Chapter 1: What is cholesterol and why is it important for our body?
How do you know if you've got high cholesterol? Are there any warning signs?
Often the warning signs are too late, so it could be a heart attack or a stroke. High cholesterol is one of the leading causes of people needing
I think there's a myth that if you have high cholesterol it's because you're overweight.
I see people who feel like they're healthy because they are slim and they come to see me after they've had a heart attack and it's because they're not thinking about what they're putting into their body because they look okay on the outside.
Why is everyone just not on a statin?
I must say, Cherry, that statins are probably... I'll be honest with you, if I had high cholesterol...
A very warm welcome to No Appointment Necessary. My name is Cherry Healy.
And I am Dr. Amir Khan. You can normally find me up in Bradford at my surgery. But once a week, I come down here and you can find me here at this podcast or stuck on a train as I was earlier today. It's up to you.
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Chapter 2: How does the liver produce cholesterol regardless of diet?
Now, when people hear the word cholesterol, usually in their head, they hear the like a bad noise, right? It's in my head right now. Because they think cholesterol, heart disease, bad strokes. But actually, what's really important to say is that cholesterol and lipids or fats in general are essential to life. You do need them in your body for really important things.
Cholesterol makes up almost everything. every single one of your cell membranes or the outer lining of the cell. It's very, very important for that. It helps you with hormone production, particularly your sex hormones like testosterone and oestrogen. It's important for vitamin D. It's really, really vital to life. So you do need it.
The problem is when there's an imbalance of fats or lipids in your body and blood and cholesterol is part of that picture. But it's only one type of fat. There are lots of other types of fats as well. But we focus in on cholesterol because we can measure it and we know about some of the outcomes if it's too high or too low.
Where is cholesterol made in the body?
It is made mainly in your liver. So your liver is like the factory of cholesterol. It senses how much cholesterol is in your blood and it will adjust its production accordingly. Now, what's really interesting about this is genetics plays a big part in how much cholesterol your liver makes. So actually, your liver will make, without any influence of diet... about 70 to 80% of your cholesterol.
So think about that. That means 20, maximum 30% of your cholesterol in your blood is diet related. The rest you have no control over whatsoever. It is your liver, your genetics, the way your body works. And that really surprises people.
Can you have high cholesterol without having a bad diet?
absolutely yes so it all depends on how well your liver is making that cholesterol and how quickly your body is breaking it down or reabsorbing it but family history plays a big part there there's something called familial hypercholesterolemia which is just essentially a genetic condition that means you make too much cholesterol so you could have the most perfect diet in the world you could be sleeping beautifully you could be exercising regularly uh
but there is only so much control over your cholesterol. That will do if you've got that genetic condition. It doesn't mean, oh my God, I've got really high cholesterol. I'm going to have a heart attack or stroke. It doesn't mean that because cholesterol is just one risk factor for heart attacks and strokes. We've got to look at a whole bigger picture about everything else.
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Chapter 3: What are the differences between HDL and LDL cholesterol?
Yes, exactly. So again, the fats in your food are good fats and bad fats, essentially. And unsaturated fats are the ones that are found in plants mainly, are things like nuts and seeds, olive oil, all of those things, carbohydrates.
Quite Mediterranean diet-y.
Yes, yeah.
Right. Good fats.
Good fats. So they're unsaturated fats. They help with your HDL levels. Right. But then you've got your saturated fats, which I always think of saturated as S for saturated, S for solid. So solid kind of fats. So like butter, those found in meat as well. Coconut oil can be solid, and that's a saturated fat as well.
I would have thought that was a healthy fat, but that's actually not.
Well, I'm being too simplistic here. It's not that they're unhealthy fats. They're not. But you can have too much of them. So within moderation, saturated fats are OK. But if you're getting too many of those things, that's when it becomes a problem. But when you're looking at fats in food, you should really focus on unsaturated fats.
Right. I mean, I love butter and I eat quite a lot of butter and it's just something to watch out for.
Yeah. And you can eat butter. Absolutely. Just not too much butter. That's the problem.
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Chapter 4: When should statins be considered for cholesterol management?
Remember, we've got millions of people on these drugs. So when you hear about, oh, I had these side effects, it's because there's so many people on them. You don't hear about the people who are doing fine on them. Yeah. So proportionately, still, the side effects are pretty slim. The most common thing we see is muscle aches with statins. People get joint pains and muscle aches.
What I would say, yes, that is a real side effect of the statins. But if that is you, don't just stop your statin. Talk to your doctor or your healthcare professional about going on a different statin. We've got a selection of them. Some of them might cause muscle aches in you. Some of them won't. We just don't know how you'll respond to that particular statin. So we will talk to you about that.
We do have to check your liver function every so often, at least every year, if not more frequently, because it's working via your liver. We just have to make sure your liver is happy with it. So as part of your annual or six-monthly review, we will check your liver blood tests.
Why is everyone just not on a statin?
Because if your risk is low of having a heart attack or stroke, then you don't need to be on it. You don't need to be on it. Then the risks of the side effects outweigh the benefits. So you don't need to be on it. I'll be honest with you. If I had high cholesterol, I would take a statin. I wouldn't wait until I'm older. I would take it.
Can you take one every single day for the rest of your life?
Yes, that's how it's prescribed. Yes, yeah, yeah. So when you're on it, you're on it. The other thing I would say is now we also have a whole suite of medication that can help lower cholesterol. So if you can't tolerate a statin or don't want a statin for whatever reason... There are other drugs. There's another one called ezetimibe. There's fibrates.
There's another one which you can inject as well. So don't just say, I can't have a statin. I'm not having any medication. I certainly would say talk to your doctor and talk about these other drugs. They're not as effective as statins, I've got to say it. But if you can't have a statin, it's better than being on nothing at all.
So in short, not all cholesterol is bad cholesterol, but if you've got the wrong type of cholesterol and it's too high, and if you're slim, it doesn't mean you don't, actually definitely do the test. Then lifestyle and statins, but do take it seriously.
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