Cholesterol: The Good, the Bad, and the Ugly Truth

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In today’s health-conscious world, pe­ople have deve­loped a significant interest in chole­sterol and its impact on our well-being. We­ often hear about the importance­ of maintaining healthy cholesterol le­vels and the risks associated with high le­vels. But what exactly is choleste­rol? And why does it matter to us? In this comprehe­nsive guide, we will de­lve into the complexitie­s of cholesterol, its vital role in our bodie­s, the various types of choleste­rol, and the factors that can influence our le­vels. 

Get ready to uncove­r the truth about cholesterol – both its positive­ and negative aspects – as we­ embark on this enlightening journe­y.

Understanding Cholesterol

What is Cholesterol?

Choleste­rol is a substance that resemble­s fat and has a waxy texture. It plays a crucial role in the­ body as it is present in eve­ry cell membrane. Chole­sterol performs important functions such as hormone production, synthe­sis of vitamin D, and aiding digestion through bile acid production. While our live­r naturally produces cholesterol, we­ can also acquire it from certain foods, espe­cially those rich in saturated and trans fats.

Importance of Cholesterol

While cholesterol has earned a reputation as a villain, it is important to recognize that it plays vital roles in the body.  Cholesterol is 

• necessary for the production of hormones, such as estrogen and testosterone, which regulate various bodily functions. 
• needed in the synthesis of vitamin D, which is essential for maintaining strong bones and a healthy immune system
• an antioxidant in the brain, protecting against oxidative damage associated with aging
• a precursor to product bile acids, which are required to break down fats for digestion

Additionally, cholesterol is a key component of cell membranes, providing stability and allowing cells to function properly. Without cholesterol, our bodies would not be able to perform essential tasks and maintain optimal health.

The Good: High-Density Lipoprotein (HDL)

To travel through the bloodstream, cholesterol needs a carrier that is fat-based, as blood is water based. These carriers are called lipoproteins. High-Density Lipoprotein (HDL) plays a crucial role in moving the cholesterol from the bloodstream back to the liver for removal. It is associated with reduced risk of heart disease and is famously known as “good” cholesterol.

The Bad: Low-Density Lipoprotein (LDL)

Low-Density Lipoprotein (LDL) is responsible for moving cholesterol from the liver to different parts of the body such as cells and arteries. If there is an excess of LDL cholesterol in the blood, it can build up on the artery walls, leading to formation of plaque and increasing the risk of heart disease, and therefore it is known as “bad” cholesterol.

The Ugly Truth: Cholesterol Myths and Misconceptions

When it comes to balancing cholesterol, just looking at the total cholesterol, HDL, LDL numbers and cutting fat from diet is not enough, as there are other factors that play an important role in increasing the risk of heart related diseases. These factors include Triglycerides, Size of LDL particles, Oxidation and Blood Sugar. Let’s look at these factors one by one.

Triglycerides

Triglycerides are a type of fat (called lipid) that circulate in the blood. It comes from dietary fat (such as butter, oil etc). In addition to dietary fat, any extra calories consumed (even from carbohydrates such as rice and pasta) are converted to triglycerides by the body. Some triglycerides are good for health, however high levels may contribute to hardening of the arteries or thickening of the artery walls leading to increased risk of stroke, heart attack and heart disease.

Size of LDL particles 

LDL particles (bad cholesterol) vary by size and density. They can be of two sizes, small and large. The small and dense particles, also called Very-Low-Density-Lipoprotein (VLDL) are more destructive than the larger ones as they have a higher probability to stay in the blood for longer and stick to the arteries. Note that normal blood tests do not reveal the particle size of LDL cholesterol.

Oxidation

So, we know that HDL moves cholesterol from the blood to the liver for removal, and LDL moves cholesterol from liver to the blood so it can perform its necessary functions in the cells. One problem is the increased number of LDL particles in the bloodstream, which can result in them attaching to the artery wall, building plaque and causing calcification of the artery wall leading to heart related diseases. 

One of the factors that causes these LDL particles to attach to the artery wall, causing plaque, is “Oxidation”. Oxidation of LDL cholesterol occurs when it reacts with free radicals. 

What are free radicals? Put simply, they are unstable molecules in the body which get created by the body as a result of normal body functions, and also due to our lifestyle and diet.Free radicals are the reason we tend to include antioxidant rich foods in our diet (such as fruits, vegetables) as they balance the free radicals.

The small, dense LDL particles (VLDL) are more prone to oxidation.

What promotes oxidation in the body?

