Brain Health: What Does the Evidence Actually Show?

When people start worrying about their memory, it is tempting to look for one thing to fix it. A supplement. A “brain food”. A test. A strict diet.

But that is not really what the evidence shows.

The strongest research points in a different direction: brain health appears to be influenced by many interconnected systems, including cardiovascular health, blood sugar regulation, movement, sleep, hearing & sight, social connection, and the overall quality of the diet.

That is actually encouraging. It means we are not relying on one magic ingredient.

And one of the most exciting findings comes from the 2024 Lancet Commission on dementia. Its authors estimated that around 45% of dementia cases could potentially be delayed or prevented by addressing 14 modifiable risk factors across the life course. These include diabetes, high blood pressure, high LDL cholesterol, smoking, physical inactivity, obesity, depression, hearing loss, untreated vision loss, and social isolation.

Please don’t take that as dementia is always preventable, or that somebody who develops it has done something wrong. Genetics, ageing and factors, which are completely outside our control, remain very important. But it does tell us that the environment in which the brain ages matters.

The Brain Does Not Live in Isolation

This is where a Functional Medicine way of thinking can be useful. Rather than treating the brain as a separate organ, we can look at the systems that support it.

The brain needs an enormous amount of energy and a continuous blood supply. It relies on healthy blood vessels to deliver oxygen and nutrients. It needs insulin signalling to work effectively. It needs sufficient vitamins, minerals, fats and protein. It is influenced by inflammation, sleep, hormones, movement, and messages coming from the gut.

Therefore, which kind of internal environment helps the brain function well for as long as possible?

What Should We Actually Eat?
Let’s start with food. There is currently no single scientifically proven “dementia prevention diet”. But, dietary patterns associated with better cognitive and cardiovascular outcomes have a remarkable amount in common.

Mediterranean-style diets emphasise veggies, fruit, beans and lentils, wholegrains, nuts, seeds, olive oil and fish, with relatively little ultra-processed food. The DASH diet has similar foundations. The MIND diet combines elements of both and places extra emphasis on green leafy vegetables and berries.

A 2024 meta-analysis found that greater adherence to a Mediterranean dietary pattern was associated with a lower risk of dementia and Alzheimer’s disease. Observational studies of the MIND diet have also been encouraging.

But here is an important reality check. In a three-year randomised controlled trial involving 604 older adults at increased risk, the MIND diet did not produce significantly greater cognitive improvement than the comparison diet. Interestingly, both groups improved their diets and lost around 5kg.

For me, that is not evidence that healthy eating “doesn’t work”. It is a reminder that we should focus on the common characteristics of healthy dietary patterns rather than becoming obsessed with one named diet.

Think plants, fibre, healthy fats, adequate protein and minimally processed food.

Feed Your Blood Vessels and You Feed Your Brain
One of the clearest themes in dementia research is cardiovascular health.

High blood pressure, diabetes and high LDL cholesterol are all included among the Lancet Commission’s modifiable dementia risk factors. In fact, the Commission estimated that high LDL cholesterol in midlife could account for around 7% of dementia cases worldwide, which is a striking statistic.

The same habits that support good cardiovascular health help support the environment in which the brain operates: plenty of plants and fibre, replacing excess saturated fat with unsaturated fats such as olive oil, nuts and seeds, regular fish, movement, not smoking, and appropriate management of blood pressure, cholesterol and glucose.

This also links back to blood sugar. Insulin resistance and type 2 diabetes can affect the small blood vessels supplying the brain and are associated with higher rates of cognitive decline. I explored this in more detail in my previous article on blood sugar, inflammation and brain health.

Do Omega-3 Fats Deserve Their Reputation?
The Omega 3 fat DHA is an important structural component of brain-cell membranes, while EPA and DHA can influence inflammatory signalling.

Eating oily fish – which is a good source of Omega 3 fats - is consistently associated with healthier cardiovascular outcomes, and many brain-healthy dietary patterns include fish regularly. Supplement research, however, is less straightforward.

A 2025 meta-analysis of 58 randomised trials suggested that omega-3 supplementation may produce modest improvements in some aspects of cognition, but the certainty of evidence varied and researchers concluded that longer, better-designed trials are still needed.

