Last year I found out I had slightly elevated cholesterol levels. Yup, fitness addict-gluten-and-sugar-free-vegetable-eating me. I got several tests done over the year and got as many different explanations and recommendations as the number of doctors I saw. Probably because cholesterol is a very complex topic. And there are a lot of differing views and research studies on its role in cardiovascular disease and on what a person with high levels of it should do. Fortunately, considerable advances have been made in recent years to understand lipidology better and many doctors, experts and researchers (Dr Ronald Krauss, Dr Rhonda Patrick, Dr Peter Attia, to name a few) have done a phenomenal job explaining this online for curious people like yours truly.
So in this article, I will attempt to simply explain what I’ve learned about cholesterol throughout my journey, more specifically what it is, what can cause it and how one can reduce it . Keep in mind, I am not a doctor, just a person who likes to share things that have helped me.
What is cholesterol
Cholesterol is a lipid molecule that is essential for many functions in our body, from hormone and bile production to the creation and repair of cells and tissues. In and of itself, cholesterol is not a bad thing, it’s vital. But having too much of the bad kind of it in your bloodstream can be.
The 101 terms
Cholesterol, triglycerides and other fats are produced in your liver and then carried around the bloodstream with protein molecules on something called lipoproteins. There are several types of lipoproteins (HDL, LDL, VLDL, chylomicrons) and they differ depending on the ratio of protein, cholesterol and triglycerides they contain. The main ones tested are HDL-C, LDL-C, VLDL, Total Cholesterol and Triglycerides.
Triglycerides are a type of fat and a component of all lipoproteins. The vast majority of triglycerides however is carried by VLDL (see below), which your liver makes, and by chylomicrons, a lipoprotein your gut makes after you eat. Triglycerides are used for positive things like energy storage and metabolism but high levels are associated to heart disease.
HDL, or High Density Lipoprotein, is loosely coined as the “good” cholesterol. We find it in fatty fish, avocados, nuts, seeds, etc. HDL is said to be protective in big part because it can extract excess LDL from your cells and tissues and bring it back to the liver. There are different forms of HDL particles but overall, high HDL is strongly associated with low heart disease risk. (1) That being said, it does not guarantee reduction of LDL in your blood.
LDL, or Low Density Lipoprotein, has always been known as the “bad’ cholesterol. But several studies in recent years have showed that just measuring the LDL-C (concentration or number of LDL particles in the blood) is not enough because not all LDL is created equal: their size matters.
Large buoyant LDL particles are actually considered a type of good LDL because it transports fatty acids and cholesterols to tissues so that you can make new cells in your organs or repair damaged ones. Smaller dense LDL particles are however considered more dangerous. They tend to stay in the circulatory system for longer and can get transformed into oxydized LDL, which can form plaque in your arteries. Unfortunately, most doctors still do not test LDL particle size, so you need to ask for it. Here in Dubai however, I did get my oxidized LDL levels done and that can be an indicator of your particle size.
VLDL, or Very Low Density Lipoprotein, contains very little protein and a high ratio of triglycerides. It is the percursor to LDL and is also considered to be “bad” cholesterol. A high VLDL can cause build up of cholesterol and increase your risk of heart disease and stroke.
How do you interpret a cholesterol test?
Everyone has a slightly different view on this in the medical litterature I have seen. But overall:
- High triglycerides are often associated with low HDL and we know that’s a pretty strong indicator of heart disease. So look at your triglycerides : HDL ratio and remember, lower is better
- While a high LDL-C may indicate a problem, you don’t necessarily have one if your LDL particles are big and buoyant. High LDL-C alone isn’t sufficient to indicate a problem, you need to get a particle size test or ask to measure oxydized LDL
- Higher HDLs are desirable but alone, that doesn’t indicate much, you know to see what the ratio is with triglycerides (see point 1)
Causes of high cholesterol
There are several and a good doctor will help you figure out what could be the cause(s) of yours to treat it properly, but here are some of the main ones.
Diet – not necessarily what you think
The average modern western diet is the likely cause of the increase in cardiovascular disease we’ve seen in the past 30 years. But there has been a lot of controversy on this topic. First, it is important to say here that only around 15% of the cholesterol found in our blood comes from the foods we eat. The rest is produced by our liver. So although cholesterol-containing foods can slightly influence your lipid numbers, they are probably not the main culprits. I’m not saying you should keep eating fatty meat every day if you have high LDL and triglycerides but from what I’ve read, it isn’t the main cause and you should probably look into what else it can also be.
Having said that, diet does affect your numbers and here’s how: the majority of today’s processed foods contain ingredients – like trans fats (hydrogenated oils, etc), most vegetable oils, processed sugar, high fructose corn syrup – that damage our arteries. When artery tissues get damaged, what goes to fix them? Cholesterol. And if you keep eating those foods, cholesterol keeps getting produced to try and repair. And that’s one of the ways arteries get blocked. Also, these foods can cause inflammation – and inflammation can oxydize your LDL particles. And oxydized particles are likely to cause plaque to build up on artery walls.
