Cholesterol, what does this word conjure up?
- Heart attacks
- Atherosclerosis
- Angina
- Clogged up arteries
- Death even?
Or perhaps simply, ‘mine is high, that’s bad’.
For decades, cholesterol has been talked about as though it is something lurking inside us waiting to cause trouble.
And then we divided it into two camps:
HDL = good. LDL = bad.
Nice and simple.
But biology is rarely that simple. If you have ever had a blood test and been told that your cholesterol is ‘high’, perhaps the first question should be, “What exactly am I looking at?” Before even asking, “How do I get my cholesterol down?” and worrying about cardiovascular disease.
What is cholesterol, and why does the body go to the trouble of making it in the first place? The majority of cholesterol is made by your body, so it is obviously important.
The skinny if you haven’t got time to read the whole thing right now
- Cholesterol isn’t the enemy. We need it for our cell membranes, brain and nervous system, steroid hormones, bile acids and vitamin D. Our body makes cholesterol for a reason.
- LDL and HDL aren’t actually cholesterol. They are lipoprotein particles. Think escorts or transport vehicles carrying cholesterol and other fats around the body. LDL generally transports cholesterol to the tissues; HDL helps transport cholesterol back to the liver.
- There isn’t just one type of LDL. LDL particles vary in size and density, from larger, more buoyant particles to small dense LDL. Small dense LDL is associated with a more atherogenic metabolicMetabolism is not a calorie-burning furnace that sits somewhere near your belly button, deciding whether you can fit into last year's jeans. Metabolism is the set of chemical processes taking place inside your body every second of every day, keeping you alive. picture. So, when was this last tested in your blood?
- Your LDL result is only part of the story. Two people can have similar LDL-C levels yet have very different metabolic profiles underneath.
- So perhaps the question isn’t simply ‘Is my cholesterol high?’ But what exactly is high, WHY might it be high, what type of LDL picture are we looking at, and what else is happening in me?
If that last question has made you think, “Hang on, nobody has ever explained my cholesterol results to me like this” then keep reading.
First things first: cholesterol is not LDL
This gets muddled quite a lot. Cholesterol is cholesterol. LDL and HDL are lipoproteins (lipo meaning fat and proteinProtein is one of the three main macronutrients, alongside fats and carbohydrates, yet for many years it was often the forgotten member of the trio. More recently, protein has become something of a celebrity in the nutrition world, appearing in everything from snack bars and cereals to coffee and desserts. Whilst the marketing can sometimes get a little carried away, the truth is that protein is essential for human health. Every cell in the body relies on it. Protein helps build and repair tissues, supports immune function, forms enzymes and hormones, transports nutrients, and helps maintain muscle mass, particularly as we age. meaning, well, just that, protein). Lipoproteins transport cholesterol and other lipids around the body. Imagine cholesterol as the passenger and LDL and HDL as part of the transport system. We need this transport system, because cholesterol is fatty and your blood is largely water. Oil and water don’t exactly mingle, so the body packages lipids (fats) into particles that can travel through the bloodstream.
Now, that already makes the labels ‘good cholesterol’ and ‘bad cholesterol’ rather misleading. LDL isn’t cholesterol. HDL isn’t cholesterol. They are lipoprotein particles carrying cholesterol, triglycerides and other molecules around your body. BTW, LDL is Low-Density Lipoprotein, and HDL is High-Density Lipoprotein. One is denser than the other due to the ‘passengers’ and some passengers are denser than others.
Why do we need cholesterol?
Great question! Cholesterol is an essential structural component of your cell membranes, and your brain is particularly rich in cholesterol. Have you read about one of the potential side effects of statin medications? Statins are medications that lower cholesterol? Statins can cause temporary memory loss, confusion, and cognitive impairment in some people. Can you see why they might do this?
Cholesterol is also involved in the formation and maintenance of myelin, the insulating material surrounding many of our nerve fibres. You also need cholesterol to make:
- steroid hormones, including cortisol, oestrogen, progesterone and testosterone
- bile acids, which help us digest and absorb fats
- vitamin D
- healthy cell membranes
Your body makes cholesterol. It isn’t simply something that arrives in your bloodstream because you ate eggs for breakfast. Cholesterol itself was never the villain of the story. The more important question is, ‘what is happening to cholesterol and the particles transporting it within the environment in YOUR body?’
Oh, and before we move on to the next section, see that cortisol up there in the first bullet point? …Well, cortisol is a stress hormone, so if you are stressed, your body tends to make more cortisol. so if your body needs to make more cortisol, it will need more cholesterol. So, when our students who are training in psychological coaching, health coaching, and nutritional medicine see high cholesterol on a blood test, they will ask, ‘Is there anything stressing you?’
