Everything you need to know about cholesterol

While the cholesterol conversation is a deep one, there are a few strong points that we must always consider.

The first point is what can we discover about the health of key systems within our body when we have high LDL or triglycerides. For this, we must also consider what each of the aspects within a lipid panel indicate.

The second point is whether statin should be a first step, what are the side effects of statins, and what must be kept in mind if we are already on statins.

The third is whether elevated cholesterol is the strongest indicator of heart disease, and is this belief part of the flawed system that exists in India?

The importance of cholesterol

Cholesterol is a sterol that is a combination of a steroid and alcohol. It is absolutely essential to life and is an important fat just like omega 3 essential fatty acids. It is a fat, but behaves very much like an alcohol. It is insoluble in water and blood. This is what makes it important for cells to regulate their internal environment and for proper functioning of nerves.

Cholesterol is the precursor to sex hormones and steroid hormones as well. Your body makes oestrogen, progesterone, testosterone, DHEA, and cortisol from it.

Corticosteroids regulate water balance and kidney function. It also helps us prepare for fight or flight, and help to quell inflammation.

Cholesterol also helps our body make vitamin D, and some of the bio acids from cholesterol support digestion and absorption of fats and the fat soluble vitamins A, D, E and K.

It is also needed for proper functioning of serotonin receptors in the brain and is half the weight of your cerebral cortex! Your brain needs it! It also plays a role in the health of the gut lining, and compromised gut lining integrity is linked to all inflammation.

We also need cholesterol to heal injuries, especially in the arteries. It protects the skin against dehydration. However, it is a proper functioning liver that will manufacture cholesterol from carbohydrates, proteins, and fats.

The key point to take from this is that the health of our liver is key to how we understand cholesterol.

Without optimal levels of cholesterol, we will have poor hormone health, adrenal health, brain health and more. The trend is of striving for lower and lower total cholesterol and being happy to have it at 130-150 is dangerous.

LDL is a low density lipoprotein and is more concentrated in cholesterol molecules. They carry triglycerides from cells that have access to these compounds to cells that can take them. Their movement is from your liver to the cells.

HDL is a high density lipoprotein, which has higher protein and less cholesterol. They carry triglycerides in the opposite direction, from your cells back to the liver.

Statin and cholesterol

Statins are HMG CoA Reductase Inhibitors. They work in the mevalonate pathway, which is the one that makes cholesterol. The enzyme known as HMG CoA Reductase converts Acetyl CoA to Mevalonate. By inhibiting this, the body does not produce cholesterol. Then our body creates more LDL in the liver, and we use that stored LDL for cholesterol synthesis and therefore it lowers LDL.

The problem with statin is that it blocks the pathway at the first step. Therefore, we block all essential pathways and some of these are involved in wound healing, fertility, hormone health, and our ability to kill cancer cells.

Side effects of statin include muscle aches, weakness, liver damage, increase in liver enzymes, brain fog, amnesia, disorientation, low libido, and nerve damage. It lowers LDL, but it does not increase HDL. Neither does it lower triglycerides. High triglycerides and low LDL are more effective markers for heart disease. It also inhibits COQ10 production which impacts heart health.

Elevated cholesterol linked to heart disease?

There are several risk factors indicated in heart disease which are key. Let’s take a look at them first.

·       Inflammation is the biggest predisposing factor in the development of heart disease.

·       Elevated CRP and homocysteine are major predisposing factor for heart disease.

·       Free radical damage and oxidative stress. In this manner, smoking creates the biggest risk factor as it increases oxidative stress.

·       Increased blood viscosity can be gauged as elevated platelets.

·       Insulin resistance and metabolic syndrome is a big risk factor as the liver is involved in both lipid management and blood sugar regulation. Insulin resistance also raises inflammation overall.

·       Infections including periodontal infections can raise inflammation. High toxicity through exposure to exogenous and endogenous toxins can distract the liver and prevent healthy liver function overall. This can also trigger hormonal imbalance, which can also be a risk for heart disease.

·       Deficiency of several nutrients including essential fatty acids or omega 3 can trigger systemic inflammation

·       Stress and lack of sleep cannot be ignored and must be addressed with appropriate measures as the body cannot do any healing under these situations.

·       Use of antacids and proton pump inhibitors are also risk factors.

·       A highly inflammatory diet with high sugars, low nutrients, and poor fats is a big risk factor as well.

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What should you consider with cholesterol?

·       If you have obvious signs of poor liver health such as dysfunctional liver markers and symptoms of poor liver health, always begin by working on the health of the liver. Elevated LDL and triglycerides can very well be poor liver health before anything else. In several cases with clients, I have had complete lowering of triglycerides and LDL, with improvement of HDL, just from liver work. It is only after the diet is anti-inflammatory, rich in fibre, protein, and fats, that you should even consider medication. Putting someone on statin without asking what their diet is, is an injustice to the entire health paradigm.

·       Two grams of plant sterols can lower LDL by 10 percent. Include plenty of beans, legumes, nuts, and seeds in your meal.

Plant sterols are steroids that heal the plant itself. Curcumin is a powerful plant sterol that can prevent oxidisation of LDL particles. It is also high in B6 and keeps homocysteine levels down, acting as a messenger with the genes in the liver, directing them to increase receptors and clear LDL. The turmeric shots are not answers to this, which can only raise gastric irritation in many. Using turmeric therapeutically under care of a health practitioner, or using turmeric with cooking is the right approach. Eating 70 percent of your meal as richly coloured plant foods is a great approach!

·       One ounce of nuts five times a week reduces risk of heart disease and lowers inflammation. This can include 24 almonds, 15 walnuts, 15 pecans or 15 cashew nuts per serving.

It is amazing how many people have become fat phobic, and stop eating all healthy fats if there is a family pattern of high cholesterol. It is only if you had genetic testing, where you have been shown that certain fats like saturated fats may be problematic for you, that you should be cautious. This should only come one year after you have done everything right with diet, exercise, and stress reduction, and the lipids are still elevated.

·       Fish oil lowers risk of heart disease. It also helps lower CRP, which is an inflammatory marker. Include fish oil if your healthcare practitioner has recommended it. Also include fatty fish several times a week. There are several healthcare practitioners themselves marketing plant based omega-3 oil. Omega-3 has ALA, EPA, and DHA. The EPA and DHA might be very much correlated with lowering cholesterol. If you are plant based, it is important that you are aware of this and look for other sources such as turmeric.

Don’t get caught up with LDL and triglycerides. Begin with dietary changes first. Anyone whose diet is prominently starch, sugar and grain, which is the bulk of Indian meals in many homes, will have poor liver health, and therefore, elevated lipid markers.

Focus on high plant foods, optimal protein, and plenty of healthy fats. Avoid processed food, junk food, trans fats, and desserts, which all contribute negatively to liver health.