HIGH CHOLESTEROL AND WHAT TO DO ABOUT IT FOR WOMEN OVER 40

Has your doctor pointed out higher cholesterol levels in your blood tests and suggested medication to bring them down? For many women over 40, cholesterol starts to creep up, and it’s labelled as the “baddie” of health. But is it really? Today, we’re breaking down the basics of cholesterol and why it’s crucial for your body, especially during perimenopause and menopause.

WHAT IS CHOLESTEROL?

Cholesterol is a waxy substance found in your blood. Cholesterol metabolism starts in your liver, and that's where it's produced. The liver packages cholesterol into particles called lipoproteins, and they transport it through the bloodstream to other tissues and organs. And then excess cholesterol is carried back to the liver, by a different lipoprotein, where it is stored in the liver or in your fat cells.

Cholesterol is much maligned, in my opinion. Contrary to popular belief, not all cholesterol is harmful. It plays an essential role in the body, and its increase in the bloodstream is often a response to underlying issues rather than a direct cause of health problems. Here are some of the really important things that cholesterol does for you:

• Hormone Production: Cholesterol is the building block for essential hormones, including estrogen and progesterone. These hormones are vital for regulating mood, metabolism, and overall well-being. During perimenopause and menopause, declining estrogen levels can lead to higher cholesterol levels as the body adjusts to hormonal changes.
• Vitamin D production depends on cholesterol.
• Cell Structure: Cholesterol helps maintain the structure and fluidity of cell membranes, ensuring cells function properly. Without sufficient cholesterol, cells would not be able to perform their essential functions, impacting overall health.
• Digestive Health: Cholesterol is crucial for producing bile acids, which aid in the digestion and absorption of dietary fats. This helps maintain a healthy digestive system.

I mentioned that not all types of cholesterol are harmful, so let's talk about the types of cholesterol and what they do in your body.

TYPES OF CHOLESTEROL

1. LDL (Low-Density Lipoprotein): Often referred to as “bad” cholesterol, high levels of LDL can lead to buildup in your arteries - ‘plaque’ - increasing the risk of heart disease. However, LDL has subtypes, some of which are more dangerous than others, but your standard cholesterol blood test doesn’t differentiate which ones you have more of:
   • Small, Dense LDL (Pattern B): More likely to contribute to buildup in your arteries and cardiovascular disease.
   • Large, Buoyant LDL (Pattern A): Less likely to cause plaque buildup and is associated with a reduced risk of cardiovascular disease.
2. HDL (High-Density Lipoprotein): Known as “good” cholesterol, HDL helps remove LDL from your bloodstream, reducing the risk of heart disease.
3. VLDL (Very Low-Density Lipoprotein): Carries triglycerides to your tissues.
4. IDL (Intermediate-Density Lipoprotein): Formed when VLDL gives up fatty acids; can be removed by the liver or converted into LDL.
5. Chylomicrons: Large particles that transport triglycerides.

WHY CHOLESTEROL ISN’T THE VILLAIN

To understand why cholesterol isn’t the villain, let's talk about why cholesterol becomes elevated.

UNDERSTANDING INFLAMMATION AND CHOLESTEROL LEVELS:

When there is inflammation (an immune response) or damage in the arteries, the body sends cholesterol to the affected areas to repair the damage. Elevated blood glucose levels, especially from consuming refined carbohydrates and sugars, are often behind the inflammation and damage. High blood glucose levels cause glycation, which is when a glucose molecule attaches to other compounds in the blood.

Glucose is quite a large, spiky molecule, so picture your bloodstream as being like a busy aisle in your fave store during the boxing day sales. There’s lots of jostling and bumping into shelves. When there is more of the spiky glucose molecules in your bloodstream, the cells lining the arteries get damaged. This damage triggers an inflammatory response, prompting the liver to produce more cholesterol, which is then transported by lipoproteins to the site of inflammation to aid in repair.

THE MAIN TRIGGERS OF HIGH CHOLESTEROL

Here’s a summary of the main triggers for elevated cholesterol that I see in the women I work with:

• Glycation: High blood sugar causes glycation, where sugar molecules bind to proteins or lipids, leading to stiff and dysfunctional blood vessels.
• Insulin Resistance: This condition, often accompanying high blood sugar, leads to higher triglyceride and cholesterol production. High insulin also boosts stress hormones and cortisol, raising blood glucose and fat storage.
• Oxidative Stress: High glucose levels lead to oxidative stress, further damaging blood vessels and prompting cholesterol deposition as a repair mechanism.
• Hormonal Fluctuations: Estrogen, which helps keep LDL levels in check, declines during menopause, potentially leading to higher LDL and lower HDL levels. This and the decline in progesterone can also result in higher cholesterol levels because there is lower hormone production and thus lower demand for cholesterol. (Remember the two hormones have a cholesterol backbone.)
• Stress: Increased stress levels during perimenopause can elevate cortisol and blood sugar levels, leading to higher cholesterol production. The decline of progesterone, a natural stress resilience hormone, further exacerbates this issue.

DON’T SHOOT THE (CHOLESTEROL) MESSENGER

Inflammations in blood vessels can cause the vessel walls to weaken and potentially tear. When this happens, cholesterol-rich deposits can be exposed to the bloodstream, leading to blood clots. These clots can cause heart attacks or strokes if they block the arteries.

