So you've gotten your pathology results back and your cholesterol is high. What do you do? Contrary to popular belief, cholesterol may not be the best test for predictor of cardiovascular disease. There are 3 myths surrounding cholesterol:
Total Cholesterol has no value in predicting heart disease. Cholesterol is the firefighter trying to put out the fire (inflammation in your body)
LDL cholesterol isn't always 'bad cholesterol'
HDL cholesterol isn't always 'good cholesterol
Elevated Triglycerides, from excess consumption of carbohydrate, sugars and alcohol, is the real marker to watch. Triglycerides, along with glucose monitoring markers are now known as the greatest blood predictors of Cardiovascular Disease, Type 2 Diabetes, Insulin Resistance, Metabolic Syndrome and more.
Cholesterol & Triglycerides Management Explained
Cholesterol & Triglyceride management in the body is very regulated as will be explained. It's when the regulatory processes don't function because they're overwhelmed that we have a problem. What overwhelms them? Let's look at the process, and define the roles of some of the test markers, to find out.
Fun fact: Vitamin E relies on the same transport system we will discuss. If this system is shut down with medication, our ability to utilise Vitamin E to protect against oxidative stress is hindered!
Dietary fats (lipids) include anything fatty that we've eaten, including foods containing cholesterol, triglycerides, fat-soluble vitamins (Vitamins A,E,D,K) and more. Most cholesterol (75%) is not obtained from our foods, but generated from our bodies as will be discussed below.
ApoLipoproteins
Are proteins that form part of the 'protective coat' that surrounds dietary fats to enable them to be water soluble. Phospholipids are the other part of the coat. ApoLipoprotein components, which will be discussed below, include:
ApoA1 - includes HDL
ApoB - includes Chylomicrons, VLDL, IDL, LDL, Lp(a)
LipoProteins
Lipoproteins = Dietary Lipids + Apolipoproteins (This is the reason why we need to be fasting, so we don't include lipids from our food in our test results).
Total cholesterol is the sum of all the Apolipoproteins, plus any dietary fat if we haven't fasted. It is not a very specific marker of what is going on in our bodies.
When we eat dietary fats, they get transported to the small intestine. As they are fatty, in a watery environment, they need help to become water soluble. This is where Lipoproteins come in. They join on to the dietary fat. Their jobs are to enable the dietary fats to become water soluble, and to enable triglycerides to be liberated for the body's energy needs.
Chylomicrons
Chylomicrons from the cells of the small intestine are initially involved, immediately after we've eaten. Chylomicrons, are mostly triglycerides, and get absorbed into our lymphatic system and then into our bloodstream, and their job is to deliver broken down triglycerides (fatty acids and glycerol) from the food we've just eaten.
Some of the triglyceride components (fatty acids) get delivered to our muscle cells (for use when we are active), or to our fat cells that get reassembled back into triglycerides (if we are inactive). This is a major reason why going for a walk after we've eaten is so valuable, so we help the lymphatic system.
To reassemble into triglycerides, the body needs carbohydrates, or alcohol. This is why people with diets high in either carbohydrates or alcohol can have high triglyceride levels, which is a negative indicator for cardiovascular health.
VLDL (Very Low Density Lipoproteins)
Leftover remnants of chylomicrons, mostly triglycerides once again, are taken to the liver and incorporated into VLDL whose job is to dispense any further triglyceride out to the cells of the body.
IDL (Intermediate Density Lipoprotein)
VLDL becomes IDL and squeezes any residual triglyceride out. It is equally high in triglyceride and cholesterol.
LDL (Low Density Lipoprotein)
These LDL carrier molecules are getting smaller as the triglyceride is now removed, and we are left with mostly cholesterol. Cholesterol has many important jobs. It is the precursor to our sex hormones (Oestrogen, Progesterone, Testosterone), Cortisol, Vitamin D, Bile Salt production, and is important for maintaining all our cell membranes. It's not necessarily the nasty we have heard it is. It is LDL's job to deliver the cholesterol to our body sites that need it. Though not a regular test request, Oxidised LDL is the marker to measure if we are concerned about levels of LDL in the body, as the Oxidised LDL is the real nasty. LDL subfractions can also be tested to make sure you have large bouyant LDL particles and not small, dense atherogenic particles.
Lp(a)
Consists of an LDL molecule bound to an ApoLipoprotein component, with a strong genetic component to its levels.
