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Authors: Jonny Bowden
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Cholesterol’s ability to fight toxins may be one reason why it’s found at the site of arterial injuries caused by inflammation. But blaming cholesterol for those injuries is a little like blaming firemen for the fire.
Now here’s an interesting fact of which you might not have been aware: It’s actually impossible to measure cholesterol directly in the bloodstream. Being a fatty substance, cholesterol is not soluble in water or blood. So how does it get in the bloodstream? Simple. Your liver coats it with a “protein wrapper” and bundles it with a few other substances (such as triglycerides); packaging it in this protective shell allows it to enter your circulatory system, much like stones would float in the ocean if they were contained in a buoyant, waterproof container. In our case, the protein wrapper acts like a passport, allowing cholesterol to travel throughout your bloodstream. It’s these packages, known as
lipoproteins
, that we actually measure when we measure our cholesterol levels.
We know these cholesterol–protein combinations as HDL (
high-density lipoprotein
) and LDL (
low-density lipoprotein
). Both contain cholesterol and triglycerides, but the percentages are different, and the two types of lipoproteins have different functions in the body. LDL, known as “bad” cholesterol, carries cholesterol to the cells that need it, while HDL, known as “good” cholesterol, picks up the excess and carries it back to the liver.
But this old idea of “good” and “bad” cholesterol is a wholly outdated concept.
We now know that there are many different “subtypes” of both HDL and LDL, and they do very different things. LDL, the imprecisely named “bad” cholesterol, has several different subtypes, and not all of them are bad at all—quite the contrary.
The most important subtypes of LDL are subtype A and subtype B. When most of your LDL is of the “A” type, you’re said to have a
pattern A
cholesterol profile. When most of your LDL is of the “B” type, you’re said to have a
pattern B
cholesterol profile. Simple, right? And absolutely essential to know for reasons soon to be made clear.
Subtype A is a big, fluffy molecule that looks like a cotton ball and does just about as much damage, which is to say none. Subtype B, however, is small, hard, and dense, like a BB gun pellet. It’s the real bad actor in the system, because it’s the one that becomes oxidized, sticks to the arterial walls, and starts the cascade of damage. Subtype B particles (what we might call the “bad” bad cholesterol) are atherogenic, meaning that they contribute significantly to heart disease. As we’ve already noted, big, fluffy LDL particles (the “good” bad cholesterol) are pretty much benign. Knowing you have a “high” LDL level is pretty much a useless piece of information
unless
you know how
much
of that LDL is the small, dense kind (harmful) and how much is the big, fluffy kind (not harmful in the least). Both of us would be totally comfortable having a high LDL number if the bulk of it was composed of the big, harmless, cotton ball–type molecules (the pattern A distribution).That’s much more preferable than having a
lower
LDL number mostly composed of the BB gun pellet–type molecules (the pattern B distribution).
Unfortunately, most doctors are behind the times on this one. They look at that total LDL number—not the size and type—and if that number is even slightly higher than the lab says it should be, out comes the prescription pad. Pharmaceutical companies love when advisory committees—which are often heavily stacked with doctors who have financial ties to the pharmaceutical companies—recommend that we maintain lower and lower LDL levels, because that means a bigger and bigger market for cholesterol-lowering drugs. Sadly, most doctors do not perform the easily available tests—often covered by insurance—that determine your LDL.
You may recall from the first chapter that
Now here’s an interesting fact of which you might not have been aware: It’s actually impossible to measure cholesterol directly in the bloodstream. Being a fatty substance, cholesterol is not soluble in water or blood. So how does it get in the bloodstream? Simple. Your liver coats it with a “protein wrapper” and bundles it with a few other substances (such as triglycerides); packaging it in this protective shell allows it to enter your circulatory system, much like stones would float in the ocean if they were contained in a buoyant, waterproof container. In our case, the protein wrapper acts like a passport, allowing cholesterol to travel throughout your bloodstream. It’s these packages, known as
lipoproteins
, that we actually measure when we measure our cholesterol levels.
We know these cholesterol–protein combinations as HDL (
high-density lipoprotein
) and LDL (
low-density lipoprotein
). Both contain cholesterol and triglycerides, but the percentages are different, and the two types of lipoproteins have different functions in the body. LDL, known as “bad” cholesterol, carries cholesterol to the cells that need it, while HDL, known as “good” cholesterol, picks up the excess and carries it back to the liver.
But this old idea of “good” and “bad” cholesterol is a wholly outdated concept.
We now know that there are many different “subtypes” of both HDL and LDL, and they do very different things. LDL, the imprecisely named “bad” cholesterol, has several different subtypes, and not all of them are bad at all—quite the contrary.
The most important subtypes of LDL are subtype A and subtype B. When most of your LDL is of the “A” type, you’re said to have a
pattern A
cholesterol profile. When most of your LDL is of the “B” type, you’re said to have a
pattern B
cholesterol profile. Simple, right? And absolutely essential to know for reasons soon to be made clear.
Subtype A is a big, fluffy molecule that looks like a cotton ball and does just about as much damage, which is to say none. Subtype B, however, is small, hard, and dense, like a BB gun pellet. It’s the real bad actor in the system, because it’s the one that becomes oxidized, sticks to the arterial walls, and starts the cascade of damage. Subtype B particles (what we might call the “bad” bad cholesterol) are atherogenic, meaning that they contribute significantly to heart disease. As we’ve already noted, big, fluffy LDL particles (the “good” bad cholesterol) are pretty much benign. Knowing you have a “high” LDL level is pretty much a useless piece of information
unless
you know how
much
of that LDL is the small, dense kind (harmful) and how much is the big, fluffy kind (not harmful in the least). Both of us would be totally comfortable having a high LDL number if the bulk of it was composed of the big, harmless, cotton ball–type molecules (the pattern A distribution).That’s much more preferable than having a
lower
LDL number mostly composed of the BB gun pellet–type molecules (the pattern B distribution).
Unfortunately, most doctors are behind the times on this one. They look at that total LDL number—not the size and type—and if that number is even slightly higher than the lab says it should be, out comes the prescription pad. Pharmaceutical companies love when advisory committees—which are often heavily stacked with doctors who have financial ties to the pharmaceutical companies—recommend that we maintain lower and lower LDL levels, because that means a bigger and bigger market for cholesterol-lowering drugs. Sadly, most doctors do not perform the easily available tests—often covered by insurance—that determine your LDL.
You may recall from the first chapter that
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