Cholesterol May Not Be As Bad As You Think: A Doctor On Heart Health Basics

Cholesterol is a word that evokes a visible fear of heart disease and stroke in people's mind.

In the past few decades, unfortunately, cholesterol has been demonised and probably misunderstood or poorly understood even by the medical fraternity. What follows is an oversimplification of an extremely complex topic concerning cholesterol.

Cholesterol is a lipid molecule present in every cell of our body and is essential for life. One cannot live without cholesterol.

Of the total cholesterol pool in the body, only one fifth is formed by the cholesterol we ingest. The remaining 80 percent is synthesised by the body itself.

As can be seen, eating cholesterol has very little impact on the cholesterol levels in our body, as also those measured in the blood. This is because most of the cholesterol we eat is not absorbed and is excreted in stool.

Good & Bad Cholesterol: Decoding The Binaries

Cholesterol is an essential part of every cell in the body. It is required to produce steroid hormones including sex hormones, certain vitamins like vitamin D, and bile acids, which are essential to digest the fat that we eat.

There is no such thing as bad cholesterol. One of the biggest misconceptions is that cholesterol is “bad” and eating cholesterol makes one fat. This could not be farther from the truth.

So where do the terms 'bad cholesterol’ and ‘good cholesterol’ come from?

Cholesterol and triglycerides (another lipid molecule) are not water soluble. Therefore, to be carried to various tissues in the body, via blood, they need to be carried by special protein-wrapped vehicles called lipoproteins.

Out of these, Low Density Lipoprotein (LDL) has been implicated in the causation of the plaque that narrows the artery and causes reduction of blood supply to the organ it supplies, including heart and brain. Hence the name bad cholesterol.

On the other hand, the High Density Lipoprotein (HDL) which is supposed to be having some protective effect against the causation of heart disease is labelled as good cholesterol.

It is important to understand how the so labelled ‘bad cholesterol’ causes the narrowing of the arteries in the body. The LDL particles deposit themselves underneath the layer which lines the lumen of the artery.

There it evokes an inflammatory response and the plaque increases in size. The question is how and in whom does the superficial layer lining the lumen of the artery, which normally is impervious to such intrusions, permit the intrusion of these particles?

An appropriate analogy is that of a non-stick pan where the oil or ghee doesn't stick to the pan itself, even when heated. However, if the nonstick teflon coating is eroded by an abrasive cleaner, the oil or the cooking fat tends to stick to that.

Similarly, if because of injurious factors like smoking, high blood pressure, diabetes, and insulin resistance, the inner lining is eroded, the LDL gains entry into the layer underneath, and causes the plaque formation which narrows the artery and may even cause clotting of the blood and block the artery completely.

Could Cholesterol Just Be A Marker Of Heart Disease?

Among some divergent views, the view that is gaining ground rapidly is that cholesterol is certainly not as bad for the heart as previously thought.

According to Dr Aseem Malhotra, an influential British cardiologist and author of several books including Statin Free Life, we still do not know at what level of cholesterol there is a significant risk of developing heart disease.

Certain industry-sponsored drug trials have failed to show any clear correlation with lowering cholesterol and reduction in the risk of developing heart disease, he says.

It appears that the levels of various Lipoproteins are just markers of heart disease development. But, by themselves, they may not be the cause of heart attacks.

There is, thus, a possibility that something else is going on and there are certain other contributing risk factors operative. For example, diabetes mellitus, smoking, liberal sugar intake, high carbohydrate diet, high alcohol intake, sedentary lifestyle, lack of sleep, etc.

On the other hand, people who have very low levels of cholesterol, possibly genetically determined, are more prone to develop cancer and developing certain infections because cholesterol is known to play a role in immune system.

There is a link suggested, between low cholesterol levels, especially in women, and depression. However, a cause-and-effect relationship has not been unequivocally established.

Lipid lowering agents or statins, as they are popularly known, are being prescribed to almost one billion people around the world, most of whom are generally at a low risk of developing heart disease.

There is now data available to show that reduction of the risk of heart disease is miniscule when this low-risk population is given statins.

However, statins do afford some protection against a second heart attack in people who already have had a heart attack.

Further, there are many side effects of statins, like extreme exhaustion, muscle pain and liver dysfunction, which may be particularly unacceptable in low risk population, in whom the usefulness of statins in any case, is limited.

So What's The Verdict On Cholesterol?

It is not to say that those who are on statins should stop it without consulting their doctor, but certainly the idea is that any such decision should be a well-informed.

This brings us to an important question.

What alternative methods do we have to lower our LDL levels?

Current scientific thinking is that refined sugar is the real villain and should be avoided and one should increase the intake of high fiber diet.

Millets fit the bill perfectly as they are an excellent source of dietary fiber, including both soluble and insoluble fiber, which help lower LDL cholesterol levels by binding to cholesterol and preventing its absorption from the intestine.

Millets also help regulate sugar absorption, thereby maintaining healthy blood sugar levels.

Further, they are rich in antioxidants, which protect the body from oxidative stress that can lead to inflammation and increased plaque formation in the blood vessels, which can lead to cardiovascular disease.

(Dr Ashwini Setya is the Adjunct Professor in Gastroenterology, ESIC Medical College, Faridabad, and Senior Consultant with Medanta Institute of Digestive & Hepatobiliary Sciences, New Delhi. Dr Setya is also an advisor and consultant in Medical Law and Ethics. He can be reached at [e-mail]. This is an opinion piece, and the views expressed are the author's own. The Quint neither endorses nor is responsible for them.)