Can someone pls explain cholesterol?

[Snoodley]

Can someone please explain good and bad cholesterol to me as if I was a 12yo? (Yes I have googled but it's still not making sense)

I had a health check today at work (from a private company). Apparently my "good" cholesterol is 2.03, which is very good, and my "bad" cholesterol is 3.64, which is fine. My total cholesterol level is 5.67, which the practitioner said was fine given the ratios of good/bad, but I looked it up and NHS says that total cholesterol should be under 5🤔

Do I need to worry? Should I stop eating so much cheese? The practitioner said I don't need to change anything, which was nice to hear, but I'm a bit worried he's wrong. If it's only the ratios that matter, and not the total, then why does the NHS give a maximum for the total? 🤯🤯🤯

It’s the ratios that matter, and your bad cholesterol and triglycerides. Having lots of good cholesterol is protective for your heart.

I’ve had my cholesterol monitored since I was a child due to family history of genetically high cholesterol. I’ve always had lots of good cholesterol, so my overall cholesterol is probably a little bit higher than yours, but it’s fine.

The science around cholesterol has changed a lot in the past few decades. I believe now that the thinking is no longer that dietary fat and cholesterol are bad for your serum cholesterol, but it’s more things that are high in glucose, white bread, cake, all the UPFs. Cholesterol in your blood is made in the liver, it doesn’t come from food. So anything that puts stress on the liver, like metabolic issues, glucose intolerance, impact cholesterol.

My cholesterol was actually lowest when I was following a paleo diet that was high protein and high fat, which seems to make sense. I wasn’t eating fast food or cake or loads of white bread and pasta. It was highest during the 20 years I was a vegetarian and eating a lot of carbs. 🤷🏻‍♀️

What is your LDL cholesterol?

Ratio is a bit old school now.

Ah, that'll be the wine then 😬

Thanks!

He only wrote down the HDL (2.03) and the total (5.67), so by my calculations that means my LDL is 3.64. Is that ok?

No, ideally your LDL would be less than 2. But I don’t think you’ve understood what I mean. Your LDL is a separate part of the lipid profile. Your cholesterol is too high, it needs to be less than 5.
Although our area lipid biochemist thinks LDL should be under 1 although not sure how achievable that is for most people.

Ok - thanks! What would be the best way to achieve that do you think?

I'm quite annoyed with this health test tbh. What's the point if they give out duff info?!

Mine was 5.8 at 40yr old health check, but GP said absolutely fine as my 'good' cholesterol was very good and the ratio was fine.

Also, could you please explain what makes up a "lipid profile" and which parts do good/bad things? Thanks!

Yeah that's basically what I got told but apparently it's wrong??

@Snoodley i am going to follow with interest then!

We have no family history of cholesterol issues and I'm super fit and eat a very good diet. So I'll be interested to see what the suggestions are.

This is the link I send my patients. It’s quite good and simple https://www.heartuk.org.uk/cholesterol/understanding-your-cholesterol-test-results-

UPF really are the enemy tbh. Plus genetics. I see really healthy lifestyle people with rubbish lipid profiles.

The ratio stuff is for QRISK and it’s daft in my opinion. We need to treat the cholesterol and LDL and get them to target or below, particularly LDL.

OP your GP really needs to update themselves.

Not my GP! It was a health check by Optima health.

Oh I see, sorry 😊

It was my GP

So if I don't eat UPF which I don't, I exercise a lot - weights and lots of walking and yoga and proper swimming, I eat a ton of healthy fats, tinned fish and avocado.

What's left?

Optima Health - they have hoovered up many occupational health public service contracts. They use tick box template reports.

I'm confused too, as my HDL increased, but then that made my overall cholesterol higher even though it was because of the 'good' cholesterol. My LDL was still quite bad (3.32, or 3.69 for non HDL). The good cholesterol meant that the ratio was OK, but it still sounds like I should be concerned about the bad stuff as they are high, as is the total. i have been eating really healthily (cutting fat, calories, carbs), exercising loads, losing lots of weight in recent months etc, so it's disappointing that the cholesterol got worse (as did glucose, despite reducing carbs so much!). It seems odd to be told your overall cholesterol is OK when it's close to the maximum on the NHS site, but also that it goes up when your good cholesterol goes up! So I understand your confusion, OP.
GP just says it's all fine as the Q score is fine. hmm