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Why Do We Need to Manage Our Cholesterol Levels? · So That's Why

• 0:04
  Jenny Oliver: Welcome to the, so that's Why podcast where we unpack
• 0:07
  the science behind everyday questions.
• 0:10
  I'm Jen.
• 0:10
  Chris Smith: I'm Chris.
• 0:12
  Matt Edmundson: And I'm Matt.
• 0:13
  Jenny Oliver: Right.
• 0:13
  So today's question, why do we need to manage our cholesterol levels?
• 0:18
  You know, you are always seeing messages on, you know, get your
• 0:20
  cholesterol level checked, but this can be confusing because cholesterol
• 0:25
  is actually essential for life.
• 0:27
  Matt Edmundson: Yeah.
• 0:27
  It's a bit like being told your car needs oil to run.
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  But that oil that you put in might also destroy your engine.
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  Come on, people.
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  Let's make it make sense.
• 0:37
  Right?
• 0:37
  Jenny Oliver: Make it make sense.
• 0:38
  Matt Edmundson: Make it make sense.
• 0:39
  That should be the name of the podcast.
• 0:40
  Jenny Oliver: Yeah.
• 0:41
  Yeah.
• 0:42
  Chris Smith: True though.
• 0:43
  Um, that contradiction you mentioned is exactly why this matters so
• 0:46
  much because cholesterol is in every single cell in our body.
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  It builds cell membranes, it makes your hormones, helps you digest
• 0:54
  food, even creates vitamin D when we're sunlight hits our skin.
• 0:59
  Jenny Oliver: So why does it have such a terrible reputation?
• 1:02
  Chris Smith: It's because when you have too much of a specific type
• 1:05
  of cholesterol floating around your bloodstream, it starts accumulating
• 1:09
  inside your artery walls, literally building up layer by layer.
• 1:12
  Matt Edmundson: And this buildup then eventually is what leads to
• 1:15
  heart attacks and strokes, right?
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  Chris Smith: Yeah.
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  And we're talking about roughly 140,000 deaths annually in
• 1:21
  England, alone from heart disease with high cholesterol affecting.
• 1:25
  Well contribute to about a quarter of those deaths.
• 1:27
  Matt Edmundson: That's insane, isn't it?
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  Jenny Oliver: Yeah, it is.
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  And what makes it genuinely scary is that you can have dangerously
• 1:33
  high cholesterol for years without feeling like anything is wrong.
• 1:38
  You know?
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  It has end the nickname, the Silent Killer.
• 1:42
  Matt Edmundson: So cholesterol's interesting though, isn't it?
• 1:43
  Because it's simultaneously keeping us alive.
• 1:46
  And also potentially killing us.
• 1:48
  Jenny Oliver: Mm-hmm.
• 1:49
  Exactly.
• 1:49
  So in this episode, we'll explore why your body sometimes struggle,
• 1:54
  struggles with the balancing act and why managing the invisible threat
• 1:58
  might be one of the most important things that you can do for your health.
• 2:02
  Matt Edmundson: Okay, so let's start talking about what's actually at stake
• 2:06
  when it comes to managing cholesterol.
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  Chris Smith: Yeah, so elevated LDL cholesterol, which is effectively bad
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  cholesterol as we'll discuss in a bit more detail, is one of the most modifiable
• 2:16
  risk factors for cardiovascular disease.
• 2:19
  Uh, there's been some research analyzing data from, I think it's over a million
• 2:23
  individuals, and it found that for each one, milli mole per liter increase in
• 2:28
  LDL cholesterol or blood cholesterol.
• 2:30
  Is associated with about a 20% increased risk of co coronary heart disease.
• 2:35
  Matt Edmundson: That's huge.
• 2:36
  Chris Smith: Yeah, it is.
• 2:36
  Matt Edmundson: Eh, so this is.
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  Isn't just sort of outline advice for best practice.
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  We're talking about cholesterol management, um, having a measurable and
• 2:46
  significant effect on heart disease risk.
• 2:49
  Mm-hmm.
• 2:49
  Chris Smith: Absolutely.
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  And when your arteries get narrowed or blocked, the
• 2:52
  consequences effect everything.
• 2:54
  So it's your brain function.
• 2:56
  Your energy levels, your ability to exercise, literally everything.
• 2:59
  Jenny Oliver: Great.
• 3:00
  So I need to worry about cholesterol from my brain, my heart, and now
• 3:03
  my general ability to function.
