What Causes High Cholesterol and How Can You Lower It?

Cholesterol has a bad reputation, but did you know that our bodies absolutely need it? It plays a vital role in many essential functions, including the production of testosterone and vitamin D. Problems arise when cholesterol levels exceed healthy limits.

When present in excess, cholesterol often accumulates in blood vessels, setting the stage for heart attacks, strokes, and other cardiovascular diseases—leading causes of death globally. To prevent or even reverse this unwanted buildup, it’s essential to care for your body. So, how can you keep your cholesterol levels in check? Let’s find out. ^[5]

What Is Cholesterol?

Cholesterol is a specific lipid that’s vital for our bodies—it plays a key role in many physiological processes. Surprisingly, most of the cholesterol in our system doesn’t come from food but is produced by our own bodies. Because cholesterol is so essential, the body ensures it meets its needs by producing about 70% of it, leaving only 30% to be sourced from our diet. However, when dietary cholesterol intake is too high, problems can arise, as we’ll explore further. ^[11]

Cholesterol is indispensable for the proper functioning of cell membranes, the production of hormones like testosterone and oestrogen, the synthesis of vitamin D, and the creation of bile acids that help digest fats. Under normal circumstances, the body self-regulates cholesterol production to meet its needs.

While our bodies produce cholesterol, we also get it from food, particularly animal products such as meat, dairy, and eggs. You won’t find cholesterol in plant-based foods, which is why many believe vegetarian diets are inherently healthier.

How Are Cholesterol Levels in the Body and Diet Linked?

Although we’re discussing the same substance, it’s important to understand how dietary cholesterol interacts with the cholesterol in our bodies. Cholesterol in the body is mainly produced by the liver, which creates exactly what the body needs. When cholesterol is consumed through food, its level in the blood can fluctuate, but not as dramatically as once thought.

In healthy individuals, the liver adjusts its production based on dietary intake. The more cholesterol we consume, the less the liver produces. However, this regulatory mechanism has its limits, and if dietary cholesterol is too high, the body can’t fully halt its own production, leading to an excess in the bloodstream. ^[11]

To fully grasp the importance of cholesterol, we need to introduce another key player—lipoproteins. Known as HDL (high-density lipoprotein) and LDL (low-density lipoprotein), these are compounds made of proteins and lipids (including cholesterol). They act as transportation systems that allow cholesterol to move through the body. Understanding their roles is crucial to maintaining good health. ^[8]

What Are LDL and HDL Cholesterol?

You’ve probably heard of LDL and HDL cholesterol. Although these lipoproteins carry more than just cholesterol, we often refer to them simply as “cholesterol” because they’re the main vehicles for this lipid in the body.

Think of lipoproteins as vehicles on a busy highway. LDL, often called “bad cholesterol,” functions like delivery vans, transporting cholesterol to tissues where it’s needed. However, if there’s too much LDL in the bloodstream, these vans can cause traffic jams, leading to cholesterol building up on artery walls. Smaller, denser LDL particles are especially problematic because they’re harder for the body to remove. ^[22]

On the other hand, HDL, the “good cholesterol,” acts as a cleanup crew. These vehicles collect excess cholesterol from the arteries and return it to the liver, where it’s processed and eliminated. With enough HDL in circulation, arteries stay clear, and traffic flows smoothly.

Joining the traffic chaos are other players – VLDL (very low-density lipoprotein) and triacylglycerols (TAG). VLDL can be thought of as tankers full of energy, with their primary role being to transport cholesterol and triacylglycerols (fats) that the body uses as an energy source or stores as reserves. Once this cargo is unloaded, VLDL transforms into LDL, which can contribute to elevated LDL levels. Similarly to cholesterol, we should also be cautious about high levels of triacylglycerols. When these levels are excessive, they promote the formation of LDL particles, leading to their accumulation in the arteries.

What’s the takeaway from this? Cholesterol itself isn’t the enemy. The key is to maintain a healthy balance between LDL, HDL, and VLDL to keep the “traffic” on your internal highways flowing smoothly. ^[2]

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Why Is There So Much Fuss About Cholesterol?

