There appears to be a considerable amount of confusion regarding the role cholesterol plays in helping to determine health status. Indeed, cholesterol is often considered to be extremely detrimental to ones health; hence the paranoia associated with eating the yolk part of an egg - a food high in cholesterol.
However, cholesterol, although harmful at elevated levels, contributes to many biological functions, and is undeserving of such a villainous reputation. The body manufactures cholesterol internally in the liver, and from the foods we eat and, as a necessary lipid (fatlike substance), is used as a building component for all of the body's cells.
Bodybuilders often consume a variety of foods, including copious amounts of fat in the off-season. As a result, they might run the risk of increasing their cholesterol to harmful levels. Elevated cholesterol levels can have dire consequences, as this article will illustrate, which include heart disease and stroke.
Indeed, keeping cholesterol levels under control will enhance overall health, and prolong ones training efforts and quality of life. This article aims to demystify the many, often confusing, aspects of cholesterol metabolism, while showing how one can improve their cholesterol profile and improve the quality of their health.
What Is Cholesterol?
Cholesterol (pronounced ko-LES-te-rol) is a fatlike, waxy substance, called a lipid, which is produced in the liver primarily (about 80% of production) and secondarily manufactured by the foods we eat.
Cholesterols name originates from the Greek word chole (bile) and stereos (solid) due to researchers initially finding it in gallstones, in a solid form. It circulates in the blood and is used as a building product for all the body's cells (cholesterol can be found in high concentrations in the muscles, brain and liver) and many sex hormones.
It travels in the blood, for the most part, packaged as two compounds, which will be explained in detail later: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). These compounds, in the wrong ratios, as well as a high total cholesterol count, can cause significant cardiovascular problems. However, cholesterol is necessary, as it plays a very important role in cellular health.
It is a necessary component of all cell membranes, and a precursor to all steroid hormones, including testosterone, estrogens and cortisol. It is also needed for brain function, and carries antioxidant vitamins to the body's tissues.
Cholesterol also helps with the production of bile acids, which help the body digest fat. Indeed, it is excess cholesterol in the blood, not cholesterol per se, that causes the associated health problems, and contributes to its reputation as something to avoid like the plague.
Cholesterol's Harmful Effects
As many as half of the 530,000 deaths from heart disease in the US in 1999, might have been a result of raised cholesterol and lipid levels. Most of the evidence surrounding death statistics concerning heart disease point to low levels of HDL (high-density lipoprotein) cholesterol and high levels of LDL (low-density lipoprotein) cholesterol as being the main offenders.
Fat-like substances called lipids (of which HDL and LDL are two lipids in the form of fat-protein complex lipoproteins) circulate in the body and, in the wrong ratios and amounts, can cause what is termed atherosclerosis (hardening of the arteries).
Atherosclerosis occurs when a plaque is formed as a result of high LDL activity; the longer a plaque is left to develop, the more fibrous it becomes and the greater the calcium build-up. When this occurs the heart is damaged in two ways:
- The Arteries eventually become narrower due to calcification and inelasticity (a condition known as stenosis). Eventually sufficient oxygen-rich blood is prevented from reaching the heart, due to the continued narrowing of the arteries.
Angina (discomfort and pain felt when a blockage in a coronary artery prevents oxygen-rich blood from reaching part of the heart), and in many cases heart attack (myocardial infarction) will ultimately result from this restriction of blood supply.
- Smaller, unstable, plaques might rupture triggering the formation of blood clots on their surface. These blood clots might eventually block the arteries and cause heart attack.
HDL & LDL Cholesterol
HDL cholesterol is referred to as a good lipoprotein as it tends to transport cholesterol away from the arterial wall, whereas LDL (referred to as bad) carries cholesterol from the liver to the arteries, where it is deposited in the artery walls as a fatty substance called a plaque.
LDL transports 75% of the bloods cholesterol around the body. However, this cholesterol sometimes undergoes a process of oxidation (it becomes an unstable molecule) which allows it to penetrate, and act dangerously, with the artery wall.
The body releases immune factors in response to the oxidized LDL. These immune factors, however, come in such abundance that they cause inflammation, which causes further damage to the artery wall.
Oxidized cholesterol also has been shown to play a role in the lowering of nitric oxide (NO). With a lack of NO, the blood cannot flow freely and further cardiovascular problems occur.
HDL, on the other hand, appears to benefit the body by, as mentioned, removing cholesterol from the arterial wall, and returning it to the liver. It also has been shown to prevent the oxidation of LDL as well as keeping the arteries open and clear.
