Cholesterol: Friend or Foe?

Cholesterol: Friend or Foe?

Cholesterol has a bad reputation. It’s something that comes up in almost every conversation with the clients we work with at Thrive Health as individuals have to think differently about everything they were previously taught.

In many people’s minds, cholesterol = clogged arteries = heart attack.

Let’s shed some light on what cholesterol is.

Cholesterol is an organic molecule, crucial for all forms of animal life. It’s found in the cell membrane of your tissues, and can also appear in certain foods. Over the years, cholesterol has gotten a bit of a bad reputation. Most people assume that cholesterol is inherently dangerous. However, recent studies have forced many health experts and scientists to reverse their position on cholesterol.

It turns out that not only is cholesterol not as harmful as experts originally thought, but it could actually be essential for the body. In fact, when obtained from the right sources, cholesterol has the following benefits for the body:

  • It’s crucial for Vitamin D synthesis — in the presence of UV light, the body transforms cholesterol into Vitamin D.
  • It helps with the formation of cell walls and the creation of vital hormones throughout the body.
  • It helps to support the immune system by enhancing T-Cell signaling.
  • It’s necessary for making steroid hormones aldosterone and cortisol, which are pivotal for mental health, weight, and circadian rhythms.
  • It helps to repair various parts of the body in instances of tissue damage and inflammation.
  • Cholesterol-rich foods can be our main dietary source of “choline”1, a B vitamin essential for the health of the liver, nervous system, and brain.

Additionally, low cholesterol often correlates with various cancers, mental health problems, and other chronic conditions. In other words, we’re all struggling to lower our cholesterol levels, when the truth is that cholesterol might not be anywhere near as dangerous as we assumed.

So, what’s the truth about cholesterol?

The first area to consider when it comes to the positives and negatives of cholesterol involves heart health. As mentioned above, cholesterol is crucial for various bodily functions and can be found in all the cell membranes of animal tissue. Without cholesterol, we simply couldn’t survive. So, why are we convinced that cholesterol is key to heart disease?

Some of the initial research into the connection between high cholesterol and heart disease took place in 1948, in a study called the “Framingham Heart Study”2. The research followed 5,000 people over fifty years and found that there was a small connection between high cholesterol levels and heart disease. When you look at the actual data, you’ll find that people with heart disease only had an 11% increase in serum cholesterol levels, and the correlation only held up until the subjects turned 50. After reaching the age of 50, the research found no correlation between high cholesterol and heart disease.

Over the years, experts have continued to discover that cholesterol and heart health might not be as intrinsically linked as they originally seemed. In fact, 75% of people who experience a heart attack3 have normal cholesterol levels. On the other hand, high levels of serum cholesterol correlate with greater health longevity4. If that wasn’t enough, cholesterol has never been clinically proven to be the cause of a single heart attack. What’s more, in women, those with higher serum cholesterol levels have a reduced risk of mortality5 from all causes.

Even the apparently “dangerous” type of cholesterol, known as LDL, doesn’t hold up as a heart disease culprit. One study conducted in 2015 that attempted to clarify the relationship between cholesterol and heart attacks found that people wither lower LDL and lower triglycerides had a higher mortality rate. This isn’t a surprising result when you consider that many countries with higher average cholesterol rates have lower rates of heart disease.

All this research doesn’t indicate that heart disease isn’t a huge problem in today’s society. Indeed, heart-related problems remain to be one of the biggest concerns any American can face. However, what the research has shown us is that the causes of heart disease6 and heart attacks are far too complex to be attributed to cholesterol levels alone. If the last four decades have shown us anything, it’s that attempting to fight back against heart disease by lowering cholesterol levels simply isn’t effective.

Of course, it’s not just the heart that we have to think about when it comes to issues with cholesterol either — there are other issues at play too.

Although cholesterol and heart health are the two factors most commonly linked, one important (and often overlooked) relationship that cholesterol has is with the human brain. A quarter of the body’s cholesterol can be found in brain tissue, and studies demonstrate that people suffer from higher rates of dementia when they have lower cholesterol. Research has also found7 a correlation between higher levels of “LDL” cholesterol and greater memory function in elderly individuals.

Scientists and health experts agree that cholesterol is vitally important to brain performance. Inside your brain, cholesterol is responsible for doing several crucial things, such as behaving as an antioxidant, managing membrane function, and creating the raw material from which we build things like estrogen, progesterone, testosterone, and cortisol.

In the study mentioned above examining the connection between cholesterol and cognitive function in elderly patients, not only did those with higher LDL perform better, but those with lower cholesterol saw a greater risk for depression and mortality. This increased understanding of the link between brain function and cholesterol becomes more essential as we continue to see recommendations that indicate Americans taking statins to lower their cholesterol may double in number over the coming years.

Low cholesterol levels are riskier8 than you might think. If your cholesterol is too low, a number of dangerous things can begin to happen to your body. After all, every one of your cells needs cholesterol to survive, including the cells in your brain. One Dutch study in 2000 found that men who have lower levels of cholesterol constantly showed a higher risk of depression-based symptoms9. This is likely because cholesterol affects serotonin metabolism, which is the substance that is required to manage the regulation of mood.

