​In my last article I talked about cholesterol, all of the important roles it has in the body, as well as some of the misinformation that connects cholesterol with cardiovascular disease.

This time I want to help you understand the numbers on you’re the blood tests your doctor performs so you are more empowered in your healthcare decisions.
So let’s start here:

What are “good” and “bad” cholesterol and what does it all mean for your health?  Well I’ve got news for you!  It is not what you think it is!

HDLs and LDLs are not actually types of cholesterol but lipoproteins.  These are special particles our body puts together because fats aren’t water-soluble. (You know, in the same way that oil and vinegar don’t mix!).  In order to transport fats and cholesterol through the bloodstream (which is watery), fats or lipids combine with proteins to form lipoproteins.

These particles transport fats around the body, moving them in and out of cells, for all those important functions we talked about last time.  It’s important to know that cholesterol is the first line of defense for damage to the blood vessels and rushes in to make repairs and protect membranes when needed.  It also works to protect cells and tissues from free radical damage.

“Bad” Cholesterol?
LDLs carry 75% of the cholesterol in our bloodstream and are the most actively involved in cell and tissue repair and protection.  HDLs carry the remaining 25% but are essentially a recycling system for cholesterol, taking it back and forth from the liver.

So given that LDLs sound so useful, why have we been told that they measure “bad” cholesterol?

Because damage to the blood vessel membranes sets off an immune response, the blood get’s thicker and the vessels contract.  LDLs rush to help and bring cholesterol to help repair tissue.  Such areas can be sites where plaque builds up.  LDLs are not the cause of the plaque but the result of the need for repair but they have nevertheless been given a bad rap.

Research shows that low levels of LDLs are associated with increased risk of anxiety, cancer and depression. Women with low cholesterol levels tend toward having babies prematurely and having infants with low birth weights.  The obsession with driving down LDLs and cholesterol with medications is frequently over aggressive.

“Good” Cholesterol
We’ve also been told that high levels of HDLs are a good thing, because they transport cholesterol out of cells to be recycled in the liver. But the cholesterol that HDLs carry isn’t taken out of the body; that cholesterol is redistributed to cells and tissues.  Hmmm.

So I guess you can tell at this point that it’s a lot more complicated than you thought.  The blood test you get once a year might not be telling you very much that’s useful.  In order to know whether there is really something to be worried about we need to go deeper.

Here are the risk factors we really need to be concerned about:

Small-Dense LDL particles
Blood levels of very small (or otherwise called dense) LDLs can be problematic because they can pass through artery walls and stay in the blood stream longer being more prone to oxidation.

Standard blood test results can be deceiving as you may have a large number of these damaging small LDLs but, since small LDLs contain less cholesterol than large LDLs, you might still have a low LDL number on your blood test and think you are in good shape.

Lipoprotein(a)
Lp(a) is a special type of small LDL particles that is hereditary and is a strong risk factor for cardiovascular disease and blood clotting.

Remnant Lipoprotein
This lipoprotein can be taken up by macrophages and transformed into a foam that is the building blocks of plaque.  It is highly correlated with cardiovascular disease.

HDL2b
This is the largest type of HDL particle and a good way to measure how well excess cholesterol is being removed.

Triglycerides
Elevated triglycerides, typically due to excess sugars and carbohydrates, are correlated with heart disease.  Look at the triglycerides to HDL ratio.  Less than 2 is ideal.  Greater than 4 is too high.

We offer comprehensive lipoprotein particles testing if we need to get the full picture of what is going on with your lipids so get in touch if you need help or have concerns.

​What does cholesterol do in our bodies?

• Cell membranes – This is kind of technical but cholesterol keeps the cell membranes at just the right level of fluidity and permeability and helps regulate what goes in and out.  In other words we need the cholesterol for the cells to function properly.
• Memory and learning – Cholesterol is needed for the neurons in the brain to form connections.  (One of the main benefits of sleep for learning and memory is due to the fact that cholesterol production is highest when we sleep.)
• Digestion of fats – Bile acids are made from cholesterol and this allows us to digest fats and access fat soluble vitamins A, D, E and K.
• Vitamin D –It isn’t just the sunlight that increases our vitamin D levels.  Cholesterol is a precursor to vitamin D.  Vitamin D is best known for its role in calcium metabolism and bone health, but new roles are continually being discovered for it, including in mental health, blood sugar regulation, the immune system, and cancer prevention.
  • Hormones - Cholesterol is the precursor to all steroid hormones, including:
  • Glucocorticoids (blood sugar regulation)
  • Mineralcorticoids (mineral balance and blood pressure regulation)
  • Sex Hormones (many functions)

Sounds important, right?  Well that’s because it really is!

So why do we think of cholesterol as the enemy?
Cholesterol has been one of the most maligned and misunderstood substances of the twentieth century.

Eating foods high in cholesterol was thought to raise blood cholesterol levels.  At the same time, high blood cholesterol has been painted as the enemy or our arteries and the main cause of heart disease.

The popular version of cholesterol goes something like this: when you eat fatty foods, especially foods rich in animal fat, the saturated fat and cholesterol in these foods ends up in your blood and sticks to your arteries. Since saturated fats are solid outside your body, they will be solid inside your body too — (despite the 30-degree increase in temperature – ha ha!). Arteries are much like pipes. When they get caked up with grease, blood flow is impaired, and a heart attack ensues.

OK, so that is just not true!

The truth is that atherosclerosis, where plaque builds up in the arteries, is actually caused by inflammation.  Initially it is caused primarily by the consumption of industrial seed oils like canola oil, which are degenerated due to the heat and pressure of processing.  Other causes of inflammation in the body can then accelerate and exacerbate the process.

Since cholesterol is found in fatty foods that contain a greater proportion of saturated fat, these high cholesterol foods are likely not the culprits of atherosclerosis and heart disease.

So, bring back cholesterol in your diet!  Bonus – it’s found in delicious foods that you are going to love reintroducing!

Want some help navigating all of this?  Get in touch for some personalized suggestions.  We can help you with your diet and offer comprehensive cardio metabolic blood testing which is a step above what you'll get from your doctor.

Check our blog next time for more info on your cholesterol blood test numbers and what to look for.