One condition that results in abnormally high HDL cholesterol levels cannot be addressed with a few simple dietary changes, and other lifestyle changes. Familial hypercholesterolemia (FH) is an inherited disorder that effects about one in 500 Americans.
It is a metabolic defect that prevents LDL cholesterol from being cleared from the bloodstream, significantly increasing ones risk of heart disease, due to the abnormally high LDL levels in the blood.
Pinkish-yellow deposits under the skin (xanthomas) particularly around the eyelids or on the tendons of the lower legs characterize FH, and some people with the severe form of this disorder can suffer heart attacks during childhood.
There are two types of FH, heterozygous FH (in which one receptor on the blood cell has mutated) and homozygous (the blood cells have two mutated receptors). In heterozygous FH, LDL cholesterol levels can run as high as 350-500 mg/lL ).
In homozygous FH, which is much rarer, LDL cholesterol levels can reach as high as 700-1,200 mg/dl. Cholesterol lowering drugs, in addition to dietary changes, are often required to treat familial hypercholesterolemia.
Symptoms Of High Cholesterol
As mentioned, atherosclerosis is often the end product of consistently high cholesterol levels. The symptoms of high cholesterol stem from the diminished blood flow resulting from atherosclerosis, and may include:
- Angina (chest pain).
- Intermittent Claudication (leg pain when walking).
- The Pinkish-Yellow deposits under the skin (xanthomas) particularly around the eyelids or on the tendons of the lower legs, associated with familial hypercholesterolemia.
HDL LDL Lipid Levels
What Do They Mean?
As alluded to earlier, there is often a misconception surrounding the respective effects the protein-attached lipids (HDL and LDL cholesterol) circulating the body in the blood, have. It is often thought, that a higher total lipid count will contribute to ill health, and hardening of the arteries (atherosclerosis). However, it is the total amount of a certain lipoprotein (LDL) that causes many of the problems associated with high cholesterol.
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Indeed, to determine a lipoprotein profile (an individual's levels of the different types of lipoproteins), four measurements need to be taken into account: total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides.
Desirable & Non-Desirable Readings Of These Measures
Note: mg/dl = milligrams per deciliter is a term used to describe how much of a substance is in a specific amount of blood.
- Total Cholesterol
(the total amount of all the cholesterol in the blood; the higher the total cholesterol, the greater the chance of heart disease).
- Less than 200mg/dl: desirable blood cholesterol.
- 200 to 239 mg/dl: borderline - high blood cholesterol.
- 240 mg/dl and above: high blood cholesterol.
- HDL Cholesterol.
- Less than 35 mg/dl: low HDL cholesterol (higher levels are more desirable).
- LDL Cholesterol.
- Less than 100 mg/dl: desirable for people with heart disease.
- Less than 130 mg/dl: desirable for people with no heart disease.
- 130 to 159 mg/dl: borderline high risk of heart disease.
- 160 mg/dl or above: high risk.
(Triglycerides are a kind of fat that is carried through your bloodstream in lipoprotein packages).
- Less than 200 mg/dl: normal triglycerides.
- 200 to 400 mg/dl: borderline high triglycerides.
- 400 to 1000 mg/dl: high triglycerides.
- Greater than 1000 mg/dl: very high triglycerides.
In terms of cardiovascular risk assessment, it is more informative to measure the HDL/LDL ratio as opposed to just total cholesterol and triglycerides. High HDL, with low LDL cholesterol, is obviously more desirable than the reverse.
Abnormal Blood Cholesterol?
What Should You Do?
If you do not currently have heart disease, and have had you your total cholesterol and HDL levels assessed, here is what should be done.
- If total cholesterol is less than 200 mg/dl and HDL is 40mg/dl or greater, things seem to be going well in terms of cholesterol status. They will not need to be checked again for another five-years. However, the positive cholesterol lowering lifestyle changes outlined in this article should still be followed to stave off any potential problems.
- If total cholesterol is less than 200 mg/dl and HDL cholesterol is below 40mg/dl, you will need a lipoprotein profile to determine LDL (bad) cholesterol. One needs to fast for nine-12 hours before this test. Nothing but water, coffee or tea should be taken.
- If total cholesterol is between 200 to 239mg/dl and HDL is 40mg/dl or greater, one will need to determine, through their doctor, if they have any other risk factors for heart disease. A lipoprotein profile may need to be done in this instance.