As we’ve mentioned, cholesterol is not the evil villain it’s often made out to be; it only becomes problematic when levels exceed healthy limits, especially in the case of LDL cholesterol. It’s this “bad” cholesterol that can trigger a chain of events leading to cardiovascular issues. High cholesterol levels mark the initial stage of conditions such as heart attack, stroke, or ischaemic diseases affecting the legs or heart (caused by insufficient blood supply to these muscles).

But how does this happen? An excess of LDL cholesterol begins to build up in the artery walls, leading to a condition called atherosclerosis. This is a chronic inflammatory disease in which lipids and other elements accumulate in the walls of the blood vessels, creating what are known as atherosclerotic plaques. When LDL cholesterol settles in the inner lining of the blood vessel (the endothelium), it undergoes oxidation and triggers inflammation. Immune cells, called macrophages, rush in to clean up the mess, but in doing so, they transform into foam cells.

These foam cells form plaques on the blood vessel walls—essentially blockages that gradually narrow the arteries and restrict blood flow. When blood flow becomes too restricted, serious complications, like a stroke, can occur. In a stroke, the brain doesn’t receive enough blood, depriving it of oxygen and glucose. ^[16]

The dangerous thing about atherosclerosis is that it often develops silently. Typical symptoms, like chest pressure, usually only appear when blood flow is blocked by 75%. For many people, a heart attack or stroke can come as a complete surprise. That’s why, if an acute issue occurs, it’s crucial to call for medical assistance immediately. In the hospital, doctors will try to reopen the blocked arteries to prevent permanent damage to the brain or heart. ^[2,20]

How to Determine Healthy Cholesterol Levels and What Counts as High?

Regular cholesterol checks are essential for maintaining a healthy heart and circulatory system. Blood tests, ideally carried out during regular check-ups with your GP, can reveal levels of total cholesterol, LDL, HDL, and triglycerides. Based on these four values, your doctor will assess whether your lipid profile is in a healthy range or needs attention.

It’s important to know all of these values. For instance, a high total cholesterol reading might alarm you, but if your LDL is within normal levels and your HDL is high, this could be perfectly fine.

Countries in the European Union follow guidelines set by the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for cholesterol evaluation.

Table: Optimal Blood Cholesterol Levels

	Criteria
Total Cholesterol	< 5 mmol/l
LDL Cholesterol	Very High Risk* < 1.4 mmol/l High Risk* < 1.8 mmol/l Moderate Risk* < 2.6 mmol/l Low Risk (Healthy Individuals)* < 3 mmol/l
HDL Cholesterol	> 1.0 mmol/l for men, > 1.2 mmol/l for women
Triglycerides	< 1,7 mmol/l

*The more severe a person’s cardiovascular issues, the stricter the LDL cholesterol target. A healthy individual can afford a higher level, whereas someone recovering from a heart attack will need stricter guidelines.

You might be wondering whether cholesterol levels vary by age or gender. The answer is that we don’t have cholesterol targets adjusted by age or gender. However, it’s common for older people to have higher LDL cholesterol levels, and men generally have higher levels than women. After menopause, women’s cholesterol levels tend to rise due to decreasing estrogen levels. Therefore, those affected should be particularly cautious and take care of their health and blood vessels. ^[21]

What Causes High Cholesterol?

You’ve likely come across advice suggesting that changing your diet can solve high cholesterol levels. While nutrition plays a critical role, cholesterol levels are also influenced by several other factors. Let’s take a closer look at what can contribute to high cholesterol levels in the blood.

