Everything you always wanted to know about Cholesterol but were too afraid to ask

However, like many people, you may be confused about what cholesterol is, how it's connected with the kind of fats you eat - and what happens to both cholesterol and fats in your body to cause a problem like a heart attack.

Here's how:

Your arteries, veins and heart form your cardiovascular system. This system can be affected by a number of medical conditions or cardiovascular diseases which include heart disease and stroke.

One of the main causes of cardiovascular disease (which in turn is one of the main causes of death in Ireland for both men and women) is a condition called atherosclerosis or simply, hardening of the arteries.

One of the best ways to prevent atherosclerosis is maintaining a healthy level of cholesterol, which is a type of fat found in the blood.

Cholesterol is very important, because it's one of the risk factors which increases your chances of getting heart disease and stroke.

Although we all need a certain amount of cholesterol for a number of reasons, including the production of important hormones, if there's too much of it in your blood some of it sticks to your artery walls. This forms a sort of plaque which builds up and may block the artery. As a result of this build-up on the artery walls, your arteries become narrowed, a process known as hardening of the arteries or atherosclerosis.

Here's the next step - if an artery supplying the heart muscle becomes completely blocked, the heart muscle becomes damaged. This is known as a heart attack.

If an artery to the brain is completely blocked, it damages the brain. This is called a stroke.

Cholesterol is made in the body, mainly by the liver, and we usually manage to maintain a healthy level of blood cholesterol. However, sometimes the balance goes awry, resulting in an increase in our blood cholesterol.

This increase may result from inherited problems. It may also result from eating too much of the wrong kind of foods such as saturated fats, which are found in foods like butter, hard margarine, lard, cream, cheese, fatty meat, cakes, biscuits and chocolates.

Vegetable oils such as coconut oil and palm oil are also high in saturated fat, so it's advised to check food labels on processed and ready-made meals for the amount of saturated fats they contain - the Irish Heart Foundation has a special card, carrying useful information on this topic, which can be accessed through the website (www.irishheart.ie).

There are actually two kinds of cholesterol - HDL cholesterol, which is called good cholesterol or healthy cholesterol, because it mops up cholesterol left behind in your arteries and carries it to your liver where it is broken down and passed out of your body. Regular physical activity and exercise can help increase your HDL level. High levels of HDL cholesterol can protect you against having a heart attack or a stroke.

LDL cholesterol, which travels from your liver through your arteries to other parts of your body is often called bad cholesterol because it sticks to the walls in your arteries - making them narrower, which in turn reduces the blood supply to your heart or brain.

Eating too many foods high in saturated fat can raise your LDL cholesterol, which in turn can - at high levels - increase your risk of heart disease and stroke.

"There has been a lot of confusion and misunderstanding about the role of fat in cholesterol in recent years," says Janis Morrissey Dietitian with the Irish Heart Foundation.

"Our advice in relation to saturated fat has not changed. We know that there is a causal link between having a lot of saturated fat in the diet and a high blood cholesterol level," she says adding that this advice stands firm, despite recent suggestions that saturated fats might not be as closely linked to high cholesterol as was previously thought.

"The most important thing in terms of cholesterol is the saturated fat in the diet and we need to eat less, but we also need to look at what we are replacing it with.

"Look at the fat in dairy produce you eat and the meat you eat - eat lean meat. We would recommend low fat milk and natural yoghurt rather than full fat or low fat version because low fat does not mean low in sugar," she says.

Some foods such as eggs, liver and shellfish contain cholesterol, but the amount of cholesterol in these foods does not greatly affect the amount of cholesterol in your blood. You can eat foods that contain cholesterol in moderation as part of a healthy varied diet. If you don't have a high blood cholesterol level, for example, you can eat up to seven eggs a week.

However if you have been diagnosed with a high cholesterol level, you may be advised to eat less eggs, depending on your diet.

You must get checked

How do you know your cholesterol is too high? Well, that's the problem, explains the Irish Heart Foundation's Nurseline Manager Patricia Hall. High cholesterol does not come with symptoms, so the only way you know about it is if you have it checked, which involves a blood test.

"The blood test will identify when you have high cholesterol," she says, adding that because it is an "invisible" condition, people may not be aware of it, or of the dangers it poses.

For some it is a lifestyle issue, she points out. Others have a predisposition towards over-producing it, which can be a problem if they are not aware of it.

There is a separate condition called Familial Hyper-Cholesterolameia when high cholesterol is genetic.

Diet and lifestyle changes can be very effective she says, although in some cases, a predisposition towards high cholesterol, or if a patient has a genetic issue with high cholesterol, may require a combination of lifestyle changes and appropriate medication in consultation with the patient's medical practitioner.

