Everything you want to know about cholestrol

In India almost 1/3rd of total deaths happens due to CVDs (cardiovascular disease) vs 1/6th 30 years back. And shockingly annual number of deaths due to CVDs have also more than doubled in last 30 years to more than 2.1 million deaths per year. It is a well-known fact that diet and cholesterol play a significant role in heart health. There have been numerous studies that have revealed the complexity of the connection between cholesterol and heart health. In a recent survey it was found that six in 10 Indians have abnormal levels of bad cholesterol. Individuals between 31 and 40 years of age have been reported with the highest prevalence of bad cholesterol. High cholesterol levels have very high correlation to heart problems. People have very shallow understanding about the causes and prevention of high cholesterol. Read on to know everything about cholesterol. 

1) What is cholesterol? Cholesterol is a waxy substance. Your body needs it to build cells and make vitamins and other hormones. Yes… you heard it right. Your body needs it and It’s not inherently “bad”, but too much cholesterol can pose a problem. Cholesterol travels through the blood on proteins called lipoproteins. Lipoproteins are a combination of proteins and various types of fats. They carry cholesterol and triglycerides through your bloodstream. There are mainly two types of lipoproteins that carry cholesterol to and from cells. One is low-density lipoprotein (or LDL). The other is high-density lipoprotein (or HDL). LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty build-ups in arteries. narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease (PAD). 

Imagine your arteries to be water pipes. You must have seen how water pipes get clogged when algae gets deposited around the inner wall of the pipes. In same fashion LDL gets deposited in the inner wall of your arteries over time, narrows it causing interrupted blood flow to the heart. From the L standing for lower, you can remember lower the LDL, healthier it is for your heart. 

Apart from cholesterol there is another type of fat in the blood stream called ‘Triglycerides’. Triglycerides are the most common type of fat in the body. They store excess energy from your diet. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals. If you regularly eat more calories than you burn, particularly from high-carbohydrate foods, you may have high triglycerides (hypertriglyceridemia). 

Not all cholesterol is bad for you. HDL cholesterol can be thought of as the “good” cholesterol because a healthy level may protect against heart attack and stroke. HDL carries LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. But HDL cholesterol doesn't completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL. From the ‘H’ standing for ‘High’ you can remember higher it is better for your health. 

A high triglyceride level combined with high LDL (bad) cholesterol or low HDL (good) cholesterol is linked with fatty build-ups within the artery walls, which increases the risk of heart attack and stroke.

1)    What causes increase in cholesterol level?

Eating too many foods that are high in cholesterol, saturated fats, and trans fats may increase your risk of developing high cholesterol. However, dietary cholesterol (the cholesterol available in food items, food from animals only like meat, poultry and dairy) does not have as much of an effect on blood cholesterol as saturated fat. It is important to regulate one’s intake of dietary fat in order to regulate blood LDL, HDL, and triglyceride levels. Modern scientific studies show a weak relationship between dietary cholesterol and his or her blood cholesterol levels.  For most people, the amount of cholesterol eaten has only a modest impact on the amount of cholesterol circulating in the blood. 

As an exception, for some people, though, blood cholesterol levels rise and fall very strongly in relation to the amount of cholesterol eaten. For these “responders,” avoiding cholesterol-rich foods can have a substantial effect on blood cholesterol levels. Unfortunately, at this point there is no way other than by trial and error to identify responders from non-responders to dietary cholesterol.

Living with obesity can also increase your risk. Other lifestyle factors that can contribute to high cholesterol include inactivity, smoking and alcohol. Your genetics can also affect your chances of developing high cholesterol. Genes are passed down from parents to children. Certain genes instruct your body on how to process cholesterol and fats. If your parents have high cholesterol, you may be at a greater risk of having it too.

In rare cases, high cholesterol is caused by familial hypercholesterolemia. This genetic disorder prevents your body from removing LDL. Other health conditions, such as diabetes and hypothyroidism, may also increase your risk of developing high cholesterol and related complications.

2)    Is there any symptom of high cholesterol and what could be its repercussion.

Unfortunately raised cholesterol level has no symptoms until it manifests in the form of heart attack stroke. It gradually builds up in your arteries over time without any symptom. It’s a silent killer.

3)    Can You Put Time on Your Side?

This process of build-up in arteries doesn’t happen overnight. “It takes years for cholesterol to build up in the arterial walls. It can begin as early as childhood, Research shows that children can have changes in their blood vessels that leads to this buildup of plaque when they grow up. 

You probably wouldn’t know it’s happening unless you get a blood test. 
Because high cholesterol causes few symptoms, many people go years without knowing their numbers. “That’s dangerous, because the plaque buildup you have in your 20s, 30s, or 40s doesn’t go away. It adds up over time, which may mean a heart attack or stroke in your 50s or 60s.

