High cholesterol needn't be alarming. But when does it get dangerous? And what can you do for better blood values yourself? The most important questions and answers on a much discussed topic.
Angela Stoll
My cholesterol levels are high. When does it get dangerous?
That depends on how healthy you are in general. First of all: Cholesterol is actually not a dangerous substance, but an essential blood fat. The body can produce it itself, but it can also take it in through food. In the bloodstream, cholesterol is bound to proteins (lipoproteins), of which there are different types. If too many of these fat-protein compounds circulate in the blood, this can lead to calcification in the long term.
But not all lipoproteins increase the risk: the "bad" LDL (low density lipoprotein) is primarily responsible. The HDL (high density lipoprotein) can probably even protect against deposits. Therefore, the total cholesterol and the LDL cholesterol value is less of a decisive factor.
If you don't have any risk factors such as high blood pressure, an LDL value of up to 130 milligrams per deciliter of blood (mg / dl) is okay. "If someone is completely healthy, you can accept a value of up to 190 milligrams per deciliter," says metabolism expert Prof. Klaus G. Parhofer from the Großhadern Clinic at the University of Munich. "With everything that is above it, you need very good arguments in order to forego medication." If someone has severe high blood pressure, has diabetes, or has had frequent family heart attacks, LDL cholesterol should at least drop below 70 milligrams per deciliter. If the risk is particularly high – for example after a heart attack – even stricter requirements apply: A value below 55 milligrams per deciliter would then be ideal.
What else can happen?
If the level of LDL cholesterol in the blood is too high for a long time, deposits can form in the arteries. The vessel walls thicken and harden as a result, making it harder for blood to flow through. This increases the risk of cardiovascular diseases, especially the dreaded heart attacks and strokes. You can't feel it. And how great the risk really is is difficult to predict. "A high LDL level is a risk factor," says Parhofer. “But just one of several.” Blood pressure and blood sugar levels also play a major role when it comes to vascular health and the risk of heart attack that arises from it. And the fact whether someone smokes and is overweight or does a lot of exercise and eats well.
I actually live healthy. Why are my values still bad?
As a rule, cholesterol levels rise with age. This is especially felt by women: after the menopause, the blood fat level changes to the negative. "Because the body produces less estrogen, there is also less HDL cholesterol," explains Parhofer. At the same time, the harmful LDL value often increases.
Apart from that, many have familial predispositions: When it comes to cholesterol, genes play a major role. Therefore, when it comes to blood lipids, it is possible that someone can eat schnitzel with french fries with impunity, but the next person has poor values despite a balanced diet and regular exercise. With some congenital metabolic disorders it even happens that children have very high cholesterol levels and have to take medication. Apart from that, there are a number of other diseases that sometimes affect cholesterol – for example, an underactive thyroid can cause lipid levels to rise.
Is it enough to change your diet?
Sometimes it does. "It is absolutely possible to influence your cholesterol level through a conscious diet," says Dr. Christine Dawczynski, nutritionist at the University of Jena. The scientist has shown in a study how much the dangerous LDL values can drop. She worked out individual nutrition plans for 20 weeks for the 60 participants, all of whom were middle-aged and had moderately high cholesterol levels, which optimally covered their nutritional needs. Plenty of vegetables, fruit, fiber and a high proportion of unsaturated fatty acids (for example in the form of linseed oil) were planned. The results were astonishing: "On average, LDL cholesterol fell by 30 percent," reports Dawczynski. At the same time, the test subjects' blood pressure and long-term blood sugar levels improved. Some of them also decreased significantly.
"We were able to observe the lowering of the cholesterol level in those of normal weight who kept their weight above the study," says the expert. Nevertheless, there are people who cannot avoid medication. You should still pay attention to your diet. "Because they may need a lower dose if they are eating consciously at the same time," says Christine Dawczynski. Conversely, that can mean fewer side effects.
What about the breakfast egg now?
Eating eggs with bacon every day is not healthy – but that's mainly due to the fatty meat. Gone are the days when eggs were considered a cholesterol culprit. Of course, they still contain a lot of cholesterol, just like organ meats, shellfish or eel. But as we now know, the cholesterol that we ingest through food does not have a significant impact on the blood cholesterol level. Saturated fatty acids (such as those contained in sausage, for example) increase the "bad" LDL level much more. "Two eggs a week are okay," says Dawczynski. Occasionally, their diet plans include some meat, but only low-fat varieties such as game and poultry. Meat in itself does not necessarily raise cholesterol levels, but large amounts of animal fat do. Research on the Tsimane in Bolivia also suggests that it is worth removing some of the saturated fatty acids from the menu: The indigenous people, who traditionally live from hunting and horticulture, have been voted the healthiest in the world by cardiologists. They see the way of life as the reason for this: the tsimans feed mainly on plants and occasionally on low-fat meat, and they also walk long distances. Their cholesterol levels are low and there are hardly any cardiovascular diseases.
Are There Individual Foods That Lower Cholesterol?
Yes, the effect has been well documented for walnuts, for example: in a study led by Parhofer, the test subjects ate a handful of them every day. After eight weeks, bad cholesterol dropped an average of about five percent. Oat and barley flakes contain the multiple sugar beta-glucan, which has a beneficial effect on the LDL level. Dawczynski has investigated how much: "In a study we were able to show that a daily serving of oat or barley flakes lowers the cholesterol level by around five percent." In general, dietary fibers, such as those found in whole grain products, are particularly valuable: They bind bile acids, which are then increasingly excreted. This lowers the LDL cholesterol level. Nevertheless, a bowl of muesli cannot simply compensate for the king-size burger. "It always depends on the diet as a whole," emphasizes the nutritionist.
When do I have to take pills?
In general, the following rule applies: the higher the individual risk, the more likely it is that drugs will prevent heart attacks and the like. But nobody can predict it with certainty. Over the past few years there have been repeated critical voices warning against taking pills quickly. In any case, you should consider how pronounced your own need for security is: Is my fear of a possible heart attack so great that I feel better if I swallow a tablet every day? Or am I very afraid of side effects? With the most common cholesterol-lowering drugs, statins, these are often muscle complaints that resemble sore muscles. "About ten percent of all patients report about it," says expert Parhofer. In addition, headaches, digestive problems and high blood sugar levels, among other things, can very rarely occur, and allergies are also possible. In such cases the dose can be reduced or another statin can be chosen.
If necessary, alternative cholesterol-lowering drugs can be considered: ezetimibe, for example, which inhibits the absorption of cholesterol in the small intestine. For a number of years there has also been an injection for cholesterol, which can greatly lower the LDL value. These so-called PCSK9 inhibitors are usually very well tolerated even by patients who cannot tolerate statins. However, they are expensive and therefore reserved for special cases.
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