Author: Dr Sarah Brewer MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, FRSM Category: Health, Heart Health, Men's Health, Women's Health
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Dr Sarah Brewer, GP, nutritionist and author of ‘Cut Your Cholesterol’ tackles the confusing subject of cholesterol

A recent survey of over 2,000 people conducted by Healthspan the supplement and wellbeing brand, found that 77 per cent of people said that, despite all the lifestyle information out there, they still do not understand the different types of cholesterol.

Here Dr Brewer tackles some of the questions raised:

What is cholesterol?

Cholesterol is waxy substance produced mainly in the liver, although most body cells can make it when necessary.  Cholesterol is vital for health as it is used to make hormones, vitamin D, bile acids and cell membranes.

There are two main types of cholesterol – ‘bad’ LDL-cholesterol and ‘good’ HDL-cholesterol which removes LDL-cholesterol from the circulation and transports it back to the liver for processing.

A raised blood level of cholesterol has been linked with an increased risk of cardiovascular disease such as heart attack and stroke.  However, the strength of this association is currently under question.  It is increasingly thought that only oxidised cholesterol is harmful.

How is cholesterol measured?

In the UK, blood cholesterol is measured in units called millimoles per litre of blood (mmol/L).

Currently, the following cholesterol levels are considered ideal:

Total cholesterol:

  • 5mmol/L or less for healthy adults
  • 4mmol/L or less for those at high risk

Low-density lipoprotein (LDL) cholesterol:

  • 3mmol/L or less for healthy adults
  • 2mmol/L or less for those at high risk

High-density lipoprotein (HDL) cholesterol:

  • Above 1mmol/L – the higher the better as a lower level of HDL can increase your risk of heart disease

Your ratio of total to HDL cholesterol (calculated by dividing your total cholesterol by your HDL level) is used to estimate your cardiovascular risk.  According to the British Heart Foundation, 54% to 64% of men and 56% to 68% of women in England have a raised cholesterol level.  Until the menopause, women generally have lower total cholesterol levels than men, but after the age 50 women often have a higher total cholesterol than men of the same age.  For both men and women, total cholesterol levels tend to rise until around the age 65.

What are the causes of raised cholesterol levels?

The main factors associated with raised cholesterol levels are the genes you inherit, your age and lifestyle – especially your diet, alcohol intake and physical activity level.  Smoking cigarettes releases a chemical called acrolein that stops ‘good’ HDL- cholesterol from transporting ‘bad’ LDL-cholesterol back to your liver for processing.  Poor functioning of the kidneys, liver or thyroid gland can also raise cholesterol levels.

How can your GP help with raised cholesterol levels?

Your doctor will estimate your 10-year risk of cardiovascular disease (CVD) based on your age, gender, smoking status, blood pressure, cholesterol balance and whether or not you have diabetes or certain other health problems.  If you do not currently have CVD your GP may offer lipid modification therapy (a statin) if your estimated 10-year risk of developing CVD is 20% or more.  This is known as primary prevention.

If you have established CVD, have type 2 diabetes or are aged 75 or over, you are also considered at high risk and are likely to be offered a statin.

If your 10 year risk of CVD is less than 20% and do not have a raised cholesterol you may not be offered a statin, but there are suggestions that people at lower risk of CVD will be offered a statin in the near future.

How can you avoid raised cholesterol levels?

You can calculate your own risk of heart disease if you know your blood pressure and cholesterol/HDL ratio – calculated by dividing your total cholesterol by your HDL level at QRISK

  1. Exercise regularly – ideally at least 30 minutes brisk walking a day, and preferably more.  Aiming for 10,000 steps a day is an excellent goal.  If you smoke, do your utmost to stop
  2. Cut back on processed foods containing added sugars or salt, and eat at least five portions of vegetables, salad stuff and fresh fruit per day. Select wholegrain foods rather than white/beige foods so that, overall, you are following a low glycaemic index diet
  3. There is a move away from low-fat diets towards sensible intakes of healthy sources of fat such as those found in the Mediterranean style of eating.  Eggs are allowed, as there is no evidence that they contribute to heart disease.  Eat at least two portions of fish per week, of which one should be oily (e.g. herring, mackerel, salmon, fresh tuna, sardines, pilchards)
  4. Aim to limit alcohol intake to, at most, 21 units spread over a week for men and 14 units spread over a week for women
  5. If you are overweight, aim to lose some excess fat and to keep it off

Reducing cholesterol

Plant sterols (e.g. 800mg three times a day) lower cholesterol levels by blocking cholesterol absorption in the gut.  A sterol rich diet can lower levels of harmful LDL-cholesterol by around 15%.  Because statins work in a different way to plant sterols, the two can be used together to lower cholesterol levels even further.  Adding sterols to statin medication is more effective than doubling the statin dose.  Try Healthspan new YoGo, a different way of taking supplements in an instant yogurt-style drink with 1,500mg of plant sterols available in natural and peach flavour. 

Taking a statin reduces your synthesis of both cholesterol and co-enzyme Q10 which may contribute to the muscle-related side effects that some people experience when taking this medication.  In fact, taking a statin can halve circulating levels of co-enzyme Q10 within just 2 weeks.  Taking co-enzyme Q10 supplements or Healthspan Ubiquinol (a body ready form which is equivalent to 280mg of CoQ10, 60 tablets £37.95) which helps to maintain blood levels of this important muscle nutrient while taking statins.  Importantly, taking Ubiquinol/CoQ10 does not affect the cholesterol-lowering action of statin drugs.

Dr Sarah Brewer’s book Cut Your Cholesterol is available from Amazon