You've probably experienced that moment of panic when receiving your cholesterol test results. Especially when your total cholesterol comes back high, your first thought is likely "What did I eat wrong?" But there are many misconceptions about cholesterol in our understanding. Let's uncover the truth about cholesterol through a doctor's explanation.
Cholesterol Isn't the Villain
An Essential Nutrient for Survival
While cholesterol is widely perceived as harmful, this is completely wrong. Cholesterol is an essential nutrient that our bodies cannot survive without. Just because it's a key component of hyperlipidemia doesn't make it bad - in fact, without cholesterol, we would die.
Let's look at cholesterol's main roles:
1. Core Component of Cell Membranes
While cholesterol isn't an energy source, it's a crucial component of cell membranes. Every cell in our body contains cholesterol in specific proportions. It regulates membrane permeability - without cholesterol, permeability becomes too high, preventing proper regulation of cellular water and various substances.
2. Raw Material for Stress Hormones
The steroid hormones released when we experience stress are created by slightly modifying cholesterol's structure. Without these steroid hormones, we couldn't handle stress and would eventually die.
3. Essential Element for Sex Hormone Production
Sex hormones necessary for reproduction are also made from cholesterol. When ovaries in women and testes in men produce sex hormones, cholesterol serves as the key raw material. Cholesterol deficiency leads to decreased sexual function and reduced ability to cope with stress necessary for survival.
The Liver's Amazing Biochemical Factory
The Mechanism of Cholesterol Synthesis
Our bodies contain an incredible biochemical factory that synthesizes proteins, cholesterol, and fats - the liver. Particularly while we sleep after eating, the liver synthesizes cholesterol through complex biochemical processes using glucose.
This synthesized cholesterol travels through the bloodstream to the testes or ovaries to be used for hormone production. When cholesterol levels drop significantly, it indicates metabolic problems, making it an important indicator of liver function.
The Existence of Constitutional Set Points
The liver's cholesterol synthesis isn't a pathological condition. It's genetically and constitutionally predetermined to synthesize a certain amount of cholesterol according to the body's various biofeedback mechanisms. If you haven't consumed excessive fats that day, cholesterol levels will likely maintain a certain baseline.
Even if extreme dietary restrictions temporarily lower cholesterol, the liver's basic setting for cholesterol synthesis is predetermined, so levels often rise again. Many people think "it goes up even when I only eat vegetables," but this isn't a pathological mechanism - it's physiological.
The Real Cause of Atherosclerosis
No Problem in Healthy Blood Vessels
If cholesterol is a necessary nutrient, why is it considered problematic? In healthy blood vessel walls, circulating cholesterol doesn't cause problems.
Problems arise when blood vessel walls are damaged by high blood pressure, smoking, or other factors. After age 40, when blood vessel walls become damaged, or when smoking causes vessel wall damage, gaps appear in the injured areas.
The Process of Atherosclerosis Development
Cholesterol that should normally go to the testes, ovaries, or adrenal glands becomes excessive, receiving "don't come" signals from these destinations. It then circulates in the blood and gets lodged in damaged vessel walls. This lodged cholesterol continues to accumulate and eventually deteriorates.
Our body recognizes this deteriorated cholesterol as a foreign substance and triggers an inflammatory response. This chronic inflammation is atherosclerosis. While the initial lesions causing atherosclerosis can be caused by high blood pressure and smoking, the material protagonist of atherosclerosis is cholesterol.
What should have been a precious essential nutrient becomes too abundant, ending up where it shouldn't go in healthy vessel walls, getting lodged and causing chronic inflammation that becomes atherosclerosis.
Causes of Cholesterol Elevation
Direct Consumption and Internal Synthesis
There are two main reasons cholesterol levels rise. First is direct consumption and absorption of cholesterol-rich foods like egg yolks. Second is when our body synthesizes cholesterol internally.
Interestingly, the only raw material for cholesterol synthesis is glucose - carbohydrates. While other pathways are scientifically possible, most of the raw material comes from carbohydrates. Therefore, even without eating fats, if you consume rice, your body can produce cholesterol.
The Relationship Between Dieting and Cholesterol
If you only eat vegetables, they contain mainly minerals and fiber with almost no carbohydrates or fats. However, drastically reducing protein or fat intake likely increases carbohydrate consumption. This can increase cholesterol synthesis in the body.
The same applies to low-carb, high-fat diets. Eating pork belly doesn't just introduce triglycerides - cholesterol comes with it too. While triglycerides are an energy source that can be burned through exercise, cholesterol isn't an energy source, so excess amounts accumulate.
