Total Cholesterol

Total cholesterol measures the overall amount of cholesterol moving through your bloodstream. It includes HDL cholesterol, LDL cholesterol, and other cholesterol-containing particles such as very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL). HDL cholesterol helps clear excess cholesterol from the body, while LDL, VLDL, and IDL are involved in transporting triglycerides and have the potential to deposit into artery walls, contributing to atherosclerosis.

Cholesterol is essential for making hormones, building cell membranes, and supporting brain function. However, balance is crucial, as both excessively high and low levels can be problematic. Lower total cholesterol levels are generally beneficial, but the complexity of cholesterol metabolism means that simply categorising cholesterol as "good" or "bad" is insufficient for comprehensive cardiovascular risk assessment

Total cholesterol is most meaningful when interpreted alongside other lipid and metabolic markers, including a lipoprotein fractionation, triglycerides, HDL, apolipoprotein B (ApoB), and lipoprotein(a). These markers help detect the risk of heart disease and guide clinical decisions around diet, lifestyle, and medical interventions.

Context matters when interpreting total cholesterol. For example, a person with high total cholesterol but predominantly large, fluffy LDL particles may have a lower risk of heart disease compared to someone with lower total cholesterol but predominantly small, dense LDL particles.

As you implement lifestyle changes that improve your cholesterol, this number may track down; however, it is not as important as looking at specific types of cholesterol. It moves in the right direction when LDL-C and non-HDL-C improve, but it cannot show whether the rise is from “good” HDL or “bad” LDL. 

Small, consistent changes add up, and the effects can be measured in your cholesterol results over time.

1. Add “viscous” fibres daily. Aim for foods rich in beta-glucan, such as oats and barley. Getting at least 3 g/day of beta-glucan is linked with meaningful reductions in total cholesterol by about 0.29 mmol/L (with similar LDL drops), typically within weeks.

What are beta-glucans?

Beta-glucans are bioactive polysaccharides notable for their immunomodulatory, antioxidant, and cholesterol-lowering effects, as well as their role as soluble dietary fiber. The foods containing the highest amounts of beta-glucans are barley, oats, and edible mushrooms. Barley and oats are the richest cereal sources.

2. Combine aerobic and resistance training. Exercise improves how your body handles fats. A 2024 meta-analysis of 148 randomised trials found exercise lowered total cholesterol by ~0.15 mmol/L on average, with combined aerobic plus resistance training performing best. More weekly sessions produced bigger shifts, so build a routine you can keep and track changes over months.

3. Embrace plant sterols / stanols. Plant sterols and plant stanols are naturally occurring compounds found in the cell membranes of plants, structurally similar to cholesterol, but differing in their side chain saturation and double bond configuration. Including foods with added plant sterols or stanols can help lower LDL, which usually nudges total cholesterol down too. Take them with meals for best effect and make them part of an overall heart-healthy pattern you can sustain.

Food sources of sterols / stanols

Plant sterols and stanols occur in the cell membranes of plants, so they’re found in trace amounts in many whole foods such as

• Nuts & Seeds (almonds, pistachios, walnuts, sunflower seeds, sesame seeds)

• Vegetable Oils (extra-virgin olive oil)

• Legumes & Whole Grains (lentils, chickpeas, peas, wholegrain bread, wheat germ, brown rice)

• Fruits & Vegetables (avocado, brussel sprouts, broccoli, cauliflower, apples, berries)

4. Layer in supportive habits.

• Replace ultra-processed snacks with whole-food swaps rich in fibre and unsaturated fats.

• Prioritise regular sleep and stress-reduction practices, which help appetite, weight, and exercise adherence, which are key drivers of total cholesterol over time.

• Optimal: < 5.2 mmol/L (< 200 mg/dL)

• Borderline high: 5.2–6.2 mmol/L (200–239 mg/dL)

• High: ≥ 6.2 mmol/L (≥ 240 mg/dL).

1. Cholesterol – Royal College of Pathologists of Australasia (RCPA), 2024. https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/C/Cholesterol
   

2. Cholesterol, mean total – World Health Organization (WHO), 2025. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2384
   

3. Manage high blood cholesterol levels – National Heart Foundation of Australia, 2025. https://www.heartfoundation.org.au/your-heart/high-blood-cholesterol
   

4. Summary of Health Canada’s Assessment of a Health Claim about Barley Products and Blood Cholesterol Lowering – Health Canada, 2025. https://www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/health-claims/assessments/assessment-health-claim-about-barley-products-blood-cholesterol-lowering.html
   

5. The Effect of Exercise Training on Blood Lipids: Systematic Review and Meta-analysis – Sports Medicine, 2024. https://link.springer.com/article/10.1007/s40279-024-02115-z

6. Dhahri, M., Dutta, A., Mohammed, H. A., et al. (2025). The isolation, bioactivity, and role of β-glucans in health: A review. International Journal of Biological Macromolecules, Article 148000. https://doi.org/10.1016/j.ijbiomac.2025.148000

7. Schmidt, M. (2022). Cereal beta-glucans: An underutilized health endorsing food ingredient. Critical Reviews in Food Science and Nutrition, 62(12), 3281–3300. https://doi.org/10.1080/10408398.2020.1864619