The advice is - have it checked. Your cholesterol can be measured by your doctor, who knows your family history. If a family member has high cholesterol, heart disease or has had a stroke, it's really important that you ask your doctor to do this test. You can do this on any visit to your doctor.

If your results show a blood cholesterol level greater than five mmol/l (the measurement used for cholesterol levels), or your doctor is concerned about your HDL (good) or LDL (bad) cholesterol, he or she will arrange for another test.

If you already have had a heart attack, bypass surgery or angioplasty, it is very important that you keep your LDL at or below 2.5 mmol/l, according to the Irish Heart Foundation - your doctor will most likely suggest medication together with healthy eating and other lifestyle changes.

‘It seemed there was an hereditary element to it — and now it was a case of what I should do about it’

‘I’ve always been a bit of a wuss about going to the doctor,” confesses well-known actor Bryan Murray (67).

However, when Bryan — who plays entrepreneur Bob Charles in the popular RTÉ soap Fair City — entered his fifties, he became more aware of the need for health-checks.

“I started to realise you need to look after yourself, and my doctor suggested that every now and again we should getting my bloods checked; I did that, and everything was fine.”

However, a few years later, when he turned 60, a routine blood test showed that his cholesterol levels were high.

“My cholesterol was up to six. I was very disappointed because I had felt that I was a healthy eater. I didn’t eat food that was associated with cholesterol,” he said, adding  however, that when he really thought about it, he recalled that both his father and his younger brother had had high cholesterol.

“It seemed there was an hereditary element to it — and now it was a case of what I should do about it.”

He was told about statins, a form of medication used to reduce cholesterol, but Bryan recalls now, he decided that he wanted to reduce his cholesterol by himself.

“I wanted to do it through lifestyle and diet.”

Over the next nine months he worked hard, walking four kilometres every day, cutting out cheese and ice-cream, eating lots and lot of vegetables and “very significantly” reducing the amount of red meat he consumed.

“It was a nightmare,” he recalls, but after the nine months when he got my cholesterol he was able to celebrate some excellent results – his cholesterol levels had dropped to under five mmol/l (the measurement used for cholesterol).

Six months after that test he had another. This time the results came as a shock.

“Even though I felt I was maintaining my sensible diet, I was back up to six.”

This time he chose to avail of medication.

“I was advised to go on the statins and I did,” he says. He is sensible about diet and lifestyle, takes his medication — he now views it simply is a case of maintaining a healthy cholesterol level — and  continues to get his blood pressure and cholesterol levels checked at regular intervals.

“My cholesterol is now fine.”

‘My cholesterol was 7.9 which came as a huge shock to me’

Aisling Holly discovered that she had high cholesterol during a routine medical check-up with her doctor in July, and the news came as a total surprise to her. The 42-year-old from Swords has a hectic work life as CEO of Enhance Medical. She also has a busy family life, as she and husband Paul have two children, Kailen (11) and Megan (5).

“My cholesterol was 7.9, which came as a huge shock to me as I’m not a heavy drinker, don’t smoke and am not overweight,” she says. “The scary thing was that if I had continued as I was, I was heart attack material.”

When she examined how this could have occurred, Aisling realised that her condition was totally lifestyle-related. She runs four clinics across Ireland that offer cosmetic surgery, weight-loss surgery and non-surgical treatments.

“When I looked at it, I realised I was making bad food choices at times,” she admits. “I travel three days per week, usually involving very early starts, and eating nutritious food on planes can be tricky. I was eating processed foods and there were midnight cheese feeds when I’d arrive home late, not to mention my usual four lattés a day. That all had to change, so  I have been attending my dietitian for advice and am being much more careful now. The lattés and cheese are gone and I’m eating lots of oats and lentils.”

Aisling’s doctor explained that one of the main reasons that slim people have high cholesterol is because they often don’t do regular exercise.

“I’m busy running around for work and doing the mammy chores, but I don’t go to the gym or get much exercise. Even though I’m active and am out and about, my core job consists of sitting at the end of a computer and being on the phone. I’ve started walking for 20 minutes daily from the car park now to introduce some regular exercise.”

While she was only diagnosed in July, Aisling successfully reduced her cholesterol to 5 within weeks without medication. She has come to realise reducing stress levels is also vital, so she is cutting back on the amount of consulting she does abroad. The most important thing she has realised is that you can make better choices around diet with a bit of preparation, and that outward appearances can be deceptive. “With underlying illnesses like high cholesterol, it’s not always physically obvious,” she warns. “It can be a silent killer as you don’t even know that you have it.”

*In conversation with Andrea Smith

‘You have to be consistent every day and stick to a diet plan. just don’t eat that croissant with nutella!’