Genes
There are a lot of genes involved in lipid metabolism and some people have versions of genes that are associated with cardiovascular issues. For example, an APOE 4 gene polymorphism is strongly associated with LDL cholesterol not being recycled by the liver very well. I won’t get into details about all the genes because a) there are many and I don’t understand enough myself and b) for any of this to be useful, you need to get DNA testing done. If you are interested in this though there are loads of DNA testing providers out there and if you want to understand this topic better, I suggest you check out Dr Rhonda Patrick, she has great explanatory videos and podcasts.
Thyroid
This and genes are the main reasons I had high cholesterol issues. Our bodies need thyroid hormones to make cholesterol and then rid itself of the surplus. When your thyroid levels are low (hypothyroidism), your body doesn’t metabolize LDL as efficiently and this can increase the levels of it in your blood. So if you have a healthy lifestyle and don’t have any genetic predispositions for high cholesterol, then it is definitely worth looking into your thyroid.
Inflammation
There is a strong link between inflammation and heart disease. In fact, according Harvard Health, only 50% of people who have heart attacks have high LDL (!). One marker that can help identify inflammation in your body is Creatine Reactive Protein (CRP) but it isn’t precise enough to really identify where the inflammation is. For that you need a doctor willing to do some detective work with you.
The gut-cholesterol connection
Our gut is host to trillions of bacteria. The highest concentration of immune cells are also in the gut because it is exposed to the external environment; so naturally, it needs to have the ability to produce an immune response. According to Dr Rhonda Patrick, “when the gut barrier becomes compromised, your immune cells start to kill bacteria in your gut and this releases something called endotoxin. Endotoxins then get into your bloodstream and bind to LDL.” LDL therefore gets rid of this endotoxin – which is a great thing – but once it is bound to the LDL receptor, the endotoxin will prevent the LDL particle from being taken back by the liver and the particle will end up floating around the bloodstream and being more likely to get oxydized. And like mentioned at the beginnning, oxydized LDL is bad news for your arteries. Conclusion? Fix your gut issues.
You have high cholesterol levels: now what?
With the help of a good doctor, find out what the root cause is. Once you treat the root cause, it becomes a lot easier to treat. Here are some tips that have been proven to help, but again, check with your doc.
Get rid of transfats, most vegetable oils, white sugar and processed foods
If you don’t want your liver producing too much bad cholesterol, then omit these foods before you do anything else. They cause damage to your arteries as well as inflammation. Trans fats in particular are known to be the Darth Vadors of the lipid world. They have been recognized by the FDA as not being safe for human consumption and by June 18, 2018, “human food must no longer contain partially hydrogenated oils for uses that have not been otherwise authorized by FDA“. As for processed sugar, I won’t get into all the studies that can prove and disprove the fact too much of it isn’t good, but it is generally accepted that it can disrupt the lipid cycle. It is linked to high triglycerides and low HDL. In fact, low HDL levels are consistently associated with increased risk of type 2 diabetes.
Eating soluble fiber
No news here. Generally, the more whole foods and plant-based your diet is, the higher your fiber intake. Studies, have proven time and time again that soluble fiber helps reduce LDL cholesterol because it binds to cholesterol as well as bile acids in the intestine and can flush them out. Oats are particularly effective because they are rich in a fiber called beta-glucan, which is known to help considerably lower levels of bad cholesterol. Other great sources of fiber include beans, dark leafy greens, eggplant, okra, avocado, fruit with pectin in them (apples, citrus, strawberries, eg), whole grains, nuts (almonds and walnuts rank high) and certain seeds like chia and flax. Supplements such as psyllium husks and acacia powder are also high in soluble fiber and can be effective for lowering your LDL. But whatever source of soluble fiber you choose, make sure it is one that works for you; don’t eat something that will cause too much inflammation in your body.
Consider plant sterols and stanols
Plant sterols and stanols are one of the most effective natural substances you can consume to lower LDL cholesterol. Apparently, they can reduce your levels by up to 10% in just a few weeks if you provided you are eating a generally healthy diet. You can find these in small amounts across grains, vegetables, fruits, seeds, nuts and legumes and for larger doses, you can also take them as a supplement.
Use extra virgin olive oil
Olive oil is one of the only vegetable oils that doesn’t get damaged when being extracted, which makes it far superior to sunflower, canola or any other monounsaturated oil. It is also high in polyphenols, which are antioxydants that have been proven to improve HDL cholesterol. It may also have an effect on reducing triglycerides and oxydative stress. Virgin and extra virgin oils have more polyphenols than regular olive oil.
Exercise
There are a ton of studies which show that exercise boosts HDL and reduces triglycerides and LDL. High intensity interval training workouts seem to be particularly effective, although any form of aerobic workout seems to show improvement in terms of lipid markers.
Chill out
Stress is suspected to play a role in a lot of physical issues including your lipid levels. It isn’t stress alone but also how you manage it that can cause your cholesterol to go up. The reasons for this aren’t clear but it seems to be related to the fact that stress hormones like cortisol and adrenaline affect your blood glucose level and in turn your triglycerides and LDL.
Increase your intake of good fats
Consuming healthy fats by eating avocados, oily fish (mackerel, salmon, herring, sardine), certain nuts (almond, walnut) will boost your HDL cholesterol, reduce inflammation and triglycerides.
