Cholesterol question

I believe the cholesterol you eat is largely passed undigested. It's a myth that high cholesterol foods cause high cholesterol directly- it's more of a side effect. Also, check what they're actually measuring as there isn't really 'good' or 'bad' cholesterol and some other measurement that I've forgotten the details of (apoB) is actually what's important.

Stick some Peter Attia cholesterol episodes in your ears and get up to speed 😀

I had a similar 10 year risk. GP seemed to think it was nothing to worry about, so I've just decided to try and beat the system 10 years at a time.

My simplistic take is to just avoid the sugary stuff - e.g. have the bagel with bacon / mackerel / etc, rather than the cake/brownie.

This is based off the idea that a (simple) sugar-filled diet causes your liver to make more ldl cholesterol, the bad type, and less hdl cholesterol, i.e. the good kind.  That's simple added sugar as opposed to sugars delivered via veg / grains / etc.  Lots of articles around on this if you have a quick google.

Dr says I have a 3.8% chance of a heart attack in next 10 years which she seemed to think was low.

You need to look at the half full glass - you have a 96.2% chance of not having a heart attack in the next 10 years, which is very high.

Increase those chances further by not worrying! 😉

But also cut out unhealthy foods.

My LDL's were the ones that are high 😟

To be honest I'm not that worried, I was just hoping that I could still happily have cake at the cafe on a bike ride! Having said that my father didn't make 40 due to lung cancer (keen smoker) and my brother only just managed 40 (keen drinker, although the alcohol didn't directly kill him , what did dependents in how much you trust the Police in Baku) so I am keen to see my son grow up and know this is not a given!

But also cut out unhealthy foods.

😰😰😰😰

Your doctor is/possibly is an idiot. High cholesterol can be genetic, certainly is in our house. I take a low dose of statins. All the checks came back exceptionally low for heart attack, but there wasn't really anything I could do to change my diet. Low dose of statins had everything in range. Both my folks are on statins.

By all means change your diet, then get tested. If it hasn't moved much it's genes !

I've a a bit longer than you, of my dad's family:

Grandad (heavy drinker)  heart attack from clogged arteries @ 67

Uncle (heavy drinker & smoker) heart attack from clogged arteries @ 71

Aunt (overweight & diabetic) heart attack from clogged arteries @ 69

Dad sweet tooth but not overweight heart attack from clogged arteries @ 69

so I've got 14-16 years to go.

Have had generally low cholesterol, but c 3 years ago it was up a bit (still in ok range) & I was overweight. Thanks to chub club I've dropped 14kg so need to sort out another cholesterol test to see if there has been any improvement.  While statins may help you drop the cholesterol level,  what happens to the fat that's been laid down in your arteries if it has been high previously?

In the family cases above, it was bits breaking off & causing blockages that caused the problem.

My sister lives in Spain-  when she went home after Dad's funeral & discussed this with her GP, she was sent for loads of tests including the stress test on a bike, plugged into machines, oxygen mask etc & pedal like mad till exhaustion and has had 2 follow ups in the 10 years since.

A little of what you fancy...

Is what my doc told me 15 years ago after my heart attack. 12 years later I'm still here, despite not having the healthiest of lifestiles, now reformed due to a TRA or two and the possible onset of diabetes.

High Cholesterol runs in my family, and I possibly have a high chance of having anoither Heart Attack, but it ain't a bad way to go... Could be much worse...

As a general rule both doctors and patients are pretty shit at understanding percentages and risks.

what inputs did they use to determine the % risk?  Was it just your age and lipid levels? Perhaps gender?  Was your activity level, your weight/height, or any other risk factor part of the calculation?  did they say having a heart attack (bad) or dying from a heart attack (more bad).  Did they say what the risk would be if you could manage to significantly reduce the level (say by 30% which would be a big change).  Did they say what the confidence interval was on 3.8%?

id hazard a guess (without having any actual stats or your details in front of me) that you are more likely to die from a heart attack in the next 10 yrs if you reduce your cholesterol by enough that your doctor makes encouraging noises, but stop exercise than if you keep doing exactly what you do just now.  If cake is your motivation for exercise (or social interaction with friends, or various other things which affect morbidity) then I’d think carefully before chasing the 3.8%…

FB-ATB - a vitamin K2 supplement may help you. Plenty of info on the web, I like to listen to this cardiologist

it’s a fat soluble vitamin, so take it with some fat.

