Unravelling the Mystery of Cholesterol: A Conversation with Dr. Shobha Rayapudi

Q: I’m doing everything right, but my cholesterol won’t come down. I don’t eat meat but eat chicken or fish occasionally. I eat healthy, I walk every day. I meditate every day. I’m not overweight yet my cholesterol continues to go up. I thought that it would go down when I cut out animal products, but it’s not budging. Is it hereditary? Is my cholesterol high because it’s hereditary as I’m doing everything right?

A: To find out if it’s hereditary, let’s first understand what cholesterol is. 

Cholesterol is something that is produced in your body. All the cells in your body can make cholesterol but it is produced mainly in the liver. Since you move from one place to another instead of remaining stationary at one place like plants, your cells need to be flexible to allow that movement. Cholesterol makes your cell membranes flexible. It is used to build your cellular walls. It is also used as a raw material to produce hormones in your body. So, if your body wants to make vitamin D, it needs cholesterol. If it’s time to produce estrogen or testosterone, cholesterol is the key ingredient. It also aids in digestion by helping to produce bile. 

Cholesterol is absolutely necessary for your health. Your body cannot function without it. Here’s a fun fact you will find 25% of your body’s cholesterol in your brain.

Now, here’s the cool part – your body produces all the cholesterol it needs, so you don’t have to go looking for extra. Unlike vitamins and minerals that you might need from your food, cholesterol is not something you have to find outside your body. It’s not like an essential nutrient; your body’s got it covered.

Q: So, Is cholesterol good or bad?

A: Cholesterol is necessary, but the problem comes when there is too much of it.

When there’s excess cholesterol in the blood, it irritates the arteries, sticking to the walls and causing plaque development. This can result in artery blockages or plaque rupture, leading to heart attacks.

Cholesterol does not dissolve in water or blood, so our bodies need a special system to transport it from the liver to the other organs and tissues in the body. Cholesterol is packed into tiny parcels in the liver- protein, lipids, cholesterol called lipoproteins which differ in how densely they are packed.  

Depending on their density they are divided into:

“LDL” cholesterol: “LDL” stands for “low-density lipoprotein.” This type of lipoprotein transports cholesterol from the liver to the rest of the body. This is also known as bad cholesterol because too much LDL can lead to plaque development in arteries, causing heart disease and strokes.

“HDL” cholesterol: “HDL” stands for “high-density lipoprotein.” Also known as good cholesterol. It’s good to have high HDL as it transports the cholesterol away from the rest of your body back to the liver to be processed and removed.

“VLDL” cholesterol Very low-density lipoprotein: These carry newly created triglycerides from your liver to your fat tissues.

Q: Should we be concerned about LDL – bad cholesterol?

High (LDL) cholesterol is a global epidemic, affecting 100 million people in the USA alone.

The severity of its effects depends on which blood vessels are affected. If the arteries supplying your heart are impacted, it increases the risk of heart attacks, the leading cause of death in the USA and the second leading cause of death in Canada. If it affects the arteries supplying your brain, there’s a risk of stroke and Alzheimer’s disease.

A lot of people know the association between cholesterol and heart disease, but not many are aware of the association between cholesterol and Alzheimer’s disease.  

In essence, it’s not something that can be taken lightly because high cholesterol is an underlying cause of various serious conditions like heart attacks, strokes, dementia, and Alzheimer’s disease. It’s crucial to pay attention to and address high cholesterol for overall health and well-being.

Q: Ok, I understand I need to keep my levels low. How low? What’s the normal range of cholesterol?

A: Depending on the country you live in you will see two types of measurements.

The government suggests that total cholesterol should be less than 200. But here’s the interesting part – even though 200 might sound like a good number, it was chosen because, on average, Americans typically have cholesterol ranging from 200mg/dL to 210mg/dL. Making it 200 seemed like an achievable and round number.

However, if we look back 75 years ago to a study in Framingham, researchers observed that when cholesterol numbers were less than 150, there were hardly any cases of heart disease. As the numbers increased from 150 to 170, incidents of heart disease started to show up, with even more cases between 170 and 190. The spike in incidents became significant beyond 200.

So, for real protection against cholesterol-related issues, maintaining a number less than 150 for total cholesterol is crucial. This conclusion is drawn from research, emphasizing the significance of this lower number, rather than the commonly suggested 200.

When it comes to the “bad” cholesterol, known as LDL cholesterol, they often recommend keeping it below 100. But for a healthier target, aim for less than 70.

Checking triglycerides, you’d ideally want them to be less than 120. Lastly, your “good” cholesterol, known as HDL, should be above 40.

So, to sum it up, in test results, these are the numbers you’d want to aim for to keep your cholesterol in check.

Q: My blood test shows a higher than normal range. I want to avoid the risk of Alzheimer’s disease, stroke and heart disease. Can I use statins or cholesterol-lowering drugs?

A: Let’s say you use statins. Slowly you begin to notice that in  2 months you start experiencing memory loss, muscle pain, or increased appetite. You are gaining weight, developing insulin resistance and diabetes. Your doctor also tells you that they need to monitor your liver function tests because statins affect your liver. 

