Cholesterol - by Dr David Delvin

If you are over 40, you really DO need to know about cholesterol!

Honestly, understanding a little bit about this interesting stuff could save your life.  Why?  Because a high cholesterol is quite likely to kill you - if you don't do something about it.

But unfortunately, I find that most people don't have much idea about what cholesterol is - or about what they can do to control it.

So in this article, I'm going to do my best to make everything clear.  Reading this simple explanation could help you - or your partner - to live longer.

WHAT ON EARTH IS CHOLESTEROL?

Cholesterol is a fatty material, which is present in your blood.

The vital thing to realise about it is this.  IF YOU'VE GOT TOO MUCH OF IT IN YOUR BLOODSTREAM, THAT MAY GIVE YOU A HEART ATTACK.

Why?  It's because of the fact that excessive cholesterol gets deposited on the walls of your arteries (that is, the tubes that carry your blood) - rather like rust inside drainpipes.  These deposits make the arteries NARROWER, so that less blood can get through.  

And the result of that impairment of the blood supply may well be a coronary (a heart attack).

So clearly, it's a good idea to keep your cholesterol down to a safe level.

WHY DO SO MANY OF US HAVE A HIGH CHOLESTEROL?

Now the fact is that in Britain and many other Western countries (especially the USA), our levels of blood cholesterol are generally much too high.  As a result, the British and the Americans have horrendous heart attack rates.  As you will probably know from the experiences of your friends and colleagues, heart attacks quite often cut people down in their 50s and 60s - at a time when they should have many years of active life in front of them.

You'll probably be amazed to hear that it wasn't always like this!  100 years ago, heart attacks were virtually unknown in the UK - and in the USA.  And so many people had very low cholesterol levels.

But after about 1910, things began to change.  The incidence of heart attacks began to sky-rocket.  And people's cholesterol started to get higher and higher - because it was largely cholesterol (with the help of some other factors, like smoking) which was causing the rise in heart attacks.  This trend continued throughout the 20th century.

Now WHY do the British and the Americans (and most other Westerners) have such high cholesterols these days?  There are the main reasons:

  • We eat a diet which contains far, far too much ANIMAL FAT - this has only been so in the last 100 years.
  • Most of us don't get anything like enough exercise (exercising helps to burn up cholesterol).

But of these two factors, the more important is our pretty dire Western diet.

OUR WESTERN DIET

Yes, the big problem is that nearly all of us eat an awful lot more animal fat than we should.  Our bodies turn this into cholesterol.

Now nearly every British patient I've ever treated for high cholesterol has assured me that 'I don't eat much fat, doctor!'

But I'm afraid that this just isn't true.  Virtually everyone in the UK - apart from a small number of vegetarians and vegans - eats much more fat than our bodies were designed to cope with.  In many other (mostly poorer) countries, the population can't afford all that animal fat in their diet - so they have much lower cholesterol, and far fewer heart attacks.

What sort of things contain animal fats?  Well, the main ones are:

  • Meat
  • Milk
  • Butter
  • Spreads - apart from the vegetable-based ones
  • Cheese
  • Cakes and pastries
  • Fried stuff
  • A lot of prepared meals from supermarkets
  • Curries

I have to admit that cutting down on fat is very difficult, because so many of the good stuffs which you buy these days do contain masses of the stuff.  Recently, I was appalled to find that manufacturers have actually been adding fat to some types of bread!

EXERCISE AND CHOLESTEROL

You don't need to go berserk about exercising in order to help keep your cholesterol down.  A bit of modest exercise every day is fine - and half an hour is plenty.

Good forms of exercise include:

  • Walking
  • Jogging
  • Swimming
  • Golf
  • Tennis
  • Gardening
  • Cycling
  • Working out at the gym

HEREDITY

High cholesterol tends to run in families - and so does heart disease.  So if YOUR close relatives had a lot of trouble with high cholesterol (or heart trouble), that means you should take care of your health - and get your blood cholesterol level checked from time to time.

However, I ought to just mention that there is a small number of people (one in 500 of the population) who have a serious familial condition called 'Familial Hyperlipidaemia' or FH.  This gives them a very high cholesterol level indeed - and therefore a very high risk of heart attacks.  Often, all the brothers and sisters in such a family will have had heart trouble by the age of 40.

Because this condition is uncommon, I'm not going to say any more about it here.  But if your father or mother or sisters or brothers had heart trouble at any early age, you should go to your doctor and get tested for FH - as a matter of urgency.

GOOD AND BAD CHOLESTEROL

A lot of confusion is caused by the fact that doctors often talk about 'good cholesterol' and 'bad cholesterol.'

You might say: 'Surely ALL cholesterol is bad, isn't it?'  But actually, that's not true.  We all need a certain amount of cholesterol in our bodies - and if the level goes too low, we can get sick.

Furthermore, there are actually TWO types of cholesterol in your blood.  They're called 'LDL cholesterol' and 'HDL cholesterol.'

LDL cholesterol is the stuff that's bad for you - because it increases your risk of heart trouble.  

In contrast, HDL cholesterol helps to 'cleanse' the circulation of fat.  Therefore, it's GOOD for you - because it seems to reduce your risk of cardiac problems.