1. Poor Nutrition

What you put on your plate has a significant impact on your blood cholesterol levels. A major culprit is the excessive intake of saturated and trans fats. These are often found in fatty meats, processed meats (like salami and bacon), and other highly processed foods. The latter is also rich in trans fats, which can raise LDL cholesterol. ^[15]

Sweets are another offender. Consuming excessive simple sugars and refined carbohydrates, such as those in sugary drinks and sweets, can stimulate the liver to produce more triglycerides. As previously discussed, these triglycerides interact with lipoproteins, contributing to higher LDL (“bad cholesterol”) levels and lower HDL (“good cholesterol”) levels. ^[15]

Additionally, a diet lacking in fibre or with excessive caloric intake can also lead to high cholesterol. For a long-term solution, it’s essential to take a comprehensive approach to your diet and gradually adopt healthier eating habits to effectively manage cholesterol levels.

2. Lack of Physical Activity

A sedentary lifestyle can be compared to neglecting the maintenance of a machine. Physical activity is essential for maintaining the body’s health, and without it, things can start to go wrong. Insufficient exercise reduces the liver’s ability to eliminate LDL cholesterol, allowing it to accumulate in blood vessels. At the same time, HDL cholesterol levels decrease.

Additionally, without regular movement, muscles cannot efficiently use triglycerides from the blood for energy. Researchers also believe that inactivity may reduce the activity of certain enzymes, such as lipoprotein lipase, which helps break down excessive lipids in the blood. This combination slows fat metabolism, promotes fat deposits in arteries, and increases the risk of atherosclerosis. ^[10,13,14]

Incorporating sports and daily physical activity into your routine should be a top priority if you want to stay healthy and fit.

3. Excess Weight and Obesity

Carrying excess body fat can disrupt cholesterol metabolism significantly. Think of the liver as a factory that processes fat and cholesterol, packaging them into VLDL particles for distribution throughout the body. When the body is overwhelmed with excessive fat released from fat tissue, the liver increases production. This results in too many VLDL particles, which eventually convert to LDL cholesterol. As we’ve discussed, excessive LDL levels can accumulate in arteries and set the stage for atherosclerosis. ^[7]

4. Smoking

The harmful effects of smoking extend beyond the lungs. Smoking also affects the blood vessels by by promoting an increase in LDL cholesterol and triglyceride levels while decreasing HDL cholesterol. It also damages blood vessel walls by triggering inflammation, leading to faster deterioration. Smoking further reduces the body’s antioxidant capacity, promoting oxidative stress and the formation of free radicals. LDL cholesterol is particularly vulnerable to oxidation, and once oxidised, it deposits in blood vessels, causing further damage. ^[6]

The good news? If you’re a smoker already, it doesn’t mean that you will have a high risk of cardiovascular problems forever. The risk of cardiovascular problems starts decreasing the moment you quit smoking. Positive effects can be observed as early as two months after quitting. ^[2,19]

5. Excessive Alcohol Consumption

Alcohol isn’t innocent either. Drinking increases blood triglyceride levels, which encourages the production of VLDL particles and their subsequent conversion to LDL cholesterol.

Alcohol also impairs liver function, which is vital for fat metabolism. Liver damage can lead to lipid build-up in the blood, further disrupting the lipid profile balance.

Minimising alcohol consumption—or better yet, avoiding it entirely—is an excellent way to maintain healthy cholesterol levels and reduce the risk of heart disease. ^[3]

6. Chronic Stress

Stress is an invisible enemy that quietly and gradually takes a toll on the body, including increasing blood cholesterol levels. Prolonged stress leads to higher production of cortisol and adrenaline—stress hormones that can stimulate the liver to produce more cholesterol.

Additionally, stress often triggers unhealthy habits, such as overeating, craving fatty or sugary foods, and consuming more alcohol, which further raises LDL cholesterol and triglyceride levels. ^[24]

It’s crucial not only to monitor cholesterol levels but also to manage stress effectively. Relaxation techniques, physical activity, and maintaining a healthy lifestyle are essential tools for combating stress.

