To lower high cholesterol, eat more soluble fibre (oats, barley, beans, lentils, fruit and vegetables), oily fish, nuts, seeds, avocado and plant oils such as olive and canola, and cut back on saturated and trans fats found in fatty and processed meat, butter, cream, hard cheese, palm and coconut oil, deep-fried food, pastries and packaged snacks. Pair these food changes with at least 150 minutes of exercise a week, not smoking, limiting alcohol and keeping to a healthy weight. Get your cholesterol checked regularly, because high cholesterol has no symptoms, and speak to your doctor about whether you also need medication.
High cholesterol is one of the most common, and most overlooked, risk factors for heart attack and stroke. The Heart and Stroke Foundation South Africa estimates that around one in four South African adults has high total cholesterol, and because it causes no symptoms, many people only find out once damage has already been done.
The good news is that cholesterol responds well to change. In this guide, Bloom and our partner Momentum Health4Me explain what cholesterol is, what healthy levels look like, which foods to eat and which to limit, the lifestyle habits that make the biggest difference, and how to get tested. If you want cover that makes regular check-ups easier, explore Bloom’s health insurance options.
Key takeaways
| • High cholesterol is silent. A simple blood test is the only way to know your levels, and the Heart and Stroke Foundation SA recommends every adult has one from around age 20. |
| • For most healthy adults, total cholesterol should be below 5 mmol/L and LDL (“bad”) cholesterol below 3 mmol/L. Your doctor may set stricter targets if you are at higher risk. |
| • Saturated and trans fats raise LDL cholesterol far more than the cholesterol in food itself, so what you limit matters as much as what you add. |
| • Soluble fibre, oily fish, nuts, seeds, legumes and plant oils all help, especially alongside regular exercise, not smoking and a healthy weight. |
| • Every Health4Me option includes an annual health assessment with a cholesterol finger-prick test, and Health4Me Gold includes chronic cover for hyperlipidaemia (high cholesterol). |
What is cholesterol?
Cholesterol is a waxy, fatty substance made mainly by your liver and carried in your blood. Your body needs a certain amount to build cell membranes and to make vitamin D and hormones such as oestrogen and testosterone. Your liver makes most of what you need, and the rest comes from animal foods such as meat, dairy and eggs.
Cholesterol travels through the bloodstream in particles called lipoproteins. The two you will hear about most are:
| • LDL (low-density lipoprotein), or “bad” cholesterol: carries cholesterol to your arteries. Too much LDL leads to fatty deposits (plaque) building up in artery walls. |
| • HDL (high-density lipoprotein), or “good” cholesterol: helps carry excess cholesterol away from the arteries and back to the liver to be removed. |
| • Triglycerides: another type of blood fat, usually measured in the same test. High triglycerides also raise heart risk and are often linked to excess weight, alcohol and refined carbohydrates. |
What is a healthy cholesterol level?
Cholesterol is measured in millimoles per litre (mmol/L). The Heart and Stroke Foundation South Africa gives these general targets for most healthy adults:
| Measurement | Healthy target |
|---|---|
| Total cholesterol | Less than 5 mmol/L |
| LDL (“bad”) cholesterol | Less than 3 mmol/L |
| HDL (“good”) cholesterol | More than 1.2 mmol/L for women, more than 1.0 mmol/L for men |
| Triglycerides (fasting) | Less than 1.7 mmol/L |
If you already have heart disease, have had a heart attack or stroke, or live with diabetes, kidney disease or inherited high cholesterol, your doctor will usually set stricter personal targets. Always interpret your results with a healthcare professional.
What causes high cholesterol?
