Cholesterol has a terrible reputation with vascular diseases, but is this fair?

High Cholesterol?

Cholesterol is vital to our very survival and yet it is clearly associated with cardiovascular disease and early death. What is it really? And do we need to fear it?

What is ‘cholesterol’?

Cholesterol is a fat and needs to be transported around the body in the blood. But blood is water based, and we know that fat and water don’t mix. This is why cholesterol needs to travel in a protein particle, called a lipoprotein. You may be aware of the two main types of these cholesterol ‘vehicles’ or lipoproteins : LDL (low density lipoprotein), the so called ‘bad’ cholesterol and HDL (high density lipoprotein), the good type.

While we worry a lot about LDL, it really plays many vital roles in the body. It is the precursor to our sex hormones, vitamin D and bile acids. It also plays an essential role in immunity and the structure and function of all our cell membranes. So, what makes it bad?

The size and quality of LDL particle ‘vehicles’ matter! For safety and efficiency, we want fewer and larger protein particles carrying greater numbers of cholesterol molecules (more passengers, less vehicles, less traffic). So, high density is better. This is why HDL is regarded as the ‘good cholesterol’, other than its important role in mopping up excess LDL and sending it off to the liver to be synthesized and excreted.

But not all LDL cholesterol is the same. While the beneficial LDL is large and fluffy, the small and densely packed type is associated with atherosclerosis. LDL can become a VLDL, a hard, very low-density lipoprotein, that damages the endothelial lining of the arteries, creating conditions for plaque build-up in those areas. We also do not want LDL to become oxidised (oxLDL), and this can happen when cholesterol containing foods or cooking oils are heated to high temperatures or when our blood sugar levels are raised.

Is cholesterol the only culprit?

Although there is more than enough evidence to show that high cholesterol is associated with cardiovascular disease (CVD), there is also evidence that the ‘condition’ of High Cholesterol is profit driven. This has meant that the benefits of diet, lifestyle and natural therapy have been downgraded and often disregarded.

From a holistic medicine viewpoint, chronic low-grade inflammation is a greater driver of cardiovascular and brain disease than cholesterol is. We also consider a number of other drivers of CVD like oxidative stress, methylation, lipid metabolism and glucose metabolism. Of course, genetic predisposition to these drivers is key.

The drivers of CVD are triggered by diet, lifestyle and inflammatory conditions.

In Functional Nutrition, we never lose sight of the fact that all our body systems work together. When we consider that the liver makes most of the cholesterol in our blood and only about 20% comes from our diet. We can ask why our liver is making too much cholesterol, rather than cutting a super-food like eggs out of our diet. Not only do we need to consider the type of fat we consume, but the efficiency of its metabolism and excretion too. The answers to all this are in our diet, lifestyle and genes.

What can we do?

Cardiovascular disease is a highly preventable disease and yet how often do we hear of ‘fit, healthy’ people dying of heart attacks or strokes? There don’t seem to be any obvious warnings, it just happens, we say. This is what makes silent conditions like high cholesterol, high homocysteine and high blood sugar so dangerous.

To protect and empower ourselves, it makes sense to include a DNA test and regular biomarker testing as part of our healthcare protocol.

DNA Testing

DNA testing is the gold standard in disease prevention. A once in a lifetime test like this can reveal blood clotting risk, potential for vascular damage and other contributors to cardiovascular and neuro degenerative disease. This invaluable information empowers us to make the right diet and lifestyle choices to avoid life changing surprises. A DNA test also alerts us to our own body’s potential for inflammation, methylation efficiency and oxidative stress, how we metabolise fats and how to manage our blood sugar. I cannot stress enough the importance of DNA testing in disease prevention.

Blood tests

The blood test most often used to test cholesterol, the Lipid Profile, measures the number of triglycerides and cholesterol particles that make up our lipoproteins (HDL, LDL and Non HDL). Unfortunately, the particularly important LDL particle size (LDL-P) is not yet included in standard cholesterol screening. We need to rely on our Non-HDL cholesterol result, which can reveal potential atherogenic particles in LDL and VLDL.

An APO B test (not part of the lipid profile test but offered by Pathcare) is the most reliable indicator of CVD, providing an accurate indication of the number of circulating atherogenic lipoproteins.

Homocysteine levels should also be tested, and too often aren't. A high homocysteine level is a significant risk factor for CVD, causing oxidative endothelial damage and atherosclerosis. It is also a risk factor for Alzheimers.

A high sensitivity C-reactive protein test (hs CRP) is another useful marker of inflammation and the condition of vessels.

How can a Nutritional Therapist help

A Nutritionist designs a personalised protocol according to her client’s unique story and information and then supports them on their journey. In most cases, it involves adding delicious, healing foods to our diets, along with optimising sleep, relaxation and movement habits. There are many simple and proven ways to use food and lifestyle modification to mitigate the risk of vascular (and other) disease.

The Nutritional Therapy approach is to:

• Maintain and support healthy gut and microbiome

• Correct LDL particle size and distribution and enhance LDL cholesterol clearance.

