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Cholesterol, Sex Drive, Bone Density, & Anxiety – What’s the Connection?

Contrary to common myth, LDL is not “bad” cholesterol.  An LDL-C lab measures lipoproteins carrying cholesterol and triglycerides away from the liver for ALL vital functions…including hormone synthesis and cellular repair and regeneration.  Check out this clinical tip video to understand what can happen and why when LDL is pushed too low (especially with the use of statin drugs).  This is an important concept to be able to explain to your clients, especially given the widespread prescription use of statin drugs today.

Functional medicine teaches that LDL below about 75 mg/dl may even impair steroid hormone synthesis which can cause an array of symptoms including low libido, depression, anxiety, poor stress resiliency, infertility, cardiovascular dysfunction (yes!), and cancer risk.  In fact, as we age, we see an inverse relationship between LDL-C and death from all causes (repeatedly).   Making this type of connection across body symptoms for a client can be a powerful way to help them understand their body more thoroughly and learn the true root causes of their challenges.

Instead of LDL, one of the most useful markers to assess in conventional lipid labwork is the ratio of Triglycerides: HDL.  This should ideally be 2.0 or less, but values of 4.0 or higher are definitely indicative of higher cardiovascular disease risk (and is validated as a better predictor than LDL-C!).   This is the best surrogate marker for predicting a patient’s LDL particle count (LDL-P, a much more accurate predictor of CVD risk than LDL-C) where this less common test is not available.  You may enjoy reviewing some references to the Trigs:HDL ratio here and here.   If you want an article that explores this marker more in-depth, consider this one.   Or if you are passionate about helping your clients and patients to avoid heart disease from multiple vantage points, you might want to consider the SAFM’s Cardiovascular Myths and Truths course – one of our student practitioners’ favorites!

P.S. If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.

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8 Questions for “Cholesterol, Sex Drive, Bone Density, & Anxiety – What’s the Connection?”

  1. 4
    Linda Watson says:

    I have a potential client who is scared to death because her cardiologist just told her that she is carrying a form of ldl cholesterol called Lipoprotein A that is inherited and raises her risk of a cardiovascular event and stroke. Her mother died of a stroke and she is now petrified. The doctor gave her statins and has just raised the amount. She is now suffering nosebleeds she feels from the statins. She afraid of the medication and afraid of the diagnosis. Can you shed some functional medicine advice on lipoprotein A and how I can go about supporting her. I will be having a consultation with her within the next couple of weeks with her blood work. I’m already focusing on her inflammation status, MTHFR gene, healing gut health etc, but is having this form of genetic lipoprotein dependent on having a statin for the rest of her life?

    • 4.1
      SAFM Team says:

      Indeed, her strong FEAR is likely doing more to increase her risk of CVD than anything else at this moment! Alas, nearly all of us have some level of Lp(a), so it’s not the presence of it but rather the level of it that is considered to be an independent risk factor for CVD (and keep in mind, it’s just one of several possible risk factors). Yes, evidence points to there being a strong genetic association in the level, but this association does not hold true in the eventual development of CVD (remember: correlation does not convey causality). However, I do not agree with (and there is not a universal standard of care) for Lp(a)=Statin. As she is already experiencing, the downsides can be significant, and the strength/resiliency of the heart itself – as a large muscle! – highly depends on excellent mitochondrial function (and in a very real way, statins are mitochondrial poisons – sometimes prudent for triage, but always requiring a careful assessment of benefits/risks). However, as is true for ALL potentially atherogenic lipoproteins, whether or not any of these becomes an active driver of disease depends on the environment in which it is circulating. I recommend looking at CRP, homocysteine, HDL/Trigs ratio, HbA1c, fasting insulin, and (if possible) urinary 8-OHdG (a potent marker of oxidative stress) to help assess specific opportunities to support this client. A good, progressive physician (even if conventional) would agree to look at other drivers/causes. I would not focus on MTHFR gene status as much because that genetic variant may or may not be having a sizable current effect in her biochemistry (to assess current methylation, look at homocysteine most importantly; if significantly elevated, consider serum B12, RBC folate, and ideally some organic acids for functional feedback on sufficiency of B12, B9, and B6 (e.g. respectively, methylmalonic acid, formiminoglutamic acid, xanthurenic acid). Of course, while she is taking the statin in the interim, I highly recommend supporting her with (1) 100-150mg CoQ10 twice daily and also some liver support (e.g. milk thistle blend).

