What is the difference between LDL and HDL cholesterol, and what are the recommended levels? Also, how do you bring cholesterol under control naturally? The Department of Dietetics from Singapore General Hospital (SGH), answers these questions and more!
High cholesterol? Don't worry (too much)!
If you have been told that your cholesterol is high, we are here to help! Unfortunately, there is no 'instant' and quick solution, but you can get there with a little effort. Simply making minor lifestyle changes can go a long way towards lowering your cholesterol levels.
“By cutting back on unhealthy fats and replacing these with ‘healthier options’, and eating more fibre-rich foods, many people see a drop in their cholesterol levels and may be able to avoid taking cholesterol-lowering medication,” advises the
Department of Dietetics from Singapore General Hospital (SGH), a member of the
What is cholesterol?
Cholesterol is a fat-like substance that your body naturally produces. It’s needed for a variety of functions, including the formation of cell membranes and production of certain hormones, vitamin D and bile acids. Our liver produces most of the cholesterol found in our body; the rest of the cholesterol is contributed by the foods we eat. Dietary cholesterol comes only from foods of animal origin, such as the liver and other organ meats; egg yolks (but not the whites, which have no cholesterol); some types of seafood such as fish roe, squid and prawns; and whole milk dairy products, including butter, cream, and cheese.
You can have an excess of cholesterol if your body makes more than it needs, or if there is too much cholesterol in your diet (as your body doesn’t adjust its own production accordingly).
TLDR ; LDL is bad, HDL is good!
Lipids (fat) such as cholesterol are insoluble in water and therefore carried throughout the body by special proteins called lipoproteins. There are two types of lipoproteins, which are commonly known as low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
LDL: LDL brings the cholesterol to where it’s needed in the body. However, if there’s an excess of LDL cholesterol in the bloodstream, it gets deposited on the walls of arteries, creating a build-up known as plaque (a condition known as
Over time, this build-up of plaque causes the arteries to narrow and can result in a
heart attack or
stroke if the blood flow to the heart or brain gets cut-off. That’s why LDL-cholesterol is called the ‘bad’ cholesterol.
HDL: HDL is called the ‘good’ cholesterol because it carries excess cholesterol circulating in the bloodstream back to the liver where it is broken down and eliminated. A high level of HDL-cholesterol lowers your risk of developing plaque in your arteries and protects you against heart disease and stroke.
Singapore’s Health Promotion Board (HPB) recommends the following cholesterol levels as optimal for both men and women:
Less than 200 milligrams per deciliter (mg/dL) or 5.2 mmol/L
Less than 130 mg/dL or 3.3 mmol/L
Greater than 40 mg/dL or 1.0 mmol/L
Check out this article on how to
improve cholesterol levels with food and what to avoid.
Causes of unhealthy cholesterol levels
Various factors can cause unhealthy cholesterol levels:
Tips to lower cholesterol
Your doctor may prescribe cholesterol-lowering medication, but before it comes to that, simply modify your lifestyle and diet! This includes maintaining a healthy weight through exercise and having a healthy balanced diet.
Did someone say 'lower cholesterol naturally'? Well, here are some tips that can help!
Keep total fat intake between 25% to 35% of calories for adults, with most fats coming from sources of polyunsaturated and monounsaturated fats.
no more than 5 to 6 per cent of calories from saturated fats and
no more than 300mg cholesterol per day.
trans fat consumption minimal, <1% of your daily energy intake.
When it comes to meat, poultry, dry beans, and dairy products, make choices that are lean, low fat or fat-free.
Choose fish, skinless poultry and lean meat.
Aim for at least ‘2+2’ – 2 servings of fruits and 2 servings of vegetables per day. Foods high in fibre, e.g. plant foods and whole grains, can help reduce your risk of heart disease.
Additionally, foods that are rich in soluble fibre, e.g. oats, barley, beans and pectin-rich fruit may help to reduce cholesterol in the body, hence lowering your risk of heart disease.
Maintain a healthy body weight. Being overweight or obese increases your chances of having a low HDL-C (good cholesterol), a high LDL-C (bad cholesterol) and high triglycerides*.