So rather than assuming that everybody needs a high-dose fish-oil supplement, a sensible food-first approach is to include oily fish regularly, such as salmon, sardines, mackerel, trout or herring. Supplements may be appropriate in some circumstances, but they should be personalised.

The Homocysteine Story Is Fascinating
Homocysteine is an amino acid produced during normal metabolism. Vitamins B12, B6 and folate help the body process it.

Higher homocysteine concentrations have been associated with cardiovascular disease, brain atrophy and cognitive decline, which has led researchers to investigate whether lowering homocysteine could help.

The VITACOG trial produced one of the more intriguing findings in nutritional neuroscience. In older people with mild cognitive impairment, high-dose B vitamins seemed to reduce homocysteine and slowed brain atrophy. A subsequent analysis found that the greatest effect was seen in participants who also had higher omega-3 status.

Again, this does not mean everyone should take high-dose B vitamins, however. Across trials, findings are mixed, particularly in cognitively healthy people. B12 and folate deficiencies should be identified and corrected appropriately, while homocysteine testing may be useful in selected clinical circumstances.

Your Muscles Are Part of Your Brain-Health Strategy
We often talk about exercise as though it is separate from nutrition, but metabolically they are deeply connected.

Muscle is one of our largest sites of glucose disposal. Maintaining muscle can therefore support insulin sensitivity as we age. Exercise also affects blood flow, cardiovascular fitness, inflammation and signalling molecules involved in brain plasticity. A 2024 systematic review of long-term exercise found benefits for cognitive outcomes in older adults.

But perhaps the most compelling evidence comes from studies where researchers changed several things at once.

The landmark Finnish FINGER trial combined dietary guidance, exercise, cognitive training and vascular risk monitoring. After two years, overall cognitive improvement was around 25% greater in the intervention group than in the control group.

Then, in 2025, came the U.S. POINTER trial. More than 2,100 older adults at increased risk of cognitive decline followed one of two programmes involving nutrition, physical activity, cognitive and social activity and health monitoring. Cognition improved in both groups, with greater improvement in the more structured programme.

That may be the biggest message of all: the evidence increasingly supports doing several sensible things together.

What About the Gut-Brain Axis?
The gut microbiome produces metabolites, including short-chain fatty acids, that can interact with immune, metabolic and nervous-system pathways. This makes the gut-brain axis biologically plausible and extremely interesting. Diets rich in diverse plant foods, fibre and polyphenols can support microbial diversity and the production of beneficial metabolites.

However, human evidence showing that manipulating the microbiome prevents dementia is not yet strong enough for such claims. So, I would recommend focussing on supporting the microbiome for overall health rather than buying expensive “brain probiotics”.

Seven Things You Can Do for Your Brain
Start with the basics rather than a supplement cupboard.

1. Build balanced meals. Include vegetables, protein, fibre-rich carbohydrates and healthy fats.
2. Eat oily fish regularly, if you enjoy it and it is appropriate for you.
3. Move every day and maintain muscle. Include resistance exercise as well as aerobic movement.
4. Know your numbers. Keep an eye on blood pressure, cholesterol and blood glucose, particularly from midlife onwards.
5. Protect your sleep. Persistent snoring, extreme daytime sleepiness or suspected sleep apnoea deserves investigation.
6. Take hearing and eyesight seriously. Treating sensory loss is part of looking after brain health.
7. Stay socially and mentally engaged. Learn, talk, read, play, volunteer, create and spend time with other people.

Perhaps the most reassuring message is that brain health is not about perfection.

The 2024 Lancet Commission describes dementia risk across an entire lifetime. FINGER and U.S. POINTER suggest that even later in life, changing several factors together can make a measurable difference to cognition. We cannot control every risk factor, and no lifestyle programme can guarantee that dementia will not occur.

But we can give the brain a healthier environment in which to age. And that means looking beyond the latest “brain food” and supporting the whole person instead. If you’re interested in knowing more, why not get in touch?

What’s Causing My Brain Fog?

