If you read nothing else
- Cholesterol on its own is a risk factor, not a diagnosis. A high number does not mean you have heart disease, and a normal one does not mean you are safe.
- The thing that damages arteries most in most people is not fat in food. It is too much sugar and refined starch, too often.
- Ask your GP for two extra blood tests: apoB and Lp(a). They are cheap, they are better than the standard panel, and Lp(a) only needs doing once in your life.
- Six changes do most of the work. They are listed below and none of them are dramatic.
- If you have been offered a statin, this page is not a reason to refuse it. Talk to your GP.
What cholesterol actually is
Cholesterol is a waxy substance your body needs. It builds cell walls, makes hormones, and helps you digest food. Your liver makes most of it. You cannot live without it.
It does not dissolve in blood, so your body packs it into tiny parcels to move it around. Those parcels are the problem, not the cholesterol itself. If too many of them are travelling through your bloodstream, some get stuck in the walls of your arteries. Over years, that build-up narrows the artery. That is what a heart attack or stroke usually comes from.
So the useful question is not how much cholesterol do I have. It is how many parcels are there, and are any getting stuck.
The bit most people get wrong
Most people who think they eat healthily are partly right and partly wrong. The part they usually get wrong is bread, rice, pasta, potatoes, breakfast cereal and "healthy" snacks.
Your body turns those into sugar quickly. When blood sugar rises, your body releases insulin to deal with it. If that happens many times a day, every day, for years, two things follow. Your liver starts making more of the bad parcels. And the lining of your arteries gets damaged, which makes it easier for parcels to lodge there.
You cannot feel any of this happening. That is why it goes on for decades unnoticed.
This is not a reason to fear all carbohydrate. Vegetables, beans, lentils and whole fruit are fine. It is the refined, quick-acting ones, in large amounts, that do the damage.
Six changes that do most of the work
You do not need to do all six at once. Pick one, make it a habit, then add another.
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Cut the quick carbohydrates first
Less bread, white rice, pasta, cereal and sugary drinks. This single change moves your numbers more than anything else on this list.
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Eat oily fish twice a week
Salmon, mackerel, sardines, herring. Tinned counts. If you do not eat fish, this is the one supplement genuinely worth taking — ask your GP or pharmacist.
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Use olive oil as your default
Extra-virgin, for cooking and for dressing. Swap out vegetable oil blends and most spreads.
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Stop eating after dinner
Aim for twelve hours between your last food at night and your first in the morning. Nothing but water, plain tea or plain coffee in between. This gives your liver time to clear out fat.
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Walk after meals, and get out of breath sometimes
Ten minutes of walking after eating blunts the blood-sugar spike. Separately, short bursts that leave you properly puffed — stairs, a hill, carrying shopping quickly — are worth far more per minute than a gentle stroll.
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Measure your waist, not your weight
A tape measure round your middle tells you more about your heart than the bathroom scales do. It also shows progress on weeks when the scales do not move.
What to ask your GP for
A standard cholesterol test is a reasonable start but it misses things. These are worth asking about. You can print this page and take it with you.
apoB
Counts the actual number of parcels, rather than weighing what is inside them. A better predictor than the usual cholesterol number, and inexpensive.
Lp(a) — say "LP little a"
An inherited type of parcel that the standard test does not look for. About one person in five has a high level. It never changes, so it only needs testing once in your life.
HbA1c
Shows your average blood sugar over the last three months. Often the first sign that the refined-carbohydrate problem above is already underway.
Thyroid function
An underactive thyroid raises cholesterol and is easily treated. Worth ruling out before anyone concludes your cholesterol is a cholesterol problem.
Speak to your GP sooner rather than later if
- You get chest pain, tightness or unusual breathlessness when you exert yourself.
- A parent, brother or sister had a heart attack or stroke before the age of 60.
- You have already had a heart attack, a stroke, or been told you have narrowed arteries.
- You have been told you have diabetes, or that you are close to it.
Any of these change the picture considerably, and in those situations medication is usually the right answer alongside the changes above — not instead of them.