A health expert who previously served as a nutritionist for Arsenal Football Club has outlined a simple dietary rule for individuals with high cholesterol: consume oily fish twice a week. Richard Allison, a Performance Nutritionist and Clinical Dietitian registered with the British Dietetic Association and the Sport and Exercise Nutritionist Register (SENr), emphasizes that this habit provides omega-3 fatty acids, which are crucial for cardiovascular health.
High cholesterol affects approximately six out of ten adults in the UK, equating to tens of millions of people, many of whom remain unaware due to the absence of clear symptoms. Elevated levels of non-HDL (bad) cholesterol can lead to atherosclerosis, where fatty plaques accumulate on artery walls, narrowing blood vessels and increasing the risk of heart attacks and strokes.
Omega-3s and Heart Health
Richard Allison advises: “Eat oily fish twice weekly for omega-3s.” Omega-3 fats are unsaturated fats that support heart health and may lower the risk of cardiovascular events. Heart UK, a cholesterol charity, explains: “Omega 3 fats are a type of unsaturated fat – the type of fat that’s good for your cholesterol levels. The other main type of fat is saturated fats, which raise your cholesterol levels. For a heart-healthy diet, it’s good to swap saturated fats for unsaturated fats.” The organization notes that countries with higher oily fish consumption, such as those in the Mediterranean, Greenland, and Japan, have lower rates of heart disease compared to the UK.
Oily fish is the richest dietary source of omega-3s. Heart UK recommends: “Aim to eat two portions of fish per week, at least one of which should be oily. A portion is 140g, but you could have two or three smaller portions throughout the week.” Options include anchovies, bloater, carp, eel, herring (kippers), mackerel, pilchards, salmon, sardines, sprats, swordfish, trout, and whitebait, available fresh, tinned, or frozen.
Additional Dietary and Lifestyle Changes
Beyond the twice-weekly fish rule, Allison recommends reducing saturated fat intake to below 20-30g daily by replacing saturated fats (found in red meat, full-fat dairy, and processed foods) with unsaturated fats. He also advises consuming at least five portions of fruits and vegetables daily, along with whole grains and foods high in soluble fibre such as porridge and lentils, which can lower LDL cholesterol by 5-10%. Limiting added sugars and salt is also essential.
For exercise, Allison suggests: “Aim for 150 minutes of moderate aerobic exercise (such as brisk walking, cycling) plus strength training twice weekly. This raises HDL and lowers LDL, with studies showing benefits within weeks.” HDL (high-density lipoprotein) cholesterol helps remove excess cholesterol from the bloodstream, while LDL (low-density lipoprotein) contributes to arterial plaque buildup.
Other Health Recommendations
Allison also urges quitting smoking and limiting alcohol intake. “Smoking lowers HDL, so quitting can increase it by 10%. Keep alcohol below 14 units weekly, as excess can raise triglycerides and contribute to dysfunctional HDL,” he said. Maintaining a healthy weight is crucial: losing 5-10% of body weight if overweight can improve lipid profiles. He recommends using BMI (below 25 kg/m²) or waist circumference (below 94cm for men, 80cm for women) as guides, and attending regular NHS Health Checks or GP visits.
NHS guidelines for healthy cholesterol levels in adults are: total cholesterol below 5 mmol/L; HDL above 1.0 mmol/L for men or 1.2 mmol/L for women; non-HDL below 4 mmol/L; and LDL typically below 3 mmol/L, or lower (e.g., below 2.6 mmol/L) after a heart attack or stroke. These ranges may vary based on individual risk factors such as age, diabetes, or family history.
Balancing Cholesterol Levels
Allison emphasizes the importance of regular blood tests (lipid profiles) through a GP to monitor total cholesterol, HDL, LDL, and triglycerides. A heart-healthy diet rich in soluble fibre (oats, beans, fruits), unsaturated fats (avocados, nuts, olive oil), and omega-3s (oily fish) combined with at least 150 minutes of moderate exercise weekly can raise HDL by up to 10% and lower LDL.
Interestingly, Allison notes that while moderate HDL levels are protective, emerging research suggests a “U-shaped” association: very high HDL levels (typically above 2.07 mmol/L or 80 mg/dL) may increase mortality and cardiovascular event risk, challenging the belief that higher HDL is always better.
