The Daunting Burden of High Cholesterol

Both adults and children in the UK have some of the highest cholesterol levels in the developed world. It is estimated that almost half of adults in England have raised cholesterol levels (>5mmol/L). Additionally, among the thousands of children in the UK that have high levels of cholesterol, very few of them know it. ⁽¹⁾

What is Cholesterol?

Cholesterol is essential for the body to make cell membranes, substances used in digestion, hormones and vitamin D. Cholesterol is a substance made by animal liver. Additionally, animal products like meat, dairy products, poultry, eggs, fish and others are food sources of cholesterol which is also known as lipid. ⁽²⁾

In the bloodstream, cholesterol binds to transporting proteins making molecules which are called lipoproteins. ⁽³⁾

Lipoproteins are divided into two main categories: the low-density lipoproteins (LDL-cholesterol) and high-density lipoproteins (HDL-cholesterol). LDL-cholesterol carries cholesterol from your liver to the cells that need it. When the amount of LDL-cholesterol is more than the required, the excess of LDL-cholesterol can built-up in the artery walls making plaques of fats and cholesterol, process also known as atherosclerosis. ⁽⁴⁾

Plaques can disrupt the blood flow to several organs like brain, heart, brain and others. Thus, atherosclerosis is considered as the major cause of cardiovascular diseases like heart failure, stroke, myocardial infarction etc. Therefore, LDL-cholesterol is also known as the bad cholesterol. ⁽⁵⁾

On the other hand, HDL-cholesterol is also known as the good cholesterol because studies have shown that high levels of HDL-cholesterol are inversely associated with cardiovascular diseases. ⁽⁶⁾

Causes of high LDL-cholesterol

According to the British Heart Foundation there are several factors that contribute in the elevation of cholesterol levels. Genetics is the factor that is inevitable and even if your lifestyle is healthy your LDL-cholesterol levels are high. This condition is called as Familial Hypercholesterolemia. Additional factors that cause high-cholesterol levels, are: diet-high in saturated fats, obesity, smoking, lack of physical activity, kidney or liver disease and high alcohol consumption. ⁽⁷⁾

Cholesterol and Food

The European Food Safety Authority reported that the consumption of saturated fat (i.e. meat and dairy) increases LDL- cholesterol levels. On the other hand, the consumption of mono- and/or polyunsaturated fats (nuts, fishes, olive oil) instead of saturated fats has been shown to lower bad cholesterol levels. ⁽⁸⁾

Additionally, trans fatty acids which are widely used in industrial products, have raising effects on LDL-cholesterol. Moreover, unlike saturated fats, they also decrease HDL cholesterol levels, effecting the LDL/HDL ratio.

Studies have shown that diets rich in fibers have a beneficial effect and lower bad cholesterol levels. It is estimated that the caused LDL-cholesterol reduction due to changes in fiber intake can reach 10 %. Thus, it is important to consume fruits, vegetables, legumes and wholegrain cereals. ⁽⁶⁾

Exercise and Cholesterol

Studies show that moderate-to-heavy aerobic exercise is associated with a better lipid profile. Regular training results to increased levels of HDL cholesterol. Studies indicate that greater changes in HDL-cholesterol levels could be achieved by additional increases in exercise training volume. ⁽⁶⁾

Supplements to improve cholesterol

Plant sterols powder is one of the best available products to improve cholesterol levels. Plant sterols can decrease intestinal absorption of cholesterol. A recently published study (2016) reported that consumption of foods with added plant sterols/stanols is associated with a significant reduction in LDL cholesterol. Moreover, researchers mentioned that plant sterols may have a role in the management of patients whose cholesterol levels and cardiovascular risk do not justify the use of pharmacotherapy. ⁽⁶⁾Additionally, plant sterols could be used on top of pharmacotherapy in patients who cannot achieve the recommended lipid levels. The association of plant sterols-fortified foods with anti-lipidemic drugs shows an additive effect on the reduction of total cholesterol and LDL-cholesterol levels. ⁽⁹⁾Plant sterols can be consumed by children. Recommended dose for children 2 years of age and older is 2g/day as a replacement for other fat sources. ⁽¹⁰⁾

Another supplement that could help in the improvement of lipid levels is psyllium husk. Researchers conducted a study to evaluate the safety and effectiveness of psyllium husk fibre used adjunctively to the diet. They concluded that psyllium husk regular use resulted to a reduction in LDL-cholesterol levels of the diabetic patients. ⁽¹¹⁾A meta-analysis of 2009 reported that consuming 5, 10, or 15 grams of psyllium daily resulted in 5.6%, 9.0% or 12.5% lower LDL-cholesterol levels. ⁽¹²⁾ According to a recently published endocrinology book, recommended doses are 6 g/day for children 2-12 years and 12 g/day for children 12 years and older. Moreover, psyllium husk soluble fiber has been shown to be well-tolerated and safe for hyper-cholesterolemic children and adolescents. ⁽¹⁰⁾

A 2013 published study on patients who had cardiovascular risk factors, reported that omega-3s slightly increased HDL-cholesterol levels, indicating the potential of omega 3s to improve good cholesterol levels. ⁽¹³⁾

Vitamin B3 or Niacin has been used for more than 30 years to treat high LDL-cholesterol levels. It lowers effectively total cholesterol, LDL-Cholesterol and increases HDL-Cholesterol levels. ⁽¹⁴⁾

Chlorella is another supplement that is effective on cholesterol levels. A Japanese study reported that chlorella’s consumption leads to improvement in several cardiovascular factors. Researchers demonstrated that chlorella intake resulted in significant reductions in cholesterol and other cardiovascular factors. ⁽¹⁵⁾ These results were confirmed by a more recent study which concluded that chlorella plays a role on glucose and lipid metabolism. ⁽¹⁶⁾

According to a research, allicin, which is a substance in the bulb of garlic, seems to improve cholesterol levels. Specifically, it reduces both synthesis and absorption of cholesterol, possessing lipid-lowering properties. The reduction of total cholesterol is estimated between 9 and 12%. ⁽⁹⁾

To sum up lifestyle modifications can be an effective way to control and improve cholesterol levels. A multifactorial approach is needed to avoid drug therapy. Healthy diet and exercise should be the main pillars of your strategy. Food supplements, like plant sterols and others, can play a key role, make the difference and enrich your diet with high quality nutrients that help you stay healthy and energetic.

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