Low fat diets eh?

I'm in the same boat (I started another thread somewhere on here about it) - for the past 2 weeks I've avoided all cake, biscuits, crisps, cheese, fast food etc, and am trying to eat as healthy as possible. A side effect is I've lost just over a kg - down to 83.5kg.

My parents have both had TIA's, which has an impact on the docs calculations on how much of a risk it is for me to have one too. They're both on statins, so it's likely I'll also be given them (regardless of if I need them or not).

I run three times a week, cycle at the weekends, walk the dogs every day and generally run about the house after our children. Yet mine is still up at around 7.1

I plan on being around to see my grandkids, so making some changes now for the better.

anything Less than 4 % risk is totally normal for someone well into middle age and not something to be worried about is saythat said if your cholesterol is high then cutting down on the saturated fat (keep to around 10g per day, easier said than done if you enjoy your food) plus increase the good hdl makes a difference I went from well over 6 total cholesterol to less than 3 through that approach. Lots of avocados seemed to help. I also take a low does statin, but should be noted I got to below 3 before I started taking them.cardiologist told me that if you can get your ldl below 1.6 you can actually reverse heart disease to some degree. but as pointed out above, some folks just have high cholesterol no matter what you eat, so if that’s the case a low dose statin may be in order. Also apparently helps stabilize existing plaques, which is why I take them.

Sorry wrong link above. Try this

what inputs did they use to determine the % risk?  Was it just your age and lipid levels? Perhaps gender?  Was your activity level, your weight/height, or any other risk factor part of the calculation?

From what I gather it involved age, weight, height (or maybe BMI) and blood pressure which was taken recently.

No confidence intervals were given, due to the fact she was bumbling on about good cholesterol and bad I didn't think it appropriate to enquire about the type of analysis that was done either although I used to do a reasonable amount of multivariate statistics myself.

id hazard a guess (without having any actual stats or your details in front of me) that you are more likely to die from a heart attack in the next 10 yrs if you reduce your cholesterol by enough that your doctor makes encouraging noises, but stop exercise than if you keep doing exactly what you do just now.  If cake is your motivation for exercise (or social interaction with friends, or various other things which affect morbidity) then I’d think carefully before chasing the 3.8%

Whilst I like that thinking, I reckon it might be possible for me to stop at a cafe and not eat cake 🤔🤔😄😄

U can always make your own cake and cut down on the nasty stuff, I am just making a banana bread and cut right down on the sugar, add some dates to make it less bland.

're 3.8% I would be highly sceptical of such a precise percentage, unless it came from an actuary.

I have annual cholesterol  checks, 1st one is really a snapshot, subsequent ones establish a pattern.  Doc always says u have to look at other markers too, height, weight, lifestyle, age, other blood markers like cell count, can't remember if it's red or white.

What are the numbers?

4% chance of a heart attack in 10y for a middle aged man is chuff all really I’d settle for those odds and I’m running marathons regularly (at a decent pace too). I’d file it under nothing to worry about.

4% chance of a heart attack in 10y for a middle aged man is chuff all really I’d settle for those odds

You are assuming it's an accurate model

for the past 2 weeks I’ve avoided all cake, biscuits, crisps, cheese, fast food etc, and am trying to eat as healthy as possible. A side effect is I’ve lost just over a kg – down to 83.5kg.

If I don't ride my bike for a fortnight but keep the same diet I tend to lose about a kilo as the muscle in my legs disappears. 😀

I’m not sure why you need to stop your mid-ride cake 🤷🏻‍♂️

What are you scared of in there? We’ve already established that dietary cholesterol is irrelevant to incidences of heart disease so it’s not the eggs.
In which case it must be the sugar but we know that is treated differently during exercise too. Your glute 4 transporters will be rippling with excitement from smashing all those hills- so the sugar in the cake will be into your muscles in no time at all (not spiking your insulin and causing fatty liver disease etc).