Have you ever walked into a room and forgotten why you went there? Struggled to find a familiar word? Or reached the middle of the afternoon and felt as though somebody had quietly switched off your brain?  Occasional lapses happen to everyone, particularly during periods of stress, poor sleep, or illness. However, ongoing brain fog, poor concentration and memory difficulties can understandably feel worrying, particularly if you have had relatives with dementia or Alzheimer’s disease.

But brain fog and cognitive decline are not the same thing. Brain fog is really just when we get a bit of forgetfulness, thinking more slowly than usual, or having difficulty concentrating. Whereas cognitive impairment involves actual measurable changes in abilities such as memory, language, reasoning, or planning.

Brain fog can still be debilitating though. And there are many reasons for feeling mentally less sharp. Lack of sleep, menopause or hormone imbalance, stress, sluggish thyroid, or deficiencies of iron, vitamin B12 or folate can all contribute. But what is particularly interesting is that research is increasingly suggesting that metabolic health also matters to the brain. The way the body manages glucose and responds to insulin may influence how alert we feel today, as well as some of the biological processes involved in cognitive ageing. 

Don’t worry – this doesn’t mean that eating sugar causes dementia or that balancing blood sugar can guarantee protection from it! The relationship is far more complex. But getting our blood sugar under control can have a positive effect on the way we think.

Why Blood Sugar Matters for the Brain

The brain is an exceptionally energy-demanding organ. Even though it is only around 2% of our total body weight, it uses approximately 20% of our body’s energy at rest. That is significant.

Much of this energy is supplied by glucose circulating in the bloodstream. Brain cells need a continuous supply of energy to communicate, maintain their structure and support attention, learning and memory. However, before you start reaching for the biscuits, this doesn’t mean that more glucose is always better. The brain depends on the body keeping blood glucose within a carefully regulated range.

After eating carbohydrate-containing foods, glucose enters the bloodstream and the pancreas releases insulin. Insulin helps glucose move into muscle and other tissues, where it can be used or stored. Insulin also acts within the brain, where it is involved in communication between nerve cells, strengthening and forming connections, appetite regulation, and processes associated with learning and memory.

Problems may arise if cells become less responsive to insulin - known as insulin resistance. The pancreas initially compensates by producing more insulin, so glucose results can remain apparently normal for some time. This compensatory rise in insulin is called hyperinsulinaemia, and it means that the body is having to work harder to maintain glucose control, even though fasting glucose or HbA1c may still be withing range on a blood test.

Researchers have identified that disrupted insulin signalling within the brain may affect how nerve cells produce energy and communicate with one another. The hippocampus, a region involved in learning and memory, appears particularly sensitive to metabolic and vascular changes.

Inflammation, Insulin Resistance and Cognitive Function

Insulin resistance and inflammation can reinforce one another.

When cells respond less effectively to insulin, glucose and insulin may remain elevated for a longer time after eating. And over time, this may contribute to oxidative stress, altered fat metabolism, and the production of inflammatory signalling molecules.

Inflammation itself is not always harmful. It is an essential part of the immune response and helps us respond to infection and injury. The concern is more the persistent, low-grade inflammation that continues quietly over months or years. Visceral fat (or fat stored round the belly) may be one source of this inflammation. It can release inflammatory signalling molecules and is closely associated with insulin resistance. And it’s important to remember that people can develop metabolic dysfunction at many different body weights. 

Inflammatory signals produced elsewhere in the body can communicate with the brain. They may affect the blood-brain barrier, the carefully regulated boundary controlling what passes from the circulation into brain tissue. They may also influence microglia, the brain’s resident immune cells. Microglia normally help defend the brain, clear damaged material and support tissue maintenance. However, prolonged activation may contribute to an inflammatory environment that disrupts communication between nerve cells.

Chronic neuroinflammation may also affect mitochondrial function. Mitochondria are the energy powerhouses inside cells. Brain cells have particularly high energy requirements, so impaired mitochondrial function may influence their ability to communicate, repair and remain resilient.

As we can see, inflammation affects many different brain processes. It may influence energy production, the strength of connections between nerve cells, the integrity of the blood-brain barrier and the clearance of cellular waste. 

