Understanding cholesterol: the good, the bad and the fatty?

A few years ago I remember watching a commercial for cereal, and the main marketing pitch was that by eating the cereal you can lower your cholesterol. The media decided to wage a war against cholesterol, without mentioning that cholesterol is an essential part of our bodies, one we could not live without.

What is cholesterol?

Cholesterol is an organic molecule that our body needs and uses in order to create a number of other molecules, for example testosterone and estrogen. It is also an essential building block in the cell membranes of our body, which is the barrier surrounding the cell for those of us who don’t remember what a membrane is.

You may have heard of ‘good’ cholesterol and ‘bad cholesterol, so let’s understand a bit more about what that means. Cholesterol is not soluble in water, and so it needs to be packaged in a special larger molecule in order to be transported through the blood in our body. The way that it is packaged is in larger molecules called lipoproteins. Lipoproteins are made up of cholesterol, proteins, triglycerides (a type of fatty acid), and lipids (a different type of fatty acid). Now it’s important to note that although ‘fat’ has a bad name, the ‘fat’ that most people think of are adipose tissue, specific cells that store fatty acids and not fat molecules like lipids, which play very important roles in our body. And although there is a connection between the two, just keep in mind that fat is not necessarily a bad thing. Lipoproteins are characterised by the different proportions of each of the 4 ingredients mentioned above, which influences the density of the molecule.

When people say ‘bad cholesterol’ what do they mean?

Low density lipoproteins, also known as LDL contain large amounts of cholesterol. Their main job is to transfer cholesterol from the liver, where the majority of cholesterol is made, to the peripheral tissue of the body. In the peripheral cells of the body the cholesterol is used to synthesise the hormones, and maintain the cell membranes. Excess cholesterol is returned to the liver to make bile acids, though this is a different topic altogether. The problem arises when there is too much LDL in our body. High levels of LDL create a situation in which there is too much cholesterol for our body to deal with, and part of it gets deposited in the walls of the blood vessels in our body, and this is when the problems start. Cholesterol in our blood vessels creates plaques, which can narrow the insides of the blood vessels, or rupture. This could lead to high blood pressure, heart attack, strokes, and many other problems as well.

What levels of LDL should we aim for?

The level of LDL that you should be aiming for depends on your risk factors for heart disease. These risk factors are age (over 45 for men, 55 for women), family history of heart disease at an age earlier than 55 for men, 65 for women, smoking, diabetes, high blood pressure and low HDL levels (we’ll get into this soon). If you have no risk factors, you should try to keep your LDL levels under 160mg/dl. With 2 or more risk factors you should aim for LDL under 130mg/dl, and if you have heart disease, or diabetes LDL levels should be under 100mg/dl. Although these are the accepted recommendations, there is some evidence to support levels even lower than that in individuals with plaque building up in their blood vessel walls (atherosclerosis). New drugs and research are looking to see just how low the level should be, though we can say with a fair amount of certainty that there is even more benefit to keep LDL levels under 70mg/dl, or lower.

When people say ‘good cholesterol’ what do they mean?

High density lipoproteins (HDL) is the ‘good cholesterol’. It is called high density even though it is the lipoprotein with the least amount of cholesterol. It contains a high proportion of proteins, which is where it gets it’s name, ‘high density’. When HDL is circulating in the blood stream its main job is to pick up excess cholesterol from the body and bring it back to the liver. If you HDL is high this can be a good thing, because not only does it remove some of the excess cholesterol from your body, it also prevents the oxidisation of LDL, and suppresses inflammation of the blood vessels. Because of these traits high levels of HDL have been known to reduce the risk of cardiovascular disease. Men should aim for an HDL level above 45mg/dl, women above 55mg/dl.

What are statins, and how do they help?

The drug of choice for individuals with high cholesterol are analogues of statins. They work by inhibiting one of the enzymes in the liver which is needed to synthesise cholesterol. Statins can lower your LDL, and raise your HDL as well. The main side effect is an elevation of liver enzymes, which is usually okay if it’s a minor elevation though if levels get too high you might have to stop taking the statin. Another side effect is muscle pain, which has a higher risk of happening if you’re taking a statin along with certain antibiotics, antifungals and some fibrates.

Can you lower your LDL or raise HDL naturally?

Absolutely. A healthy diet, along with physical activity are great ways to improve your cholesterol composition. Although we’re not going to get too deep into what a healthy diet means, the key points are:

  • Avoid processed foods as much as possible
  • Avoid sodas or any drink with sweeteners (including diet)
  • Increase the amount of vegetables
  • Choose whole grains
  • Reduce the amount of saturated fat

Physical activity can not be emphasised enough however. A strong work out regiment can go a long way to improving the cholesterol composition in your body, and making sure you are lowering the chances for cardiovascular disease. Lastly, one of the best ways to lower your LDL and increase your HDL is to quit smoking. If you smoke even small amounts, you are greatly increasing your chances of dying from cardiovascular disease.

Here we conclude our  post about cholesterol, and hopefully with this information you can understand a bit more about your lipid profile when you get blood test results from the doctor. Stay healthy, and prevent disease before it happens!

 

Take control of your health by eating properly, exercising and sleeping a good night sleep. If you’re not sleeping well, it could be severely effecting your health, find out more about your options to sleep better here. 

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