Cholesterol – good, bad or indifferent?

IMG_0274If you have a family history of heart disease then chances are you start having your cholesterol checked from an early age. But is it really a good predictor of Cardiovascular disease or are there better options for determining if you are at risk? One of the concerns about focusing solely on cholesterol is that in 2011 the Journal of the American Medical Association published results showing that 71% of heart attack sufferers had normal cholesterol levels and 14% had none of the conventional risk factors, such as smoking, diabetes, elevated cholesterol or hypertension. What do we look out for to see if we are at risk?

Cholesterol is produced naturally by the body (80%) with the rest provided by diet. Studies on consumption of eggs which are a high natural source of cholesterol showed that increasing consumption didn’t lead to an increase in cholesterol, in fact some parameters such as HDL or the so called good cholesterol actually improved as did levels of anti-oxidants in the blood. Note this study was done on whole eggs, not just the egg white. So what is happening – well if you increase dietary consumption basically the liver produces less cholesterol. So is cholesterol really the issue?

Cholesterol is a really critical molecule for the body and without it we would be incapable of producing hormones like testosterone or oestrogen and it is also incorporated in cell membranes. Structurally it is critical and that is why the liver is so good at ensuring we have enough to function properly.

What current research is showing is that its not the Cholesterol numbers that matter but rather the size of the particles. Small damaged LDL and even HDL cholesterol are more of a risk for heart disease than simply the numbers themselves. Why? Because the small damaged particles can penetrate the vessel walls and start to cause plaque which causes the artery to stiffen.

How do you find out whether your cholesterol is the right size or whether you are at risk? In the US integrative cardiologist, Dr Mark Houston, has a fabulous battery of tests which includes an Endopat test which measures endothelial dysfunction such as arterial stiffening. It isn’t currently available in Australia so here are some other measures which may be useful proxies.

1. Sit and Reach test – This is a quick and ready test that you can do yourself, sit on the floor and reach towards your toes. If you can reach or go past the toes great! If you are more than 8cm away from them you might want to investigate a little further as this could be a sign of some stiffening of the arteries.

2. C Reactive Protein – a simple blood test which measures an acute phase protein which is an indication of inflammation. Do further investigations if it is more than 3.

3. Fasting glucose – a good indicator of whether you may have elevated blood glucose which is a risk factor for Type 2 Diabetes and also indicates elevated cardiovascular risk in the future. Generally higher than 7 is a concern.

Another test I have been using in clinic is a full cholesterol panel from Nutripath. Whilst its a little pricy compared to a simple blood test it provides a full panel of cholesterol size and type making it easier to assess whether you have a concern. If you have small cholesterol particles for example , regardless of HDL or LDL they are more likely to cause damage and its these levels you should be monitoring.

Christine Pope is a nutritionist and homeopath based at Elemental Health, St Ives. She is available in clinic on Tuesdays and Wednesdays and is Head of Nutrition at Nature Care College on Mondays and Thursdays. Appointments can be made on 02 8084 0081 or through their online booking software.

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