Is Cholesterol Really The Bogey Man?
Over the past week I’ve had a few young, healthy people in my life discover they had high cholesterol. Which naturally leads to confusion/fear, considering a. they are young and healthy and b. high cholesterol = death by heart attack. But wait, is cholesterol really the defining factor for your risk of heart disease? I’m no cholesterol expert (there’s been a lot of research since I left clinical nutrition) so I decided to do some refresher research, and this is what I found.
Cholesterol Is More Than One Number
When you get your cholesterol numbers evaluated, you don’t just find out one big number. There are usually four numbers you get, and a few more you should think about. The ones you get are:
- Low Density Lipoprotein or LDL – LDL is one of five lipoproteins that transport fat molecules (including cholesterol) through extracellular fluid (the fluid in your body that is outside blood vessels). LDL has been nicknamed the “bad cholesterol” because it transports these fat molecules and deposits them in artery walls, which leads to atherosclerosis.
- High Density Lipoprotein or HDL – HDL is similar to LDL in makeup but is known as the “good cholesterol” because it tends to transport fat molecules away from the arteries (usually into the liver, adrenals, or ovaries or testes). Higher levels of HDL have been associated with a lower risk of heart disease.
- Total cholesterol – this is a measure of all the cholesterol in your blood, including HDL and LDL. This number is going to be higher than just a sum of LDL and HDL.
- Triglycerides – this is a measure of fat buildup in your bloodstream. When you eat, your body converts any excess calories to triglycerides, where they are stored in fat cells. Between meals these are released to provide energy, so regularly eating more calories than are needed can lead to high triglycerides.
Notice a pattern there? Neither HDL or LDL are cholesterol in the first place, they are just the transporters. And cholesterol isn’t necessarily bad for your body, in fact it’s needed to make steroid hormones like androgen hormones and estrogen.
In addition to these numbers, you should also pay attention to:
- Cholesterol Ratio – this is the ratio between your total cholesterol and HDL cholesterol. The American Heart Association (AHA) recommends levels below 5, with an ideal ratio of 3.5 So, if your total cholesterol is 210 (high) but your HDL is 90, that puts you at a ratio of 2.2 (ideal)
- Pattern A vs. Pattern B – according to some newer research, there are different types of LDL. Small, dense LDL and large, buoyant LDL. The small dense LDL is what causes harm to the arteries, whereas the larger, buoyant LDL does little to no harm as it floats happily through your blood vessels. In Pattern A, the small, dense LDL is low while the larger, buoyant LDL and HDL are high. In Pattern B, the small, dense LDL is higher while the large, buoyant LDL and HDL are lower. Pattern B is associated with higher risk of heart disease, while Pattern A isn’t. According to this study, the high carb, low fat/saturated fat diet can turn Pattern A into Pattern B.
We often treat cholesterol like the end all be all risk factor for heart disease. And it is still an important indicator of heart health when interpreted correctly. But there are other factors that determine whether or not you’re having a heart attack. These include:
- Weight and anthropometric measures (like body fat)
- Physical activity levels
All of the above can impact a person’s risk for heart disease (which includes heart attack, high blood pressure, stroke, and heart failure). All of these factors should be considered when assessing someone’s risk for heart disease and suggesting prevention and treatment options.
If you find you have higher than “normal” cholesterol lab values, don’t freak out. Talk to your doctor (or friendly CrossFit Dietitian), who can help you look at your lifestyle and other risk factors that may be in play. And don’t jump on the statin bandwagon before you’ve looked at other things. When should you be worried? I’d be worried if your triglycerides were high, as this indicates a pattern of overeating, if HDL was very low, or if any of these numbers were exorbitantly high.