Cholesterol forms the membrane of every cell in your body. It is used to make hormones, bile salts, and vitamin D. As you can see, cholesterol plays a vital role in human physiology. So why is some cholesterol bad?

Cholesterol is a lipid (fat) that is manufactured in the liver (and is also consumed in food). In order for cholesterol to travel in the aqueous bloodstream (remember fats & water don’t mix), the lipid component is joined with a protein and triglycerides, at which time it is referred to as a lipoprotein.

There are various kinds of lipoprotein and these are classed in terms of how much cholesterol they contain: Very Low-Density Lipoproteins (VLDL), Intermediate-Density Lipoproteins (IDL), Low-Density Lipoproteins (LDL) and High-Density Lipoproteins (HDL).

The lower the density the more triglycerides the lipoprotein contains, and the higher the density the more cholesterol it contains. VLDLs, IDLs, and LDLs carry fats to the tissues to be used as building blocks; whereas HDL carries excess cholesterol back to the liver, in order for it to be broken down.

The cholesterol hypothesis – the belief that high LDL cholesterol is associated with cardiovascular disease – is controversial; for example, there is some question regarding how dangerous LDL is:

• Research suggests that there is a direct correlation between low plasma LDL and an increased risk of cancer;[1]
• A UK systematic review suggests that elderly people with high LDL live longer;[2]
• HDL transports cholesterol to the liver either directly or ‘indirectly’ and in the latter case it does so by first ‘transferring the cholesterol to VLDL or LDL’[3];

and so it’s possible that there is more to learn about cholesterol, and that other risk factors for cardiovascular disease should be given more importance over blood test results: namely alcohol intake, smoking, obesity, and stress.

Conventional wisdom deems the following to be safe lipid levels:

HDL:                                       1 mmol/L or higher

LDL:                                       4 mmol/L or below

Fasting triglycerides:               1.7 mmol/L

Non-fasting triglycerides:       2.3 mmol/L

It is important to remember that cholesterol is nature’s elastoplast: the body uses it to patch the lining of damaged blood vessels. Cholesterol is therefore not the root problem, and the question becomes: why are the blood vessels getting damaged in the first place? The answer is usually high blood pressure, high blood glucose, cigarette smoking, habitual alcohol use, or too many inflammatory oils. The underlying cause must be addressed.

Lifestyle changes have been shown to have a positive effect on cardiovascular health. A person can help lower excess lipid levels by:

• limiting meat and dairy intake, thereby lessening the amount of cholesterol consumed in the diet
• increasing the consumption of fatty acids from seeds and/or oily fish to help prevent platelet aggregation
• regularly cooking with garlic, which can lower serum cholesterol levels
• avoiding simple carbohydrates, which helps to prevent the damage to blood vessels caused by fast sugars
• taking raw extra virgin olive oil to lower serum cholesterol and generally benefit the heart
• cooking with oils that have a high smoking temperature to prevent food oxidation, thereby minimising free radicals
• avoiding hydrogenated oils to prevent exposure to trans fats, which are linked to high cholesterol
• increasing insoluble fibre, particularly beta glucans from wholegrain cereals and oats, which can lower cholesterol by binding with cholesterol-rich bile acids
• taking regular exercise, especially exercise that mildly increases the heart rate, because this is beneficial for the circulation and for the health of the heart itself
• minimising alcohol consumption to protect the health of the liver, which is important for the efficient excretion of cholesterol
• stopping smoking, which is important for healthy vasculature because nicotine causes fibrosis in the arteries
• lowering stress levels with mindfulness techniques or by regularly engaging with nature, which has a positive effect on cardiovascular health
• consuming kefir: the high lactic acid bacteria (LAB) content of kefir can reduce cholesterol levels up to 33% by inhibiting the absorption of exogenous cholesterol in the intestine – this might be particularly important for those who consume a lot of meat products.

According to Harvard University, the biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet – not the amount of cholesterol you eat:

The discovery half a century ago that high blood cholesterol levels were strongly associated with an increased risk for heart disease triggered numerous warnings to avoid foods that contain cholesterol, especially eggs and liver. However, scientific studies show a weak relationship between the amount of cholesterol a person consumes and his or her blood cholesterol levels.[4]

Processed foods and carbohydrates may therefore be more damaging to vascular health than all other foods: a diet high in carbohydrates actually encourages the liver to make more cholesterol. Researchers looking at the association between carbohydrate consumption and serum lipids concluded that diets high in processed carbohydrates result in lower HDL cholesterol, which has implications for metabolic syndrome, diabetes, and coronary heart disease.[5]

What can herbal medicine offer?

Herbal medicine offers wide-ranging therapeutic actions to help maintain good cardiovascular health.

Some herbs, like hawthorn (Crataegus monogyna), globe artichoke (Cynara scolymus), and cinnamon (Cinnamomum zeylanicum) are directly hypocholesterolaemic. Others, like rosemary (Rosmarinus officinalis) and lime blossom (Tilia europea) are cardioprotective.

Bitter herbs increase the flow of bile from the liver and encourage more efficient processing of cholesterol, while hepatic herbs ensure the liver is at its healthiest to cope with cholesterol metabolism. Bitter and hepatic herbs can be particularly important for people with metabolic syndrome (those who have high blood pressure, high blood sugar, and carry weight around their middles) because liver health is an important factor in metabolic disease. Dandelion (Taraxacum officinale), milk thistle (Carduus marianus), and globe artichoke (Cynara scolymus) would be useful here.

Hypotensive herbs that lower blood pressure, and vasodilators that relax the blood vessels, both lessen the likelihood of plaque formation due to better blood flow. Antiplatelet herbs lower blood viscosity, preventing sluggish flow, which can contribute to the formation of plaques, while antioxidant herbs nourish the blood vessels and prevent damage by free radicals[6].

Chronic stress can lead to both an imbalance of lipid metabolism and to injury of the tunica intima (endothelium).[7] This is where Nervine herbs come into play. Immune system herbs could also play a role since cholesterol is metabolised by macrophages before being handed off to HDLs.[8]

Lastly, lymphatic herbs could also be important, because HDLs travel from the interstitium (body tissues) through the lymphatic system before re-entering the bloodstream.[9]

The important thing to remember is that conventional medicine is not your only option. Consider making lifestyle changes and visiting your local herbalist to discuss your particular concerns in more detail.

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[1] ‘Low-density lipoprotein cholesterol and the risk of cancer: a mendelian randomization study’, Benn, Marianne and others. https://pubmed.ncbi.nlm.nih.gov/21285406/

[2] ‘Lack of an association or an inverse association between low-density lipoprotein cholesterol and mortality in the elderly: a systematic review’, Ravnskov, Uffe, and others. https://bmjopen.bmj.com/content/bmjopen/6/6/e010401.full.pdf

[3] ‘Introduction to Lipids and Lipoproteins’, Feingold, Kenneth R. https://www.ncbi.nlm.nih.gov/books/NBK305896/

[4] https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/cholesterol/

[5] ‘Association between Carbohydrate Intake and Serum Lipids’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479303/

[6] ‘An antioxidant is a molecule stable enough to donate an electron to a rampaging free radical and neutralize it, thus reducing its capacity to damage’ (‘Free radicals, antioxidants and functional foods’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249911/)

[7] ‘Chronic stress: a critical risk factor for atherosclerosis’, Yao, Bo-chen and others. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460614/

[8] ‘The role of the lymphatic system in cholesterol transport’, Huang, Li-Hao and others. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557107/

[9] ‘Macrophages and lipid metabolism’, Remmerie, Anneleen. https://www.sciencedirect.com/science/article/pii/S0008874918300327.