The Fibre Mistake That’s Making Your Bloating Worse
Many of my clients have been told to cut out fibre due to their IBS symptoms or have gradually whittled down their food options until there’s none left. Fibre can be worrying if you’re bloating.
Fibre is often talked about as a single nutrition target, usually measured in grams. But when it comes to gut health, it isn’t only about how much fibre you eat. It’s also about how many different fibres you include.
Your gut microbiome thrives on variety. Different bacteria prefer different fibres, and the wider the range of plant foods you eat, the more likely you are to support a diverse, resilient microbiome.
Let’s take a look at the different types of fibre, why variety matters, common myths that keep people stuck, and how to build fibre diversity gently - especially if you’re prone to IBS symptoms.
Different Types of Fibre Explained
Fibre is the part of plant foods that the body can’t fully digest. Instead, fibre becomes fuel for gut bacteria and helps support bowel regularity, blood sugar balance and digestive comfort.
But not all fibre behaves the same way.
Soluble fibre
Soluble fibre dissolves in water and forms a gel-like texture in the gut. It can help support:
Sources include oats, chia seeds, flaxseed, beans/lentils, apples, pears, carrots and sweet potato.
Insoluble fibre
Insoluble fibre adds bulk and helps move food through the digestive tract.
Sources include wholegrains, nuts and seeds, skins of fruit/veg, kale, cabbage and green beans.
Some people with IBS symptoms find large amounts of insoluble fibre harder to tolerate, especially during flare-ups. This doesn’t mean insoluble fibre is “bad”, but it does mean the type and timing matters.
Resistant starch
Resistant starch reaches the large intestine intact, where gut bacteria ferment it.
Sources include:
Prebiotic fibres
Prebiotics are specific fibres that feed certain beneficial bacteria.
Sources include onions, garlic, leeks, asparagus, chicory and some wholegrains.
If these trigger bloating, it’s often a sign that your gut needs a gentler approach, not that you need to avoid them forever.
Why Diversity Matters More Than Fibre Counts
It’s easy to think of fibre as something you either “hit” or you don’t. But fibre intake isn’t only a numbers game.
Different fibres create different effects in the gut. They support different bacterial species, and those bacteria produce compounds (such as short-chain fatty acids) that influence gut lining integrity and immune signalling.
This is why fibre diversity can be more meaningful for long-term gut health than simply increasing fibre grams quickly.
A useful goal is to aim for:
This can be done without turning food into a tracking exercise.
If you’d like to understand more about how the microbiome affects whole-body health, you may enjoy my March blog: How Your Gut Microbiome Shapes Hormones and Immunity.
Common Fibre Myths
Myth 1: “If fibre makes me bloated, fibre is the problem.”
Often it’s the speed of increase or the types of fibre being introduced. Rapid changes can increase fermentation quickly, leading to temporary bloating and wind. This is why slow, steady changes tend to work best.
Or it can be a sign that there is an imbalance on the gut microbiome that needs investigating.
Myth 2: “I need lots of raw salads for good gut health.”
Raw veg can be difficult for some people with IBS symptoms. You can support your gut just as effectively with:
In many cases, cooked veg is the most gut-friendly starting point.
Myth 3: “Fibre only matters for constipation.”
Fibre supports far more than gut transit. The microbiome is involved in inflammation regulation, immune resilience and hormone metabolism, which is why gut support can benefit the whole body.
Building Fibre Variety Gently
If you’re prone to bloating or IBS symptoms, the goal is not to overload your gut. The goal is to build tolerance and confidence.
1. Add one new fibre-rich food every few days
For example:
2. Rotate rather than restrict
Keep your staples, but rotate one or two each week:
3. Prioritise soluble fibre first
If your gut is reactive, start with gentler fibres:
4. Use small portions of common triggers
Rather than avoiding foods completely, try micro portions:
Your Gut Called… It Wants You to Stop Ignoring It
If you’ve ever been told that bloating, IBS symptoms or fatigue are “just digestion issues”, you’re not alone. Many clients come to me feeling confused and overwhelmed after receiving restrictive gut advice, unsure what they can eat without triggering symptoms.
