The Discipline Fitness Coach

In my last post, I talked about why you shouldn't panic over cholesterol, and why you shouldn't dismiss it either. The question I got most afterwards was simple: "Okay, so what do I actually do?"

This post is the practical follow-up. I'm a personal trainer, not a doctor, so I'm not going to tell you what your numbers should be or whether you need medication. What I can do is walk you through what's worth testing, what moves the needle, and which myths I keep hearing in the gym, so you can have a better conversation with your GP.

Step 1: Know what to ask for

Most people only ever see a standard lipid panel: total cholesterol, HDL, LDL and triglycerides. It's a useful start, but it has limits.

Cholesterol tests measure the amount of cholesterol being carried in your blood. They don't tell you how many carrier particles are circulating, and the number of particles is what ends up mattering for artery plaque. That's where a blood test called ApoB comes in. It counts the particles that can get into your artery walls. For most people the two numbers line up, but some people, especially those with insulin resistance or type 2 diabetes, can have a "normal" LDL while having far more particles than the standard panel suggests. That's a false reassurance you'd never spot without the extra test.

Two other things worth raising with your GP:

• Non-HDL cholesterol. You can work this out yourself: total cholesterol minus HDL. It captures more of the plaque-forming particles than LDL alone.

• Lipoprotein(a), or Lp(a). This one is mostly set by genetics and doesn't change much over your life, so it's worth having measured once.

Targets vary between guidelines and between people, so I won't hand you a number to chase. Barbell Medicine's suggestion for generally healthy people is a non-HDL under roughly 2.6 to 3.4 mmol/L, with lower targets for people at higher risk. Take that as a conversation starter for your GP, not a goal to self-prescribe.

Step 2: Remember it's about years, not a single reading

A theme runs through everything I read for this post: "the lower, the longer, the better." Plaque builds from how much exposure your arteries have over decades, not from one bad blood test.

That has two practical consequences. First, the earlier you get on top of your numbers, the more it's worth. Second, by the time someone is very elderly, most of the lifetime exposure has already happened, which is why starting treatment late tends to have a smaller effect. It's the reason I'd rather have a 35-year-old client sort out their habits now than wait until they're 65.

Step 3: Food does more than people think

Diet is the biggest non-drug lever you've got, and it comes down to two simple moves.

Swap saturated fat for unsaturated fat. Saturated fat (butter, lard, coconut oil, fatty red meat) slows down how quickly your body clears LDL from the blood. Unsaturated fats from olive oil, nuts, seeds, avocado and fish do the opposite. A simple starting point is swapping the butter or coconut oil in your kitchen for olive oil, and having fish or legumes in place of fatty red meat a few times a week.

Aim for plenty of fibre. Around 30 grams a day is a good target, and more is fine. Soluble fibre from oats, barley, beans, lentils, chickpeas and berries binds bile in your gut, so your liver pulls more cholesterol from your blood to make new bile. It's one of the most effective food tools there is.

A couple of smaller wins: unfiltered coffee (French press, for example) contains compounds that can nudge LDL up, so paper-filtered is the safer choice if your numbers are a concern. And if your triglycerides are high, cutting back on alcohol often helps.

One more point from the research that I found interesting: studies claiming saturated fat has "no link" with heart disease often have flaws. Many compare groups that don't actually differ much in intake, ignore what the saturated fat was swapped for, or adjust for blood cholesterol in a way that removes the very pathway they're trying to measure. It's worth knowing before someone sends you a headline.

Step 4: Training is the part I can actually help with

Regular exercise helps clear LDL and triglycerides from the blood, supports healthy HDL function, and improves blood pressure, blood sugar and body composition all at once.

The baseline I give clients matches the guidelines, and it's a good floor rather than a ceiling:

• 150 to 300 minutes of moderate aerobic activity per week, or 75 to 150 minutes of vigorous activity

• At least two resistance training sessions a week covering all the major muscle groups

If you're not sure about intensity, "Zone 2" is a nice place to build most of your cardio: an effort where you can still hold a conversation, but only just. It builds fitness without leaving you too tired to train properly the rest of the week.

The gym myths I keep hearing

These come up constantly, so here's the short version of what the evidence says.

"I'll tank my testosterone if I lower my cholesterol." This worry is common among lifters. The testes make most of the cholesterol they use for testosterone themselves rather than relying on what's in the blood, and studies of cholesterol-lowering medications haven't shown a higher rate of clinically low testosterone. A blood test just doesn't tell you what's happening inside cells.

"Statins will wreck my muscles." I'll be careful here, because side effects are real for some people and I'm not a doctor. But the research is interesting. Serious muscle damage is very rare. Muscle aches are more common, yet in blinded trials, people on placebo report them at about the same rate as people on the real drug. In one well-known trial, participants who had previously quit statins over side effects rated their symptoms about the same on placebo as on a statin, and both were higher than during months with no pill at all. That points to a strong expectation effect for many people. It doesn't mean your symptoms aren't real. If you get them, tell your doctor, because there are options like different drugs, lower doses or different dosing schedules.

"My calcium score is zero, so I'm in the clear." A coronary artery calcium (CAC) scan picks up hardened plaque, which shows up late in the process. Younger people can have softer plaque that doesn't show up at all, so a zero is much more reassuring in an older person than in a 35-year-old. Whether a scan is worth it for you is a decision to make with your GP.

"Most heart attack patients have normal cholesterol." As I said last time, this is true but misleading. The "normal" cut-offs were set decades ago, and research since then has found plaque in people with no other risk factors, rising steadily with LDL even within the so-called normal range. A single blood test taken when someone is admitted with a heart attack also tends to read falsely low, because illness itself pushes cholesterol down.

"It's inflammation, not cholesterol." Inflammation does matter. But elevated cholesterol still carries extra risk even when inflammation is low, and the two together carry the most. It isn't either/or.

What I can't do

As always, I can't diagnose anything, interpret your bloods or advise on medication. If you're already on a statin or something similar, please don't stop it because of this post. Talk to your doctor or pharmacist if you're worried.

Questions to take to your GP

• Can we add an ApoB test and check my non-HDL cholesterol?

• Have I ever had my Lp(a) measured, and should I?

• What is my overall risk, and what targets make sense for me?

• Would a coronary calcium scan tell us anything useful in my situation?

• If medication comes up, what are the options if I'm worried about side effects?

The takeaway

Test properly, think in years rather than single results, eat more fibre and unsaturated fat, and train consistently. Those habits are in your hands, and they work alongside whatever your GP recommends. If you'd like help building a training routine that supports your heart health, get in touch, and we'll work out a plan that fits.

This post is general education from a personal trainer, not medical advice. Please speak with your GP about your own results and any medication.