The best thing you can do is to get fitter. Raise that Z2 power and get those mitochondria healthy 😃

@edward2000

thanks for the link. Interesting stuff

The best thing you can do is to get fitter.

Race you up a hill 😜😜

Not on flat though 😄😄😄😄

We’ve already established that dietary cholesterol is irrelevant to incidences of heart disease

Have we?

I’ve got Peter Attia’s book and interestingly, he says the main shift in his thinking since he set out to write it is that diet is almost irrelevant to health. There’s literally not enough facts to back up the inclusion or exclusion of anything in particular and is wildly unique.
And exercise that he thought was a side note at the beginning is in fact the almost powerful way to stay healthy.
He talks about imagining you are training for the centarian Olympics. We know predictably how much aerobic, anaerobic and strength fitness declines with age so to be that world beating 90 year old, you need to get as fit as possible now!!

There’s some technical bits I ignore but I’d highly recommend the book. (Outlive).

Have we?

Well I have because I read the link I posted 🤣

is that diet is almost irrelevant to health. There’s literally not enough facts to back up the inclusion or exclusion of anything

Pretty sure that a similar arguement was made that smoking wasnt bad for you.

Well I have because I read the link I posted

I got bored pretty quickly!!!

My understanding was that if you were genetically prone to high cholesterol then actually diet was more important, which sounds a bit back to front but is true

Cholesterol isn’t even the issue is it. It’s the fact that it gets dumped out in your arteries by the low density and very low density lipoprotein transporters as they gouge into the walls.
The ‘good’ and ‘bad’ lipoproteins have the exact same cholesterol inside of them.

And your liver regulates what you produce (some cells make their own, some get it from the liver). That’s partly the issue with being metabolically dysfunctional.

Most cholesterol we eat literally cannot get through our gut transporters into the blood stream anyway. As I say- we poop it out.

What you describe with smoking is what happened already with cholesterol. The cholesterol at the blockages was assumed to be the culprit. But of course it wasn’t that simple.

As Peter says regularly in his cholesterol episodes- if anyone you are discussing your health with starts mentioning ‘good’ and ‘bad’ cholesterol then they literally have nothing of use to tell you- they are the exact same cholesterol being transported in two different ways. (Cholesterol is an oil which repels water so can’t move through your blood stream without being wrapped in a lipoprotein case).

Anyway- cake isn’t an issue but I guess I’m done in this thread 😀

As Peter says regularly in his cholesterol episodes- if anyone you are discussing your health with starts mentioning ‘good’ and ‘bad’ cholesterol then they literally have nothing of use to tell you- they are the exact same cholesterol being transported in two different ways. (Cholesterol is an oil which repels water so can’t move through your blood stream without being wrapped in a lipoprotein case).

It depends on whether the person is talking about good/bad to dumb it down for you as most won't see the relevance of how it's transported.

... I reckon it might be possible for me to stop at a cafe and not eat cake 🤔🤔😄😄

Did she factor in the fact you appear not to be human in her calculations. 😉

I would be highly sceptical of such a precise percentage, unless it came from an actuary.

That was the point I was getting at.  She didn't intend it to cause alarm.   I wonder if she had said, "in general your health is good and when combined your overall risk is <5%" if the OP would have been worried enough to start the thread.  Instead, she's given a very specific number, suggesting it's more than reasoned guesswork or reading off a couple of graphs, and left him thinking, well 38 out of every 1000 people my age with my cholesterol have a heart attack in the next 10 years - which sounds scary.  What she didn't do was point out that as a relatively healthy middle-aged white man in the UK your likelihood of surviving that is somewhere approaching 90%.

I've spent a surprising amount of my life in meetings about how outcomes of tests like that are presented to users, and things like the colour of the text/background and font/capitalisation of words etc has an impact on how we perceive the meaning in the number.  It can be as much of a challenge in the opposite direction - making sure that someone takes action as doesn't overreact.  Its often the worst-funded and poorest thought-out bit of any research project around some new health initiative.

