Cholesterol is a complex type of fat, which circulates in the blood bound to proteins, in the form of lipoproteins. Dependent on the density of these lipoproteins, several cholesterol fractions have been described:
- HDL - with beneficial effects on health (HDL stands for 'high density lipoproteins')
- LDL - with detrimental effects on health (LDL stands for 'low density lipoproteins')
- VLDL - with similar detrimental effects on health (VLDL stands for 'very low density lipoproteins'). This fraction also contains significant amounts of triglycerides.
- Chilomicrons (complex particles also containing triglycerides and proteins)
Generally speaking, the following formula applies:
|TOTAL CHOLESTEROLE= HDL + LDL + Triglyceride/5
Note: This formula becomes invalid when the triglyceride levels are markedly elevated (i.e., triglycerides > 300)
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Cholesterol can be derived from dietary intake, or synthesized by one's body from
the precursor acetyl-Coenzyme A (acetyl-CoA). Therefore, since our body has the
ability to produce its own internal supplies, it is prudent to limit dietary intake
of this nutrient as much as possible. (The reasons for this will become obvious as
you keep on reading.)
This represents the 'bad' fraction of cholesterol. It is the one responsible for
plugging up arteries and causing atherosclerosis, heart attacks, strokes,
blood clots, diabetes, etc. VLDL (another cholesterol fraction mainly assembled in the liver) is largely converted into LDL in the
The current consensus is: The lower one's LDL level, the better. An
LDL level below 100 is generally recommended to ensure cardiovascular
protection. For persons with cardiovascular disease (coronary artery disease, etc),
more stringent LDL levels have been proposed, such as LDL below 90, or even
Another important factor for cardiovascular protection is the ratio of HDL to LDL. The higher this ratio, the better (implying a higher HDL
level and a proportionally lower LDL level).
An HDL / LDL ratio greater than 0.3 is deemed acceptable, with the ideal HDL
/LDL ratio being greater than 0.4.
Foods do not deliver 'good' or 'bad'
cholesterol. The good and bad fractions are formed inside our body, as dietary cholesteroleis being bound to proteins. The part bound to high density proteins will form
the HDL (good) fraction. The part bound to low
density proteins will form the LDL (bad) fraction. How
much HDL versus LDL each of us makes depends largely
on genetic factors regulating our individual metabolism.
So, for the same dietary intake, some people will
produce more LDL, while others will produce more HDL. It all depends on our genetic programming, which
dictates how much high density protein versus low density proteins we have
available in our body. A sad but true 'joke' I have heard during my medical career
is the following: "The best way of controlling your LDL is choosing your
parents wisely." Unfortunately, this is very true: The single most important factor in determining
one's HDL/LDL ratio is the genetic program inherited from
Short of altering this genetic program (which is not yet feasible in our day and
age), all that is left is to limit dietary intake as much as possible, and apply a few other methods to increase HDL levels (discussed
below). Additionally, certain medications
(LDL-lowering drugs) can be used if necessary.
This fraction is considered highly beneficial for our health: It affords
protection from arterial plaque formation and cardiovascular disease. It appears
that the HDL fraction is able to extract cholesterol from arterial plaque and
transport it back to the liver, where it is broken down and reutilized. In other words, HDL appears to be able to dissolve existing arterial plaque.
The general consensus is: The higher one's HDL level, the better.
Minimum acceptable levels are as follows:
HDL levels can be increased by the following factors:
HDL = 50 in women
HDL = 40 in men
- Weight loss
- Aerobic exercise
- Smoking cessation
- Intake of omega-3 fatty acids (from dietary sources or fish oil supplements)
- Reducing fat intake to less than 30-35% of total calories consumed
- Reducing or eliminating saturated fats from diet
- Eliminating trans fats from diet
- Adding mono- and polyunsaturated fats to diet
- Adding soluble fiber to diet (such as fruit, vegetable and whole grain products)
- Consuming 1-2 alcoholic beverages per day (Warning: This may carry other health hazards, such as liver disease, pancreatitis, neuropathy, etc.)
This term refers to the entire amount of cholesterol present in one's blood - be it HDL, LDL, VLDL, etc. An acceptable total level is up to 200, but this number is
less important as compared to the HDL/LDL ratio discussed above. In other
words, a total level below 200 does not necessarily guarantee a good
HDL/LDL ratio. For instance, one could have very low HDL level, with a total level below 200. Such a person would be at increased risk for cardiovascular
disease, regardless of his or her 'normal' total level.
Unfortunately, today's diet has all the ingredients for increasing LDL levels and decreasing HDL levels.
In general, a high HDL (which is a marker of good health) is rarely found in people who are overweight or obese.
Of itself, high HDL does not facilitate weight loss. However, weight loss is one of the proven ways to increase one's HDL level.
With regards to LDL, it's clear that high LDL levels correlate with weight gain and obesity. The situation may be compounded by a concomitant low HDL level. The way to fight back is to limit dietary intake of colesterol, and apply the above-mentioned measures for increasing HDL levels.
LDL-lowering drugs may be used to decrease persistently elevated LDL levels, however such drugs have not been shown to have any significant effects on weight.
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