Rethinking Cholesterol: The Untold Story

23 May

Cholesterol comes with a lot of confusion and conflicting information in the health world! Let me clear things up for you.

We need A LOT of cholesterol for our bodies to function. Cholesterol is a key structural molecule making up lipid layers surrounding every cell in your body, it’s the precursor to all of your sex and stress hormones, required to make vitamin D and bile and important for brain cells. Without it, or without enough, your libido would tank, your cell membranes wouldn’t work well, your immune system would suffer and energy levels would drop. I could go on but the point is, we need a lot of cholesterol!

The issue is not the amount of cholesterol, it’s the type of cholesterol.

The debate has been going on for over 150 years as to whether cholesterol causes heart disease or not. Most of you will be familiar with LDL cholesterol being termed ‘bad’ cholesterol and HDL cholesterol being termed ‘good’ cholesterol. This is nonsense when you consider the roles of these two proteins and the bigger picture.

LDL’s role is to deliver cholesterol from the liver out to the body to where it’s needed. Think of it like a delivery truck. HDL’s role is to collect any excess cholesterol floating around the body and bring it back to the liver for processing. Think of it like a pick-up truck. Both are very important roles! It’s more about looking at the ratio of these two carrier proteins (ideally 1-2 LDL:HDL) and whether they have been oxidised or not.

A 2016 (yes this information has been out there for many years now) systemic review looked at 19 cohort studies including 68,000 elderly people to analyse whether LDL levels were associated with mortality or not. Of the 19 cohorts,16 cohorts showed that those with the highest level of LDL cholesterol lived the longest! And 2 cohorts showed that mortality rates were highest in those with the lowest level of LDL.

So, it’s very clear that high levels of cholesterol, specifically LDL cholesterol, don’t drive mortality.

I often describe it to my clients like this - blaming cholesterol for heart disease is like blaming a fireman for the fire…. Cholesterol is a structural molecule. It will be sent to an area when there is inflammation/damage to fix that damage. It’s not causing the damage but is trying to fix it - like the fireman! We need to look at the root cause of what’s driving inflammation.

So then what do we need to consider with cholesterol in regards to health?

We need to consider what causes cholesterol to oxidise and what causes higher levels of LDL cholesterol compared to HDL - then we’ve got too much LDL out in the body without enough HDL to pick up the excess.

The number 1 reason for this is inflammation from insulin resistance and refined sugar intake.

Insulin resistance, obesity, diabetes all come under the umbrella of metabolic syndrome. At the core of these concerns is a hyper-glycemic state - high blood glucose levels. This is an inflammatory state to be in and causes oxidative damage around the body - including oxidation of cholesterol molecules. When these cholesterol molecules are oxidised they do become a lot more dangerous. The damage caused from the oxidation also encourages the liver to produce more LDL cholesterol as the body needs more cholesterol to fix up the structural damage.

Interestingly, B12 deficiency can also cause an increase in LDL secretion. This is a really common phenomenon now with many vegan and vegetarians that don’t take into consideration that our best source of B12 is from animal products.

Elevated triglycerides are certainly part of the cholesterol picture and a really great marker of disease risk. A high level is typically related to a higher sugar intake/high blood sugar levels but can also be affected by alcohol, an underactive thyroid, kidney disease, haemochromatosis and certain medications. Keeping this level below 1 mmol/L is ideal.

THE SOLUTION

Our solution revolves around getting to the root cause of why the LDL:HDL ratio goes out and why LDL might get oxidised. To do this we need to address blood glucose levels and inflammation.

Diet

Please don’t cut out fats or cholesterol containing foods! Your cholesterol is only 20% dependent on your diet. The most important thing is that we eat to lower your blood sugar levels and to reduce inflammation.

Eat whole real foods - meat, veggies, fruit, seafood, legumes, whole grains, dairy, eggs, nuts and seeds, poultry. These should make up at least 80% of your diet.
Eat a combination of proteins, fats and carbohydrates at every meal in order to stabilise your blood sugar levels. Each meal should keep you full for around 4 hours. If not, you’ll need to increase the protein at the previous meal. Read this blog for how much protein to consume and where to get it from.
Prioritise half a plate of leafy greens and non-starchy vegetables. The fibre, polyphenols and antioxidants in here are really important for stabilising blood sugars, feeding your beneficial bacteria and fighting off oxidation.
Cut out all trans fats and highly refined fats which will cause oxidative damage in your body. For example: canola oil, rice bran oil, sunflower oil, soy oil, grape seed oil, safflower oil, vegetable oils and corn oil. Choose good quality fats like extra virgin olive oil, butter, ghee, coconut oil, avocado oil, flaxseed oil, lard, avocado.

Lifestyle

Commit to at least 30 mins of movement per day. This is not my area of expertise but we know that movement/exercise is crucial to cardiovascular health and to reducing blood glucose levels. Find something that you enjoy and will therefore stick with!
Manage stress levels. Stress or a stressful event is often the thing that will trigger the cascade of events that leads to a heart attack. Stress alone can increase your blood pressure, raise cholesterol levels and raise your blood sugar levels. Find what works for you and prioritise this - a daily walk, less screen time, meditation, playing music, playing sport.