"It is what we know already that often prevents us from learning." –Claude Bernard

The cholesterol myth is one of medicine's most ubiquitous frauds. What your doctor understands about cholesterol underestimates the reality of this complex and essential molecule.  

Cholesterol is an indispensable compound used by the body for many wondrous processes. From essential building blocks for the developing brain, synthesis of sterol hormones (testosterone and estrogen, for example), healthy cell membrane constituents, and bile acids, cholesterol is necessary for life.

The molecule is so essential that every cell in the body can manufacture cholesterol. Despite what we have been led to believe, dietary cholesterol consists of 25% of the total cholesterol burden, and most of what we consume is undigested.  

We believe that cholesterol is a villain and that it is the cause of heart disease, strokes, and other chronic health issues. However, the reality is that this is only a tiny part of the cholesterol story.  

Because cholesterol and its partner triglyceride molecule are fat-soluble, they require a transport compound to travel in the blood or plasma. This compound is a lipoprotein -- a complex protein wrapper.

Cholesterol, in medicine today, is considered both good and bad. Yet, this is an oversimplification. Cholesterol is neither good nor bad.  

For example, HDL (high-density lipoprotein) is generally considered a healthy form of cholesterol, whereas LDL (low-density lipoprotein) is considered dangerous.  

So, if you have a routine test for your cholesterol, your physician might tell you that you have "normal total cholesterol" and plenty of the "good" HDL-type molecule. This report might seem reassuring, but in actuality may be detrimental to your cardiovascular health.

How could this be?  

First, a little-known fact is: 50% of all heart-attack victims hospitalized have total cholesterol and HDL cholesterol in the "normal" range. 

A complete understanding of cholesterol would include assessing the size and number of HDL or LDL particles. Research has shown that the number of LDL particles is the most reliable predictor of cardiovascular wellness.  

LDL is essential to transporting cholesterol in the body, delivering the molecule to areas where cell repair is needed. Additionally, LDL is required to help the body remove cholesterol via the gastrointestinal tract.

HDLs once thought to be the "good guy" molecule, may be of little value when determining overall health and wellness. This is because small HDL molecules can transport relatively few cholesterol units back to the liver for recycling.

Larger HDLs can transport relatively more cholesterol and triglycerides but are less efficient than LDL particles. Therefore, knowing that you have a "normal HDL number" doesn't necessarily give you a better cardiovascular outcome.

Let's go back to the LDL's and HDL's functions. First, remember that the HDL and LDL molecules transport cholesterol and triglycerides to various body structures, requiring transport proteins to assist this movement.

Two critical proteins providing specialized transport functions include apoA-1 and apoB. ApoA-1 helps the HDL molecule bring cholesterol to the cells making our hormones and fat storage tissues. Then, it completes the transport loop back to the liver.

The apoB protein makes the circuit from the liver to the rest of the body with the LDLs, bringing triglycerides for energy and phospholipids to repair all the cells. So ApoB, for our discussion, now becomes very important.

ApoB lipoproteins and their close association with LDL cholesterol are the culprits in clogging arteries. However, to understand this "clogging" process, we must know a bit about the anatomy of the blood vessel wall.

A blood vessel comprises three layers; inner, middle, and outer. The one we need to understand here is the inner one. When the blood vessel's inner wall ( the part exposed to the bloodstream) is inflamed, the body calls 911, and the lipoproteins respond to the damaged area.

Triggers of inflammation may include the Standard American Diet (SAD), sugar, smoking, drinking, toxins, sedentary lifestyle, lack of sleep and repair, medications, and other comorbid medical conditions (diabetes, hypertension, autoimmune disorders, etc.).

Irrespective of the cause of the inflammation, your damaged blood vessel needs to be protected and repaired. The repair involves a highly choreographed dance of proteins, cholesterol, lipids, enzymes, tissue factors, and blood components.

Most of the time, the dance is flawless, but it can go wrong.  

When tissue repair goes wrong, a "plaque" can develop. In addition, if the repair function goes badly, the apoB lipoprotein complex can penetrate the blood vessel's inner layer, triggering a second inflammation cascade (and it can allow more molecules to penetrate the wall).

Bad things can happen as the body tries to fight two fronts of the inflammation war. Gradually, the plaque increases, the lumen (opening of the blood vessel) becomes narrowed, and blood flow is restricted.

If the inner wall inflammation reaches a critical mass or weakens, it may rupture into the artery and begin the process that leads to a stroke, heart attack, or other blockages. 

What can we do?

The first and most important is prevention! Avoiding inflammation triggers, as noted above, good nutrition, exercise, whole food nutrition, organic diets, removal of toxic chemical exposures in the home, proper supplementation, and good lifestyle choices are a start. 

APPROPRIATE lab testing to determine your cardiometabolic risk factors is the next step. However, getting the "standard" lipid profile is not enough. These routine tests must appreciate the newest data showing that lipid particle number and size are the most reliable cardiovascular risk indicators.  

Ask your physician or provider for an apolipoprotein B or LDL-P NMR test. The NMR test can determine the size of the LDL particle as well.

Measuring triglycerides, insulin, HgbA1c, homocysteine, hs-CRP, and the traditional HDL/LDL levels should be considered.  

Armed with a full appreciation of the complex dynamics of the cholesterol story can be lifesaving. Therefore, the next topic will be about what you can do to reduce your cardiovascular and cerebrovascular risk profile to live a longer and healthier lifestyle.