My post this week on cholesterol is long form simply because the concept shared needs full context and explanation. For this reason I have allowed myself to write a longer piece trusting that those who are keen to dive in, will be happy to do so.
Does cholesterol cause heart disease?
The fundamental principle upon which much of pharmaceutical medicine is based, that high LDL cholesterol causes heart disease, has taken a beating in recent years. While researchers have been questioning the hypothesis for years, current practice has not yet caught up, and the measurement and prescribing of statins is still common practice in doctor’s surgeries.
Despite the impassioned opinions of many on the subject, the issue as to whether LDL is a concern in cardiovascular disease is more complex than a simple ‘yes’ or ‘no’.
Cholesterol 101
Before I go further, here is a quick biochemistry lesson (bear with me)!
Cholesterol is transported in the blood attached to lipoproteins. It can be confusing hearing about high density lipoprotein (HDL) and low density lipoprotein (LDL) referred to as “good” and “bad” cholesterol respectively. But these lipoproteins act as ‘taxi’s’, transporting cholesterol throughout the body. HDL transports cholesterol to the liver, while LDL transports cholesterol from the liver to body cells.
High cholesterol does not, in itself, cause blood vessel thickening (atherogenesis). It is important to understand that cholesterol is not a bad thing. Cholesterol is an important component of cell membranes, where it helps with permeability. It is also a precursor for several hormones, including oestrogen, progesterone, testosterone, cortisol (your body’s natural cortisone), and vitamin D.
Cholesterol: The good and bad
What researchers have found is that high cholesterol can be seen in patients who also present with insulin resistance, increased inflammation and oxidative stress from poor dietary and lifestyle choices, toxic exposure and stress. In such people, high cholesterol can simply add fuel to the fire, and cholesterol levels can be a secondary target for treatment while the primary inflammation and oxidative stress is being addressed.
What’s more, accumulating research tells us that both dietary cholesterol and saturated fat content do not consistently elevate cholesterol levels, except in some genetically predisposed individuals.
The factor which has emerged alongside genetic predisposition as a much more significant driver of plasma cholesterol elevations is inflammation.
However, in a healthy person, cholesterol has beneficial anti-inflammatory effects and could well be protective. In addition, did you know that LDL cholesterol actually protects the body against infection!
LDL can directly bind to pathogenic microbes as well as the toxins they produce. So, with this in mind, elevated cholesterol may therefore be a useful clinical sign of underlying infection, and some researchers go further to suggest that high cholesterol may be protective against cardiovascular disease, because it protects against infection. This may be particularly relevant if the ‘infection’ is via the gut – as in dysbiosis (keep reading to learn more about the role of probiotics for the management of cholesterol).
Hormones and other drivers of high cholesterol
In addition to genetics, inflammation and chronic infection, there are some other common clinical reasons why patients may present with higher cholesterol levels. These include low thyroid function (particularly in women) and low testosterone levels in men. Ironically these are also both drivers of inflammation, insulin resistance and oxidative stress which as we know, can contribute to cardiovascular disease.
Natural help for cholesterol
As a naturopath, much of my focus when treating patients is to reduce inflammation, oxidative stress and insulin resistance. Correcting simple nutrient deficiencies, restoring healthy cellular function, reducing inflammation through correct diet and exercise strategies are some of the most powerful tools I use to empower patients to improve their health.
Diet and lifestyle recommendations
What to avoid
- Limit alcohol intake. High alcohol consumption is associated with increased risk of low HDL cholesterol.
- Limit refined carbohydrates and foods high in sugar, especially added sugar and fructose which are acid-forming, pro-inflammatory and thereby can increase cholesterol levels. Sugar is also addictive!
- Avoid processed foods, especially those that are fried and contain trans fats.
- Limit coffee to no more than one or two cups per day -there is a link between cholesterol levels and high consumption of coffee – particularly if you’re hardcore and drink around six cups per day.
The exception to the rule is green tea, which does contain caffeine. It has been shown to lower both triglyceride and LDL cholesterol without negatively affecting HDL cholesterol.
What to include
- The Mediterranean diet has been thoroughly researched for benefits in preventing CVD and for managing cholesterol levels. The benefits are generally attributed to high levels of unsaturated fat from fatty fish and oils and antioxidant-rich plants, fruits and legumes. What’s more, as we know, garlic is very much part of this type of diet, which is good news as garlic has a mild cholesterol lowering effect. Include garlic in your diet wherever possible.
- Think fibre – particularly water-soluble options like oat bran, psyllium seeds, guar gum or pectin. These form a gel that binds bile and cholesterol in the gut to allow for excretion as part of your bowel motions. They have also been found to improve the radio of HDL and LDL cholesterol
- Other ‘cholesterol’ lowering foods include apples and almonds.
Natural supplements to help lower cholesterol
Natural ingredients can be effective in lowering cholesterol levels without causing the side effects associated with statin medications (such as headaches, muscle aches, fatigue, abdominal cramping, bloating, nausea, liver toxicity, vitamin D and B12 deficiency). These include:
- Omega 3 fatty acid supplement such as fish oils, or even better, krill oil, which has shown to be effective at managing cholesterol; reducing total cholesterol, LDLs and triglycerides while increasing levels of HDLs. It is important krill oil is obtained from an environmentally sustainable source.
- Coenzyme Q10 is an excellent antioxidant, improves cellular energy (working at the mitochondria level), helps to reduce blood pressure and improves insulin sensitivity. What’s more, statins deplete your CoQ10 levels so consider a high dose of CoQ10 if you do take statins.
- Niacin (vitamin B3) has been shown to raise HDL and decrease LDL and triglycerides. Sustained-release niacin reduces skin-flushing and is generally better tolerated.
- Red yeast rice contains statin-like compounds called monacolins. Studies have shown effects similar to statin drugs, where total cholesterol and LDL cholesterol levels are lowered, and HDL cholesterol levels are increased.
- Three particular strains of a probiotic called Lactobacillus plantarum have been proven in clinical trials to help maintain low dietary cholesterol levels as well as cholesterol produced by the liver. You can read about these specific strains here.
- Other helpful supplements include magnesium, vitamin D and garlic in a capsule or tablet form.
Lifestyle management
While this information in this blog is not exhaustive, no programme to reduce cholesterol (or other health problems) would be complete without mentioning regular exercise. Numerous studies have shown the importance of aerobic exercise in controlling cholesterol levels and maintaining good cardiovascular health. This simply means brisk walking is enough!
In addition, it is important to stop smoking. Smoking increases the ability of LDL cholesterol to get into artery cells and cause damage.
Lastly, do your best to manage stress. The link between stress and the production of cholesterol is well established, so take time to relax. Regular relaxation will help to keep your stress levels under control. Some stress management suggestions include meditation, relaxation CDs, exercise, yoga, reading or getting your worries down on paper.