Cholesterol, the Joe Goldberg of nutrition

If you don’t know who Joe Goldberg is then go watch “You. The reason why I made this comparison is just like Joe, cholesterol has two sides one is bad and other is good which we shall discuss but more importantly cholesterol is a misunderstood guy who is very important for our body. So what’s all this b*tching going about cholesterol? Well cholesterol has been demonized for a while as something that’s bad for you heart health and may even give you a heart attack (much like Joe) and there is some truth to it but much of it is blatant fear mongering so if you want to understand what cholesterol really is then let me simplify Joe of nutrition for you.


What?

Cholesterol is a waxy substance which is a major component used for making cell membranes, vitamin D and hormones. This may be surprising but 80% of cholesterol is made in our livers naturally so clearly it is essential for our health. To better understand this article, we need to go through some related terms like lipids, lipoproteins and triglycerides.

Lipids: these are made of hydrogen and carbons and are insoluble in water. Lipids are essential for structure and functioning of cells. Examples are oils, wax, certain vitamins (A, D, E and K). Cholesterol is a kind of lipid.

Lipoproteins: these are made of fats and protein and help in transportation of cholesterol and triglycerides. Lipoproteins are of three types based on ratio of protein to cholesterol. Low density lipoprotein (LDL), high density lipoproteins (HDL) and very low density lipoprotein (VLDL).

  1. LDLs have more cholesterol than protein and are considered ‘bad’ because they carry cholesterol to arteries and if their concentration in blood is too high, they can cause accumulation of cholesterol in walls of arteries and thus increasing CVD risk.

  2. HDLs have more protein than cholesterol and are ‘good’ because they return cholesterol back to the liver for removal thus reducing its concentration in our blood.

  3. VLDLs have least protein in comparison and hence ‘badder’ than LDLs.

Triglycerides: also a kind of lipid but serves as a source of energy. When we eat surplus calories, the extra calories are converted into triglycerides and stored in fat cells for future use.


Cholesterol and health:

Ratio of HDL to LDL in blood can depict your heart health and CVD risk. Due to their ‘personalities’ lower levels of LDL and higher HDL levels are ideal because higher than normal LDL level in blood can cause narrowing of arteries due to plaque formation and hamper blood flow throughout the body leading to multiple health problems about which you can read more of here.

Complications of high LDL-cholesterol:

  1. Atherosclerosis (narrowing of arteries due to plaque formation).

  2. High blood pressure (hypertension).

  3. Heart attack.

  4. Stroke.

  5. Angina (pain in chest).

  6. Kidney disease.

  7. Peripheral vascular disease (blood circular disorder).

Risk factors for developing high LDL-cholesterol:

  1. Obesity.

  2. Unhealthy diet.

  3. Lack of physical activity.

  4. Smoking.

  5. Genetics and family history of high cholesterol.

  6. Pre-existing medical conditions like hypothyroidism, kidney disorder, diabetes.

Diet recommendations:

If your cholesterol levels are not critically high, making changes in your diet along with adding physical exercise can help manage or even reduce the atherosclerosis risk factors.

Foods to avoid: fried foods, fast foods, processed and packed foods, alcohol, sugary and salty foods.

Foods to limit: red meat, organ meats, high fat dairy and butters and oils of cocoa, palm and coconut.

Foods to add: lean meat, fibrous fruits and vegetables, whole grains, legumes.

Superfoods which lower LDL and increase HDL cholesterol: Avocadoes, dark chocolates, almonds, walnuts, fatty fish, garlic, soy, tea and olive oil.

