Cholesterol-Friend Or Foe?

Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. Our liver produces most of the cholesterol needed by the body. Cholesterol can also be gotten from food.

Most times, cholesterol is made to look like an enemy in today’s world, but on the contrary it is absolutely vital for our existence. In fact, there are genetic disorders in which people cannot properly synthesize cholesterol, like the 7-dehydrocholesterol reductase deficiency leading to a number of problems including autism, mental retardation, and many others.

Every cell in our body is surrounded by a membrane.  These membranes are largely responsible for fluidity and permeability, which essentially controls how a cell interacts with other cells, and how it transports materials across. Cholesterol is one of the main building blocks of the cell membrane. Cholesterol is also necessary to produce vitamin D, steroid hormones, and bile acids.

Since cholesterol is a lipid, it can't dissolve in the blood. It must be transported through the bloodstream by carriers called lipoproteins, which got their name because they’re made of fat (lipid) and proteins.

• The chylomicron. This delivers triglyceride gotten from diet in the small intestine to the body for use

• The very low density lipoprotein (VLDL). The VLDL loses some triglycerides to form the LDL

• High-density lipoprotein (HDL), aka “good cholesterol”. This mops up excess cholesterol and brings it to the liver for disposal. It obviously works in our favour to prevent plaques.

• Low-density lipoprotein (LDL), aka “bad cholesterol”. It transports cholesterol and fat from the liver and deposits it in the rest of the body. This works against us because it’s a culprit in heart attacks as you will see later.
The HDL and LDL cholesterol are of more clinical importance.

What’s all the hype about cholesterol?
Cholesterol becomes an enemy when there is an excess of it in the body. High blood cholesterol (hypercholesterolemia) is a condition in which there is too much cholesterol in the blood. By itself, the condition usually has no signs or symptoms. Thus, many people don’t know that their cholesterol levels are too high.


When there is too much cholesterol in the blood, it builds up in the walls of the arteries forming a plaque. Over time, this causes hardening of the arteries (atherosclerosis) making the arteries narrow thereby hindering adequate blood flow to the heart. This deprives the tissue of oxygen and nutrients leading to tissue hypoxia. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack. Plaque also can build up in other arteries in your body, such as the arteries that bring oxygen-rich blood to the brain and limbs. This can lead to problems such as carotid artery disease and stroke.

The way forward!
The very first step is the measurement of the blood cholesterol.  It is best to have a blood test called "lipoprotein profile" to find out the concentration of the different components of cholesterol as against getting just the total cholesterol value. This blood test is done after a 9- to 12-hour fast. Below are the components of the lipid profile and their acceptable ranges.

Total Cholesterol  < 200 mg/dl
LDL-Cholesterol       < 100 mg/dl
HDL-Cholesterol       ≥ 60 mg/dl
Triglycerides       < 150 mg/dl

What can be done to lower the cholesterol?
The main goal is to lower the cholesterol level enough to reduce the risk of developing heart disease or having a heart attack. This can be done with drugs or through Lifestyle modifications. I’m an advocate of lifestyle modification especially for people with borderline values. It is also recommended for all even as an adjunct to drug therapy. It includes:

Diet: A diet that is low in saturated fats and high in fibers is ideal. Omega 3 fatty acid, which is contained in fish oil has been shown to be very useful in lowering cholesterol. Fruits and vegetables are encouraged while red meat and sugary foods should be avoided.

Weight Management. Losing weight if you are overweight can help lower LDL and is especially important for those with risk factors.

Physical Activity. Regular physical activity is recommended for everyone. Being physically active prevents heart diseases and stroke. Just 40 minutes of aerobic exercise of moderate to vigorous intensity done three to four times a week can go a long way in lowering the cholesterol level. Dancing, swimming, riding a bicycle running and brisk walking are examples.

Cessation of Cigarette smoking: smoking has been shown to lower the HDL cholesterol (which is bad) and causes an increase in cardiovascular diseases.

Maintenance of an ideal blood pressure: High blood cholesterol is worse when it is combined with high blood pressure. This is because the increased pressure further hinders adequate flow of blood to the body tissues.