Cholesterol & Why Size Matters!

Cholesterol has a bad reputation due to it mostly being known for its role in heart disease, but cholesterol is actually vital to our health and well-being and we would not be alive without it. There is a lot more to cholesterol levels than meets the eye, and high cholesterol does not automatically increase your risk of heart disease. But how do you know if your cholesterol levels are likely to be problematic or not? And what can you do about it? Read on to find out more…..

What is cholesterol?

Cholesterol is a waxy, whitish-yellow fat and is a crucial building block in cell membranes. Every cell in the body needs cholesterol, which helps the cell membranes form their layers. These layers protect the contents of the cell by acting as the gatekeeper to what things can enter or leave the cell.

We also need cholesterol to make vitamin D, hormones (including testosterone and oestrogen), and fat-dissolving bile acids. In fact, cholesterol production is so important that your liver and intestines make about 80% of the cholesterol you need to stay healthy. Only about 20% comes from the foods you eat. 

There is so much focus on the dangers of high cholesterol that most people aren’t aware that low cholesterol levels are also dangerous. Low cholesterol levels are linked to depression, increased risk of suicide, haemorrhagic strokes and progression of heart failure among other problems. 

Triglycerides are another type of fat in your blood and is included in cholesterol blood tests. Again, your body makes some triglycerides, and some comes from the food you eat. Triglycerides are used for energy and any excess is stored as fat. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572442/

Introducing LDL and HDL

Since cholesterol is a fat, it can’t travel alone in the bloodstream. It would end up as useless globs (picture bacon fat floating in a pot of water). To get around this problem, the body packages cholesterol and other lipids (fats) into miniscule protein-covered particles that mix easily with blood. These tiny particles, called lipoproteins (lipid + protein), move cholesterol and other fats throughout the body and it is these lipoproteins that we are actually measuring on a blood test.

LDL (low-density lipoprotein) is responsible for bringing cholesterol to the cells, and HDL (high-density lipoprotein) collects excess cholesterol to return to the liver. This is why LDL is often referred to as the ‘bad’ cholesterol and HDL as the ‘good’ cholesterol.

LDL has traditionally been given a pretty bad rap but in recent years, researchers have changed their mind about how LDL cholesterol influences the risk of cardiovascular disease. It used to be thought that excess cholesterol simply builds up on the walls of blood vessels causing atherosclerosis or hardening of the arteries. But that has turned out not to be true. 

It turns out that size matters!

Yes, elevated cholesterol and specifically elevated LDL cholesterol and triglycerides may increase the risk of developing cardiovascular disease but it’s a bit more complicated than that.

Most doctors focus on LDL number as a way to predict cardiovascular risk, but many people diagnosed with heart disease don’t have high LDL. Research has shown that roughly half of all people who have heart attacks have perfectly normal cholesterol levels. It turns out that LDL particles are not all created equal. The size of LDL matters.

Not all LDL gets deposited in arterial walls, causing plaque build-up. Small, dense LDL particles (think shrivelled sultanas) are much more likely to stick to the walls of blood vessels causing plaque deposits compared to large particles (think plump grapes). Also, small LDL particles are more easily oxidised.

Without getting too deep into the details, oxidised LDL cholesterol seems to be the ‘real’ bad guy- the type of cholesterol that actually causes heart disease (in contrast to the relatively innocent HDL and even non-oxidised LDL). 

Cholesterol itself isn’t dangerous. It becomes problematic, however, in the presence of inflammation and oxidative stress due to oxidation of LDL. The oxidation of LDL is thought to occur when LDL cholesterol particles in your body react with free radicals; unstable molecules that are produced as a result of normal metabolism, a disease, or exposure to toxins. 

Oxidised LDL is sticky and more able to get deposited in artery walls, causing a cascade of reactions that result in atherosclerosis.

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149933/

So, if it’s the size of LDL particles and the oxidation of LDL that actually causes cardiovascular disease why do most doctors only measure LDL number? 

Great question. 

And unfortunately, one I don’t have a good answer for! 

If you want to get a more accurate picture of your cholesterol levels and cardiovascular risk, then I recommend asking your doctor to order a more comprehensive panel of blood tests.

Cholesterol blood tests

Let’s start with the standard, run of the mill blood tests that are commonly ordered to assess cholesterol levels then we’ll have a look some extra tests that dare I say it, are likely more important to measure.

Standard blood tests:

Total cholesterol: a measure of the total amount of cholesterol in your blood. It includes LDL cholesterol, HDL cholesterol and 20% of your triglycerides.

LDL cholesterol: low-density lipoproteins are responsible for carrying cholesterol to cells that need it.

HDL cholesterol: high-density lipoproteins remove fats and cholesterol from cells and transport it back to the liver for excretion or to be re-utilised. Higher levels are seen to be protective against cardiovascular disease. 

Triglycerides: are fats made by the liver or from the food we eat that are carried in the blood. Elevated triglycerides are a major risk factor for cardiovascular disease.

Advanced cholesterol testing:

Apolipoprotein B: Apo B is the primary protein constituent of LDL and VLDL and research shows that it’s a better measure of atherogenic particles (plaque forming) and so a better marker of heart disease than LDL. Can be used as an indirect measure of LDL particle number.

