Nutritionist Sarah Di Lorenzo breaks down cholesterol — the highs, lows and what your blood test really means

When you hear “high cholesterol,” it can sound scary but cholesterol itself isn’t the villain. It’s how it’s carried in your blood, and what your numbers look like, that really matters.

I see so many patients that come to me who are nervous about high cholesterol readings and with a fear of going on statins.

But first a reminder, cholesterol is a waxy substance your body uses to make hormones, vitamin D and bile acids. Your liver makes most of it and some comes from food.

The human body needs a small amount of cholesterol because it’s a crucial building block for cell membranes, a precursor for key hormones (including sex and stress hormones), vitamin D, and bile acids that help you digest and absorb fats and fat‑soluble nutrients.

In your blood, cholesterol travels in “packages” called lipoproteins, LDL cholesterol, the “bad” one, (low‑density lipoprotein) carries cholesterol out to your tissues.

When LDL is too high, it can deposit in artery walls and contribute to plaque build-up, narrowing the arteries and increasing your risk of heart attack and stroke.

HDL cholesterol, the “good” one (high‑density lipoprotein) acts like a clean‑up, picking up excess cholesterol from the circulation and taking it back to the liver for recycling or removal. Higher HDL is generally protective.

Triglycerides are another fat in your blood. High levels, especially alongside high LDL and low HDL, significantly raise cardiovascular risk and often reflect too much refined carbohydrate, alcohol or overall energy intake.

I feel it is really important to also understand what cholesterol readings are in a blood test. I always recommend to all of my patients to look at the triglycerides as well as the LDL cholesterol, not just the total cholesterol which many focus on.

Knowing and understanding this breakdown is really important.

I always recommend the next step with a cholesterol diagnosis is to get a calcium score test done, it is a very quick test and low cost.

When assessing a patient there is so much to consider, not just a single number in isolation.

Age, blood pressure, smoking status, weight, family history and other conditions all feed into your overall cardiovascular risk.

The good news is that your numbers are highly responsive to what you eat, how you move, and your everyday habits.

You can change your cholesterol readings with compliance in diet and lifestyle changes in just three months. I help patients do this all the time in my clinic.

What you eat plays a huge role. Avoid saturated and trans fats such as fatty red meat, processed meats, butter, cream, pastries and deep‑fried foods.

Swap to lean meats, fish and plant proteins. This change alone can lower LDL by 5–15 per cent.

Lift your healthy fats. Make extra‑virgin olive oil, avocado, nuts, seeds and oily fish regulars.

These unsaturated fats help improve your overall cholesterol profile when they replace saturated fats.

Load up on soluble fibre. Think oats, barley, psyllium husk, beans and lentils, apples, pears and citrus.

This “gel‑forming” fibre binds cholesterol in the gut and helps lower LDL.

Choose whole foods over refined carbs. Swap white bread, white rice, sugary cereals and sweets for wholegrain breads, brown rice, quinoa and minimally processed foods.

This supports triglycerides, weight management and HDL.

Supplements can be really useful when combined with a heart‑healthy diet.

I offer these to all my cholesterol patients and find a good quality one that really can help.

The best supplements are Omega‑3s (fish or algae oil) as they are helpful for high triglycerides and general cardiovascular support, though they don’t dramatically drop LDL.

As well as psyllium husk — which is easily added to breakfast bowls or taken as a supplement — it boosts soluble fibre and complements dietary changes.

Always check this with your doctor for any contraindications to any current medications.

Lifestyle is just as important and this includes weight management — losing around 10 per cent of your body weight can produce meaningful improvements in LDL, triglycerides and blood pressure.

As well as exercise, aim for at least 30 minutes of moderate activity most days including walking, swimming, cycling, resistance training.

Exercise helps raise HDL, lower triglycerides and support overall vascular health.

You also need to stop smoking and avoid or severely minimise alcohol.

Not smoking, and keeping alcohol moderate (or avoiding it altogether if your triglycerides are elevated), has a clear and powerful impact on heart risk.

Cholesterol is not simply “good” or “bad” — it’s a complex, dynamic marker of heart health.

Understanding your blood test results in the Australian context, and consistently choosing more plants, fibre and healthy fats, moving your body, and managing weight and stress, can significantly improve your numbers and more importantly, your long‑term health.

Your cholesterol profile can be changed with small, consistent shifts in your plate and lifestyle which truly add up.