Cholesterol – is it good or bad?

In this article we will touch on the most essential areas around cholesterol and how you can view it in relation to circulatory diseases. We will also cover what you can do yourself and what measurements are necessary to get a clear picture of whether you are at risk for developing diseases related to the circulatory system and cholesterol. We take science and functional medicine as our starting point in this article.

What is cholesterol?

Cholesterol is a type of fat that is essential for the body’s function. It is used, among other things, to form vitamin D, sex hormones, stress hormones and for cell membranes. Cholesterol is therefore found naturally in the body, and it is important that it is present for you to function properly. Therefore, the liver is able to produce cholesterol itself, without necessarily having to be supplied through the diet.

The amount of cholesterol produced can be due to environmental factors (read more about this here), but there can also be genetic variations that can affect the amount.

What can be measured?

Cholesterol must be transported around the body in order for it to be used. This is done via lipoproteins, which have different properties. Broadly speaking, there are:

LDL particles
HDL particles
VLDL particles
IDL particles

It is especially the small LDL particles that are capable of causing health problems if the amount of these is too high. It is therefore wrong to talk about good or bad cholesterol, as cholesterol is just cholesterol – it is how cholesterol is transported around the body that can have a negative impact on your health.

Try to think of it this way; People have to be transported around the country via some vehicles. The people are cholesterol and the vehicles are the different particles. If there are many small LDL vehicles to transport the cholesterol people around, then problems can arise in the circulation, such as blood clots – or in our analogy, traffic jams. If the cholesterol people are transported around in large buses or trucks, then there are the same amount of people, but they are transported in fewer vehicles, and then it is not as big a problem. The more vehicles on the roads, the greater the risk of traffic jams.

Sample answers

When you get a blood test from your doctor, you often don’t get a test that shows how many LDL particles are carrying cholesterol around, but only the amount of cholesterol or a calculated value of the number of particles. This doesn’t mean that the test is unimportant, but for some people it can be too non-specific to assess how big the problem really is.

The best measurement for the amount of LDL particles in the blood is a so-called apoB test, as it tells us directly how many LDL particles with cholesterol are floating around in your circulation. This test also takes into account the size of your LDL particles, as they also influence your risk of circulatory diseases.

We occasionally order these tests for clients who have a genetic predisposition to high levels of LDL particles or for those who are interested in delving deeper into their physiology.

The test is sometimes done on the basis of a DNA test, where different genetic variations are assessed in relation to health. This could include clients who have the variation APOE4, which in particular increases the risk of developing, among other things, circulatory diseases or Alzheimer’s. It may therefore subsequently make sense to investigate to what extent there are actually problems with the amount of LDL particles. However, it often starts with a general test with your own doctor, which should also be included in the overall assessment of your risk.

What else should be measured?

Other measurements should be taken when assessing the risk of cardiovascular disease. The amount of HDL particles has been shown to have a beneficial effect on the circulation, so a high level is desirable. Triglycerides should also be measured, as they are also part of the bigger picture. We don’t want to have too high levels of them. Both HDL and triglycerides are often measured by your doctor.

Blood pressure

In addition to blood sampling and analysis, it is important to measure blood pressure, as this can be a contributing factor in the development of circulatory diseases. When measuring blood pressure, you should sit comfortably in a chair without your legs crossed. The blood pressure cuff is placed at heart level on the middle of the upper arm, preferably the left. Typically, you will measure your blood pressure over 3 days, 3 times a day, and note the results. Subsequently, the first measurement is typically discarded before an overall average is calculated. Often, high blood pressure does not cause any symptoms, and it is therefore important to have it measured occasionally, especially if you already have risk factors for circulatory diseases.

Blood sugar

Like blood pressure, it may be a good idea to have your long-term blood sugar, so-called HbA1c, checked occasionally. High blood sugar increases the risk of developing circulatory diseases and many people can go for years without experiencing symptoms. Some researchers believe that problems with blood sugar regulation are the basis for the vast majority of circulatory diseases. Poor blood sugar regulation can eventually lead to the development of type 2 diabetes mellitus.

There are other measurements that may be relevant to take into account, such as the amount of homocysteine, HS-CRP, Lp(a), all of which can be a contributing factor to the development of circulatory diseases.

However, blood pressure, blood sugar and the amount of LDL particles (apoB) are the most obvious place to start.

All of these tests are possible through functional medicine as we collaborate with private laboratories.

What can you do yourself?

The diet
It’s great when we can take control of ourselves, and you can do that here. Your saturated fat intake can affect the amount of LDL particles in your blood, which in practice means it can affect your apoB level.

A high intake of saturated fat, which is mainly found in animal products, can be problematic. Also, make sure you get enough fiber in your diet.

Fiber, especially soluble fiber such as beta-glucans found in oats and pectin in fruit, forms a gel-like substance in the gut. This gel binds to cholesterol and helps prevent its absorption into the bloodstream, resulting in lower levels of LDL cholesterol and thus possibly lower apoB. Furthermore, fiber increases the rate of digestion and promotes healthy bowel function. This can contribute to more efficient removal of cholesterol and other waste products from the body, which can help reduce LDL cholesterol levels (Source: Sundhed.dk).

Weight loss
It probably comes as no surprise, but losing weight can also reduce apoB levels. There are correlations between the intake of sugary foods and being overweight, so cutting back here may also have a positive impact. A high intake of sugar and refined carbohydrates (pasta, white rice, white bread, processed foods, etc.) can contribute to an increase in triglyceride levels. Limiting these foods may also reduce apoB levels.

Exercise
Exercise can help increase HDL (high-density lipoprotein) cholesterol levels and reduce apoB levels. All exercise counts, so for most people it’s just a matter of getting started. A walk in nature, lifting some weights, walking in the garden, taking a bike ride daily (preferably without electricity), going for a run, or whatever it might be – it doesn’t matter. Getting started is the most important thing; then you can always focus more on it later. (Source: SST)

It is important to note that the effect of diet on apoB levels may vary from person to person, and some individuals may have a greater or lesser response to dietary changes.