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‘Oooh no, it’s only six weeks since Christmas’. ‘I couldn’t possibly, I’m going on holiday next month and I wouldn’t want to spoil it’. ‘It was my birthday recently and I had far too much to eat/drink, not now thanks’. ‘Let me eat my new healthy diet for a while first’.

When it comes to reasons to avoid having your blood cholesterol levels measured, not only have I heard every excuse in the book, I could probably write an entirely new one. And in many cases I really do sympathise. Even though I am a medical professional, deep down when I think about my cholesterol, I feel as though I am in high school again and that those numbers are a matter of personal pride and that I should do my utmost to make myself feel good and to make my doctor proud of me, and a part of me that I cannot explain or understand feels the need to choose the exact date and time of any cholesterol test extremely carefully in order to get the best possible results. Which of course is not logical!

Until recently I had flatly refused to have anything to do with knowing my own cholesterol levels for good reasons I will explain later, but having invested in a cholesterol monitor for business purposes I needed a guinea pig to try it out on and so, being reluctant to inflict unnecessary pain on my loved ones and also conscious of having reached a certain age recently, I took one for the team and stuck the needle in myself. And after two very tense minutes, the monitor was able to tell me the news I had spent the last ten years wondering about and even mentioned to my GP (yes I have one, and they laughed and sent me away….) once – my cholesterol is OK. More of this later.

So why worry about cholesterol anyway? Essentially because it is one of a number of indirect measures of a person’s risk of developing heart disease later in life, or their chances of further problems in the future if they have already had issues in this area. Together with age, gender, waist circumference and blood pressure, cholesterol levels can be used to determine the likelihood someone will run into difficulties in the form of a heart attack, and while this is not a precise science if you are generally at ‘higher’ risk than average for your age and gender (the two factors you can do nothing about), this information is surely useful. Maybe…

As a profession we have been taught to think in terms of ‘high’ and ‘low’ cholesterol, but the situation is a bit more complicated as there are different types of cholesterol and it is the relative amounts of these that seem to most accurately predict your chances of future problems. So-called ‘LDL’ cholesterol increases the risk of heart disease and is the one that has given cholesterol overall its’ bad name, however ‘HDL’ cholesterol is ‘good’ cholesterol, and as such it is good to have high levels of this. And research has shown that what really matters in terms of heart disease is how much of your total cholesterol (TC) is HDL cholesterol, expressed as your TC:HDL ratio, and the lower this is the better your heart disease risk.

So two people with the same total cholesterol may be given very different advice depending on how much LDL and HDL they have. Here comes the science: if you are not into numbers then just remember ‘low total cholesterol and high HDL good, high total cholesterol and low HDL bad’ and jump to the next paragraph! Total cholesterol should ideally be less than 5mmol/l, however if your HDL is low at 0.5mmol/l (that’s very low!) then your TC:HDL ratio would be 10 which is very high (bad), while if your HDL is at the top end of the normal UK range at 2mmol/l then you would have a TC:HDL of 2.5 which is very healthy. Also a ‘high’ cholesterol of 6 or 7 could be considered healthy if the associated HDL was high enough, at more than 1.5.

If you do have a high TC:HDL ratio then there is usually a fair amount you can do about it. A lot of cholesterol has to do with genetics, but do not despair, unless you are one of the few who has a rare genetic condition resulting in every family member having massively elevated cholesterol levels then you should be able to make quite a difference by changing your lifestyle. It will come as no surprise that this is mainly eating a healthy diet and exercising regularly – after all, one very 21st century mantra is ‘how you heal anything is how you heal everything’; not strictly true when taken to extremes and there are a number of diseases it does no apply to, but it is true that if you make healthy lifestyle choices this does have multiple benefits, not just better cholesterol.

So, in general if you have a high TC:HDL ratio you need to either decrease your total cholesterol or increase your HDL, preferably a combination of both!

Total cholesterol can be reduced by exercising regularly and by avoiding foods that increase cholesterol including saturated animal fat in the diet, essentially red meat and high fat dairy products such as butter, cream and cheese. Equally important is to include foods that actively reduce cholesterol – these include fruit, vegetables, beans and unprocessed whole grains.

This is probably a familiar message to most people, however the importance of a higher HDL level may not be as widely known, and the most important lifestyle change that increases HDL is to eat a ‘low GI’ diet, that is foods that are not high in sugar and are not rapidly converted into sugar as soon as they are absorbed into the body. Think low sugar and brown rice instead of white rice, wholemeal pasta instead of white pasta etc. and your HDL should be increasing before you know it.

So why was I so uninterested in my cholesterol for so long? Well, I know that I don’t have a rare genetic condition causing very high cholesterol levels because both my parents have had their levels checked and they are not in that range, so I will not be either. And what if my TC:HDL ratio is low, that is to say very healthy? Is this a reason to eat what I like when I like with no thought for my health because my cholesterol is good? No, I should exercise regularly, eat plenty of fruit and vegetables, avoid saturated animal fat and choose unprocessed whole grains over white and sugary foods because this still reduces my chances of numerous common diseases such as cancer, diabetes, arthritis and so on, exactly as I should had my TC:HDL ratio been unhealthy.

If you are concerned that your cholesterol is not as it should be then you will probably have more luck than I did in persuading your GP to check it for you (my GP is great but used the above ‘you should be making healthy lifestyle choices anyway’ argument on me and did actually offer to test it in the end), just make sure they ask the lab to check your HDL too as lots of labs do not do this as part of a cholesterol test unless specifically asked to. And if your result is not ideal then please use that information as motivation rather than a reason to be miserable – with a few simple lifestyle tweaks you should have a cholesterol to be proud of in a reassuringly short time. And if you prefer not to know, as I did for a long time, just live as though it is high and you should be fine…

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