Cholesterol: The “good guy” HDL, The “bad guy” LDL, and the carrier protein, all at the tip of your fingers

In this blog, you will get to know the different members of the cholesterol family: the good and the bad guys and their origin.

You will learn about food elements including fats and sugars and how they are related to cholesterol and different types of fat including triglycerides (TG).

We will see how modifying your lifestyles makes you healthier and happier. Maybe wealthier too as your medical bills will be far lower and your brain will be clearer.


The Vitality Clinic - Controlling your cholesterolThe Vitality Clinic - Controlling your cholesterol

Which gives you the most cholesterol? Which gives you the worst cholesterol?


The Vitality Clinic - Controlling your cholesterol           The Vitality Clinic - Controlling your cholesterol

Why are they as bad as each other?

Because alcohol become sugar and sugars become fats


What is cholesterol?

Cholesterol is a lipid compound known as sterol made in small quantities in every cell in your body. It is mainly produced in your liver but you also gain some from your diet. Cholesterol plays vital roles in your body:

  • It contributes to the firm building blocks of your cell membrane, giving them the 3-dimensional structure. Without this support, your cells would collapse to a state that is not compatible with life.
  • 20% of your body cholesterol exists in the brain: in neurones (brain cells) and in the nerve covering called a myelin sheath. Abnormally low brain cholesterol levels are associated with neurodegenerative conditions such as Alzheimer’s dementia, and Parkinson’s disease.
  • Your adrenal gland uses cholesterol to make steroid hormones that include cortisol (stress hormone), and sex hormones such as oestrogen, progesterone and testosterone. These not only support your sexual drive but are crucial to your survival, memory, skin, and bone health as well.
  • Cholesterol is needed to make vitamin D, which is important for bone health, and supports your immune system.
  • If all is well, excess Cholesterol is safely excreted in bile to help in the digestion of fat, which you consume in your regular diet.


Is cholesterol the same as fat?

Cholesterol is not fat, but it is a member of the wider family of Lipid. These also include fat, waxes and oils. Informally, we use fat and lipid interchangeably and hence, cholesterol is generally considered as fat.

Cholesterol is more “expensive” compared to fat. It takes your body 30 steps to make cholesterol while only 11 steps to make fat.


Where you cholesterol come from?

You consume a tiny amount of cholesterol in your diet every day, mostly in the form of esters, (which is not readily absorbable). The best sources for cholesterol include red meat, full-fat cheese, butter and eggs.

Your liver produces around 1 gram of cholesterol every day. The production-process is governed by a key enzyme: (HMG COA reductase). After receiving signals from various body tissues, the liver produces just enough cholesterol to meet the body requirement; thus, making it impossible for your cholesterol level to go high, unless somehow the production/ excretion system has gone out of balance.

The American Nutrition Society stated in their 2014 conference: “if you don’t eat cholesterol your body will make it, if you eat more in diet then you body makes less.”


How does cholesterol moves around your body?

Cholesterol is insoluble in blood because blood is water-based. As lipid it has to be transported in vehicles called lipoproteins from the liver (where it is made) to the body tissues (where it is needed). These vehicles also carry varying amount of fat, the commonest type known as triglycerides (TG).

When the particles carry too much fat (TG) compared to lipoprotein their density lowers and they are called very low-density lipoprotein (VLDL). Such vehicles move around to deliver TG to various body tissues. As their fat content diminishes, they regain some density and become low-density lipoprotein (LDL). The process continues to gives intermediate density lipoprotein (IDL), in due course.

On the other hand, high density lipoprotein (HDL) contains more protein (55%) compared to fat and hence the relatively high density. (fat floats on water and proteins sink).

LDL often referred to as “the bad guy”, is the most abundant cholesterol in your blood (70%). Healthy LDL particles play a good job in transporting cholesterol and TG from the liver to various body tissues. However HDL is like a garbage truck that moves along blood vessels to collect damaged (oxidised) LDL and transfer them to the liver, for disposal.

Here is why HDL is often referred to as “the good guy”. Studies show that heart disease risk escalates as HDL levels fall below 1.0. While disease risk significantly declines if the HDL level is at 1.5 or above.

The term good and bad guy is just for simplification, as each has got some good and bad effects on the body.

The difference between “the good” and “the bad” cholesterol eventually comes down to their TG content. LDL “the bad guy” obviously carries more TG and this can make it harmful while the HDL has low TG content which can make it protective. However, we will see in a moment that there is a good and a bad version of LDL.

More importantly, there is a strong correlation between elevated levels of TG in blood and incidences of coronary heart disease. So could TG be the culprit of the current obesity and heart disease epidemic?