The truth is that the gut has roles that go far beyond digestion. Your gut microbiome (the community of microbes living in your digestive tract) helps shape immune function, impacts inflammation, and plays an important role in hormone balance and metabolism.
Let’s explore how gut microbes influence hormones and immunity, and how food can support a healthier, more diverse microbiome without falling into crazy restrictive patterns.
What Is the Gut Microbiome?
Your gut microbiome refers to the trillions of microorganisms living primarily in your large intestine, including bacteria, yeasts and other microbes. Many are beneficial, some are neutral, and a smaller number can be problematic if they overgrow.
A “healthy” microbiome isn’t defined by having one perfect strain of bacteria. Instead, research suggests that microbiome diversity is one of the key features associated with resilience, better gut barrier function and healthier immune responses.
Your microbiome is also constantly changing. It can be influenced by:
So, if you’ve tried multiple gut protocols in the past and still don’t feel better, it doesn’t necessarily mean you’re failing. It may mean that your gut needs a more supportive, sustainable plan.
The Gut–Hormone and Gut–Immune Links
Many people are surprised to learn just how connected the gut is to whole-body health. Your gut microbiome doesn’t work in isolation. It communicates with both the immune system and endocrine system (hormones) via multiple pathways.
Let’s break it all down:
1. Gut microbes help regulate inflammation
A large proportion of the immune system sits around the gut. This makes sense because the gut is one of the biggest points of contact between the outside world and the inside of your body.
When the microbiome becomes less diverse (or more imbalanced), it may contribute to:
This can show up as symptoms that don’t feel gut-related at all, such as skin flare-ups, fatigue, headaches or joint discomfort.
2. The microbiome influences oestrogen balance
The gut plays a role in how oestrogen is processed and eliminated. Certain gut bacteria help break down and re-circulate oestrogen, which means the microbiome can influence overall hormone balance.
If gut transit time is slow (constipation) or the microbiome is imbalanced, this may affect the way hormones are metabolised and cleared, which can contribute to symptoms such as:
Nutrition is not a replacement for medical treatment, but it can be a powerful tool in supporting healthy elimination pathways and overall hormonal resilience.
3. Gut health may influence stress hormones
The microbiome interacts with the brain and nervous system through the gut–brain axis. Some bacteria even produce neurotransmitters and metabolites that influence mood and stress resilience.
This is one reason why people often notice their gut symptoms worsen during stressful life periods, even when their diet hasn’t changed.
Supporting the Microbiome with Food
If you’ve been told you need to cut out gluten, dairy, FODMAP foods and sugar forever to “fix your gut”, it’s understandable you might feel anxious around eating.
While short-term therapeutic approaches can sometimes be useful (and should always be personalised), long-term gut health is rarely about restriction alone.
In clinic, I often focus on rebuilding confidence with food, improving microbiome diversity gradually, and supporting digestion in a way that feels sustainable. (And gut testing can be a part of this – don’t hesitate to contact me if you’d like to know more).
Here are the key nutrition foundations that I use to support microbiome health.
1. Prioritise fibre diversity (not just fibre quantity)
Many people associate fibre with bran cereals and digestive discomfort. But the microbiome thrives on a range of fibres from different plant foods, including:
If you’re prone to bloating or IBS symptoms, this doesn’t mean fibre is “wrong” for you. It may mean you need the right type, dose, and pacing.
A useful goal for many people is aiming for 30 different plant foods per week (including herbs, spices, nuts and seeds) to encourage microbial diversity. This is often a more helpful metric than focusing only on grams.
2. Include fermented foods, if tolerated
Fermented foods can be a helpful way to introduce beneficial microbes, for example:
These foods aren’t suitable for everyone (especially if histamine intolerance is suspected), but for many people they can support microbial variety and gut function.
3. Support gut motility and bowel regularity
Constipation is very common, and it matters for hormone and immune health. Regular bowel movements help reduce the recirculation of metabolic waste, including waste hormones.