Blood vessel health provides another important link. High glucose, insulin resistance, elevated blood pressure and abnormal blood lipids can all affect the lining of the blood vessels. The brain requires a continuous supply of oxygen and nutrients. Damage to its larger or smaller blood vessels can reduce this supply and may contribute to strokes, small areas of tissue injury and vascular cognitive impairment.

Brain Fog and Energy Crashes
Blood glucose fluctuations can contribute to brain fog in some people. A meal or snack dominated by simple carbs can cause glucose to enter the bloodstream quickly. The body responds by releasing insulin. Glucose may then fall relatively rapidly, which can coincide with tiredness, hunger, irritability or difficulty concentrating. This is the familiar afternoon “crash” which can reflect what’s going on for you in your life - a combination of blood sugar imbalance, lack of protein, low hydration, too much caffeine and stress, or too little sleep. No wonder our brains don’t feel at their best! 

Average glucose is only part of the picture. HbA1c (which is often on GP blood tests) estimates average glucose exposure over the preceding two to three months, but it does not show every post-meal rise or fall. Researchers are increasingly interested in glucose variability, meaning the size and frequency of fluctuations throughout the day. Repeated large changes may contribute to oxidative stress and blood-vessel dysfunction, although the long-term significance of glucose variability in people without diabetes is not yet fully understood.

Responses to the same food can also vary. Meal composition, sleep, stress, activity, muscle mass, hormones and the order in which foods are eaten can all influence the glucose response. This is one reason why a single food should not automatically be labelled either good or bad for the brain.

Hormones, Stress and Sleep
Many women first become concerned about memory and concentration during perimenopause. Word-finding difficulties, forgetfulness and feeling mentally slower are commonly reported during this stage.

Changing oestrogen levels may affect brain signalling, temperature regulation, mood and sleep. At the same time, the menopause transition can be accompanied by changes in body composition and insulin sensitivity. These factors may overlap, making it difficult to attribute brain fog to one single cause.

Experiencing brain fog during perimenopause does not mean that somebody is developing dementia. However, symptoms that are new, persistent, worsening or interfering with daily activities should be discussed with a GP.

Sleep and stress can also influence both cognition and metabolic health. Even a single poor night’s sleep can affect attention and memory the following day. Repeated sleep disruption may reduce insulin sensitivity and increase inflammatory signalling.

Chronic stress can affect concentration directly, while stress hormones may alter glucose regulation and sleep quality. Blood sugar therefore cannot be considered in isolation from the wider circumstances in which symptoms occur.

If you’d like to find out more, why not book in a call?

The Food Mood Connection

How Nutrition Shapes Mental Wellbeing

Key Takeaways

• Nutrition plays a fundamental role in brain function, influencing mood, energy, and cognitive clarity
• Neurotransmitters such as serotonin and dopamine rely on nutrients from food, particularly protein, vitamins, and minerals
• Blood sugar balance is essential for stable mood and focus, with fluctuations contributing to irritability, anxiety, and fatigue
• Dietary patterns rich in whole foods, healthy fats, and fibre are associated with better mental wellbeing
• Small, consistent changes, such as eating regular, balanced meals, can support emotional resilience over time

If you have ever noticed feeling irritable when you skip meals, or more focused after eating well, you’ve already experienced the food–mood connection in action.

Mental wellbeing is truly complex and influenced by a lot of different factors, including sleep, stress, movement, and just what’s going on in life. However, nutrition is one area that we often overlook, despite its playing a fundamental role in how our brains function.

For many people I work with, symptoms such as anxiety, low mood, brain fog, and feeling overwhelmed by food choices are common. The good news is that small, consistent changes to how you eat can support your mental wellbeing in a realistic and sustainable way.

How Food Influences Brain Chemistry

The brain is an energy-demanding organ, using around 20 percent of the body’s total energy intake. It relies on a steady supply of nutrients to produce neurotransmitters (brain signalling chemicals), regulate inflammation, and maintain healthy nerve signalling.

