RECENTLY, I found myself sitting with a blood result I hadn’t expected: high cholesterol.
The result surprised me. As a GP with a special interest in lifestyle medicine, I spend much of my time supporting patients in managing their health through diet, exercise, stress management, and sleep.
Cholesterol is a fatty substance that occurs naturally in the body. It is essential for several bodily functions, including building cell membranes and hormone production.
The main types of cholesterol are HDL (high-density lipoprotein) cholesterol and LDL (low-density lipoprotein) cholesterol.
HDL cholesterol is beneficial to the body, whereas LDL cholesterol can contribute to the build-up of fatty deposits in the blood vessels, which can narrow and harden them over time.
This can lead to blockages in the blood vessels which can result in a stroke or heart attack.
Approximately 9,000 people die every year from cardiovascular disease in Ireland, making it a leading cause of death in our country.
High cholesterol, specifically LDL cholesterol, is a major risk factor for this disease, and so I took my cholesterol result seriously.
Having high cholesterol doesn’t always present with symptoms. Like me, you may feel healthy and well, but still be at risk. That’s why regular check-ups, particularly if you have a family history of heart disease, are so important.
Most cholesterol is made in the liver, but it is also absorbed from the food we eat. Foods high in trans fats and saturated fats can increase LDL cholesterol.
The European Society of Cardiology (ESC) emphasises lifestyle measures in its guidance on lowering LDL cholesterol, so I looked to my nutritional habits first.
Like many people, I assumed I was doing enough with my diet. I swapped chips for salad, always chose brown bread over white, and had a consistent exercise routine. So, what was I doing wrong?
In the days that followed, I decided to do a deep dive into my lifestyle and dietary habits through a medical lens. What I discovered was humbling.
Yes, I was eating well, but there’s a big difference between being ‘healthy’ and eating optimally for heart health.
During my time as a junior doctor, I was diligent about choosing fresh, whole foods and cooking at home.
However, over recent years, I have developed some unhealthy habits.
Long workdays and commuting meant that convenience foods, such as ultra-processed snacks and pre-packaged meals, which tended to be higher in saturated and trans fats, had crept into my diet.
And if I were being truly honest with myself, I certainly wasn’t following the medically-approved Mediterranean-style diet.
Research consistently indicates that the Mediterranean diet is one of the most effective nutritional approaches for improving cholesterol profiles and reducing the incidence of cardiovascular disease.
In particular, the PREDIMED trial demonstrated that a Mediterranean diet, supplemented with extra-virgin olive oil or nuts, reduced the incidence of major cardiovascular events compared to those who were on a low-fat diet.
I prefer not to use the word ‘diet’ as it implies restriction and a short-term solution. However, the Mediterranean diet isn’t a strict meal plan; rather, it’s a way of eating inspired by the traditional diets from countries such as Greece, Spain and Italy.
It emphasises plant-based foods such as fruit, vegetables, and whole grains, as well as healthy fats like extra virgin olive oil, nuts, and seeds and is low in processed foods.
Even with knowledge of the science, changing my dietary habits took effort. Like so many of my patients, I had my own routine, food preferences, and time constraints, and I certainly did not overhaul my diet overnight.
The ESC guidelines recommend reducing trans and saturated fats to lower LDL cholesterol, so I started there.
Taking the time to shop for fresh groceries every week, adding unsaturated fats like extra-virgin olive oil, chia seeds, walnuts, and avocados to my diet, and prepping my meals and snacks in advance for busy days were some of the initial measures I took.
I understood that lifestyle changes are powerful and, for some people, can reduce the need for cholesterol-lowering medication.
Statins are one such medication, commonly prescribed for high cholesterol. These medications can significantly reduce cardiovascular risk, but work best alongside healthy lifestyle changes.
While I may require cholesterol-lowering medication in the future, I was eager to optimise my cholesterol as much as possible through a nutritional approach first.
Making these changes can sound daunting at first, and my experience has certainly changed how I talk to my patients when discussing the diagnosis and management of high cholesterol.
Instead of rattling off a list of “dos and don’ts,” I ask what small steps they can take today. Could you swap one red meat meal a week for a chickpea curry?
Could you try overnight oats with berries and chia seeds for breakfast instead of toast and butter? We start there.
If you’ve been told your cholesterol is high, there’s no need to panic.
Use it as an opportunity to reflect on your habits and to make changes.
I decided to implement a ‘small changes’ approach and prioritised behaviours that I could sustain, rather than a drastic short-term dietary overhaul.
Daily habits can have a significant impact on our short-term and long-term health.
We don’t have to be perfect, but we do have to start.
That’s the essence of lifestyle medicine — empowering you to take back control of your health, one daily choice at a time.
Swap out butter for extra virgin olive oil, which is rich in monounsaturated fats and can help lower LDL. Use it for cooking or mixing into salad dressings.
Aim to fill half your plate with vegetables at most meals. Add foods rich in antioxidants, such as berries, to your morning porridge or vegetables to your stews.
Oily fish like salmon and mackerel are high in omega-3 and support heart health. Canned versions are a budget and time-friendly option.
Change your ultra-processed crisps or biscuits for a handful of nuts or fruit with a bit of nut butter.
Swap out salt, which can raise blood pressure, for alternative flavourings such as garlic, herbs, and spices.