HDL (High Density Lipoprotein)
HDL molecules are made in the Liver and Gastrointestinal tract (GIT). They are mostly protein and their job is to pick up any excess cholesterol not needed for our sex hormone production, cortisol production, Vitamin D, Bile salts and cell membranes, and return it to the liver for detoxification and removal from the body bia Bile in our Faeces. This is another reason why all our detoxification pathways must work efficiently. As cholesterol is needed for cortisol production, we can see why elevated total cholesterol levels can occur when we are stressed.
Having discussed all the various components of cholesterol, clinically, it has not been shown that improving cholesterol markers improves cardiovascular risk. Other markers have been determined as better to review. These include triglycerides, glucose, insulin, HbA1c, Homocysteine, Liver Function Tests (ALT & GGT), Uric acid, and then looking at the gold star radiology method - Coronary Artery Calcium Score discussed below. Glucose, Insulin, HbA1c, and Homocysteine are discussed in separate blogs:
Triglycerides
Elevated triglycerides alert us about the potential for delayed removal of pro inflammation from our cell walls. This is what we need to watch.
Calcium Artery Score
The risk of cardiovascular disease is about the risk of plaques in our blood vessel walls. This test measures the amount of calcified plaque in our heart arteries, which may lead to thinning of the blood vessel lumen, shortness of breath (oxygen), as an estimate of the future risk of a heart attack. If you are concerned, this is definitely a test to request from your G.P.
Lipid Test Markers Functional Reference Ranges
Test Marker | Comments |
Total Cholesterol | Familial Hyperlipidaemia, a genetic condition, can see results very high results |
Triglycerides | Review for diet, lifestyle when results are high |
HDL | Desirable to be elevated, however too high along with too low is not necessarily good. |
​Triglycerides: HDL Ratio | ​Seen as a better predictor of heart disease |
LDL | Too low is not necessarily good either |
Apo B | The protein carrier of the combination of Chylomicrons, VLDL, IDL and LDL |
Apo A-1 | The protein carrier of HDL |
Apo B: Apo A1 Ratio | We want more Apo A1 than Apo B |
Table: highlighting optimal reference ranges for Lipid testing
What are the real culprits of cardiovascular disease?
The real culprits of heart disease, include excess triglycerides, excess fibrinogen, elevated homocysteine, inflammation from increased belly fat, high triglyceride to HDL ratio, and high glycaemic levels (discussed in another blog).
Strategies to improve Cardiovascular Risk
The primary goal is to get Triglycerides <1 for absolute optimal health. Keep alert when values rise above that
Losing weight - will lower triglycerides, lower LDL levels
Increasing exercise - will increase HDL levels
Decrease belly fat will come from taking a walk every day
Reduce alcohol intake to special occasions
Stopping smoking if that is a factor
Reduce inflammation in your body with a holistic health focus
Eating more plant based foods so your plate is 2/3 plant based foods to 1/3 animal based foods
Eating less sugar, and simple carbohydrates that are heavily processed, and eating more fibre (complex carbohydrates).
Take note that the Oral Contraceptive Pill (OCP) poses thrombotic risks in those women who are overweight.
Improve Thyroid function. Overt Hypothyroidism increases Cholesterol, LDL, Triglycerides. Overt Hyperthyroidism decreases those markers. Why does this happen? We need good levels of FT3 for Bile Flow to clear cholesterol. Cholesterol is also needed for Bile Salts. The Goldilocks effect once again.
Discuss your circumstances with a qualified Naturopath, to obtain nutritional information, along with herbs and supplements that can help.
Sitting is the new smoking!
Why? Lymphatic clearance is needed at the very beginning of the process. Movement is needed for lymphatic clearance. Daily bowel movements are needed as cholesterol is removed via bile in our faeces. Liver detoxification needs to work well, so it's broken down into bile, and not reabsorbed. We need to burn up what we eat. So we need to move our bodies, and not sit all day.
Special note for Menopause
Typically in menopause, Cholesterol, LDL, triglycerides all increase, while HDL decreases.
If you would like to discuss your personal circumstances, or have your pathology results reviewed in line with your current situation, feel free to make a booking with me on the bookings tab on my website.
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References:
High Circulating Triglycerides Are Most Commonly a Marker of Ectopic Fat Accumulation: Connecting the Clues to Advance Lifestyle Interventions (AHA):
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