The basics of food in five short sentences

  • Amino acids are the building blocks of protein
  • Sugars are the building blocks of Carbohydrates.
  • Fatty Acids are the building blocks of fats.
  • Vitamins are catalysts and anti oxidants
  • Minerals are also catalysts


What is triglyceride (TG)?

Excess calories in your diet are generally stored as fat in your body. TG are 3 fatty acids hooked together by a glycerol molecule. (see diagram above)

Elevated TG level is a well-documented risk factor for heart disease. So would it matter if your elevated TG comes from fat, carbohydrates or even alcohol? The answer to this question may give a clue to detecting and dealing with the thieves that rob your health and put you at risk of disease.


Sugar consumption & risk of disease!

Believe it or not, the health problems associated with indulgence in simple sugar and refined carbs are not different from that related to excess alcohol. This is no surprise because alcohol is also a carbohydrate.

When you consume a sugary drink or alcohol beverage, your body becomes inflamed. The low-grade inflammation in your body, with time, makes your cells numb to the action of insulin (causing insulin resistance). This prompts your pancreas to produce more and more of the fat storage hormone, insulin.

High insulin is the culprit that adversely change you lipid profile to high TG, VLDL, LDL and result in fatty liver. Similar to the effects of excessive alcohol consumption, the liver disease can progress in this case causing cirrhosis or even liver cancer.

Thus, consumption of simple sugar and refined carbohydrates alter your lipid profile: causing high TG and VLDL. It also results in high level of damaged (oxidised) LDL and low level of the protective HDL. This pattern is associated with high risk of heart disease.

However this imbalance is fully reversible simply by changing your diet. It is as simple as that, no catches no extras, no maybes. . You can accelerate recovery by taking fish oil that also lowers your TG. I have many patients who were surprised to see a dramatic change in their lipid profile, in just few weeks, because of a proper diet.

Does it matter if your replace sugar and refined carbs in your diet with excess dietary fat?

Dietary fat is absorbed in your intestine as chylomicrons: larger but very low density particles due to high fat content. It gives your plasma (the liquid part of blood) a milky appearance, if blood is taken shortly after eating a fatty meal.

Chylomicrons transport fat (TG) to be stored in adipose (fat) tissue and to muscles, to be used as fuel. Therefore a fatty meal does not raise your TG. It usually results in normal or slightly raised LDL: absolutely a benign blood picture. Research also failed to find any correlation between dietary fat and risk of disease.


What puts you at risk of disease & what protects you?

Although high LDL is a marker of diseases, a high HDL offers a strong protection against diseases, due to the anti-inflammatory and anti-oxidant properties of these particles. The impact of high HDL is reflected in the following data: lowering LDL by 1% reduces your risk of heart disease by 2%, while increasing your HDL by 1% reduces risk of heart disease by 3-4%

Adopting healthier Lifestyles such as physical activity, less alcohol and smoking cessation, would raise your HDL level within a few weeks.

Oxidized (damaged) LDL is a strong predictor of cardiovascular events. LDL is commonly damaged by free radical generated during the metabolic process. This is related to heavy consumption of sugar and refined carbohydrates. LDL is also damaged by high blood sugar: a process called glycation and is common in diabetic patients.

So, high cholesterol in the context of the metabolic disease is not the only culprit for vascular disease. There are many other factors contributing to the process such as low-grade inflammation, damaged (oxidised) LDL by either oxidative stress or high blood sugar.


Other causes of high cholesterol

High cholesterol could also happen due to under active thyroid with high LDL and TG. This reverses to normal level on treatment of the condition. High cholesterol also occurs due to chronic infection, environment toxins such as mercury and genetics (hereditary familial hypercholesterolemia).


What are most sensitive signs of vascular disease?

The conventional approach relies on routine lipid profile to assess risk of vascular disease. This had not been successful as over 50% of heart attacks sufferers have normal lipid profile. So few doctors, including the author, have now moved to specialised tests that assess risk of vascular diseases more accurately, using more reliable disease markers. These are described below:

The size and number of cholesterol particles has been found more accurate for depicting the risk of disease. Small dense particles (golf balls) formed from sugar and refined carbohydrates can readily stick together to form clots. The presence of these indicates a high disease risk. However, the big particles (beach balls) sourced from dietary fat are far less likely to form clots, so are usually benign.

You can fill the same space with more small balls but fewer large balls. Therefore having a high number of cholesterol particles are associated with higher risk of disease.

Just like having too many vehicles on the road increases risk of accidents irrespective of their cholesterol load. Hence high number of small cholesterol particles are more reliable disease markers than total or LDL cholesterol, according to the conventional theory.


The optimal values of conventional lipid profile:

Total CH <5.0, HDL >1.0, LDL <3.0 & TG < 2.0.