Cholesterol Basics
Cholesterol
Remember all that conflicting data years ago about how eggs were good for us one day and bad for us the next? This is a topic I could spend hours talking about. I am not here today to lecture you on statins versus natural therapies. However, this is a topic we will delve deeply into when you are a patient here in our practice. For now, let’s cover the basics.
Although the health risks versus benefits of egg consumption is no longer a hot topic, there is still a plethora of information about cholesterol out there that could be very confusing. Some of it is accurate, and some of it is not. So, what do we do about it? Who do we listen to?
There are several cardiologists that have profited from publishing books that tout the benefits of the ketogenic diet. Unfortunately, if you are a proponent of the ketogenic diet, I am here to crush your hopes and confirm that bacon everyday is not good for you. There is much to unpack regarding the complexities of the ketogenic diet. We can address it at a later date.
That said, if you are looking to optimize your cholesterol, I implore you to consider a Mediterranean diet. Or, a plant-based diet such as that found in the blue zones. You can check out the blog post titled “Nutrition 101” for further information on blue zones. Or do a robust Internet search on this topic. Where you will find plenty of reliable and useful resources.
So what exactly is good and bad, cholesterol? You may have had a primary care provider tell you that your total cholesterol is fine. But, what does that really mean? And, why does my cardiologist roll their eyes when I tell them that my primary care said my total cholesterol is fine? Should I care?
A cholesterol panel evaluates the total cholesterol, triglycerides, low density, lipoprotein (LDL), high density lipoprotein (HDL), and very low density lipoprotein (VLDL). As well as a ratio.
I often tell patients to remember that the good cholesterol, HDL, stands for Heart’s Desire Lipid. Whereas your bad cholsterol, LDL, stands for Lethal Dose Lipid. This makes it much easier to remember. The VLDL is part of your LDL measurement. It is just a smaller particle size. In the case of cholesterol, bigger is better.
Your LDL is determined utilizing the traditional Friedwald equation. Which is:
(Total Cholesterol - HDL - Triglycerides)/5
As you can see, LDL is not directly measured. It is calculated. Therefore, if your triglycerides are elevated, your LDL measurement will be falsely low. As you can also deduce, you could have a normal total cholesterol, but the breakdown may be abnormal. Which is why your cardiologist or vascular surgeon may have rolled their eyes at your GPs celebration for a “normal” total cholesterol level.
So, what excatly are my cholesterol goals?
LDL <100 (or <70 with known cardiovascular, disease)
HDL >50
Triglycerides <150
So, if the "bad "cholesterol is LDL, why should I care about HDL or triglycerides? Well, think of HDL as a street sweepr, or duster. And, think of LDL as garbage or dust. HDL is a large molecule that helps to clean up too much LDL. The more HDL, the better.
Triglycerides are also important. This is a way that our bodies have learned to protect ourselves through our evolutionary past. It is how our bodies store our calories for energy and later use.
Unfortunately, high levels of triglycerides can increase our risk of heart disease and stroke. Elevated triglycerides can be seen in obesity (particularly with central, or belly, fat), metabolic syndrome, type 2 diabetes or pre-diabetes. As well as with alcohol over consumption and liver disease.
As for HDL, our diet and lifestyle choices can also have a negative impact on our HDL. Such as belly fat, smoking, a diet high in processed foods and processed complex carbohydrates, as well as being sedentary. However, we can increase our HDL with diet, exercise and lifestyle changes.
Of course genetics plays a role in our cholesterol. We can inherit a genetic predisposition for abnormal cholesterol. We could also also dive deeper into the conversation of other less likely causes of abnormal cholesterol. However, most people fall into the categories of being genetically predispositioned, having a diet and lifestyle that increases their risk of abnormal cholesterol levels, or a combination of both. Although we can’t alter our genetics, we can still optimize our health by following a heart healthy diet and remaining active.
In practice, I embrace a holistic and evidence-based approach to lipid management. Also, a cholesterol panel in and of itself is not a definitive measure of outcomes and risks. This discussion hasn’t addressed any of the other factors that affect cardiovascular risk. However, cholesterol is an important factor in overall cardiovascular health, and should not be ignored.
If you would like to learn more about healthy food choices, how to reduce inflammation and reduce your overall risk for chronic disease and cancer, as well as maximize your health and empower yourself. Please check out our podcast and sign up for our newsletter.