Key nutrition supports include:
4. Don’t underestimate blood sugar balance
Unstable blood sugar can contribute to inflammation, stress hormone dysregulation and cravings, which can all indirectly affect the gut.
A simple but powerful strategy is to build meals around:
5. Reduce ultra-processed foods where possible
You don’t need perfection, but research suggests that diets high in ultra-processed foods may negatively impact microbiome diversity and gut barrier function over time.
If this feels daunting, start small. One practical approach is to keep convenience, but upgrade quality, such as:
Gut health isn’t about chasing the “perfect” microbiome. It’s about creating the conditions that allow the gut ecosystem to become more resilient over time.
If you’re dealing with ongoing bloating, IBS symptoms, or you feel stuck after restrictive advice, a personalised approach can help you understand what your gut needs, without unnecessary fear around food.
Ready for personalised support?
Top Tips for Everyday Anti Inflammatory Swaps
When people hear the term “anti-inflammatory diet”, it often sounds overwhelming. Many imagine long lists of foods to avoid, complicated rules, or yet another short-lived reset that does not fit real life.
In practice, the strongest evidence does not support perfection or extreme restriction. Instead, it shows that small, consistent dietary shifts can meaningfully influence inflammatory pathways, particularly when they are sustained over time - and this is what I use in clinic every day.
This blog focuses on everyday food swaps that are realistic, flexible and evidence-based, especially for those of us looking to support heart health alongside inflammation balance.
Why small swaps matter more than perfection
Chronic inflammation develops gradually and is influenced by cumulative exposures rather than single meals. Research consistently shows that overall dietary patterns, not individual “superfoods”, are what shape long-term cardiovascular and inflammatory risk.
From a physiological perspective, small swaps work because they gently shift the balance of fats, fibre, antioxidants and micronutrients that influence immune signalling, gut health, blood sugar stability and vascular function. Over weeks and months, these changes add up.
Importantly, restrictive approaches often backfire. Highly rigid diets increase stress, reduce dietary variety and are difficult to maintain. Stress itself is inflammatory, and overly restrictive eating can paradoxically undermine the very outcomes people are trying to achieve.
The goal is not to eat perfectly, but to tilt the balance in a more anti-inflammatory direction most of the time.
Easy anti-inflammatory changes for everyday meals
Rather than thinking in terms of foods to cut out, it is more helpful to think about what you can swap in.
Swap the main cooking fat most days
One of the most evidence-supported changes is replacing saturated fats with unsaturated fats.
Regular use of inflammatory seed oils, such as vegetable oil or processed sunflower oil may contribute to increased inflammation. Replacing these with extra virgin olive oil has been shown to reduce inflammatory markers and support endothelial function.
Swap refined carbohydrates for fibre-rich options
Refined carbohydrates such as white bread, white rice and many breakfast cereals digest quickly and can contribute to blood sugar fluctuations. These fluctuations are associated with increased inflammatory signalling and higher triglyceride levels.
Swapping to wholegrains where tolerated, or adding fibre-rich foods alongside refined options, helps slow glucose absorption and supports gut-derived anti-inflammatory compounds. Even modest increases in fibre intake have been associated with lower C-reactive protein levels in large cohort studies.
This might look like adding lentils to a pasta dish, choosing nuts and seeds more often at breakfast, or including veggies at meals where they were previously absent.
Swap processed snacks for combinations that stabilise blood sugar
Ultra-processed snacks often combine refined carbohydrates, industrial fats and added sugars. These combinations are strongly associated with higher inflammatory markers and poorer cardiometabolic outcomes.
A useful rule of thumb is to build snacks, when needed, around protein, fibre and healthy fats together. This supports blood sugar stability, which in turn reduces inflammatory stress on the body.
This does not require eliminating convenience foods entirely. It is about shifting the balance so that nutrient-dense options appear more often across the week.
Swap some red and processed meat for plant and fish proteins
High intakes of processed meat are associated with increased cardiovascular risk and higher inflammation. Evidence suggests that replacing some of these foods with plant proteins or fish is associated with lower inflammatory markers and improved heart health outcomes.