7. Genetics

Some people may inherit high cholesterol through their genes. Genetics influence the function of enzymes and other components involved in cholesterol metabolism. For individuals with specific genetic variations, higher cholesterol levels can occur naturally, even in fit and healthy individuals with excellent lifestyles. ^[15]

One genetic disorder, familial hypercholesterolaemia, prevents the body from effectively breaking down LDL cholesterol, causing it to accumulate in the blood despite a healthy lifestyle. According to statistics, around 1 in 313 people in the general population have this condition, even without cardiovascular issues. In such cases, cholesterol-lowering medications are crucial. ^[12,26]

While genetic factors can play a role, high cholesterol is most often the result of an unhealthy lifestyle. Fortunately, adopting positive lifestyle changes can help keep cholesterol levels under control in most cases.

How to Lower High Cholesterol

High cholesterol can gradually undermine your health. Fortunately, there are proven ways to get these levels under control while also boosting HDL cholesterol. However, this isn’t about a miracle solution like a home remedy for “cleansing arteries,” a magical cholesterol-eating food, or a special tea to lower cholesterol. Instead, it’s about implementing genuine lifestyle changes. Every step towards lowering cholesterol counts, so let’s take a closer look at what you can do to support your health.

1. Revise Your Diet

Diet is often the root cause of high cholesterol, so start by re-evaluating your eating habits. A cholesterol-friendly diet should include foods that support healthy cholesterol levels while limiting those that increase it.

What Are the Key Principles of a Cholesterol-Lowering Diet?

• Limit saturated fats (SFA): Avoid fatty meats, processed meats, tropical fats such as coconut or palm oil, and high-fat treats like chocolate or creamy ice cream.
• Avoid trans fats: These are found in partially hydrogenated oils, commonly used in confectionery with chocolate coatings, baked goods with fillings or glazes, and some processed soy products.
• Replace saturated fats with monounsaturated fats (MUFA): Replacing even 1% of SFA with MUFA can reduce LDL cholesterol levels. Good sources include plant oils, nuts, nut butters, seeds, and avocados. ^[1]
• Increase polyunsaturated fats, including omega-3s: Your diet should therefore include fatty fish, as well as the previously mentioned plant-based oils, seeds, and nuts. Among plant sources, walnuts, chia seeds, and flaxseed oil stand out as particularly rich in omega-3s. ^[1,8]
• Do you want to better understand the differences between various types of fats and how they behave in the body? Find out more in the article Healthy and Unhealthy Fats: Which Foods to Eat and Which to Avoid?
• Add fibre to your meals: Soluble fibre forms a gel in the gut that binds to bile acids, which are essential for fat digestion. These bile acids are then unable to be reabsorbed into the bloodstream, prompting the liver to use cholesterol from the blood to produce new bile acids. Excellent sources of fibre include fruits, vegetables, whole grains, legumes, nuts, and seeds. Fibre supplements are also an option. Ideally, you should aim to consume 25–30 grams of fibre daily.
• Limit your intake of simple sugars and refined carbohydrates. Simple sugars are abundant in sweets, sugary drinks, juices, and other sweet treats. Refined carbohydrates are commonly found in products made from white flour, such as pastries (e.g., croissants) and confectionery items.
• Minimise alcohol consumption: Ideally, avoid alcohol altogether to maintain healthy cholesterol levels.

If you’re looking for more guidance, check out our article What Is Healthy Eating and How Can You Learn to Eat Healthily?

Are There Specific Foods That Lower Cholesterol?

When it comes to managing cholesterol, dietary changes work best when combined, creating a synergistic effect. However, some foods stand out for their unique composition and have an even stronger impact on reducing cholesterol levels. So, what foods are particularly effective at lowering cholesterol?

• Foods rich in phytosterols: Phytosterols are structurally similar to cholesterol and block its absorption in the gut. They are found in legumes, almonds, whole grains, and plant oils (like soy or olive oil). ^[17]
• Fermented red yeast rice: Known for monacolin K, a compound that works like lovastatin—a cholesterol-lowering medication—it inhibits the enzyme responsible for cholesterol production in the liver. ^[8]
• Oats and barley: These contain beta-glucans, a type of soluble fibre that reduces cholesterol absorption from food. ^[8]
• Black garlic: This ingredient shows promising cardiovascular benefits in studies. ^[4]

Which Foods Are Suitable or Unsuitable for Cholesterol?

