“Cholesterol is a type of blood fat, which is made in the liver. It’s found in some foods, too,” says Tina Dawson, lipid specialist nurse at cholesterol charity, Heart UK. “We all need cholesterol in our bodies to keep us ticking over, but too much in the blood clogs up arteries and leads to health problems.”
That “ticking over” includes building the structure of cell membranes, making hormones and helping your metabolism. But the problems start when cholesterol levels are too high.
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“Cholesterol can’t travel in the blood on its own, so it’s carried in little parcels of fats and proteins called ‘lipoproteins’,” Dawson adds.
“There are two main types, known as low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL cholesterol is sometimes known as ‘bad cholesterol’ because excess causes that clogging. HDL cholesterol is known as ‘good cholesterol’ because it carries that excess cholesterol to your liver to be broken down.”
If the surplus isn’t broken down, it’s laid down on the walls of your arteries – the large blood vessels that carry blood around your body – and can form plaques. These harden over time, stiffening and narrowing the arteries. “This process is called atherosclerosis,” says Dawson. “Your blood can’t then flow around your body as easily and this can lead to cardiovascular disease – heart attacks and strokes.”
One of the major causes of high cholesterol is diet, specifically eating too many fatty foods. Insufficient exercise, smoking, alcohol and being overweight are other contributors.
“Usually, there aren’t any symptoms of high cholesterol,” says Regina Giblin, senior cardiac nurse at the British Heart Foundation (BHF). “That’s why regular routine testing – via a simple blood test at a GP surgery or pharmacy – is important.”
It’s advisable to have regular checks from the age of 40. “That said, some people can develop high cholesterol earlier, while others find they have healthy levels well into their 50s and 60s,” says Giblin.
Fuelling fitness
If your levels are high, cutting down on salty foods and saturated fats is essential. These are found in red and processed meats, full-fat dairy products, coconut milk, palm oil and foods like cakes and pastries. Good fats are found in oily fish, avocados, plant-based oils, nuts and seeds.
“A balanced Mediterranean-style diet is ideal, as it contains plenty of minimally or unprocessed foods such as fruit, vegetables, fish, nuts and seeds, beans, lentils and wholegrains,” says Giblin. It’s advice supported by swathes of research, including a 2018 study that showed the incidence of major cardiovascular events in a cohort deemed at high cardiovascular risk was lower among those assigned a Mediterranean diet.
The humble egg has a bit of a mixed reputation when it comes to cholesterol. “Yolks are known to be high in cholesterol,” says Heart UK dietetic advisor Lynne Garton. “The good news is that as long as your overall diet’s healthy and low in saturated fat, having eggs now and then shouldn’t be a problem.”
Cholesterol and exercise
Complement a heart-healthy diet with heart-healthy exercise. “The NHS recommends at least 150 minutes of moderate-intensity activity per week,” says Giblin. “Do what works for you but know that gardening and mowing the lawn count. It all helps decrease levels of bad and increase good cholesterol.”
See exercise and a healthy diet as your daily medicine. That’s within your control, but some things aren’t. For instance, those from a South Asian background have a higher risk of high cholesterol, while certain conditions, such as type 2 diabetes and kidney disease, can increase the risk. There’s also an inherited condition that means having high cholesterol in your blood from birth.
All of these recommendations will help lower your cholesterol levels. “But if they remain high, other options should be discussed with a healthcare professional,” says Garton. “This will be based on overall cardiovascular risk, as well as cholesterol levels.” That could well include statins, with over 70 million prescriptions dispensed annually in England. Whether statins are needed or not, exercising more and eating healthier foods will lead to proven health gains.
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