Sticky Business: Why the Quality of Your LDL Matters More Than Your Ra

"Your cholesterol is a bit high." For many people, it is one of the first moments a doctor's visit suddenly feels serious. A number on a sheet of paper, a frown, perhaps a leaflet. And then the question we hear at our counter almost every week: "What does that number actually mean?"

Good news first: cholesterol is not your enemy. It is one of the most useful molecules in your body. The real story lies not in how much of it there is, but in how it travels, and in how "sticky" the vehicles that carry it have become.

First, a little love letter to cholesterol

Before we talk about "good" and "bad", let us give cholesterol the credit it deserves.

Your hormones are made from it. Cortisol, which helps you get up in the morning. Oestrogen, progesterone and testosterone. Aldosterone, which keeps your salt and water in balance. Every one of them starts life as a cholesterol molecule.
So is vitamin D. When sunlight touches your skin, it transforms a close relative of cholesterol into vitamin D. Every sunny walk is, quite literally, cholesterol at work.
Your brain is full of it. About a quarter of all the cholesterol in your body sits in your brain, where it helps insulate nerve cells and build the connections between them.
It helps you digest. Your liver turns cholesterol into bile acids, which help you absorb fats and fat-soluble vitamins from your food.

Because it is so important, your body does not leave it to chance. Your liver makes most of your cholesterol itself; food delivers only a smaller part. In other words: cholesterol is not a problem to be eliminated. It is a precious material that needs to be delivered well.

Boats in your bloodstream: LDL and HDL

Cholesterol is a fatty substance, and fat and blood do not mix. So your body packs it into tiny transport boats called lipoproteins. Two of them star in every blood test.

LDL (low-density lipoprotein) is the delivery boat. It carries cholesterol from the liver to the cells that need it, for building membranes, hormones and more. Every LDL particle carries exactly one protein on its surface, called ApoB, a little like a licence plate.

HDL (high-density lipoprotein) is the collection boat. It picks up cholesterol that cells no longer need, including from the walls of your blood vessels, and returns it to the liver.

That is why LDL is often called "bad" and HDL "good". Simple and memorable, but only half the story.

Why the ratio is not the whole story

For years, the LDL-to-HDL ratio was the number everyone looked at. The idea: as long as there are enough collection boats for the delivery boats, all is well.

Research has since shown that two other questions matter more.

1. How many boats are there? Your standard blood test measures how much cholesterol is in your LDL boats, not how many boats there are. Imagine two people with exactly the same LDL cholesterol. One carries it in a modest fleet of large, roomy boats. The other carries it in a swarm of small, cramped boats. The second person has far more particles bumping against the vessel walls, and every particle is a chance for one to slip into the wall.

2. How sticky are they? This is where it gets interesting. Small, dense LDL particles slip more easily into the vessel wall, stay there longer and oxidise more readily. And oxidised LDL is the truly sticky kind. The immune system treats it as damaged material and tries to clear it away. Over time, that clean-up operation is what builds up into plaque.

The same nuance applies to HDL. More is not automatically better. What counts is how well your collection boats actually do their job, what researchers call cholesterol efflux capacity.

So the more useful question is not "what is my ratio?", but: how many boats do I have, and how sticky have they become?

How can you measure "sticky" LDL?

A few tests go beyond the standard panel. You can ask your GP or a laboratory about them:

ApoB. Because every LDL particle carries exactly one ApoB, this simple, affordable test effectively counts your delivery boats. If you only add one test, this is the one.
LDL particle number (LDL-P). Measured by NMR spectroscopy, it counts the particles directly and also tells you their size.
Small dense LDL (sdLDL). Measures how much of your LDL cholesterol sits in the smallest, densest particles.
Oxidised LDL (oxLDL). Measures how much LDL has already been oxidised: the stickiness itself.
Lipoprotein(a), or Lp(a). A particularly sticky variant of LDL whose level is largely inherited. Worth measuring once in your life.

A handy clue you may already have: look at your triglycerides and your HDL on your existing results. If your triglycerides are high and your HDL is low (a triglyceride-to-HDL ratio above roughly 3 when both are measured in mg/dL), that often points to more small, dense LDL particles.

Hydroxytyrosol: the bodyguard that travels with your LDL

Now to the most beautiful part of the story, and it begins in an olive grove.

Extra virgin olive oil owes its bitterness and its peppery bite to polyphenols. One family of them leads to hydroxytyrosol. In the olive, it starts as oleuropein, the compound that makes a fresh olive so bitter you cannot eat it straight from the tree. During pressing, oleuropein is transformed into oleacein and oleuropein aglycone, and in your digestive system these release hydroxytyrosol.

