The advice of Professor Carmine Gazzaruso, head of the Diabetology, Endocrinology, Metabolic and Vascular Diseases Service of the Beato Matteo Clinical Institute of Vigevano and professor of Endocrinology at the University of Milan
Diet, physical activity, genetics, smoking, stress: from what depends on cholesterol? And how can it be reduced? “Let’s first clarify what we are talking about when we talk about cholesterol. It is a fat, a lipid, essential for life “, says Professor Carmine Gazzaruso, head of the Diabetology, Endocrinology, Metabolic and Vascular Diseases Service and of the Clinical Research Center (Ce.RCA) of the Beato Matteo Clinical Institute of Vigevano and professor of Endocrinology at the University of Milan. “We need a lot of cholesterol every day for cell turnover and hormone production. But if excess cholesterol can cause damage to the level of arteries, determining atherosclerosis, which in turn can lead to heart attack, stroke or atheriopathy of the lower limbs. For this reason it is essential to check the Ldl levels in the blood”.
Diet, physical activity, stress, smoking, genetics: what does cholesterol depend on? –
We often talk about diet against cholesterol, but really it is the diet that affects the levels of Hdl e Ldl? “This is a complex matter, in which many factors affect. If we talk about Hdl, as of triglycerides, definitely the diet affects, because these two fats are closely related toinsulin resistance. The more insulin circulates in the blood, the greater the resistance to its activity, the higher the levels of triglycerides and low those of Hdl. Therefore physical activity and restricted sugar diet (intended as carbohydrates, in particular ad high glycemic index) and calories drastically reduce triglycerides and increase HDL ”, underlines Gazzaruso.
Cholesterol and metabolic syndrome –
Unlike the lipoprotein Ldl, and lipoprotein Hdl are in fact among the five criteria used for the diagnosis of metabolic syndrome: “They are together with triglycerides, all’hypertension, to glycemia and to abdominal circumference. If you have three of these five factors, you have metabolic syndrome. But theLdl it has nothing to do with it. In the speech concerning this low density lipoprotein, whose value is the one that must be taken into consideration for the most cardiovascular risk linked to cholesterol, diet is less important than HDL. In fact, 80% of LDL cholesterol is produced by the liver, while only 20% is of food origin ”, explains the professor. “The general indication is that with a good diet the cholesterol goes down, but it is not. To break down triglycerides and increase Hdl cholesterol you need above all reduce sugars. To reduce LDL, reducing sugars is certainly good, since an excess of insulin stimulates the production of cholesterol by the liver, but it is not decisive. It is also factors like it that have an impact stress and genetics “.
Mediterranean diet and cholesterol –
In any case, the Mediterranean diet can generally help to reduce the cholesterol: “The fibers found in vegetables, fruits, whole grains and legumes help eliminate cholesterol. In addition, legumes contain plant sterols, cholesterol-like substances that compete with cholesterol in the intestine and are absorbed in its place. Legumes should be eaten 2-4 times a week. Then there are other lipids, such as omega 3 fatty acids and unsaturated fats found in fish, nuts and oil seeds which can help fight cholesterol. A useful indication is to eat three to four walnuts or a handful of almonds every day. And then there is the extra virgin olive oil, which it contains oleic acid, monounsaturated fat that lowers cholesterol levels. Attention instead to the fat of the meat, to the fat cheeses, to the sausages and to the fried foods. Alcohol can be good if taken in moderation: a glass of wine with a meal reduces insulin resistance, which we have seen to be linked to cholesterol, but if you drink more or consume spirits, the opposite effect is obtained “, he explains. Professor Gazzaruso.
Cholesterol and drugs –
If diet and physical activity are not enough, the pharmacological solutions are different and innovative. “First of all, remember that the dangerous value depends on the individual patient risk. Factors such as diabetes, previous heart attack, cardiovascular events increase the risks and lower the levels within which the Ldl cholesterol. Levels that in 2019 were significantly lowered by the European Society of Cardiology and the European Atherosclerosis Society, which drafted the new guidelines on LDL cholesterol. Achieving very low values with lifestyle alone is therefore even more difficult, so help is often needed. In a healthy person they may be sufficient nutraceutici such as fermented red rice, berberine, phytosterols. If these are not enough, go to statins and to the ezetimibe. And then there are three much newer drugs. One is an inhibitor of PCSK9, an enzyme involved in cholesterol homeostasis. It is about monoclonal antibodies which destroy this enzyme and which are taken with subcutaneous injections and are able to reduce Ldl levels by 50-70%. Then there are the tablets of bempedoic acid, which acts on the hepatic synthesis of cholesterol but with a different mechanism than statins. And finally, substances have been developed that interfere with mRna (the messenger RNA also spoken of for anti Covid vaccines) that produces the PCSK9 enzymes. This new drug stops mRna from producing PCSK9. If the monoclonal antibodies mentioned above destroy the PCSK9 when they have already formed, these drugs act upstream, even before the PCSK9 are formed, reducing the LDL by 60% with injections once every six months “, explains Professor Gazzaruso.
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