• 3:05
  The 2020s are really just one long anxiety spiral, aren't we?
• 3:09
  Chris Smith: I know, yeah.
• 3:10
  I like the, uh, ministry of doom, aren't we?
• 3:13
  Um, it can sound overwhelming, but when it comes to cholesterol,
• 3:16
  it is something you can manage.
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  Mm. So for, for most people or many people, lifestyle change alone
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  can reduce LDL cholesterol by.
• 3:23
  20 to 30% and taking statins can reduce it by up to 60%.
• 3:28
  Matt Edmundson: So lifestyle helps.
• 3:30
  But also medical science has some good answers for all of this, doesn't it?
• 3:33
  Chris Smith: Thankfully.
• 3:33
  Yes.
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  So medical science means we can measure cholesterol accurately, and there are
• 3:38
  those medical interventions that work.
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  The challenge is most people don't understand why it
• 3:42
  matters until it's too late.
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  So by the time you experience chest pain associated with cholesterol,
• 3:48
  um, that significant arterial damage has probably already occurred.
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  Potentially over decades.
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  Jenny Oliver: So managing cholesterol isn't about how you feel today.
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  It's about preventing something catastrophic years from now.
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  Chris Smith: Yeah, exactly.
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  And that's why screening matters, because even when you feel perfectly healthy,
• 4:04
  you've got to keep an eye on these things.
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  Jenny Oliver: Yeah.
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  So let's get into the biology.
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  So we mentioned different types of cholesterol.
• 4:10
  Let's go through them for those who might not know.
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  Chris Smith: Yeah.
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  So chemically speaking, cholesterol is cholesterol.
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  Um, it's one single molecule.
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  Because it's fat soluble, it can't dissolve in your water-based bloodstream.
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  So what happens is your body packages this cholesterol into what are called
• 4:26
  lipoproteins, and they're essentially like little transport vehicles.
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  Matt Edmundson: Yeah.
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  I picture them like little meal delivery boxes, you know, but
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  these lipoproteins are shipping.
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  Cholesterol parcels throughout our body, right?
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  Jenny Oliver: Mm-hmm.
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  Chris Smith: Now, spot on, probably not very tasty food delivery parcels.
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  Um, but these different lipoproteins have different jobs, and the main
• 4:47
  ones are LDL and HDL cholesterol.
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  So LDL is low density lipoprotein, and HDL is high density.
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  Lipoprotein LDL cholesterol carries about two thirds of all the cholesterol into
• 5:02
  your blood, delivering from your liver to cells for making hormones and repairing.
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  Um, cell membranes.
• 5:08
  Jenny Oliver: So, LDL doing its job is, is actually helpful.
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  But this is known as the bad cholesterol, isn't it?
• 5:15
  Chris Smith: It is.
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  And it, this is why it's so kind of confusing at times.
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  So when everything's working normally, LDL is doing its job
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  in a normal and healthy way.
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  The problem is when you've got too much LDL cholesterol circulating,
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  and what happens is it, it starts infiltrating your artery walls, gets
• 5:32
  trapped and starts to deteriorate.
• 5:34
  Matt Edmundson: And so your immune system recognizes this as a problem, right?
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  Chris Smith: It does.
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  And what happens is your body sends in the white blood cells the cavalry to
• 5:42
  clean it up, but they get overwhelmed.
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  So they basically keep eating these damaged LDL cholesterol particles
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  until they're effectively stuffed.
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  Matt Edmundson: And, sorry, I'm just picturing my white blood cells
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  just like, oh, that was a taste.
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  Jenny Oliver: Yeah, yeah, yeah.
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  Matt Edmundson: I'm so full right now
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  Jenny Oliver: and don't stop eating.
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  Chris Smith: I know.
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  I could say the frothing in the mouth because literally what happens
• 6:00
  is they end up looking like foam.
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  It's foaming.
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  So if you've, um, studied biology or remember from back in the day.
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  You might have come across what's called foam cells, and that's
• 6:10
  what we're talking about here,
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  Jenny Oliver: foam cells.
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  It sounds like something you'd find in a posh latte.
• 6:14
  It's probably not as pleasant when they're accumulating in your arteries, I imagine.
• 6:18
  Chris Smith: No, just a bit.
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  Um, so these foam cells trigger inflammation, but they also attract
• 6:22
  more, um, white blood cells, which creates a vicious cycle.
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  And the ultimate result is what is known as arterial plaque.
