Hypercholesterolaemia (high cholesterol)

Hypercholesterolaemia means an excess of blood cholesterol, especially LDL (“bad” cholesterol). A lipid profile measures total cholesterol, LDL, HDL and triglycerides.

The original angle (beyond the total figure): “total cholesterol” is a crude indicator. What really matters is more nuanced:

1. The ratio of LDL to HDL and above all of triglycerides to HDL (a better predictor of metabolic risk)
2. The size and density of LDL particles: large, “fluffy” LDL particles are relatively harmless; small, dense particles (promoted by sugar and insulin resistance) are atherogenic. Two people with the same total LDL can have very different risks
3. Oxidised LDL: it is oxidised LDL (through oxidative stress or smoking) that infiltrates the arteries, not “healthy” LDL

The causes (not just diet):

• Genetics: familial hypercholesterolaemia (a mutation) causes very high levels regardless of lifestyle and needs specific medical follow-up
• Diet: less the dietary cholesterol itself (eggs have been rehabilitated) than refined sugars, trans fats and excess calories, which promote small LDL particles
• Lifestyle: sedentary habits, smoking, excess weight, stress

The documented nutritional levers:

1. Soluble fibre (oats, pulses, apples/pectin): traps cholesterol
2. Omega-3: lowers triglycerides
3. Phytosterols (plant-derived): reduce cholesterol absorption
4. Cut back on sugars and trans fats (more effective than cutting dietary cholesterol)
5. Physical activity: raises HDL
6. The Mediterranean diet: the most studied and the most effective overall

Medical nuance: hypercholesterolaemia is not managed with diet alone. Depending on overall cardiovascular risk (age, blood pressure, smoking, history), medical treatment (statins) may be necessary, a decision for your doctor.