How to lower your cholesterol
Cholesterol and Coeliac Disease:
Did you know that people with coeliac disease can have higher cholesterol? Studies have shown that people with coeliac disease need to take more care of their cholesterol than those who do not have coeliac disease 1. The reason for the increased risk is not fully understood yet, but it is suggested it could be due to a change in liver function. High cholesterol can increase your risk of having a heart attack or a stroke and so it is important to look after your cholesterol levels.
What is cholesterol?
‘Cholesterol’ and ‘high cholesterol’ are terms we have all heard, but what do they mean? Is cholesterol bad?
Cholesterol is a type of fat which is found in your blood. We need cholesterol to be healthy and your body makes all the cholesterol it needs in the liver. However, cholesterol is also found in, animal products, liver, eggs and some shellfish and so extra cholesterol sneaks into our bodies through our food. There are two different types of cholesterol high density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol 2.
What is good and bad cholesterol? (INDI, BHF, IHF)
The difference between HDL and LDL cholesterol is that one is good and one is bad. LDL cholesterol is known as ‘bad’ cholesterol. When LDL cholesterol it is found in high levels it will stick to the walls of our blood vessels and this is known as plaque2, 3. The build-up of plaque then means our blood vessels are narrower and so it is hard for blood to travel through them. This creates great pressure on the heart and can lead to serious issues such as blockages, stroke, cardiovascular disease or heart attack 2, 3. HDL cholesterol is our ‘good’ cholesterol. HDL is used for insulating nerve endings, production of hormones and making cell membranes, all of which are extremely important for our health 2. HDL (good) cholesterol also, takes LDL (bad) cholesterol from the blood stream and carries it to the liver where it can be processed, preventing LDL cholesterol building up as plaque 4. So, as you can see, not all cholesterol is bad.
Triglycerides are another fat which is found floating around in our blood stream. Again, triglycerides need to be kept in check, as high levels are not good for your health. Triglyceride levels are affected by consumption of high fat foods, alcohol, obesity, thyroid disease and underactive thyroid. High levels of triglycerides in the blood can also cause plaque to build up in the blood vessels. Omega-3 which is a healthy fatty acid found in oily fish can help to reduce triglycerides. Omga-3 can also be gotten from fish oil or EPA supplements.
What can raise my cholesterol?
There is an array of different factors which can affect someone’s cholesterol levels. Some of these factors are known as ‘modifiable risk factors’ and so they are lifestyle related, meaning we can change them to reduce our risk. However, there is also ‘non-modifiable risk factors’ which are out of our control. Some research has shown that individuals with coeliac disease have elevated cholesterol levels on diagnosis 1.
Modifiable risk factors: (BHF)
- A diet high in saturated fats: Saturated fat is found in animal products particularly red meat, processed products, cream, butter, pastries, cakes and biscuits. Excess consumption of these products can raise your cholesterol levels.
- Smoking: Smoking can cause an increase in LDL (bad) cholesterol levels.
- Overweight or obesity: Carrying extra weight increases the risks of high cholesterol as it changes how our bodies manage fat, which results in higher levels of LDL (bad) cholesterol and reduces HDL (good) cholesterol 5, 6. Excess weight also puts pressure on your heart.
- Lack of physical activity: Regular physical activity helps to increase HDL cholesterol and reduce the risk of developing high cholesterol 7.
Non-modifiable risk factors (BHF)
- Ethnicity: If you are African, African Caribbean or South Asian you are at a higher risk of high cholesterol compared to white Europeans, the reasoning is currently unknown but it is suggested that genetics have a role to play. (BHF)
- Gender: Women are typically at an increased risk of high cholesterol; however high cholesterol can still affect men 8.
- Age: as your age increases so does your risk of developing high cholesterol. This occurs because as you age the concentrations of LDL cholesterol increase in the body 9
- Familial Hypercholesterolaemia: This is a hereditary condition which results in individuals being born with high LDL cholesterol levels and they continue to rise as one ages. It affects about 1 in 250 individuals (Croi)
- Underactive thyroid / hypothyroidism: Under active thyroid can reduce the body’s ability to process LDL cholesterol as the body is not producing enough receptors to do the job 10. Underactive thyroid is often seen with coeliac disease so remember to get this checked yearly with your doctor.
- Kidney disease: kidney disease is associated with inflammation which can increase the level of LDL cholesterol which sticks within the arteries (DaVita).
- Liver disease: Higher cholesterol is seen in patients with liver disease due to impaired fat metabolism 11.
What should my cholesterol levels be to be healthy? (INDI)
Less than 5
LDL cholesterol (bad cholesterol)
Less than 3
HDL cholesterol (good cholesterol)
Between 1.1 – 1.5
These figures can vary depending on individual circumstances, for example if you have previously had a heart attack, have type 2 diabetes or have other risk factors for heart disease you may need to keep your LDL cholesterol lower than less than 5. Your doctor will advise you on your individual requirements.
