The Truth About Cholesterol

By: Cat Ebeling, RN, MSN-PHN, co-author of the best-sellers:  The Fat Burning Kitchen, The Top 101 Foods that Fight Aging & The Diabetes Fix

Have you ever had that phone call from your doctor when he (or she) says, “Your cholesterol is too high.” Other than going on dangerous statins, what do you do if your cholesterol is high? Do you cut out butter, eggs, and steak? The answer is no, you don’t have to eliminate all foods containing saturated fat or cholesterol.

I have good news for you. You can actually lower your cholesterol, reduce your risk of heart disease, and continue to eat those nutrition-packed foods.

I recently had my cholesterol panel checked. I eat a Paleo/primal diet of naturally raised meat, fish, poultry, a little full-fat sheep yogurt or cheese, lots of fresh veggies, small amounts of beans, and virtually no foods made of grains, tapioca, or other processed starches. Although I had eaten a big hunk of steak the night before and put a big hunk of grass fed butter in my coffee just prior to my lab visit, my cholesterol panel ended up looking pretty darn good. Here’s what my labs said:

• Total Cholesterol—155mg/DL     Under 200 is good
• High Density Lipoprotein (HDL)—104    Over 50 is good
• Low Density Lipoprotein (LDL)—38    Less than 100 is good
• Triglycerides—44    Less than 150 is good

As you can see, those cholesterol numbers are not too shabby.

While doctors tend to ‘freak out’ and want to put you on statins if your cholesterol is over 200, that’s not necessarily the best way to manage your cholesterol. Let’s look at where those numbers come from, and which ones are worth paying attention to.

Total Cholesterol

This is the number that many doctors tend to fixate on, and it’s actually pretty worthless. Guidelines show a total cholesterol between 200-240 mg/dl is best, there’s a lot more to the picture. Total cholesterol number will only tell us the amount of cholesterol contained in all of our lipoproteins, but it has nothing to do with which kind of lipoproteins.

Total cholesterol is determined by this formula: HDL-C+LDL-C+(Triglycerides/5) = TC.

Someone with low HDL and high triglycerides (not a good thing) could easily have the same total cholesterol numbers as someone with high HDL and low triglycerides (a very good thing) so long as the numbers work out.

Whether it’s used to predict health or disease, the total cholesterol number all by itself is pretty meaningless. So if your doctor is freaking out about your total cholesterol numbers, that is not as important as your LDL, HDL and triglyceride numbers.

Both LDL and HDL are critically important for heart health. And, surprise—diet and lifestyle are the keys to optimizing both levels.

LDL the ‘Bad’ Cholesterol

LDL is what is considered the ‘bad’ cholesterol and is one that concerns most medical professionals. However, did you know that higher blood sugar from eating a diet high in sugar and starchy foods contributes heavily to this number? High blood sugar means rising triglycerides. The liver then creates more LDL from this.

Why is LDL considered ‘bad’?

LDL particles, composed of a combination of fat molecules and protein (lipoproteins), transport cholesterol from the source in the liver to other organs.

Here’s a great analogy from Mark Sisson of Mark’s Daily Apple blog on cholesterol:

“…Both LDL-cholesterol and HDL-cholesterol, the standard, basic readings you get from the lab, do not reflect the number of LDL or HDL lipoproteins, or particles, in your serum. Instead, they reflect the total amount of cholesterol contained in your LDL and HDL particles…[this] is like counting the number of people riding in vehicles on a freeway to determine the severity of traffic. It’s data, and it might give you a rough approximation of the situation, but it’s not as useful as actually counting the number of vehicles. A reading of 100 could mean you’re dealing with a hundred compact cars, each carrying a single driver, or it could mean you’ve got four buses carrying 25 passengers each. Or it could be a couple buses and the rest cars. You simply don’t know how bad (or good) traffic is until you get a direct measurement of LDL and HDL particle number.”

Why is LDL Considered ‘Bad’?

The clearest picture of inflammation’s role in the onset of atherosclerosis comes from studies into LDL, the “bad cholesterol”. LDL particles, composed of fatty molecules and protein, transport cholesterol from their source in the liver and intestines to other organs. Scientists have long known that although the body needs LDL and cholesterol, excessive amounts promote atherosclerosis, which is, in layman’s terms, “clogging of the arteries”.

It is notable too, that LDL is made up of larger, fluffier LDL particles and also smaller, denser VLDL (very low-density lipoprotein) particles. These are generally the ones that are most damaging to blood vessels.

VLDL numbers are directly tied to triglyceride count. Since triglycerides come packaged inside VLDL, you can calculate VLDL by dividing your triglyceride count by 5.

At reasonable concentrations in the blood, LDLs can pass in and out of the inner part of the blood vessel walls. If there are excessive amounts, the LDLs can tend to become stuck, however. When LDL particles hang out in the blood too long, their fragile polyunsaturated fatty membranes are exposed to oxidation and the LDL particles oxidize.

Once oxidized, LDL particles are taken up by the inner layer of the blood vessels – to form atherosclerotic plaque. Sort of like a ‘band-aid’ in the blood vessel. When LDLs from the blood start to pile up in the blood vessels, the cells in the blood vessel wall interpret the changes as a danger sign, and signal for healing reinforcements from the body.

This begins an inflammatory response which is the type of chronic low-level inflammation that occurs in atherosclerosis. This inflammatory process changes the blood vessel wall, eventually generating a bigger, more complicated plaque. Ongoing inflammation signals to continue to build a bigger ‘band-aid’.

Other contributors to inflammation in the blood vessels include omega 6 fatty acids from vegetable seed oils (which are polyunsaturated) and elevated blood sugar levels from high sugar/carbohydrate diets. A high sugar/carb diet also leads to high triglycerides as well, which is sort of a precursor to higher levels of LDL.

