Cholesterol is fat that is found in our blood. Sometimes it’s called blood fats or lipids. When you hear the word 'cholesterol' you might think of cholesterol 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 the cells in our bodies 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 is also another type of blood fat called triglycerides (a combination of three fatty acids combined with glycerol, a form of glucose). If you have high levels of triglycerides this can have bad effects on your health, 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.
For people with diabetes, it is important that you have your levels checked every year. It's one of your annual diabetes health checks. You can find out why it's important to have your cholesterol levels checked in our video.
Your risk of high cholesterol and how it is treated
Type 2 diabetes
If you live with type 2 diabetes and you are aged between 25-84 years, then you should have your cardiovascular risk assessed using something called a QRISK calculator.
Your doctor or nurse should explain your level of cardiovascular risk and how best to manage it.
If you live with type 2 diabetes then you should be offered a statin for the primary prevention of CVD if you have a 10-year QRISK3 score of 10% or more.
Some people with a QRISK3 score of less than 10% may also be offered a statin for primary prevention. People aged 85 and older should also be considered for treatment with a statin, on an individual basis.
Type 1 diabetes
If you live with type 1 diabetes then you are considered to be at high risk of cardiovascular disease.
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.
If you live with type 1 diabetes then you o should be offered statins, regardless of yours cholesterol levels, based on this criteria:
- If you are 40 years old or older
- If you have lived with type 1 diabetes for more than 10 years
- If you have established kidney damage or other CVD risk factors
People aged 18 to 40 with type 1 diabetes, including those who have had diabetes for 10 years or less, should still be considered for statins.
All people with diabetes and chronic kidney disease should be considered for statin treatment.
How statin treatment works
To reduce your risk of developing cardiovascular disease, aim for a greater than 40% reduction in non-HDL cholesterol.
After starting statins, you should have blood tests to check lipids and liver function at 2 to 3 months. Lipids should then be checked as part of your annual diabetes health checks and liver function should be repeated at 12 months.
People who have cardiovascular disease and are taking statins (secondary prevention) should aim for low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less.
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.
- 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.
- Reduce 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.
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.
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.
Oily fish
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.
Nuts
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. Choose unsalted nuts.
Read more about healthy snacks for people with diabetes.
Soluble fibre
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
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, you need to eat them regularly with meals.
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 you take a particular medication that 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 (this might be one serving) for them to be effective.
Here are some examples of what’s available:
Benecol
This contains plant stanols that help to lower cholesterol when consumed daily. This is equal to one serving of Benecol yoghurt drink or dairy-free drink per day, one serving of Benecol yoghurt or three servings of Benecol spread.
Flora pro.activ
This contains plant sterols that help to lower cholesterol when consumed daily, three servings of spread, is recommended.
