– Hi Sandy, how are you? What can I do for you?
– Hi Doc, I’m fine, thank you. I’m not even coming for me, but for Pascal. We saw that he has high cholesterol, yet he doesn’t eat fat. I can attest to that because I’m the one who cooks. I came to see if there’s more I can do…
– Wait, Sandy, before seeing what else you can do, we’re going to check what you’re already doing…

In addition to having hyperglycemia on his blood test, our friend Pascal also had high cholesterol (and a friendly wife), which we talked about.

The idea that “cholesterol is bad for your health” is well anchored in the collective mind. However, there is a blur when talking about good cholesterol, bad cholesterol, total cholesterol, etc. In fact, important information is suppressed by false beliefs. I will try to be both clear and concise, straightforward and complete.

What is bad cholesterol?

For starters, bad cholesterol does not exist. There is just cholesterol, which is a fat cell in the blood. It has two origins:

• Exogenous: Coming from dietary intake.
• Endogenous: Manufactured by the body (liver).

Cholesterol even plays a vital role in our lives because it contributes to our cells’ membranes’ composition. It is also part of certain essential hormones.

Therefore, life without cholesterol would be impossible.

All this ambivalence is a source of misunderstanding. How can this molecule be so crucial and harmful at the same time?

The answer lies in the mode of transport. Cholesterol circulates in our body by linking to carriers (like your packages). These carriers are the apolipoprotein.

• LDL (Low-Density Lipoprotein) Cholesterol

his complex distributes cholesterol from the liver into your bloodstream. ¹ This is where the risk of deposition of atheroma plaque occurs.² That’s why LDL is called “bad cholesterol”, and your levels of it should be as low as possible.

• HDL (High-Density Lipoprotein) Cholesterol

HDL is called “good cholesterol.” This complex distributes cholesterol from the main circulatory system to the liver where it is destroyed. Your HDL levels must be high because it helps “unclog” the arteries.

Why is cholesterol demonized?

The buildup of cholesterol in the arteries is called arteriosclerosis. These deposits have multiple origins (they are multifactorial). Arteriosclerosis manifests in two ways:

• The slow and progressive growth of the atheroma plaque will gradually obstruct the blood vessels, reducing the supply of oxygen to the target organs (heart, brain, lower limbs, and kidney).
• The sudden rupture of the plaque leads to the formation of a thrombus that blocks blood circulation, causing stroke, infarction, and ischemia of the limbs. As a piece of trivia, studies say that 80% of sudden deaths are due to the rupture of a plaque.

But there is good news.

There are lipid-lowering treatments ³, reserved for specific contexts that we will not discuss here. However, research proves that a better diet can literally change your life.

Here’s an example:

Several well-backed scientific studies have shown a lower mortality rate for cardiovascular diseases in Mediterranean countries. The Mediterranean diet promotes the consumption of vegetables, fresh fruit, and fish several times a week. It requires the moderate consumption of cheese and meat, favoring white meat.

Here are the five key points:

• Eat plenty of fruits and vegetables every day.
• Use vegetable oils (e.g., olive oil, rapeseed oil, and walnut oil) to season and cook your dishes. These oils decrease the ingestion of saturated fats, which are very harmful to the body.
• Eat fish, including oily fish, at least twice a week.
• Reduce the consumption of saturated animal fats drastically. Avoid charcuterie, red meats, cream, butter, fatty cheeses, and pastries. Instead, promote the consumption of white meat.
• Eat little in the evening. You have to start the day with a nutritious breakfast and end it with a frugal dinner.

Here’s an easy way to memorize the technique:

• 5 fruits and vegetables a day
• 4 glasses of water per half day
• 3 servings of carbohydrates or starches (bread, pasta, rice) per day
• 2 times fish per week.
• 1 tablespoon of vegetable fat per day

Studies show that following these simple rules can lower your bad cholesterol levels by about fifteen to twenty percent.

And to be as consistent as possible, I’ll remind you that regular physical activity of at least thirty minutes a day contributes to overall good health.
You have certainly noticed that I talk about the bad cholesterol levels without ever giving a numerical value. Why? Because the cholesterol target value depends on variables subsumed under the umbrella of “cardiovascular risk factors.⁴”

In summary, under certain circumstances, cholesterol can be bad for your health and have serious consequences. Before starting a medication regimen to lower your bad cholesterol, try improving the points above: a healthy diet and exercise.

Whether you implement these changes, you no longer have the right to complain about not knowing.

PS: In the specific case of Pascal, a reminder of the hygieno-dietetic rules⁵ and ass-kicking (it’s for his own good, and he knows it) made up the adopted strategy. The future will tell if this was wise.

Glossary

• General circulation: Path of oxygenated blood from the heart (left ventricle) to the body’s organs via arteries.
• Atheroma plaque: Formation composed, among other things, of cholesterol which will form on the walls of the arteries and gradually clog them.
• Lipid-lowering treatments: Drug treatments aimed at reducing LDL-Cholesterol levels. They are reserved for specific cases and are prescribed by a doctor depending on the situation.
• Cardiovascular risk factors: Set of situations conducive to the formation of atherosclerotic plaques and, by extension, likely to lead to cardiovascular disease. Age, male sex, hypercholesterolemia, diabetes, and smoking are cardiovascular risk factors.
• Hygieno-dietary rules: Set of non-drug rules aimed at reducing modifiable risk factors. Physical activity, quitting smoking, and eating better are some of the most common practices.