• Consuming foods high in saturated fats
• Lack of exercise
• Obesity
• Overconsumption of alcohol
• Smoking
• Stress
• Foods fried at high temperatures
• Trans fats found in hydrogenated oils

Blood Sugar

When we try to balance our cholesterol, generally we tend to cut out fat from our diet. It might be enlightening to know that sugar plays a crucial role in increasing the small, dense LDL particles. How does this happen though? A high intake of sugar and refined carbohydrates increases the level of triglycerides, which in turn increase the small, dense LDL particles.

Often when people reduce fat from their diet, they compensate for the calories by eating refined carbohydrates, which can lead to high blood sugar. Over time, this can lead to insulin resistance and chronically high blood sugar, resulting in inflammation. High blood sugar contributes to the production of molecules called “advanced glycation end products” (AGES), which modify the LDL cholesterol particles to be easily oxidized. And as learned above, oxidation of LDL cholesterol results in them attaching to the artery walls, resulting in plaque and leading to heart disease.

Shameless plug: Feel free to check our other articles on this blog to learn about strategies to decrease inflammation and balance blood sugar (links at the end).

How to balance cholesterol levels using a holistic approch?

While genetics play a role in our cholesterol levels, lifestyle factors have a significant impact as well. By making certain modifications to our daily routines, we can effectively manage our cholesterol levels and reduce the risk of heart disease.

Before we dive into the actions that can be taken to improve cholesterol levels, note that cholesterol tests are important long before one feels sick and is old. In  the tests, 

• high triglyceride to HDL ratio is one of best indicators for risk of heart disease. (ratio of 2 or under is good, anything above 4 is risky) 
• Cholesterol-to-HDL ratio: Lower is better 
• Triglyceride to HDL ratio: Lower is better

When it comes to taking care of the cholesterol levels, the two most important factors to take care of are increasing the HDL cholesterol and decreasing the Triglyceride levels (the strategies for which would also help lower LDL cholesterol).

Some strategies to increase HDL cholesterol (if below 60mg/dl):

• Eat more olive oil
• Eat more eggs
• Follow low-carb or Keto
• Anthocyanin-rich foods, such as blueberries, blackberries, pomegranates, and other dark colored fruits and vegetables 
• Use coconut oil for cooking 
• Eat more fatty fish 
• Low amount of alcohol
• Aerobic Exercise

Some strategies to decrease triglycerides (if above 150mg/dl):

• High monounsaturated fats and omega-3 fats
• Little sugar and starch
• Vitamin C Supplement
• Fish Oil or Algae Oil
• Eat more olive oil
• Fenugreek seeds
• Ashwagandha
• Prebiotics and Probiotics
• Fruit in moderation, small dark colored berries preferably 
• Consume less calories than you burn
• Exercise before meals (brisk walking also effective)

Note: It can get pretty frustrating to figure out if you are consuming more calories than you are burning and if you are consuming high sugar (carbohydrates) based on your situation or not, therefore, it is helpful to consult a professional nutritionist or dietitian to create a personalized plan for you.

One important thing that comes into play when implementing these strategies is to be “very” aware of what you are putting into your body, that is, when eating anything from a packet, you should know each and every ingredient written on the “Ingredient” list of the pack, and know what effect each ingredient has in the body, is it a source of saturated fat? trans fat or hydrogenated fat? (the worst fat to consume), processed sugar? Because remember, the brands care about profits, so the responsibility of your health falls only on your shoulders.

Where does exercise fit in?

Exercise increases HDL cholesterol, decreases LDL cholesterol, and decreases triglycerides. However these changes are not permanent, and therefore consistency is required for long-term benefits, such as 30 min of activity daily (brisk walking, cycling etc).

Conclusion

Choleste­rol plays a crucial and intricate role in our bodies. It is ne­cessary for many physiological functions, but when there­ is an imbalance, it can lead to significant health proble­ms. By gaining an understanding of the differe­nt types of cholesterol, inte­rpreting cholesterol numbe­rs, making lifestyle changes, and se­eking appropriate medical he­lp when neede­d, we can effective­ly manage our cholesterol le­vels and lower the risk of he­art disease. It’s important to reme­mber that knowledge e­mpowers us to take control of our cardiovascular health and live­ satisfying lives.

Before­ making any major changes to your diet, exe­rcise routine, or medication, it’s crucial to consult with a he­althcare professional.

Please­ consult with a healthcare professional for any me­dical advice or concerns. This article is inte­nded for informational purposes only and should not be use­d as a substitute for professional medical guidance­.

Links

• https://theresponsiblehuman.site/why-do-we-get-fat/
• https://theresponsiblehuman.site/why-do-we-eat-part-1/

Resources

• https://drhyman.com/blog/2022/10/18/podcast-ep617/
• https://peterattiamd.com/the-straight-dope-on-cholesterol-part-i/
• https://cholesterolcode.com/
• Boundless: Upgrade Your Brain, Optimize Your Body & Defy Aging, Ben Greenfield