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Cholesterol - the good, the bad and the ugly
by Dr Rowena Nicholson MBBS MRCGP DRCOG DipPCouns DipNSpH DipTHY&R BSEM member
[this article appeared in Devon Life magazine, April 2008]
Cholesterol is essential to human health, as it is part of every cell membrane and is also required for hormone production. This may be a surprise to some, given the bad press that cholesterol usually receives.
The reason for all the excitement about cholesterol is that a high level has been found to be a risk factor for heart disease in young and middle aged men (but not in women or the elderly). In the UK, the average cholesterol is 5.5 mmol/L for men and 5.6 for women, with the ‘normal’ being considered to be 5.0. The most important thing however, is the type and balance of cholesterol. Of the 3 main types, LDL and triglycerides are considered to be harmful, whereas HDL is in fact protective against heart disease. Therefore doctors are usually more interested in the ratio of bad to good cholesterol than the actual levels.
A raised cholesterol level is of little significance in itself, but needs to be interpreted in the light of other risks factors including: age, gender, family history of heart disease, smoking status, blood pressure and other health problems, weight and exercise. Someone with a slightly raised cholesterol who is also a smoker and has high blood pressure would be more of a concern than someone who is otherwise fit and healthy.
An increasing number of people want to prevent ill health, including heart disease, through lifestyle changes, and as a result may be following a low fat diet. However if all fats are reduced to a low level, you could also miss out on essential fatty acids and fat soluble vitamins which are essential for good health. The key thing is to reduce saturated fat, which is found in animal products, particularly eggs, dairy products and some meats. At the same time, you need to increase your intake of ‘good’ or heart friendly fats found in oily fish, seeds and nuts, and/or take a fish or omega oil supplement. Vegetarians should take 1 dessert spoon of flax oil daily, but this should not be heated. This is because vegetarians tend to have a lower omega 3 and higher omega 6 intake than ideal, and flax oil is one of the few good vegetarian sources of omega 3. A diet rich in omega 3 has been shown to significantly reduce the risk of heart disease, lower your ‘bad’ LDL and triglyceride levels and reduce blood pressure. The healthiest fats to cook with are olive or canola oils; it is best to avoid margarine however, as this contains hydrogenated fats.
Other lifestyle changes can also help to reduce your risk of heart disease:
- a good intake of fruit, vegetables, grains and beans.
- reducing sugar and refined carbohydrates (e.g. white bread, flour, pastry, cakes, biscuits) in order to reduce the risk of diabetes.
- Enjoy a glass of red wine daily as your preferred alcohol choice.
- Exercise reduces your bad LDL and increases your good HDL cholesterol, as well as providing many other benefits.
Most people who are thought to be at risk of heart disease are advised to reduce their cholesterol intake. However, since most of our cholesterol is in fact made in the liver from carbohydrate, with only a small proportion coming from our diet, only a modest reduction of up to 1.0mmol/L is usually feasible. For many people the next step is often a statin drug. These do reliably reduce cholesterol, but sometimes people suffer side-effects including muscle pains and an adverse effect on the liver. Unfortunately, statins also reduce the level of co-enzyme Q10, which is one of the most important antioxidant (anti-cancer) agents in the body, and a low co-Q10 can also raise one’s homocysteine level, which in turn increases the risk of heart disease. Therefore anybody who is taking a statin drug should consider taking a co-enzyme Q10 supplement as well.
In my clinic I often see people who have not been able to tolerate statins; however, there are many nutritional and herbal options available to help reduce cholesterol levels. Many supplements are supported by good evidence, and some compare favourably with statin drugs, but usually without the side-effects. If you are in this position, it is better to have professional advice before trying supplements, as your cholesterol level will need to be monitored, and the supplement choice depends on which type of cholesterol is most abnormal and what other health issues or risks you have.
Please note that this article is not a substitute for individual medical advice; anyone who has a medical condition, is pregnant, underage or who takes medication should check with their medical practitioner before taking any supplements