CHOLESTEROL: MYTHS, ITS PURPOSE, WHAT’S IMPORTANT, WHAT’S NOT
Cholesterol has received more negative attention in the last 30 years than it ever deserved. Let’s start by dispensing with two major medical myths:
MYTH 1: Eating foods high in cholesterol will raise your cholesterol. THIS IS NOT TRUE. You can have all you want. It won’t affect your cholesterol level.
MYTH 2: High cholesterol causes heart disease. THIS IS NOT TRUE. Heart disease is caused by abnormally small lipoprotein particles. These are called LDL, and are a mix of fat, cholesterol, and some proteins. It is not the content that is important, it is the size. The small sizes are problematic, and it is primarily the fat in the particles that does the damage. The size, in turn, is controlled by diet.
Many people will know their total cholesterol number, and perhaps their ‘good’ and ‘bad’ cholesterol levels as well. These numbers by themselves haven’t much value really. The medically useful information is much more nuanced.
Lumped in with ‘bad cholesterol’ we find ‘really bad cholesterol’ and ‘not bad at all cholesterol’. Similarly within ‘good’, there is ‘really good cholesterol’ and ‘more or less neutral cholesterol’. The ‘really bad’ and the ‘really good’ are the important ones, and a more complex blood test, called an advanced lipid profile, can sort this out.
This is quite important. If you don’t have much of the ‘really bad’ cholesterol, you may not need to worry about cholesterol – period. And what’s more, you are at quite low risk for heart disease. If you do have the ‘really bad’, then you would be advised to make serious efforts to change it. Lifestyle modification can lower the amount of ‘really bad’ and increase the amount of the ‘really good’. These modifications can stop and even reverse heart disease.
So what is cholesterol all about?
Cholesterol is cholesterol is cholesterol. There aren’t really good and bad types. Cholesterol is a major cell wall building block. Without it you would probably melt. Cells make their own. The cholesterol that is packed into the LDL particles in the blood is a backup supply manufactured by the liver. The liver actually packs fat molecules-triglycerides- along with this cholesterol into tiny little balls called VLDL or Very Low Density Lipoprotein and sends them off into the bloodstream.
The Saga of the VLDL Particle
As the VLDL particle circulates about in the blood, needy cells pick at it, and tear off and eat the fat molecules. As the VLDL particle continues its perilous journey, it shrinks. As it gets smaller, it’s renamed LDL (Low Density Lipoprotein), though it’s still the same particle – minus much of its original fat. At this point there is a possible problem. If the LDL particle has gotten small enough, they tend to get stuck inside the artery wall. If it does get stuck, its contents oxidize (become rancid) and just like rancid oil, become toxic.
It’s the small size that causes atherosclerosis (hardening of the arteries). For this reason, LDL is called the ‘bad cholesterol’ – a confusing designation if there ever was one. Cholesterol had little to do with it. It was mainly just along for the ride.
HDL to the Rescue
Your body has developed an interesting way to deal with these stuck LDL’s. The liver manufactures an even tinier particle which also circulates in the blood which recovers toxic junk from stuck LDL particles, and hauls it back to the liver for disposal.
This wondrous little particle is called HDL or High Density Lipoprotein, and is known as the ‘good cholesterol’. As the tiny HDL vacuums up the stuck LDL mess it will grow in size. If you have a lot of the ‘fully grown’ HDL particles, your body is doing a splendid job of managing rancid fat and oxidized cholesterol problems. This fully grown HDL particle is the ‘really good cholesterol’ we mentioned earlier.
The advanced lipid profile sorts out HDL size as well. With this test, you can learn how much of the troublesome sort of LDL you have and how well the HDL garbage collection fleet is working. It these need fixing, here are the ways.
How to Avoid the Small Dangerous LDL Particles.
The advanced lipid profile test will also analyze the LDL sizes it finds and will determine if you have ‘Pattern A’, the large harmless LDL particle size, or ‘Pattern B’, the small dangerous ‘really bad’ size.
Whether you have Pattern ‘A’ or ‘B’ is governed by diet. Specifically, if your triglycerides are high, you will likely have the Pattern B particle size. This is not desirable. Triglycerides are circulating fat. Triglycerides are driven high, oddly, by excess sugar, starch and alcohol. Triglycerides are not driven high by the fat you eat. There’s solid reasons for this, but they are a bit beyond a 101 post.
This bears repeating. Excess amounts of small dangerous LDL particles are caused by excess sugar and starch and alcohol. They are not caused by fat or protein consumption.
If you reduce your sugar, starch and alcohol intake enough, your triglycerides will come down, and once they are below some value, you will stop having the small LDL particle sizes. This is heart health. You risk will be low and any atherosclerosis you have will be reversing.
So what is this critical level of triglycerides. It varies from person to person. The only way to know for sure is to measure, modify if necessary, and re-measure. This is the fundamental principle of Quantitative Medicine. However, for most people, a triglyceride level of under 100 mg/dl will produce the ‘A’ pattern particle size.
Going from the ‘B’ to ‘A’ particle size reduces your heart disease risk by 60%. Quite a lot of reduction for just eating sensibly.
How to Boost Your HDL
HDL and especially the ‘really good’ HDL are increased by exercise. But not just any exercise. Specifically, intense, explosive, concentric (muscles shortening) sorts of exercises will raise this. Here quality far outweighs quantity. An hour and a half a week of this sort of intense exercise will do a world of good. On the other hand, 5 hours a week of moderate aerobic will have little effect on HDL.
Do not start an exercise program of any sort without your doctor’s blessing.
You do not have to boost your HDL all that much to do a lot of good. An increase of 10 mg/dl, which is quite achievable for most, will reduce your risk of heart disease by 50%, and as a wonderful added bonus, reduce your cancer risk 35%. Why this? HDL is good at scavenging all sorts of trash, and can relieve the cellular stress that could otherwise cause cancers to start.
Double dip. Get the LDL size up with diet, and boost the HDL level with exercise, and you will probably sweep heart disease off the table.
The Strange U. S. Political History of Cholesterol and Saturated Fat
At some point in the 1970’s it was concluded that America’s health was deteriorating and that congress should be doing something about it. Thus the Federal Government officially got into the nutrition business. As is usually the case, there were myriad special interests attempting to sway things one way or the other, and out of this mire was fashioned the famous Food Pyramid. Its base was the delight of the cereal industry, and red meat was all but abolished.
This spread far and wide. Soon low fat and high carbs were all the rage and the obesity epidemic was launched. Many readers will have lived through the entire saga. It is by no means over. Many prepackaged and processed foods still proudly boast ’no cholesterol’, and many august organizations still rail against it.
But let’s look at cholesterol in isolation. The finding back then was that saturated fat eaters had high cholesterol, and that heart attack victims had a lot of both in their arteries. However, heart attack victims frequently smoked, drank too much, and had a sort of ‘healthy lifestyle is not my highest priority’ attitude. These other things are called ‘confounding variables’ in the trade, but were sort of swept under the carpet at the time. But what is the reality here?
Suppose you don’t smoke, don’t drink too much, and do pay attention to quantity and quality of what you eat. However, further suppose you regularly eat cholesterol laden red meat. The health implications for this kind of behavior are starkly different. In this setting, cholesterol and saturated fat do not cause problems. In fact, quite the opposite, they tend to reduce them. They’re protective.
All the concern was never warranted, and the high carb food pyramid condemned literally millions to a shortened diseased life because they could not tolerate the high starch diet, for exactly the reasons outlined above.