You are assuming it’s an accurate model

I don't have enough expertise in the field to have any particular reason to doubt it. If you've found sufficient research to challenge it, fair enough.

It depends on whether the person is talking about good/bad to dumb it down for you as most won’t see the relevance of how it’s transported.

There's no need to lie about it to the extent that people associate mid-ride cake with death 😉

<p style="text-align: left;">We’ve already established that dietary cholesterol is irrelevant to incidences of heart disease

</p>

total cholesterol is expressed as a combo of ldl and hdl plus triglycerides. The ldl/hdl ratio is important

Ldl is bad according to pretty much every expert I’ve spoken to (2x cardiologists plus  professor of clinical pharmacology)

all that said, I refer to my earlier post. Whilst you probably want to try to get your ldl down a bit, 3.8 % risk will be absolutely no worse than anyone else your age. And on a positive note, if its 4% chance of a heart attack, it’s probably a 1% chance of dying from a heart attack! I’d bite your hand off for those odds over the next 10 years!

The point is, LDL and HDL contain the exact same cholesterol. You could lower your cholesterol intake all you like but if your liver is making more than you need you’re in the same boat.
You can’t exist without cholesterol- it’s part of every cell. The idea isn’t to eliminate it but to stop your LDL’s dumping their load into your artery walls.

Total cholesterol doesn’t include what you eat because most of that goes straight out the back door 😀

Any improvements dietary restriction in the name of ‘lowering cholesterol intake’ makes to your total cholesterol is almost certainly a byproduct of being healthier via lowering your weight and your blood pressure and improving your metabolic health.

Eating cake mid-exercise remains a non issue 🍰 😋

That was the point I was getting at.  She didn’t intend it to cause alarm.   I wonder if she had said, “in general your health is good and when combined your overall risk is <5%” if the OP would have been worried enough to start the thread.

It didn't alarm me. Any number presented to 1/10 of a percent regarding something as complex as thisisnt worth worrying about. (This also answers the captain's question). What worried me was the fact that a Dr called me up to tell me I have high cholesterol when I eat a very low fat high fibre diet, don't drink much, don't smoke and am not overweight. Which combined with cycling to work everyday in top of two or 3 other rides a week means I don't have much "fat' to trim as far as improving this goes

Any improvements dietary restriction in the name of ‘lowering cholesterol intake’ makes to your total cholesterol is almost certainly a byproduct of being healthier via lowering your weight and your blood pressure and improving your metabolic health.

eating less saturated fat and more healthy eating has lowered my ldl massively. Without a significant change in weight or bmi. No 2 ways about it. So unless you are a doctor of some description I’d be more trusting of the advice of folks who are paid to know about this stuff and all have told me that diet plays a part in cardiovascular health.

feel free to do as you please obviously, but unless you are a doctor I don’t think it’s particularly appropriate to be handing out advice on diet in relation to heart disease on a public forum when it flies in face of what most experts agree on.

Reduce your sugar/carb/ultra processed food intake. Sugar is the killer

a_a was she testing for a particular reason? Or have you just reached an age where they do this for fun?

I haven’t given any advice other than to be aware of what is actually happening in your body.

Same as low fat diets can help you lose weight even though you can get fat without eating fat- healthier, low cholesterol diets will lower your ldl despite the fact the problem was the cholesterol you were making, not eating.

a_a was she testing for a particular reason? Or have you just reached an age where they do this for fun?

Age, pushing 50 that and I finally went to see Dr about something else and had been ingnorring all the messages about blood pressure and blood tests!!

Reduce your sugar/carb/ultra processed food intake

If I reduce my carb intake I'd feel shit on the bike, can't see how that's linked to cholesterol.

eating less saturated fat and more healthy eating has lowered my ldl massively.

That is interesting. My GP strongly believes that altering your diet makes little difference to your cholesterol levels. He claims that your cholesterol levels are almost all down to what your own body produces and that only losing weight is likely to have a significant effect.

