The Ultimate Guide to Cholesterol — Types, Factors and Research

Why Consume a Balanced Diet?

People who are habituated in eating too little or too much are perpetually risking their health. Too little causes “malnutrition” while too much causes obesity, heart ailments, and stroke. It is essential to eat a “balanced diet” comprising of adequate amounts of a combination of all food types. These include Carbohydrates, Proteins, Fats, Vitamins and Minerals. This article is about eating too many cholesterols, lipids, and fats.

People must consume a “balanced diet” complete with essential lipids, fats, and cholesterol at every meal. The consumed lipids (fats and oils) are used in the body as is. Other consumed foods are digested or broken down to their simplest forms and absorbed. These are used as ingredients for synthesising cholesterols and other nutrients more for the human body. Research has confirmed several biosynthetic processes for breaking down and making required lipids in the body.

The most significant biochemical function of lipids is storing energy as triglycerides for future use. Lipids are chemically transformed into triglycerides that are full of energy for potential use. These are oxidised to simplest forms as soon as there is a shortage of energy for functions. Lipids are used for sending messages and signalling molecules for triggering diverse activities within the body. All the required nutrients are synthesised or made within the human body. The liver makes Very Low-Density Lipoprotein (VLDL) and releases it in the bloodstream. VLDL is a type of cholesterol.

Introduction to Cholesterol

Cholesterol is a waxy, fat-like substance present naturally in all cells in the human body. It is used for making cell membranes and cell tissues for protecting organs and nerves. Also, it is utilised for making Vitamin D in the body and synthesising other essential digestive hormones. The liver produces cholesterols and other nutrients meant for healthy metabolic reactions in the human body.

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Types of Cholesterol

There are three types of cholesterols found in the human body. These include HDL, LDL, and VLDL. Generally, foods rich in cholesterol are digested and absorbed into the bloodstream. These are carried by both HDL and LDL cholesterol. As for VLDL, it carries triglycerides.

• HDL: High-density lipoprotein (HDL) is the “good” cholesterol. This is because HDL carries the cholesterol within the bloodstream in the entire body to the liver. After reaching the liver, cholesterol is utilised for synthesising various nutrients beneficial to the body. Also, other metabolic reactions are carried out using the cholesterol.
• LDL: Low-density lipoprotein (LDL) is known as the “bad” cholesterol. LDL carries the cholesterol found in the bloodstream where it combines with other substances forming plaque. Research studies have linked plaque build-up with high risk in coronary heart ailments and/or stroke.
• VLDL: Very Low Density Lipoprotein (VLDL) is also known as “bad” cholesterol. It is made in the liver and released to the bloodstream. The major function of VLDL is to carry lipid triglycerides in the bloodstream to cell membrane and tissues. The structure of VLDL is similar to LDL that carries cholesterol in the bloodstream. Excess VLDL and LDL cholesterol form harmful “sticky” plaque build-up within the arteries. This leads to increased risk of a heart ailment, stroke, and atherosclerosis.

Why are Cholesterols Harmful?

All types of cholesterols are not harmful to human health. For instance, HDL helps in carrying cholesterol from bloodstream from the entire body to the liver. The liver uses cholesterol to make other nutrients for the body. Also, the liver makes VLDL cholesterols released in the bloodstream for carrying lipid triglycerides to the cell membrane.

High levels of LDL and VLDL are both equally harmful. These cholesterols combine with other substances such as calcium, cholesterol, fats, and others in the bloodstream. This results in the formation of “sticky” plaque that adheres to the walls of the arteries.

Over time, plaque build-up causes narrowing of the arteries that harden and lose elasticity causing atherosclerosis. Often, these arteries might get ruptured and break open leading to oozing and clotting of blood. Hence, there might be blockage of the free-flowing oxygenated blood to the heart, limbs and/or brain. Thus, increases risks of getting angina (chest pain), heart attack, coronary heart ailments, and stroke.

Factors causing High Cholesterol (combined HDL, LDL and VLDL)

• Age: It is uncommon to find children and teenagers suffering from high cholesterol. However, as individual ages, he/she has a higher level of cholesterol.
• Genetics/Hereditary: People suffering from Familial hypercholesterolemia (FH) end up high cholesterol. This is a hereditary illness that is genetically passed down to future family members. Also, families with a medical history of a heart ailment and/or stroke, members are prone to high cholesterol.
• High Blood Pressure: High blood pressure is a sign of forced blood-flow through the arteries. It is recommended to get the cholesterol (LDL, HDL, and Triglyceride) levels checked.
• Race: It has been observed that African Americans have higher HDL and LDL cholesterol levels than Caucasians.
• Sedentary Lifestyle: Just sitting and lying around with no physical activity causes in lowering good HDL cholesterol.
• Smoking: Lowers good HDL cholesterol while it increases bad LDL cholesterol; this is noted mostly in women.
• Weight: People have high cholesterol when they do not maintain body weight within the recommended range of Body Mass Index (BMI). This depends on age, gender, height, and body weight. Obesity does not depend only on bodyweight shown on the balance scale. Also, the circumference of the waste should ideally be women (35 inches) and men (40 inches). This is due to the visceral fat surrounding the abdominal organs giving rise to high blood pressure, hypertension and high cholesterol.

