Why Your Cholesterol is High, Plus What To Do About It
Does red meat cause high LDL cholesterol? Yes and no. Read on to find out more.
If you have high low-density lipoprotein cholesterol (LDL-C), you’ve probably been warned by your doctor that you’re at increased risk of developing heart disease. While this is correct - high LDL-C does indeed increase the risk of heart disease, particularly atherosclerosis - the solution is a little bit more complex than cutting all saturated fat from your diet. But there is a solution to decreasing your cholesterol, don’t worry. It’s just going to require you to do a little bit of detective work.
Before we get started on some possible solutions - and this will be slightly different for different people - let’s get our heads around what LDL-C does, why we actually need to have some if it, and why it goes up in the first place.
Before we get started, a quick disclaimer: the following is general in nature and not intended as medical advice.
What is LDL-C and What Does it Do?
LDL-C is a type of cholesterol with seemingly a couple of different roles in the body. See, your body is so incredibly smart, it likes to put the one molecule to multiple uses. This is an incredibly efficient way of doing things, like repurposing items around your house for multiple uses.
The role that we know the most about is as a transport protein. Its job is to carry energy in the form of triglycerides around the body to cells that need it. This is why triglycerides and LDL-C are often elevated at the same time: you need to make more LDL-C so that you can move the triglycerides to where they need to go. Otherwise, you’ll end up with an excess of energy in the liver and end up with non-alcoholic fatty liver disease.
But on top of that, it seems to also increase as a protective response to homocysteine. Homocysteine is an amino acid produced through methylation. When methylation isn’t working properly, homocysteine accumulates, leading to increased inflammation, In the heart, it does damage to endothelial vessels in the arteries. LDL-C appears to have antioxidant properties, so is produced in excess to come and help clear up the damage.
In fact, it may even act as a compensatory mechanism when other molecules that act as antioxidants are low. Research shows that when vitamin D is low, LDL-C increases, potentially to step in and take on the antioxidant role. Supplementing with vitamin D brings it down in people who deficient in vitamin D. Perhaps not surprisingly though, vitamin D supplementation in people who aren’t low in it doesn’t budge LDL-C.
Why not surprisingly? If vitamin D deficiency isn’t the reason why LDL-C is high, then why would it go down if you’ve just given your body something it doesn’t need. It hasn’t fixed the actual problem.
Similarly, omega-3 fatty acids play an important role in keeping triglycerides low. When someone is deficient in them, triglycerides rise. LDL-C rises in equivocal fashion. When you supplement with omega-3 fatty acids, triglycerides go down and so too does LDL-C.
The downside to having LDL-C step in to help when other molecules aren deficient or can’t do their job is that it’s not very stable as an antioxidant. It can oxidise and appears to sometimes contribute to the development of plaque in arteries. The way that I interpret this is that LDL-C isn’t meant to be a long-term solution to inflammatory issues in the body. It’s a stop gap while you reduce oxidative stress and/or correct your diet so that it contains the right balance of nutrients.
What Causes High LDL-C?
As you’ve just seen, nutrient deficiencies seem to be a major cause of high LDL-C. They’re not the only cause though. Some people, known as hyper responders, do get higher LDL-C apparently directly in response to cholesterol they consume from their diet. There a couple of reasons why.
Firstly, some people have genetic mutations in genes involved in cholesterol transport, such as those encoding apolipoproteins. Apolipoproteins are proteins that bind lipids to form lipoproteins, which transport fats through the blood. Variants in the APOE gene (responsible for apolipoprotein E), for instance, have been linked to altered lipid responses, leading to different LDL-C increases depending on how effectively an individual processes and clears cholesterol from the bloodstream.
An increase in dietary cholesterol often leads to a decrease in cholesterol synthesis in the liver. This is a mechanism to maintain homeostasis, so that the body doesn’t end up with too much cholesterol. Some people have mutations that prevent this homeostatic mechanism from working as well, so they can end up with higher LDL-C.
Another hypothesis is that hyper responders have a higher rate of cholesterol absorption from the intestine, combined with altered bile acid synthesis. Bile acids, derived from cholesterol, aid in fat digestion, and their synthesis can help regulate cholesterol levels. If this synthesis is insufficient, excess cholesterol remains in circulation. This can lead to an increase in LDL particles in the bloodstream in response to higher dietary cholesterol.
Some hyper responders may also exhibit increased LDL particle retention in arterial walls or heightened sensitivity in endothelial cells to cholesterol levels. This sensitivity could potentially increase LDL particle retention, thus elevating cholesterol levels as the body attempts to compensate for tissue demand or vascular inflammation.
You know what’s interesting though? A 2018 review concluded that, while consuming more dietary cholesterol could increase serum LDL-C in hyper-responders, it was ALWAYS associated with unequivocal increase in high-density lipoprotein cholesterol (HDL-C). This is the protective form of HDL-C. In fact, the researchers reported that because of this equivocal increase in HDL-C, there was no risk of heart disease to these people.
Only around 20% of people are hyper responders. In 2008, the World Health Organisation reported that around 40% of adults globally had elevated total cholesterol. Even if all 20% of hyper responders are included in there, that means 20% of people have elevated cholesterol for other reasons. This means that at least 20% of people with high cholesterol are likely dealing with inflammation or deficiencies. If they’re not corrected, these people may, in the long term, be at increased risk of heart disease.
What to Do?
There are three very simple steps you can take.
Check for micronutrient deficiencies.
Get comprehensive testing done to see what deficiencies you have and go through them with a health professional who will help you identify what’s outside optimum ranges (not just the standard lab ranges, which are mostly useful unless you’re going into organ failure). Alternatively, I have a guide to interpreting general labs to spot nutrient deficiencies, which you can purchase here.
Correct any micronutrient deficiencies.
Make whatever dietary or supplementation adjustments are necessary. I’m a big advocate for a food first approach but I get, sometimes you need somegthing that comes in capsule form. Just make sure that anything you take is high quality and you can use my guide to safely introducing supplements here.
Retest.
After a month or two, you need to ensure that whatever you’re doing is working and you’re giving yourself full nutritional support. You also want to ensure that you’re not doing over-doing anything supplement-wise (yes, this is possible) so re-testing a little while after making some changes acts as a safety net.
That’s it! That’s a simple approach to personalise your own nutrition plan based on data.
Still need help? You can book in for an appointment with me here.