  2. 3
    Margaret says:

    Do you ever recommend Red Yeast Rice supplement to lower cholesterol? If so, should other supplements be taken with the Red Yeast Rice? I currently am taking Bisoprolol Fumarate 5mg for high blood pressure. I also have a family history of Heart disease and Breast cancer.

    • 3.1
      SAFM Team says:

      I have never recommend RYR to a client; the active ingredients in it (monacolin K) is chemically identical to the drug lovastatin. Despite being marketed otherwise, RYR has the same potential insidious side effects as statin drugs, and its mode of action is the same. My focus is on supporting clients to address the true root cause of extremely elevated cholesterol in their unique body or – for mildly/moderately elevated cholesterol – working to reduce the oxidative stress and inflammation that would potentially make that cholesterol of any concern (vs. healthy and of benefit in terms of hormone synthesis and cellular repair). For my clients who were already taking RYR and desire to continue doing so, I do educate them on the importance of supplementing with ubiquinol, the reduced form of CoQ10, synthesis of which is directly impaired by the RYR/Statin mode of action.

  3. 2
    Dawn says:

    What do you recommend when LDL is too low, like 70, and therefore causing all hormones to be low? Specifically in a patient with Hashimoto’s.

    • 2.1
      SAFM says:

      First of all, I want to say that I assume this individual is not on medication that is purposefully driving down cholesterol (and you want to check; because patients are not always forthcoming about what medications they are taking e.g. statins). Normally, we would see very low cholesterol is someone who struggles with more hyperthyroidism (not hypo); a hyperthyroid state increases LDL receptor sensitivity (which promotes more breakdown of LDL that’s been created/absorbed in the body). In the case of Hashimoto’s, it may be that this patient experiences dramatic swings in thyroid function (vs. a predominantly hypo state), or it may be that she is taking too much corrective medication. Something to consider. However, what will likely help while you are supporting them to identify and reverse the root causes of the autoimmune activation is this: (1) larger dietary intake of cholesterol (e.g. organic, free-range eggs), (2) high intake of pantothenic acid (Vitamin B5 e.g. 500mg, twice daily) which is required for cholesterol synthesis in the liver, (3) check gut health and work to heal the gut lining from any intestinal permeability (gluten-free at a minimum is key; using mucilaginous herbs and glutamine will also help e.g. Designs for Health GI Revive), and (4) support the liver dealing with toxins (which can interfere with other normal functioning; where appropriate, consider supplementation e.g. Thorne’s Liver Cleanse). For the last two items here, remember that bile reabsorption in the intestines is key for keeping cholesterol levels stable and ample. If there is a strong dysbiosis or other inflammation driver in the intestines (common in AI disease), there may be substantial fat malabsorption which would lead to much cholesterol being lost in the stool (putting more pressure on the liver to produce ever more on a daily basis). The stool may be looser and light-colored as a result (or not).

  4. 1
    Julie Oppenheimer says:

    Can the HDL be too high? (142). Ratio to LDL is .32 (LDL 98) (Triglycerides 46 and total cholesterol is 270.)

    • 1.1
      SAFM says:

      Yes! In inflammatory conditions such as metabolic syndrome or type 2 diabetes, HDL can become dysfunctional and is more likely to be so when significantly elevated. In these cases, HDL can actually become proatherogenic by participating in reverse cholesterol transport (normally HDL’s key job is to help transport oxidized LDL *out* of tissues and back to the liver). This is another reason (as we discuss in the Cardiovascular Myths and Truths course) why a detailed cholesterol assay e.g. NMR or CardioIQ is key to assess in concerning cases (where LDL and HDL particle counts and sizes/characteristics are identified vs. just a “bucket” concentration of the lipids). Elevated myeloperoxidase can also be measured as an indication of a higher likelihood of dysfunctional HDl. In these case, targeted anti-oxidant support would be quite helpful e.g. quercetin, pomegranate, EGCG, resveratrol, glutathione. You may find these of interest: http://atvb.ahajournals.org/content/32/12/2813 and https://www.ncbi.nlm.nih.gov/pubmed/20506005 and https://www.hindawi.com/journals/cholesterol/2015/296417/. Expect in the not-too-distant-future for cholesterol efflux markers to be part of progressive cardiovascular health panels: http://www.utsouthwestern.edu/newsroom/news-releases/year-2014/nov/cholesterol-rohatgi.html .

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