Cholesterol is fat that is found in our blood. Sometimes it’s called lipids. When we hear this word, we think of it building up in our arteries and contributing to long-term health problems, but cholesterol isn’t just a bad guy.
Healthy levels of cholesterol are vital for our cells to function and to make vitamin D and some hormones.
There are two main types – HDL or high-density lipoprotein (good cholesterol) and LDL or low-density lipoprotein (bad cholesterol). If the levels of your bad cholesterol become too high and the good cholesterol too low, you are at increased risk of developing cardiovascular complications (also known as CVD or heart disease).
There are also triglycerides (a combination of three fatty acids combined with glycerol, a form of glucose). These can have bad effects on your health if levels are high, too.
For many people, eating a healthy, balanced diet and being physically active is enough to keep cholesterol levels healthy. But if your bad cholesterol is high, most people need medication to lower it. And for people with diabetes, it is important that you have your levels checked every year. You can find out why it's important in our video.
Your risk of high cholesterol and how it is treated
Many people who have type 1 diabetes should be prescribed statin treatment for the primary prevention of heart disease. This means you may not have high cholesterol levels, but statins help to keep them in a healthy range and reduce the risk of heart disease.
Those people with type 1 diabetes who should be offered statins, regardless of their cholesterol levels, include:
- People older than 40 years
- Those who have had diabetes for more than 10 years
- Those with established kidney damage or other CVD risk factors
For people with type 2 diabetes, your overall CVD risk might be calculated using something called a QRISK calculator. Your healthcare team should explain what your risk of CVD is and how best to manage your blood fat levels. For primary prevention of CVD, people with type 2 diabetes who have a 10% or greater 10-year risk of developing CVD should be offered statins.
If you have high cholesterol levels, you should have a blood test to measure total cholesterol, HDL cholesterol and non-HDL cholesterol three months after starting statin treatment, with an aim of 40% reduction in non-HDL cholesterol. Ask your healthcare team what your individual targets are for your cholesterol levels.
Steps you can take to help manage your blood fats
- You should have your blood fat levels checked normally once per year. Things might be a bit different at the moment though. Read our information on what care to expect during the coronavirus pandemic.
- Ask for support to lose weight if you are living with obesity or overweight
- Eat a healthy diet based on more fruit and vegetables, nuts, oily fish and wholegrains. See our 10 tips for healthy eating with diabetes.
- Keep a check on how much alcohol you drink (even though evidence suggests that drinking alcohol in moderation can protect against heart disease, drinking an excessive amount can increase risk). Read more about alcohol and diabetes.
- If you smoke, get support to quit smoking
- Keep active and sit less. We have lots of advice on this in our article on exercise and diabetes.
Your GP can also refer you to a dietitian who can help. They will advise you to cut down on saturated fat and increase your intake of fibre.
There are natural foods you can eat to help protect your heart and products on the market that claim to lower your cholesterol – but do they work?
We looked into the best foods to eat and looked at the products you can buy.
Foods that help protect your heart
There is evidence that some foods can protect our heart, either by their effect on cholesterol, triglycerides or through other means. The way that you prepare all of these natural foods has a huge effect on your health. It’s better to boil, steam or grill them.
For example: herring, salmon, sardines and mackerel.
People with diabetes are recommended to eat two portions a week. They are good sources of omega-3 fats and have been shown to beneficial in the prevention and management of CVD. For ideas on how to cook with oily fish, visit our recipe finder. Good vegetarian and vegan sources of omega-3 fats include walnuts, linseeds, chia seeds, rapeseed or flaxseed oil.
Fruit and vegetables
Evidence shows that eating fruit and vegetables lowers risk of cardiovascular disease (CVD). They are low in saturated fat (many contain no fat at all), high in fibre and low in calories to help you manage your weight. Also, their phytochemicals (natural plant substances), vitamins, minerals and antioxidants help you maintain good health.
For example: walnuts, almonds and cashews.
Studies show that eating nuts more regularly can lower cholesterol, as well as your overall CVD risk. This is partly because, as well as unsaturated fats, nuts contain plant sterols and stanols, and are high in fibre. Opt for unsalted nuts.
For example: peas, beans, lentils, broccoli, apples, berries, prunes and sweet potato.
Wholegrains also contain good amounts of soluble fibre. This helps to regulate cholesterol.
Oats and barley
These are rich in a type of soluble fibre called beta-glucan, which forms a gel that binds cholesterol in the body, preventing it from being absorbed into the bloodstream.
Functional foods that lower cholesterol
‘Functional foods’ is a term used to describe foods or food ingredients with components that provide a specific health benefit beyond the basic nutritional value of normal foods. Many branded products claim to have health benefits, and some are scientifically proven to work.
Probiotics, for example, promote growth of healthy gut bacteria, while adding plant sterols and stanols in larger amounts than you find in natural foods can help reduce cholesterol.
Plant sterols/stanols are substances which are naturally found in small amounts in fruits, vegetables, nuts, and seeds. Research has shown that having 1.5–2.4g of plant sterols/stanols every day can lower cholesterol levels in two to three weeks. To work well, they need to be eaten regularly at meal times.
Clinical trials have also shown that sterols and stanols in fortified foods are effective in reducing cholesterol levels. Fortified foods are ones that have nutrients added to them to improve the nutritional content or help us avoid deficiencies (not having enough nutrients). Some fortified foods can become functional if a specified serving has a health benefit.
Sterols and stanols are also safe to use alongside medications such as statins or fibrates. However, even though they are proven to lower cholesterol, there is no data to say they directly reduce or prevent heart disease and stroke.
You should also be aware that:
- Some fortified foods may not be suitable for pregnant and breastfeeding women, or for children under five.
- Check with your doctor before using these products, especially if you are taking medication to help lower your cholesterol.
- If your particular medication works in the same way by reducing the amount of cholesterol you absorb, there may be no additional benefit. But, if your medication acts on liver cells to reduce cholesterol production, foods containing sterols or stanols may help. Check with your doctor.
Supermarket products with plant sterols or stanols
There are many products you can buy that contain plant sterols or stanols. They can be expensive, but supermarket own-brands may be cheaper. If you choose to buy them, check how much you need per day (i.e a serving) for them to be effective.
Here are some examples of what’s available:
This contains plant stanols that help to lower cholesterol when consumed daily. This is equal to one serving of Benecol yogurt drink or dairy-free drink per day or two to three servings of Benecol yogurt or spread.
This contains beta-glucan, a soluble oat fibre. It works by forming a gel that binds cholesterol-containing bile acid in the stomach and transports it out of the body. One serving provides 3g beta-glucan, which can help maintain normal blood cholesterol levels. Beta-glucan also slows down how your body absorbs carbohydrate. This will help you manage your blood glucose levels, offering an extra benefit to people with diabetes.
This contains plant sterols that help to lower cholesterol when consumed daily, for example one serving of milk (250ml) and/or three servings of spread, or just one mini drink.