Is “good” cholesterol always good?

Do you want me to make you some fried pork rinds? A piece of ham? / Or do you prefer fried chicken, honey? / No, chicharrón, your chicken and your ham are very tasty. / But none of that right now, darling.

Of course, the social network TikTok turned this song viral Cholesterol. And it’s because if its author Fito Olivares won the fight with cholesterol, so can we.

We may not understand the values ​​that blood tests show us, but we know that there are two numbers to pay attention to: “good” cholesterol (HDL) and “bad” cholesterol (LDL). But why do we call them that? Is the assignment of roles that clear? Let’s go in parts.

The double face of an essential lipid

Cholesterol is a lipid (fat) present in all cells of the body and essential for the body. Among other things, it is a precursor of bile acids (necessary for food digestion), sex hormones (testosterone in men, progesterone and estrogen in women) and thyroid hormones.

Although the majority is synthesized in the liver, it is also obtained by consuming foods such as eggs, red meat or dairy products.

And now let’s get acquainted with both adepts of the match. On one side of the ring we have HDL, from English high density lipoprotein (high density lipoprotein). We call it “good” cholesterol because it transports cholesterol from other parts of the body back to the liver to be eliminated. For this reason, high levels of HDL are associated with a protective effect against cardiovascular disease.

On the opposite side of the quadrilateral LDL –of low density lipoprotein (low-density lipoprotein) – is classified as “bad” because its excess accumulates in the arteries and forms atherosclerotic plaques. If these plaques settle in the arteries of the heart, they can cause angina pectoris or heart attacks, and if they accumulate in the arteries of the brain, they can cause strokes.

A little joke with how they told Spanish actor Javier Cámar in a famous TV spot about a dairy product that claimed to lower “bad” cholesterol levels.

Right on

Until now, studies have been unanimous on this point: lowering LDL and increasing HDL reduces cardiovascular risk.

According to the Spanish Heart Foundation, in people without cardiovascular disease or risk factors, normal values ​​for LDL would be below 160 mg/dL and HDL above 40 mg/dL.

A good option to follow these recommendations is to practice the Mediterranean diet. In addition, this type of diet, based on the consumption of fruits, vegetables and healthy fats, is estimated to increase HDL, or “good” cholesterol, by 10%.

Script twist: when “good” turns “bad”

However, new studies cast some doubt on the “goodness” of HDL. Or at least they limit it.

According to the results of these studies, levels above 80 mg/dL not only do not reduce the risk of cardiovascular disease, but rather increase it. Other body systems can also be affected: a study conducted in Australia found that a population with high levels of HDL had a 33% higher risk of bone fractures.

The mechanism that produces these effects is not clear, but two possible options are on the table:

• On the one hand, it is believed that the molecular structure of HDL is modified and prevents the elimination of excess cholesterol from the body when it has high levels.

• On the other hand, it can happen that in very high amounts the total amount of cholesterol – the sum of HDL and LDL – reaches the risk zone.

Is there any way to control it?

But beware, skyrocketing HDL cholesterol is rare (less than 7% of the population experiences it) and extremely rare just for a healthy lifestyle. There are organic pathologies such as hyperthyroidism, alcoholism or cirrhosis, candidates for its production.

In addition, the latest studies link high HDL levels to an increased risk of cardiovascular death in men, but not in women without coronary artery disease. Will estrogen be a protective factor?

To counter the decades of evidence confirming an inverse relationship between HDL cholesterol and cardiovascular disease risk, we need much more research and future clinical practice guidelines if they consider this to act.

There is little we can do individually to control our HDL numbers. While the science advances, let’s continue to work to keep LDL levels low with a Mediterranean diet, a healthy lifestyle, and keeping “bad” cholesterol-lowering drugs (lipid-lowering agents) on the market. ranking of the 10 most commonly prescribed drugs in the world.