High Cholesterol. Should we really worry about blood test results or take the results lightly?

[healtywealthy]

I had a blood test recently and the Dr said that my cholesterol levels are high 5.8 (non-fasting) and they will repeat a fasting one in a years time. In the meantime he sent me the NHS link for lifestyle changes. In the actual report I can see other figures too LDL, HDL etc. I've not done much research myself, however talking to people I've heard various things. Eat Chicken. Don't eat Chicken. eat chicken twice a week. Eat Tofu. Don't eat egg yolk. I looked a little on NHS website which says increase exercise eat wholegrain things etc.

Contradicting advise from one Pharmacist was that blood tests aren't all that and do make some changes but don't worry so much that you become stressed and then suffer more due to that.

Where do I go from here? What can I eat and not eat? Also to add I had a large breakfast about 25 min before the test so would that have given a higher reading? Thank you in advance :-)

Following as mine seems a bit high

@bellac11 the thought of peanut butter in porridge is giving me palpitations. I'd take a bowl of stewed apple.

I'm glad you have found ways that you like.

I cant remember if I started a thread or updated someone elses about porridge..... brace yourself......

How about peanut butter and cheese in porridge!!!!

Yes, I was eating this for a while, a nice savoury porridge

But I need to cut down on cheese so the apple came and replaced it

But sometimes I went completely the other way and had peanut butter and a bit of nutella, chocolate nutty porridge.

I have mushed up prunes in porridge made with water and a bit of salt.

I was reading that the porridge must be of the roughest sort (so oatmeal ideally) because it has a much higher glycemic index than previously thought. So definitely not the instant sachets, but jumbo rolled oats are a reasonable compromise.

Yes the pin head oatmeal is the best apparently, I'm currently using rolled oats as I bought the wrong ones and they don't soak up the milk as well

Do you mean pinhead oatmeal has a lower GI than jumbo rolled oats? Do you have a link or any info as to why that is, or the level of difference? I eat overnight rolled oats every day, I make sure I am active after eating to burn them off...but if there is a better alternative I am down for it.

I think much depends on your other health levels. They do a calculation called Qrisk and one aspect is cholestrol. It estimates the liklihood of a cardiac event
My cholestrol was 4.9 but my age and other health conditions meant my Qrisk was 14.
I was advised to take statins.
I have no objection in principle to statins. They work, and claims of side effects have not been substantiated. However I take at least 7 drugs daily so didn't want to add another. In the end though I agreed to a 10mg dose (they normally give 20mg). I actually only take it 3 times a week. Had my cholestrol measured today and it was 3 which suggests to me that the normal dose of statins is too high.

As to diet I have always eaten very healthily so have made little change. My breakfast every day is boring but healthy. Oats, prunes and milk.( Just dry oats not porridge). My weight is fine, I don't drink much and I'm fairly fit.

The trouble with the Qrisk is the way it takes age into account - once you get into your 70s, then pretty much everyone should be on statins according to it even though their cholesterols haven't risen.

The risk/benefit analysis is sketchy.

It's one of those "overall health can impact it" things as well. Actually dietary cholesterol has only a tiny impact on blood cholesterol. The old advice is to make sure you get lots of unsaturated fat and less saturated fat, but even that's in dispute.

Basically, if lifestyle is going to work then key things are: ensuring a healthy body far percentage, eating lots of varied plants and healthy fats, EXERCISE (BOLDED AND CAPPED because its impact is relatively high). If those above criteria are met over the next year (or more, if you're young) and it doesn't improve then you'll need a statin (or face the consequences associated with having dodgy cholesterol.

FWIW, I am a medic, and 32, and if I was offered a statin today (low dose) I'd take one - so convinced am I by the data for its impact on long term health (and my cholesterol errs on dodge)

I dont know about the actual levels but (and Im not obsessed with this) rolled oats are 'processed' in a way that pinhead oatmeal isnt and so what I read was that pinhead is better all round if you need to eat grains (which is another argument entirely)

Its not something Im overly bothered about because I dont believe that all processed food is bad for you, but having bought them by mistake and now using them, the consistency also isnt as good

I would rather eat a much higher protein breakfast than oats but I want to have them for fibure and cholesterol reasons so for that reason I want the most 'natural' ones I can have, so when this batch is used up, I will buy the pinhead again.

@Sillymummies123 thank you for your advice. However, in my case the high cholesterol may relate to teriparatide which I shall be on for another 10 months. It may also relate to hypothyroidism arising from Hyperthyroidism in 1992 and subsequently treated of course. What I am not sure about is the likelihood of whether the cholesterol may fall when the teriparatide ceases and I am not minded to make a life long commitment to a statin if that may be the case.