Neurotransmitters such as serotonin, dopamine, and GABA play key roles in mood, motivation, and stress response. These are made from nutrients found in food, particularly amino acids, vitamins, and minerals.

For example:

• Serotonin is derived from tryptophan, an amino acid found in protein-rich foods
• Dopamine is produced from tyrosine, also found in dietary protein
• B vitamins, iron, zinc, and magnesium act as essential cofactors in these pathways

Research continues to highlight the relationship between dietary patterns and mental health outcomes. Diets rich in whole foods such as vegetables, fruits, whole grains, healthy fats, and quality protein sources are associated with a lower risk of depression and improved psychological wellbeing.

Nutrients Linked to Mood and Resilience

Rather than focusing on single “superfoods,” it is much more helpful to consider overall dietary patterns and checking we’re getting sufficient nutrients overall.

A number of nutrients have been consistently linked to mental wellbeing:

• Omega-3 fatty acids support brain structure and may play a role in reducing inflammation associated with depression
• B vitamins are essential for energy production and neurotransmitter synthesis
• Magnesium supports the nervous system and may help regulate the stress response
• Iron and zinc are involved in cognitive function and mood regulation
• Protein provides the building blocks for neurotransmitters

Blood Sugar, Fats and Micronutrients

Blood sugar balance is one of the most important, yet often overlooked, factors in mental wellbeing.

Frequent spikes and crashes in blood glucose can contribute to:

• Anxiety and irritability
• Low energy and fatigue
• Difficulty concentrating

This is something I explore further in my November blog on steady energy.

Including a balance of protein, healthy fats, and fibre at meals can help stabilise blood sugar levels, supporting more consistent energy and mood throughout the day.

Healthy fats, particularly from sources such as olive oil, nuts, seeds, and oily fish, also play a structural role in brain health. Meanwhile, micronutrients from a wide variety of plant foods support resilience to stress and cognitive function.

Gentle Nutrition Strategies for Mental Wellbeing

When you are already feeling overwhelmed, complicated dietary rules can often make things worse. A gentle, supportive approach can be far more effective.

Here are some realistic starting points:

1. Prioritise regular meals
Aim to eat 3 good meals a day in a 12-hour window to support stable blood sugar and energy levels.

2. Build balanced plates
Include a source of protein, healthy fats, and fibre-rich carbohydrates at every single meal – not just dinner.

3. Add, rather than restrict
Focus on including more nutrient-dense foods, rather than removing foods entirely.

4. Support gut health
There is a strong connection between the gut and brain, often referred to as the gut–brain axis. You can read more in my March blog on gut health. Including fibre-rich foods and fermented foods may support this relationship.

5. Keep it simple
Consistency matters more than perfection. Simple meals that you can repeat are often the most supportive.

Improving your nutrition will not replace professional mental health support where needed, but it can be a valuable part of a wider approach to wellbeing.

As a BANT-registered Nutritional Therapist, I do not diagnose or treat medical conditions, and I always recommend speaking with your GP if you are experiencing ongoing mental health symptoms.

If you would like personalised support, I offer one-to-one sessions tailored to your needs.

Confused by Cholesterol? Here’s What Really Matters

If you’ve ever been told your cholesterol is “a bit high”, you are not alone. Many of my clients leave the GP surgery with a print-out of numbers and very little explanation of what they actually mean, or what is worth focusing on first. This can be quite worrying, particularly if you have a family history of heart disease. 

This blog will walk you through the basics in a practical way. We will take a look at what cholesterol actually is, how to interpret the key markers on a standard lipid panel (cholesterol report), and look at why two additional tests, lipoprotein(a) (Lp(a)) and apolipoprotein B (ApoB), can add some important context. And then we’ll look beyond cholesterol, because heart health is about far more than just a single number.

Cholesterol: friend, not foe

Cholesterol is a waxy, fat-like substance that your body uses to build cell membranes, make vitamin D, and produce hormones and bile acids. It is super important for your wellbeing! Your liver makes most of the cholesterol you need, and you also get a small amount from food.