Here is the remarkable part: hydroxytyrosol does not just float around in your blood. It attaches itself to your LDL particles and travels along with them, like a bodyguard on board. There it protects the LDL from oxidation, which is exactly the process that makes LDL sticky.

Spanish researchers put this to the test. For three weeks, healthy men used 25 ml a day of olive oil either rich or poor in polyphenols. With the polyphenol-rich oil, they had fewer LDL particles, fewer small LDL particles, and LDL that was less prone to oxidation (Hernáez et al., 2015). In a parallel study, their HDL collection boats also did their job better (Hernáez et al., 2014).

And its sibling, tyrosol? It is a gentler antioxidant, but more stable, and your body can convert part of it into hydroxytyrosol in the liver (Rodríguez-Morató et al., 2017). Think of it as a reserve. To this family also belongs oleocanthal, famous for the peppery tickle at the back of your throat.

This is also the basis of the only officially recognised European health claim for olive oil: olive oil polyphenols contribute to the protection of blood lipids from oxidative stress, with 20 g a day of an oil that contains at least 5 mg of hydroxytyrosol and its derivatives.

A wink to your kitchen

That makes your choice of olive oil more than a matter of taste.

Green Machine by OlvLimits, an early-harvest Coratina from Puglia, contains 27.55 mg of hydroxytyrosol, tyrosol and their derivatives per 20 g: more than five times the amount required for the EU claim. Bold, bitter and peppery, exactly as it should be.
Nocellara d'Italia by Attimo is gentle and fruity, yet surprisingly rich in oleacein (209 mg/kg), the hydroxytyrosol family's link in the oil. Proof that soft does not have to mean weak.
Picual de España by Attimo brings fresh tomato leaf and a lively, peppery finish from Jaén.

About 1½ tablespoons a day, drizzled raw over tomatoes, beans, soup or bread, is all it takes. The fun part: the more it makes you cough, the more polyphenols you are probably tasting.

Cholesterol Balance: three Mediterranean plants, one formula

For days when you would like a little extra support, we created Floruna Cholesterol Balance, together with the Belgian family company Soriphar. The formula brings together three plants that each tell their own part of this story.

Olive extract (25:1), standardised to 10 mg of hydroxytyrosol. The bodyguard from the olive grove, in a concentrated form. Artichoke and olive contribute to the maintenance of normal cholesterol levels.

Artichoke extract (6:1), standardised to 10 mg of cynarin. Cynarin gives the artichoke leaf its bitterness. It stimulates the flow of bile, and because your liver uses cholesterol to make bile, this offers your body a natural way to put cholesterol to use. Artichoke supports liver function, and researchers have also studied luteolin, another artichoke compound, for its influence on the liver's own cholesterol production.

Fermented black garlic (FBG22®, 25:1). Black garlic is garlic that has been aged slowly at gentle warmth until its cloves turn soft, dark and sweet. Along the way, it develops high levels of S-allylcysteine, a well-studied antioxidant: another ally against oxidation, and therefore against stickiness.

Two capsules a day, one with breakfast and one in the evening, and a jar lasts a month.

The Mediterranean secret is not one ingredient

In the Mediterranean, nobody speaks of "cholesterol management". People speak of long meals, of vegetables from the garden, of beans and lentils, of fish, of a handful of nuts, of a generous splash of green olive oil, and of the evening walk up the hill to watch the sun set over the sea.

That is ultimately the story of your LDL as well. Fewer boats, less stickiness, more collection: it all grows from a way of living in which good food, movement and pleasure go hand in hand.

Cholesterol is not your enemy. It is the raw material of your hormones, your vitamin D and your brain. All it asks is a smooth, clean journey.

Want to know more? Come by our shop in Hasselt, or explore our Heart Flow collection.

This article is for general information and is not medical advice. Food supplements are not a substitute for a varied, balanced diet and a healthy lifestyle. Do you take medication, such as cholesterol-lowering medication or anticoagulants, are you pregnant or breastfeeding, or do you have a medical condition? Talk to your doctor or pharmacist before use.

Sources

Hernáez Á, et al. (2015). Olive oil polyphenols decrease LDL concentrations and LDL atherogenicity in men in a randomized controlled trial. Journal of Nutrition 145(8):1692–1697.
Hernáez Á, et al. (2014). Olive oil polyphenols enhance high-density lipoprotein function in humans: a randomized controlled trial. Arteriosclerosis, Thrombosis, and Vascular Biology 34(9):2115–2119. PubMed
Rodríguez-Morató J, et al. (2017). CYP2D6 and CYP2A6 biotransform dietary tyrosol into hydroxytyrosol. Food Chemistry.
European Commission Regulation (EU) No 432/2012, authorised health claim for olive oil polyphenols.