What is Cholesterol?
Article by Dr. Jeffery P. Davies
What is Cholesterol?
Cholesterol is described by most medical textbooks as a waxy fat-like substance found in some foods and also made by the liver. Although cholesterol gets a lot of bad press, cholesterol is absolutely necessary for life. Cholesterol is used by all living cells.
A Few of the Important Roles Of Cholesterol* All cells need cholesterol to maintain the structure of their cell membranes. * Some important hormones are derived from cholesterol. * Cholesterol is essential for brain function and protects against depression.
Cholesterol is so important that the body actually manufactures cholesterol. The body has a beautiful way of handling cholesterol to keep everything in balance. If there is not enough cholesterol it makes more. If there is too much cholesterol the body removes it. However when our diet contains too much saturated fat our system becomes overwhelmed with cholesterol and the elaborate system that the body uses for keeping cholesterol in check breaks down.
Some of you may be old enough to remember “The I Love Lucy” episode where Lucy and Ethel are working in a chocolate factory. They are responsible for boxing up the chocolate as it comes down the conveyor belt. Every thing is fine and fun when the belt is moving at the right speed. However when the conveyor belt goes too fast they can’t keep up with all the chocolate. They start stuffing the chocolate in their mouths, aprons and pants to try to keep the chocolate from falling on the floor. This is what happens when we overload our diet with saturated fats. The cholesterol conveyor belt in our body starts moving too fast. The body is unable to package the cholesterol properly and the body starts looking to places to put the excess. One of the places the body put the excess cholesterol is on the blood vessel walls.
Let’s take a little closer look at what goes on in liver which is the cholesterol processing plant of the body. When we eat fats, the fats are absorbed in the intestinal wall. Here the fats are packaged up in little transport submarines called chylomicrons (ky-low-my-crons). The fats cannot travel in the blood stream without these submarines because of the simple fact that oil and water do not mix. The fats are oil and the blood is primarily water. So in order for the fats to travel in the blood stream they have to be transported in submarines. Once in the blood stream the submarines take the fats to the tissues where they are needed. The fats are a good source of energy so if they travel by a muscle that is actively working and in need of energy the muscle snatches up the fats from the submarine. If there is not much activity going on the submarine transports the fats to the fat cells for storage. The fat and muscle cells are interested in unloading only the portion of the fat that they can use.
After the muscle and fat tissue takes off what they can use the sub goes to the liver for repackaging. The empty sub is reloaded with repackaged as a lipoprotein particles. The lipoprotein particles are a combination of lipid and protein. The submarines are then sent back into the circulation. This transport system allows fat molecules to be transported from the place where they are made (the liver) to the place where that are used, namely, fat and muscle tissue. Each time the submarine goes back to the liver to get repackaged, the lipoprotein contains less and less triglyceride. Eventually the LDL (low density lipoprotein, also know as the “bad” cholesterol) gets sent out for delivery. The LDL cholesterol contains very little triglyceride and is mostly cholesterol.
Why is cholesterol important?Please keep in mind that the LDL particles are necessary for health and serve an important purpose. However the problems arise when the system gets overloaded with the LDL particles. If the liver is unable to process all the fats that show up at its door, the orphaned fats are free to roam the streets (blood vessels) looking for trouble. When the roaming LDL particles reach a certain concentration, the LDL starts to stick onto blood vessel walls. This then sets off a whole cascade of bad events that may eventually lead to heart attack and stroke.
Once the LDL binds to the blood vessel wall they are susceptible to be oxidized. The oxidized LDL then starts to attract more LDL particles and the LDL cluster gets bigger and bigger.
The next event that happens in this sequence of bad events is that the growing LDL cluster which I will call a lesion, sets off the inflammation alarms. The inflammation alarm causes the body to send in the soldier cells to try to take care of the situation. You know as well as I when the soldiers are sent into battle, even though they are well-meaning, the process of the battle causes damage to the area where the battle took place. The soldier cells that are sent in are called macrophages meaning large eating cells (“macro” = large; “phage” = to eat). The macrophages start eating the LDL but because there is so much LDL in these lesions the macrophages become what are know as lipid-laden foam cells. Thus these cells that were initially sent in to help the situation actually make the situation much worse. The growing lesion with the LDL and the foam cells becomes what is sometimes described as a pimple on the blood vessel wall. This gives a wrong picture because these plaques generally do not occur in one little area. These lesions occur more in streaks and cover long areas of the blood vessels. As the lesions get worse and worse they develop areas of calcification and develop into what are know as plaques. These calcium containing plaques make it possible for doctors to detect the presence of the plaques with some of the newer imagining techniques.
The plaques are what cause narrowing of the blood vessel and start to cause blood flow problems as the artery becomes smaller and smaller. For many years doctors thought that the blood vessel continued to narrow until it was completely closed and this was what caused the heart attacks and strokes. We know now that these plaques grow slowly enough to allow the body to remodel the blood vessel (the blood vessel bulges out) or grows new blood vessels to by pass the narrow area to maintain blood flow.
The greatest cause of heart attacks and stroke is when the blood vessel suddenly gets blocked. This occurs when plaques that are unstable suddenly burst. The contents of the lesion then attracts platelets and other chemicals that rapidly forms a clot which blocks the blood vessels.
In summary the stable plaques that narrow the blood vessel wall are not as worrisome as the fragile unstable plaques. The body can compensate for the stable plaques but the fragile clots break off, clots form that break off and suddenly close off the blood vessel. before This is what is know as a heart attack.
About the Author
Dr Jeffrey Davies is a board certified family physician and the medical director of St. Luke’s Health Alliance.
Dr. Davies, before going to medical school, was an engineer with a bachelor’s degree in chemical engineering and a Masters degree in biomedical engineering. His experience includes some 13 years working at Mass General Hospital as a biomechanical engineer conducting research on hip and knee replacement surgery. While this career was r
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