So it's a very good thing to have a LOW level of LDL, and a high level of HDL.

Different types of fat in your food can affect your levels of these two types of cholesterol - see below.

SATURATED AND UNSATURATED FATS

Now  a lot of people are a bit confused about the fact that labels on food often refer to 'SATURATED' and 'UNSATURATED' fats.

What's this all about?   Well, a very simple way of looking at it is this:

  • SATURATED fats - which are mainly ANIMAL fats - are BAD for you, because they tend to put your cholesterol up
  • UNSATURATED fats - which are mainly found in vegetables products and fish oils - are generally GOOD for you, because they do NOT put your cholesterol up.

Alas, as with most things in life, it's really a bit more complicated than that!  But if you're not interested in scientific complexities, just skip the 'box' which follows:

SATURATED FATS increase your cholesterol level - and therefore your risk of heart trouble.

They are found in animal products, such as butter, cheese, old-fashioned 'hard' margarines, lard, dripping and meat.  But they also turn up in certain vegetable products, such as palm oil and coconut oil.

*  UNSATURATED FATS are divided into three groups:

1.  POLY-UNSATURATES can low LDL ('bad') cholesterol, but may also lower HDL ('good') cholesterol.  They are found in many spreads and margarines, and also in sunflower oil, soya oil, cornflower oil and fish oils.

2.  MONO-UNSATURATES can lower LDL ('bad') cholesterol, and do not affect HDL ('good') cholesterol.  They're found in some spreads, and in olive oil, walnut oil, and avocado.

*** OMEGA-3 FATS are good at reducing certain 'bad' fats (called 'triglycerides') in the blood.  They're found in oily fish, like sardines, mackerel, kippers, tuna and trout.

SO WHAT SHOULD YOUR CHOLESTEROL BE?

Right, now what should your blood cholesterol level be?

Well, that's a subject of some argument.  For instance, I work in two seaside towns.  In one of them the hospital says that the top permitted level is FIVE units.  But in the other town, the local infirmary says that it is SIX!

However, a good general rule is that everybody's cholesterol should ideally be between THREE and FIVE units.  If you're in that range, you probably have a relatively low risk of heart attack.

But what if your reading is HIGHER?  Well, have a quick look at this rough guide which I've compiled:

CHOLESTEROL LEVEL (mmol/L):-

3 to 5       OK
5 to 6       Needs action by you - stricter dieting, plus more exercise
6 to 7       You MUST see your GP for lifestyle advice, and maybe drug treatment
7 to 8       Drug treatment definitely needed
8 or over This is serious - you need regular medical help to get the level down

I must stress that the above guide represents my own personal point of view!  There are many doctors who see things quite differently, and who are keen on starting drug treatment when the cholesterol is only moderately raised.

DRUG TREATMENT

Huge numbers of people aged over 45 are now on cholesterol lowering drugs.  There is much to be said for these pills, and they certainly save many lives.

However, it is also true that they have side effects!  Furthermore, it is a matter of concern that they're being so enthusiastically 'promoted' by some of the big drug companies who manufacture them.

These companies stand to make many millions of pounds if large 'chunks' of the population go onto cholesterol-lowering drugs.  So not surprisingly, there's now a lot of pressure on doctors to prescribe the pills.

As you may have noticed, there is now a great deal of 'PROMOTION' of the drugs to the general public - through TV commercials and other forms of advertising.  Recently, I've been surprised to see that some chemists are actually putting out literature which suggests that three-quarters of all middle-aged people suffer from a high cholesterol - and that using a particular drug would be a good idea.

Because this is a complex and contentious area, I'm not going to discuss individual drugs here.  Whether you actually NEED to go on a cholesterol-lowering drug or not is a matter for you to discuss with your own GP.  Be guided by his or her unbiased advice.
 
Q.        Is it true that eating some kind of SPREAD or YOGHURT can actually keep your cholesterol down?
A.        Yes - to some extent.  In recent years, it's become clear that certain plant-derived chemicals - called 'sterols' and 'stanols' - do reduce the amount of fat which you absorb from the food in your intestine.  Products which contain these ingredients are now to be found on the shelves of every large supermarket.  They're certainly worth a try - though at the moment we don't know much about their long-term effects.


Q.       I have a raised cholesterol.  Is it OK for me to smoke?
A.       No.  For a person with a raised cholesterol, smoking is practically suicidal.  You already have one 'danger factor' for heart disease.  Smoking would be adding another one.

Q.      My doctor is thinking of putting me on one of a group of drugs called 'statins'.  Would these help my cholesterol?  Are there any side-effects?
A.      Statins are the commonest type of cholesterol-lowering drug.  They can often get your cholesterol level down by 20%.  Possible side-effects include muscle pain (which must ALWAYS be reported to your doctor immediately), tummy upsets, tiredness, headaches and insomnia.  They are not suitable for everybody.

Q.       I have cholesterol problems, but the doctors also seem to be worried about something called my 'triglycerides'.  What on earth are they please?
A.      Triglycerides are another type of fat in the blood.  Like a high cholesterol level, a high triglyceride level increases the risk of heart disease and stroke. But the level can be brought down by a careful diet, plus exercise and (if necessary) medication

© Dr David Delvin / Retirement Matters Ltd 2007