- If total cholesterol is 240mg/dl or above, regardless of HDL cholesterol, one will need a lipoprotein profile done.
- If LDL cholesterol is less than 130mg/dl, one will only need to have their cholesterol levels tested in the next five years, as they are within the desirable range.
- If LDL is 130mg/dl or above, one will need to have their doctor assess other possible heart disease risk factors.
Conventional Medical Treatments For High Cholesterol
When cholesterol has reached clinically significant levels, and atherosclerosis has begun, or is at a life threatening stage, various conventional treatments are used. It must be remembered that, although these treatments will help with cholesterol reduction, positive lifestyle practices should not be abandoned.
Cholesterol lowering treatments include:
Statins inhibit an enzyme essential in the body's manufacturing of cholesterol. These are the most widely prescribed drugs for lowering cholesterol. These drugs may reduce cholesterol, depending on the dosage and individual response, by lowering LDL cholesterol by up to 60%.
They can also raise HDL cholesterol and lower triglycerides. Common statins include, lovastatin (Mevacor), cerivastatin (Baycol), and fluvastatin (Lescol). Gastrointestinal upsets, liver damage and muscle aches, are the most common side effects of these drugs.
- Fibric Acids.
These increase the livers oxidation of fatty acids, thus resulting in the lowering of LDL cholesterol and triglycerides. Among these drugs are, clofibrate (Atromed -S), fenofibrate (Tricor), and Gemfibrozil (Lopid). The most common side effect is stomach upset.
- Bile-Acid-Binding Resins.
These drugs function by binding with bile acids, and consequently disrupting the livers cholesterol making activities. These are usually a second choice to the statins (those already on statins might realize a greater benefit by taking these with bile-acid-binding resins simultaneously).
Bile-acid-binding resins include, colestipol (Colestid), and cholestyramine (Questran, LoCholest, and Prevalito). Common side effects include constipation, gas and feelings of fullness.
These conventional treatments are given, when cholesterol has risen to unacceptable levels, and lifestyle changes will not have any impact in terms of lowering these levels. However, prevention is better than the cure, as the cliche goes, and lifestyle management in conjunction with beneficial supplements might keep cholesterol in check over the long term.
Cholesterol Lowering Supplements
The Most Effective Ones.
- Vitamin E:
Vitamin-E has a strong antioxidant action, and is thought to prevent the damage to LDL cholesterol, that causes them to form a fatty plaque. Studies have found that people taking vitamin-E are at a reduced risk of heart disease.
- Omega-3 Fatty Acids:
Omega-3 fatty acids are found principally in fish oils and have been shown to inhibit inflammation, prevent blood clotting, and lower triglyceride levels - all of which have been shown to reduce the risk of atherosclerosis. Omega-3 can be taken in supplemental form, or naturally in the form of flaxseed, rapeseed and evening primrose oil.
- Green Tea:
Several compounds that interfere with the process of atherosclerosis can be found in green tea. The phytochemicals (or polyphenols) found in green tea appear to improve the metabolism of lipids and lower cholesterol. These compounds also act as antioxidants.
- Plant Sterol Esters:
Plant sterol esters have, in recent years, been used in products such as margarine, and salad dressing, and inhibit the absorption of LDL cholesterol from the intestines, thus hastening its excretion. Sterol esters are taken from natural substances occurring in pine trees and soybeans.
Garlic has been shown to have powerful blood thinning properties, which negate arterial clot formation. Garlic, a herb, is also thought to lower cholesterol levels. The sulphur compounds found in garlic, alliin in particular, are where its main benefits originate. The best way to take garlic is crushed and raw.
- Soy Protein:
The estrogen-like effects of soy's isoflavones (diadzein and genistein) may help to reduce the risk of atherosclerosis.
Genistein might also play a role in preventing the oxidation of LDL cholesterol, as it has antioxidant properties.
Soy, furthermore, helps to lower cholesterol, due to its increasing of bile-acid secretion.
- Nicotinic Acid (Vitamin B3):
This particular B-vitamin is often prescribed, in large doses, as a conventional treatment to lower LDL cholesterol and triglycerides, and raise HDL levels. Its main function is to mobilize fatty acids from tissues around the body. This helps to reduce the livers production of triglycerides which assists in the lowering of LDL levels. HDL can be increased by up to 30%, making Nicotinic acid extremely efficacious.