Fish provides omega-3 fatty acids, which have modest anti-inflammatory effects and support vascular health. Plant proteins such as beans and lentils also contribute fibre and polyphenols that positively influence the gut–immune axis.
This does not require becoming vegetarian. Even one or two swaps per week can contribute to a lower inflammatory load.
Swap flavourings before cutting salt entirely
Salt reduction can support blood pressure, but food does not need to become bland.
Herbs, spices, garlic, onions and citrus provide flavour while also contributing antioxidant and anti-inflammatory compounds. Diets rich in polyphenols from plant foods are consistently associated with lower inflammation and reduced cardiovascular risk.
Focusing on flavour first often makes it easier to reduce reliance on heavily processed, high-sodium foods without feeling deprived.
Making swaps sustainable
The most effective swaps are the ones you can repeat without thinking too much about them.
It can help to:
If your diet already feels quite good, these swaps are not about “doing more”. They are about fine-tuning in a way that supports inflammation balance alongside heart health.
If you would like more structured support, including practical ideas and recipes, why not join my free private Facebook group: Back to Health with Sarah and Alex – you’ll find heaps of anti-inflammatory recipes you can try.
Omega-3-Rich Mackerel and Beetroot Salad
When it comes to heart health, nutrition does not need to be complicated to be effective. Simple meals built around the right balance of fats, fibre and plant compounds can support cardiovascular health while still feeling enjoyable and realistic.
This omega-3-rich mackerel and beetroot salad is a good example of how everyday ingredients can come together to support heart health and inflammation balance, without relying on ultra-processed foods or lengthy preparation.
Why omega-3 fats support heart health
Omega-3 fatty acids, particularly EPA and DHA found in oily fish, have been widely studied in relation to cardiovascular health. Evidence from recent systematic reviews and large-scale trials suggests that omega-3 intake supports heart health through several complementary mechanisms.
Omega-3 fats help regulate inflammatory signalling pathways and are involved in the production of compounds that support resolution of inflammation. They also play a role in supporting normal triglyceride levels and vascular function.
Mackerel is one of the richest and most affordable sources of omega-3 fats available in the UK. Including oily fish regularly, in line with UK dietary guidance, is consistently associated with improved cardiovascular outcomes within overall dietary patterns such as the Mediterranean diet.
Beetroot complements this by providing dietary nitrate, fibre and polyphenols. Dietary nitrates are converted in the body to nitric oxide, which supports blood vessel function and healthy blood flow. Beetroot fibre also contributes to gut health, which is increasingly recognised as part of the inflammation and heart health picture.
Together, these ingredients create a meal that supports multiple aspects of cardiovascular health in a food-first way.
Mackerel and Beetroot Salad
This recipe works well as a light lunch or as part of a larger meal.
Serves 2
Ingredients:
Method:
Simple variations
This salad is easy to adapt depending on preferences and availability.
If you prefer a warmer dish, the beetroot can be gently warmed before assembling the salad. For extra fibre and texture, you can add cooked lentils or butter beans. If smoked mackerel feels too strong, freshly grilled or poached mackerel works just as well.
For those who do not eat mackerel, sardines or trout provide a similar omega-3 profile and can be used in the same way.
Why Inflammation Matters for Heart Health
When we talk about heart disease, cholesterol often dominates the conversation. But over the last two decades, research has increasingly pointed to another important piece of the puzzle: chronic inflammation.
Inflammation is not inherently harmful. It is a vital part of the immune response. The issue arises when inflammation becomes long-term, low-grade and persistent. This type of chronic inflammation is now recognised as a key contributor to cardiovascular disease, acting alongside cholesterol, blood pressure, blood sugar balance and lifestyle factors.
In this blog, I will explain what chronic inflammation is, how it affects the heart and blood vessels, and what the current evidence shows us about diet and lifestyle changes that may help reduce cardiovascular risk.
What is chronic inflammation?
Inflammation is the body’s natural defence mechanism. When you cut your finger or catch an infection, inflammatory signals help recruit immune cells and promote healing. This short-term response is known as acute inflammation and is both necessary and protective.
