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High Cholesterol

Understanding your cholesterol reading

Your cholesterol reading on your blood test is made up of good cholesterol ( HDL), bad cholesterol ( LDL), some other minor lipid particles that are not routinely measured on pathology testing, and finally triglycerides.

LDL – bad cholesterol
Vascular risk is mainly concerned with your bad cholesterol (LDL). And for most people, your LDL should be around 3.0 mmols per litre.

If you have had previous coronary heart disease e.g. heart bypass surgery or stenting, your target LDL should be around 1.7 – 1 .8 mmols per litre. In addition, other high-risk scenarios such as Diabetes Mellitus warrant an LDL probably under 2.5. Your LDL should go down by reducing your saturated fat intake, which mainly comes from red meats, full-fat dairy products, and unseen fats in restaurant and take-away foods, in particular.

HDL – good cholesterol
Your good cholesterol (HDL) is also important. Generally, the higher the HDL, the better. Therefore, if your HDL is above 1.5 (more common in women), one can often tolerate a slightly higher LDL, than that mentioned in the paragraph above.

High CholesterolAnother possible scenario is a very low HDL under 1.0. This is potentially a risk factor because your protective HDL (which tends to mop up bad LDL from your arterial walls) cannot therefore buffer any LDL available.

Triglycerides An isolated high triglyceride level is something that is not commonly seen — while it probably can pose some added risk to heart attack and stroke, currently we don’t know exactly how much risk, if not accompanied by a high LDL or low HDL.

We occasionally see a person with a profile of a high triglyceride (more than 1.7 mmols per litre), combined with the low HDL, which is also a risk pattern seen. Triglycerides seemed to be quite responsive in most people to reducing, particularly white carbohydrates, e.g. white rice, white bread, pasta and potatoes – swapping these food groups to low GI carbohydrates e.g. wholegrain or multigrain bread, brown rice, sweet potatoes.

Generally speaking, reduce your LDL by one mmol/ litre, reduces your risk of heart attack by up to 30% – hence its significance. Keep in mind that the risk of coronary heart disease or stroke interplay between multiple risk factors, which include family history, your age (older is high risk), your gender (male is worse), how your body handles sugar (Diabetes Mellitus being worse than impaired fasting glucose), smoking history (current smoker is worse than ex-smoker is worse than never smoker) and other minor risk factors.

Optimise your Diet

  • Eat nuts most days – at least 25 grams. It doesn’t matter what type of nut you eat. In some studies, those that ate 25 grams of nuts more than 4 days a week had a 50% lower risk of death from heart attack than the non-nut eaters.
  • Eat legumes and lentils (beans, peas, chickpeas, dahl, soya beans) most days. Eating 25 grams daily has reduced annual rate of death by up to 8% in some studies.
  • Eat lots of vegetables, salads and fruits – AT LEAST 5 varieties (preferably 15) daily, with an assortment of different colours (red, orange, green, yellow).
  • Eat fish 2-4 times a week (including tinned fish).
  • Eat lots of olive oil. Extra Virgin is best.
  • Meats are a condiment – not the main meal! The amount of meat you eat ought to be about the size of the ‘palm of your hand’.
  • Minimise the amount of saturated fats in dairy products. Try choosing low-fat versions most of the time.
  • Minimise the amount of highly refined carbohydrates you eat. – white bread, pasta, white rice. Try and aim for wholegrain carbohydrates instead. Choose carbohydrates with low glycaemic index.
  • Consider taking a quality, plant-based, effective potency multivitamin/multimineral daily, and a fish oil supplement (Omega 3 fatty acid) two-three times a day.