In part 1, I explained what cholesterol is and how essential it is for our body. If you missed that then please read part 1 first, before reading part 2.
Cholesterol is an important component in our body’s cells, it plays a very important role in many biochemical processes and is essential for all human organs. At some point, though, it became common opinion that excess amounts of cholesterol in the blood can cause heart disease. Scientists and the pharmaceutical industry then successfully developed statin drugs to lower the “dangerous” cholesterol levels in the blood, and reduce the risk of heart attacks.
However, the cholesterol that is produced in our liver exceeds what is absorbed from the diet, even when we consume a large quantity. Our brain is the most cholesterol-rich organ, even though it represents only 2-3% of our total body weight, it contains close to 25% of the whole body’s cholesterol. And cholesterol is essential for cognitive function. This is just one of the many reasons why I want my blood cholesterol levels to be high — so that I can live a quality life with a healthy brain.
How cholesterol can
affect LDL levels
As mentioned in part 1, emerging evidence suggests that the quality of the LDL particles is more important than the quantity, as it’s the quality that will largely prevent the molecule itself from oxidizing. The quality of LDL molecules will largely be due to factors related to the quality of our diet. An increased consumption of oxidative-prone, unsaturated vegetable oils and trans fatty acids are a major contributor to the degradation of LDL particles. Increased blood glucose (sugar) and hyperinsulinism will likely contribute to an increase in oxidative stress too, so it’s crucial to keep within healthy blood sugar and insulin levels.
There can be reasons why LDL levels may increase, without a connection to inflammation, glycation or oxidative stress. For example, if thyroid hormone levels are low, LDL receptors will not work well, and this may cause elevated LDL in the blood. Infection, inflammation, and high cortisol (stress hormone) levels can also raise LDL levels.
LDL testing
Low-density lipoproteins (LDL) are particles that transport lipids throughout the body. Each particle contains a combination of protein, cholesterol, triglyceride, and phospholipid molecules, and their composition changes as they circulate in the blood — some molecules are removed and others are added, resulting in LDL particles that vary from large and fluffy to small and dense. LDL particle testing determines the relative amounts of particles of differing properties in the blood.
Traditional testing measures the amount of LDL cholesterol (LDL-C) present in the blood, but it does not evaluate the number of actual LDL particles (LDL-P). Some studies have shown that increased numbers of small, dense LDL particles (sdLDL), compared to fewer light fluffy LDL particles, are associated with inflammation and are more likely to cause atherosclerosis.
So, rather than just measuring the total amount of LDL, what we really want to know is how many cholesterol molecules there are per LDL particle — i.e. whether there are a fewer amount of larger LDL particles, or a greater number of smaller particles. The body requires more cholesterol-depleted LDL particles than cholesterol-rich LDL particles to move cholesterol in plasma, and the number of cholesterol molecules depends on both size and core triglyceride content. The more triglyceride in the particle, the less cholesterol in the particle.
This means that if you were to take 2 people with the exact same amount of cholesterol in their LDL particles, one may have a very low risk and the other a much greater risk, simply because of the size of the individual particles.
Advanced lipid testing may be recommended especially for people with diabetes, insulin resistance, or cardiovascular disease. This is usually performed in addition to a standard cholesterol test or lipid panel, which measures total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides. Two commonly used advanced lipid tests are apolipoprotein B (apoB) and LDL particle number (LDL-P), both are simple blood tests and do not require fasting.
These advanced lipid tests can be very useful, because they measure both the actual number of LDL particles as well as the particle size.
A higher number of small LDL particles make it easier for them to invade the walls of the arteries, and lead to plaque formation.
For example, increased numbers of small, dense LDL particles can be caused by insulin resistance, which raises the risk for developing diabetes. Understanding this information can help to prevent onset or progression of disease.
Cholesterol levels
Total cholesterol levels less than 200 mg/dL are generally considered good, high levels are considered to be over 240 mg/dL. With HDL, higher levels are desirable. A result below 40 mg/dL is considered poor, while a reading of 60 mg/dL or higher is the best result. And for LDL, levels below 70 mg/dL are generally recommended. Individuals with no heart disease but who may be at a higher risk for developing heart disease should levels below 100 mg/dL. Levels above 190 mg/dL are considered very high.
Triglyceride levels are considered good when below 150 mg/dL. Between 150 and 199 mg/dL is borderline high, and levels between 200 and 499 mg/dL are considered high. Anything above 499 mg/dL is considered very high. Triglycerides are fats in the bloodstream that give the body energy. When they’re not used, the body stores them, so if you are sedentary or consume too many carbohydrates and/or have a high stress environment that can lead to cardiovascular disease or related health problems.
A healthy lifestyle
If you want to improve your health, you must cut out highly processed food. Unfortunately for so many people this is a large part of their staple diet. Avoid refined sugars such as soda, iced tea, smoothies, fruit juice, shaved ice, high sugar chocolate, and processed fats such as margarine, vegetable oils, and fried foods.
Also, eating too much too often can cause malnutrition, which means that the body is not effectively digesting and is not getting nutrients from the food. Eating the last meal of the day a few hours earlier can be hugely beneficial, giving the body extra time to digest the food properly and recover before eating again.
Good food choices include consuming eggs, butter, coconut, organic vegetables, low sugar fruits, grass-fed beef, organ meats (especially liver), fish (such as sardines and wild salmon), sweet potatoes, and rice. It’s also vital to consume adequate amounts of water, and it’s beneficial to add electrolytes such as lemon, salt (not table salt), and a small amount of baking soda to a glass of water.
Dietary cholesterol really plays a very trivial role in the body’s cholesterol levels, because it has esterified side chains that can’t be absorbed. Current respected literature does not support the idea that dietary cholesterol can increase the risk of heart disease in a healthy individual. The biggest influence on blood cholesterol levels is the mix of fats and carbohydrates in our diet, not the amount of cholesterol that we consume from food.
In part 3 I will talk about cholesterol lowering drugs, and the possible misinformation surrounding them, as well as the importance of asking your physician the correct questions to learn about the side effects of drugs, how long do you need to use them, and what possible alternatives there are for improving your health.
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Ayda Ersoy is a nutrition and fitness director at The Diet Doc Hawaii. She can be reached at DietDocHawaii.com, Ayda@DietDocHawaii.com or (808) 276-6892
