Cholesterol – Most Misunderstood Lipid

From the previous post we understood, Cholesterol is an integral part of human development and health. without it there is no life. Therefore, body syntheses of its Own, even you avoid.

The synthesized cholesterol needs to be circulated/sent all over the body and the only possible way to transport it thru blood stream. But, the blood and cholesterol (waxy substance) doesn’t mix! Hence, a shuttle or carrier required to transport the cholesterol molecules all over the body thru blood stream.

Those shuttles or carriers are known as LDL (fallaciously/commonly known as bad cholesterol) & HDL (commonly known as good cholesterol) But both, LDL & HDL are NOT cholesterol. They are lipoproteins.  (LDL – Low Density Lipoproteins and HDL   – High Density Lipoproteins) apart from LDL, HDL, there are other two types of proteins namely, chylomicrons and VLDL (very low-density lipoprotein)

Lipoproteins not only carries of cholesterol but, also carries the triglyceride, phospholipids and protein in different proportions. Lipoproteins can be differentiated on the basis of their density and the types of apolipoproteins they contain. The degree of lipid in a lipoprotein affects its density—the lower the density of a lipoprotein, the more lipid it contains relative to protein.

Chylomicrons are synthesized by enterocytes from lipids absorbed in the small intestine. Its triglyceride-rich lipoprotein. The function of Chylomicrons is to deliver energy-rich triacylglycerol to cells in the body.

VLDL is synthesized in the liver, from excess dietary carbohydrates.  (note: NOT from excess Dietary fat)  Also triglyceride-rich lipoprotein to deliver energy-rich triacylglycerol to cells in the body. Once, the VLDL loses or releases   the triacylglycerol, they become denser and these particles are remodeled by the liver and transformed into LDL.

LDL :  VLDL remodeled by liver as LDL (If no VLDL, No LDL) The function of LDL is to deliver cholesterol to cells, where it is used as a cell membranes and synthesis of steroid hormones. Such an important LDL is named as Bad cholesterol! If no LDL, your body cells can’t make cell membrane and steroid hormones. In other words, LDL carries “fresh” cholesterol from liver to the cells.  

HDL is synthesized and secreted by the liver and small intestine. The function of HDL is to remove the excess cholesterol from the cells (Also, when a cell die, it releases the cholesterol also picked by HDL) is brought back to the liver by HDL in a process known as reverse cholesterol transport. Then in the liver the excess cholesterol is converted into bile salts. In other words, HDL carries “recycled” cholesterol from the cell to liver. 

So, there is nothing called “Bad cholesterol” or “Good cholesterol” First of all, they are not at cholesterol, they are lipoproteins.  Like BMI and Calories people were misinformed about a vital substance cholesterol. 

Next time if someone talk about Bad cholesterol and Good cholesterol, simply ask them to write the chemical formula of both good and bad cholesterol   (They can write only the C27H46O the chemical formula of cholesterol) they can’t because there is no such thing. Technically, if there is no LDL, no HDL, As simple as that. Hence, it’s impossible to increase HDL, without increasing LDL.

Our body has got an ability (naturally) to regulate the amount of cholesterol at any given point of time. I.e. when we ingest more cholesterol from food, the body produces less; when our cholesterol intake is low, the body makes more. Therefore, there is no effect or relationship between dietary cholesterol and blood cholesterol levels. 

Also, it’s not possible to consume too much cholesterol (thanks to satiety hormones) but, it is possible to take less or no cholesterol. this case body (liver) needs to work hard to produce its own.

Now let’s see how the blood lipid profile (cholesterol test) was done……….. 

When your physician asked for standard blood lipid profile test. Where total cholesterol, HDL and Triglyceride are the ONLY measured parameters, the rest LDL and VLDL are derived parameters, using an equation derived by William Friedewald in 1972, Known as Friedewald equation.  

For mg/dl :

Total cholesterol  (TC) = LDL + HDL + Triglyceride/5   or  LDL = TC – HDL – (TG/5)    

For  mmol/L   :  

Total cholesterol  (TC)  = LDL + HDL + TG/2.2     or     LDL  = TC – HDL  – (TG/2.2)  

  

From the above, to derive the total cholesterol, there are only three different variables (3 different lipoproteins) are present. Whereas we have 5 different (variables) lipoproteins namely, chylomicrons, VLDL, LDL, HDL and TG !

But, in the equation Chylomicrons were totally ignored and VLDL, LDL were estimated. (VLDL = TG divide by 5 for mg/dl and TG divide by 2.2 for mmol/L) In order to find all the variables precisely (without estimation) we need to find at least one more variable, which is LDL. 

The ratio of TG and VLDL is (assumed as) constant at 5:1 for mg/dl and 2.2 for mmol/L. But, there is no valid physiological justification/reasoning provided for the constant.

After reviewing the lipid profile report, Physicians advise to decrease the LDL, Total cholesterol (TC) and Triglyceride (TG) and Increase the HDL.

It’s really possible to do so ? Here is an example…….

Case 1 :   LDL = Total cholesterol – HDL – (Triglyceride/5)           =>              128  = 200 – 60 – (60/5)

(Where, LDL = 128 ; TC = 200 ; HDL=60 ;  TG = 60 and VLDL = 12 )

Case 2 :  LDL = Total cholesterol – HDL – (Triglyceride/5)           =>              60  = 200 – 60 – (400/5)

(Where, LDL = 60 ; TC = 200 ; HDL=60 ; TG = 400 and VLDL = 80)

Observe both the cases, if you want to reduce LDL so called “bad cholesterol” then your Triglyceride levels will go very high. I.e. LDL and TG inversely proportional!  But, your doctor will advise to reduce both LDL and TG (because he believes LDL blocks the artery and TG is the cause for Obesity) but he won’t say how.  Because he, himself doesn’t know!

Your physician ask you to reduce LDL (because he was told to believe it’s bad) and increase the HDL. It’s impossible to increase HDL without increasing the LDL. Because, HDL production is controlled by LDL. The function of HDL is to remove the excess cholesterol from cell surfaces and from other lipoproteins. If there is no excess cholesterol, how body produce more HDL?

In Case 1, VLDL is 12 and LDL is 128, and the Case 2, VLDL is 80 and LDL is 60. We know, VLDL remodeled by liver as LDL (by removing triacylglycerol and some proteins, the percentage of weight that is cholesteryl esters increases and become LDL) other words LDL not produced directly by the liver. Just comparing the LDL, VLDL ratios, Is there any correlation between them?

Also, your doctor may tell you to reduce the total cholesterol level and Increase the HDL (because he was told to believe it’s good) but, as per the equation both TC and HDL are directly proportional. If you increase HDL (It possible ONLY by eating saturated fat, but your Doctor will say don’t eat!) your total cholesterol also will increase, then he will prescribe cholesterol drug to reduce TC!  Does it make any sense?

This is how the cholesterol formula works!! It’s still in practice and medications were prescribed based on this estimations! Is there any way to measure LDL directly? There are more than one technique is available to measure LDL accurately but not in practice. 

Moreover, LDL count doesn’t reveal anything. Rather the the count, LDL particle size and the ratio between the TG and HDL will reveal much more about CHD (Will write in detail later)

So, why this flawed formula still in practice?  All the credits goes to the Medical Associations, Drug Industry, food industry, Insurance companies and the media were joined their hand together to sell the pack of lies to the common people, to protect their interest (business)

Still do you believe cholesterol is bad for us? If yes, ask yourself, then why does the body (liver) needs to produce ? If you say No, wait for the next post