Diagnosis of High Cholesterol

Generally, there are no apparent sign or symptom found in people with high cholesterol. However, the levels of cholesterol can be measured through blood tests. Best times and frequency of taking the blood test for measuring cholesterol has been discussed below:

• Aged 19 or less: Children (2 years) need to get their first blood cholesterol level tested. This test should be carried out especially for children from families with medical history. The ailments include high cholesterol, heart attack, and stroke. Generally, children require a blood test for cholesterol every 5 years. Normally, children aged (9–11) can take their first blood test for cholesterol.
• Aged 20 or more: The blood test for measuring cholesterol should be taken every 5 years in all youngsters.
• Men (Aged 45–65)/Women (Aged 55–65): The blood test for cholesterol should be taken every 1–2 years.

Recommended Cholesterol Levels

The ideal cholesterol levels in milligrams per decilitre (mg/dl) based on the risk of heart-healthy should be as follows:

• LDL cholesterol level: Best (less than 130 mg/dl) based on risk for heart disease.
• HDL cholesterol level: Best (60 mg/dl or higher). This reduces the risk of heart disease, stroke.
• Triglycerides: Best (less than 150 mg/dl)
• Total cholesterol level: Best (less than 200 mg/dl) based on HDL and LDL cholesterol levels.

Very Low Density Lipoprotein cholesterol cannot be directly measured. However, the blood report showing triglyceride measurements can be used for determining VLDL levels. In the laboratory, the VLDL levels are estimated at approximately one-fifth of the reported triglyceride level. Yet, this method cannot be used for people who end up showing high levels of triglyceride. Ideally, the level of Very Low Density Lipoprotein should be less than 30 milligrams per decilitre (mg/dl). Higher levels of VLDL lead to increased risk in angina, heart disease, and stroke.

Methods for Lowering “Bad” Cholesterol while Increasing “Good” Cholesterols

The blood report used for measuring cholesterol levels shows how high or low the levels are. Individuals with high cholesterol should take the following actions as discussed below:

• Lowering “Bad” VLDL Cholesterol: Research proves that Very Low Density Lipoprotein levels depend on amounts of triglyceride in the bloodstream. Thus, lowering lipid triglycerides within the body automatically reduces VLDL cholesterol levels. People with high triglyceride level should combine methods (weight-loss, eating special controlled diets, and regular exercise). Also, they should cut down consumption of sugar, alcohol, and carbohydrates that are converted to triglycerides. The body uses the required amounts of calories for the various body functions. Thereafter, the lipids transform to triglycerides storing potential energy for future use. Additional prescribed medicines are also available for reducing triglycerides.
• Treatment of FH: People with Familial hypercholesterolemia (FH) often end up with high cholesterol levels. They are provided with lipoprotein aphaeresis treatment. The filtering machine is used for removing the LDL cholesterol from the bloodstream. Ultimately, the cleaned blood is returned back into the patient.
• Change in Lifestyle: Smokers must quit smoking immediately. It is recommended that everyone exercise regularly for at least 30–60 minutes. Some common physical activities including walking, swimming, running jogging and others help in entire body workout. Also, it is important to work-out on lean muscles since those increases the metabolic rate in the body. Physical activities increase levels of good HDL cholesterol.
• Reduction in Bodyweight: Regular exercising and physical activities help in maintaining the recommended range of Body Mass Index (BMI). This is based on age, gender, and height. Losing 5–10 pounds helps in reducing the levels of cholesterol and triglycerides.
• Food to Eat and Avoid: In general, it is recommended to stay away from deep-fried and processed foods. Also, eating too much red meat and dairy products rich in cholesterol is harmful. Eat lots of fresh fruits, vegetables, whole grains, lean meat, avocados, nuts, and low-fat dairy products. Eat oily fishes (Salmon, Tuna, Sardine, and others), walnuts, and almonds.

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What to Eat and Why?

