receptor to increased liver breakdown and removal of LDL. They promote a small reduction in the activity of hepatic HMG-CoA reductase, the rate limiting enzymes in cholesterol synthesis to reduce the amount of cholesterol synthesised.Without significantly affecting CoQ10 production, thus avoiding the side effects associated with Statin medications that also target this enzyme.

Citrus peel


  • Tocotrienols have been found to lower cholesterol and have anti-inflammatoryaffects to help prevent formation of cardiovascular disease by stopping the inflammatory cells sticking to the vascular walls. They have been shown to reduce LDL and prevent LDL oxidation and promote the clearance of cholesterol from the liver, by reducing the activity of the HMG-CoA reductase and reducing the cholesterol synthesis in the liver. Like PMFs, tocotrienols have very strong antioxidant ability which helps to prevent the build-upof fatty plaque in the blood vessels. Tocotrienols come from a large family with four classes of tocotrienols: alpha (α), beta (β), gamma (γ) and delta (δ) forms. Tocotrienols are relatively scarce, with palm oil and cereal grain oils such as wheat germ oil or rice bran oil being the most common dietary sources.Tocotrienols are also avail as a supplement.

Medications to lower cholesterol

The pathway to synthesise cholesterol is controlled by the rate-limiting step in this process with an enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase, more commonly known as HMG-CoA reductase. Attempts to control blood cholesterol levels have largely centred around reducing or stopping this enzyme.Which has led to the development of a class of medications called statins.

Cholesterol Medication

These are successful at controlling cholesterol in many patients. However, for some people statins are also associated with unwanted side effects such muscle aches, pain and breakdown of muscles, fatigue, and liver problems, especially with long term use.

Another down side to taking Statins is that it becomes a quick fix for many people, who are then less likely to address the diet and lifestyle factors that are driving the increase in cholesterol. If you only rely on medications and do not address lifestyle factors, overtime you will require more medication and/or higher doses which can result in more side effects.

Takeaway Message

What you can take away from this information is that there are things you can do to lower cholesterol. Your next step is to decide which option is best for you.

If you would like any further information or help with dietary and lifestyle changes, please contact us.