High cholesterol is frequently encountered in clinical practice and is influenced by a range of genetic, lifestyle and metabolic factors that may develop over time. Dietary and non-dietary strategies can support cholesterol reduction, with increased fibre intake recognised as an important dietary approach. Dietitians play a key role in cholesterol management through the assessment of dietary patterns, eating behaviours, lifestyle habits and overall metabolic health. Nutritional interventions should be individualised to meet the patient’s specific needs and tailored alongside the management of any coexisting conditions or comorbidities.

  1. Schade DS, Shey L, Eaton RP. Cholesterol review: A metabolically important molecule. Endocrine Practice. 2020.26:1514–1523. doi: 10.4158/EP‑2020‑0347
  2. British Dietetic Association. Cholesterol. 2021. Available at: ​​Accessed: 20 January 2026
  3. British Heart Foundation. High cholesterol: causes, symptoms and treatment. 2021. Available at: ​. Accessed 22 April 2021
  4. Qiao Y‑N, Zou Y‑L, Guo S‑D. Low‑density lipoprotein particles in atherosclerosis. Frontiers in Physiology. 2022.13
  5. Raja V, Aguiar C, Alsayed N et al. Non‑HDL‑cholesterol in dyslipidemia: Review of the state‑of‑the‑art literature and outlook. Atherosclerosis. 2023.383: Available at: https://www.sciencedirect.com/science/article/pii/S0021915023052334
  6. Jovanovski E, Khayyat R, Zurbau A et al. Psyllium reduces total and LDL‑cholesterol in people with hypercholesterolemia: a systematic review and meta‑analysis of controlled feeding trials. American Journal of Clinical Nutrition. 2018.108:922–932
  7. Estruch R, Ros E, Salas‑Salvadó J et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra‑virgin olive oil or nuts. New England Journal of Medicine. 2018.378: E34
  8. NHS (2021) Lower your cholesterol. Available at: https://www.nhs.uk/live-well/healthy-body/lower-your-cholesterol/
  9. Franzosa EA, Sirota‑Madi A, Avila‑Pacheco J et al. Gut microbiome features associated with cholesterol metabolism and cardiovascular risk. Cell 2024.187:2155–2173. Available at: https://www.cell.com/cell/fulltext/S0092-8674(24)00305-2
  10. Zhang Y, Li X, Chen H. Gut microbiota–cholesterol crosstalk: implications for cardiovascular disease. Nutrition & Metabolism. 2025.22: 51
  11. Wang Z, Zhao Y, Nicholson JK. Gut microbiome‑mediated mechanisms for reducing cholesterol levels: implications for ameliorating cardiovascular disease. Trends in Endocrinology & Metabolism. 2023.34:85–98
  12. British Dietetic Association (BDA) (2023) Fibre Food Fact Sheet. Available at: https://www.bda.uk.com/resource/fibre.html
  13. Cook JR, Hawkins MA, Pajvani UB. Liver insulinization as a driver of triglyceride dysmetabolism. Nature Metabolism. 2023.5:1–12.
  14. Jia B, Zou Y, Han X, Bae J‑W, Jeon CO. Gut microbiome‑mediated mechanisms for reducing cholesterol levels: implications for ameliorating cardiovascular disease’, Trends in Microbiology. 2023. 31: 76–91. https://doi.org/10.1016/j.tim.2022.08.003
  15. Jovanovski E, Nguyen M, Kurahashi Y et al. Are all fibres created equal with respect to lipid lowering? Comparing the effect of viscous dietary fibre to non‑viscous fibre from cereal sources: a systematic review and meta‑analysis of randomised controlled trials’, British Journal of Nutrition. 2022.129:1180–1192.

About the Author: Hannah Pritchard, RD

Hannah is a Senior Gut Health Dietitian with extensive NHS experience. She currently works in the research team at the University of Chester and delivers freelance dietetic projects.