Reading Blood Test Results Properly
The Delivery Box System
Since cholesterol is a lipid, it can't simply mix with blood, which is water-based. So our body created delivery boxes - protein-made containers that transport cholesterol.
Cholesterol contained in low-density lipoprotein (LDL) delivery boxes is called LDL cholesterol, while cholesterol wrapped in high-density lipoprotein (HDL) boxes is called HDL cholesterol.
LDL delivery boxes transport cholesterol to destinations like ovaries and testes. However, when there's too much, destinations refuse delivery, leaving it circulating in the blood. HDL delivery boxes are empty containers sent from the liver to collect improperly distributed cholesterol and return it to the liver.
The Total Cholesterol Trap
Total cholesterol is the sum of LDL cholesterol, HDL cholesterol, and VLDL. Since it combines potentially good HDL cholesterol with potentially bad LDL cholesterol, you can't simply judge based on whether total cholesterol is high or low.
What's really important is the LDL cholesterol level. While total cholesterol over 200 suggests bad cholesterol might be high, that alone can't determine good or bad.
Personalized Management Strategies
Staged Approach Based on Risk Level
The most important aspect of cholesterol management is understanding your stage.
Stage 1: General Population (Before age 50, no risk factors)
If you have no risk factors and no atherosclerosis, you don't need to take hyperlipidemia too seriously. If LDL cholesterol exceeds 160, try lifestyle modifications, and if it doesn't decrease after several years, seriously consider drug therapy.
Stage 2: Those with Risk Factors
If you have atherosclerosis, high blood pressure, and smoke, you should actively consider medication if LDL cholesterol exceeds 160.
Stage 3: High-Risk Group
If you've been diagnosed with severe atherosclerosis or have had a stroke or heart attack, specific numbers don't matter. You need to reduce levels by over 70%, which is impossible through lifestyle changes alone, so medication is absolutely necessary.
Advice on HDL and Triglycerides
While high HDL cholesterol is good, artificially raising it is nearly impossible. For 20 years, attempts to create HDL-raising drugs have mostly failed with more severe side effects. Therefore, don't worry too much about HDL levels and leave it to your doctor.
Triglycerides are often measured incorrectly. Since triglycerides are an energy source, eating fats immediately raises levels. Eating pork belly can instantly push levels over 500. You must fast for 8-12 hours and test in the morning for accurate results.
Understanding Statin Medications
Balancing Effects and Side Effects
For stroke or heart attack patients, statins are nearly essential medications. Because they're so effective, many people take them, leading to more awareness of side effects.
Statins don't just work in the liver - they affect the entire body. Cholesterol synthesis occurs throughout the body, but is most active in muscles. Muscles have lots of movement and damage, requiring frequent cell membrane repair.
When statins enter, they interfere with cholesterol biosynthesis, potentially reducing muscle cell physiological activity. However, current medications are composed only of drugs that don't increase rhabdomyolysis or muscle cell damage compared to control groups.
Proper Understanding of Side Effects
The problem is that patients may feel "something's wrong with my muscles" even when muscle cells aren't actually damaged. In such cases, doctors would prefer to advise stopping statins, but patients often become excessively anxious due to various misinformation.
High blood pressure and hyperlipidemia are truly silent killers with no symptoms. They damage blood vessels later, and while blood pressure and cholesterol medications can cause side effects that inconvenience patients, this discomfort usually decreases with adaptation, and in most cases, there's no need for anxiety even with slight discomfort.
Limitations and Possibilities of Lifestyle Improvements
A Realistic Approach
If cholesterol levels remain high despite doing your best for health, you should recognize that compared to conditions like high blood pressure, there's limited room for control. This is because from the liver's perspective, it's working hard.
However, if you can reduce cholesterol intake by eating less, that's something worth effort. Reducing dietary cholesterol can be somewhat helpful.
Exercise can increase the utilization capacity of sex hormones and steroid hormones, potentially increasing cholesterol consumption. However, we must acknowledge that what we can control is inherently limited.
## Conclusion
We need proper understanding of cholesterol. Cholesterol is an essential nutrient for our bodies, not simply something bad. Don't get caught up in total cholesterol numbers - focus on LDL cholesterol and manage according to your risk level.
Most importantly, based on medically sound information, consult with your doctor to find the optimal management method for you personally. Cholesterol management isn't a simple numbers game - it requires a comprehensive approach for overall cardiovascular health.
*Source: Reconstructed based on a doctor's lecture content on cholesterol*.
0 comments:
댓글 쓰기