High cholesterol typically develops without obvious symptoms, but visible changes on the hands, feet, or eyes may indicate elevated levels, according to research and health organisations.
Understanding cholesterol and its types
Cholesterol is a waxy, yellowish fat that the body needs for vital functions, including hormone production, cell building, digestion, and vitamin D synthesis from sunlight. While often linked to foods such as red meat, milk, and eggs, most cholesterol is actually produced by the body itself.
Two types of lipoproteins carry cholesterol through the body: low-density lipoprotein (LDL), known as "bad" cholesterol, and high-density lipoprotein (HDL), or "good" cholesterol. Excess LDL can build up in blood vessel walls, raising the risk of heart attack or stroke. HDL helps remove LDL from arteries, carrying it to the liver and lowering cardiovascular risk.
Visible signs of high cholesterol
High cholesterol usually causes no symptoms, and a blood test is the only sure way to diagnose it. However, research has linked cholesterol deposits to visible body changes. A 2013 case study reported a 42-year-old man with difficulty moving the fourth and fifth fingers of his left hand. His cholesterol levels were elevated, and a biopsy revealed xanthoma cells, intradermal cholesterol deposits, along the tendons.
The British Heart Foundation (BHF) describes tendon xanthomata as "swellings made from cholesterol on the knuckles of your hands, your knees or the Achilles tendon at the back of your ankle." The BHF also advises watching for small, yellow lumps near the inner corner of the eye, called xanthelasmas, and a pale white ring around the coloured part of the eye, known as corneal arcus. These signs are generally linked to familial hypercholesterolaemia, a genetic condition causing extremely high cholesterol levels from birth.
Risk factors and reducing cholesterol
The NHS notes that high cholesterol is more likely in people over 50, men, those who have been through menopause, and individuals of South Asian or sub-Saharan African origin. It can be genetic or worsened by a fatty diet, lack of exercise, being overweight, smoking, and drinking alcohol. The NHS adds that a GP might suggest a test based on age, weight, or conditions like high blood pressure or diabetes.
To lower LDL levels, medication is available, along with dietary changes and increased exercise. Dr Sarah Berry, chief scientist at Zoe and academic leader in cardio-metabolic health at King's College London, says "the right diet [can] improve your cholesterol as much as medication." Harvard Health advises adding foods that lower LDL, such as minimally processed oats containing soluble fibre, which binds to cholesterol in the digestive system so it is excreted rather than circulated in the blood. Heart UK also recommends reducing saturated fat intake, found in butter, lard, ghee, fatty meats, and cheese, and replacing it with unsaturated fats.
