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. Oxidation | 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)