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What is high cholesterol (hypercholesterolaemia)?

Understanding your condition

High cholesterol (Hypercholesterolaemia) is a general term used to describe dyslipidaemia - a suboptimal blood lipids profile.

Cholesterol is important for the production of steroids, sex hormones, bile acids, and as a component of all cell membranes.  Our bodies only require a small amount of cholesterol to perform these important functions, and when blood lipid levels become altered, there is an increased risk of cardiovascular disease and development of cardiometabolic disease.

High cholesterol requires a deeper look

Cholesterol, and more broadly dyslipidemia, should not be considered in isolation, but as one component of a comprehensive cardiovascular and cardiometabolic disease risk assessment.

The functional medicine approach assesses a person holistically to understand why blood lipids are abnormal. Once identified, the best natural treatment for high cholesterol involves treating the underlying causes so a person's cardiovascular health can be improved, reducing the risk of cardiovascular events.

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Symptoms of high cholesterol

Unfortunately, most people who develop hypercholesterolaemia will have no overt signs and symptoms, and the dyslipidaemia is only discovered by chance when the blood is tested during a routine health check.  This is why it is vitally important to have your lipid profile checked regularly, especially if you are:

  • Over 40 years of age
  • Overweight or obese
  • A smoker
  • Have excessive alcohol intake
  • Consume a diet high in saturated fats and low in fibre
  • Lead a sedentary lifestyle, or;
  • Have a family history of hypertension or cardiovascular disease

Cholesterol markers - what do they mean?

Hypercholesterolaemia is diagnosed when an elevated level of total cholesterol is found on a blood lipids panel.  Australian guidelines currently recommend a total cholesterol level of less than 4.0mmol/L for people at high risk for the development of cardiovascular disease, or less than 5.5mmol/L for the general healthy population. Elevated total cholesterol however, is not a reliable indicator for cardiovascular disease risk, and the standard medical approach is to test for High Density Lipoprotein (HDL) often referred to as good cholesterol, Low Density Lipoprotein (LDL), HDL:LDL ratio and triglycerides.  If these markers are outside the normal ranges then dyslipidaemia is diagnosed.

Cholesterol is an essential fat produced in the liver and some other tissues. It is then transported in the blood attached to lipoproteins (fat transporting proteins), which is why a lipid profile will usually include the following markers (optimal ranges included):

  • High Density Lipoprotein (HDL-c) 1.0-2.0mmol/L
  • Low Density Lipoprotein (LDL-c)   2.0-3.5mmol/L
  • Total Cholesterol (TC) 3.0-5.5mmol/L
  • Non-HDL Cholesterol <3.37mmol/L
  • Triglycerides <1.7mmol/L

In addition to the standard lipid profile, it is advisable to also measure:

  • Apolipoprotein B (APO-B) <130mg/dL
  • Very Low Density Lipoprotein (VLDL) <30mg/d

HDL-c

HDL-c is often referred to as “good” cholesterol as it is responsible for transporting cholesterol out of the cells and back to the liver where it is synthesised into bile acids and excreted.

LDL-c

LDL-c is often referred to as “bad” cholesterol as it transports cholesterol from the liver to the cells where it is used in cell structures or to make various hormones.  For this reason LDL-c should not be considered “bad” but recognised as being in excess.

VLDL

VLDL is responsible for transporting triglycerides to the cells of the body to make energy.  If triglycerides are high, VLDL will transport them to adipose tissue where they are stored as body fat.

APO-B

APO-B is another type of protein that is associated with cardiovascular disease, as it is atherogenic - meaning it is able to contribute to arterial plaque associated with cardiovascular disease.  APO-B attaches to other atherogenic lipoproteins such as LDL-c and VLDL to provide structural support to the fatty plaque-like structure. Having a high level of APO-B correlates to a high level of atherosclerotic plaque forming lipoprotein structures in the blood.  Current evidence suggests that APO-B is a better marker than cholesterol, HDL, and LDL to determine cardiovascular disease risk.

However, cholesterol isn't the problem

A common misconception about cholesterol is that it is “bad” and therefore if you lower cholesterol, you lower your risk for developing cardiovascular disease. Yet the main problem with hypercholesterolaemia is less about the cholesterol and more about these plaque forming lipoproteins that are responsible for the transport of cholesterol and triglycerides around the body.  It is these lipoprotein structures (LDL, VLDL, APO-B) that correlate to cardiovascular disease development.

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:

Genetics

Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.

