What is cholesterol
It is a yellowish, waxy substance that is soluble in fats but is not a fat as such. The actual fat in blood is called ‘triglycerides’. It is estimated that 75% of cholesterol is produced by the liver and all cells in the body while only 25% comes from the diet. In other words, the body produces the necessary amounts from all types of fats, carbohydrates and even proteins, regardless of ingested cholesterol - this is how vital it is. Some say that the less cholesterol we eat, the more work the body has to do.
We would not survive without sufficient cholesterol, and here is why.
Functions of cholesterol
Integral component of cell membranes, modulating cell membrane fluidity. The membrane can’t be either too fluid or too rigid so that substances like nutrients and waste can get in and out of cells but crucial cell components called organelles don’t spill out
Brain health: approx. 20% of total body cholesterol is taken by the brain
Key component of the myelin sheath. The myelin insulates all nerve fibres so that electrical signals can be transmitted
Precursor of all steroid hormones: cortisol, aldosterone, all sex hormones and vitamin D. A healthy response to stress and good fertility are only possible with ample cholesterol
Anti-inflammatory / antioxidant agent
Immune enhancer
Precursor of bile which aids the digestion of fats, absorption of fat soluble vitamins A, D, E and K and detoxification. Bile is our master detoxifier. Without quality bile and good bile flow toxins don’t leave the body as they should. It’s often missed in detox programmes
There is only one cholesterol
Cholesterol can’t move in blood (fat-like substances and water don’t mix) so it needs a vessle. All vessles in the body are proteins and carry various molecules through body liquids like submarines. There are three major vessles that carry cholesterol around the body, called lipoproteins. These lipoproteins also carry fat soluble vitamins A, D, E and K, steroid hormones and triglycerides. They differ by density which pertains to the amount of protein in a given vessle. The less dense, the less protein in the vessle, and more fat. Total cholesterol reading means nothing - we can only tell a little more when we measure total cholesterol and the following 3 fractions:
VLDL - very low density lipoprotein: contains the least protein but the most cholesterol and triglycerides. As it travels around the bloodstream, it loses some of its contents and becomes LDL. You don’t want VLDL high and if your LDL is high, ALWAYS check VLDL as well.
LDL - low density lipoprotein: contains a little more protein and less cholesterol and triglycerides. LDL carries cholesterol, fat soluble vitamins and steroid hormones to tissues, like a site of inflammation or the endocrine system.
HDL - high density lipoprotein: contains the most protein and the least amount of cholesterol and triglycerides. HDL takes the very same cholesterol back to the liver.
Basically, it’s the vessle that differentiates the ‘good’ and ‘bad’ cholesterol but cholesterol is always the very same substance. If, say, cholesterol needs to be sent to a site of damage to dampen inflammation, is it fair to call it ‘bad’? I love dr Natasha Campbell McBride’s explanation: calling LDL cholesterol ‘bad’ and HDL cholesterol ‘good’ it like calling an ambulance that goes to a site of an accident a ‘bad’ ambulance, but the one that brings the casualty back to the hospital is a ‘good’ ambulance.
In other words, it’s not the cholesterol itself that is the problem but why it’s present at higher amounts. If cholesterol is high, look for metabolic dysfunctions, poor bile flow, choline deficiency, some sort of a damage (like autoimmune processes), inflammation, immune deficiency or hereditary tendencies.
Optimal cholesterol
Since I look at functional, rather than conventional ranges, my optimum for total cholesterol is 180-220. I also think it’s absolutely fine at higher levels, given that insulin, glucose, HbaA1c, triglycerides, uric acid, ferritin, hs-CRP, Apo-A1, Apo B (od LDL-P), Lp(a) and homocysteine are optimal too, as these are associated with atherosclerosis. And the older one gets, the higher levels are desirable but again, given the other markers are good.
There should be sufficient HDL cholesterol (‘good’), between 60-70. When troops go to war, you hope to get them back. But obviously not more than you send out. Sometimes I see HDL higher than LDL which may look great for some. In fact, excess HDL is associated with oxidative stress and autoimmune processes.
One should also look into the total cholesterol to HDL, and triglycerides to HDL ratios.
