Cholesterol

One of the things that most concerns – and confuses – people is cholesterol. Understanding cholesterol and how it works in the body is a complex topic, but there is often a lot of confusion surrounding how levels are measured and what to do about it. There is also a lot of confusion about how cholesterol is used in the human body. For instance, did you know that cholesterol is essential for making and repairing cells? Or that it is necessary for cellular function and many other health functions?

 

What is Cholesterol?

Simply put, cholesterol is a fatty substance or lipid which circulates around the body through the bloodstream in the form of lipoproteins. This lipoproteins are known as High-density lipoprotein (HDL) & Low-density lipoprotein (LDL).

 

What is the problem with cholesterol?

To understand the problem, we need to understand the difference between High-Density Lipoprotein (HDL) & Low-Density Lipoprotein (LDL).

High-Density Lipoprotein (HDL) cholesterol carries cholesterol to your liver and is thought to be good because it is expelled from the body.

Low-Density Lipoprotein (LDL) cholesterol, since it carries cholesterol to the arteries, is thought to be bad. This is because fatty deposits may build up on the artery walls and may cause a narrowing of the arteries known as atherosclerosis. If arteries become blocked, it could lead to a heart attack.

However, recent research is providing evidence that high levels of LDL cholesterol do not always correlate with heart disease. Obsessing about lowering LDL or using statins to lower LDL may be misleading because LDL levels are not good biomarkers of heart disease. They do not accurately predict someone’s risk of heart disease and there are many other reasons why someone may experience atherosclerosis.

 

How do we test for cholesterol?

A typical lipid panel includes total cholesterol, triglycerides, HDL, LDL, non-LDL and total ratio. You may have had a blood test and a discussion with your doctor about high levels of cholesterol, or you might have heard lots of ads on TV or the radio that warn you about the dangers of high cholesterol. If so, you might find the following frequently asked questions helpful!

 

Confusion 1 – ‘High Cholesterol is bad’

First of all the important question to ask is WHICH cholesterol markers are high?

We are all aware that high levels of cholesterol may increase the risk of premature cardiovascular diseases. But what does ‘high cholesterol’ mean? It is generally accepted that high levels of LDL are one of the major risk factors contributing to plaque in the arteries (atherosclerotic plaques). However, even though there is a strong link between LDL and cardiovascular risk, LDL is not necessarily the cause.

 

Confusion 2 –  ‘Eggs are bad for people with high cholesterol’

Eggs are an interesting one as for many years we have been told to avoid eggs due to the amount of cholesterol they contain. This isn’t necessarily untrue, as eggs do contain cholesterol, but they also contain a vital mineral choline that is thought to help break down cholesterol. Many studies have suggested eggs are fine in moderation, like everything, except for fried eggs which are thought to cause oxidative damage. So, instead of removing eggs completely focus more on boiled and poached.

 

Confusion 3 – ‘All fats are bad’

The most unhealthy fats are trans fats and you should aim to have no trans fats in your diet at all, along with no highly processed foods. Trans fats are particularly damaging because they raise LDL and lower HDL at the same time. They are found in industrially hydrogenated oils, processed foods and fried foods. If you see ‘partially hydrogenated vegetable oil’ in the list of ingredients of a product, you can know it contains industrially produced trans fat, so do not consume it!

Increasing healthy fats has been shown to improve the consistency of the blood which reduces the risk of coronary heart disease. In contrast to ‘no fat’ or ‘low fat’ diets, healthy fats are both necessary and beneficial for health.

The best thing you can do for your overall health is to replace saturated fat with unsaturated fat. Rather than just reduce all fat, the replacement of more healthy fat is able to reduce both total and LDL cholesterol. The dietary fat review of Heart UK in 2024 points to saturated fatty acids as the greatest impact on LDL cholesterol.

The replacement of saturated fats was of far more benefit than just removing unhealthy unsaturated fats. For people who are nervous of having fats in their diet, consider the findings from the Nurses’ Health Study[1] and the Health Professionals Follow-up Study[2] which showed no link between the overall percentage of calories from fat and any important health outcome for cancer, heart disease, or weight gain.

 

Confusion 5 – ‘I need to go on Statins’

There are other things you can do first to keep your cholesterol within healthy markers. Many doctors do not properly explain the difference between LDL and HDL levels to their patients. Many doctors prescribe statins as a preventative medication and do not properly explain the potentially serious risks and side effects.

