ldl cholesterol level under 100
milligrams per deciliter is often
described as desirable but did you know
that ldl and ldl cholesterol are two
very different things that cholesterol
itself is not the main problem that hdl
is not good cholesterol and even ldl is
not bad per se what
fat and water don't mix so our body
found a solution to transport fats in
our bloodstream lipoproteins lipo means
fat
so a lipo protein is basically a ball of
fat and protein you know at least two of
them low density lipoprotein or ldl and
high density lipoprotein or hdl okay how
exactly does this nerd fest help me with
my health your lab results usually don't
show ldl they show ldl cholesterol level
so what's that lipoproteins like ldl
carry different types of fat cholesterol
is one type so ldl cholesterol is the
cholesterol carried in ldl lipoproteins
imagine each ldl lipoprotein is like a
car driving down the road
ldl cholesterol are the passengers in
those cars and hdl cholesterol which you
also have in your lab results is of
course the cholesterol traveling in the
hdl lipoproteins bonus question what do
you get if you add up all the
cholesterol all the passengers in all
the cars in your bloodstream
total cholesterol which you also have in
your lab results the other thing on your
labs are triglycerides which is another
type of fat that also travels in
lipoproteins in our bloodstream so
they're another type of passenger okay
so now you know the difference between
ldl and ldl cholesterol one is the
vehicle the other is the passenger why
does any of this matter we'll find out
in a second what about the story of good
cholesterol and bad cholesterol where
does that come from let's start with ldl
cholesterol why do people say it's bad
we know that lab animals with high ldl
cholesterol level can form artery plaque
okay but mice also like to run in wheels
how do we know this has anything to do
with humans population studies show that
people with high ldl cholesterol level
also tend to have more heart disease
interesting but if you saw the previous
videos on olive oil and saturated fat
you know that these population studies
can be a little tricky maybe people with
low ldl cholesterol level are health
freaks and they exercise more and smoke
less and have kale smoothies and
meditate all day long so we want to
avoid jumping to conclusions just based
on population studies by now you
probably know the drill we need to
randomize people to different groups
lower ldl cholesterol level in only one
and see what happens
this has been done many times using
different drugs including statins and
many others
and in study after study the group that
gets the drug and has its ldl
cholesterol level lowered has less heart
disease
if instead of drugs you use diet you get
a similar result as we saw in the
saturated fat video okay so high ldl
cholesterol level is a problem in lab
animals and in population studies
and if you lower it experimentally you
lower the risk this makes a very strong
case that high ldl cholesterol level is
an issue but there's even more evidence
we all have different genetics that's
why we're all a little different some
are taller some have wavy hair some have
big noses
hey
our genetic differences also mean that
we have different levels of ldl
cholesterol among each other so
scientists studied people who have low
ldl cholesterol level from birth
and they have much less heart disease
than the average population up to 10
times less in some cases this does not
mean that your ldl cholesterol level is
100 determined by your genes and there's
nothing you can do period that's a
common belief and it's not factual at
all genes play a role just like in
everything else but there's a lot we can
do with lifestyle for example we just
saw that the saturated fat we eat is a
major player we'll come back to this all
this evidence accumulated over decades
is why scientists are very confident
that a high ldl cholesterol level spells
trouble check out the wording in this
study there is no longer an ldl
cholesterol hypothesis but established
facts that increased ldl cholesterol
level is causally related to
atherosclerotic cardiovascular disease
that's black in the arteries and that
lowering ldl particles and other apo b
containing lipoproteins we'll see what
that means in a minute as much as
possible reduces cardiovascular events
so that's very striking language because
scientists are usually tentative in how
they phrase their findings when we
publish papers we write things like
the data indicates or this suggests that
but here the wording couldn't be any
stronger so who are these authors is it
some fringe vegan scientist no these are
the official guidelines from the
european society of cardiology and it's
the same thing all over the world here's
the american heart association establish
the causal role of
cholesterol-containing lipoproteins
particularly ldl in the genesis of
coronary heart disease so now we
understand the why what evidence led to
these conclusions it's not some doctrine
down from above okay so high ldl
cholesterol level causes heart disease
right i think i got it uh not quite plot
twist see ldl cholesterol is not the
main problem the main problem are the
lipoproteins themselves the vehicles as
these authors explain
their work suggests that it is the
number of lipoprotein particles rather
than the amount of cholesterol or
triglycerides per se
