Blood cholesterol levels rise with age and after menopause in women. Photo / 123RF
It was a bid to improve her “monotone” diet and inspire her food shopping that drove Agata Pawlikowska to a nutritionist, but the results from her blood tests came as a shock.
At just 39, she had high cholesterol, a health risk stereotypically attributed to those older or overweight and yet here she was, a slim, 5ft 6in pescatarian with an LDL or “bad cholesterol” score of 4.1mmol/L, substantially higher than the desired healthy level of 3.0mmol/L or under, as set out by the cholesterol charity Heart UK.
Meanwhile, her total cholesterol was 6 mmol/L, which the charity suggests should be 5mmol/L or lower. “I only went to the nutritionist because I felt like I needed a bit of a change as I was eating a lot of bread and butter, pastry and ready meals and yet I always felt hungry,” says Pawlikowska, an engineer at an aerospace company in Edinburgh.
“When the blood tests revealed I had high cholesterol, I couldn’t believe it. I wasn’t overweight, I didn’t eat meat or what I thought were particularly fatty foods and I exercised daily, going for fast 40-minute walks and cycling to and from work. How could it apply to me? I didn’t realise there were lots of hidden saturated fats in the foods I was eating which were often marketed as healthy.”
Pawlikowska’s surprise results had a knock-on effect and drove her 32-year-old partner, Ross Donaldson, to get his cholesterol levels tested too.
“My diet wasn’t too bad at the time, but I rarely had fruit or veges and I ate a lot of beef, sausages, black pudding and pastries,” says Donaldson, an assistant professor of physics at Heriot-Watt university, who cycled to work most days but, at 6ft, weighed more than 18st (114kg).
“I figured if Agata’s was high, mine would inevitably be higher and I was right – my LDL level was 4.6mmol/L and my total cholesterol was 6.8 mmol/L. Like Agata, I had no idea people our age could have high cholesterol. I used to think it was only those in their 50s or above.”
In England, high cholesterol leads to more than 7 per cent of all deaths and affects up to 60 per cent of adults.
“Cholesterol is a fatty substance which is an important raw material needed by every cell in our bodies,” explains Dr Dermot Neely, consultant lipidologist and member of the Heart UK Health Care Committee.
“The majority of it is produced in the liver and is sent out into the blood in tiny globules, packaged together with other essential fats (lipids), for delivery to keep our cells supplied. Once the deliveries have been completed, any leftover cholesterol, in small globules known as LDL, is removed promptly by the liver for recycling.
“However, if there’s an imbalance between cholesterol production and removal, this can cause a rise in blood cholesterol and increase the risk that LDL cholesterol could be deposited in the blood vessel wall, which over time could cause narrowing and a blockage of arteries, leading to heart attacks or strokes.”
Blood cholesterol levels rise with age and after menopause in women, but what Pawlikowska and most young people fail to realise is that a diet too high in refined and processed foods – and therefore too much hidden saturated fat – alongside inactivity or smoking and alcohol use will also increase levels of LDL, or “bad cholesterol”.
A 2019 landmark study published in The Lancet medical journal involving data from nearly 400,000 people in 19 countries established for the first time that levels of non-HDL, or “bad cholesterol”, in the blood are closely linked to the risk of heart disease across the entire life course, and there’s now a growing school of thought that young people should know their cholesterol levels earlier so they can make suitable lifestyle adjustments or take statins, drugs proven to reduce cholesterol.
Dr Iqbal Malik, a consultant cardiologist at Hammersmith Hospital and One Welbeck Heart Health, is not sure this is a good idea and thinks early cholesterol testing is only advisable if there’s a strong family history of high cholesterol or heart disease, or for those who are overweight or obese.
“Obesity increases cardiovascular risk through risk factors such as high LDL cholesterol, low HDL cholesterol, elevated blood glucose and insulin levels and high blood pressure,” he explains.
“For younger, healthy people with no cardiac history or risk, there’s insufficient evidence that starting early with statins to reduce cholesterol prevents a cardiac event later on and until we have more evidence, the cost of implementing earlier testing as an NHS policy doesn’t seem worth it.
“Forty is the right age to get tested as the event rate for a heart attack or stroke is low in young people.
