What you should know about | Cholesterol

Cholesterol – what is it & where does it come from?

Cholesterol is a form of lipid (or fat) that our body is able to both absorb through the diet and synthesize. Many people do not know that part of the liver and intestines’ jobs are to produce cholesterol.


Although it is often vilified, every cell in the body requires a certain level of cholesterol to carry out its function or maintain its structure. It is necessary to keep our skin looking healthy, transmit nerve signals properly, make hormones, and absorb fat soluble vitamins such as Vitamin D, K, A and E.


If we need it, why should we be concerned about cholesterol levels?


There are two main reasons why everyone should be aware of their cholesterol status:


1. Oxidization | When cholesterol is oxidized (i.e. due to poor diet, sedentary lifestyle, smoking, etc.) its structure changes in a way that essentially makes it stickier. When this form of cholesterol is in the blood stream, it has a greater chance of sticking to the walls of the blood vessels and building what is called plaque. Over time, as plaque builds there is a greater chance that the pressure of your blood flow will cause it to loosen or dislodge and travel to your heart, possibly causing a myocardial infarction (aka: heart attack.)(1)


2. Quantity | Given that we now know that oxidized cholesterol can become sticky and form plaque, it is understandable that having more total cholesterol in the system poses a risk that more cholesterol has the chance to become oxidized.

 

Testing


Given that you cannot “feel” high cholesterol, getting tested annually is a key preventative measure.


A lipid panel is the most common way to assess cholesterol status. This tests the total cholesterol circulating in the blood stream as well as the quantity of proteins that carry that cholesterol throughout the body. These proteins are known as lipoproteins, which come in multiple forms:

· High density lipoprotein (HDL)

· Low density lipoprotein (LDL)

· Very low-density lipoprotein (VLDL)


HDL takes cholesterol from circulation to the liver to be eliminated properly; therefore, higher levels of this are typically considered “good”. LDL and VLDL on the other hand take cholesterol from the liver to the tissues, where it has more chance to become sticky or plaque. Because of this, these are typically considered the “bad” forms of cholesterol.

 

Finding a Balance


Diet & Lifestyle:

Diet and lifestyle modifications can help lower total cholesterol and the risk of oxidation in most individuals. That said, nothing is a one-size fits all in medicine and the diet and lifestyle alone may not sufficiently lower total cholesterol in those who have a strong genetic predisposition for dyslipidemia (ie. high cholesterol). In that case supplementation or medication may be warranted.


Intermittent Fasting

Despite becoming a dietary trend, intermittent fasting can be a supportive lifestyle measure in managing cholesterol. A clinical trial published in February of this year showed improved HDL, lowered LDL, and weight loss after six weeks in participants who fasted for greater than 12-hours, three days weekly.(7)


Fiber and phytosterols

Fibers and phytosterols are a key in balancing cholesterol levels through the diet. They work by preventing absorption of dietary cholesterol and support proper clearance through the stool. Oat, psyllium, flax are a few examples of soluble fibers that have shown cholesterol balancing effect. Phytosterols come from vegetables, legumes, nuts, seeds, plant oils, and various herbs.(8,9)


Exercise

Lack of movement in particular reduces the amount of good cholesterol, increases oxidative stress on the body, and affects cardiovascular health as a whole (ie. raises blood pressure, increases triglycerides, etc.). It can be daunting to transition from a sedentary to active lifestyle, but not all movement needs to be intense weight or HIIT training! Studies show even mild to moderate exercise intensity can improve cholesterol levels.(2,3)


Smoking cessation

Smoking tobacco, even in younger age, can negatively impact a myriad of cardiovascular factors including affecting blood sugar dysregulation in diabetes (raising HbA1c), increasing the risk of metabolic syndrome, increasing blood pressure, lowering HDL, increasing LDL & triglycerides, and stiffening the arteries.(4,5,6)


Beyond Food:

If 6-9 months of committed dietary and lifestyle modifications fail to affect cholesterol levels, supplementation and possible medication would be warranted. Medications often used to manage cholesterol include statins or Ezetimibe. Supplements that have the best evidence to support cholesterol balancing effects include niacin (Vitamin B3), fish oil, and artichoke extract.(10,11)

 

Talk to your naturopathic doctor today to tailor a plan to your needs!

 
Disclaimer: this information is meant for educational purposes only, and should not be used as a replacement for professional medical advice.

References:

1. Valenzuela A, Sanhueza J, Nieto S. Cholesterol oxidation: Health hazard and the role of antioxidants in prevention. Biol Res. 2003;36(3-4).
2. Crichton GE, Alkerwi A. Physical activity, sedentary behavior time and lipid levels in the Observation of Cardiovascular Risk Factors in Luxembourg study. Lipids Health Dis. 2015;14:87. Published 2015 Aug 11. doi:10.1186/s12944-015-0085-3
3. Wood G, Taylor E, Ng V, et al Determining the effect size of aerobic exercise training on the standard lipid profile in sedentary adults with three or more metabolic syndrome factors: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2021. doi: 10.1136/bjsports-2021-103999
4. Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J. 2011;161(1):145-151. doi:10.1016/j.ahj.2010.09.023
5. Kar D, Gillies C, Zaccardi F, et al. Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2016;15(1):158. Published 2016 Nov 24. doi:10.1186/s12933-016-0475-5
6. Kim SW, Kim HJ, Min K, et al. The relationship between smoking cigarettes and metabolic syndrome: A cross-sectional study with non-single residents of Seoul under 40 years old. PLoS One. 2021;16(8):e0256257. Published 2021 Aug 19. doi:10.1371/journal.pone.0256257
7. Ahmed N, Farooq J, Siddiqi HS, et al. Impact of intermittent fasting on lipid profile–a quasi-randomized clinical trial. Front Nutr. 2021;7:596787.
8. Phytosterols. Linus Pauling Institute: Micronutrient Information Center. Oregon State University. Accessed from: https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/phytosterols. Accessed: October 18, 2021.
9. Cicero AFG, Fogacci F, Stoian AP, et al. Nutraceuticals in the Management of Dyslipidemia: Which, When, and for Whom? Could Nutraceuticals Help Low-Risk Individuals with Non-optimal Lipid Levels?. Curr Atheroscler Rep. 2021;23(10):57. Published 2021 Aug 4. doi:10.1007/s11883-021-00955-y
10. Rosenson RS, Cannon CP. Patient Eduction: High cholesterol and lipid treatment options (Beyond the basics). UpToDate. Updated: July 19, 2021. Accessed from: https://www.uptodate.com/contents/high-cholesterol-and-lipid-treatment-options-beyond-the-basics?topicRef=3440&source=see_link. Accessed: October 18, 2021.
11. Sahebkar A, Pirro M, Banach M, Mikhailidis DP, Atkin SL, Cicero AFG. Lipid-lowering activity of artichoke extracts: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018;58(15):2549-2556.


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