Diabetes and Heart Health: Rethinking Cholesterol
Most of us have had it drummed into our heads that LDL cholesterol is bad, contributing to heart disease, while HDL cholesterol benefits our health.
However, it turns out this view of cholesterol is too black and white because in the world of LDL particles, circumference matters.
Fluffy or Dense
New technology that can measure the size of lipoprotein particles has revealed that LDL, or low-density lipoprotein comes in a couple basic sizes. They can be either:
- Large and “fluffy,” or
- Small and dense
It is small, dense LDL molecules that create a higher risk of cardiovascular problems. These particles are compact enough to get between the cells lining artery walls. Any particles that get “stuck” between the cells may oxidize and turn rancid, leading to inflammation and the formation of plaque.
The larger, fluffier LDL particles, being too wide to get caught in the arterial lining, go about doing LDL business—delivering cholesterol to cells for building cell membranes, protecting nerves, the manufacture of vitamin D, and hormones.
Although extensive studies show that people with primarily small LDL particles are at higher risk for cardiovascular disease (CVD), other research suggests that eating healthy saturated fats (e.g., raw, organic nuts and seeds, avocados, organic eggs, grass-fed meats, and virgin coconut oil) plumps-up the small LDL molecules, effectively reducing CVD likelihood.
Heart of the Matter
While not all doctors may be on board with the new thinking about cholesterol, the American Heart Association no longer recommends LDL levels from regular blood tests be a guide when assessing the risk for CVD, or for prescribing statin drugs.
A more important heart health predictor is the ratio between our HDL, or high density lipoprotein, and our total cholesterol. This ratio is obtained by dividing our HDL by our total cholesterol, multiplied by 100; ideally, it should be above 24 percent.
A third type of cholesterol - and a significant CVD risk factor - are triglycerides, formed in the body with excess blood sugar from diets high in carbohydrate. Our triglyceride to HDL ratio should ideally be under 2 percent (divide triglycerides by HDL, multiplied by 100). Keeping triglyceride levels down is a significant beneficial side-effect of good daily glucose control.
Another reason that cholesterol is not a black and white issue is our own uniqueness. Though the liver produces most of the cholesterol each body requires, we also get cholesterol from some of the foods we eat. Each of us absorbs this dietary cholesterol at rates that vary between 20 and 60 percent, so some people’s cholesterol levels are more affected by diet than others.
This means, naturally, that we must work with our doctors and dietitians to optimize our diet and treatment plans according to our body’s specific needs. Though this might have seemed easier when lipoproteins were simply labeled “good” or “bad,” understanding more about cholesterol will ultimately help us lead healthier lives.