Top tips to lower your cholesterol
- Maintain a healthy body weight.
- Quit smoking.
- Heart healthy diet:
Fibre: As I am sure you have heard over and over ‘eat more fibre’!!! Fibre is so important in the diet for a variety of reasons and one of them being its heart healthy properties and ability to reduce cholesterol. Gluten free high fibre cereal for breakfast or gluten free oats are a great way to kick start the day with some fibre. Gluten free wholegrain and high fibre breads are a great source of fibre to include for lunch. For dinner add gluten free wholegrain pasta or rice to your meals and some beans or lentils. These tips should help you hit your 30g/day. (INDI, Croi, NHS)
Fruit & vegetables: Fruits and vegetables are jam packed full of vitamins such as Vitamin C, minerals and antioxidants which all contribute to a healthy happy heart. Potassium found in bananas is great to help reduce blood pressure. Fruit and vegetables are naturally gluten free! Fruit and vegetables are handy snacks to chop up and eat raw, pairing your fruit with some yogurt or your vegetables with some hummus is a delicious way to meet your 5 a day. Adding fruit to your breakfast cereals or having a smoothie with lunch. Top smoothie tip is to add frozen fruits to create a delicious icy cold drink. With dinner making sure one third of your plate is nice a colourful with different vegetables will ensure you’re getting a good variety in each day. (INDI)
Reduce saturated fats: Saturated fats are the fat’s that you find in meat and animal products. An easy way to reduce your consumption is to cut off any visible fat from your meat, for example the rind on rashers, the fat on steaks and the skin on chicken. Limiting the consumption of butter and cream can also help to cut down the saturated fats in your diet. Remember, don’t cut out dairy such as yogurt, milk and cheese, to reduce saturated fats, as it is an important source of calcium for those strong bones. Choosing low fat cooking methods such as grilling, baking or boiling will cut down saturated fats as cooking oils and butter contain high levels of saturated fat.
Fish: Fish contains lots of lovely omega-3 fatty acids which are great for maintaining heart health. Fish is naturally gluten free and including it in your diet one or two days a week can reduce your risk of heart attack by 30%.
Plant Sterols & Stanols: Plant sterols and stanols are found in a wide variety of foods and help to reduce your cholesterol by blocking your body from absorbing cholesterol from foods. They are found naturally in plant food such as beans, lentils, cereals and nuts and are often added to yogurt drinks, yogurts and spreads. Although sterols and stanols are found naturally in lots of foods, the amounts are too small to lower cholesterol so you will need to look to food which have added sterols and stanols. Check the Coeliac Society Food List for gluten free options. Consuming 1.5-3g of plant sterols and stanols per day can reduce cholesterol by nearly 7-10%. (INDI, NHS)
- Physical Activity: Meeting the physical activity requirements for your age will help to keep your cholesterol at a healthy level. This is the minimum recommendation so feel free to do more! The more the merrier!
The guidelines for physical activity in Ireland are (HSE.ie/ Healthy Ireland)
- 2-12 years: 60 minutes of moderate to vigorous activity daily.
- 8-64 years: 30 minutes of moderate activity 5 days per week.
- 65+ years: 30 minutes of moderate activity 5 days per week, focusing on aerobic, muscle strengthening and balance exercises.
- Children & adults with a disability: Aim to be as active as your disability allows, aiming to meet the recommendations for your age group.
- Potter MDE, Brienesse SC, Walker MM, et al. Effect of the gluten‐free diet on cardiovascular risk factors in patients with coeliac disease: A systematic review. Journal of gastroenterology and hepatology 2018; 33: 781-791.
- Ma H and Shieh K-J. Cholesterol and human health. The Journal of American Science 2006; 2: 46-50.
- Houston DK, Ding J, Lee JS, et al. Dietary fat and cholesterol and risk of cardiovascular disease in older adults: the Health ABC Study. Nutrition, metabolism and cardiovascular diseases 2011; 21: 430-437.
- Barter P, Gotto AM, LaRosa JC, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. New England Journal of Medicine 2007; 357: 1301-1310.
- Klop B, Elte JWF and Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients 2013; 5: 1218-1240.
- Bogers RP, Bemelmans WJE, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Archives of internal medicine 2007; 167: 1720-1728.
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- Gupta R, Sharma M, Goyal NK, et al. Gender differences in 7 years trends in cholesterol lipoproteins and lipids in India: Insights from a hospital database. Indian journal of endocrinology and metabolism 2016; 20: 211.
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- Rizos CV, Elisaf MS and Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. The open cardiovascular medicine journal 2011; 5: 76.
- Ghadir MR, Riahin AA, Havaspour A, et al. The relationship between lipid profile and severity of liver damage in cirrhotic patients. Hepatitis monthly 2010; 10: 285.