If you are like me, you have received threats from your doctor after your last checkup. Actually, I have heard those threats my whole life. My cholesterol has always been high. At some point, it reached a comical level: I weighed no more than 110 pounds, exercised at least an hour a day, had been a vegetarian (understand, plant-based eater) for more than 10 years, had never smoked, ate very, very little fat, and received a pamphlet advising me to lose weight, exercise more, eat less fat, stop smoking and eat less meat. I laughed. But I still had high cholesterol, so what did that mean? MDs eventually told me that my bad cholesterol was probably genetic. So, does that mean I am at higher risk for cardiovascular diseases? And… is there anything we can do?

Well I didn’t chose to eat less fat. Actually, a few weeks ago I made the complete opposite decision. After reading about the benefits of the ketogenic diet, I decided to try it for myself to see if my life-long recurrent and persistent migraines could be improved on a high-fat, low carbohydrate diet. I dropped the dairy and gluten, reduced my carbohydrate intake, and added fat (mostly tahini and flaxseeds) to my diet. My migraines improved drastically. I was able to stop my daily migraine medication and I now have about one manageable headache a month (which I had while medicated anyway). I thought it would be a good idea to check my cholesterol again and to see the consequences of such drastic dietary changes.

The results are in. My cholesterol has slightly increased (by 10 points): I am at the superior limit – I already was a year ago, and my LDL (bad cholesterol) slightly increased (3 points) as well. However, the most significant changes are my HDL (good cholesterol) level, which increased by 25 points and my triglyceride level, which decreased by 44 points. You know what? I am satisfied with these results, and here is why:

What is cholesterol?

“Cholesterol is a Janus-faced molecule. The very property that makes it useful in cell membranes, namely its absolute insolubility in water, also makes it lethal.”

-Michael Brown and Joseph Goldstein Nobel Lectures (1985)

Cholesterol is a fundamental lipid, critical element of the membranes of all animal cells, and precursor all steroid hormones such as progesterone, testosterone, estradiol, and cortisol. It is synthesized from acetyl CoA, a product of cell aerobic metabolism.

Most of the cholesterol is produced in the liver (only a small proportion comes from our diet) and transported in the blood to the organs and tissues in the body. Extra cholesterol is carried back to the liver in the bloodstream.

What are HDL, LDL and triglycerides?

• LDL: “LDL” stands for “low-density lipoprotein.” LDL transports cholesterol from the liver to the rest of the body. LDL is often referred to as ‘bad cholesterol” because high levels of LDL cholesterol have been associated with a higher risk of cardiovascular disease.
• HDL: “HDL” stands for “high-density lipoprotein.” HDL transports cholesterol back to the liver from the body’s organs and tissues. HDL is often referred to as ‘good cholesterol’ because high levels of HDL cholesterol have been associated with a lower risk of cardiovascular disease.
• Triglycerides: Triglycerides are a form of fat that is stored in fat cells. High triglyceride levels are related to excess weight, physical inactivity, cigarette smoking, excess alcohol consumption or high carbohydrate diets (more than 60% of total calories).

Is high cholesterol a problem?

There is current controversy about whether high cholesterol levels are actually related to increased risk of coronary heart disease and heart attack. Previous theories were that excess cholesterol in the blood would result in deposits, which would eventually block arteries and produce cardiovascular accidents.  More recent research suggests that the main cause of atherosclerosis (narrowing of the arteries) is the presence of small inflammations in the blood vessels, which make the deposit of LDL cholesterol more likely and may cause the formation of clots. Depending on where deposits and clots develop, they can lead to heart attacks or strokes.

However, even more than high LDL, recent studies have linked risks of cardiovascular disease to low levels of the good cholesterol HDL. Levels inferior to 35mg/dL have been identified as important risks factors, whereas levels superior to 60mg/dL have been shown to protect against cardiovascular disease. Studies show that the risk related to low HDL is actually independent from other factors and in particular from levels in LDL. This suggests that total cholesterol might not be the best predictor of risk of cardiovascular disease. Some studies suggest that increasing levels of HDL reduces risks of cardiovascular disease, however, increase in HDL related to pharmaceutical drugs has not proven effective. This points to diet modification and exercise as the more effective source of HDL level control.

Another potentially problematic lipid profile is related to high levels of triglycerides. Triglycerides levels have regularly increased in the United States during the last decades (probably due to increased consumption of refined carbohydrates) and is now adding to the list of cardiovascular risk factors.

What does this all mean?

Coronary heart disease and heart attacks are related to many different risks factors, including increased weight and obesity, high blood pressure, diabetes and prediabetes, smoking, lack of physical activity, stress and lipid blood profile (cholesterol). This means that no single risk factor in an otherwise healthy person is a death sentence, but that the accumulation of above risks should raise attention. In addition, recent findings suggest that high cholesterol levels need to be interpreted with regard to HDL, LDL and triglyceride values and not as a global index only.

I am personally satisfied with my current lipid profile, because, even though I have changed my diet drastically, by incorporating much more fat than I used to,  I have increased my good HDL level (which is at a level that is supposed to be protective against cardiovascular diseases) and I have reduced my triglycerides. I feel that I can relax about the threats I generally hear about my cholesterol, since I have no other risk factor for cardiovascular disease at this moment.

As usual, I am absolutely not advising any diet modification or self-medication and believe in checking with health practitioners about all changes. I am just relating my personal experience in the view of scientific literature. I believe that understanding what numbers mean is a good start to health.

What is your personal experience?