Cholesterol: What You Need to Know About Levels, Diet & Treatment

Is Cholesterol Necessary?

Cholesterol is a fundamental building block for cell membranes, hormones – such as estrogen and testosterone – vitamin D, and bile acids. It is, absolutely essential for the functioning of the body. However, its quantity and distribution are crucial for human health.

When cholesterol levels in the blood are elevated, it can quickly become a threat to health. Many people associate cholesterol primarily with diet. For years, eggs, processed meats, butter, and cream were considered the main culprits behind high cholesterol. Doctors warned against excessive consumption of fatty animal products. The suggestion was that eating too much cholesterol would lead to illness. This creates uncertainty among many people.

But when is cholesterol too high? What are the potential health consequences? And when is it appropriate to consider medications to lower cholesterol? Scientists worldwide continue to seek answers to these questions.

Do Oats Help Lower Cholesterol? New Research

Researchers at the University of Bonn recently discovered that oats can help lower excessively high cholesterol levels in the blood. The results of the study were published in the journal Nature Communications.

The study involved 68 participants and consisted of several intervention phases. For two days, each of the three meals consisted exclusively of oats. Participants consumed a total of 300g of cooked oatmeal with a small amount of fruit. The meals were low in calories – participants received only half the calories they usually consumed. A control group was also on a calorie-restricted diet, but without oats.

All participants had been diagnosed with metabolic syndrome, also known as the “deadly quartet.” These individuals were overweight, had high blood pressure, elevated blood sugar, and high cholesterol. The results of blood and stool samples surprised the researchers: levels of harmful cholesterol fell by 10 percent. Participants lost an average of two kilograms, and their blood pressure decreased slightly.

The research team explains the lower cholesterol levels by the fact that when oats enter the intestines, bacteria inhabiting the digestive tract break down the grain, producing phenolic compounds. These so-called secondary plant compounds act as antioxidants in the human body, have anti-inflammatory properties, and protect cells. Anti-inflammatory compounds have a beneficial effect on cholesterol metabolism – this has already been shown in animal studies.

What Impact Does Diet Really Have on Cholesterol?

“Diet has only a small impact on cholesterol levels in the blood,” says Jean-François Chenot in an interview with “Die Welt.” He is a professor and head of the Department of Family Medicine at the University of Greifswald.

“Even if you follow a very restrictive diet, you can only lower cholesterol, for example, from 200 to 190 mg/dl,” he says. Most cholesterol is produced in the liver, and only a small amount comes from food.

“You can eat as many eggs as you want.” “The yolk does contain a lot of cholesterol, but there is no evidence that eating more eggs increases the risk of cardiovascular disease,” he adds. “I recommend eating as little dead animal as possible.”

The height of cholesterol is largely determined by genetics. People with a lot of fat in their blood suffer from hereditary hypercholesterolemia. According to data from the German Heart Foundation, approximately 1 in 250 people are born with this disease.

What is the Correct Cholesterol Level for Women and Men?

Cholesterol levels can be checked with a blood test. The results include three indicators – each with its own norms:

• Total cholesterol: <200 mg/dl (<5.2 mmol/l),
• LDL cholesterol: <116 mg/dl (<3.0 mmol/l),
• HDL cholesterol: >35 mg/dl (>0.9 mmol/l) – for men preferably >40 mg/dl (1.0 mmol/l), and for women >50 mg/dl (1.3 mmol/l).

Total cholesterol is the sum of LDL and HDL cholesterol in the blood. This parameter can indicate disturbances in lipid metabolism. LDL is considered “bad” cholesterol. High values of HDL, protect against the effects of bad cholesterol.

Why is high cholesterol problematic? When the liver produces too much “bad” cholesterol, fat deposits on the walls of blood vessels.

In people with advanced narrowing of the vessels, there is a feeling of pressure, chest pain, or dizziness, while elevated cholesterol itself does not cause any symptoms for a long time. Complications occur when plaques begin to rupture. In such a situation, a clot forms and the vessel becomes completely blocked. This leads to a heart attack or stroke – a life-threatening condition.

“Cholesterol is Not a Disease, It’s a Risk Factor”

“The norms determining what level of cholesterol is considered too high have been changed many times. It is in this area that disputes arise between family doctors and cardiologists,” says Chenot in an interview with “Die Welt.” The decision of when to introduce cholesterol-lowering drugs, so-called statins, has long been a subject of discussion among doctors.

“As a family doctor, I introduce the following data into a risk calculator: cholesterol level, blood pressure, whether the patient has diabetes, whether they smoke, age, and gender. The program calculates the percentage risk of a cardiovascular event in the next ten years,” he explains.

In December 2024, the Joint Federal Committee (G-BA), which decides on the rules for the use of cholesterol-lowering drugs, introduced new regulations regarding the prescription of statins. Since then, treatment can also be given to patients whose risk of heart attack or stroke within ten years is at least 10 percent. Previously, this threshold was 20 percent. As a result of the introduction of the new rules, more people automatically qualify for treatment.

“A healthy 70-year-old with optimal blood pressure and lipid results has a risk of a cardiovascular event of around ten to twelve percent within the next ten years,” Chenot explains. However, despite the fact that this risk is rather low for his age, he should be prescribed cholesterol-lowering drugs because it exceeds the ten percent threshold. However, age is the deciding factor: “I don’t treat age. In this case, it is difficult to justify the introduction of statins,” he emphasizes.

A family doctor gives an example: if a 35-year-old woman has a risk of 10 percent, she would get a pill. “Compared to her peers, she has an increased risk. Cholesterol is not a disease, it is a risk factor, along with many others,” he notes. If you can limit the other risk factors, you can live with elevated cholesterol.

“If a smoker quits smoking, their risk of heart attack drops by 50 percent,” he says. “If I give you a cholesterol-lowering drug, the risk drops by 20 percent. These are actions that significantly more effectively reduce risk than the drug itself.” Chenot criticizes the fact that some cardiologists focus solely on cholesterol levels or use risk thresholds that do not take age into account: “Cholesterol is high and can be controlled with medication, so we prescribe medication.”

“Many patients do not know who to believe – the family doctor or the cardiologist,” says Chenot. “If you proceed mechanically, as suggested by the European Society of Cardiology (ESC), then 70-80 percent of people in Germany would be taking cholesterol-lowering drugs.”

Ulrich Laufs has, predictably, a different opinion. Laufs is a professor and head of the Department of Cardiology at the University of Leipzig. “We believe that two-thirds of heart attacks and strokes can be prevented if low blood pressure and cholesterol levels are maintained early on,” says Laufs in an interview with “Die Welt.”

High doses of statins can lower LDL cholesterol levels in the blood by as much as 50 percent. With a moderate dose, the value decreases by 30-50 percent. The reported side effects of statins include muscle pain and a slightly increased risk of diabetes.

The cardiologist emphasizes: “Lifestyle is the foundation, and then medication. The most important factors are exercise, not smoking, and a healthy weight,” he lists. “Alcohol also raises blood fat levels,” he adds. To prevent heart and vascular diseases, it is also important to regularly check your own cholesterol level. People insured under public health insurance can have such a test performed by their family doctor.

A preventive examination for people aged 18-34 is entitled once in a lifetime, and from the age of 35, it can be performed free of charge every three years. Laufs emphasizes that the use of cholesterol-lowering drugs with high cholesterol levels makes sense to prevent the formation of deposits. “Once deposits have formed, drugs can at least stop their development, and sometimes even reduce them slightly.”