Chapter Eight: CHOLESTEROL
The Good, The Bad and The Ugly
Most of you certainly know about cholesterol. Cholesterol is terrible. Awful for the body. We’d be better off without it! Right?
Wrong.
The truth is, cholesterol is one of the building blocks to our cells. Every cell in our body has cholesterol in it, including those in our brain, heart, muscles, intestines, skin and nerves. Cholesterol is also the backbone of male and female hormones, as well as vitamin D and the bile acids that help digest fat.
In other words, we need cholesterol to be healthy. That’s why our body makes its own cholesterol in the liver. We need only small amounts of cholesterol in our blood to supply these requirements.
But we also take in cholesterol from outside our body – through food. Many people consume too much cholesterol because of the types and amounts of foods they are eating. When that happens, the extra cholesterol in our bloodstream can deposit in our arteries. This is often a prime focus of the cardiologist.
Genetics Can Play a Role
Before we continue, let me point out that too much cholesterol isn’t always because of a bad diet. Some people have genetically high cholesterol. Researchers are not sure yet if this is because they produce it more, absorb it more, or from some other cause. Though rare, some people can exercise and watch their diet, but still have a lot of bad cholesterol. For these people especially, their only method to control their levels is through some kind of medication, which I’ll address in detail in Chapter 39.
On the other hand, though also rare, some people can be obese and not exercise – and their cholesterol is perfect. They’re among the very fortunate, and can thank their genetics for that one.
Why is Too Much Cholesterol a Problem?
Though I will go into further detail later in this book, let’s simply start here by saying that if you have too much of the bad type of cholesterol, it can enter the inner lining of an artery, causing inflammation that may promote plaque formation and lead to blockages.
But truly understanding cholesterol begins with realizing there are three main components to “total cholesterol.” They are what I like to call The Good, The Bad and The Ugly.
The good is HDL cholesterol.
The bad is LDL cholesterol.
The ugly are triglycerides.
Because of this, I do not look at total cholesterol as a marker (indicator) for having high cholesterol. That is how it was done in “the old days” when someone would say, “My cholesterol is 250.” My reasoning is this total cholesterol number is the sum of all your types of cholesterol – including the components of good cholesterol. For example, your total cholesterol could be 250, but your HDL (good cholesterol) could be 80. Your LDL (bad cholesterol) could be 130, and your triglycerides 200.
In general, you want to increase your levels of HDL, to above 40 for men and above 50 for women. Similarly, it’s best to decrease your LDL – generally to below 100.
Fortunately, with new advancements, we can now be even more precise with these measurements.
Going Further – Subclasses of LDL
We now even go beyond dividing cholesterol into its three categories. There are tests today that can examine within the LDL, looking at two subclasses, A or B.
The A subclass is large and buoyant, and is preferred as it will not go through inner linings of vessels to cause blockages. But the B is smaller and denser, and can traverse the inner lining of the vessel and cause fat buildup, which can cause inflammation and then blockage, which can eventually lead to a heart attack.
Just to demonstrate how cardiology is evolving, we’ve also now discovered an offshoot of LDL called LPa. It’s similar to LDL, but can cause more blockages. At this point, the only medication that can lower LPa in our system is niacin, which is a B vitamin (which I’ll address further in Chapter 39).
Personally, I think everyone should be tested for these types of detailed factors. A person could do a regular LDL lipid panel and have it show that everything is good. But you really want to know which subtype you have within your LDL.
The test is called a VAP test. Turns out, this more detailed blood work isn’t really more expensive. It was costly when it first came out, but no longer.
We’ve now found that even HDL has subtypes, some being most beneficial, while others not helping that much. But at this point in time, these HDL different levels are very hard to adjust, so I don’t put too much focus on them. We simply look at the HDL levels. For women, the goal is to be above 50. For men, about 40. If tests were to show less than these numbers, that’s when cardiologists advise taking actions to raise the HDL, such as exercising, or stopping smoking if you are a smoker.
So what about “The Ugly?”
Many have heard of triglycerides, yet most still don’t know they are basically fat. That by itself can lead to more of the bad subclass of LDL cholesterol. Accordingly, cardiologists want to keep patient triglyceride levels low – below 150. If their levels are above this, patients may be advised to alter their diets, eating less of certain foods, and more of others like fish.
Too Little Cholesterol?
Theoretically, someone could have too little cholesterol. We don’t know exactly what might be too little. But we can cite that a little baby’s LDL cholesterol is only 30, and babies experience the highest body growth rate and are in more need of generating cells than anyone. So you would think that even levels down to 30 would be fine.
Educate Your Doctor?
All these new tests really are a blessing. Consider Jim Fixx, an accomplished runner who wrote the best-seller, “The Complete Book of Running.” Everyone assumed he was extraordinarily healthy. Then in 1984, he died of a heart attack.
Why? High cholesterol. Back then, there wasn’t the sophistication that we have today to measure the subtleties of cholesterol. Yet even today, some primary physicians do not know the distinctions of the different types of LDL that should be measured. That’s one of the main reasons I want readers to learn from this book – so they can take an active role in their own health. Sometimes they have to educate their doctors. Sometimes, they have to change their doctors.
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Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.
For more information visit: www.drmanshadi.com