Cholesterol - what's the worry?

Cholesterol is bad for you - right? Well, usually. Excess cholesterol is carried round the blood system and deposited on the walls of our arteries. This furs them up and increases the risk of a total blockage, causing a heart attack or stroke. High cholesterol is probably the single biggest risk factor for heart attack.

We do need some cholesterol - it's one of the building blocks of the cells of our body. However, most of us have masses more than we need. To make things more complicated still, there is one kind of cholesterol (HDL or 'good' cholesterol) that actually protects you against heart disease and stroke!

What your doctor will measure

The main 'bad' kind of fat is LDL cholesterol. If you just get your total cholesterol measured, you could be worried unnecessarily if your total is high, because your 'good' cholesterol is high; or lulled into a false sense of security because your total cholesterol looks normal, but raised levels of 'bad' cholesterol are hidden by your low level of 'good' cholesterol. So overall, don't worry too much about your cholesterol level. The figures you need to know are your LDL cholesterol level and the ratio of total to 'good' HDL cholesterol.

What your levels need to be

For most of us, a total cholesterol below five (measured in millimols per litre, or mmol/l) and a 'bad' LDL cholesterol of below three mmol/l is fine. If you've had a heart attack or stroke, or if you have diabetes or kidney disease, you need extra protection. For you, total cholesterol should be below four mmol/l and LDL cholesterol below two. The lower your ratio of total to 'good' cholesterol the better. Below five is okay, but above 6 puts you in a high risk category automatically. Ask your doctor about yours.

Cholesterol - what you can do

There is LOTS of good news here!

• Watch your weight. If you're overweight, getting your weight down will make a huge difference. Cutting your weight by 10% (say, losing just over a stone if you weight 11 stone) will cut your bad cholesterol by 15% and raise your good cholesterol by 8%
• Dig out those walking shoes. Regular aerobic exercise (the kind that makes you mildly breathless) will raise your levels of 'good' cholesterol
• Take a Mediterranean holiday all year round in your kitchen! Try the Med diet (less meat; more fish; lots of fruit and veg; olive or rape seed oil instead of butter and cream)
• Small changes add up. You can improve your diet in lots of small ways. For instance: grill instead of fry meat; take the skin off chicken; buy semi-skimmed rather than full fat milk; switch from butter to spreads high in mono- or polyunsaturated oils. Even better, use a sterol-based spread, such as Flora pro.activ.

Foods that 'lower cholesterol' - Do they really work?

There are extremely strict controls on the claims that drug companies can make about their products. If they want to say their medicine cuts your risk of having a heart attack, they have to have huge studies that prove it without a doubt. Until recently, the same has not been true of food products. However, so many dubious health claims have been made by food manufacturers across Europe in recent years, that the European Commission set up a special commission to look into them at the end of 2009. They have approved the claim that 'plant sterols have been proven to lower cholesterol significantly. Blood cholesterol lowering has been proven to reduce the risk of heart disease'. The Flora pro.activ range all contain these plant sterols - a case of a food that isn't 'naughty but nice', but rather 'nice but nice