This is not something that you want to deal with. If you can achieve the same thing without the drug, wouldn’t that be golden?

Statins may have side effects but Lifestyle changes, focusing on diet, can achieve similar results without the drawbacks.

Instead of focusing just on medicines, or on some magical thing that is going to bring your cholesterol down…Look at what brings it up and get away from it​

Q: What raises cholesterol levels? What can I do to get my cholesterol down?

A: So what gets the number up – cholesterol itself. If your day starts with eggs or dairy or any animal products, you’re taking in cholesterol – it’s time to stop. Just like sugar raises blood sugar levels, eating cholesterol raises blood cholesterol. But it gets trickier – animal foods not only have cholesterol but also a type of fat called saturated fat that boosts your body’s cholesterol production. 

Animal foods are rich in saturated fat, but be aware that some plant products, like certain tropical oils such as palm oil or coconut oil, are also high in saturated fat. Surprisingly, even some seemingly healthy choices like organic peanut butter might contain palm oil. That’s why it’s essential to read nutrition labels when you’re shopping.

Other factors that may raise your cholesterol include Smoking, Alcohol, Inactivity, Obesity or being overweight, taking certain medications such as blood pressure medications (beta-blockers and diuretics), birth control pills, hormone replacement therapy, or steroids.

 So, to keep it simple, The first step is to cut out animal products from your diet because cholesterol is only found in them. Second, steer clear of saturated fats, and say no to tropical oils for a healthier approach to managing your cholesterol.

Q: Are there foods that reduce cholesterol production?

A: Yes, soy products, soluble fibers, plant sterols and stanol can signal the body to lower cholesterol. 

Plant sterols or Phytosterols are a group of plant-derived compounds that are structurally similar to cholesterol in the human body. When consumed, they compete with cholesterol absorption in the digestive tract and block it.

The following foods contain the highest amounts of phytosterols: Nuts, Whole grains, Vegetables and Fruits.

Soluble fiber binds to the cholesterol particles in your small intestine, preventing them from travelling to your bloodstream and other parts of your body. It removes cholesterol by way of excretion through your colon. Foods rich in soluble fiber are Legumes (including beans, peas, and lentils), Whole grains, and Berries

Eating just a ½ cup of legumes per day can lower LDL cholesterol by an average of 6.6 mg/dl, compared to the effects of not eating legumes at all (As shown in  2014 review of 26 randomized controlled trials, published in CMAJ) 

Eating three servings of whole grains daily could lower the risk of stroke and heart disease by up to 20%.(A 2016 review published in BMJ)

Dark leafy greens like kale, spinach, broccoli, and collards, are high in carotenoids such as lutein, that can lower LDL cholesterol levels.

Q: Ok, I get it, no need to convince me that greens, veggies and fruits are good. I do have them but why can’t I have my chicken, beef, or eggs occasionally? I am already doing a lot…exercising, meditating, eating healthy.

A: A lot of people consider eating chicken, or olive oil as healthy. Let us have a look. Olive oil has much less saturated fat compared to coconut oil, beef, chicken, or dairy products. That’s true but if you look Beef has 50% saturated fat, chicken has 30% and olive oil has 14% saturated fat.

Dietary guidelines recommend that your saturated fat intake should be less than 10%. So by what standards are chicken and olive oil healthy?

The other type of fat (86%) present in olive oil won’t raise your cholesterol but this 14% of saturated fat will raise your cholesterol.​

So don’t be under the misconception that you are doing everything right, but your cholesterol is still high. Focus on a whole-food, plant-based diet, minimize saturated fats, and avoid external cholesterol.

Q: How quickly can lifestyle changes improve cholesterol numbers?

A: Changes in diet can show improvements within a couple of weeks, but patience is key. 

Q: It’s very difficult for me to give up cheese, chicken, dairy and deep-fried foods. 

A: Making a lifestyle change is hard. Based on our culture, we are attached to certain kinds of foods and we become quite sensitive about them. But when we learn the skill of plantifying our favourite foods, making that dietary change becomes easy peasy. When you can still have your chicken sandwich, fries, pizza, burgers, scrambled eggs, cheese or any of your favourite foods you don’t feel like you are missing out on something or giving up anything.

As a Lifestyle medicine doctor, I help people struggling with high cholesterol, high blood pressure and other chronic conditions to break free from diseases, reduce dependency on medications and transform their health with delicious nourishing foods that love them back. 

Dr. Shobha emphasizes the importance of understanding cholesterol beyond just numbers, urging everyone to take proactive steps toward heart health through informed dietary choices and lifestyle modifications.

You have incredible power in your hands to lower your cholesterol, and prevent and reverse heart disease.

Tell us in the comments:

• After reading this, do you better understand cholesterol?

• Do you eat foods containing saturated fat and cholesterol?

• Do you accept the challenge of incorporating more cholesterol-lowering foods into your diet?