Hormones

Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

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What causes high cholesterol?

For the majority of the 1.5 million Australians who have high cholesterol, the root cause for elevated cholesterol levels and dyslipidemia will be dietary.  Foods that can cause high cholesterol are those high in saturated and trans-fats, and low in unsaturated plant based fats, or omega 3 fatty acids (fish oils). A diet low in fruits, vegetables and fibre and a high consumption of alcohol will also contribute to elevated cholesterol and an altered lipid profile. However dyslipidaemia should not be considered in isolation, but as part of a complete cardiovascular or cardiometabolic risk assessment.  

As with all cardiometabolic disease, the principle underlying problems are dysregulation of the neuro-endocrine and immuno-inflammatory pathways that impacts the cardiovascular system in some way.  The systemic vascular inflammation present makes the vessel tissue fragile and prone to injury. When this occurs, atherosclerotic plaque forms, and immune cells migrate to the site progressively impeding blood flow, and potentially fragmenting the plaque leading to a blockage in a blood vessel and the potential for heart attack and stroke.  The risk of this occurring is higher in people with dyslipidemia.

Familial hypercholesterolaemia


Less commonly, some people may have a hereditary predisposition to high cholesterol, known as familial hypercholesterolaemia, which affects 1 in 250 people in Australia. Familial hypercholesterolaemia prevents the  body from removing low-density lipoprotein (LDL) cholesterol from the  blood which can lead to extremely high cholesterol levels. A diagnosis of familial hypercholesterolaemia can be made using family history, cholesterol levels and genetic testing.  There are also certain populations of people, such as indigenous persons or those of African heritage, who have a hereditary predisposition to developing dyslipidaemia and cardiovascular or cardiometabolic disease.

Factors contributing to high cholesterol

Other than diet, other contributing factors are those common to all cardiovascular and cardiometabolic diseases:

  • Genetic predisposition
  • Family history of cardiovascular/cardiometabolic disease
  • Psychosocial stress
  • Sedentary lifestyle
  • Obesity
  • Smoking
  • Inflammation
  • Development of insulin resistance

Conventional treatments for high cholesterol

Dietary modification and lifestyle factors such as exercise and smoking cessation are the first line strategies in conventional care for dyslipidaemia.  If these strategies are not successful in correcting the lipid profile within 3 months, then pharmaceutical medications may be prescribed.

The most common class of medications used to treat dyslipidaemia are statins which inhibit a metabolic pathway (HMG-CoA reductase) for endogenous production of cholesterol.  One of the most common side effects of statins is persistent muscle aches and pains. If the use of statins alone is not effective in lowering cholesterol and correcting the lipid profile, or if a patient is unable to tolerate statin medications, other medications such as fibrates, nicotinic acid, or Ezetimibe may be prescribed.

However, treating elevated cholesterol and dyslipidaemia in isolation of a total cardiovascular risk profile can be problematic, as it may not necessarily reduce cardiovascular disease risk.

The Melbourne Functional Medicine approach - natural treatment for high cholesterol

A personalised assessment of your cardiometabolic health

Our cardiometabolic practitioner Mark Payne assesses a person's health from a 360 perspective, taking in their health history, genetics, lifestyle and risk factors to deeply understand their cardiometabolic health. Beyond a thorough case taking, functional testing may be used to either assess cardiometabolic risk, or to further investigate the underlying cause of high cholesterol.

Assessing cardiometabolic risk with functional testing

While the conventional blood lipids give some indication of altered blood lipids, a more insightful, comprehensive test looks at particle size and quantity of LDL cholesterol, which are more accurate markers to determine cardiovascular risk. This comprehensive cardiovascular profile screens for the most important markers for cardiovascular disease and cardiometabolic disease, including multiple sub-fractions of LDL-c, blood clotting factors, as well as inflammatory markers.

In some cases, natural treatment for high cholesterol will include running general pathology tests for other factors that might be influencing cardiometabolic health, like:

  • Vitamin B12
  • Folate
  • Vitamin D
  • Iron studies
  • Kidney function
  • Liver function

Creation of a personalised protocol to improve your cardiovascular health

Your functional medicine practitioner will then discuss how you can lower your high cholesterol levels naturally and work with you to create a personalised protocol to improve your cardiovascular or cardiometabolic health, that may include:

  • Hypercholesterolaemia dietary management including tailored nutritional interventions to improve blood lipid profile e.g. a high fibre, reduced fat diet
  • Supplement recommendations to support healthy cholesterol metabolism
  • An anti-inflammatory protocol - dietary and prescribed anti-inflammatory supplements
  • Stress management and reduction
  • Lifestyle recommendations like exercise

Studies show that having the support of a health coach to implement these measures improves outcomes for those with cardiometabolic health issues. This is why, in our clinic, you have the ongoing guidance and support of a health coach so you can achieve your health goals and reduce your cardiovascular risk.

