High cholesterol is very common in the developed and western world, usually with total cholesterol above 200 (*units), and unfortunately becoming even more prevalent in countries that adapt these same eating and lifestyle habits.
Total cholesterol is comprised of a few different types, such as high-density lipoprotein (HDL; ‘good cholesterol’), low-density lipoprotein (LDL; ‘bad cholesterol’), very low-density lipoprotein (VLDL), and triglycerides (TAG). Each have a different role and meaning in the body, and beyond ‘eating cholesterol raises cholesterol’, triglycerides can also reflect sugar intake.
Triglycerides are 3 fatty acids (acyl groups) bound to a glycerol molecule (a carbohydrate), which then the body stores as fat, and then uses it as energy during a fasting state. Limited digestion occurs in the mouth and stomach, though fats are emulsified in the intestines upon release of hormone cholecystokinin (CCK), which signals the gallbladder to contract and release bile, and the pancreas to release digestive enzymes.
Bile salts bind to the TAG until pancreatic lipase (digests fat) hydrolyzes it into free fatty acids and 2-monoacylglycerol, and then another enzyme to make triacylglycerol (another name for TAG). Then they get packaged in chylomicrons (or would get stuck in the bloodstream), which also carry cholesterol and fat-soluble vitamins) and then distributed to tissues in the body to be used for energy (Leiberman & Marks, 2005).
On the other hand, cholesterol is made up of HDL and LDL, contributes to production of bile acids (help absorb fat-soluble vitamins A, D, E, K), hormone production, and cell membrane integrity, hence why we do need fats in our diet. Humans produce the majority of cholesterol, while only 15% of it comes from our nutrition intake.
The Merck Manual describes dyslipidemia as the elevation of plasma cholesterol, TAG’s, or both, or LDL that contributes to development of atherosclerosis (hardening of arteries), though there’s a few different combinations of molecules that can make a diagnosis of high cholesterol.
Primary causes of elevated TAG are due to single or multiple genetic mutations that decrease clearance, or increase production rate. Secondary causes tend to be lifestyle related with the most important factors being a sedentary lifestyle with diet high in saturated fats and sugar.
Other contributing factors could be thyroid, liver enzymes, fasting glucose, creatinine, and urinary protein, while additional concerns around heart disease risk factors should be addressed like cigarette use, diabetes mellitus, high blood pressure, and family history of heart disease (Goldberg).
Consider also testing c-reactive protein and homocysteine as they are great markers for cardiovascular risk, as well as hemoglobin A1c (amount of sugar on a red blood cell for 3 months). Further, elevated estrogen and testosterone, as well as elevated cortisol (e.g. stress, poor sleep) can also raise TAG.
Guidelines are typically under 150 mg/dL, but lab ranges are based on pathological changes- the higher the TAG, the higher the chance of increased amount of small dense LDL particles (versus big and fluffy) that get lodged in blood vessels and raise the risk of heart attack or stroke.
Narrowing down the range so that it’s never twice the amount of HDL (regardless of total cholesterol), yet about 75-100 mg/dL has clinically shown to be a healthy level. When triglycerides get too low and blood sugar is normal, there may actually be a perpetual stress response as cortisol prompts the body to ‘eat it’s own tissues’ due to releasing stored fat and protein getting converted to sugar (contribute to normal sugar response)- yet these people may be going through repeated hypoglycemia (e.g. fainting, feeling tired, bursts of energy, cravings).
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High triglycerides can be due to a variety of factors, and all of those need to be addressed regardless of just ‘blaming’ genetics (only a blueprint, usually not solely the reason why). While certain therapies (either natural or pharmaceutical) can lower cholesterol, treating other factors not only contributes to lower levels, but can improve existing conditions and/or prevent them.
Regular physical activity like resistance training and moderate intensity aerobic exercise (high intensity is optimal) helps improve TAG (Mann, Beedie, & Jimenez, 2014), and high-intensity interval training (HIIT) is great to balance blood sugar and reduce carbohydrate/sugar cravings.
A Mediterranean based diet full of vegetables, fiber (e.g. ground flaxseed, vegetables) healthy oils (e.g. avocado, olive oil), and protein sources (e.g. fish, chicken, beans) is a great foundation, in addition to reducing/eliminating alcohol (gets metabolized right to sugar), and sugar (e.g. anything that ends in ‘ose’). Not just those found in preservatives, but lots of fruit can also be an issue.
Supplement wise (still best to have a healthful diet and lifestyle), omega 3 fatty acids (EPA and DHA) (Bradberry & Hilleman, 2013) and niacin (decreases conversion to triglyceride stores) can be helpful (Ganji, Kamanna, & Kashyap, 2003).
Stress management is incredibly important too as high stress can affect many other processes both directly and indirectly involved in triglyceride formation. Stress increases our need for sugar, which is then made, and also craved (cookies for immediate energy anyone?), and can manifest as emotional, overexercising, many physical symptoms/concerns, and poor sleep.
Consider discussing too with an integrative or naturopathic doctor who is well versed in herb/drug/nutrient interaction, and can best address multiple concerns, risk factors, and develop an individualized plan.
This great guest post was written by Dr. Serena Goldstein, a naturopathic doctor specializing in natural hormone balance! I encourage you to go check out her website!
Bradberry & Hilleman, 2013
Ganji, Kamanna, & Kashyap, 2003
Leiberman, M. & Marks, A. (2005). Basic medical biochemistry, a clinical approach: third edition. Lippincott & Williams. p. 595-596.
Mann, Beedie, & Jimenez, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906547/
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