Curious About Cholesterol

Our bodies cannot function without this vital lipid, but how do we separate the good from the bad?

PHOTOGRAPHS BY Scott Henderson

Cholesterol. We’ve seen the term on grocery labels, heard it discussed in the media, maybe even had a talking-to from our doctor about our own lipid levels. High cholesterol affects 38 percent of Americans, according to the Centers for Disease Control, but if asked to define cholesterol, could you? The key to managing cholesterol is understanding exactly what this necessary but sometimes naughty substance is, how it functions in the body, where it comes from and how to keep it in balance.

The Good vs. the Bad

Cholesterol is a lipid, a fat-like substance that our bodies use to create cells as well as make vitamin D and hormones such as testosterone and estrogen. This waxy material comes to us from two different sources. The first, the liver, naturally makes about 80 percent of the cholesterol in the bloodstream, which is all a person really needs. The second, our diet, introduces additional cholesterol through animal products like meat, poultry and dairy. High in saturated and trans fats, these foods cause the liver to produce even more cholesterol. “Cholesterol is necessary for our bodies to function properly,” explains Dr. Robin Malik, a Roper St. Francis Healthcare affiliated primary care doctor, “but high levels of cholesterol can be problematic.”

Dr. Robin Malik

Also called lipid disorder, hyperlipidemia or hypercholesterolemia, high cholesterol is an asymptomatic condition that raises a person’s risk of coronary heart disease, the leading cause of death in this country for both men and women. When too much cholesterol builds up in the bloodstream, fatty deposits, known as plaques, can accumulate on the artery walls and reduce blood flow. Think of cholesterol as vehicles on a highway and high cholesterol as rush hour traffic, when too many cars jam the lanes. If a fender bender occurs, traffic can slow to a crawl or stop completely. In the same way, if those plaques tear or rupture, a blood clot may form and block blood flow or plug an artery downstream, potentially leading to a heart attack or stroke.

The source of our cholesterol isn’t the only distinction when it comes to types of cholesterol. You’re likely familiar with the idea of “good” and “bad” cholesterol. This classification has to do with the type of protein attached to a cholesterol particle, a pairing called a lipoprotein. There’s high-density lipoprotein (HDL, aka “the good kind”) and low-density lipoprotein (LDL, aka “the bad kind”). A healthy level of HDL may protect against heart attack and stroke, while high levels of LDL can contribute to plaque buildup that narrows the arteries and increases the risk for major medical events.

“HDL is an active form of cholesterol that actually binds some of the LDL and helps the body secrete it,” explains Dr. Malik. To better understand how these two types operate, let’s return to that traffic analogy. If cholesterol particles are the cars, then their protein partners are the drivers ferrying them along the bloodstream highway. LDL carries cholesterol throughout the body, where it collects on the walls of the arteries. HDL, on the other hand, drives excess cholesterol away from the arteries and back to the liver, where it is broken down and passed out of the body. HDL cholesterol doesn’t entirely eliminate LDL cholesterol, though, some smart lifestyle choices are also necessary to maintain healthy levels of this important substance.

Active Maintenance

With additional cholesterol introduced to the body via animal products, it’s no surprise that one of the first steps to lowering our levels is taking a closer look at the foods we consume. “I encourage a Mediterranean diet, mostly large amounts of vegetables, whole grains, beans, nuts, healthy fats and lean proteins such as fish,” says Dr. Malik. This way of eating is naturally high in fiber, which can help reduce cholesterol levels, and low in saturated fat and refined grains and sugars, which raise cholesterol levels.

Diet’s lifelong counterpart, exercise, also plays an integral role in maintaining a healthy cholesterol balance. “Increasing how much you exercise actually boosts HDL cholesterol,” explains Dr. Malik. Not only does exercise raise levels of “good” cholesterol to help take care of the “bad,” it’s also crucial to controlling another cholesterol influencer: weight. Being overweight or obese increases a person’s odds of having high cholesterol, since it affects the way the body makes and manages blood fats and lipids such as cholesterol and triglycerides.

The most common type of fat in the body, triglycerides store excess energy from the food you eat. If your body stores more energy than you need, your triglyceride levels become elevated, resulting in more fat tissue in the body and greater amounts of free fatty acids being delivered to the liver. Carrying excess weight also causes inflammation, which can impact how the body handles HDL cholesterol.

Beyond diet and exercise, other lifestyle choices such as smoking and alcohol consumption impact cholesterol levels. Cigarette use may also lower your “good” HDL levels, while too much imbibing can elevate overall cholesterol levels.

Family Ties

While we can control many factors when it comes to cholesterol levels, some people are simply predisposed to cholesterol problems. “A family history of high cholesterol puts you at a greater risk,” says Dr. Malik. Even when her patients dedicate themselves to a nutritional diet, regular exercise and not smoking, genetics still sometimes win out. “When lifestyle modifications aren’t sufficient to maintain healthy cholesterol levels, there are a number of medications that doctors can prescribe to help lower cholesterol.”

Among the wide variety of cholesterol medications on the market, “statins are the most common,” continues the doctor. These drugs work by blocking an enzyme that the liver needs to make cholesterol. Statins not only work to lower cholesterol levels, they can help protect against heart attack and stroke, too.

Even with medication in the mix, a healthy lifestyle is still the first defense against high cholesterol. Consistent exercise and a diet low in saturated fats may lead to lower dosages of these medications and an overall reduction in the risk for heart-related issues.

Checking Up

Unlike many health and wellness issues, high cholesterol doesn’t just appear one day in the form of pain or a physical abnormality alerting you to a problem. “There are really no signs or symptoms that your cholesterol is elevated, unless you have an event such as a heart attack or stroke and subsequently find out you have coronary artery disease,” explains Dr. Malik. “That’s why it’s so vital to see your doctor regularly.”

The primary care doctor recommends a yearly checkup and lipid panel for the general population. Those with a genetic predisposition to high cholesterol should see their doctor sooner rather than later. “It’s important to know your risk factors and control what you can,” she says. A quick and painless blood draw, the cholesterol test measures the amount of cholesterol and triglycerides in your blood, which lets your doctor evaluate your risk for plaque buildup. This tool can also identify narrowed or blocked arteries and determine if you’re at risk for coronary artery disease before a major heart-related event occurs. The National Heart, Lung, and Blood Institute encourages cholesterol screenings beginning as early as age nine and continuing every five years until middle age. Men ages 45 to 65 and women 55 to 65 should get screenings every year or two and then annually after age 65.

In order to steer away from the risk of high cholesterol and, as a result, coronary heart disease, it’s important to be aware of your family history, commit to a healthy diet, follow a consistent exercise routine and quit smoking if cigarettes are a habit. When it comes to managing our cholesterol levels, a lot of mileage can be gained with positive lifestyle choices.