“And realistically, would the average 30-year-old take a daily tablet if there was a risk – based on a number – they were going to have a heart attack at 55? It’s unlikely. We already have lots of healthy messaging around food and exercise and I’m not sure adding a blood test with a number for cholesterol is worth the trouble, unless of course the individuals were extremely motivated, in which case they could get a private test.”
Ruth Goss, senior cardiac nurse at the British Heart Foundation, agrees that for young adults the first remedy for high non-HDL cholesterol should be exercise and losing extra weight, followed by eating a healthier diet.
“Statins might be effective for lowering cholesterol, but we would always advise making lifestyle changes first, at least for a few months, as this can bring down cholesterol levels, and there can be side effects with statins such as muscle pains that need to be taken into account,” Goss says.
Knowing their cholesterol numbers was just the motivation Pawlikowska and Donaldson needed to overhaul their diet completely.
They followed Heart UK’s Ultimate Cholesterol Lowering Plan and, within nine weeks, Donaldson’s LDL went down 30 per cent to a much healthier 3.2mmol/L and Pawlikowska’s LDL cholesterol saw a 34 per cent drop to 2.7mmol/L – proof high cholesterol can be reversed with vigilance and good eating habits.
“I cut out all the pastries and ready meals and made more of an effort to put 30 different vegetables and fruits into our shopping trolley each week, so if I bought blueberries one week, I’d buy raspberries or strawberries the next, always trying to mix things up so our diet was varied,” Pawlikowska says.
“I’ve swapped butter for Benecol spread and white bread for wholemeal and will take the time to make soups filled with vegetables or cook proper meals with oily fish such as salmon, or have tofu or quorn with vegetables. Seeing my cholesterol improving made me want to stay on track with healthier eating and it became a habit I started to really enjoy.”
After eating hardly any veg for years, Donaldson is enjoying his new varied diet and isn’t missing meat as much as he thought he would. “I eat it when I’m out but I really like the taste of Quorn products and I’m happy having porridge for breakfast and soup for lunch instead of sandwiches and crisps,” he says. “I feel much more energetic and have lost over half a stone.”
Both Pawlikowska and Donaldson are still cycling to work, and they agree it’s been much easier overhauling their diet together.
“It’s been a bonding experience and it’s great we’ve been working towards the same goal,” says Pawlikowska. “We’ll definitely continue to keep our cholesterol low.”
If you have a cholesterol test, it measures the following:
Total cholesterol
This refers to your overall level of cholesterol. A healthy level should be 5mmol/L (millimoles per litre) or below.
Non-HDL cholesterol
Total cholesterol minus HDL cholesterol. It’s all the “bad” cholesterol added together including LDL cholesterol. Aim for below 4mmol/L.
HDL (good cholesterol)
This helps to clear LDL cholesterol out of your arteries and should be 1.0mmol/L or above for a man and 1.2mmol/L or above for a woman.
LDL (bad cholesterol)
This is the cholesterol that can clog up your arteries and should be 3mmol/L or below.
* If your doctor only gives a total cholesterol reading, you can ask for a breakdown
Eat less saturated fat
Diets high in saturated fat, found in foods such as fatty and processed meats, pastries, cakes, butter, lard, ghee and coconut oil, as well as full-fat dairy, can increase blood cholesterol. “The key is to cut down on saturated fat and include more healthy fats found in olive and rapeseed oil, nuts, seeds and oily fish such as sardines, salmon or herring,” says Lynne Garton, dietetic adviser at Heart UK.
Add fibre
Oats and barley contain a special form of soluble fibre called beta glucan, which as part of a healthy diet can help to lower cholesterol. Think oatcakes, soups with pearl barley and porridge.
Choose sterols and stanols
These are plant chemicals which are a similar size and shape to cholesterol. They are absorbed from the intestines into the bloodstream and block some cholesterol from being absorbed, lowering the cholesterol in your blood. Sterols can be found in plant-based foods such as vegetable oils, lentils, mushrooms, nuts and seeds.
Get your blood moving
Physical activity can also help lower cholesterol, as well as reduce other risk factors associated with heart disease including high blood pressure and extra weight. In one study, people who walked for one hour a day, five days per week saw a reduction in the amount of LDL cholesterol in their body. “You should aim to do at least 150 minutes of moderate-intensity exercise a week,” says Goss.