High healthy cholesterol is good for me

Good diagnostic science relies on us knowing what we’re measuring and why

In a nutshell

• There is no such thing as good and bad cholesterol, there is just cholesterol, and healthy cholesterol is good for me

• LDL and HDL are not cholesterol, they are lipoproteins used to transport cholesterol (and other fats) in our blood

• LDL can be damaged by high blood glucose to form small dense LDL (sdLDL)

• sdLDL is associated with ill health including heart disease and stroke

I’ve embedded below a video conversation between a medical doctor and a scientist involved in cardiovascular disease risk. I think they do a great job of emphasising the importance of healthy cholesterol in normal human metabolism and how LDL can get damaged, and from there become problematic.

Let’s remind ourselves of a couple of important points. Firstly, there is no such thing as good and bad cholesterol, there is just cholesterol. Secondly, LDL and HDL are not types of cholesterol, they are tiny cholesterol carriers called lipoproteins. LDL stands for low density lipoprotein and HDL stands for high density lipoprotein. I’ve described both issues when describing my heart disease before.

I’ve also previously described how my diet high in processed food, including readily bioavailable carbohydrates (resulting in insulin resistance) and seed oils contributed to my heart disease. This discussion specifically focuses on the impact of readily bioavailable carbohydrates.

I enjoyed this conversation because the speakers provide published data to support their points and they discuss things in ways that are understandable by a non-expert like me.

I took away the following main points:

1. High levels of healthy LDL are not associated with death in the elderly. In fact, elderly people with high levels of LDL may live longer than otherwise

2. High levels of blood clotting factors (specifically a protein called fibrinogen) are associated with risk of heart disease and stroke

3. LDL can exist in two forms in our blood. Healthy LDL is a vital component of a healthy metabolism and exists in a form called large buoyant LDL (lbLDL) particles

4. Unhealthy LDL can exist in a form called small dense LDL (sdLDL) particles

5. LDL can become damaged by high blood sugar caused by a diet high in bioavailable carbohydrates leading to the formation of sdLDL particles

6. sdLDL particles are associated with signs of ill health such as metabolic syndrome, high blood pressure and increased risk of heart disease and stroke

7. If I want to understand my heart disease risk, it is worth trying to be more specific than the typical lipid panel. For example:

   1. Measure blood clotting factors

   2. A total cholesterol or total LDL measure isn’t good enough, I should measure the size of the LDL particles and determine if I have circulating sdLDL

It is clear from this discussion that healthy cholesterol is good for me and I should have healthy LDL and HDL circulating in my blood. LDL which has been damaged by a highly bioavailable carbohydrate diet is associated with ill-health, including heart disease. Thankfully I decided to eliminate processed food, including, most bioavailable carbohydrates from my diet shortly after being diagnosed with advanced heart disease.

Knowing all of this, it’s worth my seeking more detailed blood tests than those typically requested by my doctor.

I hope you enjoyed the discussion.