How to Lower Cholesterol: The Swaps That Count and the Myths to Drop.
A blood test comes back with cholesterol flagged as raised, and a common first response is to cut out eggs, swap butter for a low fat spread and fill the fridge with light yoghurts. It feels like the sensible thing to do. Yet the next result can come back unchanged, or higher.
October is National Cholesterol Month, and this year HEART UK’s message is “Cholesterol Matters. Every Swap Counts.” The principle is sound: small changes to food and movement add up over time. The difficulty is that some of the most familiar swaps are based on advice the research no longer supports. This article covers what cholesterol is, two myths worth letting go of, five swaps that help lower cholesterol along with the reasons they work, and the other causes of raised cholesterol to discuss with your GP.
What Is Cholesterol?
Cholesterol is a waxy, fat like substance, and the body cannot function without it. It is used to build the wall of every cell, to make hormones such as oestrogen, testosterone and cortisol, and to produce the bile that digests fat.
It matters so much that the body does not leave the supply to chance. It makes around three quarters of what it needs, most of it in the liver. The rest comes from food.
Fat and water don’t mix, and blood is water based, so cholesterol travels around the body inside tiny parcels. Two of them matter here:
LDL is the delivery service. It carries cholesterol from the liver out to the cells that need it. When there are more LDL particles in the blood than the cells can use, LDL can pass into the lining of the artery walls, become trapped and build up there over time, forming the fatty deposits known as plaque. This is why LDL is the type linked to heart disease.
HDL is the collection service. It picks up spare cholesterol, including cholesterol from artery walls, and takes it back to the liver to be recycled or removed.
What Are Triglycerides?
Triglycerides are the main type of fat in the body and the form in which it stores spare energy. When food provides more energy than the body needs, the liver turns the surplus into triglycerides. Sugar, refined starch and alcohol drive this process most.
Triglycerides travel through the blood in the same way as cholesterol, inside tiny parcels made by the liver. The parcel that carries them out of the liver is called VLDL (very low density lipoprotein). It leaves the liver full of triglycerides, with some cholesterol on board as well.
As it travels around the body, it delivers its load:
Muscles take some of the triglycerides to burn for energy.
Fat cells take the rest to store.
With the triglycerides delivered, the parcel is smaller and what remains inside is mostly cholesterol. At this point, it has become LDL.
LDL is what VLDL becomes once it has delivered its triglycerides. The more triglycerides the liver makes, the more VLDL it sends out, and the more LDL ends up in the blood.
This is why raised triglycerides and raised LDL often appear on the same blood test result, and why several of the swaps below focus on bringing triglycerides down.
Common Myths About Cholesterol
Myth One: Eating Fat Gives You High Cholesterol
For decades, the standard advice for lowering cholesterol was to eat less fat. When that advice was put to the test in large, long term studies, cutting fat did not reduce heart disease or stroke. Diets highest in carbohydrate, on the other hand, were linked to poorer outcomes.
The reason comes back to the liver. When fat is taken out of a diet, sugar and starch tend to take its place, and the liver turns that surplus into triglycerides.
The type of fat matters more than the amount. Olive oil, nuts, seeds, avocado and oily fish support healthy cholesterol. The fats to limit are those found in processed food, such as pastries, biscuits, processed meats and deep fried food, which raise LDL.
Myth Two: Eggs Raise Your Cholesterol
Egg yolks are rich in cholesterol, so for years egg intake was restricted. That advice overlooked how the body regulates its own supply.
When more cholesterol comes in from food, the liver makes less and the gut absorbs less. In healthy adults, the cholesterol in an egg has little effect on the cholesterol in the blood, and long term research has found that an egg a day is not linked to a higher risk of heart disease or stroke.
Eggs are also a good source of protein, vitamin B12 and choline.
There are exceptions. Some adults are more sensitive to cholesterol from food, and anyone with familial hypercholesterolaemia, explained further down, should follow the advice of their specialist team on eggs.
Myth Three: All Cholesterol Is Bad
Cholesterol has a poor reputation, yet without it the body could not build cells, make hormones or digest fat. The harm comes not from cholesterol itself but from where it ends up.
LDL becomes a problem when there is more of it in the blood than the cells can use, and it builds up in the artery walls. HDL does the opposite, collecting spare cholesterol and returning it to the liver, which is why a higher HDL level is protective.