Case study

See how functional medicine is helping our patients achieve better health and richer lives.

Are you ready for a personalised, natural functional medicine treatment? Our unique model of care was designed with you in mind. Find out how here, then book a call today!

FAQs

What are the causes of high cholesterol?

A small percentage of the population have familial hypercholesterolaemia, a genetic condition that results in dysregulation of fat metabolism pathways. For the remainder of people with high cholesterol, the primary cause of elevated cholesterol levels is a diet high in saturated and trans fats, low unsaturated plant based fats, or omega 3 fatty acids (fish oils), and low in fruits, vegetables and fibre, that contribute to altered lipid profiles. Smoking, being overweight or obese, having insulin resistance, and living a sedentary lifestyle are also contributing factors. However, high cholesterol is a symptom of suboptimal cardiometabolic health, with the principle underlying problems being dysregulation of the neuro-endocrine and immuno-inflammatory pathways impacting the cardiovascular system.

How do I lower familial hypercholesterolaemia naturally?

Improving lipid metabolism involves first understanding a person's lipid profile through a comprehensive lipid profile analysis, to then provide a targeted approach to improving fat metabolism that may include supplementation. Modifying dietary and lifestyle factors like reducing dietary intake of saturated fats, avoiding trans fats, consuming a diet rich in fruits, vegetables and fibre, regular exercise, weight management, smoking cessation, reducing alcohol intake and managing stress effectively all contribute to an improvement in lipids thereby helping to lower high cholesterol levels naturally and reducing your risk for cardiovascular disease.

How is familial hypercholesterolaemia inherited?

Familial hypercholesterolaemia is an autosomal dominant condition whereby one or both parents carry an altered gene that affects the low-density lipoprotein receptor that removes LDL cholesterol from the blood. A parent who carries this altered gene has a 50% chance of passing it on to their children. Children who inherit the altered gene from both parents will usually have a more serious form of hypercholesterolaemia that would require life-long diet and lifestyle management, and potentially medication to reduce risk of atherosclerosis formation and heart attack.


Does coconut oil cause high cholesterol?

There is a significant body of evidence that both supports the use of coconut oil, as well as advises against over-consumption of it.  Coconut oil is a plant derived fat that is composed of a significant amount of saturated fats, as well as a good concentration of medium chain fatty acids such as lauric acid.  

The fatty acid composition of coconut oil has been found to have some health benefits relating to reduced inflammation, improved cardiovascular health, and improved weight loss.  However, there is evidence that coconut oil will increase total blood blood cholesterol, both LDL (Bad) and HDL (Good) cholesterol.

Consumption of healthy fats as part of a balanced diet is important.  Equally important is the quality of the fats consumed.  Plant derived saturated and unsaturated fats are generally considered a better choice over animal derived saturated fats which often contain a higher concentration of trans fats.  



What are the top foods that can cause high cholesterol?

Foods that can cause high cholesterol are those high in saturated and trans- fats, and low in unsaturated plant based fats, or omega 3 fatty acids (fish oils). A high consumption of alcohol can also contribute to elevated cholesterol and an altered lipid profile. 


What are some hypercholesterolemia dietary management tips?

Focus on a diet that includes good fats in foods like wild-caught fish, extra-virgin olive oil, avocado, coconut oil, nuts, and seeds to improve the type and quantity of cholesterol in your body.


How to treat high cholesterol naturally?

The functional medicine approach to treating cholesterol naturally will start with a thorough investigation of your health picture, which may include functional testing to assess your cardiometabolic risk as well as other contributing factors. Natural treatment for high cholesterol  may include:

  • Hypercholesterolaemia dietary management including tailored nutritional interventions to improve blood lipid profile e.g. a high fibre, reduced fat diet
  • Supplementation to support healthy cholesterol metabolism
  • An anti-inflammatory protocol - dietary and prescribed anti-inflammatory supplements
  • Stress management and reduction
  • Lifestyle recommendations like exercise

Can’t find what you’re looking for? Reach out to the team directly – we’ll be happy to assist.