Triglycerides*, which are produced in the liver, are another type of fat found in the blood and in food. Increased levels of triglycerides in the blood may be due to being overweight/obese, sedentary lifestyles, cigarette smoking, excess alcohol intake, and a diet very high in carbohydrates (60 per cent of calories or higher). For tips on how to lower triglycerides, read this
Exercise regularly – aim for 150 minutes of physical activity each week. Regular physical activity can help you manage your weight and therefore help lower your LDL-C (bad cholesterol) and triglycerides, and raise HDL-C (good cholesterol), improve the fitness of your heart and lungs, and lower blood pressure.
Here are some exercises you can try.
Stop smoking (if you haven't) as smoking raises triglycerides and lowers HDL-C (good cholesterol).
Avoid alcohol. However if you are planning to drink, restrict alcohol intake to no more than 2 standard drinks for men and 1 standard drink for women in a day.
Tell me more about cholesterol and food!
We cannot emphasize enough on the link between food and cholesterol, so here is more in-depth reading for your knowledge...because knowledge is power!
1. Cut back on cholesterol-rich foods, saturated fats and trans fats.
Cholesterol is found in foods of animal origin such as meat and poultry. The following foods are especially rich in cholesterol: organs/offal, egg yolks and shellfish.
Saturated fats can be found in foods like full cream versions of dairy products, butter, coconut milk/oil, palm oil, poultry skin and animal fats like ghee and lard. This group of fats can increase the levels of LDL-cholesterol in our body.
Trans fats present in store-bought cookies, cakes, doughnuts, crackers, margarine, shortening and fried foods also raise LDL-cholesterol levels. Fast food chains often use hydrogenated oils that contain trans fats.
2. Opt for ‘healthier’ fats and oils instead.
‘Good’ fats generally refer to monounsaturated fats, polyunsaturated fats and omega-3 fats. These are considered ‘good’ because they seem to lower LDL-cholesterol levels. However, you need to stay mindful of the calories. Too much fat, even good fat, will still provide excess calories!
Sources of monounsaturated fat include some vegetable oils such as olive oil, canola oil, nuts like almonds and cashews, and avocados. Polyunsaturated fats can be found in vegetable oils like soybean oil, sunflower oil and corn oil. They are also present in walnuts and sunflower seeds. Omega-3 fats can be found in salmon, sardines and mackerel. Some food products like bread and eggs are enriched or fortified with omega-3 as well.
3. Increase your consumption of fibre-rich foods.
You can improve your cholesterol profile by having a balanced diet that includes adequate amounts of dietary fibre. There are namely two types of fibre, soluble and insoluble. HPB Singapore recommends a daily intake of 20g a day of dietary fibre for women and 26g a day for men. Fibre, particularly soluble fibre, is beneficial because it binds excess cholesterol and eliminates it from the body through waste.
Both soluble and insoluble fibre can be found in grains, lentils, legumes, fruits and vegetables. Examples of sources of fibre are oats, brown rice, kidney beans, peas, apples, bananas and spinach. A good way of including more fibre in your diet is to have the whole fruit with the skin on, such as apples and grapes.
4. Consider including some foods fortified with sterols and stanols.
Stanols and sterols are plant compounds found naturally in some vegetable oils, nuts, grains, legumes, fruits and vegetables. They can help lower LDL-cholesterol levels by interfering with cholesterol absorption in the body. In Singapore, you can find them in some fortified food products such as milk and margarine.
Additional food tips for managing cholesterol
As with all foods, moderation is important when it comes to the consumption of cholesterol-lowering foods, particularly vegetable oils, nuts and seeds. Although healthy, such foods can be high in calories, as they contain fats.
To reduce calorie intake, use healthier cooking methods such as baking and grilling instead of deep-frying. Alternatively, try to opt for lower fat versions of foods like yogurt, milk and cheese. Need tips on how to cook healthy?
Read our companion article
Check out other articles on cholesterol:
Slim but with High Cholesterol, is it Possible?
Exercises to Lower Bad Cholesterol (and Increase the Good)
Can Plant Sterols Lower Bad Cholesterol?
Cholesterol Meds: Alternatives to Statins