Chronic inflammation is different. It refers to a persistent, low-level inflammatory state that can continue for months or years. It often develops quietly, without obvious symptoms, and is influenced by factors such as excess body fat, insulin resistance, smoking, poor sleep, chronic stress, physical inactivity, ultra-processed diets and some long-term health conditions.
In research settings, chronic inflammation is commonly assessed using blood markers such as C-reactive protein (CRP), particularly high-sensitivity CRP (hs-CRP). Elevated hs-CRP has been consistently associated with increased cardiovascular risk, even when cholesterol levels are not markedly raised.
How inflammation affects blood vessels and the heart
The cardiovascular system is lined with a delicate layer of cells called the endothelium. This lining helps regulate blood flow, blood pressure and clotting. Chronic inflammation disrupts normal endothelial function, making blood vessels less flexible and more prone to damage.
Inflammatory signals also play a direct role in the development of atherosclerosis. Rather than cholesterol simply building up passively in artery walls, we now understand that atherosclerosis is an inflammatory process. Cholesterol-containing particles that enter the artery wall trigger an immune response. Over time, this leads to the formation of plaques that can narrow arteries or become unstable and rupture.
Large genetic, observational and interventional studies over the last five years have strengthened the link between inflammation and cardiovascular events. Importantly, these associations persist even after adjusting for traditional risk factors such as LDL cholesterol.
Links with cholesterol and blood pressure
Unsurprisingly, inflammation and cholesterol are closely intertwined. Inflammation increases the likelihood that cholesterol-containing particles will penetrate and be retained in the artery wall. Plus, it impairs the body’s ability to clear these particles effectively. This may explain why some people experience cardiovascular events despite having LDL cholesterol levels that are not dramatically elevated.
Blood pressure is also affected by inflammatory processes. Chronic inflammation contributes to endothelial dysfunction and arterial stiffness, both of which increase vascular resistance and raise blood pressure over time. Elevated blood pressure, in turn, further damages the vessel wall, creating a reinforcing cycle.
This is why cardiovascular risk assessment increasingly focuses on the broader picture rather than a single number.
Nutritional strategies supported by research
Nutrition cannot remove cardiovascular risk entirely, and it should never be positioned as a replacement for medical care where that is needed. However, a growing body of peer-reviewed evidence shows that diet plays a meaningful role in modulating inflammatory pathways linked to heart disease.
Dietary patterns matter more than individual foods
Recent systematic reviews and meta-analyses consistently show that overall dietary patterns are more predictive of cardiovascular outcomes than individual nutrients in isolation.
Mediterranean-style dietary patterns are associated with lower inflammatory markers, reduced cardiovascular events and improved endothelial function. These benefits appear to be driven by a combination of factors including higher intakes of vegetables, fruit, legumes, wholegrains, nuts, seeds and olive oil, alongside regular fish intake and lower consumption of ultra-processed foods.
Importantly, these effects are observed even when weight loss is modest or absent, suggesting benefits beyond calorie reduction alone.
The role of fats in inflammation
The type of fat consumed influences inflammatory signalling. Replacing saturated fats with unsaturated fats, particularly monounsaturated and omega-3 fats, has been shown to reduce inflammatory markers and improve lipid profiles in controlled trials. Extra virgin olive oil, oily fish, nuts and seeds are key contributors within dietary patterns associated with lower cardiovascular risk.
Omega-3 fatty acids from oily fish appear to have modest anti-inflammatory effects, partly through the production of specialised pro-resolving mediators that help switch off inflammatory responses once they are no longer needed.
Fibre and the gut–inflammation link
Dietary fibre, particularly soluble and fermentable fibre, plays an important role in inflammation regulation.
Fibre supports gut microbiota diversity and the production of short-chain fatty acids, such as butyrate. These compounds help maintain gut barrier integrity and modulate immune activity. Poor gut barrier function has been linked to increased systemic inflammation and cardiometabolic risk.