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  It's a fatty deposit that builds up in inside your artery wall.
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  The body tries to contain it, but as the problem grows, there are
• 6:38
  risks of blood clot formation.
• 6:40
  Matt Edmundson: Okay.
• 6:41
  So then what happens?
• 6:43
  Jenny Oliver: So if a clot blocks an artery, you have a heart attack.
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  If it blocks a brain artery, you have a stroke.
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  But the whole process can take decades, which is why early intervention matters.
• 6:55
  Chris Smith: Yeah, exactly.
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  Um.
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  So then when we look at HDL cholesterol particles, so these
• 7:00
  are high density lipoproteins.
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  These are essentially known as good cholesterol.
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  Jenny Oliver: Yay.
• 7:07
  Matt Edmundson: Woohoo.
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  Chris Smith: These HDL lipoproteins, they work in the opposite
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  direction, so they collect excess, uh, cholesterol from tissues and
• 7:14
  artery walls, and they transport it back to your liver for excretion.
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  That's why HDL cholesterol is known as good cholesterol,
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  and LDL is bad cholesterol.
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  Matt Edmundson: So I've got a plan.
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  Why don't we just like boost HDL, uh, you know.
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  And just call it a day.
• 7:28
  Jenny Oliver: Yeah, I'm with you on that plan.
• 7:30
  Chris Smith: Yep.
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  Done.
• 7:32
  End, end of episode.
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  Matt Edmundson: End, end of podcast if only.
• 7:33
  Was that easy?
• 7:34
  Yeah.
• 7:35
  Chris Smith: Yeah.
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  Unfortunately, it's been tried.
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  Um, raising HDL cholesterol therapeutically, it hasn't been as
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  successful as hoped because what matters is the level of the LDL.
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  We've got to lower that rather than just increasing the other.
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  Jenny Oliver: So you can't have an LDL cholesterol ever.
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  That's too low.
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  Chris Smith: Not really, because your liver still produces enough for all
• 7:57
  the essential functions because you might not know this, but 80% of our
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  cholesterol is made by our livers with only 20% coming from our diet.
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  Matt Edmundson: No, I did not know that.
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  And it, it, it's an interesting one, isn't it?
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  In, in the face of current messages that 80% of it is controlled by my liver.
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  That's how it sort of functions.
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  So let's.
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  Let's talk about this then.
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  How does this play out?
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  Say with someone like me who used to be in their forties, has recently
• 8:24
  entered their fifties with sort of cholesterol levels slowly.
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  Why are you laughing?
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  Like cholesterol levels slowly climbing.
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  Chris Smith: Yeah, and and they do.
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  So LDL cholesterol levels naturally increase with age as the liver
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  becomes a little bit less efficient.
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  Even in us, you know, natural athletes despite age.
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  Matt Edmundson: Yeah.
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  Yeah.
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  That's what we are natural athletes.
• 8:42
  Chris Smith: And, and this, this rising, it is often, it's a combination.
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  It's, so, it's age related changes.
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  It's maybe a little bit of weight gain, a little bit less physical
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  activity and dietary shifts.
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  Matt Edmundson: So what is the intervention then?
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  Jenny Oliver: So often people will try lifestyle changes first.
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  You know, looking at the diet, exercising with the view to, you
• 9:02
  know, losing a little bit of weight.
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  Um.
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  But there was a study that documented someone, um, reducing LDL by over 50% in
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  six weeks through dietary changes alone.
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  But this does vary between individuals.
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  And for someone with like moderately elevated LDL plus high blood pressure,
• 9:22
  diabetes, family history, even moderate cholesterol becomes concerning.
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  Matt Edmundson: Yeah.
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  And I guess that's because you're stacking all the risk factors, aren't you?
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  Jenny Oliver: Yeah,
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  Chris Smith: yeah, precisely.
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  So risk assessment looks at the whole picture.
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  So the same cholesterol number carries very different
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  implications depending on context.
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  Matt Edmundson: Mm-hmm.
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  Jenny Oliver: And there's also an inherited genetic disorder
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  called familial hyper cholesterol.
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  Or FH for short.
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  Matt Edmundson: And that, I bet you can't say that more than once quickly.
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  Jenny Oliver: No, I'm not gonna, but that, that affects a small number of
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  individuals, like maybe one in 200.
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  Um, and their born with two to three times the normal level of LDL
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  cholesterol and their body body's ability to remove that Isn't that great?
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  It's impaired.
