Cholesterol and Metabolic Health: A Critical Relation!

Cholesterol is a type of lipid that proteins transport via blood circulation. Your liver produces the majority of cholesterol. LDL (bad cholesterol) and HDL (good cholesterol), which comprise most of our total circulating cholesterol, only account for roughly 25%. Only foods from animals contain cholesterol; the body produces the rest.

The body’s function of cholesterol is complicated. It helps in the formation and fluidity of cell membranes. Also, it contributes to creating the covering that shields our nerves. It serves as the building block for bile salts, which our body needs to digest fats. It also plays a role in producing sex hormones like progesterone and testosterone. Cholesterol is essential for the skin as it helps make vitamin D, which is used in calcium uptake and regulates bone density.

Cholesterol may be challenging to understand because of certain popular myths based on obsolete facts. For example, one common myth is that cholesterol is unhealthy, and one should avoid foods that add to cholesterol levels. However, cholesterol is essential for maintaining human health. Although cholesterol has a negative image, it is vital for cellular health.

High LDL levels are associated with an increased risk for atherosclerosis and plaque build-up in the arteries. It also increases the risk of other cardiovascular diseases and stroke. Cholesterol is a crucial indicator of metabolic health and can even be used to detect insulin resistance. The HealthifyPro’s 5-way approach to maintaining healthy metabolism can help. It involves a metabolic panel that measures over 80 parameters. Furthermore, Continuous Glucose Monitoring and real-time feedback from the Pro coaches are some of HealthifyPro’s features. You can utilise these features to maintain healthy cholesterol levels, contributing to improved metabolic health.

Cholesterol and Triglycerides

Lipids are substances insoluble in water, including fats, oils, hormones, and waxes. Although cholesterol and triglycerides are both lipids, there are prominent differences. Triglycerides are fats obtained from the foods you eat. Your body converts the excess calories that you consume into triglycerides. These are then stored in fat cells and are released periodically to release energy from them between meals.

Cholesterol, in contrast, is not fat. Instead, it is an odourless and waxy substance produced by the liver. Triglycerides give you energy, whereas cholesterol helps build cells, among other functions. High cholesterol and triglycerides do not show significant symptoms, and you can only diagnose them through blood tests. However, high triglycerides can contribute to atherosclerosis; even higher levels can cause pancreas inflammation. This pancreatitis can lead to life-threatening consequences.

Metabolic Health and Cholesterol

Before understanding the association between cholesterol and metabolic health, it is essential to know the parameters that define healthy metabolic health. So, some of the parameters that define healthy metabolic health are:

• Waist circumference less than 102 cm for men and 88 cm for women
• Fasting glucose levels less than 100mg/dL
• Normal range of haemoglobin
• Blood pressure (systolic less than 120mmHg and diastolic less than 80mmHg)
• Triglycerides less than 150mg/dL
• High density lipoprotein cholesterol (less than or equal to 40mg/dL for men and 50mg/dL for women)
• No medication to manage any abnormality in the metabolic parameters

According to a nationwide study in the US, less than one-third of adults in the average body weight range were metabolically healthy. However, certain factors were prevalent in those with optimal metabolic health. These factors included gender (females having optimal metabolic health), age (young people with better metabolic health), having higher education, no smoking, having low body mass index and exercising regularly.

Out of the various parameters of healthy metabolic health, cholesterol impacts many of them. Now, having poor metabolic health can contribute to several problems. The most dominant problem is cardiovascular disease, followed by stroke. A WHO research shows cardiovascular diseases are the leading cause of death, taking around 17.9 million lives each year. 

Most cardiovascular issues result from high LDL (bad) cholesterol. It is also a parameter of healthy metabolic health. If you have high LDL levels, your metabolic health is not optimal because high levels of LDL can also increase cardiovascular health risks. Therefore, regulating your cholesterol levels and keeping them in the normal range is essential.

Cholesterol and Cardiovascular Issues

According to a WHO report, increased cholesterol levels contribute to heart disease and stroke risks. Worldwide, a third of coronary artery disease (also called coronary heart disease or ischaemic heart disease) results from high cholesterol levels. The plaque built up in the arteries results in narrowed arteries. That leads to a lesser supply of blood and oxygen to the heart, resulting in heart attacks. These statistics suggest that abnormal cholesterol levels contribute to cardiovascular issues, a global concern. In addition, it can result in impaired metabolic health.

Cholesterol and Metabolic Syndrome

One study estimates that around one in three adults in India might suffer from metabolic syndrome. Another research by the Centers for Disease Control and Prevention says that around 30% might have metabolic syndrome in the United States.

Metabolic syndrome is caused due to high blood pressure, increased glucose levels, abnormal levels of cholesterol and triglycerides, and increased waist circumference. Essentially, abnormal levels of any parameter that defines metabolic health can lead to metabolic syndrome.

The HealthifyMe Note

Cholesterol is a type of lipid that helps in the formation of cell membranes, production of sex hormones, covering of the nerve cells and building bile salts which in turn digest fat. Cholesterol is misperceived as harmful but serves crucial functions in the body. A comprehensive lipid panel test helps monitor cholesterol levels. Cholesterol levels strongly influence metabolic health as high levels of it can lead to metabolic syndrome, cardiovascular diseases, stroke, etc. 