High cholesterol usually comes from a combination of lifestyle and genetics. Common causes and risk factors include:
| • A diet high in saturated and trans fats, such as fatty meat, full-cream dairy, fried food, pastries and processed snacks. |
| • Too little physical activity and a mostly sedentary lifestyle. |
| • Carrying excess weight, particularly around the waist. |
| • Smoking, which lowers HDL (“good”) cholesterol and damages artery walls. |
| • Drinking too much alcohol, which raises triglycerides. |
| • Other health conditions, including type 2 diabetes, kidney disease, liver disease and an underactive thyroid. |
| • Age and family history. Cholesterol tends to rise with age, and high cholesterol often runs in families. |
Inherited high cholesterol is more common in South Africa
Familial hypercholesterolaemia (FH) is a genetic condition that causes very high LDL cholesterol from birth, regardless of diet. It affects roughly one in 500 South Africans and is far more common in some communities, including Afrikaans-speaking, Ashkenazi Jewish and Gujarati Indian families, because of a founder effect. If a parent, sibling or grandparent had a heart attack at a young age, ask your doctor about testing.
Why high cholesterol is a risk to your heart
Over time, excess LDL cholesterol builds up as plaque inside your arteries. This process, called atherosclerosis, narrows and stiffens the arteries and restricts blood flow. If a piece of plaque ruptures, a blood clot can form and block the artery completely. That is why high cholesterol is so closely tied to cardiovascular disease, one of the leading causes of death in South Africa. The main risks include:
| • Coronary artery disease and heart attack: narrowed arteries reduce oxygen to the heart muscle, which can cause chest pain (angina) or a heart attack. |
| • Stroke: plaque in the arteries that supply the brain, or a clot that travels there, can cause a stroke. |
| • Peripheral artery disease: reduced blood flow to the legs can cause pain when walking and slow wound healing. |
| • Compounded risk with other conditions: high cholesterol often occurs alongside high blood pressure and type 2 diabetes, and together they multiply the risk of heart disease. |
| • Other complications: excess cholesterol in bile can contribute to gallstones, and very high triglycerides can trigger pancreatitis. |
How to lower your cholesterol: 7 steps that work
For many people, lifestyle changes alone can meaningfully lower LDL cholesterol. For others, particularly those with inherited high cholesterol or existing heart disease, medication is needed as well. These steps help either way:
|
1
|
Switch to a heart-healthy eating pattern Focus on vegetables, fruit, whole grains, legumes, nuts, fish and plant oils, and cut back on saturated and trans fats. The food lists below show exactly what to add and what to limit. |
|
2
|
Move for at least 150 minutes a week Aim for about 30 minutes of moderate aerobic activity, such as brisk walking, cycling or swimming, on most days. Regular exercise raises HDL cholesterol and helps lower triglycerides and blood pressure. |
|
3
|
Stop smoking Smoking lowers HDL cholesterol and damages the lining of your arteries, making it easier for plaque to build up. Quitting benefits your heart within months. Read more about the effects of smoking on your health. |
|
4
|
Keep to a healthy weight Losing even a small amount of excess weight, especially around the waist, can improve cholesterol and triglyceride levels. Balanced meals and sensible portions matter more than crash diets. |
|
5
|
Limit alcohol Alcohol raises triglycerides and adds extra kilojoules. Keep within recommended limits, or cut it out if your triglycerides are high. |
|
6
|
Manage stress and sleep well Long-term stress and poor sleep make it harder to stick to healthy habits. Regular exercise, time outdoors, relaxation techniques and a consistent sleep routine all help. |
|
7
|
Know your numbers and follow your treatment plan Get tested regularly and, if your doctor prescribes cholesterol-lowering medication such as a statin, take it as directed. Diet and exercise still matter when you are on medication. |
The best foods to lower cholesterol
No single food is a cure, but building your meals around these foods can help lower LDL cholesterol and support overall heart health:
| Food | How it helps |
|---|---|
| Oats and barley | Rich in soluble fibre (beta-glucan), which forms a gel in the gut that binds cholesterol and helps remove it from the body. |
| Beans, lentils and chickpeas | Excellent sources of soluble fibre and plant protein, and a filling swap for fatty meat. |