If I reduce my carb intake I’d feel shit on the bike

That can't be right surely, unless you are quite a few hours into an endurance ride?

I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.

But perhaps I have more fat reserves than you!

I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.

A lot of people are proud of that ability but I think it's pretty much genetic and the habitual component is itself most likely derived from your genetics.  If you can't do it, it's not necessarily because you're weak/a fattie/a rubbish cyclist etc etc.

I hadn't realised that having carbs before a bike ride was a necessity for some people, obviously it eventually becomes one. But if I couldn't ride a bike without significant carb loading I would assume that something wasn't quite right.

And btw I was suggesting that it might be me who is the fatty with plenty of reserve fuel! I am probably about half a stone overweight.

Being a carb monster lowers your insulin sensitivity and messes up your profile of ldl/hdl.

https://www.verywellhealth.com/high-blood-sugar-and-cholesterol-697781#:~:text=The%20linking%20factor%3A%20insulin%20resistance,%22)%2C%20and%20high%20triglycerides.

Hence why cake MID RIDE is neither here nor there as it doesn’t spike your insulin.

This comes back to my point about diet. You can’t see the relevance as you’re determined not to understand the true nature of the problem 😉
🚨 It’s not about Cholesterol in your diet. 🚨

It’s about maintaining a healthy metabolism. Which starts with the mitochondria and good old Z2 training 🤣🤣🤣

It’s not tied to weight either. If anyone used to watch ‘supersize V superskinny’ it was always picked up on how many of the skinny folk had shocking metabolisms because they ate junk.

They were skinny and unhealthy.

This study found the link between insulin sensitivity and cholesterol disfunction (they made more and absorbed less) to be greater than with BMI.

https://www.sciencedirect.com/science/article/pii/S0022227520318782

if I couldn’t ride a bike without significant carb loading I would assume that something wasn’t quite right.

Having a bowl of porridge oats and a coffee before a ride is hardly carbo loading, it's just breakfast and I seriously doubt that cutting out my oats, fruit and low fat yoghurt in the morning is going to have any impact on my cholesterol

I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.

So could I, but I would be only able to pootle, maybe you just pootle.

 If anyone used to watch ‘supersize V superskinny

Never watched it, but one day at school many years I had to cover a pshe lessons and the just had to watch an episode of super size v super skinny kids...turns out I used to know the dietician really quite well for a short time years before!!

Crosshair, my understanding is  that in people with a genetic predisposition to high cholesterol there is a stronger link between dietary cholesterol and blood cholesterol.

I seriously doubt that cutting out my oats, fruit and low fat yoghurt in the morning is going to have any impact on my cholesterol

It can potentially have an effect, but a negative effect.

https://joinzoe.com/learn/can-eating-oats-reduce-cholesterol.amp

Having a bowl of porridge oats and a coffee before a ride is hardly carbo loading

Apologies there is obviously a bit of a misunderstanding, you talked about just reducing your carbs would make you "feel shit".

I took feeling shit as "feeling unwell". And that you would therefore feel unwell if you had half a bowl of porridge.

Yeah if you can’t do up to a 90 min smashfest on the bike with no carbs then I’d say there’s work to do.

The only thing I can find about hyperresponders to dietary cholesterol suggests that you would have as much extra HDL as you do LDL. Ie you’d have higher total cholesterol for zero extra risk of heart disease.

But if both HDL and LDL go up you still have higher ldl? I doubt the "science" on this is as definitive as you, or that doctor blokey you linked to hope. Let's not forget I am a doctor too and know my multivariate stats and the limitations.

PS Chelsea bun, flat white and a banana on my ride today is that too much or not enough carbs over my 75km ride for the carb police? Don't forget I had a bowl of oats for breakfast with a coffee too ( that had skimmed milk). Just for reference it was a steady flat ride but I did sit on the front for most of it!!

Most GP’s went to med school 20-30 or so years ago where nutritional training was close to zero.

Cholesterol now seen as lagging indicator and Apob more important. Listening to a few podcasts from Attia and reading the journals it seems like the last 30 years have fell to correlation = causation. Some now believe cholesterol is actually a response to damage and is used by the body to repair so while high cholesterol is bad, it is not the cause.