Significance of Measuring Cholesterol

A lipid panel is a blood test used to measure the levels of cholesterol and triglycerides. In addition to other metrics, a lipid panel at the doctor’s office includes data for our LDL (bad cholesterol) and HDL (good cholesterol). Your arteries, present throughout the body, deliver oxygen-rich blood to various organs and cells. LDL helps to carry cholesterol to arterial wall cells. These cholesterol deposits and other materials can eventually develop plaque through different processes. 

These plaques constrict the artery walls, leading to atherosclerosis. Additionally, atherosclerosis raises the chance of having a heart attack or stroke. In contrast, HDL transports some cholesterol back to the liver, where it is digested and eliminated via faeces.

People are afraid of cholesterol. For years, well-meaning doctors have stressed what they have long considered a close connection between cholesterol and mortality from heart disease. The media reinforced these supposed facts. However, the reality is far more nuanced. Cholesterol is just one of several variables affecting your chance of developing heart disease.

Important Numbers

Try to get a comprehensive lipid panel. Make sure you’re looking at the correct statistics and your family history. It will ensure an accurate understanding of the results.

TG: HDL

The ratio we obtain by dividing the level of triglycerides (in mg/dL) by HDL (in mg/dL; TG/HDL) is remarkably effective in predicting LDL size. That is because the more significant, buoyant LDL particles, or LDL A, are more abundant when the ratio is smaller (for example, 2.0). But when the ratio increases (>2.0), the LDL B particles that are tiny and dense become more prevalent. Since almost all blood tests will include TG and HDL, we may easily determine our unique LDL pattern type without needing a specific test.

You should check your TG level if your LDL is between 100 and 300. Until otherwise demonstrated, if the TG level is above 150, it is metabolic syndrome. There have been medications like statins available for high LDL. However, until fifteen years ago, no treatment was available for high TG levels. You could only control it through diet, and it wasn’t paid much attention to by the medical professionals. Hence, they disregarded TG and didn’t consider it essential.

Total HDL

It doesn’t matter what the other fractions are if the total HDL exceeds 60 because this indicates good cardiovascular health. Conversely, if the HDL is under 40 in men or 50 in women, it suggests an increased risk of developing heart disease.

Total LDL

The tiny dense fraction cannot be significant enough to be detrimental if the total LDL is below 100. However, suppose it is greater than 300. In that case, you may have the uncommon hereditary condition familial hypercholesterolemia (FH). As a result, you may be unable to reduce your LDL. In this instance, a low-fat diet and maybe the use of a statin will be necessary to avoid possible heart attacks. 

Total Cholesterol: HDL

Your total cholesterol to HDL ratio has to be less than 3.0.

Contributors to Cardiovascular and Metabolic Diseases

LDL Levels

Heart attacks and other cardiovascular issues result from high LDL-C levels for a long time. And it could be true for people whose LDL-C is more than 200 mg/dL. Genetics frequently plays a role in certain situations. However, studies indicate that it is not a risk factor until it reaches that point. Moreover, LDL-C is not a very good indicator of who will have a heart attack in the general population. It is accurate to say that the HR ratio (hazard risk ratio) for LDL-C is 1.3, which translates to a 30% higher risk for a heart attack if your LDL-C is high.

Correlation does not imply causality, however. For instance, high LDL-C levels correlate with a shorter lifespan when younger people are not part of the research, and it considers only elderly persons (more than sixty years). Therefore, high LDL-C levels might not be as harmful as people portray them.

Inflammation

LDL is not the only factor in atherosclerosis. In this condition, the blood arteries constrict and stiffen. However, the build-up of cholesterol in the blood vessel wall’s endothelium is not a disease in and of itself. Cholesterol and lipids are not harmful when they penetrate the endothelium; they don’t seem to cause adverse reactions. Like other cells in the body, blood vessel lining cells require cholesterol and lipids to be healthy. 

The lipids might not remain harmless for very long, however. Something changes the cholesterol and lipids in certain people, making them toxic. When cholesterol and fat are oxidised, it becomes dangerous. Following this, plaque accumulation can happen. In addition, our immune system may wrongly judge the oxidised cholesterol as bacteria and produce an immune response. It results in inflammation. 

A variety of lifestyle choices or underlying medical issues can also cause inflammation. This inflammation primarily causes heart attacks, which also makes cholesterol harmful. In addition, an unhealthy diet (high in sugar, trans fats, and saturated fats), a sedentary lifestyle, stress, autoimmune illness, food allergies, infections like gum disease, and pollutants like mercury can cause inflammation. 

C-Reactive Protein

According to a study, people with high levels of C-reactive protein, which differs from people with high cholesterol, are more prone to developing heart disease. Normal cholesterol levels are not a protective factor for patients with elevated C-reactive protein levels. High levels of this C-reactive protein and cholesterol pose the most danger for various diseases.