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  Matt Edmundson: Yeah.
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  I, I mean that as well as being difficult to say that actually sounds quite serious.
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  Jenny Oliver: Yeah, it is.
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  Without treatment, about 50% of men with it.
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  Do go on to develop heart disease before the age of 50.
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  Um, and they've got 20 times the risk compared to the general population,
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  you know, but often they're started with statins when they're in their,
• 10:27
  their childhood to deal with it.
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  Matt Edmundson: Wow.
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  That's, that's pretty intense.
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  Um, okay, so, uh, that aside, let's get practical if someone's
• 10:35
  cholesterol is actually elevated.
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  Right.
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  I'm not saying mine is, but I'm asking for a friend what actually works.
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  Chris Smith: So start with diet.
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  Um, if you can reduce saturated fat from your diet, that's a great start.
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  So if you're a meat eater, start by reducing red meat intake, but also
• 10:53
  reducing things like full fat dairy items such as butter make a big difference.
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  You still need oils, of course, the fat in your diet.
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  So.
• 11:00
  You, you need to look at healthy oils.
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  We all know about olive oil being healthier.
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  Nuts.
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  For instance, Omega-3 rich foods or supplements.
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  These actively help to lower LDL while maintaining HDL.
• 11:12
  Jenny Oliver: And fiber is important too, isn't it?
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  Don't forget the fiber.
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  Chris Smith: No, it is soluble.
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  Fiber is brilliant.
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  So for, for many reasons.
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  But it, it binds cholesterol in your digestive tract, prevented
• 11:22
  its absorption and it, it's things like oats, uh, beans, lentils.
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  Uh, apples and pears, such fruits that they're all great sources and
• 11:32
  studies have shown that, um, as low as 10 grams of fiber per day can
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  meaningfully reduce LDL cholesterol.
• 11:40
  Matt Edmundson: So, hang on a minute.
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  So now I'm, I'm gonna have to track my fiber grams as well as,
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  you know, my fat percentages.
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  And it's, I, I hear a lot of these things and I feel like, man, do
• 11:52
  I need a nutrition degree just to, you know, figure out what I
• 11:55
  should be having for my breakfast.
• 11:57
  Jenny Oliver: It's a fair point, but maybe we could take a simpler approach
• 12:01
  and you know, fill half your plate with vegetables, a quarter with whole
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  grains and a quarter with a protein, whatever your choice of protein would
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  be, and use olive oil for cooking.
• 12:12
  I think that covers most of the recommendations
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  without getting too complex.
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  Matt Edmundson: That's really handy.
• 12:18
  Thank you.
• 12:20
  'cause I do not want to get complex, otherwise I just won't do it.
• 12:23
  So as well as nutrition.
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  What about exercise?
• 12:26
  Chris Smith: Yeah, of course.
• 12:27
  It's always important.
• 12:28
  So when it comes to cholesterol, we looking for at least 150 minutes.
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  That's two and a half hours of moderate intensity activity every week.
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  So think of it as 20 to 30 minutes most days.
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  And that could be a brisk walk, it could be cycling, it could be swimming.
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  It's basically any, anything that elevates your heart rate.
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  Jenny Oliver: What about if someone is quite active already and they
• 12:52
  still have high cholesterol,
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  Chris Smith: which can happen?
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  Um, and genetics really drive that.
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  And, but, and that's where medication comes in.
• 12:59
  So statins remain the first line treatment.
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  Mm-hmm.
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  And they can reduce cholesterol by, well, LDL cholesterol by up to 60%.
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  Most people can tolerate statins, but there are alternatives
• 13:10
  for, for those that can't.
• 13:12
  Matt Edmundson: So let's say I have to start taking statins or, or, you
• 13:15
  know, doing all these things, how long.
• 13:18
  Before I see changes, how quickly do they work?
• 13:21
  Chris Smith: So on average, so diet and exercise changes, show effects within
• 13:25
  four to eight weeks, thereabouts.
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  But statins work faster, so you get a substantial reduction within
• 13:31
  about six weeks of taking statins.
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  And the key thing with all of these treatments is consistency
• 13:37
  in thinking long term.
• 13:38
  Matt Edmundson: Yeah.
• 13:38
  So they act quick, but as long as you're consistent, right?
• 13:41
  Mm-hmm.
• 13:42
  Um, and so cholesterol management then seems to sort of connect.
• 13:45
  To basically everything else in, in my health regime.
• 13:48
  Really.
