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Total Cholesterol

10 min read
July 21, 2020

What is total cholesterol?

Although cholesterol often receives bad press, it is essential for life because it helps to make the cell membranes in all tissues and organs in the human body. Cholesterol is also vital to produce hormones and bile acids. There are two ways the body can get cholesterol; the body can produce its own cholesterol in the liver and it also comes from our diet.[1]

Why take a total cholesterol blood test?

A total cholesterol blood test measures both types of cholesterol in the blood. The test is usually used to see if cholesterol levels are high which is commonly caused by having too much bad cholesterol in the blood.

The problem with cholesterol is it doesn’t cause symptoms if it is high or low, so you may not know if you have high levels of bad cholesterol which can be dangerous. Instead, a test is the only way to find out your cholesterol levels.[2] High levels of circulating bad cholesterol are bad for our health and can increase the risk of life-threatening conditions.

A total cholesterol test measures the total HDL, non-HDL and triglyceride levels.

You can test your total cholesterol levels by purchasing a simple at-home finger prick test kit which is then analysed at an accredited lab. Forth offers a number of blood tests which include total cholesterol such as a Cholesterol Check which can be purchased for just £39.00 or our best-selling Baseline Plus test which includes cholesterol and more than 15 other biomarkers essential to good health.

What function does total cholesterol have in the body?

Cholesterol has essential roles in the physiology of cell membranes, the absorption of nutrients from the diet, calcium metabolism, sexual reproduction and the balance of salt and water.

Some of the cholesterol in the body travels in the blood in complex proteins called lipoproteins. High-density lipoprotein (HDL) is also known as ‘good’ cholesterol because it removes excess cholesterol from the tissues in the body and transports it to the liver for disposal.[3]

Low-density lipoprotein (LDL) or non-HDL cholesterol, on the other hand, is the opposite of HDL. It is often referred to as ‘bad’ cholesterol because it carries cholesterol from the liver and deposits it in the walls of the arteries which can cause ‘furring’ of the arterial walls leading to a condition called atherosclerosis. Atherosclerosis increases the risk of cardiovascular disease.[4]

Triglycerides are a type of fat present in the blood. When we eat, if there are excess calories, the body will quickly convert them to triglycerides. Triglycerides are stored in fat cells until they are released for energy later. Triglycerides, therefore, have two functions; they are used by the cells to make energy and they can be stored as fat for use as energy later. [5]

Cholesterol is a major component of cell membranes. If kept in balance, cholesterol helps to maintain healthy cells and ultimately a healthy body. An imbalance in cholesterol has been identified in diseases such as cancer and Alzheimer’s Disease. Cell membranes are responsible for keeping the contents of the cell separate from the external environment. Cholesterol regulates the thickness and fluidity of the cell membrane and helps to maintain its rigidity. [6]

Another function of cholesterol is the production of bile salts. Bile salts are a major component of bile, a fluid produced by the liver and stored in the gallbladder to emulsify fats. Cholesterol is converted to cholyl CoA, an activated intermediate essential for bile salt production. Cholesterol is a precursor for steroid hormones, too, including sex hormones. [7]

How do changes in total cholesterol affect health and wellbeing

Low levels of cholesterol are better for our health and so are not usually a cause for concern. Instead, high cholesterol increases the risk of cardiovascular disease, diabetes and strokes. High levels of circulating cholesterol don’t cause any symptoms. However, if the excess cholesterol causes other medical conditions such as atherosclerosis, cardiovascular disease or diabetes, then these can cause some unpleasant and life-threatening symptoms.

A build-up of non-HDL cholesterol on the walls of the arteries leads to blood flow being restricted to vital organs like the heart and brain. As cholesterol levels increase, the risk of coronary artery disease and angina also increases. Equally, high levels of cholesterol also increase the risk of type II diabetes, a condition where the body doesn’t produce enough insulin or the cells no longer react to the insulin being released by the body. The result of this is prolonged high blood glucose levels.

If you are worried about your total cholesterol level or just want to check where you fall on the range, you can test your level with a simple at-home blood test.

What can cause total cholesterol to change?

High cholesterol can affect anyone, but in some cases, it can also be prevented. High cholesterol can be caused by many things but you can lower your risk by controlling certain lifestyle choices.

High cholesterol can be caused by:

Consuming too much saturated fat
Leading a sedentary life
Having too much body fat, particularly around your middle

Smokers have reduced levels of HDL cholesterol compared to non-smokers. Quitting smoking rapidly increases the level of HDL. Therefore, smoking lowers the ‘good’ cholesterol in the blood which prevents ‘bad’ cholesterol from attaching to and clogging artery walls. The tar which comes from smoking also makes it easier for cholesterol to stick to the artery walls. Therefore, quitting smoking is key to improving health and increasing HDL levels in the blood.[8]

There are also some causes of high cholesterol which are out of our control, including:

Increasing age
Gender
Ethnicity
Kidney or liver disease
An underactive thyroid
Genetics – Familial Hypercholesterolemia[9]

What are the most common symptoms of high cholesterol?

