Cholesterol is a special type of fat that is made in the body by the liver or obtained from animal foods in the diet. It has a number of important biological functions.

Cholesterol is required for:

• Building and maintaining cell membranes – having the correct amount of cholesterol in a cell membrane helps to ensure the membrane is both robust and flexible.
• Making myelin sheaths – these are fatty protective coverings that insulate nerve cells and help to ensure nerve conduction is efficient.
  Production of bile – bile is essential for the absorption and digestion of fat molecules and fat-soluble vitamins.
• Biosynthesis of vitamin D – cholesterol is an important precursor molecule for making vitamin D when our skin is exposed to the sun.
• Synthesis of stress and sex hormones – cholesterol is essential for making steroid hormones. These include the stress hormones such as cortisol and aldosterone as well as the sex hormones oestrogen, progesterone and testosterone.
• Since cholesterol is a fat, it doesn’t mix well with water. Therefore in order to be transported around in the blood cholesterol has to be hidden inside special transport molecules called lipoproteins. Lipoproteins are classified according to their densities, which reflect the type of fats they’re carrying

Low-density lipoprotein (LDL) carries cholesterol from the liver to the cells. If present in excessive quantities, this type of lipoprotein can lead to the formation of arterial plaque. These plaques are considered a major risk factor strokes, heart attacks and various other cardiovascular diseases. That is why LDL is often referred to as bad cholesterol.

High-density lipoprotein (HDL) is used to carry cholesterol back to the liver for excretion or to the other tissues for further use like production of hormones. This process is known as reverse cholesterol transport. HDL is considered good for health so is termed as good cholesterol.

Most conventional blood tests will measure total cholesterol, LDL and HDL. However, in reality, what is important is the ratio of LDL:HDL as well as what type of LDL and HDL you have. For example, smaller LDL molecules are much more likely to lead to arterial plaque than the larger fluffy variety.

Although not directly related to cholesterol, triglycerides are also an important consideration when it comes to cardiovascular health. High blood levels of triglycerides are also a risk factor for heart disease and stroke.

How functional medicine may be able to help

When it comes to cholesterol it’s all about balance and type. If your doctor has told you that you have high cholesterol level, a functional medicine practitioner can do further tests to determine what type of cholesterol you have so it can be targeted more effectively ¹.

It’s also important to remember that cholesterol is only a small part of a much bigger picture when it comes to heart disease. Functional medicine takes a broader view and will consider factors such as blood pressure, inflammation and lifestyle factors.

A plan can then be created to help you restore your cholesterol level to within the healthy range. This will include:

• A personalised diet based around the heart healthy Mediterranean diet. The eating plan will be specifically designed so that it is low in fat and cholesterol and high in foods that protect cardiovascular health. ^{2 3}
• Recommendations for the use of specific therapeutic foods and herbs that can assist cholesterol management ^{4 5}
• Advice on balancing blood sugar levels as excess sugar in the blood can lead to increases in cholesterol levels. Learning what and how to eat to balance blood sugar levels is important for protecting cardiovascular health long term. ⁶
• Assessment of inflammation and oxidative stress, as well as guidance on balancing these through nutrition ⁷
• Lifestyle adjustments to help improve cardiovascular health and keep blood pressure levels healthy ⁸