Cholesterol gets a pretty bad reputation in the self-care health circles but it may be time to revisit this ubiquitous molecule. Cholesterol is the backbone of steroid hormones, bile salts, vitamin D, and cell membranes. Without cholesterol, we would not be able to digest foods properly; our cell structure would not be able to withstand any changes in temperature, and a significant number of important hormones such as estrogen and testosterone could not be produced. So how can it be that bad? Well, like all good things it is best in moderation. High total cholesterol, triglycerides, LDL, and trans fats are linked to an increased risk of cardiovascular events. Our bodies have developed endogenous (internal) systems for the balanced production and elimination of cholesterol. Cholesterol can build up due to increased production, increased consumption, or decreased excretion. Ultimately leading to an imbalance. When the ratios different types of cholesterol are not balanced, we get dyslipidemias, meaning elevated triglycerides and LDL, and/or low HDL (the good chaperone) cholesterol.

A key player in cholesterol production in the liver is acetyl coenzyme. A number of reactions convert this into cholesterol. One step in this process that became the target of pharmaceutical development is the enzyme HMG-CoA (3-hydroxy-3-methyl-glutaryl-CoA) reductase. Inhibition of this enzyme can block your endogenous production (irrespective of how much cholesterol you are consuming from foods.) Statin drugs are HMG-CoA reductase inhibitors. Think of this like blocking a dam upstream, everything downstream will dry up. Unfortunately, downstream products of this process include many other molecules such as co-enzyme Q10, arachidonic acid and more. Hence, the systemic effects of statin drugs, which can often result in the patient having to discontinue use as well as statin-induced muscle pain, elevated liver enzymes, lung disease, and in a small subset of patients, increased risk for type 2 diabetes mellitus. So clearly, we need to examine a multifactorial approach to cholesterol management including reducing exogenous intake, increasing elimination, and improving the ratio towards the healthy fats to reduce risk.

Limiting cholesterol consumption

The standard North American diet is full of highly processed, saturated trans fats. So, what are some pitfalls we should avoid:

1. Saturated vs. unsaturated oils: Saturated fats mean the oil is not fluid, it is rigid and well packed, perfect for clogging. Unsaturated oils are usually liquid at room temperature and can solidify when cooled. These tend to be better for cooking and consuming.

2. Cis vs. trans fats: This is a buzz term that relates to the chemical configuration cis (same side) while trans (opposite sides.) The problem is that the trans-configuration is not a natural configuration and is usually the result of partial hydrogenation during production. It allows the fatty chains to pack more closely together, much like a saturated oil. This configuration increases the risks of plaque formation.

3. Cold vs heated oils: The configuration, length of bonds determine if the oil can and should be used in cooking. For example, those that are solid at room temperature can withstand more heat, while shorter chain fatty acids may be better as cold bases for dressings etc.

Increase excretion

Cholesterol is packaged into bile for excretion, much of which can be reabsorbed in the GI tract. It is important to bind these onto indigestible fibres that pass through the GI tract. Hence, fibre and regular bowel movements should be a primary target for cholesterol management. You should aim to get at least 35 grams of fibre in your diet daily, from plants, psyllium, oats, and supplements if necessary. Removing inflammatory foods, promoting nutrient absorption, populating a healthy microbiome, and stimulating a healthy migrating motor complex are also ways to improve digestive function.

Managing Healthy Cholesterol Levels Naturally:

1. Dietary HDL: Since HDL is able to scavenge for excess cholesterol in tissues and in circulation to take back to the liver for excretion, it is an important target for the treatment of dyslipidemia. Certain types of healthy fats in the diet such as unsaturated, non-trans fats like olive oil or fish oil can promote HDL, while saturated and trans-fats increase the LDL content. HDL can increase by eating more good fats particularly those that are unsaturated, non-trans, with one or more double bond present, like olive or fish oils.
2. Red Yeast Rice: A traditional Chinese approach to dyslipidemia is the consumption of Red Yeast Rice (RYR). Monocolin K-free red yeast rice has demonstrated the ability to favorably affect cholesterol levels
3. Bergamot: This citrus fruit is found in earl grey tea and is the ingredient responsible for its distinctive flavor. Multiple studies have focused on bergamot’s beneficial effects on total cholesterol, LDL, HDL, triglycerides, blood sugar, and markers of oxidative stress. It was studied in high cholesterol patients, those with fatty liver disease, metabolic syndrome, and in conjunction with statin drugs.
4. Tocotrienols: Four tocotrienol molecules comprise the eight-member vitamin E family. These vitamers were studied for their independent benefit on blood cholesterol. Participants of a double-blind placebo-controlled trial, with high blood cholesterol level receiving daily supplementation with mixed tocotrienol had significant reductions in total and low-density lipoprotein (LDL) cholesterol levels by the fourth month of supplementation.
5. Plant Sterols from fruits and vegetables can help block excessive absorption of cholesterol and reduce circulating LDL cholesterol.