Cholesterol and lipid metabolism disorders

Elevated blood lipid levels are a common phenomenon in the population. Even if they do not cause any complaints at the moment, they can develop into one of the biggest health problems of our time: Cardiovascular disease. In Germany alone, around 300,000 people suffer a heart attack every year, which is partly due to high cholesterol levels in the blood. Elevated levels of LDL cholesterol in particular are considered a serious risk factor for the health of blood vessels.

Why is there "bad" cholesterol?

Cholesterol itself is an important building material for the body, which, among other things, gives our cells elasticity as a component of cell membranes or serves as a starting material for the formation of steroid and sex hormones, vitamin D and bile acids. Cholesterol is so important for the body that the liver produces it itself when our food only provides small amounts. The liver generally acts as a kind of transshipment point for fats and cholesterol. Fats and cholesterol are formed here and, together with dietary fat and cholesterol, are prepared for transportation to the various body tissues. At the same time, the liver reabsorbs excess fats, fatty acids and cholesterol and "disposes" of them.

As fat-soluble substances such as fat, fatty acids, cholesterol and fat-soluble vitamins are poorly soluble in aqueous blood, they are transported in special "transport vesicles" known as lipoproteins. A distinction is made between different lipoprotein groups, depending on how densely these are packed and what proportion of the individual fat-soluble substances they contain.

VLDL (very low density lipoprotein): The VLDL lipoproteins formed in the liver are still large, loosely packed and have a high proportion of triglycerides (neutral fat). A high triglyceride value is therefore an indication of a high VLDL concentration in the blood. A common reason for this is a diet high in sugar and especially fructose, but also high alcohol consumption.

LDL (low density lipoprotein): On their way through the blood, VLDL lipoproteins release fats into the surrounding body tissue. In the process, the lipoprotein shrinks more and more and the smaller, more densely packed LDL lipoproteins are formed, which now have a significantly higher cholesterol content. The LDL cholesterol determined by the doctor therefore provides an indication of the concentration of LDL lipoproteins in the blood. But why is this often referred to as "bad cholesterol"? LDL particles tend to be oxidized. Such oxidized LDL is unusable for the body and is increasingly taken up by special immune cells, so-called scavenger cells, in the vascular walls. The higher the level of such altered LDL in the blood, the more LDL the scavenger cells take up, become increasingly immobile and are deposited in the vessel walls. Over time, the LDL-filled cells can also burst, causing their cell contents to spill into the tissue and trigger an inflammatory immune reaction. This leads to the formation of deposits known as plaques. In the course of these processes, the vessel wall thickens more and more, the blood flows more and more poorly and, in the worst case, the blood flow can stop completely at a constriction. If this is the case, a heart attack or stroke occurs.

HDL (high density lipoprotein): HDL, often referred to as "good cholesterol", comprises small, very densely packed lipoproteins with a high cholesterol content. These mainly transport cholesterol from the body's tissues to the liver, where it is broken down and thus "disposed of". Doctors currently assume that a high level of HDL in the blood minimizes vasoconstriction, as HDL absorbs cholesterol from the plaques and transports it away.

What role do sugars play in cholesterol and lipid metabolism disorders?

But what does all this have to do with sugar?

As doctors and nutritional therapists have increasingly recognized in recent years, the cholesterol content of our food only plays a role in the blood lipid levels of a few patients. Of much greater importance is the intake of high-glycemic carbohydrate sources such as simple sugars and white flour products ^{1 2}. This is also illustrated by the fact that lipometabolic disorders and type 2 diabetes mellitus are often closely associated.

A high intake of simple carbohydrates such as sugar and insulin resistance change the lipoprotein and fat metabolism and thus increase the risk of vascular calcification (arteriosclerosis). Fat formation in the liver increases, more cholesterol-rich VLDL particles and "small dense LDL" are formed and the HDL level falls ³.

A key factor is fructose, which we consume today as a component of household sugar or in the form of glucose-fructose syrup in many products. When ingested in large quantities, it is converted into fat in the liver, some of which is stored in liver tissue (which can contribute to a fatty liver) and some of which is packaged in VLDL and released into the blood. This can increase the triglyceride level.

In the case of insulin resistance, which is also influenced by a high sugar intake, more fatty acids are transported from the fatty tissue to the liver, where they are broken down into fat and released back into the blood packaged in VLDL. This can also increase the triglyceride level.

In the blood, there is a lively exchange between VLDL, LDL and HDL, especially in the case of insulin resistance ⁴. VLDL releases fats to HDL in exchange for cholesterol. The cholesterol-rich VLDL promotes vascular calcification (arteriosclerosis). The fat-rich HDL is broken down, causing the HDL level to fall. The exchange of fat and cholesterol between VLDL and LDL produces smaller, more densely packed LDL particles. This so-called "small dense LDL" also has a high arteriosclerosis-promoting potential.

What contribution can Dr. Coy's sugars make to cholesterol and lipometabolic disorders?

Dr. Coy's sugars have a low glycemic index and therefore have a low impact on insulin levels and insulin resistance.
Galactose, tagatose and erythritol in particular can prove useful in the prevention and treatment of lipometabolic disorders.

Tagatose is metabolized in a similar way to fructose. Nevertheless, the low absorption rate and the low blood sugar-raising effect appear to have a positive effect on lipometabolic disorders. In experiments on mice, replacing household sugar with tagatose was already associated with a lower level of obesity, increased triglyceride and blood sugar levels and arteriosclerosis ⁵. Diabetics who took 15 g of tagatose 3 times a day with meals not only improved their blood glucose and HbA1c levels, but also reduced their total and LDL cholesterol levels ⁶. In a similar study with diabetics, their weight and HDL levels also improved ⁷.

Galactose is absorbed and utilized slowly compared to other simple sugars such as glucose and fructose. The insulin-independent absorption into cells is also a great advantage here. This gives the body time to use galactose as an energy source even in cases of insulin resistance, instead of converting it to fat.

Erythritol is excreted unchanged by the body and has no effect on blood sugar and insulin levels, nor does it contribute to fat formation and thus to increased blood lipid levels.