Fat chance: Why your cholesterol level is a matter of life and death
LAST week I was chatting with a man in my surgery about his weight, his smoking and his cholesterol. I found that we spent the majority of the consultation on his diet as some of the information he was working with was right, some was wrong and some of it was just bizarre.
At least part of the problem is that there is a huge amount of confusion about cholesterol in the media these days.
One week soy milk is full of good cholesterol, the next week it’s the reason for male infertility (it’s not by the way).
Telling the truth from marketing can be difficult.
What is cholesterol and why should I care?
Cholesterol is a fatty substance most of which is made in the liver, and it is essential for forming our cells, hormones and even some vitamins.
We talk about three main types of cholesterol high-density lipoprotein (HDL aka good cholesterol); low-density lipoprotein (LDL, aka bad cholesterol) and triglycerides (you won’t hear much about these unless they’re way off).
LDL is made by your liver and sent out into the body to be used. It is easy for cells to break down but if it gets damaged or, if there’s just too much, it sticks to the inside of the blood vessel walls and narrows them.
This is like drains getting blocked but instead of the only problem being a backed up loo, when the pipes inside your heart get blocked that’s a heart attack, if it’s the ones to your brain then you’re looking at a stroke.
HDL is cholesterol on its way back to the liver for storage or removal. You can think about it as the body’s way of removing unused cholesterol from the bloodstream so the higher this is, the more it works to protect the inside of the blood vessels.
Most people will be told the figure for total cholesterol (TC) which is a combination of the three above (and a few others).
Why should men care?
Heart disease and stroke kill approximately 10,000 people in Ireland every year. That’s a fairly significant number and when you think that this doesn’t take into account the number of people who survive but are left disabled, you start to realise this is something we should all take seriously.
Heart disease happens in men about 10 years earlier than in women so we need to be more careful about it.
What should you be aiming for?
The first number to look at is total cholesterol. That number should be less than 5mmol/l. In more detail, we would like LDL to be less than 3 and HDL to be greater than 1. These are a guideline and there are some finer points but it’s a good place to start.
How do I find out?
Unfortunately, high cholesterol doesn’t have any symptoms until its too late. It’s not much good finding out after your first heart attack that you should have been looking after your cholesterol 10 years ago.
The only way to know is to have a fasting blood test done with your doctor. For accurate results, you need to have not eaten anything for eight to 10 hours before the test, and this includes drinking tea or coffee with milk or sugar. Drinking water doesn’t affect the results, so if you usually take regular medication in the morning you can still take them the day of the blood test.
Pop-up cholesterol clinics are useful to give a rough idea of whether or not there is a big problem but your GP can get accurate results and explain whether or not to worry about them.
How to fix it (without meds)
So you have high cholesterol? The first two questions my patients ask are: Why me? And how can I fix it without having to go on medication?
First things first, there can be a few reasons that your cholesterol might be high. To begin, look at your diet. High sugar intake and alcohol (particularly binge drinking) will drive your cholesterol up and will tend to push up your LDL more than anything else. Eating a lot of red meat and processed or fried foods will also drive up your numbers.
Genetics is the next thing. If your dad and mum both have high cholesterol chances are, so do you. This is down to how our liver goes about making and removing cholesterol. For some people with a genetic predisposition
to high cholesterol, their bodies auto-adjust so that a level 6 or 7 is normal. But it’s not.
If you have parents on cholesterol meds and any family history of heart disease or stroke get tested.
That’s the why, so what can you do about it? Get active. Exercise will both drop your total cholesterol and tend to increase your HDL. Getting at least 150 minutes of cardiovascular exercise per week will have a significant impact on you cholesterol levels and has loads of other medical benefits. Throw in some resistance training too and the benefits increase dramatically.
Watch your weight. Having excess weight puts your body under increased pressure to run properly. Too much fat, particularly around your belly button area, makes life harder for your metabolism.
This means that insulin, which not only controls your sugar levels but also has a big role to play with cholesterol, doesn’t work very well, pushing up your risk of heart disease and diabetes.
Adding certain plant-based cholesterols and fibres to your diet can help too. I usually recommend looking into the portfolio diet. This involves combining a healthy diet of oats/porridge and fruit with almonds or other tree nuts and plant sterols (the stuff you find in cholesterol-lowering drinks or spreads). The Irish Nutrition and Dietetic Institute website has a really clear guide to this diet.
How to fix it (with meds)
You’ve tried to reduce it and it’s not coming down enough? I would recommend a class of medication called statins (chances are you know a few people who already take these). These are very effective at reducing cholesterol and most people don’t have suffer any side effects from them. By taking medication and dropping your cholesterol, let us say, from 6 to 4, your can reduce your risk of a heart attack or stroke by up to 40%.
Bottom line
Know your levels. If they’re normal getting them checked every five to six years is plenty and if they’re not, get them down. Your life may depend on it.