I am also mindful that there is no heart disease on my side of the family with greats dying at 84 and 85 in the 60s, grands at 85 and 92 in the 90s and mother, albeit on a statin since 64 is as fit as a flea. Therefore there may be a familial tendency of hypercholastemia (hers was 8.8). Further my BP is presently 110/63. My Q3 risk is about 5%.

Therefore I have made an appointment to see a consultant endocrinologist and physician for expert advice based on decades of practice. Principally because all thse things have knock on effects and an holistic and informed view needs to be taken on an individual and case by case basis.

It isn't as simple as you have portrayed it despite the fact that you are a doctor.

Cholesterol is very multifactorial, as is heart disease.

Of course, a statin is not the first port of call and lifestyle advice generally proceeds that in young/ otherwise healthy people. Obviously, the decision also has to be viewed in the context of medication and existing health conditions.

Im not advising as such, simply saying that I would take one now if offered (I would), as I'm convinced of the long term benefit in terms of CVD - then again, I have my own health problems that put me at an increased risk of CVD (psoriasis). There are other drugs I'd take, for the record, if offered. Some are so benign in their long term effects and offer protection that I'm interested in (like SGLT-2 inhibitors or a very low dose ACE inhibitor).

Well we’d all die without cholesterol, why do you think our bodies make it?

Anyone talking in terms of risk from Total Cholesterol is at least 20 years out of date.

Anyone talking about risk from good versus bad cholesterol is 10 years out of date.

For at least 10 years we have known that particle size is very important as large particles can’t get through the endothelium.

Unfortunately the NHS is very out of date and doesn’t provide LDL-p tests (that measure particle size), so you have to get it done privately. More advanced countries like Australia do this routinely.

There is no such thing as “bad cholesterol” - there is however “potentially problematic” cholesterol.

Potentially problematic cholesterol is small particles of LDL - either oxidised particles, particles such as LP(a) which are a genetic variant that can’t be recycled or small triglyceride lipid remnants that contain cholesterol.

Large particles of LDL that can be recycled are actually healthy.

Cholesterol is only ever a problem when the arteries have been damaged by smoking or decades of high blood sugar levels from refined carbs.

Dietary cholesterol usually makes up a relatively small amount of the cholesterol in our bodies - our liver makes 75% or more of it.

Half of the people who have heart attacks have low cholesterol - including low amounts of the so-called “bad” type.

Statins work to reduce the cholesterol your liver makes, but they have zero impact on CVD risk. All cause mortality for example is not improved by statins.

The only reason people should be put on statins is for secondary prevention, and even then the benefit is not the cholesterol reduction but the reduction in cardiovascular inflammation that statins have.

But what if someone has the genetic LP(a) that results in high choleserol readings? (25% of the population have this). The answer is lifestyle changes have no effect on it, and statins are of no help either as it just builds up due to not being bale to be recycled. The only real option these people have is a PCSK9 inhibitor drug - thesee are relatively new (released in the last couple of years) or taking flush type Niacin (usually 1 mg or 2 mg day) - this is what used to get prescribed for high cholesterol by doctors before statins were invented.

I have researched this subject extensively since I had a heart attack and 3 stents put in 4 years ago. If you like watching videos, look for Thomas Dayspring ( worldwide lipid expert) and Ford Brewer (for preventative medicine).

If you like nerd material:
https://www.ahajournals.org/doi/pdf/10.1161/circoutcomes.115.002436

@TheBabylonian that's very interesting. Thank you.

@TheBabylonian at last! A really educated and knowledgeable view. I have also read all the points you have made, and secretly despair at the amount of statin prescriptions that seem to be pushed on us.

I’m 76, and have higher cholesterol than NICE advises, have tried statins twice, which affected me within a day of starting them and made me feel quite ill after a week, so I stopped them, and refuse to take them ever again.

The NHS seems to be behind the times, especially re: testing, hopefully one day they will catch up.

So if someone has good blood pressure, good cholesterol (however that is measured), good blood sugars they can still have heart problems or a heart attack?

Yep.

I think you have to be careful that doesn't descend into well sod it, nothing I do to help matters so I won't bother then.

"If someone has good blood pressure, good cholesterol (however that is measured), good blood sugars" AND DOES CONSISTENT EXERCISE "they can still have heart problems or a heart attack" - unlikely, no?

Yes I forgot the exercise, this is symbolic of my life. Hate it.