Cholesterol only becomes a problem when cholesterol-containing particles build up in artery walls over time, contributing to atherosclerosis (narrowing and hardening of the arteries). This process is influenced by many things - including blood pressure, blood sugar balance, inflammation, smoking, genetics, menopause, stress, sleep and how much exercise you do.

What is a lipid profile actually measuring?

A standard lipid profile usually includes:

Total cholesterol

This is the overall amount of cholesterol in your blood. It is a broad measure and does not tell you how cholesterol is being carried.

LDL cholesterol (often called “bad cholesterol”)

LDL stands for low-density lipoprotein. LDL particles carry cholesterol from the liver out to tissues. When LDL particles are present in higher numbers, or are circulating for longer, the risk of cholesterol being deposited in artery walls may be increased.

HDL cholesterol (often called “good cholesterol”)

HDL stands for high-density lipoprotein. HDL particles are involved in reverse cholesterol transport, moving cholesterol away from tissues back towards the liver – they are like the rubbish truck coming and taking away the waste. HDL is not a simple “the higher the better” marker, but in general, low HDL can be a sign of metabolic risk.

Triglycerides

Triglycerides are a type of fat used for energy storage. They often rise with insulin resistance (when blood sugar isn’t under control), excess alcohol intake, high intakes of ultra-processed foods, and low activity levels. They can also rise if the blood test is taken soon after eating, which is why your GP may request a fasting test.

Non-HDL cholesterol

This is not always reported, but it is easy to calculate: total cholesterol minus HDL cholesterol. It represents the cholesterol carried by all potentially atherogenic particles (not just LDL), ie the particles that are linked to potential heart disease. In UK practice, non-HDL cholesterol is often used in risk assessment and monitoring. 

Why “LDL cholesterol” is not the whole story

LDL cholesterol tells you how much cholesterol is being carried inside LDL particles. But it does not tell you how many particles are carrying it.

This matters because atherosclerosis is driven by the number of atherogenic particles entering the artery wall. Two people can have the same LDL cholesterol but a very different number of LDL particles. This is one reason why measuring something called ApoB can actually be more helpful in ascertaining your risk of heart disease.

ApoB: the marker many people have never heard of

Apolipoprotein B (ApoB) is a protein found on the surface of atherogenic lipoproteins (including LDL, VLDL and remnants), ie the cholesterol carriers that may lead to heart disease. Each particle carries one ApoB, so ApoB is effectively a count of the number of “risk-carrying” particles.

Recent expert discussions and guideline conversations increasingly highlight ApoB as a strong predictor of cardiovascular risk, particularly when LDL cholesterol alone may underestimate risk (for example, in insulin resistance or higher triglycerides). 

When might ApoB testing be useful?

ApoB is not essential for everyone, but it is worth discussing with your GP (or clinician) if any of these apply:

• A family history of early heart disease
• Type 2 diabetes, prediabetes, PCOS, fatty liver, or metabolic syndrome
• Higher triglycerides
• “Normal” LDL cholesterol but ongoing concern about risk, especially if other markers or symptoms suggest metabolic strain

This is something you can request from your GP, or there are many private labs that offer this measurement. If this is something that you’d like to look at, please do get in touch as this is something that I can potentially help with.

Lp(a): a genetic risk factor worth knowing about

Lipoprotein(a), written as Lp(a), is an LDL-like particle with an additional protein attached (apolipoprotein(a)). Lp(a) is largely genetic and remains fairly stable across your lifetime.

However, elevated Lp(a) is now recognised as an independent risk factor for cardiovascular disease. It can contribute to risk even when other cholesterol markers look “fine”. European guidance and consensus documents support measuring Lp(a), often at least once in adulthood, to identify inherited elevation and refine risk assessment. 

Research shows that high Lp(a) increases heart disease risk by acting like "sticky" LDL cholesterol, promoting plaque buildup (atherosclerosis) and blood clots in arteries, potentially leading to heart attacks and strokes, even with normal cholesterol. This is because its unique protein (Apo(a)) hinders plaque breakdown and encourages clot formation. This genetic factor causes more aggressive plaque, calcification, and inflammation, independently raising cardiovascular danger, especially with other risk factors present. 

