Hmmm! Should You be Concerned about Your Cholesterol?
You did your annual blood test. Your doctor says you have too much cholesterol showing up in various lipoproteins, whatever those are. He says you need to take a statin, whatever that is, to reduce the amount. So this is a big question. Should you be concerned about your cholesterol and those other weird things on your “lipid panel”? A little more information will help you make a thoughtful decision.
Cholesterol, whatever that is.
Per TrueMD (and just about every other place you can get a definition), “Cholesterol is an essential component of cell membrane that is needed to maintain proper membrane permeability and fluidity. It is also needed for the synthesis of Steroid Hormones, Vitamin D and Bile Acids. Cholesterol is required for building and maintaining animal cell membranes.”
So the dang stuff is important. Most every cell in your body makes its own supply. The liver itself makes about 20% of the total cholesterol in your body. Normally the cholesterol in your diet is insignificant. The bulk of dietary cholesterol ends up being excreted (you know what that means). Having cholesterol is a good thing. So why might you have “too much”?
Too much cholesterol?
Chances are variation in your genes are contributing to the problem. Some of those genes make enzymes that essentially do three things.
- increase or decrease the synthesis (creation) of cholesterol
- allow for the intestinal excretion (disposal) or absorption of cholesterol
- control the reception of cholesterol carrying lipoproteins in various places
Cholesterol is created and then wanders around in your blood stream, getting absorbed or rejected all the time.
This is complicated. Studying it is like drinking from a fire hose (I stole that phrase). We have made and used cholesterol forever. We have also had variations in genes required to create and control that process forever. So how come now this all seems out of control? Why do we have a growing number of medications to control one or more of those various processes?
Why? Because the rate of heart disease (and other chronic conditions I’ll get to later) is sky high – unlike 100 years ago. The genes aren’t different. The requirement for cholesterol isn’t different. What IS different?
The difference has to do with inflammation and bleeding.
You stab your finger (or your leg, arm, neck, toe, etc.). Let the bleeding begin. Quick, press on the cut for a minute or so until the blood clots and the bleeding stops. Your immune system kicks in and the area around the damage becomes inflamed (that means red and probably hot to the touch). Then slowly the inflammation goes away as a new bunch of skin cells grow underneath the wound. This is called “healing.” It scabs over and the scab falls off.
The bleeding will begin regardless of the damage location. Why? Because your blood stream goes everywhere delivering oxygen/nutrition and immune system response (and everything else) to every single body cell. It’s keeping you alive.
The blood steam (the vascular system) has to do its job for your body to work correctly . All those arteries, veins, and capillaries are made up of cells and are, unfortunately, just as susceptible to damage as your finger.
So what happens when that blood stream is damaged? Almost the same thing as I described about your finger. There is bleeding, clotting, inflammation, and hopefully healing. However, we don’t want scabs floating around in the blood stream. So the newly created cells cover over the damage instead of growing underneath.
Your body expects to respond to damage. Its part of the grand design. Problem is, while we don’t usually keep stabbing the same finger over and over again, the sources of damage to the blood stream can allow a lot of repetitive “jabs.” There is such a thing as too much damage.
So what are all these sources of too much damage?
Sources of damage are high blood insulin, insulin resistance, and high blood sugar plus chemicals (toxins) in drugs/ food/air, high blood pressure, smoking, etc. Not occasional damage but persistent (as in going on all the time).
What are the results of too much?
Anything that persistently damages the blood stream also damages body organs like the liver, pancreas, kidneys, eyes, and even your brain. High blood insulin and sugar also damage the nerves in the body. And all of this damage arrives through your blood stream, generating inflammation and bleeding along the way.
In other words, high blood insulin,, the resulting insulin resistance, followed by high blood sugar are the big three sources of damage to blood vessels of all sizes. Anyone who thinks diabetes is no big deal is forgetting one important thing. The same things that result in diabetes also result in much, much more – including cardiovascular disease, the one thing we are all most likely to die from.
NOTE: and this is important. The first problem is high blood insulin. That’s the one thing your doctor will NOT measure. Then the resistance steps up. And FINALLY your blood sugar becomes high. It’s a cascade.
Your diet sets you up for high blood insulin, insulin resistance, and then high blood sugar.
How far out of whack your diet can safely go without creating high levels of insulin also depends on your genetic ability to store fat (that stuff that determines the size of your clothes). You can read more about that here and here. Understand this diet thing by taking a trip through my book It’s All about the Food and other posts on this website.
In my experience, people are more motivated to change their diet when they are worried about their body weight. Unfortunately, deciding to “forget it, I’d rather eat what I want to eat” is so easy. So concern about weight may not be the best reason to change your diet.
Nobody seems to die from diabetes (at least according to death certificates) but most will die of some cardiovascular condition. High blood insulin, insulin resistance, and high blood sugar are the primary characteristics of both.
A little closer look at heart disease
The general medical view blames heart disease on the cholesterol in lipoprotein particles that carry around triglycerides (fat) and cholesterol in your blood stream. That’s the stuff that is typically measured in a standard lipid panel. Not reported in that test but really important is that the lipoproteins also deliver the phospholipids (no need to remember the name) required to surround every cell your body has or will make.
In fact the primary role of lipoproteins is to deliver fat and phospholipids. Cholesterol carrying is a secondary job that moves cholesterol around to places just in case it’s needed. None the less, the expressed medical concern is usually attached to the amount of cholesterol.
The most current scientific view (although your doctor may not agree or even know) is that the number of those lipoprotein particles is the most important. And why would that be? Because when the arteries are damaged, the barrage of lipoprotein (particularly LDL) particles can get stuck in the damage and make things a lot worse. So, think about this, what is the problem? As one expert said, “It’s the damage, stupid.”
Should you use a medication?
Genes can’t always be depended on to operate perfectly and most of us don’t know the condition of our genes. Medications of any kind will always have “unintended consequences.” Over a year ago I posted on the unintended consequences of long term usage of NSAIDs for pain. In one example a woman had to have a kidney transplant. Therefore, any medication your doctor gives you to manage your cholesterol (or anything else) has the potential to cause a problem you aren’t expecting. You may want to ask your doctor what side effects a prescribed medication might have.
Eventually you will probably succumb to heart disease.
Sorry but we all have to go from something. The question is: how soon would you like that to be? In the end, the condition of your blood vessels may be the deciding factor. In the end, whether you might need a medication is likely to depend on the amount of damage you are allowing to accrue and not allowing to heal.
Forget medications for just an instant. Whether or not you and your doctor decide treating your “cholesterol” is the smart thing to do, the most important thing you can do to extend your life and health will be to manage your blood insulin, insulin resistance, and blood sugar. Please remember that is accomplished with diet. That is why I wrote the book. You can learn what foods have a high insulin requirement. Moderate/eliminate them before the resistance and high blood sugar present themselves. Consider reading it and adjusting your diet accordingly.