Is Cholesterol That Bad?

Is it Cholesterol that Bad?

In previous blogs, I have presented the benefits of most of the major nutrients required for our existence. Carbohydrates, protein and fats provide essential substances that allow the body to function properly. This time, I will be discussing the importance of cholesterol and the risk when one’s cholesterol level is elevated.

For many years, cholesterol and fat have been blamed for the increase in the incidence and the mortality caused from cardiovascular disease, stroke and hypertension. The truth is that cholesterol is an extremely important substance—without it, the body will show signs of malfunction.

Most of the time, patients ask me what the benefits of cholesterol are and how much they should eat.

I will start by defining what cholesterol is. Cholesterol is a waxy, fat-like substance that is synthesized in the liver and is part of all cells in our bodies. The liver makes approximately 80 percent of the cholesterol needed and the rest comes from the diet. Cholesterol can be found in many of the animal products we eat such as red meats, eggs and dairy products.

Cholesterol is a complex molecule; it is not soluble in the blood, so it needs to be transported in the bloodstream attached to protein. This complex is called “lipoprotein”.

Cholesterol is an important substance affecting the following functions:

• Important precursor for the production of sex hormones and steroids
• Allows the body to produce vitamin D in the skin
• Important component of the digestive enzymes and bile acids in the intestine helping with the digestion
• Contributes to the structure of cell membranes
• Makes the myelin sheath that coats the nerve cells

A diet high in saturated fats, trans-fats and refined sugars can increase the production of cholesterol and can elevate the cholesterol level in the blood, leading to buildup of cholesterol plaques in the arteries.

There are different types of cholesterol depending on the amount of protein in relation to fat and cholesterol in the molecule.

Low Density Lipoprotein (LDL cholesterol): Also known as “bad” cholesterol. It is responsible for the cholesterol buildup in the arteries and heart.

High Density Lipoprotein (HDL cholesterol): Also known as “good” cholesterol. It is responsible to remove the cholesterol from other areas of the body back to the liver.

Very Low Density Lipoprotein (VLDL cholesterol): is similar to LDL and it has the same effect in the arteries and the heart. It contains mostly cholesterol and not much protein. This type of cholesterol also carries triglycerides (another type of fat).

What factors can affect cholesterol levels?

Cholesterol level can be affected by a variety of factors.

Diet high in saturated fats, trans-fats and refined sugars:
Individuals who tend to consume diet rich in these types of unhealthy nutrients may develop high cholesterol, increasing their risk for obesity, cardiovascular disease, diabetes and hypertension.

Age and gender:
Men tend to have higher cholesterol levels compared to women. After menopause, LDL cholesterol levels in women can begin to rise.

Excess weight:
Not everyone suffering from overweight or obesity will have high cholesterol. However, the incidence is higher in individuals suffering from these conditions.

Sedentary lifestyle:
Inactivity associated with unhealthy meals can raise total and LDL cholesterol and decrease HDL cholesterol.

• Heredity:
There are families with genetic disorders that can cause an elevation of their LDL cholesterol or low HDL cholesterol. Most of the time, a low fat or low cholesterol diet may not be sufficient to decrease the level of cholesterol in these individuals, and they may require pharmacological therapy.

1. Thyroid disease: Patients who suffer with hypothyroidism can have elevation of their total cholesterol levels. After the hormone deficiency is corrected, the cholesterol level usually returns to a normal level.
2. Diabetes: Individuals with poorly controlled diabetes tend to have a higher level of cholesterol and triglycerides.

Expecting mothers tend to have elevated total cholesterol that is considered “physiologic” normal. No treatment is necessary.

Certain medications such as anabolic steroids, Accutane, certain beta-blockers and diuretics may increase the level of total cholesterol, LDL or HDL cholesterol.

How much cholesterol should I eat?

Cholesterol is an important substance in our bodies. The Institute of Medicine recommends a daily cholesterol intake at 200 mg.

Remember, the body produces most of the cholesterol it needs. However, it is the LDL cholesterol that has been associated with the risk of developing atherosclerosis (hardening and narrowing of the arteries due to deposits of cholesterol plaques). Diets high in saturated fat, trans-fats and refined sugars can increase the bad cholesterol levels.

Is there a blood test that measures my cholesterol levels?

Knowing your total cholesterol and subtypes can help identify your risk to develop atherosclerosis. Most patients with elevated cholesterol do not experience any symptoms. Your physician can order a simple blood test, which measures the different subtypes of cholesterol and triglycerides in your bloodstream.

LIPID PANEL Recommended Level
Total Cholesterol-Normal <200 mg/dl
HDL Cholesterol-Normal >40
Major risk factor for heart disease <40
Negative risk factor for heart disease >60
LDL Cholesterol
Optimal <100
Near Optimal 100-129
Borderline High 130-159
High 160-189
Very High >190
LDL/HDL ratio
Cardiovascular risk Women Men
1/2 average risk 1.0 1.5
Average risk 3.6 3.2
2X average risk 6.3 5
3X average risk 8 6.1
VLDL Cholesterol 5-40 mg/dl
Cholesterol/HDL ratio Women Men
Cardiovascular risk
1/2 average risk 3.4 3.3
Average risk 5 4.4
2X average risk 9.6 7.1
3X average risk 23.4 11
Triglycerides-Normal <150mg/dl
Borderline High 150-199
High 200-499 3.3
Very High >500 11

There are new, specialized blood tests that measure the LDL particle size. It has been discovered that some LDL particles are more dangerous than others. Small LDL particles have been found to increase the risk of cardiovascular disease. You physician can order this test if you have a strong family history of heart disease and your LDL cholesterol is borderline.

What types of treatments are available?

The main goal of cholesterol treatment is to reduce LDL and increase HDL levels. The main non-pharmacological therapy is lifestyle modification (reduction of saturated fats, trans-fats, refined sugars and processed foods in your diet and practice a routine exercise program). However, patients with very high cholesterol levels unresponsive to diet and exercise may require pharmacological therapy. The most commonly prescribed medications are the “statins,” bile acid sequestrants , niacin and fibrates and Ezetimibe. Your physician will select the best treatment option.


Cholesterol is another vital substance that participates in a series of processes in the body. Eating a healthy diet and following a regular exercise program can reduce the risk of developing high cholesterol. As always, I strongly recommend you take an active role in your own health. Schedule an annual examination with your physician. Prevention is always the best approach, helping reduce the chances of preventable chronic medical conditions.

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LDL particles:

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