Is Cholesterol Really The Issue?

The relationship between dietary cholesterol and blood cholesterol is misunderstood and much more complex than previously recognised. It was once believed that consuming foods high in cholesterol directly elevated blood cholesterol levels, which demonised cholesterol-rich foods into being the main cause of cardiovascular disease. Current research suggests otherwise, now highlighting a much more nuanced connection, and highlighting the nutritional potency of cholesterol-rich foods. Cholesterol often gets a bad rap but in today's blog, we want to clear that up. Together we are going to unpack how dietary cholesterol differs from blood cholesterol, why cholesterol is so important for us, and when it actually does become problematic. 

How does the body manage its cholesterol levels? 

The liver is a key player in cholesterol regulation. It produces cholesterol endogenously (within the body), which is influenced by both genetic factors and dietary intake. When dietary cholesterol increases, the liver often compensates by reducing its cholesterol production. Similarly, a reduction in dietary cholesterol may prompt the liver to produce more cholesterol to maintain balance. The intestines also play a major role in tightly regulating cholesterol absorption, which again depends on one’s genetic factors and also the gut microbiome. 

Cholesterol is a vital component in the synthesis of bile acids, which are required for digestion and absorption of dietary fats. However, after aiding in fat digestion, a portion of bile acids reach the small intestine, where some are reabsorbed back into the bloodstream and transported back to the liver through the portal circulation i.e. enterohepatic recycling of cholesterol. This is an important feedback mechanism the body uses to regulate cholesterol levels. As you can see, these aspects are using endogenous cholesterol regulation i.e. cholesterol the body makes itself. 

So, what is cholesterol’s role in the body?

Cholesterol's very important role in the body is unfortunately often overlooked. Cholesterol is required to create many hormones, including our sex hormones. It is the first step in the formation of pregnenolone, the precursor to all things like DHEA, androstenedione, testosterone, oestrogen, progesterone and more. We don’t only need our sex hormones to reproduce but we need them to feel good in everyday life. They are key players in energy, sleep, mood, and connection. Therefore, we need adequate levels of cholesterol to function healthily. 

When a patient presents with high cholesterol, the first thing recommended in mainstream medicine is removing high cholesterol foods from the diet. In a situation where this was not totally indicated, yet someone still went on to significantly reduce dietary cholesterol and likely then consume inadequate amounts of saturated fats, is when we generally witness hormonal issues in both males and females. 

Let’s look at some examples in clinical practice… 
When a patient presents with high cholesterol and their diet is flooded with trans fats, refined sugar, poor quality processed meats and vegetable oils, cholesterol itself isn’t the main culprit here. The cholesterol present in these forms of foods is contributing to the larger picture of cardiometabolic inflammation. Cutting cholesterol from this type of diet by eliminating said inflammatory foods may actually improve cardiometabolic status. Is this because of reducing cholesterol or reducing highly processed, non-nutritive inflammatory foods? Knowing what we now know about cholesterol, one could argue that simply by swapping this person's diet to healthy and nourishing foods (that still contain adequate amounts of cholesterol), would have a similar effect on cardiometabolic status. 

So, if a patient presented with high cholesterol in their pathology but their diet contained nourishing wholefoods, healthy amounts of saturated fats, sustainable and organic meats and dairy, no inflammatory processed goods or vegetable oils, where could the issue be coming from? You guessed it… likely their liver, genetics, and/or microbiome. By supporting these aspects, cholesterol can lower without the use of statins. 

One last thing to consider in this case is the interpretation of pathology testing holistically. Often cholesterol pathology is assessed in isolation, but when looking for patterns, clues and states of disease, someone's complete pathology needs to be utilised. Cholesterol alone is not a huge indicator of health or disease. When we are looking for cardiometabolic dysfunction, assessing blood glucose levels, insulin, leptin, inflammatory markers, liver enzymes, and anthropometrics, are all vital pieces to the puzzle. When these markers are viewed together and are all suboptimal, yes, there is a red flag. When these markers are viewed together and are all fantastic besides cholesterol being slightly elevated, this isn’t the end of the world (as much as mainstream medicine makes it out to be), but rather an indication the body needs support in one of these areas discussed. 

Have you been told you have high cholesterol and need medication? 

Has your healthcare provider assessed your pathology and case holistically, including various cardiometabolic markers? 

Have you tried supporting your liver and bowels to improve cholesterol metabolism to see if anything changes? 

If not, one of our practitioners in our clinic would love to support you. 

Written with love by Sheridan Austin and Jessie Johns.

References: 

Gorska-Warsewicz, H., Rejman, K., Laskowski, W., & Kulykovets, O. (2021). Food Sources of Cholesterol and Their Influence on Dietary Intakes of Cholesterol in the Western Diet. Nutrients, 13(8), 2849. https://doi.org/10.3390/nu13082849

P2Namara D. J. (1997). Cholesterol intake and plasma cholesterol: an update. Journal of the American College of Nutrition, 16(6), 530–534.

Soliman G. A. (2018). Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients, 10(6), 780. https://doi.org/10.3390/nu10060780

Stellaard F. (2022). From Dietary Cholesterol to Blood Cholesterol, Physiological Lipid Fluxes, and Cholesterol Homeostasis. Nutrients, 14(8), 1643. https://doi.org/10.3390/nu14081643