It’s important to remember that cholesterol is a responder, it is there in response to another issue or driving factor, and it is not the cause of the problem.

So blaming cholesterol for cardiovascular disease is like blaming firefighters for a fire because they’re always at the scene. (And yes, I know, sometimes firefighters are the lighters of the fires, but most of the time, they are not.)

Cholesterol is responding to an issue, not causing it. The real culprits are often inflammation and damage to arteries from high blood sugar, insulin, and refined carbohydrate consumption.

The more that your body's having to patch up then the more cholesterol in your arteries, and it's going to block them, of course, if that keeps happening. But we need to look at the driving factor for the elevation. And this is the difference here, I think, between Western medicine and how naturopathic medicine looks at things. We're looking for that driving factor, the underlying cause.

We're not just trying to reduce your body's cholesterol production overall, to suppress it. What we're actually looking to do is resolve the problem driving the elevation, so you get long term symptom resolution.

That's what I'm always doing with my clients and helping them do. And it means that then we've got the opportunity for preventative care and to avoid medications.

Sometimes medications are the needed course of action. It may be the right decision for you. But I do firmly believe that we must make an informed decision around the medication, and ideally, why not try food, lifestyle and nutritional and/or herbal medicine first? Because there is a sequelae, a flow on effect of taking medications like statins.

Pharmaceuticals tend to work on on pathway, or one enzyme, one biochemical reaction, but they often impact other molecules too. For example, statins reduce your body’s CoQ10 production. This compound is key in your energy metabolism, so it impacts how you feel overall.

MANAGING CHOLESTEROL NATURALLY

All right, so what can we do about rising cholesterol levels to keep our risk of cardiovascular issues down, and our doctor happy?

If you grew up in the seventies and eighties, then you grew up in the era when eggs were bad because they have cholesterol in them. Do you remember everyone throwing out the nutrient-dense egg yolks, “because of cholesterol” and just eating egg white omelettes? Of course, eggs weren’t the only victim of the low-cholesterol, low-fat brigade. Dairy took a significant hit too.

Before you go and cut eggs from your diet, let me tell you two important facts:

1. About 80% of cholesterol is produced by the body, independent of what you consume.
2. The gut can only absorb 600mg of cholesterol per day, equivalent to two eggs.

A low-cholesterol diet isn’t really the solution, it’s only going to have a small influence on your cholesterol levels. And you’ll miss out on lots of vitamins and minerals if you cut out things like meat, eggs, butter, (goat’s/sheep’s) cheese and yoghurt. Instead, focus on overall diet quality and lifestyle changes.

DIETARY TIPS:

I have been talking a lot lately about my Guiding Principles when it comes to the food on your plate. And what I am aiming for. It’s no different for cholesterol, you need the 4 pillars on your plate:

• Phytoestrogens: Found in foods like flaxseeds, soy, and legumes, phytoestrogens can help balance hormones and support heart health.
• Protein: Include proteins such as red meat, fish, chicken, beans, and legumes. Protein helps in muscle maintenance and overall metabolic health.
• Healthy Fats: Incorporate omega-3-rich fats from sources like salmon, sardines, mackerel, olive oil, flax, pumpkin, and sunflower seeds, and nuts like almonds, walnuts. These fats support heart health and reduce inflammation.
• Avoid Processed Foods: Limit intake of processed and ultra-processed foods, which often contain unhealthy fats and sugars that can raise cholesterol levels.
• Reduce Sugar and Alcohol: High sugar intake and excessive alcohol can contribute to high triglycerides and cholesterol levels.

LIFESTYLE CHANGES:

• Stress Management: Your stress resilience changes in perimenopause because of declining progesterone. While we can’t always remove the stressors - thanks #mumlife - you can focus on boosting your resilience by working with your body. Nourish it with food, avoid calorie restriction, and choose gentle, resistance training exercises like yoga, pilates, walking, swimming, and weights.
• Sleep: The biggest tool in your stress management arsenal is sleep. Make sure you have adequate sleep, avoid late-night screen time, and manage your schedule to reduce being rushed and over-busy. Proper sleep helps maintain insulin sensitivity, reducing blood glucose and cholesterol levels. Meal planning can help, or consider joining PerimenoGO for a ready-made nutrition plan and more training on my Guiding Principles and what’s changing in your body in perimenopause.

Cholesterol plays a crucial role in your body, especially during perimenopause and menopause. Understanding its importance and how to manage it naturally can help you maintain your health and well-being.

For those concerned about heart disease, focusing on reducing triglycerides is also crucial, as they are a significant risk factor for cardiovascular health. (And very responsive to diet!)

Listen to the podcast episode (below) for more info about cholesterol, triglycerides, and what to do to help reduce your cholesterol naturally.

NEED MORE HELP?

To help you take control of your health and manage cholesterol naturally, have a look at PerimenoGO. It helps you understand the principles of nutrition for peri and post-menopause and includes a delicious 4-week nutrition plan with (easy, quick) recipes. This program gives you the owners manual for your over 40 body, AND the skills and tools to fix it, so you can feel amazing in your body, mind, and clothes again.