Being the armchair scientist myself from the school of YouTube I’d put 50% down to genetics, 25% to calorie excess / quality and 25% to being sedentary for most of the day.

Blaming sugar is way too easy IMO. People look for magic cure / reason but if your dog gets fat / I'll you simply feed less and walk more...

Need to add lack of sleep / stress somewhere in the mix too. Cortisol is not good but carbs actually help reduce it.

My take as a GP:

Total Cholesterol = HDL Cholesterol (technically HDL-C but we will use HDL for simplicity) + Non HDL Cholesterol (technically Non HDL-C but we will use Non HDL). Non HDL Cholesterol includes LDL, VLDL plus others. We generally use Non HDL as a marker (rather than eg LDL) as it is easier to accurately measure. Cholesterol is Cholesterol. When we discuss Non HDL or HDL we are discussing the transporter which is carrying Cholesterol in the bloodstream. They can be "big/good" transporters (like buses) = HDL, or "small/bad" transporters (like mopeds) = Non HDL. We are generally better off with more buses and less mopeds as it seems to be the mopeds that sneak into blood vessel walls which have been temporarily damaged (by eg chronic high blood pressure/ chronic inflammation in Diabetes etc). They then deposit their Cholesterol which then leads to inflammation and hence poor repair. Ultimately this leads to thickened, unstable blood vessel walls and hence heart attacks/strokes etc.

Raised Non HDL Cholesterol is an independent risk factor for cardiovascular disease. Once you normalize for Non HDL it seems that HDL, Triglycerides (TG) etc have little bearing on that specific risk. HDL and TG are important for helping to determine your metabolic health overall so a low HDL, high fasting TG pattern would typically be seen in someone who is more at risk of metabolic issues like Type 2 Diabetes, Non Alcoholic Fatty Liver Disease (NAFLD), Hypertension, Obesity and High Non HDL. Another way of looking at it would be that as someone gets more metabolically unfit, they will likely see their HDL drop and their Non HDL and TG rise. There are a range of conditions called Familial Hypercholesterolemia which are genetic, relatively common and fall outwith what we might expect above, so can confuse the picture. Your own genetics will certainly play a part in your Cholesterol profile, but that is true for everything from hair color to height etc.

Apolipoprotein B (ApoB) measurement gives an exact number of the harmful transporters in the bloodstream (Non HDL Cholesterol tells you the molar concentration or mass of the harmful particles, not the number) and it is likely that knowing the number of them is more useful than the mass, but it is not widely available in the UK. It is probably more useful than Non HDL, and it would make all our lives easier as we would be dealing with one number only - it is also often conceptually challenging to have this discussion around a number defined as a Non-number (Non HDL).

Obesity is associated with a higher risk of metabolic illness as above but not in a 1 to 1 ratio. So say around 60-70% of obese people have evidence of metabolic illness, compared to 20% of normal weight people (I'm not certain on the exact numbers).  Therefore it seems it is possible to be obese and healthy (well, normal life expectancy etc) and it is certainly possible to be slim and unhealthy (any/all of the metabolic issues above).

Any lifestyle intervention will have the biggest health impact on the most unhealthy people. So for example if you are in the bottom 25% for diet (very difficult to define that group as so many variables but hey ho - this is just conceptual) then dietary changes may have a significant impact on your Non HDL as well as your metabolic parameters generally. But if you are already top 25% for diet then further fine tuning, eg further reducing saturated fats, is unlikely to have much impact.

If someone is obese and metabolically unhealthy then a healthier lifestyle will improve metabolic markers (Abnormal Cholesterol profile, Hypertension, NAFLD etc) and outcomes long term but may or may not effect significant weight loss. In my opinion it is important to separate weight (which isn't a great health metric to track) from the metabolic markers above (which are). In general when doctors advise weight loss, I suspect we mean improve metabolic health/fitness though we aren't at the stage as a scientific community to be certain about that yet.

