Cholesterol: What It Is,

How It's Made, and How to Control It

Cholesterol has been in the news quite a lot lately. There are foods and drugs purported to lower “bad” cholesterol and raise “good” cholesterol. People believe that certain foods raise cholesterol (egg yolks, for example). There is also the trans fat controversy, with many individuals believing that this fat contributes to high cholesterol and cardiovascular disease. What people may not realize is just how vital cholesterol is to overall health and well-being. Our liver makes about ¾ of our total cholesterol, with the remaining ¼ derived from food. Cholesterol is used as the main building block of cell membranes, bile salts, vitamin D, and steroid hormones such as estrogen, testosterone, and cortisol. It is also involved in the metabolism of vitamins A, D, E, and K.

Pure cholesterol is not soluble in water (and therefore is not soluble in blood). When produced in the liver, it combines with compounds called apolipoproteins to form lipoproteins, spherical particles whose exteriors are composed of water-soluble proteins. Low-density lipoprotein (LDL) is the “bad” cholesterol which travels from the liver to other parts of the body via the bloodstream. Due to its low protein amount, LDL has a tendency to break up and stick to blood vessel walls. When this occurs, the plaque deposits narrow and stiffen our arteries, eventually causing blockages that lead to heart attacks and strokes.

By comparison, high-density lipoprotein (HDL) is more stable because it has a higher protein to cholesterol ratio within its structure. HDL transports LDL to the liver, where it is processed and eliminated. Some researchers also believe that HDL removes cholesterol from existent plaque deposits. Therefore, high levels of HDL are thought to reduce your risk of cardiovascular disease.

Your doctor can provide you with a complete lipid profile, which will include values for total cholesterol, LDL and HDL cholesterol, and triglycerides (blood fats). Target normal values are below 200 mg/dL for total cholesterol, below 100 mg/dL for LDL cholesterol, not less than 40 mg/dL for HDL cholesterol, and below 150 mg/dL for triglycerides. A total cholesterol/HDL ratio of 3.5 or below is considered ideal.

If you’ve already obtained your lipid profile and your numbers are not ideal, what can you do to improve them? Can a healthy diet and exercise affect your cholesterol levels and ratios?

To some extent, yes, they can. Losing weight, exercising, and quitting smoking can help lower total and LDL cholesterol. In terms of diet, eating foods which are high in monounsaturated fats (olive oil) and polyunsaturated fats (nuts, whole grains, and fish) may help raise HDL cholesterol.

In some cases, people have a natural tendency to overproduce cholesterol regardless of how much they exercise or how healthy they eat. Remember that the body already manufactures ¾ of your total cholesterol and only ¼ is derived from food. In such cases, it may be necessary to treat high cholesterol with prescription medication.

Do trans fats affect a person’s cholesterol? Recent medical research suggests that trans fats do indeed raise total and LDL cholesterol levels, resulting in up to a 93% increase in the risk of cardiovascular disease. This is thought to occur because trans fats are hydrogenated, meaning that the chemical structure of the original fatty acid is changed. Natural fatty acids have a three-dimensional structure that takes a cis configuration. Hydrogenation, which is the addition of hydrogen atoms and groups to the carbon skeleton of the fatty acid, results in the fat taking an unnatural trans configuration.

When trans fats enter the body, they are incorporated into cell membranes just like their natural cis counterparts. However, they do not have the same configuration as their cis cohorts. This difference results in increased cell membrane permeability and damage. Also, the function of enzymes contained within these membranes is altered. Transport enzymes for sodium, potassium, calcium and magnesium are impaired, leading to cell stress and even death. As a result, the liver produces additional cholesterol to repair the cell membranes and/or make new ones. Cholesterol is packaged into LDL and sent out to the damaged areas. As a consequence, overall circulating cholesterol is increased.

Trans fats are used everywhere for the cheap and rapid preservation of food. Some of the food items to which trans fat is added are not what you would expect: mass-marketed bread and pastries, for example, often contain trans fat. Currently, the FDA does not require that manufacturers declare how much trans fat is included with their food products. However, you can tell which foods contain trans fat by looking at their ingredients label. If partially hydrogenated or hydrogenated oil/fat is listed, that means there is trans fat present. One can estimate the quantity of trans fat present by subtracting the amount of monounsaturated, polyunsaturated, and saturated fat from the total fat listed for a food item. If there is any fat remaining, that fat is trans fat.

In conclusion, by maintaining a healthy lifestyle and eating a diet low in saturated fat, you can significantly reduce your cholesterol level and risk of heart disease and stroke. However, the process requires due diligence, especially since trans fat abounds almost ubiquitously throughout food products. With the right research, you can become quite savvy in spotting hidden trans fat sources, thus ensuring that your health is not jeopardized by the occasional scone or muffin.

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