In functional medicine, cholesterol equal to or lower than 150 is considered too low. This is where fertility, immunity, resilience to stress and the brain may need support. This is often a result of being on a low fat diet, impaired fat absorption or being a vegan.
When can cholesterol be high
Inability to metabolise cholesterol into bile acids: cholesterol becomes a component of bile with certain enzymatic reactions that require nutrients, such as choline and taurine which can be deficient for various reasons, which can impair cholesterol metabolism. Poor bile flow will also cause a higher cholesterol.
If you notice that your cholesterol goes up and stays up when you eat more animal fats, this may be why. In other words - it’s not the fat that’s to blame but how the body’s inability to process it correctly. A diet that reduces animal food intake does not address the cause. Saying that, if you experience this, please do include more veg, fruit, beans, flax and chia in your diet. Work on your digestion, bile flow and gut health. Interestingly, many people who need to work on their bile also tend to be constipated which, on top of everything else, disables cholesterol removal. The above foods will help.
Please note that if you significantly increase animal fats but your bile is good, your cholesterol will most probably increase temporarily anyways because the body needs to adjust to the new way of eating.
Genetics (familial hypercholesterolemia): this is when total, HDL and LDL cholesterol markers are all elevated. It can be related to lipoprotein receptors dysfunction, inability to clear LDL particles, and an increased number of Lp(a) particles. Appropriate lifelong diet and lifestyle are key for people with hereditary tendencies.
Metabolic syndrome (Syndrome X) and inflammation: a cluster of symptoms that may increase the risk of cardiovascular disease. It is characterised by increased triglycerides, poor glucose and insulin management, high total and LDL cholesterol, low HDL cholesterol, abdominal fat and often the fatty liver. The usual culprits include the reliance on processed carbohydrates, isolated sugars including processed fructose, commercial plant oils used for cooking and insufficient intake of quality fats and fibre. Since a pro-inflammatory diet is damaging to the artery walls, cholesterol will want to heal that inflammation. It works like a soothing plaster. When the source of inflammation is not addressed, cholesterol will keep building up and up. The process signalises a type of white blood cells called macrophages. They gobble up oxidised cholesterol in the artery wall but may eventually burst from ‘overeating’, which causes major inflammation. This is how atherosclerosis happens. To sum up, it’s the inflammation that needs addressing, not just the high cholesterol.
Increased homocysteine: it’s a damaging waste product of lean protein metabolism which is cleared out of the system with sufficient folate, B12, B6, glycine (collagen, gelatin, collagen rich foods and broth) zinc and magnesium. Some people have a genetic mutation preventing them to metabolise folate and B12 effectively. Others may have an unhealthy gut resulting in the same. Homocysteine damages arterial walls which will induce the same process as described above. I usually address homocysteine when it goes above 8.
Underactive thyroid: when thyroid hormone levels are low, the body cannot break down and remove LDL cholesterol efficiently. It may be a result of Hashimoto’s thyroditis.
The menopause and andropause: since all steroid hormones are made from cholesterol, once the production of sex hormones drops, cholesterol may be high for a while, until the body adjusts to the new situation. Also, oestrogen and testosterone directly influence cholesterol metabolism so after the reproductive years cholesterol is naturally higher.
Chronic infections: the body will produce as much as necessary to keep dealing with the invader on an ongoing basis. There is a link between high cholesterol and low white blood cell count.
Gut flora imbalance (dysbiosis): some bacteria are responsible for cholesterol metabolism in the intestines, preventing it from circling back to the system or causing bile gallstones. An unhealthy gut can cause increased cholesterol, even in the absence of any gut symptoms.
Being a lean mass hyper responder: some people (usually those who are slim and fit) who go on the keto diet may notice rapid elevations in cholesterol. To find out more, go to Dave Feldman’s Cholesterol Code.
Lack of sunshine and a diet poor in sulphur: This is a new hypothesis that sun exposure and a diet rich in sulphur, help to produce cholesterol sulphate. In this form, it is water soluble and does not require a vessle to travel around in the body (no LDL or HDL). As a result, it doesn’t trigger macrophages, which keeps atherosclerosis at bay. Sulphur containing foods include cauliflower, broccoli, kale, cabbage, onion, garlic, leek, eggs, dairy, meat and seafood. Some people may have genetically impaired sulphonation in which case cholesterol sulphate or vitamin D sulphate are not produced at an optimal level. To learn more, check out Stephanie Seneff’s research.