This is also why a single total cholesterol figure can be misleading. A total made up of plenty of HDL tells a very different story to one made up of high LDL and triglycerides. The breakdown matters more than the headline number.
Myth Four: Low Fat Products Are the Healthier Choice
“Low fat” on a label suggests a heart healthy choice. Removing fat from a food changes its taste and texture, though, and sugar, starch or thickeners are often added to make up for it. Low fat yoghurts, dressings, ready meals and cereal bars can contain more sugar than their full fat versions.
That extra sugar reaches the liver, which turns the surplus into triglycerides, the starting point for more LDL. A low fat product can work against the very thing it was chosen to help.
The natural fats in foods such as plain full fat yoghurt, olive oil and nuts also help meals feel more satisfying, which makes reaching for a snack an hour later less likely.
Myth Five: Only People Who Are Overweight Get High Cholesterol
Body weight is a poor guide to what is happening in the blood. Several causes of raised cholesterol, including an inherited condition, an underactive thyroid and menopause, have nothing to do with size.
Where fat is stored matters too. Fat stored deep inside the abdomen, around the liver and other organs, behaves differently from the fat that sits under the skin. It is closely linked to insulin resistance and raised triglycerides, and it can be present in someone whose weight sits within the healthy range.
A diet high in sugar, refined starch and alcohol can also raise triglycerides and LDL without any change on the scales. The only way to know your cholesterol level is a blood test, whatever your size.
Myth Six: High Cholesterol Is Always Caused by Diet
Food is one influence among several. When habits are already good and cholesterol remains raised, one of the following may be contributing.
Blood Sugar and Insulin
When the body takes in more sugar and refined starch than it can use, blood sugar rises and insulin is released to bring it down. Over time, cells can become less responsive to insulin, so the body produces more of it. This is known as insulin resistance.
High insulin signals the liver to turn spare sugar into fat. Triglycerides rise, HDL falls, and LDL particles become smaller and denser, a form that enters artery walls with greater ease.
This is why raised cholesterol, raised blood sugar and weight around the middle often appear together.
An Underactive Thyroid
Thyroid hormone sets the pace of metabolism, including how fast the liver removes LDL from the blood. When the thyroid is underactive, removal slows and LDL builds up.
Raised cholesterol can be an early sign, alongside:
Tiredness
Feeling the cold
Constipation
Dry skin
Weight gain
These are worth mentioning to your GP.
Menopause and Cholesterol
Oestrogen helps the liver clear LDL from the blood. As oestrogen falls, that clearance slows, and research tracking women through midlife has found that LDL rises in the year either side of the final period, linked to menopause rather than age.
This is why cholesterol can rise at this stage of life with no change in diet or weight. It reflects a change in physiology, not a lack of effort.
Family History
Around 1 in 250 people inherit a gene that stops the liver clearing LDL as it should. The condition is called familial hypercholesterolaemia, or FH, and it means LDL is high from childhood, regardless of diet or lifestyle.
The strongest clue is a parent, brother or sister with high cholesterol or heart disease before the age of 60. Your GP can arrange an assessment. Medication is the main treatment for FH, and food supports it.
Some medicines, kidney and liver conditions, and smoking also affect cholesterol, which is why your GP is the right person to review the full picture.
Five Swaps That Help Lower Cholesterol
Where diet and lifestyle are part of the picture, each of these swaps addresses the process behind raised cholesterol, not the number alone.
1. Swap the Scroll for a Stroll
This is HEART UK’s own challenge for October: trade some screen time for walking, with a target of 50, 100 or 150 miles across the month.
When muscles work, they draw triglycerides out of the blood to use as fuel. Regular walking also gives HDL, the collection service, a modest boost.
The benefit begins at around two hours of walking a week, and the length of each walk matters more than the pace. A longer walk does more than a short, fast one.
2. Swap Fruit Juice for Whole Fruit
A glass of fruit juice contains the sugar from several pieces of fruit with the fibre removed. That sugar reaches the liver fast, and what the liver cannot store, it turns into triglycerides.
The fibre in whole fruit slows the release of sugar, which is why whole fruit is linked to a lower risk of type 2 diabetes while a daily glass of juice is linked to a higher one.
3. Swap the Low Fat Version for the Original
As Myth Three explains, low fat versions can contain more sugar than the originals. Read the ingredients list as well as the front of the pack, and choose plain yoghurt over flavoured.
