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Contributed By Michelle Baglio, MS, RD, LD Did you know that nearly one-third of United States adults has high cholesterol? Considered a major risk factor for heart disease and stroke, high blood cholesterol is often a silent symptom. Heart disease (including coronary heart disease, high blood pressure, and stroke) has been the number 1 cause of death in this country for nearly a century. However, to many people, cholesterol can be confusing! Here, we’ll dispel some myths about this important molecule while gaining a clearer understanding of how it helps and hurts. Myth #1: “Cholesterol” is cholesterol Cholesterol is a molecule that is one component of a compound that floats around your blood. These compounds, called lipoproteins, contain cholesterol as well as fats and special proteins. The compound is more important than how much cholesterol there is overall. In fact, it depends on what the cholesterol is combined as to the effects it has on your arteries and heart. They're grouped into two main categories: HDL: High Density Lipoprotein (AKA “good” cholesterol) that “cleans up” some of those infamous “arterial plaques” and transports cholesterol back to the liver. LDL: Low Density Lipoprotein (AKA “bad” cholesterol) that transports cholesterol from the liver (and is the kind found to accumulate in arteries and become easily oxidized hence their “badness”). And yes, it gets more complicated. Each of these categories is further broken down into subcategories which can also be measured in a blood test. So “cholesterol” isn't simply cholesterol because it has very different effects on your body depending on which other molecules it's bound to in your blood and what it is actually doing there. Myth #2: Cholesterol is bad Cholesterol is absolutely necessary for your body to produce critical things like vitamin D when your skin is exposed to the sun, your sex hormones (e.g. estrogen and testosterone), as well as bile to help you absorb dietary fats. Not to mention that it's incorporated into the membranes of your cells. The overall amount of cholesterol in your blood (“total cholesterol”) isn't nearly as important as how much of each kind you have in your blood. While way too much LDL cholesterol as compared with HDL (the LDL:HDL ratio) may be associated with an increased risk of heart disease it is absolutely not the only thing to consider for heart health. Myth #3: Eating cholesterol increases your bad cholesterol Most of the cholesterol in your blood is made by your liver. It's actually not from the cholesterol you eat. That’s why some cholesterol medications block an enzyme in your liver (HMG Co-A reductase, to be exact). Others have an effect on your bile acids that limits the amount of cholesterol and fat your body can absorb. However, what you eat still can affect how much cholesterol your liver produces. After a cholesterol-rich meal, your liver doesn't need to make as much. Myth #4: Your cholesterol should be as low as possible As with almost everything in health and wellness, there's a balance that needs to be maintained. There are very few extremes that are going to serve you well. People with too-low levels of cholesterol have increased risk of death from other non-heart-related issues like certain types of cancers, depression, and anxiety. Symptoms of low cholesterol may be related to mental health such as having feelings of hopelessness, nervousness, confusion, or agitation; difficulty making decisions, and/or changes in mood, sleep, or eating patterns. Myth #5: Drugs are the only way to get a good cholesterol balance If you are currently taking a cholesterol-lowering medication, the first thing to do is to continue taking medications prescribed by your doctor. Be sure to talk with your doctor before discontinuing medication or making changes to your regimen. However, while drugs can certainly lower the “bad” LDL cholesterol, they don't seem to be able to raise the “good” HDL cholesterol all that well. Guess what does? Nutrition and exercise! One of the most impactful ways to lower your cholesterol with diet is to eat lots of fruits and veggies. I mean lots, say up to 10 servings a day. Every day. Also, make an effort to exercise, lose weight, stop smoking, and eat better quality fats. That means fatty fish, avocados and olive oil. Avoid highly processed convenience foods. Summary: The science of cholesterol and heart health is complicated and we're learning more every day. You may not need to be as afraid of it as you are. And there is a lot you can do from a nutrition and lifestyle perspective to improve your cholesterol level. References: https://www.cdc.gov/heartdisease/american_heart_month.htm https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018---at-a-glance-ucm_498848.pdf https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5606a2.htm http://www.precisionnutrition.com/all-about-cholesterol https://www.healthline.com/health/cholesterol-can-it-be-too-low#low-cholesterol-symptoms https://authoritynutrition.com/top-9-biggest-lies-about-dietary-fat-and-cholesterol/

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