Improve Cholesterol by Improving Estrogen
Many of you are familiar with the cholesterol blood test because it’s regularly measured at your doctor’s office visits. You may even note high cholesterol running in your family. But, have you ever stopped to wonder why this occurs? You and your family members were likely not born that way, and for much of your life your cholesterol was possibly normal, so why is it elevated now?
It turns out, there are several pathways for cholesterol regulation! In fact 80% of your cholesterol is created by your own body. Dietary intake only accounts for 20% of the cholesterol value. (1) So dietary fat intake is not actually the most impactful factor for stabilizing high cholesterol! Now, that doesn’t mean to eat all the mayo and bacon you can, but let’s understand just why cholesterol becomes elevated.
Circumstances in your body that elevate cholesterol are things like insulin resistance, intracellular malabsorption of cholesterol, and inflammation, just to name a few (2, 3, 4). One of the biggest influences on your cholesterol is actually your hormones. In fact, estrogen has a very important regulatory influence on cholesterol. In this article, we discuss the impact estrogen has on your cholesterol.
You see, cholesterol is actually used for things in your body. We have labeled types of cholesterol as “bad” and “good” to easily discuss pathology. This is probably a bit unfair because all types of cholesterol, good and bad, are used for making things like hormones, bile salts, Vitamin D and cortisol. In addition, cholesterol stabilizes cell membranes. Remember, we are not trees; we don’t have cell walls. Our cell membranes are made of a lipid bilayer and cholesterol is used as “scaffolding” to stabilize this bilayer. Organelles such as mitochondria also use cholesterol to stabilize their structure. Think of mitochondria as the batteries of your cells because they are energy producing.
For men and women alike, hormone changes influence cholesterol, but women particularly see this during perimenopausal or menopausal years. This is not to discount younger populations who struggle with hormone balance. In fact it is strategic to test hormones if you see an elevated shift in cholesterol in people of any age.
Estrogen Lowers LDL
Estrogen actually increases the production of the receptors to Low Density Lipoprotein (LDL) in your body. In fact, researchers found that estrogen is the most potent LDL-receptor stimulating agent available, and estrogen treatment in humans increased LDL receptors 4-10 fold, thus lowering LDL cholesterol on labs (5). Having more receptors means LDL is taken out of the blood where, in excessive amounts, it damages blood vessels setting the stage for strokes and heart attacks.
Estrogen Raises HDL
Estrogen has been found to increase the production of HDL (High-Density Lipoprotein), the good cholesterol. It does this by up-regulating Apolipoprotein A, the main protein used to make HDL. This form of cholesterol is considered good because it reduces plaquing in blood vessels, effectively transporting cholesterol from the blood vessel walls to the liver to be made into things we mentioned, bile salts, vitamin D, etc. Think of HDL as an antioxidant, reducing vessel wall inflammation and helping the blood vessels vasodilate properly (thus helping maintain healthy blood pressure).
In observational studies, researchers noted that women who experience early menopause have a higher incidence of coronary heart disease than do premenopausal women of similar age; however, this risk is decreased in women treated with bioidentical estrogen. When given oral bioidentical estradiol, plasma concentrations of HDL increased and LDL decreased. (6) Strongly consider hormonal therapies if you have a family history of heart disease.
How Do You Stabilize Estrogen?
First, have testing performed to assess your hormones. This is typically done through blood testing. However, urinary testing offers accurate, reliable data on free hormone levels as well as liver metabolites. My preferred method for hormone assessment for both men and women is the DUTCH test (Dried Urine Test for Cortisol and Hormones). This test shows you all the hormones, their metabolites, precursors, cortisol levels, melatonin relationship, and even organic acids to further assess mood, energy, and inflammation. You get A LOT out of this simple test.
Second, if you do have low estrogen observed on testing, know that you have options. For women, the herb rhapontic rhubarb is an estrogen-adaptogen. This is found in the products RhuyBestRyn or EstroVera. This herb balances and boosts your own body’s estrogen production without throwing you into estrogen excess. DHEA (dehydroepiandrosterone) is also an over-the-counter supplement and an estrogen precursor. Dosing for DHEA is highly dependent on testing, so it is best to work with a healthcare provider if you are using this support.
For men, understanding the testosterone pathways is important. Testosterone converts to Estradiol (E2) by way of the aromatase enzyme. By testing both E2, testosterone, DHEA, and Dihyrotestosterone (DHT) you can begin to assess if this is a conversion issue or a lack of production. In men, testosterone depletion is adrenal fatigue until proven otherwise.
Managing cholesterol involves understanding why it developed. It’s not that you have high cholesterol; it’s knowing why you have high cholesterol. When you investigate that process, you have more tools and may uncover various root causes of pathology. In addition, if you have stubborn cholesterol numbers that are not budging despite typical protocols, applying hormonal treatments whether through herbs, supplemental hormone precursors, or even a bioidentical hormone prescription by your MD may be a key. Keep seeking answers and being open to learning. Understanding your pathologies helps you know your body.
Footnotes:
Hoenig MR, Sellke FW. Insulin resistance is associated with increased cholesterol synthesis, decreased cholesterol absorption and enhanced lipid response to statin therapy. Atherosclerosis. 2010 Jul;211(1):260-5. doi: 10.1016/j.atherosclerosis.2010.02.029. Epub 2010 Mar 1. PMID: 20356594.
Prinz WA. A cholesterol-sensing mechanism unfolds. J Biol Chem. 2017 Dec 8;292(49):19974-19975. doi: 10.1074/jbc.H117.794230. PMID: 29222193; PMCID: PMC5723985.
Alfaddagh A, Martin SS, Leucker TM, Michos ED, Blaha MJ, Lowenstein CJ, Jones SR, Toth PP. Inflammation and cardiovascular disease: From mechanisms to therapeutics. Am J Prev Cardiol. 2020 Nov 21;4:100130. doi: 10.1016/j.ajpc.2020.100130. PMID: 34327481; PMCID: PMC8315628.