Cholesterol is a maths problem

Notes from a clinical lipidologist

Dr. Thomas Dayspring is a clinical lipidologist and sits on the American Board of Clinical Lipidology.

i..e He has spent decades understanding fats and lipids.

I recently saw a 6 hour lecture that uncovers lipids, heart disease, testing parameters and biochemistry.

It is beyond fascinating.

Here’s my attempt to summarize some of the learnings on just Cholesterol from Dr. Dayspring’s lectures.

Cholesterol

Cholesterol is a simple maths problem.

Cholesterol Made (By Body) + Cholesterol Consumed (From Diet) > Cholesterol Used

So if you have high cholesterol, this means the problem could be in 3 places:

1. Making too much

2. Eating too much

3. Using too litte

If you find the right issue, you’ll be able to bring your cholesterol down on your own.

#1 Making too much

Researchers call these cholesterol hyper-producers.

How to test?

Check if desmosterol or lithosterol levels are high.

Here's the science: 

Your body takes citrate or actetate and converts it into cholesterol in 36 steps. 

On step #35, it needs either desmosterol or lithosterol to make the cholesterol. 

If either of these are high, it suggests that the production of cholesterol from your body is high. 

Hence, you may be a cholesterol hyper-producer.  

Statins - the #1 cholesterol drug - work really well on this subset as they usually prevent cholesterol production in the body.

Note: Statins also increase the risk of diabetes, so I do not endorse statins. I’m merely sharing the findings.

#2 Eating too much

Researchers call these cholesterol hyper-absorbers.

As the name suggests hyper-absorbers seems to absorb more dietary cholesterol (50%+) than food than the average person (~50%).

There are multiple reasons, but no one knows for sure:

1. Different Genes (See if several people in your immediate/distant family have elevated cholesterol)

If you get a gene test done, look for issues with the expression of the Niemann–Pick transporter or ABCG5/G8

2. Different Gut Bacteria (Research is still early)

Your liver uses cholesterol to make bile and releases it into the small intestine for digestion. 

From this bile, the body recycles and reabsorbs cholesterol. 

Gut bacteria play a HUGE role in this process. 

Hence, there is ongoing research to understand how different gut bacteria can make you a hyper-absorber. 

How to test?

The expensive way is to do a gene test is you have a history of cholesterol in the family.

The inexpensive (and sometimes inaccurate) way: check if your HDL and LDL levels are elevated.

Here's the science: 

Your body manages cholesterol VERY tightly.

If you absorb a lot, you will produce less. 
If you produce a lot, you will absorb less.

When you absorb a lot, it first goes to the liver. 

When the liver cannot accept anymore, it will start to dump this in the blood.

The liver may also stop accepting cholesterol from other cells.

How? By downregulating LDL receptors. 

Cholesterol in blood is usually scavenged by HDL and passed onto LDL through a system called reverse cholesterol transport.

So when LDL cannot remove its load, HDL cannot transfer it load. 

Both stay in the blood at high levels.

The result: elevated LDL and HDL count.*
        

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Dr. Dayspring’s recommendations were centered around medications, so I did a little extra digging on point #3.

What follows below is not covered in Dr. Dayspring’s talk.

#3 Using too little

There are 3 key places cholesterol is used in the body:

1. To form cell membranes and repair muscles

2. To make hormones

5 key hormones that you make: thyroid, estrogen, androgen, growth hormone and irisin. Changes (reductions) in each of these 5 are linked to higher levels of cholesterol in blood.

Interestingly, increasing physical activity and exercise helps to increase ratios of nearly all key hormones.  

3. To make Vitamin D

Cholesterol on skin (in the form of 7-DHC) gets converted to a form of Vitamin D when sunlight hits it. 

No sunlight = not enough vitamin D.

Not enough vitamin D = cholesterol remains unused.  

Examine yourself:

1. Do you have a hormonal imbalance that you know of?

2. Do you spend virtually no time outdoors?

3. Is your level of physical activity very low?

This may suggest that your utilization of cholesterol has dropped, significantly.

There is a fourth large component of cholesterol usage: bile flow from liver.

Check your direct bilirubin levels. 

Are they on the lower end? 

It may be an indication that your liver is not producing enough bile 

i.e. not breaking down enough cholesterol, as well.

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Cholesterol management is simple maths.

In my opinion, it rarely needs medicines.

Sunlight, very regular exercise and a focus on quality of fats can make a massive difference to your daily levels.

Next time you see a high cholesterol reading, don’t freak out.

Just identify which of the 3 is happening to you…

…and start solving it.

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Here’s the link to Dr. Dayspring’s Series with Simon Hill

Here’s some more reading material for those who are interested.

1. https://www.radcliffecardiology.com/articles/understanding-cholesterol-synthesis-and-absorption-key-achieving-cholesterol-targets

2. https://www.intechopen.com/chapters/60965

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