In this video, the speaker discusses the misconceptions surrounding cholesterol and the terminology used to describe it. They explain that cholesterol is essential for cell creation and the production of hormones and bile acids. The speaker highlights that cholesterol is transported through lipoproteins, which are part lipid and part protein, and mentions families such as VLDL, IDL, LDL, and HDL. They emphasize that LDL and HDL are lipoproteins, not cholesterol itself, and that categorizing them as „bad“ or „good“ cholesterol is inaccurate. The speaker suggests that understanding the basics of lipids and lipoproteins is crucial for a more accurate understanding of cholesterol.
Key Insights:
- Cholesterol is a lipid synthesized by every cell in the body and is essential for cell creation, fluidity, and transport.
- Not every cell can produce enough cholesterol, so it needs to be transported through the circulatory system.
- Lipoproteins, which are part lipid and part protein, act as vehicles to transport cholesterol in the circulatory system.
- There are two main families of lipoproteins: ApoB (VLDL, IDL, LDL) and ApoA (HDL).
- LDL cholesterol is often referred to as „bad cholesterol“ because when LDL particles enter artery walls, they can lead to atherosclerosis.
- HDL cholesterol is often referred to as „good cholesterol,“ but it’s important to note that cholesterol itself is the same in LDL and HDL.
- The functionality of HDL and LDL particles is crucial, and it cannot be determined solely based on cholesterol levels.
- Assessing ApoB concentration is a preferred metric for predicting cardiometabolic risk because it captures all atherogenic particles.
- Understanding the basics of lipids and lipoproteins is crucial when interpreting information about cholesterol.
- Misusing terms like „good cholesterol“ or „bad cholesterol“ indicates a lack of understanding in lipids and lipoproteins.
Transcript
So, I recently posted something on social media expressing my frustration with the way the press and sometimes even the medical establishment writes about cholesterol, using terms like good cholesterol and bad cholesterol. I’ve talked about this topic extensively in my podcasts, with over 25 hours of content on cholesterol over the past four years. However, many comments suggested that there are people new to this discussion who haven’t followed me or listened to my podcasts. They were looking for a condensed version of the cholesterol topic, so I thought this was a great opportunity to provide it.
To understand why I criticize the use of terms like good and bad cholesterol, it’s crucial to understand what cholesterol is and why imprecise language is unhelpful. Cholesterol is a lipid synthesized by every cell in our body. It is vital for the creation of cells and provides fluidity to cell membranes. Cholesterol also allows the transport of various substances across cell membranes, including glucose, ions, and hormones. In short, without cholesterol, we wouldn’t have cells, and therefore, no life.
Additionally, cholesterol serves as a precursor to important hormones like vitamin D, cortisol, estrogen, testosterone, and progesterone. It is also necessary for the production of bile acids, which aid in the digestion of fatty foods. The list goes on regarding why cholesterol is essential for our bodies.
However, not every cell can produce enough cholesterol to meet its individual needs. Therefore, the body has to transport cholesterol. This poses a challenge because cholesterol is hydrophobic and unable to move directly through the circulatory system, which mainly transports water-soluble substances. To overcome this, the body creates vehicles called lipoproteins, which are part lipid and part protein. The lipid part carries the cholesterol cargo, while the protein part makes it water-soluble, allowing it to move through the circulatory system.
These lipoproteins can be categorized into two main families: those defined by apolipoprotein B (apoB) and those defined by apolipoprotein A (apoA). Lipoproteins like VLDL, IDL, LDL, and Lp(a) belong to the apoB family, while HDL belongs to the apoA family. The names VLDL, IDL, LDL, and HDL refer to their density and can be separated based on their density in a lab experiment.
It’s crucial to acknowledge that when people talk about LDL and HDL cholesterol, they are referring to laboratory metrics. However, there is no laboratory metric called LDL or HDL. There is LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), as well as LDL particle number (LDL-P) and HDL particle number (HDL-P) that can be measured through various methods. My preferred method is assessing apoB concentration, which captures all the atherogenic particles and allows us to predict cardiometabolic risk.
LDL particles are often referred to as bad cholesterol because they can enter artery walls, get oxidized, and contribute to atherosclerosis. HDL particles, on the other hand, are often called good cholesterol because higher levels of HDL cholesterol are associated with better metabolic health. However, it is important to note that the functionality of HDL particles matters more than their cholesterol content.
In conclusion, it is incorrect to categorize cholesterol as good or bad. LDL and HDL are lipoproteins that transport cholesterol, and the cholesterol within them is the same. Understanding the basics of lipids and lipoproteins is crucial, as it forms the foundation for comprehending this complex topic. If someone is misrepresenting this fundamental knowledge, it raises doubts about the accuracy of their further claims.
