Understanding Cholesterol

I get alot of queries about cholesterol.  Here are 10 things to know about cholesterol in general. 

2. What is it? Cholesterol is fatty stuff in your blood. We need some cholesterol to make hormones, but too much of it can just get sticky. It can start to coat the inside of your blood vessels, and they can get narrower. The narrowing and changes to the vessel lining can lead to blockages that cause heart attacks and stroke.

3. “Do I need to be fasting to have my cholesterol checked? I heard it doesn’t matter. ” It is true that it might not matter for everyone.  However, especially the first time you get it checked, it’s best to be fasting (nothing to eat or drink) for about 10 hours.  This is because if your number comes back high, it might need to be repeated. It gets a bit technical, but it has to do with how triglycerides at high levels can affect your LDL measurement. Triglycerides rise after you eat. Some studies have found it isn’t significant, but is a factor if you have high triglycerides or if there is a possiblity you could have high triglycerides.

4. “What does a cholesterol test show?” Docs actually request the lab to do a “lipid profile”.  This includes, usually, your total cholesterol (the “good” and the “bad”), your LDL (sometimes called “bad”), your HDL (sometimes called “good”), and your triglycerides.

5. “What should my numbers be?”

• Total cholesterol: Less than 5

• LDL : Less than 3 (but for people with some other risk factors for heart disease or stroke, it should be less than 2.5!)

• HDL cholesterol: OVER 1 for men or 1.2 for women

• Triglycerides: Less than 1.7

5. “My cholesterol isn’t important – my overall health is.” Your health is more than your cholesterol BUT a high LDL cholesterol is an independent risk factor for things like heart disease and stroke. There are a few risk calculators, but in daily practice, I like to use the ASCVD, which includes age, sex, total cholesterol, LDL, HDL, smoking, diabetes, high blood pressure, and use of medication. This can estimate a 10-year risk of cardiovascular disease, and it’s useful to re-calculated at 6 month and 12 month follow-ups with my patients to see if we are making progress (risk reducing).

6. “My doctor prescribed a statin (a medication to lower my cholesterol) – is there any option?” The short answer:  It depends on you, so talk to your doctor.  This is what I do in clinic every week!  Many factors can affect your cholesterol, but genetics are also very important.  For some people, there may be changes that could be made.  For others, they are doing as much as they can do already, so they may need medication.  This isn’t always about how hard you’re trying – some families have genes for high cholesterol.   These families will usually also have a family history of heart disease or stroke.

7. What can I do to look after my cholesterol?

   • Exercise – Physical activity can be a great way to lower your cholesterol. Like many aspects of health, it’s not all about one thing.  Exercise can also regulate blood glucose and reduce blood pressure, among other benefits.

   • Smoking – yes, it affects your cholesterol!

   • Alcohol – stick to low risk drinking

   • Get enough sleep

   • Manage or reduce stress

8. What about medical conditions that cause high cholesterol?

There are two conditions worth mentioning here.  One is low thyroid.  The other is obesity. In both cases, getting treatment for those conditions will often help improve your cholesterol.

9. “I don’t want to take statins. I’ve got some supplements. Will they work?”

   • Most supplements simply have a food that would be better just eating the food. It’s hardly natural to take food that you should be eating in ground up power or capsule form.  Including healthy foods like garlic, fish, or flaxseed in your diet often would be a better options than a supplement.

   • “Natural” on a supplement label has no meaning.  Remember that many drugs started out as natural (digoxin is foxglove and warfarin started as mouldy hay.)   Red Yeast supplements are known to sometimes contain monacolin K, which is the same stuff found in lovastatin (so also risks the same side effects!)

   • Many supplements for cholesterol advertise plant stanols or sterols. Around 2g a day of sterols or stanols may help lower cholesterol, so this can be found in one serving of stanol/sterol fortified yogurt or one glass of fortified milk. This can be through fortified food instead a supplement.   It is only helpful in the context of an otherwise health diet.  There is no evidence that more than this has any further effect.

10. “What about diet?”

    • Diet in the management of cholesterol is really important. I could write pages on this, but I’m going to keep this really short:  high in fibre, vegetables, legumes (beans, lentils), fruits, and whole grains (oats!) are good.  Also good are nuts such as almonds, walnuts, and pecans.  Foods rich in Omega-3 (flax seed, chia seed, fish), and foods naturally rich in plant sterols, such as soya or avocado.  Reducing processed/ultra-processed foods and animal products can help.  Avoid transfats and saturated fats.  The Mediterrean diet can be great for looking after heart health!  Whole-food, plant-predominant diets are associated with lower cholesterol.

Wait, what about The Portfolio?  This diet is based on a 2003 study in which a 3 groups of study participants were followed over 2 weeks.  One group got a drug, lovastatin and a low-saturated fat diet.  One group was advised to eat low-saturated fat diet, but didn’t get any expert diet counselling.  The last group was fed the “Portfolio” diet high in cholesterol-lowering foods that contained plant sterols and high fibre and was low in saturated fat.  At the end, the portfolio diet group had lowered their cholesterol by 28.6%, nearly as much as the lovastatin group – 30.9%.  So, in theory, it can work. However, these were screened study participants followed only over a few weeks.

               Before you do Portfolio, what should you know to do it safely?

1) Always talk to your doctor or cardiologist first to make sure it’s the right step for you – it’s not right for everyone

2) Your doctor may suggest you also work with an INDI/CORU registered dietitian

3) It should be part of other steps to lower your cholesterol.

Still have questions?  It’s best to get an expert answer on your cholesterol numbers – in the context of your risk – from a qualified doc.