Higher fibre intakes are consistently associated with lower CRP levels and reduced cardiovascular events in large prospective studies, with benefits seen across a range of populations.
Ultra-processed foods and inflammatory load
Diets high in ultra-processed foods are associated with higher inflammatory markers and increased cardiovascular risk. These foods often combine refined carbohydrates, industrial fats, additives and excess sodium, while displacing fibre-rich, nutrient-dense foods.
Reducing ultra-processed food intake does not require perfection. Even partial replacement with whole or minimally processed foods has been shown to improve inflammatory profiles in controlled feeding studies.
Alcohol, stress and sleep also matter
Inflammation does not arise from diet alone. Alcohol intake, chronic psychological stress and poor sleep quality all influence inflammatory pathways that directly affect cardiovascular risk.
Alcohol and inflammation
Alcohol has a complex relationship with cardiovascular health, but recent evidence has shifted the conversation away from the idea that alcohol is protective.
Large observational studies and Mendelian randomisation analyses published in the last five years suggest that lower alcohol intake is associated with lower cardiovascular risk, with no clear threshold at which alcohol becomes beneficial. Alcohol consumption is linked to higher blood pressure, raised triglycerides and increased systemic inflammation, even at moderate intakes.
Alcohol can increase gut permeability, sometimes referred to as “leaky gut”. This allows inflammatory compounds to pass into the bloodstream more easily, activating immune responses that contribute to chronic low-grade inflammation. Alcohol metabolism also generates oxidative stress, further amplifying inflammatory signalling.
From a practical perspective, people concerned about heart health may benefit from:
Stress, the nervous system and inflammation
Chronic stress is a powerful but often underestimated driver of inflammation.
Persistent activation of the stress response leads to dysregulation of cortisol and other stress hormones. Over time, this can promote insulin resistance, abdominal fat accumulation and increased production of pro-inflammatory cytokines. Chronic stress is also associated with higher CRP levels and increased cardiovascular event risk, independent of traditional risk factors.
Stress influences cardiovascular health through both biological and behavioural pathways. It can directly affect blood vessels and immune signalling, while also increasing the likelihood of poor sleep, irregular eating patterns, higher alcohol intake and reduced physical activity.
Supportive strategies do not need to be complicated. Evidence suggests that even modest, regular practices can help reduce inflammatory load, including:
Importantly, stress reduction is not about removing stress entirely, but about improving the body’s ability to recover after stress.
Sleep and cardiovascular inflammation
Sleep plays a central role in regulating immune and inflammatory processes.
Short sleep duration and poor sleep quality are both associated with higher CRP levels, increased blood pressure, impaired glucose regulation and greater cardiovascular risk. Experimental studies show that even a few nights of restricted sleep can raise inflammatory markers and impair endothelial function.
Sleep disruption also alters appetite-regulating hormones, increasing hunger and cravings for ultra-processed foods, which can further exacerbate inflammation.
From a heart health perspective, supportive sleep strategies include:
For individuals experiencing ongoing sleep problems, addressing sleep quality can be just as important as dietary changes when aiming to reduce cardiovascular risk.
Why this matters in practice
When alcohol intake, stress and sleep are overlooked, people can do everything “right” nutritionally and still see limited improvement in inflammatory markers or cardiovascular risk factors.
The most effective approach to heart health recognises that inflammation sits at the intersection of diet, lifestyle and physiology. Supporting recovery, regulation and resilience is often what allows nutritional strategies to work more effectively.
Bringing it together
Chronic inflammation is not a vague or theoretical concept. It is a measurable biological process that plays a central role in cardiovascular disease development.
For individuals concerned about heart health, the most effective approach is rarely about eliminating a single food or chasing one marker. Instead, it involves supporting the body’s inflammatory balance through consistent, sustainable changes that address diet quality, metabolic health, lifestyle stressors and overall cardiovascular risk.
If you would like support translating this evidence into a personalised plan that fits your health history, preferences and test results, why not get in touch?
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:
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:
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.
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.
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.
Please get in touch and find out more - I offer a free 30-minute exploratory call.
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