A detailed discussion of what should be consumed and why have been discussed as follows:

• Lipids: These include all sorts of fats that exist in liquid and solid forms at room temperature. Lipids are known to be building blocks of cell membrane and tissues. Also, lipids are used for various metabolisms in the body. Recent research studies prove the composition of the cell membrane has proteins and lipids. Depending on its location, lipids can range from 20% to 80% of the cell membrane. The remaining proportion is made of proteins.
• The body utilizes calories from carbohydrates and fats for all functions and metabolic reactions within the body. Thereafter, excess calories are converted to lipid triglycerides, an ester composed of glycerol and 3-fatty acids. As soon as the body requires energy, triglycerides are oxidised to simplest form releasing stored energy. The simplest forms of lipids include hydrocarbon molecules capable of storing energy for future use.
• Another function of triglycerides is aiding the synthesis of fatty acids (lipogenesis) in the endoplasmic reticulum. Triglycerides and acetyl-CoA are used by a single protein with multi-functions for synthesising fatty acids using the mevalonate pathway. Various isoprenoids (cholesterol and steroid hormones) are synthesised within the body. Yet, it cannot make Omega-3-fatty acids so this should be added to a regular balanced diet.
• Types of Lipids: There are two major types of lipids — Hydrolysable and Non-hydrolysable.
• Hydrolysable: Lipids soluble in water such as modified lipids or esters. These include lipids with ester functional group such as glycolipids, neutral fats, phospholipids, and waxes. Others include lipids (fats and oils) made of triglycerides (glycerol + 1, 2, 3-trihydroxypropane) and 3 fatty acids forming tri-ester. Triglycerides are present in the bloodstream and stored in fat cells. After dissolving in water, triacylglycerols produces 3 fatty acids and 1 glycerol molecule.
• Non-hydrolysable: Lipids like steroids and fat-soluble Vitamins (A, D, E, and K) that are not soluble in water. These are soluble in solvents such as chloroform.
• Fatty Acids: These are lipids made of long-chained carboxylic acids. These have more than 16 carbon atoms that may or may not have carbon-carbon double bonds. Generally, the number of carbon atoms exists as even numbers and are not branched. The most commonly known fatty acid is Oleic acid that is often referred to as monounsaturated since it has a single double bond.
• Waxes/Fats and Oils: These are lipids that exist as esters with long-chain carboxylic acids and long-chain alcohols. Fats, a certain class of triglycerides, exist in solid/semisolid form at room temperature. Fats derived from animals (Butter, Cream, Cheese, Bacon, and Fatty Meat) are animal fats. Fats derived from plants (Coconut Oil, Palm Oil) are plant fats. Oils are special triglycerides that remain in liquid status at room temperature. Oils are derived from mostly plants (Corn oil, Flax seed oil, Olive oil, Peanut oil) and some fishes.
• Saturated Fats (Solid Fats): Fatty acids with no carbon-carbon double bonds. These saturated fats are efficiently packed and hence remain in a solid state at room temperature. Saturated fats are found in Animals (bacon, poultry skin, meat, and dairy products); baked/processed products (biscuits, cakes, chips, and pastries); vegetable fats (Coconut oil, palm oil, and cocoa butter). When people consume saturated fats over a long time, they risk getting heart disease and stroke. People should consume less than 10% of saturated fats.
• Unsaturated Fats: Fatty acids assume the geometrical shape of the container. The molecules are not well-packed, unlike saturated fats. These remain in a liquid state at room temperature. Also, their boiling point is a lot lower than saturated fats. Unsaturated fats are referred to as “good fats”. This exists as monounsaturated and polyunsaturated fats.
• Monounsaturated Fats: Fats containing only one hydrogen atom in every molecule. These fats reduce low-density lipoprotein (LDL) cholesterol levels and increase high-density lipoprotein (HDL) levels. According to research scientists, intake of monosaccharide in monounsaturated fat reduces the risk of heart ailments. This monosaccharide is mostly found in avocados, olive oil and olives, nuts, and peanut butter.
• Polyunsaturated Fats: Fats made of two or more double bonds. These fats have lots of space around the molecule that gets covered with several hydrogen atoms. Common ones are Omega-3 polyunsaturated fatty acids and Omega-6- polyunsaturated fatty acids present in fish, nuts. Omega-3 fatty acids lower blood cholesterol levels in the bloodstream and prevent inflammation. Thereby, it protects against heart diseases and/or stroke. Taking too much Omega-6 fatty acid found in vegetable oils and processed foods cause inflammation. Sources of polyunsaturated fatty acids include oily fishes (Herring, Mackerel, Sardines, Salmon, and Trout). Others sources are derived from plants (Rapeseed oil, Safflower oil, Soybean oil, and Sunflower oil). Other healthy sources are (nuts, seeds, and pastured eggs with omega-3 fatty acids).
• Trans Fats (Partially Hydrogenated Oils): Fats synthetically prepared in the industry after adding hydrogen to liquid vegetable oils. As a result, the liquid form turns solid. Unlike other fats, Trans fats are non-essential to the body and harmful to health. Intake of Trans fat increases LDL cholesterol and lowers HDL cholesterol levels. This increases the risk of coronary heart disease and stroke by 3 folds.
• Research from The Harvard School of Public Health reported Trans Fats causes 50,000 fatal heart attacks annually. Also, Trans fat increases the risk of getting Type 2 diabetes. Due to health hazards, the use of Trans fats has been banned in California, Philadelphia, and New York City. Prior to this, fast-food joints used Trans fats because of their cheap availability and easy use.

