Interesting
@HairySmurf . I too have high LDL Cholesterol. My Triglycerides are very low 0.54. I eat little to no fat. I have had problems with fats for many years, now I cannot tolerate fat at all. I am having problems with my gallbladder and pancreas with bouts of inflammation. Scans show no gall stones are present. It seems my liver is determined to produce cholesterol in the absence of fat in my diet. I am lean and fit. So I am now on statins.
So does the liver make cholesterol regardless of whether one eats fats in their diet or not? It’s a question in my own head. Do you have a source for your plant sterols “'jamming' the pathways through which cholesterol is absorbed from the intestine”. I’m interested as it is an issue for me at the moment.
Yes the liver will and must make cholesterol in order to 'manufacture' bile acids which is important for how our digestive system works. Every cell in the body can and does manufacture its own cholesterol but the liver has a very high demand for it in order to create bile acids. Manufacturing cholesterol inside the liver is 'expensive' though, it's a precious resource that the body doesn't like to waste much like everything else that's useful. All cholesterol interventions/medications work by influencing the uptake of LDL particles from the blood by the liver, a ready source of cholesterol that it can draw on, either by affecting how 'precious' cholesterol is as a resource in the body, how scare or how hard it is to manufacture basically, or by directly interfering with the rate at which the liver takes up LDL particles, which is how the newest medications work. Those new medications don't affect cholesterol supply in the body at all, just the receptors on the liver, 'forcing' it to take up more LDL particles from the blood. Those medications are expensive though and will continue to be for many years.
High fat intake doesn't affect cholesterol directly though specific fat molecules, trans fats and a subset of saturated fats, influence the number of receptors on the liver which pull in LDL particles, if there is high intake of these specific fats over time.
Most of the information about cholesterol came from this series of interviews with lipidologist Dr. Thomas Dayspring -
Link - links to the interviews as podcasts or on Youtube on that page. Interview 1 of the 3 contains the information on the mechanism by which the body takes in cholesterol from the intestine and how plant sterols mess with it. He does not go into fats much in those interviews. This article lists the specific saturated fat molecules that can influence LDL particles -
Link. As far as I know all trans fat molecules do it too but I never looked that up. Other kinds of fats - monounsaturated, polyunsaturated etc. do not mess with the LDL receptors in the liver directly as far as I know.
Your situation appears to be unusual though - lean and fit with low trigs and high LDL while not eating a lot of trans or saturated fats. I suspect the typical advice that might apply well to the average person might not suit you. One thing to investigate might be the profile of the cholesterol 'hyper-absorber' - mentioned in the video interviews. Some people are genetically setup to absorb a lot of cholesterol from the intestine. These people are affected by the cholesterol in eggs for example while most of us aren't. Those people respond much better to ezetimibe than to statins I believe and around around 1 in 20 of the population, if I recall correctly. They're one example of how some people can vary widely in what influences their cholesterol levels. I believe Dayspring does talk about a specific test for hyperabsorption in one of the videos and talks about signs of other unusual circumstances. Maybe something in there might provide clues?