The idea that cholesterol is a harmful substance is a reminder that our medical system is largely ignorant when it comes to the design of the body. When reviewing lab testing with a new patient, I am often asked very quickly how their total and LDL levels look. Anxiety abounds as these patients wait to see their numbers, as they have been led to believe that heart disease risk is equivalent to the blood levels of these substances. This outdated concept is a testimony to the power of the marketing abilities of pharmaceutical companies and their influence on doctors and patients. Effective marketing requires simple messaging, such as: “Cholesterol is dangerous…get the levels down...mainly with drugs.”
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Although the terms LDL and HDL are referred to as types of cholesterol, they are technically lipoproteins. Lipoproteins are round particles composed of a core of lipids (fats, including cholesterol) and a shell of proteins and phospholipids. The two common types of lipoproteins you hear about are HDL (high-density lipoprotein) and LDL (low-density lipoprotein). Therefore, when you have your “cholesterol” levels tested, you are really having various lipoprotein levels tested. Cholesterol does not circulate by itself in the blood; it is transported in the blood by lipoproteins, which the blood tests measure.
The liver mainly makes cholesterol but is also produced in the brain and most body cells. Look at any basic biochemistry book, and it will state how cholesterol is a vital building block of cell membranes, many hormones, and vitamin D! Your body sends cholesterol to areas of damage as a healing agent since cholesterol is involved in the repair and regeneration of cells, including immune cells and the lining of blood vessels (endothelium). Moreover, cholesterol acts as an antioxidant in the body to help heal wounds and counter free radicals associated with infections and toxin exposure. Research has shown that LDL contains different antioxidants such as vitamin E, beta carotene, and ubiquinol (CoQ10). HDL has powerful antioxidant properties that prevent the oxidation (damage) of LDL and respond to infection and those with inflammatory diseases like cancer.
The type of LDL measured on typical lipid panels provides incomplete information. We have known for years that the size of LDL particles is what matters most. The small, dense LDL particles are associated with heart disease as they become oxidized and more easily penetrate into a damaged arterial wall. An article in the journal Current Opinion in Lipidology states: “A growing body of data points to sdLDL(small density lipoprotein) concentration as a significant determinant of ASCVD(atherosclerotic cardiovascular disease) risk.” The small, dense particles create inflammation and plaque formation. The large, buoyant LDL does not penetrate the arterial wall. It is also good to know your LDL pattern. The most protective pattern is known as Pattern A: small, dense LDL is low, large, buoyant LDL is high, and HDL is high. Whereas Pattern B is associated with an increased risk of heart disease: small, dense LDL is high, HDL is low, and triglycerides are high. This type of valuable information is available in a lipoprotein fraction lab test.
What is the best way to improve the small, dense LDL particles? It is not to avoid fat. The best way is to consume fewer carbohydrates, especially simple carbohydrates and sugars. An increase in blood sugar and insulin results in the liver producing small, dense LDL particles. Another interesting fact is that eggs increase HDL when consumed in combination with moderate carbohydrate restriction. Moreover, I have written about how Berberine and Bergamot extracts reduce small, dense LDL particles.
References
Campos, A. L., Sawada, M. I. B. A. C., Santana, M. F. M., Iborra, R. T., de Assis, S. I. S., Reis, M., de Carvalho, J. X., Gebrim, L. H., & Passarelli, M. (2023). The increased antioxidant action of HDL is independent of HDL cholesterol plasma levels in triple-negative breast cancer. Frontiers in Oncology, 13, 1111094. https://doi.org/10.3389/fonc.2023.1111094
Krauss R. M. (2022). Small dense low-density lipoprotein particles: clinically relevant?. Current opinion in lipidology, 33(3), 160–166. https://doi.org/10.1097/MOL.0000000000000824
Haward, R., Chacko, J., Konjeti, S., Metri, G. R., Binoy, B. K., Haward, R., & Raju, S. (2024). Debunking the Myth: Eggs and Heart Disease. Cureus, 16(5), e59952. https://doi.org/10.7759/cureus.59952
Singh, N., Singh, N., Kumar Singh, S., Kumar Singh, A., Kafle, D., & Agrawal, N. (2012). Reduced Antioxidant Potential of LDL Is Associated With Increased Susceptibility to LDL Peroxidation in Type II Diabetic Patients. International journal of endocrinology and metabolism, 10(4), 582–586. https://doi.org/10.5812/ijem.5029
