Two-minute micro-walks and three cloves of garlic a day: The new rules for cholesterol control 

Cholesterol is a type of blood fat present in every cell in your body and is essential for making vitamin D and bile, which helps digest the fats you consume. Some cholesterol comes from food, but about 80% is made in the liver.

There are several types of cholesterol, but of the two main types, it is non-HDL (non-high-density lipoproteins, or LDL – low-density lipoproteins) often referred to as “bad” cholesterol, that delivers cholesterol to where it is needed and HDL, the “good” variety, that grabs and flushes out cholesterol from the body. When they work in harmony, cholesterol keeps the body healthy, but when non-HDL or LDL exceeds the amount HDL can remove, it begins to accumulate in the arteries and can lead to health problems.

Why our cholesterol levels rise is not straightforward, but the main risk factors remain smoking, inactivity, obesity, and poor diet with high consumption of saturated animal fat. Age and gender also affect the risk, with older women more prone to elevated levels. “Hormone changes mean that women’s levels of LDL cholesterol tend to rise in women after the menopause,” says Dr Angie Brown, medical director of the Irish Heart Foundation (IHF).

Some people are genetically more likely to have raised cholesterol and a condition called “familial hypocholesterolemia” (or FH). An inherited condition that causes exceptionally high cholesterol from birth and which cannot be controlled by diet and lifestyle changes alone, FH affects one in every 200-250 people in Ireland according to the IHF. True numbers are thought to be much higher as FH is poorly diagnosed and it could mean that at least 10,000 people in Ireland are affected.

While many people push cholesterol to the back of their minds, assuming it is a problem that can wait to be tackled until they are older, the Boston team suggest that careful management of cholesterol from early adulthood is important for lowering the risk of cardiovascular disease, type 2 diabetes and Alzheimer’s.

But how best to keep it in check? Here are the new rules for cholesterol control:

Have 2 tbsp of sesame seeds on porridge every day

“Oats rich in a fibre called beta-glucan that has been shown to have a favourable effect on cholesterol,” says dietitian Aveen Bannon. “We should try and eat oats every day for cholesterol lowering.”

Adding nuts and seeds will also be beneficial, Bannon says, as “they are great sources of omega-3 fatty acids that help to lower cholesterol too”.

Try sesame seeds as they contain iron, zinc, calcium, magnesium, and vitamin E, which are important for preventing furring of the arteries. The seeds are also a source of soluble fibre and alpha-linolenic acid, both known to lower total cholesterol, and of compounds called sesamin and sesamolin associated with reducing blood lipid and cholesterol levels. In a study published in the International Journal of Food Science and Nutrition, people with raised cholesterol who consumed between 25-50g (2-3 tbsp) of sesame seeds daily for up to two months effectively reduced their total cholesterol and triglyceride levels.

Eat blueberries daily

“Increasing your intake of fruit and vegetables provides valuable fibre essential for cholesterol lowering,” Bannon says.

Blueberries are packed with heart-healthy fibre and anthocyanin flavonoids, which give the fruit their purple hue and have potent heart health properties. In a report in the American Journal of Clinical Nutrition, researchers showed how eating 150g of blueberries every day for six months improved cholesterol levels in people with metabolic syndrome, a cluster of symptoms that includes high blood pressure and high cholesterol.

“We showed that blueberries improved the concentration of lipids and lipoproteins, which are thought to scavenge harmful fats from the system, including the blood vessel walls,” says Aedin Cassidy, a professor in the school of biological sciences at Queen’s University in Belfast. “The berries also seem to help relax tissues around the arteries, also helping with heart health.”

Take two-minute micro walks and one 30-minute walk every day

Aerobic activity – walking, jogging, and cycling – significantly impacts cholesterol levels. It helps raise HDL, the good cholesterol that removes fat from the arteries, and lower LDL, the bad cholesterol. We should aim to meet at least the current recommendations of 150 minutes of moderate cardiovascular activity or 75 minutes of vigorous exercise each week.

If you can’t manage that, breaking up periods of sitting with regular micro-walks will help. Researchers from the University of Otago in New Zealand showed how breaking up the working day with regular two-minute walks while also completing one half-hour walk each day can significantly lower blood lipid or fat levels. “This approach, if maintained over months or years, may be enough to explain why individuals who regularly break up sedentary time have better cardio-metabolic health outcomes,” they reported in the Journal of Clinical Lipidology.