From a similar perspective, Canadian researchers found10 that people with the lowest amount of cholesterol in their study were six times more likely to commit suicide than those with the highest concentration of cholesterol. Dozens of additional studies also link a connection between violent behavior and lower cholesterol levels. Through the same pathway, it seems that lowered cholesterol levels might lead to reduced brain serotonin activity, which in turn prompts increased aggression and violence.

In terms of brain health, cholesterol isn’t just essential for good mental and emotional health. One particularly interesting meta-analysis11 of more than 41,000 patient records discovered that people taking statin drugs to reduce cholesterol levels might have a higher-than-usual risk of cancer.

With so much evidence pointing to the fact that cholesterol is more “friend” than it is “foe”, you might be wondering why we have such a skewed opinion of the substance to begin with. Today, experts are suggesting that anything under 150 on the cholesterol scale is too low, while doctors continue to say that you need a number underneath 200 to be healthy. Part of the problem may be with the problematic measuring solutions we use to address cholesterol, but we’ll come back to that later.

For now, let’s start by saying that our perception of cholesterol12 has changed over the years. Back in the 1970s, there were two prevailing theories associated with heart disease. One theory assumed that high cholesterol levels were responsible for heart disease. The people who believed this suggested that simply lowering your total levels of cholesterol could be enough to cure heart problems for good. The other theory suggested that heart disease was more complex than cholesterol accounted for, and required us to look at the disease as a complex inflammatory process.

As research progressed, scientists evolved from thinking that we needed to worry about our “total” cholesterol level to determining that there was both good and bad cholesterol to consider. “Good” cholesterol was found in high-density lipoprotein or HDL particles, while “bad” cholesterol came in low-density lipoprotein or LDL particles. This understanding began a war against “bad” cholesterol, often elevated by saturated fat.

Now, of course, scientists have begun to discover that there are more types of LDL cholesterol than we thought. While one consists of large LDL particles, that have no potential to cause plaque on arteries or atherosclerosis, the other consists of denser, smaller LDL particles that can increase the risk of heart problems. In other words, our understanding of what makes up “good” and “bad13” cholesterol has changed. Improving your health from a cholesterol perspective is no longer about reducing the overall levels of LDL you might have, but eliminating the higher density particles.

Telling what type of LDL you have means determining your ratio of HDL cholesterol to triglycerides, which would generally be found as part of a cholesterol screening. Unfortunately, the standard test simply isn’t as effective as it was once considered. It can tell you how much HDL and LDL you have, but it can’t tell you the size of the particles in your system, and that’s the thing that’s causing the most danger to people with problematic cholesterol levels.

As is often the case when making breakthrough discoveries in the world of health, understanding that different particle sizes in cholesterol measurements are more important than the overall ratio means we need to start thinking about different testing options for people who want to assess their well-being.

Standard blood lipid tests are somewhat useful for helping doctors to figure out whether an individual’s ratio of total LDL to HDL cholesterol14 is within a healthy range — but that’s no longer what we’re looking for when it comes to establishing the risk of heart and brain problems in people with cholesterol issues. Lipid tests simply don’t show any useful information about your LDL and HDL fractions or whether you have predominantly large, buoyant particles, or small, denser ones.

So, why is particle size so important in the first place? Research tells us that smaller, denser LDL cholesterol particles are the ones that we need to worry about when it comes to health conditions and heart problems. Small LDL particles are toxic and inflammatory to our blood vessels. Even more troubling is the fact that a high level of lipoprotein(a) (the high-density particles that are most dangerous to human health) makes your blood more prone to clotting.

While most people feel that they already know enough about cholesterol thanks to a general understanding of “good” HDL cholesterol and “bad” LDL cholesterol, the truth is that the issues go deeper than those two categories. With an advanced “particle test” for high cholesterol, you can get a better insight into whether you have “really bad” LDL cholesterol — the stuff that we should actually be worried about.

The particle test essentially breaks the LDL cholesterol in your system down into a collection of different particle types, helping to measure your ratio of small, dense particles compared to large, buoyant particles. An increased level of small, dense particles could mean that you have a higher risk of heart disease, because these are the substances that increase your risk of plaque forming in your arteries15, leading to heart attaches and strokes.

It’s the smaller LDL particles that appear to be able to move through the small openings between the cells lining the inside of your arteries. That means it’s much easier for them to build up into blockages that cause strokes and heart attacks. The small particles are also most likely to escape detection during most routine cholesterol screening processes. This could be why it’s so common for people who do have heart attacks and heart disease to measure as having “normal” cholesterol.

What the Particle Test Tells You

Some studies indicate16 that the particle test designed for high cholesterol screening will be able to help doctors determine which patients are most likely to suffer from a heart attack or stroke — particularly among people whose standard tests would otherwise be likely to show normal results. However, at this stage, most health experts are in a state of disagreement about who should get the particle test. Some doctors believe that the particle test might not be right for everyone.

One thing that most experts do seem to agree on is the fact that the particle test could be most useful for people who seem to have a higher-than-normal risk of stroke or heart disease. In other words, if you have a family history of these conditions, or you’ve experienced the early stages of heart disease, then you might be better suited for a particle test. The test can show:

Though some medical professionals believe that we still need to invest in additional research into cholesterol to develop a better understanding of the role it has to play in human health, most experts agree that it is the dense LDL particles that represent a serious threat to human health.

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