Levels are largely determined by genetics (inherited from your parents), explaining why some people develop severe heart disease early without typical risk factors. It's often overlooked in routine checks but is a major contributor to premature cardiovascular disease, according to UK experts like the British Cardiovascular Society. Your level of Lp(a) is believed to be the same from the age of 5 onwards and can’t be massively changed by diet and lifestyle. That’s why it’s worth getting it checked at least once in your lifetime to help determine your risk. 

A note on numbers and units

Lp(a) can be reported in mg/dL or nmol/L. You cannot reliably convert between the two because the particles vary in size between individuals.

A commonly used threshold for increased risk is around 50 mg/dL or 125 nmol/L, but your full clinical picture matters too. 

Can you lower Lp(a) with diet?

Because Lp(a) is genetic, lifestyle changes tend not to shift the number very much. The focus is usually on lowering overall risk by improving other modifiable factors (LDL cholesterol, blood pressure, blood sugar, inflammation, smoking status, fitness, sleep). 

Specialist medications specifically targeting Lp(a) are under investigation, but lifestyle still matters because it reduces the total risk burden. 

How can you test ApoB and Lp(a) in the UK?

Both tests are simple blood tests. They are not always included in routine NHS lipid panels, so you may need to request them.

A practical approach is:

1. Ask your GP whether ApoB and/or Lp(a) are appropriate for you, based on your family history and overall risk.
2. If they are not available locally, a private blood test may be an option, and this is something I can organise for you if you are interested.

If you have a known high Lp(a), it is also worth telling close relatives, as this can run strongly in families and testing can be helpful for them too. 

Cholesterol is one piece of heart health. Blood pressure is another

High blood pressure increases strain on artery walls and is a major driver of cardiovascular risk. Nutrition and lifestyle changes can make a meaningful difference.  A large meta-analysis of randomised trials found the DASH dietary pattern reduces blood pressure in adults with and without hypertension. 

Separately, a dose response meta-analysis of clinical trials shows that reducing sodium intake lowers blood pressure, with stronger effects in those with higher starting blood pressure. 

As we age, keeping an eye on your blood pressure can be very useful. Blood pressure increases with age largely because arteries naturally become stiffer, thicker, and less flexible due to biological aging and wear-and-tear, forcing the heart to work harder to pump blood through them. This stiffening, known as arteriosclerosis, means blood vessels can't expand as well as they once did, leading to higher pressure against artery walls, even with healthy habits. Other contributing factors include lifestyle changes, genetics, and other medical conditions, but the vascular stiffening is the main physiological driver.  Using a home blood pressure kit can be helpful but make sure to test your blood pressure three times in a row – taking an average of the three – and try to take it at the same time of day each time. Take these results to your GP to discuss.

What actually helps in real life? Evidence-based priorities

Cardiovascular disease affects more than 7 million people in the UK alone, causing about a quarter of all deaths and 1 in 4 premature deaths. So, it’s super important to keep an eye on our heart health! There are number of changes that we can make to our diet and lifestyle to help improve our odds. If you are trying to support cholesterol, blood pressure and overall cardiovascular risk, these are the foundations I prioritise with my clients.

• Build meals around a heart-supportive pattern

A Mediterranean-style dietary pattern has consistently been associated with improved cardiovascular outcomes across multiple high-quality reviews. 

In practice, this looks like:
Plenty of vegetables, beans and lentils, fruit, extra virgin olive oil, nuts and seeds, wholegrains where tolerated, and regular fish, alongside much less ultra-processed food.

• Focus on the fats that genuinely move the needle

The strongest nutrition evidence is not about “low fat” diets. It is about the type of fat.

When we talk about fats and heart health, the conversation often becomes overly simplistic. Saturated fat is frequently grouped together as something to avoid, but the evidence does not support treating all saturated fats as equal.

Whole-food fats such as butter, ghee and coconut oil have been part of traditional diets for generations and are chemically stable, particularly at higher cooking temperatures. In contrast, the strongest evidence of harm relates to industrial trans fats and highly processed sources of saturated fat, such as those found in commercially baked goods, pastries, deep-fried foods and processed meats.