I have had several patients come in recently concerned about their cholesterol levels being high. The cholesterol bogeyman has raised its head again in these Covid virus times since the biggest co-factor that contributes to poor outcomes with a bout of Covid is metabolic syndrome, and high cholesterol is often part of the metabolic syndrome story. So high cholesterol is a red flag letting you know that something is amiss, probably. A few years back, I wrote an article about cholesterol in which I outlined its invention as a bogeyman that causes heart attacks back in the 1950s. I also mentioned how even the best of studies show that cholesterol is not related to worse cardiovascular outcomes until your total cholesterol levels exceed 240. Yet in spite of the science, doctors are being told by their cholesterol drug reps that everyone must be under 200 – in some cases, I am hearing under 180 is preferable. In my opinion, this is craziness (unless your real goal is to sell cholesterol-lowering drugs).
While there is a big conversation about how to lower cholesterol levels, both with drugs and through diet, as well as natural remedies, I hear almost nothing about why our cholesterol goes up in the first place. In my article years ago, I talked about how our body manufactures cholesterol primarily in the liver, but also in every cell in the body because the walls around every cell are made from cholesterol. Cholesterol is turned into all our hormones as well as being turned into the neurotransmitters that make our brain function. Cholesterol is a heavy hitter in the body – it does a lot of stuff. So willy-nilly lowering cholesterol levels is a bad idea – it needs to be approached very carefully. You need to know why the body is making so much cholesterol. What is it using all this cholesterol for? No one seems to ask this question.
There are two particular causes that I wish to write about that likely are behind most of the high levels of cholesterol we see these days – stress and free radicals. Both of these were big news 20 years ago, and both of them have sort of slipped off to the sidelines because there is no easy pill-popping answer for them. We like our enemies simple and easily beaten with minimal effort. We tend to ignore the bad guys that are around all the time that we don’t know what to do with. Well as Covid is showing us, the “ignore the problem” approach is not working for us. It is killing us instead.
When I write about stress, I am writing about the body’s hormonal response to stress. For an assessment of the many types of things that can trigger stress in the body go here: https://fairoakshealth.com/2021/09/19/life-stress-assessment/
In an acute stress situation, two primary hormones get released – adrenaline and cortisol. The adrenaline pumps us up and gets us moving to either fight or run away. Adrenaline acts like dumping gasoline on a fire. Cortisol supports this call to action by mobilizing sugar from the liver for the muscles to burn while altering the immune system and shutting down non-essential systems for the moment, like digestion. In the short run, cortisol dampens inflammation and decreases pain, much the same as using cortisone cream on a wound. Cortisone is just the man-made drug version of cortisol. This is all well and good for a few minutes while you get out of harm’s way. But chronic triggering of cortisol creates all sorts of problems like heart disease, stroke, anxiety, depression, digestive issues, sleep problems, weight gain, headaches, and so on.
So what does all this drama have to do with cholesterol? The issue has to do with something called the pregnenolone steal. Pregnenolone is the mother hormone all the other hormones are made from, and it is directly made from cholesterol. When we are under stress, the body steals the pregnenolone from the hormone systems and uses it to make cortisol. This would be no big deal if stress were only for a few minutes a couple of times a week, but these days many folks live in a state of chronic stress. Without the ingredients needed to make hormones, the body tells the liver to make more cholesterol with which to make the hormones from. So this is one signal that ramps up the liver’s production of cholesterol. Stress comes in so many forms these days that we all seem to be in chronic stress all the time. When you look for what to do about this, the answer usually comes back as “relax more”, meditate, journal, take walks in nature, listen to music, and exercise. While these are certainly useful and do indeed help, rarely do I find stressed folks actually doing any of them. There are reasons for their stress that all these wonderful activities do nothing to resolve. So the stress continues and the cholesterol levels keep going up.
Another big reason for cholesterol levels to rise is “free radicals” in the body. Free radicals are nasty chemicals that destroy healthy tissue in the body. Various forms of oxygen are the most common and as such it travels around in the bloodstream readily. That puts these free radicals in contact with blood vessel wall cells where these nasty guys like to attack and damage the lining of our blood vessels. One of our main defense systems is cholesterol. They sacrifice themselves in order to protect our blood vessel walls. When LDL cholesterol is manufactured in the liver it can start out as a big fluffy happy type 1B form or a small dense LDLs. The big fluffy ones have high levels of antioxidants that protect themselves from free radical oxidizers while the small dense ones have very little. These cholesterol particles bind to the free radicals to neutralize them and protect the blood vessel walls. Unfortunately, if you have a preponderance of the small dense type of LDL, once they become oxidized they become able to adhere to blood vessel walls forming atherosclerosis. They are attracted to any inflamed areas of the blood vessels, such as that caused by turbulence and pressure – such as around the heart. This is all much more complex than I am able to go into here, but the bottom line is when your doctor says you have too high a level of LDL, you need to find out what type of LDL he is talking about. If it is the 1b fluffy type, you are okay, but if it is a lot of the small dense type then you are in trouble.
What causes the body to form the small dense type of LDL cholesterol? There are many causes, but the main ones are fructose, insulin resistance, trans fats, and inflammatory omega 6 oils (vegetable oils). Saturated fats and monosaturated fats form the good fluffy cholesterol, not the bad small dense ones. So saturated fats from butter, bacon and egg yolks are all good guys on this front along with virgin olive oil, avocado oil, and omega 3 oils. It is sugar, margarine, vegetable oils, and trans fats that are the villains in this story, as well as the free radicals.
Back when the free radicals were all the rage, the usual advice was to eat more foods with antioxidants in them to fight the free radicals. This was sort of good advice, but not entirely. Antioxidants are found in many plant foods, and the usual place folks go is to eat more fruit and drink more fruit smoothies. This is a terrible idea. While the antioxidants are a good idea, the sugar levels in the fruit way out-way the benefit. Antioxidant vegetables, green tea, coffee, low sugar fruits, like lemons and berries, are all good choices. But the very best choice, like a 1000 times more powerful than any vegetable you could eat is raw dark chocolate – not the stuff you buy in the stores. Real dark chocolate in its original form is a super powerful antioxidant, but the nature of its power gives it a very bitter astringent taste. Chocolate manufacturers mix the chocolate with an alkali to remove the antioxidants that give it its bitter taste in a process called Dutching. The chocolate most people eat has more sugar than chocolate. Just a side note for you chocolate lovers. The real thing is very good for you.
So here are two possible reasons why your cholesterol levels are too high – stress and crappy food. There are many other reasons for cholesterol to go up, such as hormone issues like diabetes/insulin resistance, thyroid problems, menopause, and pregnancy. Certain medications raise cholesterol such as birth control, steroids, diuretics, some antivirals, and others. Fatty liver disease and kidney disease can raise your cholesterol. And a really unexpected one, sitting – messes you up by reducing the formation of a protective enzyme called lipoprotein lipase, which breaks down the fats in your blood. Your muscles need to be regularly flexed to produce this enzyme. So, many things can affect your cholesterol levels.
We have discussed what good food looks like many times in this newsletter. If you want a clue as to how pervasive stress is check out the stress summary on my website. My three favorite supplements for reducing cholesterol beyond what I have discussed so far are krill oil, niacin (1 gram a day), and Bergamont. Add in regular exercise, cut out the sugar, and replace any vegetable oils with olive or avocado oil and you are off to a good start. Hope this helps.
Take care,
David