I've been told I have high cholesterol - now what?
This is one of the most common reasons that people see me in my lifestyle medicine clinic. Patients see their GP, have some routine blood tests as a health check, and then, there it is, a high cholesterol reading. This can be a scary result; we've all heard of the risks of having high cholesterol. There may have been talk of starting a statin, and you might have read some less than complimentary articles on statins and their side effects. In light of this, lots of people are reluctant to start taking a statin without exploring other options first, and/or want to make some proactive changes to their lifestyle, which is where I come in.
Before I cover what you can do to minimise your risk of cardiovascular disease, I'm going to talk about cholesterol first. Cholesterol is a fat chemical that is made in your body. We need cholesterol to make, amongst other things, hormones, bile acids to help digest our food, and to make up all of the cell membranes in our body. It's carried around in our bloodstreams by 2 main carrying particles - low density lipoprotein (LDL), and high density lipoprotein (HDL). When we talk about cholesterol, the common belief is that LDL furs up the arteries in a process called atherosclerosis, in which the artery becomes hardened and narrowed, increasing the risk of clots and blockages. Conversely, HDL plays a helpful role in transporting cholesterol away from tissues and back to the liver, where it is processed ready for excretion. High LDL levels have been associated with heart disease (1), but cholesterol is just one factor in a whole host of others. There is debate raging around the relevance of cholesterol readings, with a recent review (2) finding that LDL doesn't cause heart disease. While the camps are divided on it, I prefer to take a more pragmatic approach. Namely, if you've had your cholesterol levels flagged up by your doctor, why not take this opportunity to look at your health and see if you can optimise it? If cholesterol is not a cause of heart disease, it is still associated with it, so let's do what we can to get that number down. That means more than number-checking on a blood test - it means looking at all the lifestyle factors that we know contribute to higher cholesterol (and worse health) and addressing them. Doing so can only be beneficial.
1. If you're smoking, stop. It damages the inner lining of your arteries, which causes build up of fatty material (including cholesterol) - called atheroma. This narrows the arteries and makes it much harder for your body to get blood where it needs to go, and increases the risks of blood clots forming.
2. Reduce your alcohol intake if possible. National guidelines recommend no more than 14 units/week for both men and women, (not drunk all at once on a Friday night though!).
3. Exercise regularly. That doesn't have to be sweating it out in the gym - it just means getting your body moving energetically, regularly, preferably in a way that you enjoy!
4. Have a look at your diet. Eat a balanced one - including healthy fats (e.g. avocado, nuts, seeds, coconut oil). Aim for whole foods, as minimally processed as possible, and make sure you're getting lots of fibre. If your diet really needs work, start simple - drink an extra glass of water a day, swap one snack for a handful of nuts or a piece of fruit. Don't try to overhaul everything at once. Small steps, every day, lead to big changes in time.
5. Finally, make sure you're getting all the vitamins and minerals you need. If you know you don't eat a varied colourful diet comprising lots of fruit and veg (not skittles!), it may be worth getting a good quality multi-vitamin. Over winter in the UK, we should all be supplementing with vitamin D. Omega 3 fish or algae oil (the vegan/vegetarian alternative) has been shown to lower the risk of cardiovascular disease - it's a great choice.
If you're worried about your cholesterol levels, or if you have a family history of cardiovascular disease, and you're looking for a personalised lifestyle medicine consultation with advice tailored to you, do get in touch to arrange a free scoping call.
1. Law M.R., Wald N.J., Rudnicka A.R. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: Systematic review and meta-analysis. BMJ. 2003;326:1423. doi: 10.1136/bmj.326.7404.1423.
2. Uffe Ravnskov, Michel de Lorgeril, David M Diamond, Rokuro Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Luca Mascitelli, Kilmer S McCully, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan & Ralf Sundberg (2018) LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology, 11:10, 959-970,DOI: 10.1080/17512433.2018.1519391