Do You Know What Your Cholesterol Is?
September 24, 2010
An inside look at "Good" and "Bad" cholesterol.
Numerous times when we have been in hunting camps throughout North America the question invariably comes up "Really, how important is our cholesterol number?" Albeit, that question usually surfaces later in the hunt when all the hunting stories that could have been told have been; but it shows that at least some people are aware that cholesterol is a potential health risk. Of course like smoking, not everyone who has high cholesterol levels will have a heart attack nor will every person who smokes get lung cancer. But since we as physicians aren't perfect in predicting the future, it's not the best idea to smoke or have high cholesterol.
If you have a family history of early Coronary Artery Disease, you smoke, are overweight, don't exercise, have diabetes or high blood pressure, or are male just to name a few of the more important risk factors, your cholesterol levels become much more important to know, treat and follow. We always get asked, "What should my cholesterol number be?" As with everything that's unhealthy, the less cholesterol you have the better. Everybody has heard of the bad and good cholesterol but there is more to the story.
First of all, your total number is important but knowing more detailed information about your cholesterol is far more important and informative. "Good" cholesterol is scientifically known as your HDL (high density lipoprotein). The higher this number, the better. There are actually multiple types of HDL and only one is really protective and that is HDL 2b. In another words, if your HDL is 70 but your HDL 2b is 2 percent, then you are at high risk for coronary disease regardless of that 70 number. In layman terms, the HDL 2b protein actively picks up free floating cholesterol from your blood, binds to it and delivers it back to your liver which disposes of it. So obviously the more HDL 2b you have the better, no matter how high it drives up your total cholesterol. Your native amount of HDL 2b is an inherited trait controlled by your genes not your diet. Unfortunately, the only way to increase your HDL 2b is heavy aerobic exercise or high doses of Niacin, which is a B vitamin (only available by prescription at these doses).
"Bad cholesterol" is your LDL (low density lipoprotein). The higher this number is, the more severe your risk. Ideally, you want this number under 100 to be considered low risk but as above, this is not as simple as that. There are many different sizes of LDL cholesterol so let's make this easy to understand. The smaller and denser the LDL particle the easier it can get push through the arterial wall and build a plaque. The larger or more buoyant the LDL particle, the harder it is to get through the arterial wall, reducing its ability to form plaques in your arteries. You want all your "bad cholesterol" to be large, buoyant particles. The distribution of your LDL particle size is also genetically inherited and not related to your diet. Your diet can increase or decrease your total LDL amount but not the particle size. The only thing found to increase your particle size effectively is also Niacin but there are a whole host of medications that will lower your total LDL cholesterol effectively especially the class known as "statins" but we will leave that to your physician.
When you get your cholesterol levels checked, make sure they draw a cholesterol panel that includes a break down of your HDL types and a delineation of your LDL particle sizes. That way you not only know what your total cholesterol, total HDL and total LDL levels are, you now have your HDL 2b levels and particle size information. Your risk can be much more accurately gauged and your treatment, if needed, can planned intelligently with minimum guessing.
Without spending much time on diet, cholesterol comes from animal sources. Vegetable oil doesn't contain cholesterol. The highest concentration of cholesterol is in egg yellows, second in line is the delicious fatty chicken skin we all love, third is fatty red meats and it falls off from there. Any oil or fat derived from animals is also high in cholesterol. So as usual, if it tastes good, spit it out because it's probably bad for you.
We hope this clears up all the confusion on cholesterol and helps you make informed decisions with your doctor about your heart health. This is important since 50 percent of all people that die in the U.S. do so of some cardiac related problem. So as usual be safe and enjoy the outdoors.