by Diana Arundell
With 30-50% of Australian adults having high cholesterol it’s important to understand more about this substance and it’s impact on the body.
Firstly cholesterol is essential for life. The cells in our body require cholesterol to function and many of our hormones are derived from cholesterol, so it certainly isn’t something to be scared of. More recent studies in the British Medical Journal (BMJ) looking into high cholesterol and mortality suggest that high cholesterol may not cause heart disease as we originally thought and higher levels of cholesterol may in fact be protective in the elderly. It’s important to consider the individuals bigger picture of health including the ratios of the different types of cholesterol, particle size, triglycerides (fats) and all other cardiovascular risk factors.
High total cholesterol in the blood on it’s own doesn’t give adequate information nor is it an indicator of mortality. The real question is what makes up the high total cholesterol. Cholesterol is carried around the blood stream attached to proteins called lipoproteins and there are two main types of these lipoproteins that have been referred to as ‘good’ cholesterol and ‘bad’ cholesterol. These are high density lipoproteins (HDL) which are considered ‘good’ cholesterol as these HDL molecules help transport cholesterol away from arteries to the liver for elimination. It’s the low density lipoproteins (LDL – and very low density lipoproteins VLDL) which have the ‘bad’ cholesterol tag as these are the ones that can deposit in the arteries, become sticky and cause atherosclerosis which is a known risk factor for heart attack and stroke. It’s important to know the ratio of protective HDL cholesterol to potentially harmful LDL cholesterol and it’s often the combination of high triglycerides, high LDL and low HDL that is more of a concern when it comes to cardiovascular disease.
Recently there are more specific functional tests available to establish more accurately the impact of high cholesterol on the body as high cholesterol levels aren’t always associated with plaque build up in the arteries. If people with high cholesterol levels are otherwise leading a healthy lifestyle and consuming good nutrition it may not be necessary to take medication as long as other risk factors have been investigated. Coronary calcium score can establish if there is calcium build up in the arteries and establish cardiac event risk. Other blood tests can also identify other risk factors for cardiac events including high homocysteine levels and high sensitive c reactive protein. Raised levels of blood homocysteine (>10mcmol/L) is linked to high cholesterol levels and associated with increased risk of coronary artery disease and stroke. High levels of sensitive c reactive protein indicate inflammation is present and this can affect the oxidation of LDL particles in the arteries. There are also more options these days for more detailed testing looking at sub-fractions of LDL particles to establish more specific risk factor information. This information can be particularly useful for those that can’t tolerate cholesterol lowing medication.
Modern medical treatment for high LDL and triglycerides includes the prescription of ‘statin’ drugs (HMG CoA reductase inhibitors). These drugs work by inhibiting cholesterol synthesis and increasing the elimination of LDL cholesterol. Side effects of these drugs may include digestive upset, aches and pains, may increase blood sugar and the risk of type 2 diabetes mellitus. The statin drugs can also lower the level of co-enzyme Q10 which is produced by the body to help with cellular energy production and its also a powerful antioxidant which protects cells and DNA from free radical damage. It’s recommended for those taking this class of cholesterol lowering drugs to also take a co-enzyme Q10 supplement as side effects may increase with lowering levels of co-enzyme Q10.
For those who have been told their high cholesterol levels are genetic and there’s not option other than to take medication, it’s still important to address diet and lifestyle choices to support good health. Dietary and lifestyle choices can affect how our genes express. Making healthier nutrition and lifestyle choices may mean lower doses of medication as well as improvement across the board in general health and well being.
Plant sterols found in cholesterol lowering margarines and various supplements have been shown to reduce cholesterol levels. For some with only slightly elevated LDL this in conjunction with other dietary and lifestyle choices may be sufficient however for others with significantly high LDL, these treatments may not be enough to make a significant difference. Plant sterols work by reducing the absorption of cholesterol and unfortunately the absorption of other beneficial nutrients can also be reduced such as the fat soluble vitamins D and A.
Naturopathic treatment of high cholesterol includes addressing diet, lifestyle, investigating the cause of high homocysteine if present and implementing stress management strategies. Cholesterol is involved in stress hormone production and the more stressed a person is, the more cholesterol the body will produce so stress management is an essential part of treatment.
From a dietary perspective the main things to avoid are saturated fats as these appear to be more of an issue than dietary cholesterol. Saturated fats are found in animal products including full fat dairy products especially cheese. Highly processed carbohydrate diets (most packaged food and meals) are also negatively correlated with high cholesterol. Eating fresh food and less food from packages is a good start to eating a healthier diet. Eggs and seafood which are actually high in dietary cholesterol are ok to eat, just avoid cooking them in saturated fats such as deep frying.
The Mediterranean style diet shows the best evidence to support healthy cholesterol levels. This style of eating includes an abundance of fresh vegetables and fruit, fish, olive oil, garlic and healthy fats such as avocado and nuts and seeds. Consistent intake of these foods can support increasing favourable HDL cholesterol and lowering the oxidation of unfavourable LDL cholesterol. Other things that may help reduce cholesterol include oats, psyllium husks and good quality fish oils (high dose EPA/DHA – up to 9000mg day). High intake of coconut oil can raise cholesterol levels in some individuals and a diet high in water soluble fibre helps to reduce the absorption of cholesterol and improve the elimination.
Regular physical exercise and quitting smoking is also essential to help reduce the risk of cardiovascular disease.
There is not one treatment plan whether its pharmaceutical or more natural that fits everyone and sometimes it’s a combination of several approaches that works best. Time needs to be taken to understand the complete health picture of an individual in order to prescribe the best course of treatment, because after all we are treating people not diseases. If high cholesterol has been diagnosed it’s important to have regular heart check ups and also check other issues which may be related such as low vitamin D levels and Hashimoto’s thyroid disease.
Diana Arundell is a university-qualified naturopath and consults from her Avoca Naturopath clinic. She has a special interest in fertility and pregnancy health, digestive health, immune function and family wellness programs. She was a nutrition lecturer at Macquarie University for 10years, and is an accredited Journey Practitioner. www.avocanaturopath.com.au