Preferred Foods	Foods to Consume in Moderation	Unsuitable Foods
Whole grains (rye, barley, oats, millet, rice, etc.) Pseudocereals (quinoa, buckwheat, amaranth) Whole-grain products (whole-grain pasta, bread, oats, etc.) Vegetables Legumes Fruit Fish Poultry Low- and medium-fat dairy products	Products made from white flour (white bread, etc.) Dried fruit Lean red meat Eggs Oils	Confectionery Cakes, pastries Sugar-sweetened drinks High-fat cheeses Processed meats Fatty meat Margarines Coconut or palm fats

2. Be Physically Active

Exercise is one of your best allies for maintaining good health. The World Health Organisation (WHO) recommends regular physical activity, as it has been proven to lower mortality rates related to cardiovascular diseases.

• According to the WHO, a healthy person should engage in at least 150–300 minutes of moderate-intensity activities weekly. This equates to 2.5–5 hours of endurance exercises at a relaxed pace, such as walking, jogging, cycling, swimming, etc.
• Alternatively, this can be replaced with at least 75–150 minutes of high-intensity aerobic activities, which involve breaking a sweat and getting out of breath (faster running, cycling, interval training, etc.). Activities of varying intensity can, of course, be combined.
• Adults are also encouraged to include strength training as part of their routine. ^[25]

To specifically lower cholesterol, studies indicate that endurance activities and more intensive exercise deliver the best results. It’s beneficial to incorporate activities such as running, higher-intensity swimming, cycling, HIIT (e.g., TABATA), circuit training, and other vigorous sports into your workout plan are excellent choices. ^[23]

For optimal results, combine endurance sports, strength training, and high-intensity exercises. These support heart health, bone strength, and overall fitness. While WHO guidelines provide a minimum, exceeding them can yield even better outcomes. Additionally, incorporate natural daily movement, such as walking, and minimise sedentary time whenever possible.

3. Learn to Manage Stress

By learning to manage stress, you can benefit not only your heart and arteries but also your overall health. There are numerous techniques to reduce stress—choose what suits your lifestyle best.

• Engage in regular exercise and sports as effective stress-relief tools.
• Dedicate time to hobbies you enjoy, such as painting, reading, yoga, dancing, or any activity that brings you joy.
• Spend quality time with loved ones.
• Keep a journal.
• Try meditation or mindfulness practices.
• Consider adaptogens—supplements designed to help manage stress.

For more information on the effects of stress on health and tips for managing it, read our article Why Is Stress Dangerous and How to Reduce It?

4. Lose Weight if Overweight or Obese

If high cholesterol and excess weight are concerns, losing weight can make a significant difference. Research shows that losing just 5–10% of body weight can help reduce LDL cholesterol and triglycerides while increasing HDL cholesterol. For instance, if you weigh 90 kg, losing 4.5–9 kg can lead to noticeable improvements. ^[18]

If you’re aiming to lower your cholesterol, it can often go hand in hand with weight loss when you create the right caloric deficit. To assist with this, you can use our online energy intake and macronutrient calculator to determine the optimal balance of proteins, carbohydrates, and fats for your needs. Furthermore, our comprehensive guide to creating a personalised meal plan will help you structure your meals based on these calculations. Achieving weight loss is possible through proper nutrition alone, without the need to turn to medications like Ozempic, Wegovy, or similar weight-loss drugs.

Successful weight loss doesn’t just mean eating smaller portions. If you’re curious about all the aspects you need to consider for a weight-loss diet, don’t miss our article 15 Tips for Losing Weight, Starting to Exercise, and Eating Healthier.

5. Try Supplements

The foundation of any journey toward healthier cholesterol levels should be a change in lifestyle. For even better results, you can also explore nutritional supplements.

