Lipids such as cholesterol and triglyceride do not dissolve in the blood, which is a water-soluble environment. Water and oil cannot be mixed. So, lipids must be covered with protein to flow through the blood. This covered state is called lipoprotein.
Lipoproteins are classified into five groups according to the proportion of lipid components. Two of them are LDL (low density lipoprotein) and HDL (high density lipoprotein). LDL contains about 50 % cholesterol, about 10 % triglycerides, and the rest are phospholipids and proteins. HDL is composed of about 20 % cholesterol and about 10% triglycerides.
The reason why LDL cholesterol is said to be bad is that it can easily enter the inner lining of the artery and easily cause atherosclerosis. The reason why HDL cholesterol is said to be good is because it transports cholesterol attached to blood vessels back to the liver.
However, both of them are absolutely necessary for us to survive. In addition, especially when infection occurs after surgery, "good" HDL may accelerate oxidation of LDL. That’s why we cannot say "good" or "bad". In other words, what is important is the balance of the two. We are inclined to think LDL is bad and HDL is good, but this is not correct. Both of them are important to the body, which is why they exist.
Then, cardiologists always have objections as follows.
"It should be obsolete to make diagnosis only by total cholesterol, triglyceride, LDL, HDL. It is necessary to conduct further tests such as detailed VAP and LPP (Lipoprotein Particle Profile) and to investigate fine fractions of lipids."
But this seems to be equal to "You cannot see the wood for the trees". In other words, the more detailed examinations of lipid profiles are done, the less we can see our total body and the deeper blind alley we may be driven to. After all, our medical knowledge is quite limited compared with Great Nature. For some people, the human body increases LDL, which is called bad, as it may be necessary for some reason. Indeed, lowering unnecessarily LDL increases the incidence of cancer.
In addition, too low LDL sometimes leads to weak resistance to a Gram negative bacteria. Escherichia coli is a gram-negative. And Helicobacter pylori, causing stomach ulcer, is also a gram-negative. Many Japanese have H. pylori, but they do not develop stomach ulcer. So, if LDL got reduced artificially by drugs, they might develop ulcer or even stomach cancer.
We should not destroy unnecessarily the delicate balance between LDL and H. pylori by drugs. As a general physician, I have many patients who are suffering from obesity. Some of them report that they got obese immediately after they had eradicated H. pylori by antibiotics.
Helicobacter pylori is living in the stomach quietly perhaps by maintaining the delicate balance with LDL. The obesity rate in 2014: the United States 35%. Japan 3.5% (exactly one tenth of the United States). It is said Japanese have more H. pylori than Americans. So, some researchers even argue that the reason why the obesity rate in Japan is very small is thanks to H. pylori.
We really don't know what would happen if the delicate balance was artificially destroyed by reducing LDL too much. Our medical science has not yet advanced enough to know it. We should be more modest and more prudent.
Indeed it is epidemiologically proven that lowering LDL reduces the risk of coronary artery disease (myocardial infarction, angina pectoris, etc.), but people don't die always of myocardial infarction and angina pectoris. They also die of cancer, infectious diseases, suicide, and other ailments. Rather, lowering cholesterol tends to increase the rate of these diseases.
After being a general physician for 38 years, I've got to understand well that lowering cholesterol and triglyceride wouldn't make people healthier. That reducing cholesterol contributes to general health is quite nonsense idea except regarding to CHD (coronary heart disease). And I would like to emphasize that 70% of people don't die of CHD. Especially in developing countries, 90% of people don't die of CHD. Rather, they die of infectious diseases due to weakened immune system. And if the level of cholesterol gets reduced, immune system gets reduced.
For 24 hours your body is trying to keep the most optimal level of cholesterol for you by calculating the ratio of myocardial infarction and the ratio of cancer incidence and the ratio of infectious diseases and ratio of suicide and ratio of other diseases due to reduced immune system. But the specialists think it is possible to improve our health only by reducing cholesterol level without considering the great natural control mechanism of our body, and they pour the harsh chemicals into the human body. This sounds too much arrogant, medical hubris. Even if the probability of death due to myocardial infarction got reduced but the death rate due to cancer or infectious diseases got increased, lowering cholesterol wouldn't contribute to your lifespan after all.
And what to pay particular attention to is that you should not lower cholesterol level too much. If your total cholesterol level becomes less than 160 mg/dl, be very careful. And if suddenly reduced, check your thyroid and liver function.
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