Cracking the Cholesterol Code

Did you know that September is National Cholesterol Education Month? Yeah, I didn’t either. Let’s just say that my Instagram feed is riveting. 

It’s just as good a time as any to talk about cholesterol, so let’s do it. What is it, and why does it matter? 

Cholesterol comes from 2 places - the body makes its own cholesterol in the liver, AND it is also absorbed from dietary sources. 

Cholesterol is actually a good thing. It provides structure to cell membranes and it is a building block for steroid hormones, vitamin D, and bile acids, so that’s why we need it.

As with anything, there can be too much of a good thing. When you have too much cholesterol, it sticks to artery walls, where it forms plaques that can build up and eventually cause blockages that lead to heart attack or stroke, among other things. 

Plaque buildup due to LDL deposits in an artery causes blocked arteries.

Let’s talk about what makes up cholesterol.

The cholesterol number that you get when you have your labs done is made up of 3 things. 

Low-density lipoprotein (LDL) (sometimes called “bad cholesterol”) - this delivers cholesterol to the tissues so it can do its job, but it also can stash it in the arteries, where it can stick to the walls and cause plaque deposits which cause heart disease (eg heart attack) and stroke. 

High-density lipoprotein (HDL) takes the LDL away from the arteries back to the liver where it is processed to be excreted. This is why it is sometimes called “good cholesterol.”

Triglycerides are a type of fat in the blood that store energy. After eating, extra calories (especially from carbohydrates and fats) are turned into triglycerides and stored in fatty tissue. These vary significantly after eating, so this is the reason that you need to be fasting when you have your cholesterol checked. 

Why do some people have too much? 

When it comes to cholesterol, there is a part that you can control, and there is a part that you can’t control. The part you can’t control is your genetic

s. Sometimes high cholesterol runs on families no matter how meticulous you are with your diet. People with a gene for Familial Hypercholesterolemia don’t have as many receptors on the cells to shuttle cholesterol out of the blood and into the cell for processing. The part you can control is the cholesterol that comes from your diet. Some people have too much in their diet, and the body can only process so much.

Foods high in saturated or trans fats, smoking, lack of physical activity, alcohol, and stress can all increase LDL and triglycerides.  

Things that decrease LDL/or improve HDL- a high fiber diet (women aim for at least 25g/day, men aim for at least 35g/day). The following foods are helpful in getting LDL down or HDL up:

• Nuts (especially almonds & walnuts)

• Seeds (eg chia, basil, or flax seeds)

• Legumes (especially lentils)

• Whole grains (oats, barley)

• Fruits & vegetables (berries, avocados & cruciferous vegetables are especially good)

• Omega 3 fatty acids found in fatty fish (salmon, mackerel. If you don’t eat fatty fish twice a week, you may want to consider a fish oil supplement or even algae oil if you can’t stand fish oil). 

• Exercise, including resistance training and aerobic exercise, can increase HDL.

As you age, at some point, the liver becomes less effective at eliminating bad cholesterol, which is why we often see cholesterol going up as we age. 

Of course, my friend estrogen has to have a hand in this too. As estrogen decreases with age, HDL goes down and LDL goes up, which is why many women are first diagnosed with high cholesterol as they approach menopause. 

So what are the ideal numbers? Well, it depends, but lower LDL and triglycerides are better, and higher HDL (to a point) is better. The ideal ranges provided by the lab may not be ideal for you. For instance, if you have diabetes or heart disease, your doctor may want these numbers to be lower than the “normal” range provided on the lab report. 

When you can’t get your LDL into the ideal range for you with diet and exercise alone, that’s when your doctor might recommend medication to help get it down. The reason for this is to prevent heart disease, vascular disease, or stroke. People always want to know when is the best time to start medication and whether they can put it off longer. Think of your risk for heart/vascular disease based on your cholesterol in terms of “LDL years” - how long has that high LDL been around dumping plaque in your arteries. Ideally, you want to keep this number down rather than waiting until you have signs of plaque buildup in your arteries to act, but this is a conversation to have with your doctor. 

If you made it this far, thanks for sticking around. I admire your commitment to learning about lipids. 

Head on over to my instagram for more where I share some real life examples and talk more cholesterol.

I could easily nerd out on this topic (as if I haven’t already) and go on and on and on and on. Did you find this helpful? Would you like a Part 2 where I dive into some additional cholesterol and heart disease markers? Let me know!