High sensitivity CRP: a protein produced by the liver that increases in response to inflammation. Inflammation has been shown to be a more important risk factor than cholesterol when it comes to atherosclerosis and CVD.

Lipoprotein (a): a lipid protein that is similar to LDL but contains Aop B attached to apolipoprotein (a). Think of this as the glue that traps Apo B or LDL into a plaque. Elevated lipoprotein (a) is a cause of atherosclerosis. 

Oxidised LDL: oxidised LDL (Ox-LDL) is a sensitive biomarker of atherosclerosis. Elevated Ox-LDL is associated with accelerated atherogenesis, coronary artery disease, heart attack and angina. 

LDL Particle number: measure the actual number of LDL particles that carry LDL cholesterol. Used to get a more accurate measure of LDL. LDL particle number more accurately predicts risk of cardiovascular disease than LDL.

The Dangers of Cholesterol

Hopefully now you have a better idea about when cholesterol can become a problem. Here are some of the problems associated with ‘unhealthy’ cholesterol:

•     Heart disease
•     Stroke
•     Heart attack
•     Peripheral vascular disease
•     Atherosclerosis 
•     Kidney disease

What’s the link between cholesterol and kidney disease?

https://journals.physiology.org/doi/pdf/10.1152/ajprenal.00375.2015

People with CKD are more likely to have abnormal cholesterol levels and abnormal cholesterol levels are linked to the progression of kidney disease.

The reason why lipid abnormalities can contribute to progression of kidney disease isn’t completely understood however it is believed that inflammation and oxidative stress which are usually higher in people with CKD may contribute to the lipid induced kidney damage. 

Natural treatment of Elevated Cholesterol

Hopefully now you understand that there’s more to cholesterol than just how much there is in your system. The health of your cholesterol is also important as is the amount of oxidative stress and inflammation in your body.

I’m going to highlight some dietary recommendations as well as specific herbal and nutritional supplements that have been shown to improve cholesterol levels, the great thing about utilising diet and natural medicines to lower your cholesterol is that they are also going to improve the health of your cholesterol and reduce oxidation and inflammation within the body. 

The lower your levels of oxidative stress and inflammation, the less likely cholesterol and triglycerides will go on to cause atherosclerosis or contribute to your risk of cardiovascular events or damage the kidneys. 

The dietary and lifestyle advice are important regardless of which of your cholesterol markers are abnormal, but I’ve broken up the herbal and nutritional supplement recommendations into sections depending on which markers you are trying to alter. 

Dietary and Lifestyle Advice

Dietary advice:

• Eliminate saturated fats and trans fats
• Avoid hydrogenated oils (eg. margarine)
• Increase fibre intake- particularly soluble fibre
• Follow a primarily vegetarian diet
• Eliminate caffeine
• Avoid refined carbohydrates
• Follow an alkaline diet
• Specific foods to decrease blood lipids include fermented soy foods, garlic, onions, turmeric, ginger, omega-3 fatty acids (fatty fish, flaxseeds (high in potassium), monounsaturated oils (olive oil), fresh fruit and vegetables, nuts and seeds (high potassium)

Lifestyle recommendations:

• Maintain a healthy weight
• Exercise regularly 
• Stop smoking
• Control blood sugar levels and treat insulin resistance
• Actively manage stress

Elevated Triglycerides

• Specific nutrients: fish oil, alpha lipoic acid, chromium
• Specific herbs: Globe artichoke, Commiphora mol mol, Garlic, Fenugreek, Gymnema

Elevated Apolipoprotein B

• Specific nutrients: Fish oil, zinc, chromium, niacin
• Specific herbs: Commiphora mol mol, Globe artichoke, Garlic, Fenugreek

Elevated Lipoprotein (a)

• Specific nutrients: vitamin C, niacin, alpha lipoic acid, n-acetyl cysteine, fish oil, Coenzyme Q10
• Specific herbs: Commiphora mol mol, Globe artichoke, Garlic, Fenugreek

Elevated LDL (includes increased LDL-particles and oxidised LDL)

• Specific nutrients: chromium, vitamin A, C, E (should contain tocotrienols), resveratrol, bioflavonoids, niacin, magnesium, krill oil, fish oil, alpha lipoic acid, Coenzyme Q10, quercetin
• Specific herbs: Commiphora mol mol, Globe artichoke, Garlic

Low HDL

• Specific nutrients: krill oil, fish oil, chromium, vanadium, resveratrol
• Specific herbs: Commiphora mol mol, Globe artichoke, Garlic, Gymnema, Turmeric

Elevated Hs-CRP

• Specific nutrients: vitamin A, C, E, krill oil, fish oil, alpha lipoic acid, resveratrol, quercetin, glutathione, N-acetyl cysteine
• Specific herbs: Boswellia, Ginger, Turmeric, Echinacea, Rehmannia

Now, you don’t need to take every herb and nutrient in the category in order to improve your levels, I’ve just included a number of different options for you. You probably also noticed that many of the herbs and nutrients are repeated because they influence more than one cholesterol marker.

Don’t forget…

Make sure you discuss any new supplements with your doctor or naturopath to ensure they are appropriate for your use.

So there you have it, hopefully I’ve given you a better understanding about the truth about cholesterol, which blood tests will give you a more accurate picture of your own cholesterol levels and finally some strategies to use to improve your cholesterol naturally.

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