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Cholesterol, High

High cholesterol increases your risk of having a stroke or heart attack. It’s not the only risk factor; a blood test reading of high cholesterol is considered alongside a raft of other things including a family history of heart disease, high blood pressure, being a bloke, getting older, being overweight, having diabetes and smoking.

Symptoms

There are no symptoms when your cholesterol is high. The first time you know about it is via a blood test. High blood pressure, another risk factor for heart disease, is also sneakily silent when it comes to symptoms. Therefore, regular checkups are key to knowing your heart disease risk status.

Behind-the-scenes

Cholesterol is a type of fat manufactured by the liver of animals and man. Naturally occuring in animal foods such as chicken, eggs, lamb, beef, dairy, shellfish and pork, you will not find cholesterol in plant foods – even those high in fat such as avocadoes and coconuts. Avocadoes and coconuts do not have livers, therefore cannot produce cholesterol. Cholesterol is a vital molecule in the body, being the precursor to important substances including the digestive fluid bile, the sex hormones; oestrogen, progesterone and testosterone, the stress hormone, cortisol, and vitamin D. Cholesterol is also an integral component of every cell membrane and forms part of the myelin sheath that surrounds nerve fibres. The alarm about cholesterol was raised several decades ago when it was found in the arteries of people with atherosclerosis. However, cholesterol in the arteries is just a sign, not the cause of atherosclerosis. Blaming cholesterol for heart disease is akin to shooting the messenger.

Good and Bad cholesterol

Even more important than a blood test reading of high cholesterol is the ratio between ‘good’ and ‘bad’. Good cholesterol is High Density Lipoproteins (HDL) and bad cholesterol is Low Density Lipoprotein (LDL). A lipoprotein is a vehicle which transports fats, including cholesterol, around the body in the bloodstream. Blood is predominantly water. Water and fat don’t mix. So these transporters of fat are covered in a thin coat of protein, which is water soluble. Hence the name Lipo (fat) – protein. Lipoproteins come in several shapes and sizes, and are named according to their proportions of fat to protein. LDLs, containing more fat, are less dense than HDLs, and have the job of distributing cholesterol (and fats) around the body. HDLs return cholesterol back to the liver to be excreted as bile. Both lipoproteins are important, but as LDLs are responsible for depositing the cholesterol, they have been dubbed ‘bad cholesterol’.

The story doesn’t end here. Cholesterol in the LDLs can become oxidised by free radicals. When this oxidised cholesterol ends up in artery wall it creates a small wound, which recruits cholesterol, calcium and various cells as a bandaid. This creates what is known as an atheroma or plaque, and not only narrows the artery, thereby increasing blood pressure, but has the potential to peel away, blocking arteries to the heart and brain, causing heart attacks and strokes.

The take home message is to focus on the ratio between the lipoproteins; the higher the ratio of HDLs to LDLs, the lower the risk of heart disease. If you happen to have high LDL levels, and you are at a higher risk of heart disease, your doctor might also ask for further blood tests including High-Sensity C-Reactive Protein (hsCRP) and Lipoprotein a (Lp(a)). These are other blood markers of increased likelihood of heart disease).

What causes it?

  • It used to be thought that if you ate a lot of high cholesterol food such as eggs and prawns, you would end up with high cholesterol in your bloodstream, but we now know this is not the case. Shellfish are of the hook, so to speak.
  • What does appear to increase cholesterol levels is a diet high in sugar and refined carbohydrates (bread, sweets, pastries, biscuits, etc). Trans fatty acids are also to blame, these are found in fatty takeaway foods and baked goods including pastries and cakes (again, there is a theme here). Steer clear of too much saturated fats such as the fattier cuts of meat, brie, camembert and blue cheese. Favour the leaner meats such as chicken without the skin, and choose fetta, ricotta and cottage cheese rather than the creamier varieties.
  • Stress is a major factor. Cortisol the stress hormone is manufactured from cholesterol. You need to make more cholesterol to make cortisol when you are stressed.
  • Genetics There is an hereditary condition known as familial hypercholesteraemia. No amount of dieting or exercise will significantly lower your cholesterol levels if you have this condition.
  • Being overweight increases your risk of having high cholesterol.
  • Being inactive is another causative factor.

What To Do

As there are no obvious symptoms to high cholesterol, it is wise to have regular blood tests just to keep an eye that everything is ticketyboo in the heart department.

