Everything You Always Wanted to Know About Cholesterol (And Then Some)
One of the first things your doctor does at your annual check-up is test your cholesterol level. It’s an important indicator of your health, and problems with your cholesterol might suggest a wide range of illnesses, including those that affect your liver, kidneys, eyes, and most importantly your heart.
Cardiovascular disease kills three quarters of a million Americans every year and is more deadly than all forms of cancer combined.
Taking care of your heart starts with your cholesterol.
What is cholesterol?
Cholesterol is a lipid, or fat based organic molecules. It has a bad reputation, but it’s essential for building the fatty phospholipid cell membranes in all animals including humans, helping them to maintain a stiff but flexible shape.
Plants, on the other hand, contain only minuscule amounts of cholesterol. The walls of plant cells are made up of cellulose, a hard, complex carbohydrate.
This is one of the main reasons you’re squishy while a carrot is not.
Nerves fibers in your brain and body are insulated, just like electrical wires. A fat layer called a myelin sheath, which is partially made of cholesterol, protects them.
This is essential for uninterrupted, controlled nerve impulses. A lack of myelin causes nervous system disorders, the most common of which is multiple sclerosis.
As well as cell structure and nerve function, cholesterol is also an important element in making hormones and digestive bile. It has plenty of roles in your body besides clogging your arteries.
Your body needs cholesterol.
The question is how much, and what kind?
There are a few basic kinds of insoluble fat compounds in your body.
Triglycerides are mainly body fat of humans and the animals we eat. Your body breaks them down to obtain glucose, and creates them to store excess energy.
Phospholipids make up all the cell membranes in your body and determine what goes in and out of a cell.
Sterols make up a variety of substances vital for your health, including cholesterol, bile acid, adrenal hormones like cortisol and Vitamin D, and sex hormones like testosterone.
Cholesterol doesn’t dissolve in your blood; carriers called lipoproteins transport it around your body. You have two distinct types of these: Low Density Lipoproteins (LDLs) and High Density Lipoproteins (HDLs).
LDLs are considered “bad” carriers of cholesterol — they’re the evil twins responsible for blocked arteries, strokes, and heart attacks.
HDLs, on the other hand, are the golden children. Because they clean out the LDLs by returning them to the liver for elimination, they’re referred to as “good” carriers of cholesterol, and the higher your HDL number is, the better.
Triglycerides, lastly, are a good indicator of your overall health and your cardiovascular system. High levels are associated with metabolic syndrome, which includes obesity, Type II diabetes, high blood pressure, and insulin resistance.
Along with phospholipids, they’re also a key ingredient of LDLs. Anyone can have high cholesterol — even people who look like the picture of health.
If you haven’t been tested within the last four years, it’s time to take care of your heart.
Here’s what the American Heart Association deems to be “healthy” blood test results:
Total Blood Cholesterol (TBC): Less than 240 milligrams per deciliter (mg/dL), preferably less than 200.
LDL: Less than 150mg/dL, preferably less than 100. Over 150 puts you at high risk for heart disease!
HDL: More than 40mg/dL for men, 50mg/dL for women. Your doctor may use a ratio of HDL to TBC.
Triglycerides: Less than 200, preferably less than 150.
High total cholesterol more than doubles your risk of heart disease.
According to the Minnesota Heart Survey, a survey of more than 5,000 participants taken every five years, nearly 60 percent of men with high cholesterol levels were unaware of them or were untreated.
Among women, the percentage was over 67 percent. The Center for Disease Control and Prevention (CDC) found that of the third of Americans with high LDL levels, only half are seeking treatment.
Lately, an extremely popular “biohack” is to increase your intake of saturated fat. Ketogenic diets, bulletproof coffee, and the ever-popular paleo all recommend this practice, but how do you maintain a healthy level of cholesterol while still eating fat?
Where does cholesterol come from?
The healthiness of your cholesterol depends on where it comes from. The two main sources are meat and your very own body.
Since cholesterol is so important for your cells, your body can generate all the cholesterol you need. Liver cells make the most and distribute it through your blood, but all cells in all organs make enough to support their respective functions and maintain their membranes’ structure and transport systems.
Trans fats, the unhealthy kind of fats found in hydrogenated cooking oils, mass-produced baked goods, and margarine vastly increase your levels of LDLs. They are a leading cause of heart disease, type 2 (non-insulin dependent) diabetes, and a decreased life expectancy, causing an estimated 30,000 premature deaths per year in the USA!
Saturated fats, on the other hand, are the bees’ knees.
They’re heart healthy, a compact energy source, and great for increasing your HDL levels.
Let’s say that again: SATURATED FAT IS GOOD FOR YOUR HEART.
Animal meat — and fat — contain varying amounts of saturated (good) fats, triglycerides, phospholipids, and cholesterol.