Yeah the carb thing is not an easy answer. I guess the simplest way is to think of it as rocket fuel- so when you're being a rocket, there's no harm to it 😉

Fuelling for performance is very different than fuelling for health...

https://megaphone.link/FL9154070915

This is a pretty interesting episode where they discuss the balance between the two.

Sports drinks, gels, and race food are focused on one thing—getting simple sugars from our mouths to our muscles. Research unequivocally supports their use for maximizing performance, but there’s also a mounting body of evidence that associates simple sugars with diabetes, heart disease, dementia, cancer, and other conditions. Because we care about both our performance and our health, we have to ask an important question: Where’s the balance?

Fuelling your ride today won't have done any harm, but being able to jump on the bike and do a couple of hours (of any intensity) after an overnight fast should be achievable if you have good metabolic flexibility.

Skipping breakfast and eating on the bike once your aerobic system is firing is a good starting point.

After listening to the original Attia/San Milan stuff, I built up to doing 6hr fasted rides in 2021 at low intensity to try and kick start my own metabolism after I got fat during my broken leg recovery in 2020. Who's to say if it worked but I definitely felt like a different person afterwards. Even silly stuff like my Hayfever and asthma is better. And then building on that in 2022, I've really noticed the difference on the way home from group rides etc. My bottom end endurance is almost limitless regardless of whether I've ridden hard. Back in 17/18/19 that wasn't the case. I'd normally limp home from a Banjo or Chainy.

Thanks @Ioneonic that's a super interesting summary 🙏🏻

So for example if you are in the bottom 25% for diet (very difficult to define that group as so many variables but hey ho – this is just conceptual) then dietary changes may have a significant impact on your Non HDL as well as your metabolic parameters generally. But if you are already top 25% for diet then further fine tuning, eg further reducing saturated fats, is unlikely to have much impact.

Thanks Ioneonic, explained like that it is very obvious and makes perfect sense, I just didn't think of it!

I couldn't understand why someone had said earlier that a change of diet had caused a huge change in their cholesterol levels when my GP is absolutely adamant that I cannot reduce my cholesterol levels significantly through diet.

My GP who I have known for decades knows my lifestyle very well and will be aware that I have a heavily Mediterranean diet. He keeps telling that my "good" cholesterol is exceptionally high which why my total cholesterol is slightly high.

He tells not to worry about my cholesterol levels but then says that I might as well take statins as they won't do me any harm! I am currently sitting on a statin prescription which he has given me whilst "I think about it"!

Fat Fiction - Full Movie - Free - YouTube

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Raising HDL is easy and effective | The BMJ

https://www.bmj.com/content/349/bmj.g4379/rr/761535

They’ve even thought about adding statins to the water supply in the USA 🤣

https://bigthink.com/health/statins-drinking-water-wonder-drugs/

Statins in our drinking water? Do you realize that 70 percent of you is water?
And as human beings, you and I need fresh, pure water to replenish our precious bodily fluids.

@ernielynch you raise a slightly different but much more useful point. The question we should ask isn't "What is my cholesterol?". It is "What is my cardiovascular risk and how do I best reduce it?".

Once you reach around 40 to 50 we can say the biggest threats to your health and longevity will be Cardiovascular Disease (CVD), Alzheimer's Dementia, Cancer (Lung most commonly), Frailty and Type 2 Diabetes (T2DM).

The same healthy lifestyle will reduce the risk of all of these:

1. Sleep - 7h per night

2. Activity - 2 hours or 10k steps equivalent daily (not bankable)

3. Exercise - 150 minutes of moderate or above per week plus resistance

4. Nutrition - whole food diet (Mediterranean Diet probably has the most evidence)

5. Smoking - zero

6. Alcohol - increasingly looks like zero

That covers risk reduction for them all.

In addition your CVD risk can be reduced by the following:

7. Treating blood pressure to 120/80 if above this

8. Lowering Non HDL Cholesterol

And that is it. Everything else is fine tuning or debatable as far as I can see. So the choice of doing 1-8 depends on an individualised risk benefit analysis for each. If your risk is high enough then the pendulum swings to doing more of them. If you are already following as healthy a lifestyle as you want/can but your risk remains unacceptably high for you, then you might decide to lower your BP if it is above 120/80, or to take medication to lower your Non HDL Cholesterol. Note I've not mentioned a number for the latter - it is a sliding scale, the lower the Non HDL, the lower the risk.