LDL can also be abnormally high if you are losing weight, have a low thyroid, kidney disease, diabetes or Cushing’s syndrome.

Where Does HDL Come In?

The higher your HDL cholesterol the better, but benefits depend on how you get there.

HDL is generally very beneficial to the body. As levels of this “good cholesterol” decline, the likelihood of suffering a heart attack goes up. This is one reason why physicians measure cardiovascular risk by looking at triglycerides and the ratio of LDL to HDL.

HDL (the ‘good guy’ in the cholesterol panel) fights LDL (bad cholesterol). Like a well-trained military army, the HDL particles patrol the blood vessels, grabbing the cholesterol from circulating LDL particles and also from the dangerous, gunky plaque that lines blood vessels walls. This HDL army carries away their fatty cargo to the liver for recycling or disposal out the intestines.

However, HDL cholesterol is a bit more complex than just that. Instead of a single kind of particle, HDL cholesterol is a family of different particles. Some types of HDL are great at taking cholesterol away from LDL and blood vessel walls while other types are indifferent to cholesterol, and some even transfer cholesterol the wrong way — into LDL and cells.

Some HDL particles will protect LDL from oxidation, which is when LDL becomes dangerous. Other types of HDL particles can slow down inflammation and stimulate production of nitric oxide, a molecule that helps artery walls relax, and prevents blood clots from forming inside arteries, i.e., heart attacks and strokes.

So, the aim here is to keep the HDL numbers up. Exercise is a huge factor in raising up HDL numbers as is maintaining a healthy weight. And if you smoke cigarettes, quitting will raise up your HDL just by stopping—in addition to all those other health benefits.

In general, women tend to have higher HDL numbers than men, but postmenopausal women need to pay close attention to HDL numbers. After you’ve gone through menopause, HDL tends to decrease, raising your risk of heart attacks and strokes.

What About Triglycerides?

Having triglycerides over 150 can increase your risk of heart disease. Triglycerides are a type of fat found in your blood. When you eat, your body converts calories—especially from carbs and sugars into fat, via the liver. The triglycerides are stored in your fat cells and in your liver. Along the way, triglycerides can be released for energy between meals or for endurance activities.

The triglyceride measurement is a ‘no-brainer’. If you eat more calories than you will burn, particularly from high-carbohydrate foods, this is converted directly into triglycerides.

Many people have high triglyceride levels due to being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or diet. High triglycerides are primarily a lifestyle-related risk factor.

High triglycerides are strongly connected to the more harmful smaller, denser VLDL. High triglycerides, then, could indicate that you have more oxidized (or oxidizable) LDL.

High fructose corn syrup, when consumed, is immediately turned into fat by the liver. This fat is triglycerides. Only two weeks of modest consumption of high-fructose corn syrup causes cholesterol and triglycerides levels to rise, and the more consumed, the greater the increases.

A study reported in The American Journal of Clinical Nutrition, shows that the more high fructose corn syrup, the worse the lipid profile. So, if you consume a lot of high fructose corn syrup, you can drastically—and quickly–lower your triglycerides and LDL just by eliminating that one ingredient.

Side note: when I worked in the hospital as a nurse, it was very obvious to see which people had high triglycerides. Much like salad dressing that separates, you could actually see the fatty particle layer in someone’s blood.

Because of the conflicting information tossed about concerning cholesterol and saturated fats, you may think that cholesterol in foods and saturated fats are harmful substances that should be avoided at all costs. Many still do—in fact, many conventional doctors do.

In fact, though, quite the opposite is true. Cholesterol is an essential element in our bodies. It is found in all the cells of the body, particularly in the brain and nerve cells. As cells go through the constant renewal process of dying, and news ones are created, cholesterol is the major building block for our cell walls.

Cholesterol is also used to make a number of other important substances: sex hormones (including testosterone, estrogen, and progesterone), participating in the immune response, helping creating bile acids, and vitamin D 3. Our bodies use large quantities of cholesterol every day and it is vital to life.

Your cholesterol profile may be influenced by other conditions such as alcohol consumption, cigarette smoking, hypothyroidism, untreated diabetes or pre-diabetes, pregnancy, lactation, stress, kidney disease, and liver conditions. Weight loss or fasting can also temporarily increase cholesterol. Ask your health care provider to measure other important biomarkers, including C-reactive protein (an inflammatory indicator), oxidized LDL, and ApoB, or Apoliprotein B.

Cholesterol may be derived externally from animal products in your diet, but this less than twenty percent of your body’s cholesterol needs. Your body will make up the difference. If you eat less cholesterol than you need, your body compensates by making more.

Key to remember:

• A raised blood cholesterol is not a predictor of coronary artery disease.
• Research has established inflammation as one of the primary factors in atherosclerosis.
• A low carb/low grain/low sugar diet consisting of grass fed meats, wild caught fish, free range chicken and vegetables combined with regular exercise and maintaining a good weight, can reduce risk of inflammation, heart attacks and strokes.
• The level of cholesterol in your blood is affected very little by the amount of cholesterol in your diet.

 

 

References
https://health.clevelandclinic.org/sweet-tooth-spells-trouble-heart/
https://www.marksdailyapple.com/cholesterol/
https://www.marksdailyapple.com/how-to-interpret-cholesterol-test-results
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186
https://www.healthline.com/health/vldl-vs-ldl

Barry Groves, PhD, “The Great Cholesterol Lie”
http://www.second-opinions.co.uk/cholesterol_myth_1.html

By Peter Libby, “Atherosclerosis: The New View”, Scientific American, November 10, 2008.
https://www.health.harvard.edu/newsletter_article/hdl-the-good-but-complex-cholesterol