The takeaway box:

Although I have put some diet recommendations, recent research has shown no substantial link between consuming cholesterol and saturated fat rich diet to increased CVD risk. I know! Stop scratching your head and remember when I told you that our liver makes cholesterol? That’s where the answer lies, our body automatically regulates levels of cholesterol, so if you eat more cholesterol then your body produces less and vice versa. There are some people known as ‘hyperresponders’ whose LDL cholesterol levels do go up when they eat high cholesterol diet but so does their HDL levels which balances the ratio again. Foods that you should definitely avoid are ones rich in trans fat, sugar and salt due to their multiple negative aspects but consuming organic foods rich in saturated fats may not be that bad, for example egg yolks have been under fire for a while because of their high cholesterol levels and it was thought they may increase CVD risk that is why SO much of this superfood was binned but recent studies have proved their innocence along with their multifaceted health benefits. Rather than increasing CVD risks, consuming whole eggs has shown improved LDL to HDL ratios. Having a balanced and diverse diet consisting of healthy portions of saturated fats such as fatty fish, whole eggs, dairy, red and organ meats may not be a huge problem for most of us but for people who already have high cholesterol issues should surely limit their intake. So you see, just like Joe, cholesterol isn’t inherently bad but can be at the wrong place at the wrong time and we all have some cholesterol Joe inside of us we just don’t want the LDL (possessive) version to be higher than HDL (loving) version. PS, do watch the show :D



References and further reading:


Bhatt, D., 2016. Low Levels Of HDL (The “Good” Cholesterol) Appear Connected To Many Health Risks, Not Just Heart Disease. [online] Harvard Health Blog. Available at: <https://www.health.harvard.edu/blog/low-levels-of-hdl-the-good-cholesterol-appear-connected-to-many-health-risks-not-just-heart-disease-2016110210626> [Accessed 5 July 2020].


Centers for Disease Control and Prevention. 2020. LDL And HDL Cholesterol: “Bad” And “Good” Cholesterol. [online] Available at: <https://www.cdc.gov/cholesterol/ldl_hdl.htm> [Accessed 5 August 2020].


David, C., 2018. Cholesterol: High, Normal & Low Levels. [online] MedicineNet. Available at: <https://www.medicinenet.com/cholesterol_management/article.htm> [Accessed 5 July 2020].


Fernandez ML. Rethinking dietary cholesterol. Curr Opin Clin Nutr Metab Care. 2012;15(2):117-121. doi:10.1097/MCO.0b013e32834d2259.


Graudal, Niels Albert, Thorbjorn Hubeck‐Graudal, and Gesche Jurgens. "Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride." Cochrane Database of Systematic Reviews 4 (2017).


Heart.org. 2017. What Is Cholesterol?. [online] Available at: <https://www.heart.org/en/health-topics/cholesterol/about-cholesterol> [Accessed 4 July 2020].


Jennings, K., 2018. 13 Cholesterol-Lowering Foods To Add To Your Diet Today. [online] Healthline. Available at: <https://www.healthline.com/nutrition/13-foods-that-lower-cholesterol-levels> [Accessed 5 July 2020].


Jones PJ, Pappu AS, Hatcher L, Li ZC, Illingworth DR, Connor WE. Dietary cholesterol feeding suppresses human cholesterol synthesis measured by deuterium incorporation and urinary mevalonic acid levels. Arterioscler Thromb Vasc Biol. 1996;16(10):1222-1228. doi:10.1161/01.atv.16.10.1222.


Luo, E., 2020. High Cholesterol: Causes, Symptoms, Foods, Treatment & More. [online] Healthline. Available at: <https://www.healthline.com/health/high-cholesterol> [Accessed 5 July 2020].


McDonell, K., 2019. Why Dietary Cholesterol Does Not Matter (For Most People). [online] Healthline. Available at: <https://www.healthline.com/nutrition/dietary-cholesterol-does-not-matter#types> [Accessed 5 July 2020].


Rees K, Takeda A, Martin N, et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2019;3(3):CD009825. Published 2019 Mar 13. doi:10.1002/14651858.CD009825.pub3.


Thomas, L., 2018. What Are Lipoproteins?. [online] News-Medical.net. Available at: <https://www.news-medical.net/life-sciences/What-are-Lipoproteins.aspx> [Accessed 5 July 2020].