Demystifying Cholesterol: All About LDL, HDL and Triglycerides

Is Cholesterol really a villain? Demystifying Cholesterol 

For the past four decades, cholesterol has been made into a fall guy responsible for clogging our arteries and causing premature deaths. Is cholesterol really bad for our health? If it is so bad then why does our liver produce 1-2 gm of cholesterol every single day?  Also, if we eat less cholesterol our liver compensates by producing more.  What is going on? Let us try to understand cholesterol in detail and how heart attacks are caused.

What is Cholesterol?

Cholesterol is an essential building block of the body and is required for building cell membranes, brain cells, sex hormones, cortisol, bile and Vitamin D. It is vital for our immune functions as well.

Cholesterol is defined as a waxy pale yellow lipid that travels through the bloodstream in tiny, protein covered wrappers called lipoproteins. As fat and cholesterol are neither soluble in water or blood, lipoproteins are used as vehicles for shuttling them around the body. Broadly cholesterol is divided into Low-Density Lipoproteins or LDL and High-Density Lipoproteins or HDL.  Triglycerides, a form of fat are also carried by lipoproteins called chylomicrons

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Low-Density Lipoproteins (LDL)

The LDL carries cholesterol from the liver to the rest of the body. The cells of the body latch on to these particles and extract fat and cholesterol from them for their normal functioning.It is said that when there is too much LDL in the blood, these particles can deposit on the walls of the arteries forming plaques. Plaques narrow the articles and limit the flow of the blood. LDL is often referred to as bad cholesterol.

LDL comes in two forms- Type A and Type B. Type A particles are large and fluffy whereas type B particles are small and dense. It is type B particles that are responsible for blocking our arteries. An advanced test called gel electrophoresis can measure relative concentration of type A versus Type B.

High-Density Lipoproteins

HDL sponges up the cholesterol from the wall of the arteries and bloodstream and transport it back to the liver for disposal. It is like a cleaning truck that removes garbage from the arteries. HDL is often referred to as good cholesterol.

HDL is not a monolithic particle. It comes in different shapes and sizes. Some types are spherical, while others are doughnut-shaped. Some types of HDL are great at collecting cholesterol from LDL and artery walls, while other types are indifferent to cholesterol, and some even transfer cholesterol the wrong way — into LDL and cells. A new test called the cholesterol efflux test measures the effectiveness of HDL particles in removing cholesterol out of plaques. Efflux test in future would be used to predict the risk of heart attack.

Triglycerides

Triglycerides are made up of fat derived from the fat you eat and sugar converted into fat by the liver. They are also transported through lipoproteins called chylomicrons. As the body’s main vehicle for transporting fat to cells, triglycerides are important for health but too much of triglycerides are harmful to the body.

New findings in the cholesterol discourse that will make you rethink

1. A series of studies have conclusively proven that there is no direct relationship between the amount of cholesterol a person consumes and his and her cholesterol levels. Kratz, M., Dietary Cholesterol, Atherosclerosis and coronary heart diseases. Hand Exp Pharmacol 2005(170); p195-213
2. Only about 20 percent of the cholesterol in our bloodstream comes from the food we eat. The other 80 percent is made by the liver. In fact, every cell in our body except the brain has the capacity to make its own cholesterol.
3. Saturated fat found in milk, ghee, butter, cheese, the cream is not as harmful as it was made out to be. On the contrary, it raises the levels of beneficial HDL in the body.
4. More than saturated fat, vegetable oils and trans fat along with simple carbohydrates and refined sugar are the real villain responsible for a surge in cardiovascular diseases in the past 40 years.
5. Trans fat found in bakery products and vegetable oils such as corn oil, safflower oil, soybean oil, canola oil etc. that were popularized as healthy oils are rich in omega 6 polyunsaturated fatty acid that if consumed in large proportions gets converted to highly inflammatory mediators.
6. Omega 3 fatty acids, another family of polyunsaturated fats, on the other hand, are mainly anti-inflammatory. They can also help to convert small dense type B LDL particles into large buoyant type A versions. Food rich in omega 3 fatty acid is flax seeds, walnuts, oily fish such as sardines and salmons.
7. Ideally, the dietary ratio of Omega 6 and Omega 3 fatty acids should be 1:1 but the modern diet consisting of processed food, vegetable oils, and bakery trans fat has tilted disproportionately the ratio towards omega 6. This high dietary ratio of omega 6: 3 increases inflammation, potentially worsening the risk of cardiovascular diseases.
8. The latest research shows that a plaque develops as a response to injury and wear and tear of arteries. Because of chronic inflammation and Vitamin C deficiency, the walls of the arteries become damaged. Plaques are formed as a short-term healing band-aid at the site of damage. But these short-term healing plaques may prove fatal in the long-term. Though the immediate cause of heart attack may be the deposit of LDL or plaque the real cause is inflammation. Heart attacks and strokes are predominantly inflammatory diseases, rather than simply diseases of high cholesterol levels.  This is the reason that C-reactive protein or CRP test by measuring the level of inflammation in the arteries can predict the risk of developing atherosclerosis.
9. Triglycerides, another marker for heart disease, are found to be more important as a risk factor for heart disease. When we eat too much of simple carbohydrates and sugar, our liver converts them to triglycerides or fat. This dietary refined sugar and simple carbohydrates switch on the accelerated fat production in our liver, creating an internal process of the de novo fat generation called lipogenesis. This accelerated fat produced gets deposited as visceral fat around the vital internal organs of the abdomen like the liver, pancreas, and intestine. Visceral fat is a health hazard that is associated with higher risk of developing insulin resistance, type 2 diabetes, heart diseases, Alzheimer’s and breast and colorectal cancer.
10. High carbohydrate diet also causes hyperinsulinemia and insulin resistance. Persistent high insulin levels in the body impair the capacity of the body to use fat as a source of energy as a result fat stays locked inside the cells and the person becomes fatter and fatter.

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11. Higher HDL may not always be effective in lowering LDL. The protective role of HDL depends on the levels of both LDL and triglycerides.  The research, published online May 10, 2016, by Circulation: Cardiovascular Quality and Outcomes, analyzed data over 25 years on about 3,500 people. Researchers looked at people with both low and high HDL levels and those with normal and high levels of LDL and triglycerides. The study found that for optimal protection against cardiovascular disease, there needs to be a balance among all three. Higher HDL (40 mg/dL or higher) helped to reduce cardiovascular disease only when LDL and triglycerides were low (100 mg/dL or less). When LDL and triglycerides rose above 100 mg/dL or 150 mg/DL, respectively, higher HDL had no effect

12. Those with High Triglycerides and Low HDL Cholesterol have a six times greater risk of heart attack than those with Low Triglycerides and High HDL Cholesterol.

13. In a recent study, the researchers claim that statins, the cholesterol-lowering drugs prescribed to prevent heart attacks, are neither as effective nor as safe as we have been led to believe. Statins may produce a dramatic reduction in cholesterol levels but have failed to substantially improve cardiovascular outcomes. The side-effects of memory loss and muscle spasm are real.

The nutritional failure of the past 40 years is responsible for the epidemic of type 2 diabetes and heart diseases. Substitution of beneficial saturated fats with high glycemic carbohydrates and polyunsaturated oils has instead of solving the problem of cardiovascular diseases has made it worse. It is time for course correction. The best approach for minimizing heart disease risk is to replace refined grains, starchy carbohydrates, trans fats and polyunsaturated oils with healthy fats, saturated oils like coconut oil, ghee, and butter, fresh fruits and vegetables, easily digestible proteins, nuts, and seeds.