Meet the escorts: LDL and HDL
HDL (High-Density Lipoprotein): HDL moves cholesterol between tissues and back towards the liver, part of what is commonly called reverse cholesterol transport. And because of this, HDL earned itself the rather lovely title, aka ‘Good cholesterol’, because it ‘puts away the cholesterol’. LDL does the opposite: it transports cholesterol from the liver to other parts of the body. So LDL became the naughty child and HDL became the well-behaved sibling.
However, having more HDL isn’t automatically synonymous with being healthier. HDL particles have multiple functions, and their behaviour and composition can change according to the metabolic and inflammatory environment too!
LDL (Low-Density Lipoprotein): LDL carries cholesterol from the liver through the circulation, where it can be delivered to tissues. Those tissues need cholesterol. Your adrenal glands need cholesterol. Your gonads need cholesterol. Your cells need cholesterol. Your nervous system needs cholesterol. The very existence of LDL has a physiological purpose.
Calling LDL ‘bad cholesterol’ makes it sound as though it has somehow escaped from the body’s design and gone rogue! It hasn’t. But this is an important caveat, it doesn’t mean LDL can never become problematic. LDL particles can contribute to the development of atherosclerosis, particularly when they enter and become retained within the artery wall. So perhaps the question isn’t simply, ‘Is LDL good or bad?’
The better questions are:
- How much LDL is circulating?
- How many atherogenic particles are there?
- How long have they been circulating?
- And what else is happening metabolically and within the artery wall?
This is how we teach Nutritional Medicine at the New School. We don’t simply put a red flag next to a laboratory result. We ask what might be driving this ‘marker’, what else is happening metabolically, and most importantly, what is this person’s story?
There isn’t just one type of LDL
When your blood test gives you an LDL-C result, it can look as though LDL is one single thing. It isn’t quite that simple. LDL particles can vary in size, density and the amount of cholesterol they are carrying. At one end, we have larger, more buoyant LDL particles and, at the other, smaller, denser LDL particles, often called small dense LDL (sdLDL).
But, your LDL-C result tells you how much cholesterol is being carried inside those LDL particles. It doesn’t tell you how many particles are carrying it. Think of your LDL particles as escorts or taxis and the cholesterol inside them as passengers.
LDL-C = the passengers. Now imagine you and your BFF each have the equivalent of 10 passengers to transport in your blood. Your cholesterol might be carried in 2 larger taxis, (5 passengers in each taxi) with each taxi carrying more passengers. Your BFF’s cholesterol might be spread across 10 smaller taxis, (2 passengers in each taxi) with fewer passengers in each. Same amount of cholesterol but different number of taxis on the road (blood). More taxis on the road means a greater likelihood of ‘collisions’.
So how can we get an indication of how many LDL escorts/taxis are circulating? Meet ApoB.
ApoB: counting the escorts/taxis
ApoB stands for Apolipoprotein B. Each LDL particle has one ApoB protein on its surface. So: One LDL particle = one ApoB. This gives us a beautifully simple way of thinking about the difference:
- LDL-C = how much cholesterol is being carried, aka the passengers.
- LDL particle size = how big or small the taxis are.
- ApoB = how many atherogenic vehicles are on the road.
If cholesterol (LDL-C) is carried in more particles, more ApoB-containing particles circulate, increasing the opportunities for them to enter and become retained within the arterial wall, increasing the risk of cardiovascular disease.
So when LDL-C and ApoB don’t tell quite the same story, for example, LDL-C doesn’t look particularly high but ApoB is relatively high, this can suggest that the cholesterol is being carried in a greater number of atherogenic particles.
HDL does not carry ApoB. Its main structural apolipoprotein is ApoA-I, which is not considered atherogenic and helps HDL collect cholesterol from tissues and move it back towards the liver.”
Viewing cholesterol simply as ‘good’ and ‘bad’ misses an enormous part of the story. The bigger message here is: don’t just look at the number; ask ‘why’. In the next blog, we’ll dive a little deeper into the metabolic picture surrounding cholesterol and cardiovascular risk.
Want to learn to think like this? Our two-year Diploma in Nutritional Medicine, Integrative Psychological Coaching and Health Coaching starts 19th September. APPLY NOW.
To WHOLEness!
From the team at The New School Of Nutritional Medicine
Learn about the Founder & Principal of the New School of Nutritional Medicine, Dr Khush Mark PhD HERE.