4. Swap the Afternoon Biscuit for a Handful of Nuts
Nuts contain plant sterols, natural compounds so similar in shape to cholesterol that they compete with it for absorption in the gut. As a result, less cholesterol is absorbed into the blood, and regular nut eaters have a lower risk of heart disease.
A handful is around 30g, and unsalted is best.
5. Swap a Weeknight Drink for an Alcohol Free One
The liver deals with alcohol before anything else. While it does, it stops burning fat and turns part of the alcohol into new fat. That fat leaves the liver as triglycerides and enters the blood, where part of it goes on to become LDL.
For anyone taking part in Sober October, this is the process the liver is being given a break from.
How to Lower Cholesterol: Where to Start
Choose the swap that fits your own day and begin there. One change kept is worth more than five dropped by November.
If cholesterol is raised and habits are already good, talk to your GP about the causes in Myth Six. Lifestyle and medical care work best together.
A raised cholesterol result is information, not a verdict. Understanding what is driving it is the first step towards changing it.
Your Cholesterol Questions Answered
What is a healthy cholesterol level? In the UK, cholesterol is measured in millimoles per litre, shown as mmol/L. As a general guide, the NHS suggests total cholesterol of 5 or below, LDL of 3 or below, HDL of 1 or above for men and 1.2 or above for women, and triglycerides of 2.3 or below. Your GP will interpret your results alongside your overall risk, including blood pressure, smoking and family history.
Does a cholesterol test include triglycerides? A full cholesterol test, sometimes called a lipid profile, usually reports total cholesterol, LDL, HDL, non HDL cholesterol and triglycerides. If your results only show a total figure, it is worth asking your GP for the breakdown.
Can I eat eggs if my cholesterol is high? For healthy adults, an egg a day is not linked to a higher risk of heart disease or stroke. Anyone with familial hypercholesterolaemia, or who has been told they are sensitive to cholesterol from food, should follow the advice of their GP or specialist team.
Why has my cholesterol gone up during menopause when nothing else has changed?
Falling oestrogen slows the liver’s clearance of LDL, so cholesterol can rise around menopause even when diet and weight stay the same.
Can food changes lower cholesterol without medication?Where raised cholesterol is driven by blood sugar, diet, alcohol or inactivity, the swaps above address those causes directly. Where it is inherited, as with FH, medication is the main treatment and food supports it. Any decision about medication should be made with your GP.
Talk It Through
If a blood test has shown raised cholesterol and the reason isn’t clear, a free 30 minute health chat is a relaxed, judgement free space to talk through your results and symptoms and see whether nutritional therapy could help. Everyone is individual, and that is where the conversation starts.
Book your free 30 minute health chat by clicking the button below:
References
HEART UK. National Cholesterol Month 2026.
NHS. High cholesterol: cholesterol levels.
Lecerf JM, de Lorgeril M. Dietary cholesterol: from physiology to cardiovascular risk. British Journal of Nutrition, 2011.
Howard BV, et al. Low fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative. JAMA, 2006.
Dehghan M, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries (PURE). The Lancet, 2017.
Mozaffarian D, et al. Trans fatty acids and cardiovascular disease. New England Journal of Medicine, 2006.
Drouin-Chartier JP, et al. Egg consumption and risk of cardiovascular disease. BMJ, 2020.
Kodama S, et al. Effect of aerobic exercise training on serum levels of high density lipoprotein cholesterol. Archives of Internal Medicine, 2007.
Muraki I, et al. Fruit consumption and risk of type 2 diabetes. BMJ, 2013.
Te Morenga LA, et al. Dietary sugars and cardiometabolic risk. American Journal of Clinical Nutrition, 2014.
Nguyen PK, et al. A systematic comparison of sugar content in low fat vs regular versions of food. Nutrition and Diabetes, 2016.
Guasch-Ferré M, et al. Nut consumption and risk of cardiovascular disease. Journal of the American College of Cardiology, 2017.
Klop B, et al. Alcohol and plasma triglycerides. Current Opinion in Lipidology, 2013.
Adiels M, et al. Overproduction of very low density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular Biology, 2008.
Duntas LH. Thyroid disease and lipids. Thyroid, 2002.
Matthews KA, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? Journal of the American College of Cardiology, 2009.
Akioyamen LE, et al. Estimating the prevalence of heterozygous familial hypercholesterolaemia. BMJ Open, 2017.
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