• Beta-glucans: Reduce cholesterol absorption from the digestive system, helping maintain normal cholesterol levels.
• Glucomannan: A type of fibre that, in doses of 4 g per day, helps regulate cholesterol.
• Chitosan: Another fibre with effects similar to glucomannan.
• Fermented red yeast rice extract: Contains monacolin K, a compound that acts like cholesterol-lowering medication.
• Omega-3 fatty acids: Widely recognised for their cardiovascular benefits. ^[9]
• Plant sterols and stanols, collectively known as phytosterols, are natural compounds that compete with cholesterol during absorption in the intestines. This process reduces cholesterol absorption and leads to a decrease in LDL cholesterol levels. ^[17]
• There are also natural remedies for managing cholesterol that combine multiple active ingredients and extracts. One such example is arterin.

Sample Meal Plan for Lowering Cholesterol

Here’s a sample one-day menu designed for a 30-year-old woman looking to lower cholesterol and lose weight. She exercises twice a week with strength training and goes for a run once a week. Her daily calorie intake is 1,800 kcal, divided into macronutrients: 128 g protein, 206 g carbohydrates, and 49 g fat.

Daily Menu	Foods
Breakfast	Oatmeal with chia seeds Oats (50 g) Whey protein (20 g) Apple (70 g) Raspberries (50 g) Chia seeds (10 g) Cinnamon
First Snack	Plain yoghurt with fruit Low-fat plain yoghurt (150 g) Blueberries (50 g) Buckwheat flakes (30 g)
Lunch	Baked salmon with quinoa and steamed vegetables Baked salmon (100 g) Quinoa (60 g) broccoli, carrot, courgette (200 g) Olive oil (1 tsp)
Afternoon Snack	Wholemeal bread with cottage cheese spread and avocado Wholemeal bread (50 g) Spread (40 g) Avocado (30 g) Cherry tomatoes (50 g)
Dinner	Chickpea and tofu salad Chickpeas (80 g, cooked) Vegetables – Cucumber, pepper, etc. (150 g) Salad mix (100 g) Tofu (70 g) Lemon juice and olive oil for dressing (1 tsp)

Of course, this single day is just an example of how a diet plan might look. Ultimately, it depends on each person’s individual preferences, what foods they include in their diet, and how many meals they choose to have each day. Additionally, the structure of the plan will vary depending on how elevated your cholesterol levels are. The higher the levels, the stricter the diet should be.

How Do Cholesterol-Lowering Medications Work?

High cholesterol is a serious health issue. If dietary changes, increased physical activity, and supplements fail to effectively manage cholesterol levels, a doctor may prescribe medication. There are several types of cholesterol-lowering drugs, each with a distinct mechanism of action aimed at addressing this condition effectively.

• Statins: Reduce cholesterol production in the liver, prompting it to draw more cholesterol from the blood. Examples include atorvastatin, simvastatin, and rosuvastatin.
• Cholesterol absorption inhibitors: Ezetimibe, for example, decreases cholesterol absorption from the gut.
• Fibrates: Lower triglyceride levels.
• Bile acid sequestrants: Reduce the reabsorption of bile acids from the intestine into the bloodstream. Since cholesterol is required for the production of bile acids, the body is forced to tap into its cholesterol reserves to create new bile acids, thereby lowering cholesterol levels in the blood.
• PCSK9 inhibitors: Increase LDL receptor activity in liver cells, promoting LDL cholesterol clearance. ^[8]

What Should You Remember?

Cholesterol isn’t your enemy but an essential player in the biochemical processes of our body. However, when its levels exceed the healthy range, it can cause significant trouble. To minimise the risks of atherosclerosis, heart attack, stroke, and other complications, we need to keep it under control. The key to maintaining healthy cholesterol levels lies in balancing your diet, exercise, stress management, and overall lifestyle. Nutritious meals, regular physical activity, stress control, and healthy habits can lower LDL cholesterol, raise HDL, and keep your blood vessels in good shape.

Don’t forget that prevention is always easier than solving problems later. Monitor your cholesterol levels regularly, work closely with your doctor, and incorporate small changes into your daily routine. Your heart will thank you – and you’ll feel better, healthier, and more energised.

Did this article inspire you to take better care of your body? Share it with friends and family to spread the knowledge.

Sources:

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