ASK THE DOCTOR: My husband scoffs fat but has low cholesterol 

By Martin Scurr for the Daily Mail

Published: 18:53 EST, 10 August 2015 | Updated: 23:55 EST, 10 August 2015

My husband and I recently had tests for our cholesterol levels. Despite his fat-laden diet, my husband's was fine - yet while I have a balanced diet and exercise regularly, mine wasn't. Can you explain this?

Mrs D. Owen, Liverpool.

The simple answer to your question is that everyone's body chemistry is different. The fact is that the cholesterol in your blood is not just related to what you eat, but is manufactured in your liver.

So someone could live on a strictly vegan diet (i.e. with no dairy or animal fat), yet still have a high cholesterol level if their in-house production of cholesterol was excessive.

'Despite his fat-laden diet, my husband's was fine - yet while I have a balanced diet and exercise regularly, mine wasn't. Can you explain this?'

This has been put down to our different genetic make-up, but it might not be as clear-cut as this.

It's recently emerged, for example, that microbiome, the bacteria in our intestine, also have a profound effect on our physiology, though there's more to learn on that one.

What we do know is that most (around 80 per cent) of the cholesterol in our blood is made by the body - just 20 per cent comes from food. We do need cholesterol. It is the raw material from which we make many hormones, such as oestrogen, as well as a key component in the construction of cell walls.

However, cholesterol is a type of fat. As such, it is insoluble in water. In order for it to be transported around the body in the blood, it must bind to proteins. These fat/protein balls are known as lipoproteins, and there are two types.

Around 60 to 70 per cent of cholesterol is transported around the body via low-density lipoproteins (LDL). Over-production of these is linked to clogged up arteries, as the LDL lodges in the blood vessel walls.

The other type, high-density lipoproteins (HDL), carries 20 to 30 per cent of the cholesterol.

HDL is the so-called 'good' cholesterol, as it helps remove damaging LDL cholesterol.

What's the best way to cut your cholesterol? Most importantly, cut your saturated fat intake [file photo]

The worry about cholesterol is that high levels of LDL are strongly linked to the build-up of plaque in vital arteries, restricting the supply of oxygen and nutrients to the heart - the classic picture of coronary heart disease.

The risk of this is twice as great in people with a total cholesterol reading of 6.5 as in those whose level is 5.2 (the official advice is that levels should be 5 or lower).

So what's the best way to cut your cholesterol? If you're obese, losing weight will partly reduce your levels.

But the most important thing is to cut your saturated fat intake. Research shows that a patient who swaps from a typical UK-type diet - which universally contains too much saturated fat - to a healthy, Mediterranean diet will experience a 20 per cent drop in cholesterol.

(There has been much talk recently of sugar, the inflammation it may cause and its potential role in heart disease - but, for me, the evidence is that it is still saturated fat that is the issue.)

It does take six to 12 months to achieve the maximum reduction in cholesterol you can by changing your diet - and this must be a lifetime change.

Changing behaviours of our patients is one of the greatest problems that doctors face and, all too easily, our knee-jerk reaction is to prescribe a statin.

For those with a history of a coronary or a stroke, there is no debate: statins are life-saving.

But for the otherwise healthy person, statins are the subject of much debate: to save two people, 100 need to be treated, long term.

And is it sensible, given the costs, small incidence of side-effects and the fact that taking a drug seems to license people not to take all the other important steps to avoid a heart attack, such as stopping smoking, taking daily exercise, paying attention to blood pressure and, most importantly, making dietary changes? My advice to you is to stick to these tried and tested principles.

We just have to accept that your husband seems to be one of the lucky ones when it comes to cholesterol - but for all sorts of other reasons, he, too, should try to stick to a healthy lifestyle.

Dr. Jonathan Morrell on the dangers of high cholesterol (related)

A year ago, I was diagnosed with colon cancer. It was at an early stage and, after surgery, I didn't need further treatment. I am 67, exercise every day, do not drink or smoke and I am not overweight. I've read about taking aspirin daily to help prevent colon and other cancers. But when I asked my surgeon about this, he said not to bother because this had not been proved.

Mrs Barbara Coleman, Norwich.

I AM sorry to hear you had the shock of this diagnosis and needed major surgery, but I am glad that, thanks to your early diagnosis, the cancer had not spread.

As you know, colorectal is one of the most common types of cancer, affecting more than 5 per cent of us. But should you take aspirin as a preventative? Your surgeon says the use of aspirin to prevent cancer is 'not proved', however I am not convinced he is correct.

The idea of using the drug in this way emerged in 1988, when a large study that looked at a number of medicines and their links to cancer and other diseases found that those on long-term aspirin treatment had a lower incidence of colorectal cancer specifically.

This triggered further research, and there's now a large body of evidence showing that aspirin (and other non-steroid anti-inflammatory drugs, such as sulindac and celecoxib) inhibit cancer formation, with a 20 to 40 per cent reduction in the risk of colonic adenomas (polyps that can turn into cancer) and colonic cancer itself.

So the case for colon cancer is proven, and I beg to differ with your surgeon! Indeed, there is now growing evidence for using aspirin for cancer prevention - not just for colon cancer.

In an analysis in The Lancet in 2011, which involved data from 12,000 patients, those who took daily aspirin for more than five years had a significantly lower death rate - i.e. dying over the next 20 years - from all solid cancers (as distinct from blood cancers), not just gastrointestinal cancer.

The longer the aspirin treatment continued, the greater the reduction in premature death.

And this was independent of the dose given, whether it was just 75mg a day or more.

There is also evidence that aspirin might inhibit metastasis, where cancer cells spread elsewhere in the body.

This all sounds like a no-brainer, but the potential benefits of long-term aspirin must be weighed against the potential side-effects, the main one being bleeding from the stomach and upper part of the small intestine, which can be fatal.

Aspirin has an undoubted place in cancer prevention, and we have more yet to learn.

There are other questions to address, such as the role of aspirin in cancer treatment. I would talk again with your specialist.

Colon cancer symptoms and information

By the way... No wonder it's so hard to recruit nurses

There is now such a shortage of nurses in London that hospital wards and operating theatres are unable to function.

There are thousands of vacancies for nurses and, in some ways, this parallels the shortage of GPs. In both cases, there used to be multiple applications for every post, with the lure of a highly valued job for life and no prospect of unemployment.

What can be the factors underlying the shortage of recruits to the nursing profession? And, as with doctors, is it right that we are now forced to burgle trained professionals from Third World countries? Are these personnel, trained overseas, what we want?

To the second question first. Nursing needs a level of cultural understanding, not to mention a comprehension of mental health issues, learning disability, urgent and emergency care, maternity care and primary and community services as provided here in the UK - and it's not clear to me that staff trained overseas have this.

But even given those strictures, I don't think it's ethical to take skilled professionals away from Third World countries.

As to why nurses are in such short supply here, there are a number of factors. But a key one is respect.

When I was a junior hospital doctor, both the doctors and the nurses were considered an elite: we were treated with respect - and we were treated well. Each hospital had nurses' homes, substantial buildings close to the hospital in which they worked.

This meant that, even though their pay wasn't handsome, there were compensations such as a place to live and no pressure to commute long distances - an important factor, given the antisocial hours nursing staff often have to work.

These precious assets were sold off long ago to try to fill endless spending cutbacks.

Meanwhile, the nursing profession has been devalued by scandals such as Mid Staffs and the Liverpool Care Pathway.

The cost of this is now counted in poor recruitment. 

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