Posted by: Chris Maloney | November 8, 2013

Cholesterol, HDL, LDL, VLDL, LOLLDL?

English: HDL

English: HDL (Photo credit: Wikipedia)

Ok, a quick primer on cholesterol.  Cholesterol is what your body uses to keep things flexible and moving.  If you eat no cholesterol, your liver will produce it for you.  Let’s repeat that, because there seems to be some confusion.  If you eat a fat-free diet, your own body will produce cholesterol, and you may still have high cholesterol -even if you don’t eat any. Eating cholesterol may just add to that amount.

Up here in Maine, we have families with familial hypercholesterolemia.  In English, that means they tend to run in the high 300’s for cholesterol just because dad did, grandad did, etc. Why on earth would this be something the body would want to do?  Cholesterol thick blood is slower freezing blood.  If you spend all day in twenty below, your body might just decide that a lot of cholesterol was a good thing.

Another reason the body might want a lot of cholesterol is that cholesterol acts as the building block for all your hormones.  If you want a high cholesterol, check a stressed, athletic, adolescent girl who is having trouble with her monthly cycle. She’s trying to make adrenaline and her female hormones while probably not eating enough.

But we all know high cholesterol is bad for you. Yes, the families with high cholesterol do have more deaths earlier from heart attacks.  But dropping cholesterol only helps somewhat.

The way we live, our lifestyle, affects more than just our cholesterol.  Just because you eat fat-free chips all day and drop your cholesterol to 198 doesn’t equate to a risk-free life.  If you want to bounce your numbers around, eat a half-gallon of ice cream the night before your blood test.  My cholesterol wasn’t high, but my triglycerides (three sugars stuck together, a middle step to making cholesterol) were in the 400’s.  Most people do the opposite, avoiding their favorite triple mocha brownie sundae the day before they get their borderline results.  Then they hear they’re risk-free for the next six months and go out to celebrate with a five gallon discount store tub of vanilla.

When it comes to pulling cholesterol out of your blood, you want to have a lot of HDL.  That’s high density lipoprotein, which moves like a compact baseball through your arteries, pulling the other junk with it.  The other junk is LDL, low density lipoprotein, what my patients call “the bad fat.” Then there’s VLDL, which is basically worse than LDL.  Think of both these as cotton candy in the arteries, pulled along by the baseball of HDL.

To get the right proportion of HDL to LDL, calculate the square root of I don’t care and add two nosehairs.  These calculations are not something the average person is going to understand and they are debatable among the medical community.

I’ve seen patients with very high HDL who just didn’t look well.  Their numbers looked good, but they didn’t.  More commonly I’ll see patients who look great, but who had a borderline cholesterol and are now panicking that they will keel over or need statins for the rest of their lives.  (BTW, this is the industry preferred new route we’ll all be going.  Watch for the “acceptable cholesterol” to drop to 100 and the sales of statins to skyrocket.)

Remember the rule of 80/20 before you either ignore your results or panic.  If most of your food and lifestyle choices are healthy, then an occasional indulgence (once a week) is going to happen anyway, so don’t feel guilty.  But if most of your life involves eating foods with ingredients you can’t pronounce that came out of a window, then it’s time to change directions.



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