Diabesity

The actual cause of “bad” cholesterol is diabesity, the presence of either pre-diabetes or diabetes plus obesity. Diabetes creates a vicious cycle, lowering HDL (good cholesterol) while raising triglycerides and harmful tiny LDL particles (bad cholesterol), and further promoting inflammation and oxidative stress (which leads to damage to the cells and tissues). 

Type of LDL

High LDL cholesterol levels are dangerous for your heart. However, additional research shows that it’s not only the quantity of LDL in your blood but also the quality. The kind of LDL in your body also influences the chance of developing heart disease in the future. A type of LDL cholesterol known as small, dense LDL is a risk factor for cardiovascular disease. This cholesterol is lighter and smaller than usual LDL cholesterol. Because it is thin enough to pass through the walls of arteries, more vulnerable to oxidation, and present in the bloodstream for a more extended period, small, dense LDL might lead to atherosclerosis.

Cholesterol and Statins

Statin is beneficial if your LDL cholesterol is high. The HMG-CoA (3-hydroxy-3-methyl-glutaryl-coenzyme A) reductase enzyme in the liver, which regulates the body’s manufacture of cholesterol, is blocked by statins. Indeed, statins reduce overall LDL because they reduce the size of the big particles, which make up around 80% of the LDL in our blood. The small dense pattern B particles that make up the remaining 20% of LDL are what cause atherosclerosis. Statins are a quick technique to lower total LDL-C if that is the objective. Additionally, they are a crucial method to use if you have a hereditary condition. However, they do not generally lower heart attack risk.

Statins are not a miracle. In some circumstances, they can be doing more damage than help. For example, research suggests that statins raise the risk of weight gain, diabetes, and glucose intolerance. In addition, statins may make insulin resistance (where cells cannot use insulin, resulting in high blood glucose levels) worse by impacting the liver. Therefore, you should take statins only with medical supervision because the side effects include muscle deterioration, renal failure and type 2 diabetes.

Dietary Changes for Maintaining Cholesterol Levels

Fat and Sugar Content

Doctors frequently advocate a low-fat diet in combination with statins to decrease LDL. But here, obesity isn’t the enemy. It is sugar. The liver’s production of cholesterol is triggered when you consume sugar, especially fructose or high fructose corn syrup. Therefore, a low-fat diet will inevitably be higher in sugar. The best dietary solution for this issue is to stop eating sugar and flour (which turns into sugar) if you have high triglycerides, low HDL, or high total cholesterol. 

A low-fat diet may reduce your LDL, but probably not in a good way. A low-fat diet will only lower the large A-type LDL, not the tiny B-type, just like statins do. In reality, refined dietary carbohydrates (i.e., foods without fibre) and sugar intake, used to replace dietary fat, cause small dense LDL to rise. The Lyon Diet Heart Study is one of the strongest arguments against LDL-C being the main focus of cardiovascular disease prevention. Switching to a Mediterranean diet was better and acted as a protective factor.

A Natural Food diet (free of processed foods) had far better outcomes than statins, without the side effects and at a considerably cheaper cost. And this diet is not low-fat. Statins can appear to protect against cardiovascular diseases while having harmful side effects. Therefore, dietary intervention might work better than statins and improve life quality. 

Inflammation

Another dietary strategy for enhancing general health should be to reduce oxidative stress and inflammation. Remember that those tiny, dense LDL-C particles lead to plaque development because of oxidised fat and cholesterol. Antioxidants neutralise free radicals that cause oxidative stress. Beans, onions, raisins, plums, apples and eggplants have antioxidants. Consuming plenty of micronutrients can also help. You can find them in various fruits, vegetables, meats and dairy products.

Linoleic Acid

Linoleic acid, a polyunsaturated fat particularly prevalent in seed oils like soybean oil, is the lipid that oxidises the most easily (far more easily than cholesterol) and is probably a significant factor in causing cardiovascular problems. In small amounts, linoleic acid helps improve bone density, brain activity, hair growth, etc. But it can have harmful effects if consumed in excess. Therefore, you should avoid foods having a high quantity of linoleic acid.

The HealthifyMe Note

Factors like high LDL in specific populations, inflammation, diabetes (combination of diabetes and obesity) and type of LDL can lead to metabolic and cardiovascular problems. Statins are a standard treatment option for those with high cholesterol levels. However, it would help if you consumed them only under medical supervision because of the adverse side effects. A natural foods diet (which doesn’t have processed foods), foods rich in antioxidants and micronutrients and foods with low linoleic acid levels are best to control cholesterol levels.

Conclusion

The story of good vs bad cholesterol is incomplete. There are two sizes of LDL particles, namely big and small, denser ones. However, the concern is about the smaller, denser particles. You should thoroughly examine your cholesterol test results while evaluating them. Simply falling within “normal” levels does not guarantee your safety. With the conventional lipid panel values and a high LDL level, we need to examine the quantity and quality of the smaller, dense LDL particles.

Statins help decrease cholesterol. However, they mainly focus on the bigger particles. Because low-fat diets frequently contain much sugar, they may result in more significant amounts of unsettling smaller LDL particles. Therefore, eliminate as many processed and high-carbohydrate foods as possible, and replace them with more antioxidant-rich fruits, vegetables, and fats to maintain healthy cholesterol and metabolic fitness.