What to do
To start with, cholesterol should never be evaluated as a stand-alone marker because it’s part of a bigger picture.
If total or LDL cholesterol is high and the ‘risky’ markers are optimal, let cholesterol do its job and support the body accordingly, e.g. nourish the adrenals or the immune system by eating quality sources of cholesterol including egg yolks, cold water fish and shellfish, while reducing processed carbohydrates and isolated sugar. A general anti-inflammatory diet, accompanied by some movement, is always a good place to start.
Reduce inflammatory foods: I recommend not to deep fry, perhaps even not using the frying pan for a couple of weeks. Roast and grill your meat and fish, boil or poach your eggs, and make frittatas in the oven. Add as much vegetables as possible, and dress them in cold pressed oils with vinegar or lemon juice. Get rid of crisps, fries, sweets, ice cream, carton juice, sweet fizzy drinks, beer, milk, processed meats like sausages and frankfurters, pies, mass produced bread and other baked goods. Eat antioxidant rich foods like berries, pomegranate and drink green tea.
Do not combine saturated fats with starchy carbs. Even though butter is great, you may have it on your broccoli instead of a baguette. Mashed potato is out. I mean, there is nothing wrong with these combinations for a healthy person but not when addressing metabolic health.
Support cholesterol removal: Oats, legumes and mushrooms contain a special type of fibre called ‘beta glucan’ which binds to excess cholesterol before it’s abrosbed. Flax and chia seeds also enable cholesterol removal and optimise bowel movements if sluggish. The seeds can be added conveniently to a smoothie or blended with kefir which will further optimise cholesterol metabolism through gut support. It’s important to keep the bowels moving because cholesterol is cleared via bile and the excess is excreted in feces. And the more bile stimulation, the more cholesterol will be directed towards its production because, again, cholesterol is a key component of bile. Beetroot is great for that.
Include plant sterols: they have a similar structure to cholesterol so they compete with cholesterol for absorption. The more sterols you eat, the less cholesterol will be absorbed. Plant sterols include nuts, seeds, quality soy foods (natto, tempeh, miso), other legumes and whole grains.
Include omega 3 fatty acids: these don’t reduce LDL as such but mitigate any risks associated with inflammation and heart disease. Foods rich in omega 3 fatty acids include SMASH fish (sardines, mackerel, anchovies, salmon and herring) but all fish is an excellent choice. Bake, poach or steam your fish for the best results, have some sushi and gravlax. Other foods include chia and flax seeds, walnuts, seaweed, pastured egg yolks and meats from grass fed and wild animals.
Increase HDL by eating olive oil, olives, avocado, nuts (esp. macadamia), fish, fish oil, cod liver oil, meat from pastured or wild animals and quality dairy, especially from goat and sheep’s milk. Coconut products are also great. By just increasing HDL cholesterol, some of the risk is already mitigated.
Supplementation is always individual and should support dysfunctional areas. Some supplements reduce cholesterol production while other help with its metabolism or excretion. Try and always get to the root of your issue. While plant sterols may work for some, red yeast rice, garlic, beta glucan or nattokinase might be better for others. Fish oils usually work well for everyone, to at least partially address inflammation and address elevated triglycerides. Last but not least are my four of my favourites: artichoke extract, phosphatydilcholine, taurine and beetroot extract, all of which support bile.
It is also worth mentioning the statins. Some people will definitely benefit from taking them for a short period of time while implementing dietary and lifestyle changes (if you decide to just take statins and do nothing else, your cholesterol will be back to square one as soon as you stop them). However, they do not address the cause and just block cholesterol synthesis while at the same time reducing coenzyme Q10 which is vital to a healthy heart function. In fact, the deficiency of CoQ10 is associated with the weakening of the heart muscle. Isn’t that counter effective? If you decide to go on statins, supplementing with CoQ10 is a must.
In my previous post I discussed what fats to use in the kitchen and when. I hope it will all come together :)