that is the important driver of heart
disease heart disease is caused by
lipoproteins getting stuck in the artery
wall and potentially causing a blockage
so what causes the traffic jam is in
excess of cars not passengers so can we
count cars because normally our lab
results only show passengers ldl
cholesterol triglycerides yes we can we
can measure something called apob which
is one of the proteins carried by ldl so
if we count how many apo b proteins
there are we know the number of
lipoproteins that carry it another test
is called ldlp where p stands for
particle and it's literally a count of
the number of ldl lipoproteins so both
of these are a measure of cars not
passengers and they're not done
routinely by primary care physicians but
if you're seeing a cardiologist for
example and if he or she thinks it makes
sense they might request it okay so if
the number of ldl lipoproteins the
vehicles is the main cause of heart
disease but normally our lab results
only show passengers the cholesterol
then what's the point is ldl cholesterol
level useless for most people these
metrics go hand in hand more
lipoproteins in our blood normally means
more cholesterol being carried inside
them in a percentage of people around 20
give or take depending on the study
there can be a disconnect and that's
worth bearing in mind but for the
majority of us ldl cholesterol level is
a decent estimation and it's still
considered an important parameter even
by cardiologists another metric is
non-hdl cholesterol which is just the
total minus hdl cholesterol
so it's all the cholesterol not carried
by hdl lipoproteins
and it's also commonly used by doctors i
swear to god if this guy shows one more
acronym i'm going back to cat videos i
know this is a lot of different terms so
we'll do a quick review in a second so
if your ldl cholesterol level is good
chances are your ldl particle number is
also okay but if you have concerns and
you want to make sure maybe if you have
family history see your doctor and
consider seeing a cardiologist and i'll
try to have one on here soon so we can
ask additional questions you guys may
have okay i think i got it so
lipoproteins carry cholesterol and other
fats lipoproteins can cause heart
disease if there are too many of them
especially ldl and ldl cholesterol is
just the passenger but it gives us an
idea of the number of ldl lipoproteins
all right and hdl is good right uh
actually blot twist ugh this guy is
worse than den brown in the population
studies people with high hdl cholesterol
tend to have less heart disease that's
why people started calling it good
cholesterol but when scientists tried to
confirm it
raising hdl cholesterol with drugs
didn't help at all their risk did not
improve and people who have genetically
high hdl cholesterol aren't better off
either so this was a huge surprise but
it's actually very consistent this study
concludes although observational studies
that's the population studies we looked
at
might suggest a simplistic hypothesis
for hdl cholesterol namely that
increasing its level reduces
cardiovascular events
substantial trials do not support this
concept and they pulled 39 trials for
this analysis done with three different
drugs so it pretty much looks like a
dead horse now that doesn't mean hdl is
useless not at all we know the hdl
lipoproteins the vehicles play many
physiological roles like for example
pulling cholesterol from plaque but this
simplistic idea of trying to raise hdl
cholesterol i hear people all the time
how do i get my hdl higher and they say
hdl but they really mean hdl cholesterol
the value we see in our lab results
right and now we know the difference
trying to raise our hdl cholesterol
there's no evidence that it helps at all
in fact this gets even worse some
studies suggest that a very high hdl
cholesterol level is associated with
higher cardiovascular risk so this idea
that having high ldl cholesterol is fine
as long as your hdl cholesterol is also
high looking at all the evidence there's
no reason to believe that idea so are
you saying hdl cholesterol is bad no i'm
saying we should avoid thinking in those
terms altogether this almost cartoonish
idea of the good and bad cholesterol
doesn't match the evidence but
simplicity sticks so a lot of people
still think this way in fact ldl isn't
bad either we all have ldl we all have
ldl cholesterol as we should
it's only when it gets off the charts
that it becomes a problem some people
have high glucose or high potassium and
we don't say potassium is bad if you
look at your lab results almost every
parameter has a range
above a certain level it starts to get
too high and it can lead to
physiological problems
ldl cholesterol is no different if you
want more details on lowering your
cholesterol with healthy foods including
specific recipes we just put together
this step-by-step program based on the
best available science it gradually
transitions you over the course of seven
days to a cholesterol lowering menu
where every recipe is designed to get
your blood lipids to ideal levels also
this video covers all the logic and the
science behind the program how to lower
your cholesterol just with healthy foods
on the next video we'll continue looking
at cholesterol including ideal ranges
and some common misconceptions so write
your questions below we'll try to
address as many as we can
peace
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