Should you stop eating fat to decrease your total cholesterol? No. Absolutely not.
For one thing, we receive major health benefits from eating good quality, saturated fat.
Secondly, studies show that because there are so many factors affecting the absorption of cholesterol from food and because your body self-regulates to keep a fairly constant level, dietary intake has little to no effect on total blood cholesterol levels.
In February 2015, the USDA Dietary Guidelines Advisory Committee reversed its long-standing position, removing its recommendation on restriction of dietary cholesterol, saying “Cholesterol is not a nutrient of concern for overconsumption.”
Look’s like fat’s back on the menu, boys!
To improve your overall health, you need to improve your ratio of LDL to HDL, and lower the level of triglycerides in your blood.
One way to do that is to replace some animal-based fats with plant-based fats. Plants contain phytosterols and stanols — compounds that reduce cholesterol absorption triglycerides.
According to the European Food Safety Authority, consuming around two grams of plant stanols and sterols per day can reduce your blood cholesterol by 10%. Some plants — avocados, peanuts, and some seeds — contain large amounts of phytosterols and can actively reduce your LDL cholesterol.
How does cholesterol lead to heart attacks?
Because it’s so waxy, cholesterol circulating in your blood, especially when transported by LDLs, has a bad habit of sticking to the walls of your arteries. This process usually starts because of damage to the artery wall, but is also common in narrow, high-flowing arteries like those in your heart.
That damage causes inflammation, and as white blood cells and platelets gather to repair the wall, cholesterol gets stuck to the bottleneck, which eventually causes buildup called plaques, or atherosclerosis.
One of three things can happen:
- The plaque completely blocks the artery
- The plaque bursts, causing inflammation, and blood clots around it, blocking the artery
- The plaque and/or blood clot break off and travel around your body until they block a smaller artery.
This usually occurs in your heart or brain, causing a heart attack or a stroke.
The blocked blood vessels can burst, causing internal bleeding and brain damage. Arteries in your retinas can also be affected, leading to blindness, or your kidneys, leading to reduced kidney function and a buildup of toxins and waste in your body.
It’s easy to think of your cholesterol levels as a number you only consider once a year after your physical, or something you ignore until it’s too late.
Proactively keeping your cholesterol levels within healthy limits is as important as brushing your teeth. In other words, prevention is a lot easier, cheaper, and less painful than the alternative.
Why is decreasing your total cholesterol levels so hard?
Cholesterol is recycled in your body. Your liver processes a large amount, transforming it into digestive bile, which is then excreted into your small intestine (along with unprocessed cholesterol).
Unfortunately, 95% of bile acid cholesterol and 50% of unprocessed cholesterol is reabsorbed. Your body also auto-regulates the amount of cholesterol it synthesizes, compensating for the amount of cholesterol you’ve digested by reducing the amount it makes.
This process keeps your total cholesterol level fairly constant. What’s important is the amount of HDL vs. LDL and triglycerides that make up your total cholesterol count.
In extreme cases of high cholesterol (hypercholesterolemia), taking medication is necessary in order to prevent heart disease.
The most common of these are statins, which can lower LDLs by more than 50%.
But statins are well-known for their multiple side effects, however, and it’s far easier and healthier to keep your cholesterol in check with a few simple changes.
What can you do on a daily basis?
Exercise. Getting your heart rate up on a regular basis can clean out arterial plaques, make your artery and heart muscles stronger, and decrease your triglyceride levels.
“Physical activity is an amazingly important behavior,” says Dr. Pearson. “You could argue that it’s an absolutely essential part of therapeutic regimens.”
With regular exercise, people who have had a heart attack can reduce their death risk by 25%!
Quit smoking. We all know that smoking (including cigarettes, cigars, and e-cigarettes) increases your risk of lung and other cancers.
Did you know it’s also affecting your cholesterol?
It reduces your level of HDLs and increases your triglycerides, increasing your risk of atherosclerosis, heart attack, and stroke. In addition, a high-cholesterol smoker’s risk of death is up to 20 times higher.
Eat more fish. A heart-healthy diet should include two servings of oily fish (salmon, trout, sardines, etc.) per week. Plant sources such as flax and hemp seeds are a good alternative, but their heart-healthy omega-3’s are harder to absorb. Studies show that increased levels of omega-3 fatty acids can help lower LDLs and blood triglycerides.
Increase your dietary fiber. By eating more vegetables, legumes, and fruit, you can prevent LDLs from being absorbed in your intestine.
Fiber binds to LDLs, lowering their absorption by about 5%. “It could be called a modest addition to the therapeutic regimen,” explains Dr. Pearson. Most adults don’t eat enough fiber, and eating more helps improve your overall health!
What steps are you taking to protect your heart? And don’t say cutting down on fat.
That’s so eighties.