• Boost HDL cholesterol levels

• Reduce LDL oxidation

• Increase antioxidant potential

• Maintain healthy endothelial function

• Maintain healthy triglyceride levels

• Balance blood sugar and reduce blood glucose levels

• Maintain a healthy weight

• Decrease inflammation (CVD is primarily an inflammatory condition)

• Maintain healthy homocysteine levels

It is a journey worth taking, not only to avoid disease but to live a life filled with vitality.

RESOURCES CONSULTED AND THAT YOU COULD REFER TO TOO

Books

BLAND, J., COSTARELLA, L., LEVIN, B., LISKA, D., LUKACZER, D., SCHILTZ, B. AND SCHMIDT, M.A., 1999. Clinical nutrition: A functional approach. The Institute for Functional Medicine, Gig Harbor, Wash, USA.

JONES, D.S., 2010. Textbook of functional medicine. Institute for Functional Medicine.

MURRAY, M.T. AND PIZZORNO, J.E., 1998. Encyclopaedia of natural medicine. Three Rivers Press.

MURRAY, M.T. AND PIZZORNO, J., 2010. The encyclopaedia of healing foods. Simon and Schuster.

Websites

AP News. (2018). Global Hypercholesterolemia Drugs Market: Industry Analysis, Trends, Market Size and Forecasts up to 2024 - ResearchAndMarkets.com. [online] Available at: https://www.apnews.com/0ed278de05674e2b8860a2f44b49d236 [Accessed 18 Aug. 2018]

Foundation South Africa. (2018). Cholesterol | Heart & Stroke Foundation South Africa. [online] Available at: http://www.heartfoundation.co.za/cholesterol/ [Accessed 12 Aug. 2018].

Greenmedinfo.com. (2018). Protective Effects of Nigella sativa on Metabolic Syndrome in Menopausal Women. [online] Available at: http://www.greenmedinfo.com/article/protective-effects-nigella-sativa-metabolic-syndrome-menopausal-women [Accessed 16 Aug. 2018].

Pathcare.co.za. (2018). Apolipoprotein B and A1. [online] Available at:https://www.pathcare.co.za/webfiles/files/articles/APOLIPOPROTEIN%20B%20&%20A1_v4.pdf [Accessed 19 Aug. 2018].

Published Research Papers

Alvarez, C., Ramirez-Campillo, R., Martinez-Salazar, C., Castillo, A., Gallardo, F. and Ciolac, E.G., 2018. High-Intensity Interval Training as a Tool for Counteracting Dyslipidaemia in Women. International journal of sports medicine, 39(05), pp.397-406.

Farshchi, H.R., Taylor, M.A. and Macdonald, I.A., 2005. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women–. The American journal of clinical nutrition, 81(2), pp.388-396.

Giral, P., Bruckert, E., Jacob, N., Chapman, M.J., Foglietti, M.J. and Turpin, G., 2001. Homocysteine and lipid lowering agents. A comparison between atorvastatin and fenofibrate in patients with mixed hyperlipidemia. Atherosclerosis, 154(2), pp.421-427.

Grimaldi, M., Ciano, O., Manzo, M., Rispoli, M., Guglielmi, M., Limardi, A., Calatola, P., Lucibello, M., Pardo, S., Capaldo, B. and Riccardi, G., 2018. Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study. Acta diabetologica, 55(3), pp.219-226.

Lustig, R.H. and Malhotra, A., 2018. The cholesterol and calorie hypotheses are both dead—it is time to focus on the real culprit: insulin resistance.

Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. Jama, 292(12), pp.1440-1446.Mourad, A.M., de Carvalho Pincinato, E., Mazzola, P.G., Sabha,

M. and Moriel, P., 2009. Influence of soy lecithin administration on hypercholesterolemia. Cholesterol, 2010.

Mohan, V., Gayathri, R., Jaacks, L.M., Lakshmipriya, N., Anjana, R.M., Spiegelman, D., Jeevan, R.G., Balasubramaniam, K.K., Shobana, S., Jayanthan, M. and Gopinath, V., 2018. Cashew Nut Consumption Increases HDL Cholesterol and Reduces Systolic Blood Pressure in Asian Indians with Type 2 Diabetes: A 12-Week Randomized Controlled Trial. The Journal of nutrition, 148(1), pp.63-69.

Pfeiffer, L., Wahl, S., Pilling, L.C., Reischl, E., Sandling, J.K., Kunze, S., Holdt, L.M., Kretschmer, A., Schramm, K., Adamski, J. and Klopp, N., 2015. DNA methylation of lipid-related genes affects blood lipid levels. Circulation: Genomic and Precision Medicine, 8(2), pp.334-342.

Swiger, K.J. and Martin, S.S., 2015. PCSK9 inhibitors and neurocognitive adverse events: exploring the FDA directive and a proposal for N-of-1 trials. Drug safety, 38(6), pp.519-526.

Westman, E.C., Yancy Jr, W.S., Olsen, M.K., Dudley, T. and Guyton, J.R., 2006. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. International journal of cardiology, 110(2), pp.212-216.

Seminars

Bridget Briggs Advanced Cardiovascular Solutions Seminar (Amipro) Cape Town August 2016.