What is HDL and LDL cholesterol?

Cholesterol is a fat-like, waxy substance that is found in the body. It cannot be dissolved in your blood and is instead carried through the bloodstream in little packages called lipoproteins. Cholesterol is a form of lipid (or fat) that is needed to make up the structure of our cell membranes. Cholesterol is also used to create certain hormones and vitamin D.

There are two types of lipoprotein packages that can carry cholesterol:

  • High density lipoproteins (HDL)
  • Low density lipoproteins (LDL)

Cholesterol can come from two sources. The body, and particularly the liver (1,000mg per day), makes cholesterol and it can also be consumed by eating certain foods such as meats, poultry and dairy products. The body can produce enough cholesterol by itself and the liver will increase its production of it if you're eating high volumes of saturated fats and trans fats. Therefore, it is easy to take in too much cholesterol as a result of an unbalanced diet.

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Is all cholesterol bad?

No, cholesterol itself is not bad. A lack of education regarding the importance of cholesterol or a negative portrayal in the media has led many to believe that cholesterol is a harmful element in an individual's diet. This isn't the case as cholesterol is an essential substance.

Cholesterol is a substance that our body uses to keep us healthy. Cholesterol is vital because it's a component of cell membranes and serves as a precursor in the synthesis of bile acids, vitamin D and steroid hormones (including testosterone, cortisol and oestrogen). Humans require 0.5g to 1g of cholesterol each day.

Our bodies use cholesterol in a number of ways:

  • To produce hormones such as oestrogen, progesterone and testosterone that are essential to development and reproduction.
  • To produce other hormones such as cortisol and aldosterone, which help regulate blood sugars and retention of water and salts.
  • To help produce Vitamin D that's needed for healthy teeth and bones.
  • To make bile that helps digestion by helping the body break down and absorb fats.

What is LDL?

Low Density Lipoprotein, or LDL, is commonly referred to as 'bad cholesterol'. In high levels, it can contribute to fatty deposits and plaques on arterial walls that cause them to harden and clog; a condition known as arteriosclerosis. These plaque and fatty build ups, and the resulting narrowing of the arteries, put you at a high risk of experiencing heart attacks, strokes and circulation issues. By monitoring LDL cholesterol levels is a good way of predicting and furthermore preventing the possibility of experiencing heart conditions in the future. You can avoid taking in too much 'bad cholesterol' by keeping to a balanced, healthy diet.

What is HDL?

High Density Lipoprotein, or HDL, is often referred to as the 'good cholesterol'. It is estimated that a quarter to a third of your cholesterol is carried by HDL and it's thought that this good cholesterol helps remove and carry away LDLs from the artery walls, carrying them back to the liver where they can be broken down. Low levels of HDL can also increase your risk of heart attack and stroke, whilst high levels can increase your heart and circulation health. HDL cholesterol can be found in natural foods, such as lentils, beans, fish, onions and garlic.

Preventing a rise in LDL

You can help prevent high levels of LDL by making healthy lifestyles changes. These include a healthy diet that is low in saturated fats, getting frequent exercise, quitting smoking and reducing your alcohol intake. This will lower the possibility of having an imbalance in cholesterol levels. By creating an effective and personalised diet plan you can ensure you are consuming the right combination of nutrients and can avoid consuming too many foods containing LDL cholesterol.

Heart Healthy Diet

A diet that is high in saturated fats affects your cholesterol levels in two ways. Firstly, you'll be ingesting cholesterol from the food you're eating and secondly you can trigger your liver to increase the body's own production of cholesterol to produce more bile to aid digestion of the fats.

To prevent a rise in your LDL levels, a heart healthy diet is essential. This involves reducing your intake of saturated fats through foods like meats, full fat dairy products and oils like coconut oil. Instead, it is recommended that you swap them for foods that contain unsaturated fats such as oily fish, avocados, seeds, nuts and oils like olive or sunflower oil.

Exercise

Getting regular exercise can help boost the levels of HDL in your body, which in turn helps reduce your LDL levels; removing them from the artery walls and transporting them to the liver where they can be broken down. In addition, exercise will help lower your weight, which can also contribute to high LDL levels, and will help lower your blood pressure and keep your heart and blood vessels healthy.

The NHS recommends that you get a minimum of 150 minutes of moderate exercise each week to help lower or prevent your LDL levels from rising. This can be broken out into four or five sessions during the week.

Tobacco

A chemical contained within cigarettes, known as arcolein, can inhibit the ability of HDL to remove LDL from the artery walls and transport it to the liver to be broken down. This can lead to an increase in your LDL levels and leave you at a higher risk of developing atherosclerosis. This condition restricts blood flow through the body, which can eventually lead to the creation of blood clots and furthermore, a heart attack after years of growth. The negative impact of tobacco on cholesterol was first recognised in the 1970s. Smoking tobacco has been found to worsen the negative effects that LDL cholesterol has on the body.

Lowering cholesterol levels

An LDL level of 190 or above it is considered high and will require treatment. Treatment to lower cholesterol levels may involve a combination of the healthy lifestyle changes outlined above and the use of medications.

The most commonly prescribed group of medications to reduce cholesterol levels are called statins. They work by inhibiting an enzyme in your liver called HMG-CoA reductase that helps to make cholesterol. They involve taking a tablet daily, usually around the same time each day. The majority of people they will remain on statins for life as if you stop, your cholesterol levels can start to increase again.

The most common types of statins include Pravastatin, Atorvastatin, Lescol, Lipostat and Zocor. They all work in largely the same way, but their strengths do vary. Your doctor will help you choose the right statin medication for you.