Weight train at least once a week

Emerging evidence, including a review published in the Journal of Physical Activity and Health, suggests that lifting weights and doing resistance exercises using your bodyweight – squats, planks, and lunges – helps decrease cholesterol and blood fat levels. An hour-long session once a week might be enough to make a difference.

A group of 65-year olds had lower cholesterol when they did one strength session a week for nine months, researchers at the University of Jyväskylä in Finland discovered. In each session, they performed two to five sets and four to 12 repetitions of whole-body strength exercises with around seven to nine exercises per session. But more weekly sessions led to no greater improvement in cholesterol lowering.

“We found that individuals who were close to having high blood pressure, high cholesterol, high blood glucose, or high levels of inflammation improved the most after our nine-month training programme,” says Dr Simon Walker, a researcher in sport and health sciences and lead author of the paper.

Switch to olive or rapeseed oil

Replacing saturated fats found in butter and lard with olive or rapeseed oils remains an important step in the fight against cholesterol. “Replacing saturated fats with monounsaturated fats –the type found mostly plant foods – has a very positive effect on lowering blood cholesterol,” Bannon says.

Last year a team of Harvard nutritionists who reported their findings in the Journal of the American College of Cardiology showed that substituting just over two teaspoons (10g) of butter, margarine, and mayonnaise with olive oil was associated with up to a 34% lower risk of death caused by heart disease compared with those who didn’t make the switch.

Olive and rapeseed oil contain monounsaturated fatty acids known to be beneficial for cholesterol.

Maintain a healthy weight

Bannon says that maintaining a healthy weight is “very important” for cholesterol control. When weight increases, cholesterol production also increases, pushing blood cholesterol even higher.

Losing just 10 % of excess body weight (around a stone for many people) can help lower your cholesterol and triglyceride (another type of blood fat) levels, as well as reduce your blood pressure and risk of type 2 diabetes – all risk factors for heart disease, studies have shown.

Consume three cloves of garlic and 1 tbsp of lemon juice a day

Garlic is known to affect blood lipid levels when consumed regularly. “Crush a clove of garlic and allow it to sit for 20 minutes before use so that the enzyme alliinase interacts with the cysteine compound alliin to produce allicin that enhances the potency in respect of reducing cholesterol,” says nutrition therapist Ian Marber.

Adding lemon juice, also shown in some studies to have cholesterol-lowering benefits thanks to the high levels of polyphenol plant compounds it contains, might help, according to one group of researchers. Reporting in the International Journal of Preventive Medicine, they gave one group of study participants 20g of crushed garlic (about 4 tsp or three crushed cloves) and 1 tbsp of lemon juice daily, another ate just 20g of garlic, a third group consumed just 1 tbsp of lemon juice and a control group consumed neither garlic nor lemon juice. Results showed that non-HDL cholesterol dropped by an average 30 milligrams per decilitre (mg/dL) and total cholesterol by 41 mg/dL in those who had the garlic and lemon combination.

What about statins and drugs?

The Irish Longitudinal Study on Ageing (Tilda), conducted between 2009 and 2011, estimated that one-third of Irish adults in the over-50 age group were taking statins. These drugs work by slowing down the production of cholesterol in your liver, thereby lowering LDL cholesterol. Other types of cholesterol-lowering medications work by preventing the intestines from absorbing cholesterol either from food or bile acids and can be as effective as statins for some people.

Diet and lifestyle habits remain the absolute first step in the fight against spiralling cholesterol, says the IHF. But for people with FH, such medication is often essential and statins are often effective in secondary prevention following a first stroke or heart attack and for patients with a significant risk of developing cardiovascular disease such as those with diabetes, says Dr Brown.

There’s less evidence that statins are beneficial in patients over 80 years of age. However, in one of the few clinical trials conducted in 2020 on older people, geriatricians at Brigham and Women’s Hospital in Boston, Massachusetts, analysed data on more than 300,000 Americans aged at least 75 and found that those taking statins were 25% less likely to die from any cause and that the drugs lowered the risk of having a stroke or heart attack by a fifth.