How can nutrition and lifestyle support good cardiovascular health? Nutritional therapist Karen Geary takes a look at the evidence

The impact of cholesterol is a controversial topic in the world of medicine. Earlier this month I had a number of questions from clients about whether or not they should consider a statin and join the eight million other people in the UK who take them. I have read a number of papers on cholesterol over the years, often conflicting in nature, which means that today at least, there is not a clear-cut answer.
I’m a nutritionist who supports pharmaceuticals only where they are necessary and life changing, but generally my approach is first to adopt preventative strategies based on nutrition and lifestyle, as my aim is to help people lead healthier lives. However the topic of cholesterol transportation in the body is pretty complicated – we need cholesterol to build cell walls, make hormones, help make vitamin D, produce bile acids and more. And then there is the research that hypothesises that people with high cholesterol live longer.
Who is right?

Statins for millions more people?
Widespread statin therapy is financially beneficial for the NHS, as the cost of providing statins to a large population is relatively small. But so are the protective effects. This is called the ‘number needed to treat’ which is currently four. What that means is that if 1,000 people with a 10% chance of heart attack or stroke within a decade are put on statins, around four cases may be prevented. Good news for the four who needed it, but there are 996 who probably didn’t need it.

Your own preventative strategy
Regardless of whether you choose statin therapy, in my experience you can make a sizeable change to your cholesterol readings within three to six months with a little self-help and dedication:

• Movement. Consistent exercise can really move the needle on cholesterol numbers. It’s not about hitting the gym, either – increasing the length of the daily walk and walking more briskly is often enough. Put some effort into it so you become a little breathless each day.
• Weight loss. While it is true that slim people may also have cholesterol numbers that cause concern, if you are overweight, chances are that you can materially influence your data without having to resort to statin therapy if you shed some kilos. You will also reduce your diabetes and stroke risk too.
• Nutrition. One misconception about ‘abnormal’ cholesterol is that saturated fat is to blame. This is not totally the case; it’s primarily sugar and high Glycaemic Index carbs. Reduce sugar and your triglyceride numbers go down, thus reducing your risk level. Too many carbs and alcohol raise triglycerides. It is true that if you follow a strict ketogenic diet, it can temporarily raise both HDL and LDL cholesterol, but there is no evidence that this may be harmful.
• Choose ‘good’ foods. Many foods may be supportive of ‘good’ cholesterol function, for example dark leafy green vegetables, cruciferous vegetables, oats, green tea, ginger, beetroot, dark chocolate, oily fish (omega 3), olive oil (and olives) and avocado.
  Stick to low-sugar fruits such as berries and apples. No juices! Purple foods (for the polyphenols) are your friends.
  Avoid inflammatory fats like sunflower or ‘vegetable’ oils, which are high in omega 6 and highly processed. Try to eat a diet which contains minimally processed foods (i.e.. the picture on the right!).
• Supplementation. There are certain vitamins, minerals and probiotics that may support the management of cholesterol as well as supporting any nutrient deficiencies which may have been created by statin therapy. These are very individual in nature – they require personalised advice depending upon your own health goals, medical conditions and also any pharmaceutical contraindications.

If you are diagnosed with high cholesterol, don’t be afraid to ask your GP detailed questions about your data and your risk level. In the meantime, if you would like to better understand how to interpret your own cholesterol panel (in conjunction with something called your QRISK score), the importance of HDL/triglyceride ratio, the different types of LDL and other measures of cardiovascular health, such as ApoB and homocysteine, you can read a longer version of this article on my website.