Case 423: Cholesterol v. The People


Like clockwork, the seasons change, time sneaks by, and despite it seeming like just yesterday since your last, Doc Rx informs you that your annual lipid panel has been ordered. Fear sets in, but you can’t quite decide if the fear is spawning from a razor-sharp needle, soon to pierce your self-proclaimed thick skin, or the results of the dreaded report that will leave you running to Google for translation. Did you listen to Doc and avoid the evil, saturated fats and foods high in cholesterol? Are you on a fast-track to being put on a statin, the most prescribed pharmaceutical drug in the world? Allow me, your non-credentialed, non-board certified, gatherer of relevant research information to attempt the unpacking of what is a very confusing, moderately intimidating, “total cholesterol” story.

Let’s take this down one layer at a time. What in the world is LDL, HDL, and triglycerides anyhow? Glad you asked. The glass half-full side of me opts to lead with the good, proceed into the bad (maybe), and finish with the ugly.

The good: HDL. That aforementioned Google search plug boils down a quick-and-clean definition looking something like this: “NOUN biochemistry1. high-density lipoprotein”. So it appears that HDL is simply a dense lipoprotein. Great, now what? A deeper dig explains that HDL is uniquely created and secreted by the liver and intestine. (1) Its main role, the role defining it as “good”, is the transport or “clean-up” task that involves transporting excess cholesterol from bodily tissues to the liver. The cholesterol synthesized in these tissues is fast-tracked to the liver for disposal. Want an efficient clean-up crew? Ensure that your HDL level is nice and high, and by high, I mean >60 mg/dl.

The bad (maybe): LDL. Back to Google we go for a terrifying search result: BAD. For most, this is where the reading stops. Let’s dig a bit deeper. Low-density lipoprotein (LDL), also a transporter of cholesterol by trade, is commonly associated with plaque found in arteries. How is this little guy so much worse than its denser brother? It’s all in the fluff. But, is it safe to say that the simple presence of LDL in the blood is purely responsible for jamming the arterial roadways with plaque? While studies show that an elevated LDL reading does correlate to an increased risk of experiencing a heart attack (2), the devil may be in the details. Understanding that there are people experiencing heart attacks, despite having low LDL levels, challenges the status quo that states: Low LDL=good. Inversely, how do we explain the fact that all people wielding high LDL levels aren’t dropping like flies? Allow us to try and agree on a few things, while leaving the waters a bit hazy. There is no excuse for discrediting the vast research that shows the negative connection between elevated LDL levels and heart attacks. However, the study of endocrinology – more specifically the role of LDL in the body – is a very detailed, quite complex network of rabbit holes that has yet to be perfectly pieced together. Don’t believe me? Click Hereto learn about LDL oxidation and let this content toss another wrench into your understanding.

The ugly: Triglycerides. Simply stated, triglycerides are the thousand-foot view showing how much fat is present in the blood stream. More specifically, they are the end product or final breakdown of fats (lipids) from the simple carbohydrate rich or deliciously fatty meal that you just ate. They can also be found floating the main stream during a fasting window as the body breaks down stored fat to use for energy. If you eat more than your body needs at the time of consumption or are temporarily under-fed, triglycerides will be found en route to their storage site for later use. They may also be heading out for work with available energy in hand. You may be asking, “These don’t sound so bad, what’s the big deal?” I see where you’re coming from. Let’s approach it with this: like most things in life, more doesn’t mean better. Studies and observations now show that consistently elevated triglyceride levels may be associated with a few things:

1) An increased risk in developing heart disease or experiencing a heart attack (3)

2) A greater chance of fouling normal processes, resulting in conditions like obesity, metabolic syndrome, high blood pressure, abnormal cholesterol levels, etc.

With these themes in mind, maintaining triglyceride levels <150 mg/dl is our best option to avoid any or all bumps on our road of good health. Now that we have a base understanding established, lets square a few things up, dig one shovel full deeper, and bring this chat full circle.

We want HDL levels high. And I mean, excitement level after ‘PRing’ your favorite lift high. How do you do that? Well, the good news is that by simply reading this and being a 10 Experience member, you are on the right track. Eat good food; realfood. Perform some form of physical activity for at least 30 minutes a day, 3+ days a week, and maintain a healthy weight or strive to reach one.

Check.

We want LDL managed. Your head may still be wading through the above LDL fog. Here is how to attack it in layman terms: cut out trans-fats. I understand that giving up that beautifully constructed, processed, snack cake is a monumental task, but it is a must (a quick dig into what a trans-fat actually is will likely leave you running anyhow). Replace the franken-oils (trans-fats) with foods high in Omega-3 fatty acids. Eat wild caught fish, healthy nuts, grass-fed meats (believe it or not) and, for ease sake, take a quality fish oil supplement.

Check.

We want triglycerides low. Easy stuff. Follow the guidelines listed above, kick the booze, and avoid a diet high in refined carbohydrates like sugary sodas, breads, Oreos, and pasta (sorry Olive Garden, I still love you).

Check.

And here we are, the final 9 pull-ups of Fran. I hope that this was equal parts beneficial and enjoyable. I sure have had fun writing it. If you take anything away from the quite wordy content above, please allow it to be these few themes:

1) “Total cholesterol” is confusing, dig deeper

2) Your health, well-being, physical and physiological longevity, happiness, and success is in your hands, not the pharmaceutical company’s.

Being curiously curious shows that you are on the right track. Just by dedicating yourself to furthered self-education shows your worth and by understanding the importance of investment through the avenue of fitness/nutrition proves your #Outlier status. Perhaps, if we continue to move a lot, eat more to fuel and less to please, and strive to be more human, when Doc brings in the results from that ole’ lipid panel and asks how in the world you have improved your numbers without statins, you can simply give an innocent smirk and tell him that you have chosen to live a #10exlife.

Cheers,

-Taryn

 

References:

  • Botham KM MP. Lipid Transport & Storage. Murray RK BD, Botham KM, Kennelly PJ, Rodwell VW, Weil PA, ed. Harper’s Illustrated Biochemistry. 28th ed. New York McGraw-Hill: 2009
  • Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-Density Lipoprotein Subclass Patterns and Risk of Myocardial Infarction. 1988;260(13):1917–1921. doi:10.1001/jama.1988.03410130125037
  • Stampfer MJ, Krauss RM, Ma J, et al. A Prospective Study of Triglyceride Level, Low-Density Lipoprotein Particle Diameter, and Risk of Myocardial Infarction. 1996;276(11):882–888. doi:10.1001/jama.1996.03540110036029