You may think you are eating healthily by gulping down smoothies and tucking into the muesli. Surprisingly, though, that’s still no guarantee that your cholesterol isn’t dangerously high.
The average adult in the UK has levels that are above the safe upper limit — and given that more than half the deaths in the UK from heart disease are down to excess cholesterol in the blood, it is well worth having it tested. This can be done by your GP, who can also rule out other conditions, such as an underactive thyroid, diabetes and kidney and liver problems, which can be responsible for raising blood cholesterol. Equally, your doctor can determine whether you are among the one in 500 people with familial hypercholesterolaemia, an inherited condition in which the liver produces too much cholesterol. This is usually treated with drugs called statins, which reduce the amount of cholesterol the body makes each day. The downside is that some statins have side effects. They have been found to trigger muscle inflammation and muscle breakdown, and it is suspected that they may also reduce the pigment in the macula lutea in the eye, which could ultimately result in blindness.
For the majority of people, however, raised cholesterol is largely a question of diet, and a serious overhaul of the way you eat can put you back on track. Begin by cutting back on foods that are rich in saturated and trans-fats, as these stimulate the liver to produce extra cholesterol. It usually produces about 1g of cholesterol a day, but this can be increased several times over by the consumption of foods such as fatty cuts of meat, rich ready-meals and puddings, biscuits, cakes, pies and pastries and even apparently healthy breakfast bars, which can contain trans-fats.
Ditch these and follow the pyramid diet, far right — wholegrain foods, lots of vegetables, some fruit, low-fat dairy foods, very lean meat and fish, as well as small amounts of fat and sugar.
It can have dramatic results, as Ernst John Schaefer, professor of medicine at Tufts University school of medicine in Boston and a leading expert in heart-disease prevention, explains: “In our experience, when we put people on such a diet under controlled circumstances, reductions in LDL cholesterol of 15%–20% have been achieved.” That’s enough to bring the average adult’s level of cholesterol down from 5.5 mmol/l to a respectable and safe 4.6 mmol/l — or, in other words, reducing it enough to be a life-saver. And then, of course, there is the added benefit that a cholesterol-lowering style of eating often leads to weight loss.”
Jeya Henry, professor of nutrition at Oxford Brookes University, says that getting down to within a normal weight for your height can lop off a further 1 mmol/l of cholesterol.
The benefits of the basic pyramid diet can be increased further by actively selecting specific foods with additional proven cholesterol-lowering benefits. Cholesterol not only flows around the body in the blood, it also circulates into and out of the intestines. About half the cholesterol in the digestive system is reabsorbed back into the blood. While the cholesterol is in the intestines, phytosterols (a plant compound found in nuts) can block its absorption, grab the molecules and cart them out of our bodies in faecal matter.
Soluble fibre found in oats, apples, pears and legumes such as peas and red kidney beans has a similar ability to grab cholesterol, as do stanol esters, the active cholesterol-lowering ingredient added to Benecol products such as yoghurt and margarine, which, it is claimed, can reduce LDL cholesterol by up to 14% (again, about 1 mmol/l) if you slurp down one a day.
Drinking two glasses of soya milk (which, combined, contain roughly 25g of soy protein) is also said to lower cholesterol, although how it does so is unclear. Similarly, one glass of alcohol a day (red wine or otherwise), omega-3 oils from oily fish and hemp seeds, and bread, milk, eggs and garlic fortified with omega-3 have similar effects, although, as with soya milk, the way they do this is not fully understood.
Avocados contain beta-sitosterol, a supernutrient that blocks cholesterol absorption through the intestine wall. And the supernutrients in pomegranates seem to boost levels of the paraoxonase enzyme, which attacks and breaks down cholesterol patches on artery walls. Just 100ml of pomegranate juice daily seems to do the trick. Very little of the cholesterol found in eggs, prawns, shellfish and liver is absorbed by the intestine and into your blood, so unless you have familial hypercholesterolaemia, there is no need to cut these out of your diet.
I know people who have managed to reduce their cholesterol levels from about 7.5 mmol/l to under 5 mmol/l simply by changing the way they eat. Diet alone does not work for everyone, but there are thousands for whom it can. If you can lower your cholesterol (without resorting to drugs), lose weight and, incidentally, increase your antioxidant intake from fruit, vegetables and wholegrain foods — which help you to look younger — it has to be worth a try.
THE PYRAMID DIET
Aim to base your daily diet on the following
Very sparing use of fats and sugar CUTTING BACK ON FATS
Avoid foods containing trans-fats - these are usually described as "hydrogenated vegetable fats" on the label. WHAT IS CHOLESTEROL
Cholesterol is one of the body’s fats, or lipids. It is important in producing hormones and maintaining the smooth running of every cell in the body. Too much cholesterol in the blood is not a disease in itself, but can cause hardening and narrowing of blood vessels.
This, in turn, increases the risk of problems such as heart attacks and strokes. In many people, a high cholesterol level is due to a poor diet, but others inherit the tendency even if they eat healthily.
Cholesterol is measured by a blood test conducted after 12 hours of fasting. In the UK, the average cholesterol level is just under 6 millimoles per litre (mmol/l) of blood. Ideally, it should be below 5 mmol/l, which means that the average person suffers from high cholesterol.
There are two different types of cholesterol: low-density lipoproteins (LDL, or “bad” cholesterol) and high-density (HDL or “good” cholesterol). An unhealthy balance between them can lead to heart disease, as can smoking, diabetes, alcohol abuse, obesity and lack of exercise.
As HDL cholesterol is carried in our blood away from artery walls and out of harm’s way, the goal is to have LDL levels below 3 mmol/l and for HDL levels to be higher, so that more cholesterol is taken away from — rather than transported to — the arteries.
Dr Roger Henderson