- Folic Acid, Vitamin B12 & Vitamin B6:
Low levels of B12 and B6 have been shown to result in increased levels of the heart-damaging homocystine. This significantly increases the risk of atherosclerosis and coronary heart disease.
Risk Factors Associated With High Cholesterol
As mentioned, high cholesterol can contribute to more serious problems. Short of testing specifically for cholesterol counts, it is important to understand the risk factors associated with high cholesterol. The following are the five of the main ones:
- Leading A Sedentary Lifestyle.
Insufficient exercise will lead to an accumulation of the bad type of cholesterol (LDL), and a subsequent risk of cardiovascular disease.
High cholesterol is often associated with excess body-fat. Obesity is thus a good predictor of potential cardiovascular problems.
Increases the viscosity of the blood and promotes arterial constriction, both of which contribute to high cholesterol and heart disease.
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- Directly consuming a diet high in cholesterol and saturated fats will raise cholesterol, in particular, the problematic LDL type.
- Hereditary Factors. If one has a parent or sibling with high cholesterol, this automatically places them at greater risk of high cholesterol.
Live An Athlete's Lifestyle & Enjoy Lower Cholesterol
The above risk factors can be negated, and in some cases obviated, if one engages in a healthy, athletic, lifestyle. The reasons for this are below:
- Athletes, by the very nature of their quest for physical superiority, eat the best of food, in the right ratios. In fact, the diets of many athletes are in line with the American Heart Association recommendations of no more than 30% of total calories from fat.
Other recommendations, that athletes tend to take on board, include limiting saturated fats (A type of fat found in greatest amounts in food from animals, such as butter, cheese, milk, and cream, as well as meat and poultry skin) to 8-10% of calories, polyunsaturated fat (a certain type of fat of plant origin.
Good Fats, Bad Fats.
This article will focus on fats, the recent health claims approved by the FDA regarding keeping your diet healthy with the right kinds of fats (the good fats), and how to apply this to a bodybuilding diet.
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These fats tend to lower blood cholesterol) to 10% and monounsaturated fat (liquid at room temperature and found in olive and canola oils, this fat appears to lower LDL levels) to 15%.
Other cholesterol-lowering, dietary guidelines, athletes typically follow include:
- Eating plenty of soluble fiber, including oatmeal, apples, beans, peas and barley.
- Eating lean protein sources such as skinless chicken, small amounts of very lean meats, and fish.
- Reducing non-essential fats like butter, cheese and whole milk.
- Avoiding trans-fatty-acids (hydrogenated fats that act like saturated fats and reduce the beneficial HDL cholesterol while increasing the harmful LDL).
- Weight Loss in the form of fat is one of the fundamental requirements of becoming a fit and healthy athlete. Losing as little as 10 lbs can make a tremendous difference in terms of cholesterol reduction.
- Athletes exercise regularly and this strengthens the heart muscle, helps to maintain a healthy weight, assists with the maintenance of a healthy blood pressure, and improves the balance of good vs. bad cholesterol in the blood.
- Athletes typically do not smoke. Smoking increases total cholesterol and decreases the beneficial HDL cholesterol. It is thought, the risk of heart disease is up to 300-times greater for the smoker as compared to the non-smoking population.
- The Exercise, healthy eating and concentration associated with training for an athletic event, helps one to deal with the stresses of daily life. Stress, anger and hostility have all been shown as precursors to heart disease. Reducing these can reduce the risk of cardiovascular problems.
Cholesterol, as has been shown throughout this article, is a complex and important substance, responsible for a wide range of functions in the body. Without cholesterol, we would die.
However, too much of this life supporting lipid, and deleterious health consequences result. Indeed, cholesterol can both give life and take it away, depending of the predominance of the type circulating in the blood, and its total concentration. Learn to control your cholesterol levels and live a longer, healthier, life.
- American Heart Association.(2005). Cholesterol. [Online]
- Life Clinic.(2004). Blood Cholesterol Levels: What you should do. [Online]
- Ockene IS, Chiriboga DE, Stanek EJ 3rd, Harmatz MG, Nicolosi R, Saperia G, Well AD, Freedson P, Merriam PA, Reed G, Ma Y, Matthews CE, Hebert JR. Seasonal variation in serum cholesterol levels: treatment implications and possible mechanisms. Arch Intern Med 2004;164:863-70
- Roberts, A,. O, Brien M,. & Subak-Sharp, G.(2001). Nutraceuticals: The Complete Encyclopaedia. Pedigree, NYC.
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