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High cholesterol is frequently encountered in clinical practice and is influenced by a range of genetic, lifestyle and metabolic factors that may develop over time. Dietary and non-dietary strategies can support cholesterol reduction, with increased fibre intake recognised as an important dietary approach. Dietitians play a key role in cholesterol management through the assessment of dietary patterns, eating behaviours, lifestyle habits and overall metabolic health. Nutritional interventions should be individualised to meet the patient’s specific needs and tailored alongside the management of any coexisting conditions or comorbidities.

  1. Schade DS, Shey L, Eaton RP. Cholesterol review: A metabolically important molecule. Endocrine Practice. 2020.26:1514–1523. doi: 10.4158/EP‑2020‑0347
  2. British Dietetic Association. Cholesterol. 2021. Available at: ​​Accessed: 20 January 2026
  3. British Heart Foundation. High cholesterol: causes, symptoms and treatment. 2021. Available at: ​. Accessed 22 April 2021
  4. Qiao Y‑N, Zou Y‑L, Guo S‑D. Low‑density lipoprotein particles in atherosclerosis. Frontiers in Physiology. 2022.13
  5. Raja V, Aguiar C, Alsayed N et al. Non‑HDL‑cholesterol in dyslipidemia: Review of the state‑of‑the‑art literature and outlook. Atherosclerosis. 2023.383: Available at: https://www.sciencedirect.com/science/article/pii/S0021915023052334
  6. Jovanovski E, Khayyat R, Zurbau A et al. Psyllium reduces total and LDL‑cholesterol in people with hypercholesterolemia: a systematic review and meta‑analysis of controlled feeding trials. American Journal of Clinical Nutrition. 2018.108:922–932
  7. Estruch R, Ros E, Salas‑Salvadó J et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra‑virgin olive oil or nuts. New England Journal of Medicine. 2018.378: E34
  8. NHS (2021) Lower your cholesterol. Available at: https://www.nhs.uk/live-well/healthy-body/lower-your-cholesterol/
  9. Franzosa EA, Sirota‑Madi A, Avila‑Pacheco J et al. Gut microbiome features associated with cholesterol metabolism and cardiovascular risk. Cell 2024.187:2155–2173. Available at: https://www.cell.com/cell/fulltext/S0092-8674(24)00305-2
  10. Zhang Y, Li X, Chen H. Gut microbiota–cholesterol crosstalk: implications for cardiovascular disease. Nutrition & Metabolism. 2025.22: 51
  11. Wang Z, Zhao Y, Nicholson JK. Gut microbiome‑mediated mechanisms for reducing cholesterol levels: implications for ameliorating cardiovascular disease. Trends in Endocrinology & Metabolism. 2023.34:85–98
  12. British Dietetic Association (BDA) (2023) Fibre Food Fact Sheet. Available at: https://www.bda.uk.com/resource/fibre.html
  13. Cook JR, Hawkins MA, Pajvani UB. Liver insulinization as a driver of triglyceride dysmetabolism. Nature Metabolism. 2023.5:1–12.
  14. Jia B, Zou Y, Han X, Bae J‑W, Jeon CO. Gut microbiome‑mediated mechanisms for reducing cholesterol levels: implications for ameliorating cardiovascular disease’, Trends in Microbiology. 2023. 31: 76–91. https://doi.org/10.1016/j.tim.2022.08.003
  15. Jovanovski E, Nguyen M, Kurahashi Y et al. Are all fibres created equal with respect to lipid lowering? Comparing the effect of viscous dietary fibre to non‑viscous fibre from cereal sources: a systematic review and meta‑analysis of randomised controlled trials’, British Journal of Nutrition. 2022.129:1180–1192.

About the Author: Hannah Pritchard, RD

Hannah is a Senior Gut Health Dietitian with extensive NHS experience. She currently works in the research team at the University of Chester and delivers freelance dietetic projects.

Leave A Comment

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