• 13:49
  Chris Smith: Yeah, absolutely.
• 13:50
  And to look at it in the round, managing cholesterol is essentially about vascular
• 13:54
  health, so the health of our veins and arteries, because your vascular health
• 13:58
  touches every organ in your body.
• 14:00
  And we're talking, you know, brain health, energy levels, exercise capacity, they all
• 14:04
  depend on having healthy blood vessels.
• 14:07
  Jenny Oliver: And where sleep champions sleep always comes up
• 14:09
  in these episodes, doesn't it?
• 14:11
  Chris Smith: Certainly does.
• 14:12
  Uh, sleep affects cholesterol metabolism.
• 14:14
  So, and it also affects inflammation, but poor sleep affects how
• 14:18
  we can process those lipids.
• 14:20
  So as we always say, yeah, everything is interconnected here.
• 14:23
  Jenny Oliver: Mm-hmm.
• 14:23
  Matt Edmundson: Yeah.
• 14:23
  It is.
• 14:24
  It is.
• 14:24
  So, okay, I'm getting the picture.
• 14:26
  What about how, if we are looking about all the interconnectedness
• 14:31
  of all this, what about.
• 14:33
  Um, weight and diabetes.
• 14:35
  Jenny Oliver: So there's a huge connection here.
• 14:37
  Excess weight raises, LDL, cholesterol lowers HDL cholesterol, and then if
• 14:43
  you've got type two diabetes as well, that can dramatically alter, um, how
• 14:48
  your body, you know, metabolizes lipids, you know, and how the, and that also
• 14:54
  accelerates the buildup in our arteries.
• 14:56
  So managing the cholesterol often means addressing your weight
• 15:00
  and diabetes simultaneously.
• 15:03
  Chris Smith: That's it.
• 15:03
  Exactly.
• 15:03
  And the, the one bit of good news is that interventions in
• 15:07
  one area would benefit another.
• 15:09
  Mm-hmm.
• 15:09
  So if we look at it, um, exercise improves cholesterol, but also
• 15:14
  improves weight, sleep and mood.
• 15:16
  Of course, if you've got a better diet that improves cholesterol,
• 15:19
  but it also improves your energy and reduces inflammation.
• 15:22
  Your cardiovascular system is literally the infrastructure that delivering
• 15:26
  nutrients everywhere across your body.
• 15:28
  And getting that right creates the foundations that allows.
• 15:31
  Absolutely everything to function optimally.
• 15:34
  Jenny Oliver: So to recap, why do we need to manage our cholesterol levels?
• 15:39
  Chris Smith: So we need to manage cholesterol because it's
• 15:41
  essential for life building cell membranes and making hormones.
• 15:44
  But LDL cholesterol causes problems that silently build up over decades and
• 15:49
  can cause heart attacks and strokes.
• 15:51
  Matt Edmundson: So the cholesterol building.
• 15:54
  Um, your cells today might be blocking your arteries tomorrow.
• 15:59
  It's the ultimate frenemy situation and I'm just really stoked I
• 16:03
  could bring in that word frenemy.
• 16:04
  Jenny Oliver: Frenemy.
• 16:05
  I know that was quite an achievement, um, because the process is completely silent.
• 16:10
  You can have dangerous levels for years without actually feeling anything.
• 16:14
  Chris Smith: That's right.
• 16:15
  And, but that one bit of good news is cholesterol's one of the most
• 16:18
  manageable risk factors in medicine.
• 16:20
  We can measure it accurately, which is really important.
• 16:22
  We can understand the mechanisms, and we have those medical
• 16:25
  interventions and lifestyle interventions that work really well.
• 16:29
  Early detection and management can prevent decades of arterial damage, and
• 16:33
  that's so important to keep in mind.
• 16:35
  Jenny Oliver: So that's why we need to manage cholesterol levels, not because
• 16:38
  cholesterol itself is always bad, but because our modern lifestyles, extended
• 16:43
  lifespans and individual genetics can push it out of balance with huge consequences.
• 16:49
  So that's it for this week.
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  Make sure you hit that subscribe button.
• 16:53
  We're gonna keep unpacking the science behind everyday questions.
• 16:56
  Tell us in the comments what you'd like us to explore.
• 16:59
  Thanks for geeking out with us, but for now, that's it from me.
• 17:03
  Matt Edmundson: That's it from me.
• 17:05
  Chris Smith: And that's it from me.
• 17:06
  Jenny Oliver: Bye for now.