Healthspan September 21, 2017

Everything you need to know about cholesterol, including what it is in the first place and how to tell the good from the bad… 

Did you know? Six out of ten people in the UK have raised or abnormal levels of cholesterol. Also known as the silent killer, high cholesterol is responsible for all manner of conditions, including stroke, heart attack and angina, but has no obvious symptoms otherwise.

According to Heart UK, high cholesterol is also the leading cause of death in the UK. But it’s not all bad news. There are plenty of simple lifestyle changes you can make that will make a huge difference and help to keep your heart healthy:

What is cholesterol?

Cholesterol is a waxy, fat-like substance produced by the liver that is found in all animal-sourced food.

“Cholesterol is vital for health as it is used by the body to make hormones, vitamin D and bile acids, and maintain healthy cell membranes”, explains Dr Sarah Brewer.

There are two types of cholesterol: ‘good’ HDL cholesterol and ‘bad’ LDL cholesterol which travel through your blood wrapped up in protein particles called ‘lipoproteins’.

What’s the difference between ‘good’ and ‘bad’ cholesterol?

Too much ‘bad’ cholesterol can build up in your arteries causing them to harden or fur, which restricts the blood flow to your heart and increases your risk of heart disease.

‘Good’ cholesterol helps to control the amount of bad cholesterol in your blood by transporting excess LDL cholesterol from your arteries to your liver for removal.

It’s all about balance

Your balance of ‘good’ and ‘bad’ cholesterol is one factor influencing your risk of heart disease, and it’s important to be aware of, says Dr Sarah Brewer.

“Like many things in life, it’s important to have just the right amount,” she explains. “Too much cholesterol may be bad for health, although this is no longer as clear cut as once believed.”

It's not just the total level of cholesterol, LDL or HDL cholesterol that's important, but your balance of IDL, VLDL and lipoprotein(a), aka: ‘non-HDL’ cholesterol.

What causes high cholesterol?

There are a variety of genetic, health and lifestyle factors that can raise your cholesterol levels, including:

  • Having an immediate family member with high cholesterol
  • Having an immediate family member under the age of 60 who had suffered heart attack, stroke or angina
  • Having type 2 diabetes
  • Being physically inactive
  • Smoking
  • Following a diet high in animal and saturated fats

How to reduce cholesterol

If you’re worried about your genetic risk of high cholesterol, have been diagnosed with, or your GP has advised your cholesterol is rising, try these simple hacks to lower your risk naturally:

  1. Eat more… fruit and vegetables, pulses such as lentils, chickpeas, kidney beans and black beans per day, and include wholegrains in as many meals as possible. Try to eat fish twice a week, making sure one of these is oily - salmon, mackerel, sardines or tuna are good options.

    “Your intake of antioxidants from fruit and veg is important, as these protect LDL cholesterol from oxidation and prevent the furring up of the arteries”, says Dr Sarah. “That's why eggs are no longer off the menu - their antioxidant, vitamin and other nutrient content can offset the effects of the cholesterol present, so they can be included as part of a varied, balanced diet.

  2. Cut back on… saturated fats like butter, full-fat milk, cream and cheese, coconut and palm oils. Instead, choose modest amounts olive, rapeseed, sunflower and other plant oils and spreads, almond milk and cottage or other lower fat cheeses.

  3. Move regularly… to keep your heart and circulatory system healthy. Aim for a minimum of 150 minutes of moderate exercise per week – aka 30 minutes per day. Or, 75 minutes of vigorous exercise such as running, swimming or cycling, plus resistance training to strengthen muscles and joints on two additional days.

  4. Lose weight… in order to maintain a healthy weight, your BMI should be between 18.5 and 24.9. While eating a healthy balanced diet and exercising regularly have their own benefits, they also mean a reduction in risk of type 2 diabetes when combined with weight loss: aka, a lower risk of heart disease.

  5. Quit smoking… by visiting www.smokefree.gov, now.

  6. Try a supplement… did you know? “Plant sterols are one of the best, natural ways to bring down high cholesterol,” says Dr Sarah Brewer.

Know your numbers:

Cholesterol levels are only one of many different risk factors used to assess your risk of heart disease. You can calculate your own risk if you know your blood pressure and cholesterol/HDL ratio (calculated by dividing your total cholesterol by your HDL level) at http://qrisk.org

“Ideally, your non-HDL cholesterol should be lower than 4mmol/L and your total cholesterol should be 5mmol/L or less.”, advises Dr Sarah. “Your ratio of total cholesterol divided by HDL cholesterol should be less than 6. A ratio above 6 is considered high risk, so the lower the ratio the better.”

The following are healthy for most people:

Total cholesterol: 5 mmol/L or less

Non HDL-cholesterol: 4 mmol/L or less

LDL-cholesterol: 3 mmol/L or less

*Mmol/L=millimoles per litre (source: Heart UK)

If you are at a higher risk of heart disease or already have heart disease you may need to further reduce cholesterol. Check with your GP.

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