When 29-year-old Alexandru Victoriu was diagnosed with high cholesterol earlier this year, the news was unexpected. The elevated level of 6.5 came as a surprise to him when it was discovered during a routine full medical examination for work. He’s a fit young man who is just under six foot tall and weighs 12 stone 6lbs, but as he was to learn, outward appearances don’t always reflect what’s going on inside.

“I’m not overweight, so I was very surprised to hear that my cholesterol was so high,” he says. “In my defence, it was just after Christmas and New Year when it was tested, so I was eating and drinking a lot more than normal.”

Alexandru is from Romania and has been living in Ireland for four years. He works in marketing at Google Ireland, which involves a lot of travel. There is a history of heart disease in his family, so the doctor told him that he needed to be even more careful around his diagnosis.

“A lot of it is down to diet, and the tastier the food, the worse it seems to be for your cholesterol,” he groans. “I try to stay away from fried food and fatty food and have started eating low-carb meals, so no potatoes and less rice. I drink a lot of water too and stay away from alcohol.”

Having stuck to his new eating plan, Alexandru was re-tested in May and his cholesterol level had reduced to 5. It’s still not as low as he would like and he aims to reduce it even further, but he was heartened to see the decrease.

As he travels a lot for work, he’s not always in control of what is on offer, but strives to make healthy choices. He also keeps fit and does a lot of exercise and trains in the gym. He works out twice-weekly with James Murphy of Zest Fitness, who has given him great advice, and by himself twice more.

“Exercise is a big help,” he says. “I think cardio is the best type of workout for this condition. I do a lot of weight training, and one day a week I do cardio, running and the bike. I’ve come to realise that it’s all about making good food choices, and you have to be consistent every day and stick to a diet plan. Just don’t eat that croissant with Nutella!”

*In conversation with Andrea Smith

‘My Cholesterol was reading 9.6. I was shocked because I was only in my late 30s, didn’t smoke and was very fit’

Anne Maher is the director and co-founder of Ballet Ireland and is one of Ireland’s most respected voices in ballet and dance with an international career spanning over 30 years. As a ballerina, she trained in Monaco and danced all over the world, but discovered that she had high cholesterol 15 years ago.

Anne knew there were heart problems in the family as her dad had open heart surgery, but she never imagined that she would be at risk too. “I kind of thought it was a male thing, and that stress and everything else had led to his problem,” she says.

“I happened to be in the supermarket one Saturday morning and one of those mobile units from the Irish Heart Foundation was outside, so I casually went over because they were inviting everyone in to be tested.”

The doctor took Anne’s blood pressure, which was really good, and then did the cholesterol test. She advised her that the results suggested that she needed to visit her doctor.

Anne didn’t take it too seriously as you are supposed to fast before you get the test and she had eaten breakfast that morning, so she presumed that might be a factor in her results. Nonetheless, she followed it up and went for further testing, after which her own GP gave her some bad news.

“My cholesterol was reading 9.6, which is alarmingly high,” she says. “I was completely shocked because I was only in my late 30s, didn’t smoke and was very fit. We had a long discussion about my diet, because I was thin and didn’t have an issue with keeping my weight down so I indulged in lovely things. I never considered that I needed to control my diet in any way, and was partial to a nice fillet steak and loved cheese. Unfortunately all of those things are not terribly good for a healthy heart.”

Anne went away for six months to work on her diet, and cut down on some things, like red meat, and completely cut out a lot of others, like butter. When she went back for the next check-up, her cholesterol was down to 6.9, and she was sent away to work on her diet even further.

“I was staying around the 7 mark no matter what I did, so the doctor recommended that I take Lipitor, which is a statin,” she says. “My cholesterol reading plummeted after that, so I have been on the medication ever since.”

Now 53 and living in Meath, Anne admits that once the tablets helped to reduce her cholesterol, she wasn’t always as strict with her diet as she should have been. She works now on keeping it in check, as her levels have crept back up a bit over the years. That can happen as you get older, she says, and her Lipitor dosage has been increased. She goes once a year to have a full set of blood tests done, which provides reassurance.

“I am in and around the 5 mark now,” she says. “I try not to eat red meat more than once a week, and strive to eat more fish. If I eat any more chicken, I think I’m going to take flight! Cholesterol problems are a lifelong thing and I was very lucky mine was caught when it was.

“It’s mad that you can look fine and have no physical symptoms, but something could still be wrong inside. It was pure chance that I went that day to be checked, but I’m really grateful to the Irish Heart Foundation people that they continue to have these mobile vans and entice people in to be checked.”

*In conversation with Andrea Smith