We have population level targets for diagnosing Hypertension, or when to consider statins but on an individual basis we can discuss them at any stage. Generally the risk of treating a BP of 121/80 will outweigh the benefit so we don't do it (in general we don’t treat BP unless it is >135/85 as a home average) but that doesn't change the underlying science.

So I would tend to go through 1-6 and catch the low hanging fruit… I try and see in which of these you are in the lower 25% and encourage improvement eg If you are already a heavy exerciser but sleep is terrible then exercising more isn't your best option - sleep optimisation is.

If the risk is high enough anyway, or there is not much you can or will change in 1-6 then we would discuss the risk/benefit of doing 7 and/or 8. You can already see that if your BP is normal then the only other lever available is lowering your Non HDL (first line drug treatment is with statins - this is a common scenario) - there isn’t really a lower limit.

We use Risk calculators for CVD risk - you can use them yourself online. I think most UK GP systems use QRisk 2 though the updated QRisk 3 is available online. If the 10 year risk > 10% then your GP would generally initiate a risk reduction discussion but you can initiate at a lower risk if you wish. (* A significant concern is that a 10 year risk assessment is not forward looking enough, but it is the best we have. It should act as a basis for discussion, not be definitive). Age and sex are factored into risk (CVD unusual in 20s, very common on 70s) so at some point your age alone will take you across the 10% risk threshold. Irrespective of why your risk is raised, lowering your non HDL will reduce it - it might not be the best way of doing so (you might be better off stopping smoking, or reversing your T2DM) but it will.

It looks likely that intervening early (ie lowering your risk/Non HDL/BP) before you reach higher (eg >10%) risk later in life is beneficial but I'm not aware of firm evidence backing this up. My risk in my mid 50s is 4.9% (relatively low) but we have a strong family history of CVD from 45 onwards, and a genetic high non HDL. I am also pretty good on 1-7 so 8 is my "low hanging fruit". Hence I take a statin though many/most wouldn't, and I respect that (as long as they have had a full explanation).

Hope that makes sense. Your 3.8% risk is low if you are in your 50s, maybe a concern if much younger.

And I'd agree with @crosshair that performance and health are not the same thing. The best time to have a cake is mid ride or straight after a ride (GLUT4 stuff above, much reduced insulin response so you have limited the "harm") but it is still cake with saturated fat or whatever - it doesn't magically make it not cake. I'd enjoy eating it, lick the plate and move on.

More interesting would be the use of energy bars/gels/recovery drinks during or after a ride to aid performance (most people are not having these for pleasure) - eating wholefood carbs here are probably a better option for health - this might be unacceptable for convenience or performance reasons but the gels etc are not likely to be in any way healthy. I use energy bars for convenience during rides but wholefood carbs after.

Thanks for your input Ioneonic, a few things to think about! 👍

Incidentally I saw my Chinese acupuncturist this afternoon and I mentioned that I had slightly raised cholesterol, she responded by saying that I should drink clove water every morning and that after six weeks I would see a drop in my cholesterol level.

I have checked and there is indeed apparently fairly strong evidence that clove reduces HDL. I thought great, unlike statins something natural like cloves can't possibly have side effects.

But then I checked......

Side effects include rare allergic reactions, local irritation, contact dermatitis, haemorrhagic pulmonary oedema, bronchitis, pneumonia, occupational allergic contact dermatitis, and central nervous system depression.

I guess anything that actually works is also likely to do stuff that you don't want it to do.

Probably quoting a QRisk score or similar. You can have a play with the inputs here:

https://qrisk.org/

Given risk increases with age, I'd be more interested in the relative position I had to someone with optimally controlled metrics. It may be that you close to normal population risk.

On the topic of Attia's 'Cetenarian Decathlon' philosophy and what that looks like:

Not watched it yet but seems like a nice précis some of his book takeaways.