Cholesterol: The Inside Story

When someone says cholesterol, it’s easy for someone to immediately think about heart attacks and regret devouring that greasy burger at lunch. Others may zone out when they start hearing scientific terms like HDL and triglycerides—comedian Steven Wright once made the tongue-in-cheek remark, “I drive way too fast to worry about cholesterol.”

With September being National Cholesterol Education Month, Learning the Healer’s Art sat down with BYU College of Nursing assistant professor Dr. Neil Peterson to learn the important facts about cholesterol and its impact on the body.

Learning the Healer’s Art: You’re one of our experts here in the College on physical fitness and related topics. This whole month is National Cholesterol Education Month and we’re trying to explain to students what cholesterol is and why it matters. What is cholesterol?

Dr. Neil Peterson: Cholesterol is an essential compound that stabilizes literally every cell in our body. It’s part of the cell wall. Some of the cholesterol you get from nutritional intake, but the rest of it is made by your body. Your body can usually make enough cholesterol for you to live on. Cholesterol is necessary for all of your cells and hormones and the bile that helps to break down fat that you eat. You do need cholesterol. It always has a bad connotation, of course, but it’s essential for living, kind of like fat. Everybody thinks fat is bad, but it’s essential as well.

LTHA: So cholesterol is something that your body needs.

Peterson: Yes. Not only does your body use it for all of your cell walls, but you need it for some hormones like testosterone and estrogen. It’s involved in the synthesis of Vitamin D, which is particularly important during winter time because people who have low levels of Vitamin D might be more depressed or have Seasonal Affective Disorder. It’s used in your bile which your body uses to break down fat that you eat, which is plentiful in the American diet.

LTHA: If we get most of our cholesterol naturally, when we eat a lot of unhealthy food, does that bring a lot of unnecessary cholesterol?

Peterson: Yes, that’s true. Now usually your body handles that just fine by processing it and just sending it right through your body. But still some of it does get absorbed, and the problem with that is excess cholesterol along with high amounts of fat can get deposited between cells and contribute to the hardening of your arteries. You’re more likely to have decreased blood flow and have strokes, heart attacks, and stuff like that.

LTHA: So if you get too much cholesterol, your body cannot handle all of it and it gets jammed in your veins?

Peterson: If your body cannot get rid of it, it just deposits it in places in your body. Generally we talk about two types of cholesterol: good cholesterol– High Density Lipoprotein (HDL)–and bad cholesterol, which is LDL or Low Density Lipoprotein. What happens is your body sends cholesterol out everywhere and transports it using LDL, but you don’t want it out there if it’s not being used. The way that your body brings it back to the liver is through HDL. Since we almost always have an excess of LDL, then you really want a high HDL (or good cholesterol) to bring it back to the liver to be processed and sent out of the body.

LTHA: What do you have to do to have high HDL?

Peterson: There’s a few things you can do. Exercise is one. Exercising increases HDL production. A lot of it has to do, we suspect, through this mechanism of increased blood through, especially at the skin level. When you exercise, especially vigorously, you can increase your HDL. Having a higher body weight or higher BMI can sometimes make it harder for your body to produce more HDL or you end up making more LDL cholesterol. Women tend to have really good HDL because of their hormones, but men’s HDL tends to not be as good.

LTHA: Does an unhealthy diet contribute?

Peterson: It mostly contributes to high fat content and also LDL, so bad cholesterol, but there’s a few things you can try to take to try and increase HDL naturally like Niacin*.

LTHA: When I go to the doctor and they test my cholesterol, what are they measuring?

Peterson: We have the ability to test lots of different types of cholesterol, but in general they’re looking at your triglycerides, which are a reflection of your diet. High sugar intake and high carbon intake will bump that up significantly. Then they look at LDL and HDL, and then they can look at other things like the ration of good to bad cholesterol, your total amount of cholesterol. One nice thing to look at is the ratio because if maybe your bad cholesterol is on the higher end, but if you’ve got really good HDL and as your body deposits the cholesterol you’re able to compensate for it by bringing it all back using your good cholesterol, then that’s not as bad. But you could have a normal LDL but if your HDL is so low that it can’t protect you from the LDL deposits peripherally, then you can still be in trouble.

LTHA: What are triglycerides?

Peterson: Triglycerides are a reflection of your diet. We do put that in with our cholesterol panel when we draw that on somebody.

LTHA: What are some health problems associated with having an HDL/LDL imbalance?

Peterson: When you have a hardening of the arteries, everybody usually thinks about having heart disease. What I think that some people don’t realize is that the hardening of the arteries is literally happening everywhere in your body. You have a higher chance of having heart disease, you have a higher chance of having a stroke of brain disease from those blood vessels being hardened, kidney problems, liver problems, everywhere. Blood vessels feed your entire body, and if those vessels are hardening everywhere, then you could be in trouble anywhere in your body from that. We just happen to see its affects more readily in places like the heart and brain.

LTHA: Is healthy living the main way to avoid these problems?

Peterson: Yes. To some degree you can’t stop it from happening because like I said your body naturally makes cholesterol and you need it for a lot of different things. Some is naturally going to get deposited in your blood vessels, but you can do some things to try to limit that, especially exercise. Good diet, as well. You can’t get cholesterol from plants; plants in general don’t contribute to your cholesterol at all. Eating lots of plant-based foods would prevent you from having too much dietary intake of cholesterol. We get it all from animal sources: beef, chicken, pork, stuff like that because again it’s animal-type cells that make cholesterol.

*Peterson notes that versions of Niacin that are promoted as “flush-free” deactivate the property of Niacin that addresses cholesterol problems and are significantly less useful.

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