Cholesterol
Cholesterol is an essential fat that the body uses to build cell membranes, form hormones (e.g. sex hormones and cortisol), vitamin D and bile acids for digestion.
Cholesterol is obtained from animal foods and is also produced in the liver. Since cholesterol is a lipid (i.e. fat), it cannot mix with water, and therefore needs a "transporter" when it is in our blood. The transporter is called a lipoprotein, and there are different types of them, including VLDL, LDL and HLD.
When cholesterol levels become too high or too low, it is rarely just about fat in the diet, but it becomes a symptom that something in the body is not functioning optimally.
Too high cholesterol, especially LDL, increases the risk of cardiovascular diseases such as atherosclerosis, heart attack and stroke.
Typical markers measured in connection with cholesterol:
•Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides
(and from a functional perspective often also particle size, ApoB and inflammation)
Most common causes of high cholesterol:
1. Insulin resistance - When cells do not respond optimally to insulin, the liver produces more VLDL (precursor to LDL).
Insulin resistance is often seen before prediabetes and type 2 diabetes.
2. Diet high in refined carbohydrates and sugar.
It is often carbohydrate overload, not necessarily saturated fat alone, that drives the problem.
3. Genetics (familial hypercholesterolemia)
For example, in familial hypercholesterolemia, the ability to remove LDL from the blood is reduced. Cholesterol can be very high even at a young age.
4. Low metabolism (hypothyroidism)
LDL receptors are downregulated in the liver, so LDL is no longer removed as effectively from the blood.
5. Obesity and fatty liver
Fat around the abdomen, in particular, increases the liver's production of VLDL.
6. Lack of movement
7. Chronic stress and elevated cortisol
Increases blood sugar, increases VLDL production and affects liver fat metabolism
8. Alcohol
9. Medicine
For example Birth control pills, corticosteroids, certain antidepressants
"Cholesterol is not the problem - it is the signal"
We are often told that we should eat healthier and exercise more, but it is rarely that simple.
In the clinic we go in and look for the underlying causes. Is it perhaps menopause or too little testosterone that is at play?
Is your gastrointestinal system malfunctioning, causing you to be constipated and unable to reabsorb the cholesterol that would otherwise have been excreted in your stool?
Or is your liver working overtime and lacking important nutrients to function optimally?
There are many factors that play into the "cholesterol picture" and often it is a combination of several things.
The good thing is that there is a lot you can do yourself to improve your cholesterol levels, and who wouldn't want to avoid medication if possible?