Many of us are aware that maintaining a healthy lipid profile is essential for the health of our cardiovascular system. It also supports the health of our liver, impacts our risk of type 2 diabetes and our risk of stroke.
So, what can we do to maintain a healthy balance?
Before we start looking at what we can do, it is useful to understand what is involved in the lipid profile and what levels we are looking at to indicate good health.
Our lipid profile includes:
- Total cholesterol
- Low-Density Lipoprotein (LDL) Cholesterol
- High-Density Lipoprotein (HDL) Cholesterol
- Non-HDL Cholesterol
- Total Cholesterol: HDL-C Ratio
Cholesterol is a fatty substance found in your blood. It is produced naturally in the liver and is essential for health, as every cell in our body uses it. We also get some of this cholesterol from the food we eat.
A healthy total cholesterol is less than or equal to 5mmol/L. Levels higher than this may indicate an increased risk of heart disease and stroke.
There are two main types of cholesterol, High Density Lipoprotein and Low-density lipoprotein:
High-density lipoprotein (HDL)
HDL cholesterol is called ‘good’ cholesterol because it gets rid of the ‘bad’ cholesterol from your blood. It takes cholesterol that you do not need back to the liver. The liver breaks it down so it can be passed out of your body. A level below 1.2mmol/L is considered low, with ≥1.2mmol/L being normal.
Low-density lipoprotein (LDL)
This was originally referred to as ‘bad’ cholesterol. It was identified as a primary determinant of risk of cardiovascular disease due to excessive levels building up on the lining of blood vessels, causing them to narrow.
A level of ≤3mmol/L is considered normal, with levels above this indicating increased risk.
Non-high-density lipoproteins (non-HDL)
Recent evidence has identified other forms of non-high-density lipoprotein which contribute to the accumulation of fatty deposits inside blood vessels. These non-high-density lipoproteins or non-HDL are now referred to a ‘bad’ cholesterol and are included in lipid profile results, to offer better overall picture. A level <4mmol/L is considered normal, with increased levels indicating increased risk.
Total cholesterol: HDL-cholesterol ratio
This is a simple calculation which helps to identify if there is an elevated level of non-HDL cholesterol in the blood, considering the total cholesterol level.
A level below 4 is normal, with greater values indicating increased risk.
This is another type of fat present in our blood. It is stored in our body’s fat cells. High levels of which, can be the result of being overweight (BMI>25kg/m2), eating a diet high in fatty or sugary foods or drinking too much alcohol.
Normal levels of HDL and non-HDL cholesterol can be found alongside elevated triglycerides. This finding may still indicate an increased risk of developing heart disease.
What are considered healthy levels?
What causes high cholesterol?
The key risk factors for developing high cholesterol are made up of modifiable (things we can change) and non-modifiable (things that we cannot change) elements.
Non-modifiable risk factors:
- Family history of high cholesterol, known as familial hypercholesterolaemia
- Having kidney or liver disease
- Underactive thyroid
It is useful to be aware of these non-modifiable risk factors. Even if you are unable to change them, knowing your risk highlights the importance of incorporating modifiable factors into your lifestyle.
Modifiable risk factors:
- Being overweight, or obese
- Sedentary lifestyle
- High intake of saturated and trans fats.
What are the risks of high cholesterol?
Having high levels of non-HDL cholesterol can be harmful because it sticks to the inside walls of your arteries. This can lead to fatty material (atheroma) building up – this process is known as atherosclerosis. It makes it harder for blood to flow through, which can lead to a heart attack or stroke.
If your total cholesterol is high, it can mean that you have a lot of bad (non-HDL) cholesterol in your blood. A high level of good (HDL) cholesterol can help keep that bad cholesterol in check and remove it from your body.
Managing our cholesterol
There are many things that you can do to support your cholesterol and keep each of the elements within an optimum range for health.
As the food and drink you consume has a direct effect on our cholesterol levels, it is a good place to start.
There are some things that you will want to reduce in our diet and others that you will want to ensure that you are getting adequate amounts and regularly. Let’s start with the ones that we want to reduce.
These have a direct impact on your cholesterol level, increasing the levels of LDL cholesterol. Saturated fats are found typically in animal products, such as meat and dairy, although there are some plant sources which are high in saturated fat, such as coconut oil, which is around 80g of saturated fat per 100g. Even in small amounts, regular intake can raise your LDL cholesterol levels.
These are found naturally in nature, but typically in very small amounts in foods produced from ruminant animals, such as milk, beef, or lamb. However, most of our exposure to trans fats comes from foods which have been undergone hydrogenation of vegetable oils into semi-solid fats. This makes them easier and most cost effect to use in mass food production, but despite being an unsaturated fat, the change in their structure means they have the same impact on cholesterol levels as saturated fats. It is widely recommended that these are best avoided, although this is difficult as there is no UK legislation to state that manufacturers need to include the quantity of trans fats in a product in the nutritional information. They are commonly found in bakery products, fried foods, and hard margarines.
The recommendations in the UK for alcohol intake suggest a maximum of 14 units per week for both men and women, spread over several days and for two consecutive days to be alcohol free. An intake above this can cause damage to the liver, but also to your lipid profile.
Alcohol is broken down by the liver and rebuild as triglycerides and cholesterol, so too much alcohol (above the recommendations) can result in higher level of triglycerides and total cholesterol.
How can we improve our lipid profile?
Fruits & Vegetables
We are recommended to have at least 5 portions of fruit and vegetables per day, with the majority coming from vegetables and to aim for a nice colourful variety. The colours in fruits and vegetables, give an indication as to the micronutrients they will provide, such as blueberries, which are rich in anthocyanins, broccoli which is rich in vitamin K and oranges which are rich in vitamin C. If you are trying to reduce your weight, it can be useful to ensure that half of your plate is filled with vegetables or salad.
The carbohydrates we eat should be from wholegrain sources, such as wholegrain bread, pasta, brown rice for example. This will ensure that not only does the energy they provide release slowly into the blood stream (beneficial for stabilising energy levels), but they also provide a valuable source of fibre, which is shown to be beneficial in reducing cholesterol.
Fibre comes in two forms, soluble and insoluble. Soluble fibre which we get from the flesh of fruits and vegetables, some grains (particularly oats), and legumes, forms a thick and gummy substance called mucilage in the intestine, which lubricates the intestine, enabling digestive waste to move through, in addition this can prevent the reabsorption of cholesterol into the bloodstream, reducing the total amount in circulation. The insoluble fibre, which we get from the skins of vegetables and fruit and the bran portion of wholegrains form the bulk of the stool and aid elimination and digestion.
Beans & Pulses
A valuable source of protein, which should be regularly included in the diet, displacing some of the animal sources of protein. This can be beneficial due to the increase in dietary fibre and a reduction in saturated and unsaturated fat, aiding both lipid profile and weight management.
Foods including salmon, mackerel, herring, pilchards, etc. provide a source of the essential fatty acid, omega-3. This has been shown to have a positive impact on lipid profile, so try to incorporate at least 1 portion of oily fish each week.
Plant sterols / stanols
Evidence shows that 2g of plant sterols per day can have a beneficial impact on lipid profile, especially where individuals have a family history of high cholesterol (known as familiar hypercholesterolaemia). Plant sterols are found in foods such as nuts, seeds, and vegetable oils. A range of products have been developed which have plant sterols added to them, such as Flora Proactiv® and Benecol®. These products contain spreads, yoghurts and drinks which provide a source of plant sterols. Many of these projects are high in fat, so caution with the amount being used is advised to avoid the risk of weight gain or increase total fat intake.
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