There is way too much misinformation and simplification when it comes to cholesterol as the leading culprit behind cardiovascular disease, and one of the infamous targets of drug therapy. It’s time to bust some big dietary myths around this controversy. Cholesterol isn’t just a number; it’s a story of good guys, bad guys, and some downright sneaky villains.
Heart disease is the leading cause of death in the United States. One person dies every 33 seconds in the United States from cardiovascular disease.[1] You’ve probably heard that too much saturated fat can lead to high cholesterol and eventually heart disease.
In fact, oxidized cholesterol is what poses the danger here. But it’s not enough to make cholesterol the villain – we need to look deeper to understand that it is simply a marker for a deeper root issue, which needs to be addressed.
What is cholesterol?
Cholesterol is a wax-like substance that is naturally synthesized and regulated by the liver. It is technically a “sterol”, which is a type of lipid that is soluble in fat. You also get cholesterol from the foods that you eat. Cholesterol plays a significant role in inflammatory pathways, impacting immune responses and disease processes. Research highlights the intricate connection between cholesterol metabolism and inflammation, particularly in immune cells like macrophages. Cholesterol serves several crucial functions in the body:
- Cell Membrane Structure: Cholesterol is a major component of cell membranes, where it helps maintain membrane integrity and fluidity. It ensures the proper functioning of cell membranes, allowing cells to communicate and transport substances in and out.
- Hormone Synthesis: Cholesterol is a precursor for the synthesis of various hormones, including steroid hormones such as cortisol, aldosterone, and sex hormones (estrogen and testosterone). These hormones play vital roles in the regulation of metabolism, stress response, and reproductive functions.
- Vitamin D Synthesis: Cholesterol is a precursor for the synthesis of vitamin D. When the skin is exposed to ultraviolet B (UVB) sunlight, cholesterol in the skin is converted into vitamin D, which is essential for calcium absorption and bone health.
- Bile Acid Production: Cholesterol is a precursor for bile acids, which are essential for the digestion and absorption of dietary fats. Bile acids emulsify fats, facilitating their breakdown by digestive enzymes and absorption in the intestines.
Sounds great! So what’s the connection to heart disease?
If you have a buildup of cholesterol in your bloodstream, it can form a substance called plaque in between layers of your artery walls. The buildup makes it harder for your heart to keep the blood circulating. If the plaque breaks apart, it can lead to blood clots. Strokes occur when a clot blocks any of the arteries that lead to the brain. If an artery leading to your heart is blocked, you can have a heart attack.
So the main question becomes: how does the plaque form and how do we prevent it?
There are two main types of cholesterol, distinguished by its carrier lipoproteins: high-density lipoprotein (HDL), also referred to as “good” cholesterol, and low-density lipoprotein (LDL), aka “bad” cholesterol. However, there isn’t a change in the cholesterol itself, but we delineate the two types based on where these carrier proteins are carrying them. HDL carries cholesterol back to the liver for recycling, while LDL carries it towards the heart via systemic circulation, where it can become problematic.
LDL is made up of fats and proteins, and when in excess can contribute to plaque buildup in the arteries. This extra buildup makes the arteries less flexible and leads to atherosclerosis or hardening of the arteries.
What is the role of oxidized cholesterol?
Oxidation is the result of a normal body process, but if something triggers an overproduction of oxidized cholesterol, it can be dangerous. This overproduction can be caused by:
- Free Radicals: These are unstable molecules that damage cells throughout the body, including LDL cholesterol. Free radicals can come from various sources, including cigarette smoke, air pollution, and even from normal metabolic and detoxification processes.
- Dietary Factors: Consuming excessive amounts of saturated and trans fats can promote LDL oxidation. Conversely, antioxidants found in fruits, vegetables, and whole grains can help prevent this process.
- Chronic Inflammation: Ongoing inflammation in the body can also contribute to LDL oxidation.
The cholesterol that dangerously builds up on artery walls is oxidized. Oxidation is very damaging to the cholesterol cells.
Your immune system may mistake oxidized cholesterol for bacteria. Your immune system then tries to fight it off, which can cause inflammation inside the arterial wall. This can lead to atherosclerosis or heart disease.
What are the risk factors associated with oxidized cholesterol?
There are three main ways oxidized cholesterol builds up in your bloodstream:
- Cigarette smoking.
- Inflammatory seed oils (even though they have polyunsaturated fatty acids, which have been considered “healthy” for a long time, for example in the Mediterranean diet).
- Partially hydrogenated oils, or trans fats, are some of the unhealthiest fats you can eat. For example, margarine and vegetable oils that have had an extra hydrogen molecule added during production. These make products more shelf-stable and have been commercially available for decades, and marketed to us shamelessly. While a convenience in the food industry, it is the most unhealthy thing you can eat!
Processed foods are also sources of oxidized cholesterol. These include:
- Fast foods
- Fried foods, especially deep fried
- Commercially baked goods
All of these foods cause inflammation in your body. This inflammation is caused by damage to your cell membrane and the oxidized LDL particles present.
Eliminating the risk of oxidized cholesterol
There are things that you can do to stop the damage from oxidized LDL.
- Incorporate healthy fats into your diet. It has been found that monounsaturated fats have anti-inflammatory properties.
- Consume saturated fats judiciously, sourcing from high quality animal products such as grass-fed and pastured.
- “Eat the rainbow”: make sure that your diet contains a lot of fresh fruits and vegetables, diverse in colors. The more saturated the colors, the higher the level of antioxidants, which will help fight free radicals.
- Ensure that you pay attention to the nutrition labels, and steer clear of items that have been hydrogenated or partially hydrogenated. In fact, the less packaged goods you consume, the better. Stick to the items your grandma would recognize and avoid ultra-processed foods.
- Your physician may be able to prescribe you some medication, but in most cases, the most effective defense is a good diet, regular elimination and detoxification, because the liver plays an important role in cholesterol management.
Speak with your physician before starting a new supplement. Some supplements may interact poorly with the medications you’re taking.
If you have high cholesterol or high blood pressure, your doctor can test you to see if you have a high level of oxidized LDL in your body. A routine lipid profile blood test can give you total cholesterol results, but it doesn’t test for oxidized cholesterol. More advanced lipid testing can measure the more direct risk of plaques by measuring either the lipoprotein particle size, or the amount of calcified plaque, such as the coronary artery calcium score CT scan.
Atherosclerosis is a dangerous condition, and you should take it seriously. You may not show any symptoms, so it’s important that you get regular physicals, especially if you have any of the risk factors. Your doctor can keep an eye on your oxidized LDL levels and treat you to prevent it from getting worse.
Research is still being conducted on oxidized LDL and the best treatment. The best defense is a healthy diet and lifestyle, so talk to your practitioner and get the right support for you.
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