19 - Putting Raised Cholesterol Into Context

Cholesterol is one of those things that people often get really worried about. And yes, I do like to address anything that’s out of a reference range and give it proper consideration.

But I think it’s really important with cholesterol that we don’t just see it as a raised marker that we want to squash back down again and forget about. It’s an interesting marker that tells us a lot about the body, and it’s worth understanding what it’s there for so that we can more appropriately address it.

Step One: What Type of Cholesterol Is Raised?

When cholesterol is raised, the first thing I want to think about is what type of cholesterol is raised. This is where we do a bit of a risk assessment.

Total cholesterol might be raised, but is it the LDL? If so, what are the particle sizes, and which LDL particles are elevated? It’s really only the very low-density LDL particles that are more concerning compared to the larger, high-density ones.

I also want to know if triglycerides are raised and how they compare to HDL — so we look at that ratio. And we want to see whether the individual has more lipoprotein A or lipoprotein B, because one can be more of a risk factor than the other.

So it’s really about putting cholesterol into context and understanding exactly what’s going on. It’s not just, “Okay, cholesterol’s raised, let’s get it down.” It’s, “Hang on — let’s look at the details. What is raised, and how are all these markers relating to each other?”

This matters because HDL cholesterol is more protective. If HDL is higher and that’s increasing total cholesterol, that’s less of a concern than if HDL is low but total cholesterol is high.

Likewise, triglycerides are more concerning than larger, higher-density LDL particles. The larger LDL particles are generally less concerning than the very low-density ones.

So we want to properly look at what’s happening and get the full picture rather than reacting to one number.

The Bigger Question: Why Is Cholesterol Raised?

Once we’ve established what’s going on, and started any necessary treatment regimes, I also want to ask: why would cholesterol be raised for this person?

It’s not just a matter of, “It’s high, let’s lower it.” It’s about understanding why it’s high in the first place.

There used to be thinking that if we ate high-cholesterol foods, we’d automatically have high cholesterol in our blood. It doesn’t really work that way, because our body also makes cholesterol.

So why would our body make cholesterol if it were a bad thing? Cholesterol isn’t bad in itself. We make it because we need it.

We use cholesterol to make hormones like cortisol and sex hormones. We use it to strengthen cell membranes — it’s like the foundation wall of your home, the strong structural part of the cell membrane.

We also use cholesterol to make vitamin D. When our skin comes into contact with sunlight, that triggers a chemical process that converts cholesterol, over many steps within the liver and kidneys, into vitamin D.

So cholesterol has many essential roles. If the body is making more cholesterol, it’s often because the body needs support somewhere.

Stress, Hormones, and Vitamin D

When cholesterol levels are high, I always ask:

• Is this person running on stress and needing to make a lot of cortisol?
  If so, they’ll need to make more cholesterol to support that.

• Does this person have low vitamin D and is the body trying to produce more cholesterol in the hope it will be converted when exposed to sunlight?

• Is there disruption to sex hormones?

• What is the thyroid function like?

All of these are reasons why someone might be producing more cholesterol internally, or in the case of thyroid issues, eliminating less of it.

Cholesterol, Digestion, and Elimination

We take some cholesterol in through our food and eliminate it through the digestive tract.

So, if cholesterol is high, we need to ask: are we eliminating it properly?
Is there regular bowel movement? Is there enough fibre in the diet? Are you making enough bile salts to bind cholesterol and move it through the digestive system so it can be excreted rather than reabsorbed?

Yes, we can look at what cholesterol is coming in through the diet and make preferable food choices. But it’s equally important to look at digestion, bile production, fibre intake, and elimination.

Thyroid Function and Cholesterol

Another important driver of cholesterol is thyroid function.

The thyroid is like the metabolic switch of the body. If thyroid function is low, there’s reduced bile salt production and reduced processing and elimination of cholesterol. This can lead to cholesterol building up.

In fact, elevated cholesterol is one of the signs we look out for that may indicate an under-functioning thyroid. That’s why thyroid health is so important to assess in this context.

Cholesterol Within Overall Cardiovascular Risk

I also want to look at where cholesterol sits within the bigger picture of cardiovascular risk.

People worry about cholesterol because of the attention around it being a cardiovascular risk factor. And yes, it’s important. But it’s not the only factor.

We also want to assess:

• Blood pressure

• Calcium artery score

• Blood thickness or stickiness

• Family history of cardiovascular disease

• Insulin resistance, blood sugar, and insulin levels

• Diet and lifestyle factors that either support or increase cardiovascular risk

• Homocysteine and methylation

• Diet, stress, sleep and exercise

Looking Upstream and Downstream

If you come to me with raised cholesterol, I will want to explore:

• What type of cholesterol is raised?

• Is it higher or lower risk?

• How do we address it?

I’m also really keen to look upstream:

• Diet

• Digestion

• Vitamin D

• Cortisol and stress

• Sex hormones

• Thyroid function

And I look downstream:

·       How does cholesterol contribute to your specific cardiovascular picture?

·       How is your cardiovascular health generally? Have other contributing factors been assessed and explored?

·       Are there family history or genetic factors?

All of these help to put your cholesterol scores into context.

The Whole-Person Approach

As you can see, it’s not just:
“High cholesterol = lower the cholesterol.”

It’s about asking:

• What’s upstream?

• What’s downstream?

• What’s in the fine detail right in front of us?

This allows us to look at cholesterol in context and address the whole person, not just the number on the page.

Next Steps

If you have raised cholesterol yourself, I hope this has been informative, reassuring, and helpful in giving you direction about what might be worth investigating and discussing .

If you’d like support in exploring your raised cholesterol more deeply and looking at all the factors we’ve discussed, please email me at kath@kathleenrobb.com. You can book an appointment or a discovery call, and we can talk about what’s happening for you and how I can help.