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When did cholesterol get so complicated? Years ago, people were advised to keep their "cholesterol" below 200. Science found out simply having elevated cholesterol did not lead to full-blown cardiovascular disease (CVD). Total cholesterol was then broken down into "good" and "bad" forms of cholesterol; now the bad cholesterol is further characterized by severity of density and level of oxidation.
Cholesterol is a fat-like compound in the steroid family. It is either taken in from food or produced in the liver; other body cells, including those lining the small intestines, can also produce cholesterol. Despite its negative connotation, cholesterol has beneficial actions in the body, including the production of sex hormones, the formation and maintenance of cell membranes, the production of bile salts (helps digestion) and the synthesis of vitamin D.
Cholesterol may be necessary for these and other functions, but most of the cholesterol the body needs is produced endogenously. It stands to reason then that high dietary intake of cholesterol is not only unnecessary, but could be unhealthy. Surplus cholesterol can contribute to artery clogs and plaques that restrict blood flow at the clog site, or possibly break apart and travel to another part of the body and clog another vessel.
How cholesterol is carried in the bloodstream is important. Proteins called apoproteins combine with triglycerides and transport cholesterol in the bloodstream. Called a lipoprotein, this combination can have varying ratios of protein-to-cholesterol. Low amounts of protein in the combo results in low-density lipoprotein (LDL). This is known a "bad" cholesterol, because high levels of LDL have been associated with increased arterial clogging and plaques (atherosclerosis), contributing to poor heart health. When the amount of protein is higher, the combo is called high-density lipoprotein (HDL). This is known as "good" cholesterol, because HDL generally takes cholesterol from the bloodstream and returns it to the liver for disposal.
Two other variations include very-low-density lipoprotein (VLDL) and oxidized LDL, although neither of these has become common in cholesterol health screenings, due to challenges in accurately measuring these compounds. VLDL has the highest amount of triglycerides among the lipoproteins. High triglyceride levels have been shown to contribute to coronary artery disease, heart attacks and strokes. As noted in its name, oxidized LDL contains a free radical, which contributes to increased thrombosis and plaque formation, and can damage the endothelial cells lining the artery.
Genetics can be a major factor in endogenous levels of LDL and HDL, but diet is a major source of cholesterol and is a controllable risk factor. Cholesterol is found only in animal-based foods. However, the American Heart Association (AHA) warns foods high in cholesterol are not the only problem, as foods high in saturated fats contribute to high cholesterol. In fact, plant foods can be high in saturated fats, meaning they are not as healthy as they might seem as a cholesterol-free food. Other factors in cholesterol levels include age, gender, weight and lifestyle—stress, alcohol, exercise and smoking can all affect levels.
Next: Natural Ingredients for Cholesterol Control
