HDL Cholesterol – Cholesterol Isn’t Either “Good” or “Bad”

It is almost medical heresy to suggest that LDL cholesterol isn’t necessarily a bad thing, but scientists have known this for over 25 years. The truth about cholesterol has been hidden by a medical establishment that supposes the public is too stupid to understand the facts about cholesterol and by health faddists who suppose everything about a position is right or everything about a position is wrong. This article is about what modern science really says.

Cholesterol is a fatty substance, and the bloodstream is made up mostly of water. If cholesterol were not encased in a ball of protein, it could not travel throughout the body. That is what the “lipoprotein” you hear about does. It covers and carries a ball of cholesterol where it needs to go through the bloodstream.

Every single cell in every human being is coated with a mixture of cholesterol and other proteins. Every cell in the human body can make cholesterol out of fats, although some cells make more. The body makes most of its cholesterol out of other kinds of fats and triglycerides (the storage form of both excess fat and excess sugar). Only a small part of the body’s cholesterol, about 15 per cent, comes from food.

When reference is made to LDL or low-density lipoprotein, VLDL or very low-density protein, and HDL, or high-density lipoprotein, the terms really mean that cholesterol and be large and light or small and heavy. It used to be thought that larger, lighter balls of cholesterol were more likely to get “stuck” in blood vessels, so LDL cholesterol came to be known as “bad.

It turned out, however, that not all LDL cholesterol was “bad.” That is because the stuff that clogs arteries isn’t just cholesterol. It’s also the white blood cells that get stuck in the blood vessel wall when they come to feed on the cholesterol, and the additional white blood cells that get stuck in the blood vessel wall they come to remove the first white blood cell when it dies.

And even this mixture of cholesterol and white blood cells isn’t especially harmful until the process of oxidation makes it something like cement. It turns out that some kinds of LDL cholesterol harden, and some kinds of LDL cholesterol don’t. If the protein is a lipoprotein known as apo-B, then the LDL cholesterol can form a plaque. If the protein is a lipoprotein known as apo-A, then it doesn’t.

LDL and HDL aren’t good predictors of whether you are at risk for heart disease. Apo-A and apo-B are. Doctors do know that LDL and HDL tests don’t give the best information, but they order them because they are cheap and patients expect them. Whether you will find the test to be “cheap” depends on whether you suffer side effects from cholesterol medications you don’t really need.

So what should potential high cholesterol patients do before taking cholesterol medications? First, make sure you need the drug. The best way to find out is by taking a blood test to measure the ratio of apo-B to apo-A. You don’t have to fast to take it, and if your local lab can’t run it, it can send a frozen blood sample to a lab that can. In the USA, this test now costs about $55, although many doctors and clinics add a significant surcharge (up to $250) to send off your sample.

The next thing you should be ready to do is to take a medication if you have an unacceptably high ratio of apo-B to apo-A. However, be aware that you can have high LDL and low apo-B, and not need to take a medication. Also, you can have “normal” or even low LDL but high apo-B, and need medication.

What are good HDL cholesterol levels? Generally speaking, the numbers that really make a difference for your cardiovascular health are apo-A and apo-B. Your ratio of LDL to HDL is a good “guestimate” (about 4 is a maximum), but it is far, far more important to measure apo-A and apo-B. Total cholesterol measurements really don’t give you or your doctor any useful information.