As high cholesterol doesn’t have any symptoms, the conditions it can cause do. The symptoms of type II diabetes include:

Excess thirst
Extreme fatigue
Weight loss
Needing to pee more often
Blurred vision
Itching around the genital area
Slow healing cuts[10]

Atherosclerosis is a serious condition where the arteries become clogged with fatty plaques. These deposits increase the risk of cardiovascular disease which includes:

Coronary heart disease
Angina
Heart attacks
Strokes
Transient ischaemic attacks
Peripheral arterial disease[11]

How to keep total cholesterol in the healthy range

Following a healthy lifestyle is the best way to control your cholesterol levels. Exercise helps to increase HDL levels, while diet can reduce excess cholesterol and saturated fat intake. In short, quitting smoking, reducing alcohol intake and increasing unsaturated fat intake can all benefit HDL levels and reduce non-HDL.

A diet which has been shown to be particularly effective for preventing the development of type II diabetes and keeping ‘bad’ cholesterol levels low is the Mediterranean diet. Classically, the diet has a high fruit, vegetable, nut, olive oil and grain intake alongside a moderate consumption of fish and wine. However, it promotes only a low intake of processed and red meats as well as whole-fat dairy products.

When considering your diet and cholesterol levels, you should:

avoid saturated fats
- butter
- lard
- meat
- full-fat dairy products
swap saturated fat cooking products for olive oil, rapeseed, sunflower or corn oil
use starchy foods as a base for meals. use wholegrain varieties of:
- bread
- pasta
- rice
- noodles
- potatoes
try to eat at least 5 portions of fruit and veg per day
swap full-fat dairy for low-fat or alternatives
swap sugary snacks for a handful of nuts
porridge can reduce your cholesterol levels and make you feel full up for longer. Try to limit the amount of sugar or salt you add and make it with water rather than milk[12]

Aerobic is beneficial for heart health. It increases your heart and breathing rate. Aerobic exercise includes activities like:

walking
jogging
cycling
swimming
dancing
using gym equipment[13]

Exercise can also increase HDL levels which, in turn, can help to remove excess cholesterol from the body. Exercise also enhances the ability of the skeletal muscles to use lipids as a source of energy rather than glycogen which reduces blood lipid levels.[14]

Everyone should aim to exercise for at least 30 minutes per day, 5 times weekly to remain healthy and reduce cholesterol levels.

Total Cholesterol Tests

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Cholesterol Blood Test

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If you're concerned about your heart health, our cholesterol home blood test is an easy and accurate way to check your levels.

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Baseline Health Check

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A general health blood test that checks bone health, heart, liver and energy levels, and nutrition.

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References

[1] Lab Tests Online UK. (2015). Cholesterol Test. Available at: https://labtestsonline.org.uk/tests/cholesterol-test

[2] NHS. (2019). Getting Tested High Cholesterol. Available at: https://www.nhs.uk/conditions/high-cholesterol/getting-tested/

[3] Lab Tests Online UK. (2015). HDL Cholesterol Test. Available at: https://labtestsonline.org.uk/tests/hdl-cholesterol-test

[4] Lab Tests Online UK. (2015). Non-HDL Cholesterol Test. Available at: https://labtestsonline.org.uk/tests/non-hdl-cholesterol-test

[5] Heart UK. (2018). Triglycerides. Available at: https://heartuk.org.uk/health-and-high-cholesterol/triglycerides

[6] Grouleff, J., Irudayam, S, J., Skeby, K, K and SchiØtt, B. (2015). The Influence of Cholesterol on Membrane Protein Structure, Function, and Dynamics Studied by Molecular Dynamics Simulations. Biochimica et Biophysica Acta (BBA) – Biomembranes: 1848(9), pp 1783-1795.

[7] Berg J, M., Tymoczko J., L, Stryer, L. (2002). Biochemistry. 5th edition. New York: W H Freeman. Section 26.4, Important Derivatives of Cholesterol Include Bile Salts and Steroid Hormones. Available from: https://www.ncbi.nlm.nih.gov/books/NBK22339/

[8] Forey, B, A et al. (2013). The Effect of Quitting Smoking on HDL-Cholesterol – A Review Based on Within-Subject Changes. Biomarker Research: 1.

[9] British Heart Foundation. (2019). High Cholesterol – Causes, Symptoms and Treatments. Available at: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol

[10] National Health Service. (2016). Diabetes. Available at: https://www.nhs.uk/conditions/diabetes/

[11] NHS. (2019). Atherosclerosis. Available at: https://www.nhs.uk/conditions/atherosclerosis/

[12] Heart UK. (2018). For Good Cholesterol Levels. Available at: https://heartuk.org.uk/files/uploads/documents/huk_fs_d02_forgoodcholesterollevels.pdf

[13] Heart UK. (2018). Physical Activity. Available at: https://heartuk.org.uk/files/uploads/documents/huk_fs_mfsB_physicalactivity.pdf

[14] Mann, S et al. (2014). Differential Effects of Aerobic Exercise, Resistance Training and Combined Exercise Modalities on Cholesterol and the Lipid Profile: Review, Synthesis and Recommendations. Sports Med: 44(2), pp 211-221.

Medically reviewed

This information has been medically reviewed by Dr Nicola Keay.

Nicola has extensive clinical and research experience in the fields of endocrinology and sport and exercise medicine. Nicky is a member of the Royal College of Physicians, Honorary Fellow in the Department of Sport and Exercise Sciences at Durham University and former Research Fellow at St. Thomas’ Hospital.

Dr Nicola Keay

BA, MA (Cantab), MB, BChir, MRCP.