Many people think that there are no alternative to statins. However, there are many things you can do to manage cholesterol and keep your cholesterol within healthy markers. A healthy diet, being active and limiting stressors, should always be the first line of defense

Lifestyle changes such as more exercise and changes in diet and specific supplementation plans have shown to be favourable in reducing cholesterol. For instance, moderate exercise of 2.5 hours a week, or 30 minutes 5 days a week, has been proven to reduce LDL and increase HDL. Studies have also shown that flaxseed at 14-40g a day can reduce LDL, increase HDL and reduce oxidation.

Ongoing research on statins

Ongoing research on cholesterol and statins can be very controversial. It is interesting to follow some of the latest research, including some of the challenges to established knowledge about statins. Often breakthroughs in medical science came from questioning even though it is deemed controversial or dangerous at the time.

Recently Dr Mark Hyman (functional medicine expert) interviewed Dr Aseem Malhotra (cardiologist) about his research on statins. He explores the limitations and side effects of statins and recommends more nuanced insights before taking statins. You can read his book titled A Statin Free Life if you want to know the other side of the story surround statins. He explains why statins are not a preventative treatment for heart disease and recommends more serious discussions about the inherent risks associated with them. You can listen to him talk on Dr Hyman’s podcast here.: ‘How to Naturally Lower Cholesterol with Dr. Aseem Malhotra’.  And of course, with any podcast link, please refer to the disclaimer at the bottom of this blog.

 

Healthy Fat replacements

Dietary changes can Aim to increase healthy fats to displace less favourable foods — processed foods, refined carbohydrates, and saturated fat — which indirectly supports LDL management.

Make sure to eat more of these foods to reduce LDL:

• Oily fish – mackerel, anchovies, salmon (wild), herring and sardines You can remember these fish by the anacronym MASHS!
• Pulses — choose foods that are high in soluble fibre and plant protein such as chickpeas, lentils, kidney beans, black beans, cannellini beans, and peas.
• Nuts are high in unsaturated fat, plant protein, fibre, and phytosterols. Walnuts are particularly noteworthy as a plant-based source of omega-3 alpha-linolenic acid (ALA), which contributes to triglyceride reduction.
• Extra virgin olive oil is rich in monounsaturated fat and contains anti-inflammatory polyphenols. Both olive oil and rapeseed oil are recommended by the BHF and NHS. Make sure your oil is cold-pressed and organic for the most healthy option!
• Avocado is rich in monounsaturated fat and plant sterols and also provides beneficial fibre, potassium, and folate.
• Fruit and vegetables all support broader cardiovascular health. An excellent combination is 2 raw carrots, 1 garlic clove and an old fashioned apple (e.g., a cox or Braeburn) which can help lower cholesterol!

Supplements to take:

• If you would like to know what supplements are helpful in maintaining healthy cholesterol balances, I would recommend Lecithin, Plant Sterols, Niacin (vitamin B3) and fish oils as helpful. Please talk to me in your consultation to see how these will fit your nutritional profile and existing plan.
• Some people use niacin (vitamin B3) at high doses to bring down cholesterol. Several years ago a client had great success with this approach and gave me a book called Cholesterol Control Without Diet: The Niacin Solution by William Parsons. It is important to note that you should not take high doses of niacin, as Dr. Parsons emphasizes, without active supervision and close monitoring of your blood lipids and liver enzymes.

Makes sure to eat less of these of these foods to reduce LDL:

• Fatty meats such as pork belly and processed meats such as sausages, bacon, salami, chorizo.
• Most commercially baked goods will have lots of sugars and unhealthy fats. If you want to eat pastry, biscuits, cakes, and croissants make sure to check the ingredients carefully or try to make your own!
• Coconut oil and palm oil as they are very high in saturated fat.
• Chocolate (particularly milk and white) is very unhealthy – opt for chocolate with cocoa solids of 70% and above and make sure it is organic!
• Ready meals and processed foods are made with cheap cooking oils and processed meat and have many hidden saturated fats, along with other unhealthy ingredients. Try to make your own food from scratch or check ingredient labels carefully.

With every blessing,

Emma

 

Emma Maitland-Carew – Registered Nutritional Therapist

Dip.ION, mBANT, CHNC Registered Practitioner, ILM Accredited Wellbeing Coach

Certified Live and Dried Blood Analysis, Metabolic Balance® Coach, HeartMath Coach, Accredited Wellbeing Coach

Disclaimer

Please note that the information contained within this website does not and should not replace medical advice, and is not intended to treat or diagnose. We always recommend you consult with your doctor. Our Nutritional Therapy team is highly trained and we offer one to one Nutritional Therapy Consultations, which are designed to be complementary to any medical treatment from a functional medicine approach, as well as offering a preventative & optimal health focus.