Yesterday’s post PART 1 was all about cholesterol; where it comes from and why it’s harmful. So lets take this further and look at how we can lower the harmful LDL, or ‘bad’ cholesterol levels in our body, including the role of statins.

Before we start, lets look at what are our cholesterol levels should be:

Cholesterol levels are measured via a blood test.  To get an accurate result, you should not eat for 10-12 hours before the test. This ensures that any food you will have eaten the evening before will have been completely digested and will not affect the result – cholesterol levels can fluctuate after eating, taking around 3hrs to peak, depending on what you have eaten.

The tests are designed to determine your risk of developing cardiovascular disease (and suffering a heart attack or stroke) within the next 10 years. So what is measured?

Total cholesterol level

Healthy adults should have a total cholesterol level in their blood of 5mmol/L.  

Over 60% of adults have levels above this figure and often women have slightly higher levels than men.

Knowing more than the total amount of cholesterol is often more helpful though in determining someone’s risk of heart disease. It can be very useful to know what your total cholesterol level is made up of, i.e. how much good cholesterol do you have and how much bad.  For example if your cholesterol level is a little over 5mmol/L, there may be no need to worry if you have lots of the good cholesterol (HDL) and not very much of the bad cholesterol (LDL).

Level of LDL

Healthy adults should have an LDL level of 3mmol/L or less. This being the bad stuff, less is best.

For those who may already be at risk of cardiovascular disease (because it runs in the family, or they have diabetes or high blood pressure), we look for an LDL level of less than 2mmol/L.

Level of HDL

HDL should be above 1mmol/L. In other words more is better.

A lower level of this good cholesterol can increase your risk of heart disease.

Diet and cholesterol

What can I eat so that my cholesterol levels are at a healthy level.

There are 3 things you can do:

1. Cut down on saturated fats
2. Choose unsaturated, healthy fats instead
3. Eat plenty of fibre rich food (fruit and vegetables)

Cut out the saturates

In my previous post I explained we should be eating fewer foods that contain saturated fat because these raise our cholesterol levels.

• Men should eat no more than 30g of saturated fat a day.
• Women should eat no more than 20g of saturated fat a day.

To help you pick foods the right foods when shopping, check the traffic light colours on food labels and GO FOR GREEN:

High: More than 5g saturates per 100g. These foods should be limited.

Medium: If the amount of saturated fat per 100g is in between 1.5-5g Consume these foods in moderation.

Low: 1.5g saturates or less per 100g. It’s fine to eat these foods.

For more information about cutting down on saturated foods, please click this link to the NHS Choices page: http://www.nhs.uk/Livewell/Goodfood/Pages/Eat-less-saturated-fat.aspx

Choose unsaturated fats

We don’t need to cut down on all fats. Unsaturated fats can actually help protect our heart and many of us should be eating more of them. Eating unsaturated fats instead of saturated can help increase the levels of HDL (good) cholesterol and lower our risk of cardiovascular disease.

Good sources of unsaturated fats are:

• oily fish (mackerel, pilchards, sardines, herring, salmon and fresh but not tinned tuna)
• vegetable and nut oils like sunflower, corn, linseed, walnut and olive oils
• nuts and seeds – any type (as long as they are unsalted) like almonds, cashews, walnuts, peanuts and Brazil nuts, sunflower and pumpkin seeds.
• avocados

What we do need to remember however is that all fats are the same when we think about energy (Calorie) content. Fats contain over double the amount of calories compared to carbohydrates and proteins so we need watch how much fat we have. There are around 100 Calories in 1 tablespoon of olive oil so we should still remember to use fats and oils sparingly. Just because something is good, more is not necessarily better but it will certainly help if we swap the bad fats for the good ones!

Eat more soluble fibre

Soluble fibre is probably best known for its cholesterol lowering effect (specifically lowering LDL cholesterol), when eaten as part of a low-fat diet.  It can work in 2 ways:

1. Most foods contain both soluble and insoluble fibre.  Soluble fibre absorbs water in the bowel forming a soft gel-like substance. This gel binds with cholesterol and therefore makes it easier to eliminate from the body.
2. Another benefit from eating soluble fibre is that although we don’t digest it directly ourselves, the bacteria that live in our gut do. They break it down through a fermentation process that yields products called short chain fatty acids (SCFA’s).  Some of these have been shown to slow our body’s production of cholesterol by the liver, so again if combined with a healthy diet, soluble fibre can help lower our total cholesterol levels. Great stuff!

Foods rich in soluble fibre include:

• oats
• bananas
• apples
• carrots
• potatoes
• peas
• beans
• lentils

Plant sterols

You could also consider including some plant sterols in your diet but I must emphasise this suggestion is only for those with raised cholesterol levels – there is no real benefit if your cholesterol level is normal. They are also not suitable for children, pregnant or breast feeding women.

You will probably have seen plant sterols in the chilled section of the supermarket? Products like Flora proactive or Benecol? They make a range of spreads, yoghurts and milks that contain substances called sterols.  Basically, these look like and mimic cholesterol. Sterols compete with dietary cholesterol for absorption, reducing the amount of cholesterol we absorb in the gut. Over time, more and more cholesterol is removed from the bloodstream as our body uses it up, the result being our cholesterol levels lower.

Current advice suggests eating between 1.5g – 2.4g of plant sterols each day to significantly reduce LDL (bad cholesterol) by up to 10%.  There is no additional benefit in taking more than 3g per day. You could achieve this by consuming the following:

250ml fortified milk + 2 teaspoons of a fortified spread + 1 individual fortified yoghurt OR 1 fortified yoghurt drink (67.5-100ml)

I must add however, that plant sterols will not compensate for a poor diet. In other words eating a slice of cake, followed by a yoghurt drink will not work!

Finally  we come to statins.

What do statins do?

Statins primarily reduce the production of cholesterol by the liver, which makes around 70%  of the total cholesterol in the body. They may also have a number of other effects that can help cardiovascular health but I won’t go into them here. Statins switch off an enzyme in the liver, blocking the pathway to make cholesterol ourselves. Combined with a healthy diet, they can be very effective at helping to lower cholesterol levels but like sterols are not a substitute for a poor diet. Lowering your cholesterol needs a ‘whole lifestyle approach’ – if you are offered statins, you will also be advised about stopping smoking, watching your alcohol intake and taking regular exercise.

Statins have been used since the mid 1990’s and there is plenty of evidence supporting their use in preventing heart disease – there are no major concerns about their use. What has popped up in the news this week though is the proposal to lower the ‘treatment threshold’ so that millions more people at a lower risk of heart attack or stroke would be given them.  The worry is that with more people taking statins, it is likely to increase the number of people experiencing side effects.

Now all drugs have side effects, even paracetamol – this is not new.  It’s about weighing up the benefits and risks – in high risk patients the side effects will be negligible compared to their benefits in cutting the chances of heart disease, it’s a no-brainer! But lowering the threshold at which patients would be put into statins (to include low-risk patients) could mean that the side effects may outweigh the small benefits of them taking statins.  Arguments have taken place this week because the recommendations that will be published at the end of July are based on data that has not been made available for researchers to review. How can an ‘evidence based’ recommendation be made if we can’t see the evidence?! So it’s ‘watch this space’  but in the mean time one of the big questions is this:

Should I carry on taking my statins?

Absolutely, yes. The current guidance, under which you will have been prescribed a statin, is not disputed.

I hope you have found these 2 posts useful and they have given you some food for thought…………..please do share / like / comment or ask me questions!!

Posts coming soon will include butter vs margarine and coconuts (as there has been a surge of popularity concerning coconut water drinks and coconut oil). see you soon 🙂