Diet

  • Avoid or reduce sugar. A few pieces of fruit daily are fine, but avoid added sugar. Any sugar over 5 g/100 g on a packaged food is ‘added’ sugar.
  • Reduce saturated fats, especially animal fats and in particular butter, yellow and decadent creamy cheese, cream, ice-cream, lard, fattier cuts of beef, pork and lamb, bacon and deli meats.
  • Avoid trans fatty acids. Trans fatty acids now need to be declared on food labels.
  • Increase fish especially the omega 3 rich fish such salmon, sardines, mackerel.
  • Use cold-pressed olive oil, coconut oil and any nut oil.
  • Increase fibre-rich whole grains, nuts, legumes, seeds, fruit and vegetables, particularly those high in soluble fibre. Brown rice, rolled oats, chia seeds.
  • Foods with particular cholesterol-lowering effects include artichokes, ginger, cucumber, seaweed, banana, quince, onion, garlic, oatmeal, legumes, bitter melon, grapefruit, oranges, apples, yoghurt, carrots, barley, eggplant and shiitake mushrooms.
  • Add foods high in antioxidants. Foods containing betacarotene, vitamin C, Oligomeric proanthocyanidins, bioflavonoids, quercetin, resveratrol, vitamin E and zinc. Add antioxidant foods to the diet. Broccoli and the brassica family, berr, for example (AQ: blahxx) to reduce the risk of ‘bad’ cholesterol becoming oxidised causing damage to artery walls, creating arteriosclerosis.
  • Margarines that include plant sterols act to reduce absorption of cholesterol from the intestine. Studies have shown they have a small effect on lowering blood cholesterol levels. They are a highly processed food and choosing a spread of avocado or olive oil would be a naturopathic preference.

Remedies

  • Soluble fibre reduces cholesterol by preventing it from being absorbed, or reabsorbed from the intestines. The soluble fibre ‘chelates’ or holds on to the cholesterol, and eliminates it via the bowel. In addition to dietary fibre, the following fibre supplements help lower cholesterol levels. One to two tablespoons of the following: psyllium, pectin, chia seeds, oat bran, rice bran, barley bran.
  • Take 10 mls of fish oil daily. This is a very effective way to reduce your cholesterol levels. 10mls equates to 10 g and it is much more economical and easy to buy a liquid fish oil product. Fear not, most varieties nowadays are relatively palatable.
  • Krill oil has been found to be effective in reducing cholesterol levels and you need to take a smaller dose than fish oil, but then again it is more expensive.
  • Garlic helps lower cholesterol levels. Go for capsules or tablets that contain whole freeze-dried garlic.
  • Herbs which help the liver excrete excess cholesterol include St Mary’s thistle, celery seed, dandelion root, globe artichoke, tribulus and chelidonium.
  • Polycosanol is a compound isolated from sugar cane (something useful coming from sugar!) that has been found in several studies to help lower cholesterol levels.
  • Another supplement with some impressive results is the Red Yeast Rice, a traditional Chinese food and remedy.
  • Vitamin B3 (niacin) does lower cholesterol. However, it is required in fairly large amounts and has an unpleasant side-effects of hot flushes.
  • If you are taking statin drugs to lower cholesterol and experience muscle pain as a side-effect, Coenzyme Q10 and magnesium may be helpful.

Other

  • Stress may be behind increased cholesterol levels. Endeavour to find ways to reduce your stress, and hopefully your cholesterol. Meditation, yoga, a pussy cat perhaps?
  • Aerobic exercise, anything that gets you huffing and puffing and heart rate raised, lowers cholesterol levels and improves the HDL/LDL ratios.
  • Being overweight raises cholesterol levels and losing weight lowers cholesterol levels.

At a glance

Diet

  • Eat plenty of high fibre foods, these help take cholesterol out of the body. Increase all vegetables, oats, brown rice, pears.
  • Eat at least 3 serves of omega-3 fish weekly such as sardines, salmon, mackerel. Omega 3 fatty acids helps to lower cholesterol.
  • Avoid or reduce sugar.
  • Steer clear of the fattier cuts of meat. Choose ricotta and fetta over camembert and the high fat cheeses.
  • Avoid trans fatty acids, they are in take away and commercial baked foods.
  • Include foods with particular cholesterol-lowering effects such as artichokes, ginger, cucumber, seaweed, banana, quince, onion, garlic, oatmeal, legumes, bitter melon, grapefruit, oranges, apples, yoghurt, carrots, barley, eggplant, and shiitake mushrooms.

Remedies

  • Take 10 mls of fish oil daily. More economical to take as an oil rather than the equivalent 10 capsules. Citrus-flavoured fish oils are available and can be more palatable.
  • Take a tablespoon of a soluble fibre supplement daily such as psyllium or chia seeds. Soluble fibre stops cholesterol from being reabsorbed back into the bloodstream.
  • Garlic helps lower cholesterol levels. Try capsules or tablets of whole freeze-dried garlic.

Other

  • Stress may be behind increased cholesterol levels. Endeavour to find ways to reduce your stress, and hopefully your cholesterol along with it. Try meditation, yoga, a pussy cat perhaps?
  • Aerobic exercise, anything that gets you huffing and puffing and heart rate raised, lowers cholesterol levels and improves the HDL/LDL ratios.
  • Being overweight raises cholesterol levels and losing weight lowers cholesterol levels. Do you need lose weight?
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