| Vegetables and leafy greens | Spinach, cabbage, broccoli and other vegetables add fibre and antioxidants with very little fat. |
| Fruit, especially citrus, apples and berries | Contain pectin, a soluble fibre that helps lower LDL cholesterol. |
| Oily fish | Pilchards, sardines, mackerel, salmon and trout provide omega-3 fats, which lower triglycerides and protect the heart. Aim for two to three portions a week. |
| Nuts and seeds | Almonds, walnuts, peanuts, flaxseeds and chia seeds provide unsaturated fats, fibre and plant sterols. A small handful a day is enough. |
| Avocado | Rich in monounsaturated fat, which can help lower LDL when it replaces saturated fat. |
| Olive, canola and sunflower oil | Unsaturated plant oils are a healthier choice than butter, lard, palm oil or coconut oil for cooking. |
| Soya foods | Tofu, soya milk and edamame are a good source of plant protein that can replace some meat and full-cream dairy. |
| Foods fortified with plant sterols | Some spreads, yoghurts and milks have added plant sterols or stanols, which reduce how much cholesterol your gut absorbs. |
| Lean protein | Skinless chicken, fish and legumes help reduce your overall saturated fat intake compared with fatty red and processed meat. |
Foods to limit or avoid with high cholesterol
The biggest dietary drivers of high LDL cholesterol are saturated and trans fats. Try to limit:
| Food | Why to limit it |
|---|---|
| Fatty and processed meat | Boerewors, sausages, polony, bacon, salami, fatty mince and red meat with visible fat are high in saturated fat. Organ meats are also very high in cholesterol. |
| Full-cream dairy | Butter, cream, hard cheese and full-cream milk are major sources of saturated fat. Choose low-fat or fat-free versions. |
| Palm oil, coconut oil, lard and ghee | These fats are high in saturated fat. Check ingredient lists, as palm oil is common in processed foods. |
| Deep-fried and fast food | Slap chips, fried chicken, vetkoek and takeaways are often cooked in reused or hydrogenated oils that are high in trans and saturated fats. |
| Baked goods and pastries | Pies, pastries, biscuits, cakes and doughnuts often contain hard margarine or shortening, a source of trans fats. |
| Packaged and ultra-processed snacks | Crisps, instant noodles, ready meals and savoury snacks are often high in saturated fat, trans fat and salt. |
| Sugary foods, refined starches and alcohol | Excess sugar, white bread and alcohol can raise triglycerides and contribute to weight gain. |
What about eggs?
Older advice suggested cutting out egg yolks, but current guidance, including that of the Heart and Stroke Foundation SA, is that the cholesterol in food has a much smaller effect on blood cholesterol than saturated and trans fats. For most healthy people, eggs can be part of a balanced diet. Pay more attention to what you eat them with, such as bacon, sausages and buttered white toast. If you have diabetes, heart disease or inherited high cholesterol, ask your doctor or dietitian for personal advice.
Heart-healthy cooking and shopping tips
| • Grill, bake, steam, boil or air-fry instead of deep-frying. |
| • Trim visible fat from meat and remove the skin from chicken before cooking. |
| • Cook with small amounts of olive, canola or sunflower oil rather than butter, lard or hard margarine. |
| • Fill half your plate with vegetables, a quarter with whole grains and a quarter with lean protein. |
| • Swap refined starches for whole-grain bread, brown rice, oats and whole-wheat pasta. |
| • Read food labels and choose products lower in saturated fat, and look for the Heart and Stroke Foundation’s Heart Mark logo on healthier options. |
| • If you are unsure where to start, a registered dietitian can build an eating plan around your health, culture and budget. |
How to get your cholesterol checked
Because high cholesterol has no warning signs, a blood test is the only way to know your levels. There are two common options:
| • A finger-prick screening test: a quick test at a pharmacy clinic or wellness day that measures your total cholesterol in a few minutes. It is a good first check. |
| • A full lipogram: a blood test ordered by a doctor, usually after fasting for eight to 12 hours, that breaks down your LDL, HDL and triglycerides. |
The Heart and Stroke Foundation SA recommends that all adults have a fasting lipogram at least once from around age 20, repeated every few years if the results are normal. If your LDL is high, or you have diabetes, kidney disease, excess weight or a family history of heart disease, your doctor may check your levels much more often.