Recommended Intake of All Types of Lipids, Fats, and Cholesterols

The American Heart Association (AHA) has recommended the following consumption of fats. People need to get (25–35%) calories from unsaturated fat; however, those may not always be heart-healthy. Recent studies proved the goodness of saturated fats that were earlier thought to be harmful. The AHA has recommended people to get (5–6%) of daily calories from saturated fat.

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Recent Report in the Journal of American Heart Association (20th December 2017)

The research article has reported that eating almonds, chocolates, and cocoa reduces cholesterols. The study was carried out by 31 obese adults. They had high cholesterol and a high risk of cardiac heart ailments. Their daily diet comprised of almonds, dark chocolate, and cocoa. Within one month, their cholesterol was lowered. The average American diet (cheese, meatloaf, milk, tuna fish and white bread) was used as a control diet. This diet provides around 1,800–3,300 calories/day. The second diet was similar but, certain items were replaced with almonds (42.5 grams per day). The third diet replaced certain items with cocoa powder (18 grams per day) and dark chocolate (43 grams per day). The fourth diet included all three — almonds, chocolates, and cocoa. After comparing with the control diet, the results were obtained. As per research results, the almond diet reduced total cholesterol by 4% and reduced LDL by 7%. This research study confirmed the direct link between diet and cholesterol. Chocolates are well-known for lowering levels of cholesterol. This is because those contain high levels of flavanols and cocoa powder.

Prescribed Medications: When all else fails, people can consult their physician to take prescribed medications. One of them is Statins, drugs for lowering LDL cholesterol levels and increasing HDL cholesterol levels. Statins prevent the body from making new cholesterols such that the body uses up all stored ones. Statins reduce the plaque formation and build-up that stops adhering to the walls of the arteries. Most patients taking Statin suffer from muscular pain and this is the most common side effect. Several patients allergic to Statin take Ezetimibe and PCSK9 inhibitors (non-Statin drugs) for reducing cholesterol.

Recent Studies in the Journal of the American College of Cardiology (25th July 2018)

Research article discusses alternative methods of taking nutraceuticals, food supplements for health benefits. These include berberine, bergamot, garlic, green tea, Lupin, omega-3 fatty acids, red yeast rice, soy proteins, and spirulina. Research studies show that natural remedies are safe to take. They have no apparent side-effects while they definitely lower bad cholesterol. However, these nutraceuticals should not be used in replacement of Statin or medication. They can be used as added on complement.

How “Low” should the LDL Cholesterol Levels Be Lowered To?

Above, all information shows how to control high cholesterol to reach healthy levels of the same. It is understood that high levels of bad cholesterol LDL and VLDL increases risk in heart-health and more. Hence, it is important to lower high cholesterol. On discovering high levels, one should consult one’s physician for advice. Today, there are several methods of reducing cholesterol especially “bad” ones without any significant side effects. Doctors can prescribe medications including Statin and non-Statin drugs. Also, there are alternatives and natural remedies that one can add on. Other methods include changing lifestyle, exercising, eating healthy and more.

While lowering cholesterol, one should be under the supervision of an expert health professional. This is such that the levels of the total cholesterol do not reach dangerous “low” levels. Yet, there is no definite compromise at to what should be considered “low” cholesterol level. When LDL cholesterol level reaches less than 40mg/dl, its level is considered as “low” level. Generally, this condition of reaching very “low” levels of LDL cholesterol is very unusual and/or rare.

People showing very “low” LDL cholesterol level end up with ailments/health risks as follows:

• Anxiety
• Cancer
• Depression
• Hemorrhagic stroke
• Pregnant women with low LDL levels — deliver prematurely or baby’s birth weight is low.

The actual results in some of the above cases are debatable as far as doctors are concerned. It is unclear if “low” LDL cholesterol causes the symptoms of the above illnesses. It could also be that the illness caused the symptom of “low” LDL cholesterol level. People suffering from depression show “low” LDL cholesterol levels. Yet, to date, no research studies have been carried out to find if Statin causes depression.

The risk of lowering LDL cholesterol to very “low” levels is still under observation and/or investigation. Today, doctors are studying the impact of “low” LDL cholesterol on the increased risk of health issues.

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Originally published at www.beaninspirer.com on March 4, 2019.