The longer you have high cholesterol, the more likely you are to develop heart disease. In one study, people who had high levels for 11 years or more had double the risk than those who had them for 10 years or less.

Most people with high cholesterol don’t have any warning signs. The exception is people with a genetic disorder called hypercholesterolemia.

4)    How obesity causes higher cholesterol levels?

Obesity clearly means your body is making higher than required triglycerides. Triglycerides form in your liver from free fatty acids (fats) and a kind of glucose (sugar). If your body makes too many triglycerides, that can lead to higher levels of other lipoproteins as well, including cholesterol. Being obese puts you at significantly risk of high cholesterol levels. But it’s not just high cholesterol that’s the problem. It’s the specific changes in your cholesterol panel, a test that breaks down the different types of cholesterol and other blood fats. In obesity, triglycerides, and LDL—or “bad”—cholesterol tends to be high. HDL—or “good”—cholesterol is too low. This increases your risk of heart disease, heart attack, and stroke.

In fact, body weight has a direct association with cardiovascular risk factors, including high cholesterol. This means that as weight increases, so does LDL cholesterol and triglycerides. However, there are exceptions, and it cannot be true 100% of the times.

5)    How much cholesterol is acceptable in blood?

Basically, you need to focus on four readings when you check your cholesterol. Your total cholesterol level Your LDL level and your HDL level. Along with this one should see his or her triglycerides level.

-       Total cholesterol

ü  desirable: less than 200 milligrams per decilitre (mg/dl)

ü  borderline high: 200–239 mg/dl

ü  high: 240 mg/d or above

-       LDL cholesterol

ü  optimal: less than 100 mg/dl

ü  close to or above optimal: 100–129 mg/dl

ü  borderline high: 130–159 mg/dl

ü  high: 160–189 mg/dl

ü  very high: 190 mg/dl or above

-       HDL cholesterol

ü  protective against heart disease: 60 mg/dl and above

ü  medium risk: 40–59 mg/dl

ü  serious risk factor for heart disease: less than 40 mg/dl

 

-       Triglycerides

ü  level of less than 150 mg/dL.

ü  Borderline high: A triglyceride level between 150-199 mg/dL.

ü  High: A triglyceride level between 200-499 mg/dL.

ü  Very high: A triglyceride level of 500 mg/dL or higher.

 

6)    Some common misconceptions and frequently asked questions about cholesterol

ü  Thin people don’t have high cholesterol - False: Thin people can also suffer from this condition, although, overweight people are more likely to have high cholesterol. Many people don’t easily gain weight but are often less aware of how much saturated and trans-fat they eat. Nobody can “eat anything they want” and stay heart healthy. Your genes can also play a role.

 ü  Only diet and physical activity dictate your cholesterol level - False: There are other factors (other than diet and physical activity) which matters in your cholesterol level. Diet & physical activity do have a major impact on overall blood cholesterol levels, but other factors do as well. Chronic stress leads to higher cholesterol. Obesity tends to increase bad cholesterol (LDL) & triglycerides and lower good cholesterol (HDL). Getting older also causes LDL cholesterol to rise. For some, heredity may even play a role. Nonetheless, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health.

 ü  With medications, no lifestyle changes are needed - False: Medications can help control cholesterol levels, but making diet and lifestyle changes is the best way to reduce heart disease and stroke risk. To lower your cholesterol, eat a heart-healthy diet and get a minimum of 40 minutes of moderate- to vigorous-intensity aerobic exercise, three to four times a week. You should also take your medication exactly as your doctor has instructed.

 ü  If the Nutrition Facts label shows no cholesterol, a food is “heart-healthy” - False: Zero cholesterol or no cholesterol does not mean no saturated fat or no trans-fat. Look for how much saturated fat, trans fat and total calories are in a serving, Even foods sold as “low-fat” may have a surprisingly high sugar content which leads to high triglycerides and high LDL. In fact, in   studies, it has found that your dietary cholesterol intake has weak relationship to your blood cholesterol level. Whereas Its highly linked to your saturated fat intake and trans-fat intake and overall calorie intake. For the same reason egg yolks which were once considered un-healthy for heart health due to higher cholesterol, are now proven to be extremely healthy in modern studies. The biggest culprit for higher cholesterol in your blood is the high fat and carbohydrates you eat not the cholesterol you eat (dietary cholesterol)

In nutshell to keep your cholesterol in check you need to  1) eat healthy (less of fat especially saturated fat and trans fat less sugar/carbs and higher protein) 2) be stress free and sleep well 3) move more. Means a healthy active lifestyle can definitely keep your heart healthy.