The term "fat metabolism" refers to the following processes in the body:
- the formation of fat in the liver and intestine,
- absorption of fats from the intestine,
- the transport of the fats in the blood,
- absorption from the blood into the cells for recycling,
- Return transport from cells to liver,
- Conversion and breakdown of fats in the liver and their excretion.
In many instances, these processes can be impaired. The most well-known blood fat is cholesterol. In addition to total cholesterol, the sub-groups LDL (low density lipoprotein) and HDL (high density lipoprotein) cholesterol are usually determined. In addition, the level of triglycerides should be determined, as these are also an important component of fat metabolism. Cholesterol is a vital substance that is an important component of the body's cell membranes. Cholesterol also produces hormones, such as the gender hormones oestrogen and testosterone, vitamin D and bile acids, which are needed for digestion. Cholesterol enters the bloodstream in two ways: The liver manufactures cholesterol by itself (up to 70 %) and additionally cholesterol is taken in through the diet (up to 30 %) via animal fats (meat, sausage, milk and dairy products). The blood transports cholesterol to the body cells.
Since fats, like cholesterol, are not soluble in the blood, our organism wraps cholesterol in protein and forms so-called lipoprotein particles out of fat (lipids) and protein (protein), which are water-soluble. These lipoproteins have different functions. The LDLs bring cholesterol to the cells in the body and release it there. If there is too much LDL cholesterol in the blood and the cells can no longer absorb, cholesterol can build up in the vessel walls. The arteries can then "calcify" which leads to atherosclerosis, which can have a negative effect on the coronary and/or cerebral vessels.
In contract to LDL cholesterol, HDL can reabsorb the cholesterol that has entered the vessels via the LDL deposits and transport it back to the liver. The liver then excretes the cholesterol in bile. As a result of these different functions, LDL cholesterol is called „bad" cholesterol, the protective HDL cholesterol is called "good" cholesterol.
To maintain health, it is important that LDL cholesterol is as low as possible: If there are no other cardiovascular risk factors, it should be below 160 mg/dl (4.1 mmol/l). On the other hand, HDL cholesterol should be as high as possible, but at least 40 mg/dl (1.0 mmol/l).
The most common causes of excessive LDL cholesterol, is when HDL cholesterol is too low, or when triglycerides are too high: Inheritance, malnutrition, diabetes mellitus, obesity, smoking and lack of exercise.
Treatment of fat metabolic disorder
The treatment begins with lifestyle changes (weight reduction, low fat diet, increased physical activity, no smoking). If these measures fail, medication must be administered. Medications such as statins, which can also be combined with other substances, are primarily used for this. Some of these drugs are available as injections. Your physician will guide the treatment and, if necessary, also prescribe a mechanical reduction of blood lipids and a reduction of Lp(a) level, ("lipoprotein small a"). This treatment process is called lipid apheresis. It is used when a particularly severe form of metabolic disorder and vascular disease have been identified that cannot be adequately treated in other ways.
If treatment is necessary and provided that the patient gives consent, the procedure for applying to the respective health insurance company for the covering of costs can be initiated by the doctor. Lipid apheresis therapy may also be necessary in the rare case of intolerance to lipid-lowering medication. This treatment is then carried out regularly at intervals of one to two weeks and is very effective.