Cholesterol seems to be one of the larger focuses in health care these days. Everyone seems to know their cholesterol levels. Some people seem a bit obsessed and think of cholesterol as a poison. Doctors also sometimes seem to treat cholesterol like the plague. I’ve had some patients’ doctors trying to bring their cholesterol below 100.
I remember first hearing about cholesterol from Dr. Bland at a seminar in chiropractic school. Back then the most common treatment was a low cholesterol diet. He told the story of a patient in the hospital with high cholesterol that he had consulted with. This patient while in hospital had his cholesterol skyrocket on the diet. The more restrictive the diet the higher the cholesterol increased. Dr. Bland had the patient go back on eggs and other fatty foods. Once the patient did that his cholesterol started to move back to normal.
I remember this story even though I heard it over 30 years ago because it taught me that things are not always what they seem in the human body. We are complex biochemical creatures with complex control mechanisms. There are many external factors that influence outcomes.
What is Cholesterol?
The name comes from Greek where chole means bile and stereos is a solid and the ol indicates it is an alcohol. Cholesterol is essential to the body. It makes up cellular membranes and helps keep them fluid. It is also a part of cellular transport in the cell.
Cholesterol is also an essential component of the steroid hormones. These hormones are synthesized in the gonads or the adrenal glands. Cholesterol is also a component of vitamin D.
Given the essential nature of cholesterol does it make sense to drop it so low? There are risks to low cholesterol. Low cholesterol can increase the risks of cancer, anxiety, stoke, infection and depression. Levels below 165 total cholesterol can result in an increased risk of suicide and accidents. This makes a lot of sense when you consider cholesterol is needed to make cortisol. So you really need to wonder when your doctor is working at dropping your cholesterol too low.
Cholesterol is also a component of progesterone, estrogens and testosterone. Think of what low cholesterol levels can do to these hormone levels. We know that men get depressed with low testosterone levels. (It is always on the television) So does it makes sense to keep bringing down the levels lower and lower
Cholesterol, where does it come from?
Most people think we only get cholesterol from our diet. We find cholesterol levels on product labels. However, only 20-30% of cholesterol comes from the diet the rest is made by the body. Cholesterol that is consumed is also not well absorbed. That is why low cholesterol diets of the past didn’t work well. That is why when Dr. Bland put the patient back on cholesterol his levels of cholesterol dropped. The man’s problem was that he was making too much cholesterol. When his dietary intake was reduced his body increased production of cholesterol in response to lower dietary cholesterol.
Types of Cholesterol
There are two major types of cholesterol and we think of them often as the good and the bad cholesterol.
First the good type of cholesterol is high density lipoproteins (HDL). HDL is contains more protein and less fat. This is the type of cholesterol you want to see at higher levels. High levels are associated with health and lower levels increase the risk of heart disease and arteriosclerosis.
Low density lipoproteins (LDL) are also known as bad cholesterol because the presence of LDL is associated with an increase of arteriosclerosis or plaque in the wall of the arteries. You’ll often see on blood tests one more type of cholesterol called very low density lipoproteins or VLDL. VLDL is similar to LDL as both contain a higher fat content and both are bad types of cholesterol.
When it comes to cholesterol you want higher amounts of the good cholesterol (HDL) and lower amounts of the bad cholesterol (LDL). We look at this in a ratio in order to understand it better. To determine this ratio we divide the total cholesterol by the HDL. So if your total cholesterol is 180 and your HLD is 60 your ratio is 3:1.
The American Heart Association wants our cholesterol below 200 and our ratio less than 5:1. In the above example the above person is looking great with a total of 180 and a 3:1 ratio. But let’s look at the same person with a HDL of 30. Now their risk has increased. Their cholesterol is below 200, but their ratio is now 6:1.
There are tests to measure the size of cholesterol particles. For example the smaller the size of LDL particle the more damage they cause and the greater the risk of arteriosclerosis. Size of LDL particles can be change by diet and exercise. The same exact size rule holds true for HDLs, the smaller the size of the cholesterol particles the greater the risk of heart disease. This information can be helpful to make informed decisions for people on the boarder as to what they want to do as far as treatment goes.
Part 2 Cholesterol Continued On May 21