We have heard it many times, “What goes up must come down”. In the case of high cholesterol, you must bring the level down if you want to reduce your risk of heart attack and stroke. The big question is, how to bring it down? Unfortunately, gravity is not going to help.



What is Cholesterol?

The word “cholesterol” has gotten such a bad rap over the years. However, it is not, by itself, a bad thing. Cholesterol is a soft, faintly yellow, naturally occurring waxy substance found in cell walls and membranes throughout your body, including your brain, nerves, muscles, skin, liver, intestines, and heart. It is one of the several fats or lipids your body produce. Without cholesterol, you cannot live.

Cholesterol is used to produce sex hormones, vitamin D, and bile acids that help you to digest fats. You need only a very small amount to take care of these things. Your body is able to manufacture plenty of it, meaning that you could possibly go the rest of your life without ever consuming another bite of cholesterol and you will be just fine.


The Good and Bad of Cholesterol

Like many things, cholesterol isn’t bad unless there is too much of it. However, it is not that a simple balance because there are different kinds of cholesterol- some bad, some good. The level of each type of cholesterol makes a big difference in your likelihood of developing CHD. In fact, it is not the cholesterol per se that is bad for you, but it is the “vehicle” through which it travels in your bloodstream. Cholesterol is waxy so it cannot be mixed with blood (like oil and water). So to enter the cells and tissues it needs to hook up with proteins, creating special transporters called “lipoproteins”, similar to “submarine-like bubbles” that carry cholesterol around the body.

Low Density Lipoprotein (LDL)

LDLs are the primary foes, and it carries most of the cholesterol (75-80%) in the blood, depositing it into the cells including the arteries. There, these particles contribute to the formation of plague, which narrows the arteries. When that happens, it reduces the amount of blood that can get through, thus diminishing the amount of oxygen that reaches the heart.

Everything from your weight to smoking to family health history, even the amount of stress you are under, affects your LDL level. Of course, your diet makes a difference too.

High Density Lipoproteins (HDL)

HDLs are the “good guys”, and it transport 20-25% of the cholesterol in your blood. Their role is somewhat like “garbage truck” carrying away cholesterol from your tissues to your liver, which disposes of it. The more HDL in your bloodstream the more artery-clogging cholesterol is removed

Low-level HDL levels often signify other problems, such as having high levels of other dangerous blood fats like triglycerides. Smoking, being overweight, a sedentary lifestyle, and high consumption of carbohydrates (more than 60% of daily total calories) can contribute to low HDL levels.

The Ratio

What is even more important than your total cholesterol- LDL and HDL alone, is the proportion of good to bad cholesterol in your blood. For easy reference below are the tables:

LDL Levels

LDL Levels


HDL Levels

HDL Levels


You can measure the proportion of the different types of cholesterol in the blood using one of the many ways: take your total cholesterol level and divide by the amount of HDL. E.g. total cholesterol 240, HDL 60. Ratio = 4:1

An acceptable ratio is less than 5:1, although a better ratio is 4.5: 1 for men and 4:1 for pre-menopausal women.


Cholesterol: The Myth and the Reality

Myth 1- Cholesterol is inherently bad
Fact: Cholesterol is essential for survival.

Myth 2- Having high cholesterol is dangerous
Fact: High cholesterol is not a problem by itself but an unfavourable ratio is the main problem, along with your weight, amount of exercise you do, and your family health history is a concern.

Myth 3- People with high cholesterol have heart attacks.
Fact: High cholesterol is a major risk factor in heart disease, some people do develop heart disease and suffer heart attacks even when their cholesterol is at the normal level.

Myth 4- You must cut out cholesterol-containing foods if you want to lower your blood cholesterol levels.
Fact: Cholesterol in the blood comes from your diet but also from your liver. In fact, your liver makes much more cholesterol than you eat, and cutting back on dietary cholesterol may not have a significant impact.

Myth 5- Young people don’t have high cholesterol
Fact: Everyone from age 20 and up should have their cholesterol measured. Studies have shown that plaque can build up in the arteries that supply blood to the heart as early as late teens.


Reference: Cut Your Cholesterol, David L.Katz, M.D. and Debra L. Gordon

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