Most people hear the word Cholesterol and think it to be something bad for the body. The reality is more complex and cholesterol is not as bad as it is made out to be. If so, the liver would not be producing 80% of the body’s cholesterol.

You may have heard the terms “lipids” and “cholesterol” used interchangeably, and assumed they meant the same thing. Lipids are fat-like molecules that circulate in your bloodstream. They can also be found in cells and tissues throughout your body. Cholesterol is actually part lipid, part protein. This is why the different kinds of cholesterol are called lipoproteins. Another type of lipid is a triglyceride.

Cholesterol is vital for life and your body makes all the cholesterol it needs. It is required by the body for performing many vital functions like secretion of enzymes and production of hormones, synthesis of Vit D,  helping in digestion, etc.

Cholesterol is a waxy fat-like substance found in all the cells of the body. It does not travel freely through the bloodstream. It is carried through the bloodstream by low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

The LDL is also known as bad cholesterol as they contain a higher ratio of cholesterol to protein. Elevated levels of the LDL particles is known to increase the risk of cardiovascular diseases as they form plaques on the inside of the artery walls and over time restricts the smooth flow of blood.

HDL, on the other hand, is made up of a higher level of proteins and low levels of cholesterol. It helps carry the LDL, away from the arteries and back to the liver where it is broken down and then expelled out of the body. It is therefore known as the good cholesterol.

Very low-density lipoproteins (VLDL) contain even fewer proteins than LDL. VLDL like LDL has been associated with plaque deposits.

Triglycerides (a type of fat) may increase cholesterol-containing plaques if levels of LDL are high and HDL is low.

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol. When you have very high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, and thus preventable and treatable.

The table below is a guideline to assess your cholesterol/lipid profile in a blood report.

Ideal Range	<180 mg/dl         (LDL < 100, VLDL < 25)
Borderline High	180-200 mg/dl    (LDL 100-130, VLDL 25-35)
HIGH	>200 mg/dl         (LDL >130, VLDL > 35)

Myths surrounding cholesterol levels:

1. High Cholesterol is caused by what you eat.

This is simply untrue. The biggest factor in cholesterol is not a diet but genetics or heredity. Your liver is designed to remove excess cholesterol from your body, but genetics play a large part in your liver’s ability to regulate cholesterol to a healthy level. It’s not dietary cholesterol that can raise your cholesterol, but, the excess trans fats and saturated fats in diet that can raise cholesterol in the body.

For reference click here

2. Everyone’s total cholesterol levels exceeding 200 mg/dl will lead to cardiovascular diseases.

If your doctor tells you your cholesterol is too high based on the standard lipid profile, getting a more complete picture is important—especially if you have a family history of heart disease or other risk factors.

You can ask for an NMR Lipo Profile, which looks at particle sizes of LDL cholesterol.

Large LDL particles are not harmful. Only small dense LDL particles can potentially be a problem, as they can squeeze through the lining of your arteries.

Click here for NCBI study on small dense LDL as Biomarker for Atherosclerotic Diseases

In addition, the following tests can give you a far better assessment of your heart disease risk than your total cholesterol alone:

• HDL/Cholesterol ratio: HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your total cholesterol. That percentage should ideally be above 24 percent.
• Triglyceride/HDL ratios: You can also do the same thing with your triglycerides and HDL ratio. That percentage should be below 2.
• Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increased higher risk of having coronary heart disease than people with a level below 79 mg/dl.
• Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml.

3. Chicken eggs are bad for people with cholesterol:

Chicken eggs are high in cholesterol, but the effect of egg consumption on blood cholesterol is minimal when compared with the effect of trans fats and saturated fats. It matters greatly what you eat your eggs with. So, butter, sausages, bacon, bad carbs like in white toast, fries, pastries, hash browns etc. is what can raise your cholesterol levels rather than the cholesterol in eggs.

Research has shown that most of the cholesterol in our body is made by our liver; it doesn’t come from cholesterol we eat. The liver is stimulated to make cholesterol primarily by saturated fats and trans fats in our diet, not dietary cholesterol.

For reference click here

However, the story is different for people with a predisposition to cardiovascular diseases and diabetes. It is advisable to refrain from having egg yolks. If you like eggs but don’t want the extra cholesterol, use only the egg whites. Egg whites contain no cholesterol.

4. Children Cannot Have High Cholesterol

It is possible for children to have high cholesterol levels, which is typically due to a liver problem that makes the liver unable to remove excess cholesterol from the body. Lifestyle changes, including exercise, limiting sugar intake and eating real (not processed) foods, will often help to restore healthy levels.

Click here for reference

5. Margarine Is Better Than Butter for Cholesterol

Butter, especially raw organic butter from grass-fed cows, is a wealth of nutrition and nourishing fats. Research points to the fact that butter may have both short-term and long-term benefits for your health provided it is used very sparingly because it is high on saturated fats.

Swapping margarine for healthy butter may not be what your body needs for heart health. This is because margarine may contain less saturated fats but can have excess trans fats.

Click here for Harvard Medical School article on the same

However, there is surely a small benefit of replacing saturated fats with polyunsaturated fats like those found in nuts, seeds, fatty fish, extra virgin olive oil and avocados. This does not mean that saturated fats are bad; it just means that replacing something neutral with something that is very healthy will give you net health benefits.

So, having debunked some of the common myths about cholesterol, there are other issues much more worthy of your attention to maintain healthy cholesterol levels and give you overall health benefits. Mainly :

1. Increase fiber intake to more than 30-40 gms per day. This can be done by having fiber-rich foods like oats, rotis made from whole wheat flour/ bajra/ jowar/ buckwheat etc. Also, increase intake of fruits and vegetables in daily diet.
2. Avoid refined carbs found in cakes, cookies, sugary drinks, desserts, fast food, and junk food.
3. Include 8-10 Almonds in a daily diet.
4. Avoid Outside foods, Spicy, Oily, Fried & Chinese food.
   If eating out then stick to Grilled/Roasted/Steamed Fish/Chicken/Veggies options or Stir-fry Chicken/Vegetables, Clear soups without starch.
5. Exercise regularly (at least 5-6 days a week) alternating with cardio & weight training sessions. Weight Training should be done under the supervision of a qualified Fitness Trainer/Consultant.
6. Reduce Body Fat and Increase Metabolism with proper diet and exercise.
7. Restrict alcohol intake.
8. Quit smoking.