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Want to balance your cholesterol? Consider these gut health strategies

4 March 2024

By The Gut Health Doctor Team

Dr Megan Rossi in a lab looking through a microscope

You’ve probably heard a lot about cholesterol and its negative impact on cardiovascular health. There’s no question it can and does cause health problems. But did you know that cholesterol has some important benefits? With all the bad press surrounding it, this might come as a surprise.

For instance, it plays a critical role in building the structure of cell membranes, is necessary for vitamin D production, makes vital hormones and is a precursor to bile acid, which enables the breakdown of dietary fats as they move through the gut.

Bottom line is, we can’t survive without cholesterol but, equally, we don’t want it ‘running amok’. Making sure we maintain it at healthy levels is key.

What’s the latest on cholesterol?

An image of a man uncomfortably clutching his chest

In recent years, our understanding has shifted. Scientists used to believe that diet was the major cause of high cholesterol, so the general recommendation was to limit intake of cholesterol-rich foods. Now we know that almost 80% of cholesterol is made by the body in the liver, so dietary cholesterol is off the hook. This is good news for lovers of eggs, shellfish, organ meats and other foods that are naturally high in cholesterol.

Most of us have heard that our total cholesterol level is made up of ‘good’ cholesterol (HDL* cholesterol, which carries circulating cholesterol to the liver to be recycled or broken down) and ‘bad’ cholesterol (LDL† cholesterol, thought to cause damage by infiltrating tiny nicks in blood vessel linings). But we now know there are different types of LDL, with the smaller, more dense types thought to be the ones causing damage to vessels, rather than larger LDL molecules.

Can you control your cholesterol?

There’s a lot we can do to keep levels under control, and we should try to have a healthy lifestyle to reduce our risk of heart disease. But for some, it’s a little more complicated. About one in 250 people has familial hypercholesterolaemia (FH), an inherited condition that means their levels are higher than normal from birth. FH is generally treated with cholesterol-lowering drugs, as well as the healthy, balanced diet that is important for us all. Here are some of the dietary actions we can all take to keep levels in check.

Dietary do’s

1. Be open to oats

Oats have been in the media lately, owing to reports of high levels of the pesticide glyphosate being found in samples. This is unfortunate, since oats are a rich source of beta-glucan, a soluble fibre that gels in the gut and reduces absorption. An average bowl of porridge contains around 2g – which research shows is two-thirds of the amount needed to substantially lower LDL. While most oat products available meet food safety standards, you can always opt for organic oats and oat products, to be 100% sure they’re glyphosate-free and never miss out on their cholesterol-lowering benefit.

2. Pick up some plant points

Eating more plant foods is a great way to ‘up the ante’ on balancing levels. In this context, we’re after the sterols and stanols found in fruit, vegetables, nuts, seeds and other plant foods. These natural compounds are shaped like cholesterol; eating them means less gets absorbed via the gut. Around 400mg is good for general health, but five times this is needed to reduce LDL. You could try sterol-enriched products (e.g. yoghurt drinks), but these often contain added sugars and other ingredients that aren’t good for the heart. Alternatively, just go for gut health gold by aiming for 30 plant points a week!

3. Love those legumes

Your gut bacteria love legumes, from black-eyed to borlotti beans, cannellini to kidney beans, and everything in between. Feeding your gut bacteria helps with digesting cholesterol and, according to a recent Harvard study, people with certain gut microbes, including Lactobacillus and Bifidobacterium, scored lower than those with less of these beneficial bacteria. So it might be worth chowing down on chickpeas to curb!

Dietary dont’s

1. Turn away from trans fats

Despite some scientific debate around what constitutes ‘good’ and ‘bad’ fats, there is a general consensus that trans fats are bad for our health. These harmful fats increase LDL, while reducing HDL cholesterol. Found in commercial baked goods, such as cakes, pies and biscuits, they are used by manufacturers to extend shelf life. Thankfully, they are being phased out, but check labels for the ingredient ‘partially hydrogenated vegetable oils’.

A photo of a cheeseburger with fries and onion rings

2. Swap out poor saturated fat sources

Saturated fats have been demonised over the years, but it’s not all black and white. Not all saturated fats are equal (e.g. saturated fat in cheese isn’t actually linked with heart disease), and some foods that are rich in saturated fats have great nutritional benefits. But saturated fats in ultra-processed foods can be a problem, as these may hinder LDL receptors on liver cells from removing LDL from the blood, and allow cholesterol levels to build up. Substituting poor sources of saturated fat in processed foods with unprocessed foods will help balance dietary fat intake to favour optimising cholesterol levels.

An image of someone uncomfortably clutching their stomach

3. Put a cap on constipation

There’s a definite link between constipation and heart disease. Could it be that with constipation, cholesterol-rich bile acids linger in the gut, so more cholesterol is reabsorbed and pushes up blood cholesterol? Either way, drinking more fluid is the place to start with constipation – focus on getting in two litres a day. Eating 4-6 prunes or 2 kiwi fruit might also be an effective remedy, or taking psyllium husk, mixed with water. For more easy-to-follow, science-backed strategies for constipation relief, head to Dr Megan Rossi’s best-selling book, Eat Yourself Healthy.

Takeaway

High cholesterol levels can put your card An illustration of doctors iovascular health at risk, which is why keeping levels in check, particularly LDL cholesterol, should be high on your list of health priorities.

Feeding your gut the right foods (30 plant points a week) is linked to maintaining healthy levels. Oats, for example, contain cholesterol-reducing beta-glucan; sterols and stanols in plant foods mimic cholesterol in the gut and thereby reduce absorption into the blood; legumes feed your gut bacteria which, in turn, are thought to digest cholesterol.

This, combined with common sense strategies like balancing intake of saturated and unsaturated fats, avoiding harmful fats, and keeping your bowels regular through good hydration and plenty of movement, will give you the best chance of keeping your levels under control.

If you’re concerned about your levels, come and talk to one of our specialist registered dietitians at The Gut Health Clinic. They can tailor an appropriate diet to target the problem and help put your gut health on track.

* High-density lipoprotein †Low-density lipoprotein