Every Momentum Health4Me option, Bronze, Silver and Gold, includes one health assessment per member per year. It covers cholesterol and blood sugar finger-prick tests, a blood pressure check, and height, weight and waist measurements, and is done at a wellness day or pharmacy clinic, preferably at Dis-Chem, Clicks or MediRite. If your results need follow-up, a Hello Doctor or Network GP consultation can refer you for pathology tests on the applicable Health4Me pathology list.
Heart Awareness Month: a yearly reminder to check your numbers
September is Heart Awareness Month in South Africa, and World Heart Day is marked every year on 29 September. Led locally by the Heart and Stroke Foundation SA, the campaign raises awareness of cardiovascular disease and encourages South Africans to know their risk factors, including cholesterol, blood pressure and blood sugar.
It is a useful annual prompt to book your health assessment, but cholesterol deserves attention all year round. Learn more about preventing cardiovascular disease.
Know the warning signs of a heart attack or stroke
Chest pain, pressure or tightness, pain spreading to the arm, jaw or back, shortness of breath, cold sweats, a drooping face, weakness in an arm or leg, or slurred speech all need emergency help. Call emergency services immediately and do not wait for symptoms to pass. Health4Me members with accident and emergency cover can call Netcare 911 on 082 911 for emergency transport.
How Bloom cover supports healthy cholesterol
Managing cholesterol is easier when regular check-ups, doctor visits and medication are within reach. Here is how Momentum Health4Me, through Bloom, can help:
| Benefit | How it helps with cholesterol | Available on |
|---|---|---|
| Health assessment | One screening per member per year, including a cholesterol finger-prick test, blood sugar and blood pressure. | Bronze, Silver and Gold |
| Unlimited GP visits | Unlimited visits to a Network GP to discuss results, risk factors and a treatment plan. | Bronze, Silver and Gold |
| Hello Doctor | Unlimited virtual GP consultations by chat, phone or video, including referrals for pathology tests on the applicable Health4Me list. | Bronze, Silver and Gold |
| Basic pathology | Cover for pathology on the applicable Health4Me list when referred by a Hello Doctor or Network GP. | Bronze, Silver and Gold |
| Chronic benefit | Covers 27 chronic conditions, including hyperlipidaemia (high cholesterol), hypertension and coronary artery disease, with medication from the Network chronic formulary. Pre-authorisation is required and waiting periods apply. | Gold |
| Employee Assistance Programme | Telephonic counselling and support services, helpful when stress is affecting your health. | Bronze, Silver and Gold |
| Accident and emergency cover | Includes cover for a heart attack or stroke at a private hospital, subject to the qualifying criteria and per-event limits. | Major medical event benefits, added to any day-to-day option |
If you need more comprehensive chronic cover, registered medical schemes must cover the Chronic Disease List conditions, which include hyperlipidaemia, as Prescribed Minimum Benefits. Bloom also offers Momentum Medical Scheme options that you can compare side by side. To see which Health4Me option fits your needs, compare Health4Me options or browse the full range of benefits.
Keep your heart health in check with BloomHealth4Me gives you an annual health assessment, unlimited GP and Hello Doctor consultations and, on the Gold option, chronic cover for high cholesterol. Leave your details and a Bloom consultant will call you back. |
Frequently asked questions
What is the fastest way to lower cholesterol?
What foods should I avoid if I have high cholesterol?
Which foods help lower cholesterol?
Can I eat eggs if I have high cholesterol?
What is a normal cholesterol level in South Africa?
How often should I get my cholesterol checked?
Does Health4Me cover cholesterol tests and medication?
When is Heart Awareness Month in South Africa?
Final thoughts
High cholesterol rarely makes itself known until it causes a serious problem, but it is one of the most manageable heart risk factors there is. Knowing your numbers, choosing the right foods, staying active and following your doctor’s advice can make a lasting difference to your heart health.
Make sure cost is never the reason you skip a check-up. Explore affordable health insurance from Bloom and Momentum Health4Me, compare the options, or use Hello Doctor to speak to a GP from wherever you are. To get started, leave your details and we will call you back.
Medical content disclaimer: This article is for general information only and does not constitute medical advice. It is not a substitute for an independent professional medical opinion, diagnosis or treatment. Always consult a qualified healthcare professional about your own health.
