The media often portrays cholesterol as the number one reason for heart disease but how many of us know that our body produces cholesterol on its own too?

In fact, cholesterol helps our body produce hormones, insulate nerves, and even build new cells. Generally, the liver produces enough cholesterol that the body needs, however, it can also be gathered through animal-based foods such as eggs, meat, and milk.

“Our body needs cholesterol for various functions. Apart from the cell membranes needing it as an important building block, other organs need cholesterol too,” explains Dr Zubin.

“For example, the brain uses a lot of cholesterol in the myelin sheath, a fatty material that surrounds the nerve fibres. In the brain, cholesterol also aids nerve cells to communicate with each other and exchange electrical signals. And this is just naming a few functions of cholesterol in our body.”

Although there are a few different types of cholesterol identified based on their density and size, the most commonly known ones are LDL (Low Density Lipoprotein) and HDL (High Density Lipoprotein). 

The Good and the Bad

Traditionally, these two types of cholesterol have been labelled ‘good’ and ‘bad’ cholesterol based on their functions: LDL delivers fat molecules to cells while HDL removes fat molecules from cells to the liver for excretion or re-utilisation. Nonetheless, studies have found that it is not that simplistic when it comes to cholesterol.

“The notion of bad cholesterol and good cholesterol may still be used but shouldn’t be wholeheartedly adhered to as it is being done now. Even the good cholesterol (HDL) could be problematic; its numbers may be normal but due to some reasons its function may be abnormal,” says Dr Zubin.

Classification technicalities aside, the main reason of fear among the public for cholesterol is hypercholesterolemia, the state in which too much of the lipoprotein is present in the blood circulation causing build up within the artery wall and leading to atherosclerosis, where the arteries narrowed causing the available blood flow to the heart to be reduced in times of exertion or intense exercise. In certain chronic states, the blood vessels may be completely blocked.

However, in the state of confusion and information overload, patients tend to overlook the fact that hypercholesterolemia is not caused entirely by dietary cholesterol but also other factors.

“Over time, the public and many doctors too may have become too focused on cholesterol that we’ve neglected many other risk factors that could lead to heart disease.

High cholesterol is just one major risk factor and we may have occasionally neglected everything else. At what stage should they be concerned about cholesterol?

The Other Heart-Health Risk Factors

The most consistent and important risk factor for heart disease so far is age. So, if you have high cholesterol at the age of 80 it is fine but if you have high cholesterol at 40 that means you have a higher chance of experiencing problems,” Dr Zubin cautions.

The other risk factors that both patients and doctors need to pay attention to before focusing on treating just the cholesterol with medication includes smoking, physical inactivity, obesity, hypertension, diabetes and excessive alcohol drinking.

The possibility of familial hypercholesterolemia, which is an inherited condition which causes very high cholesterol leading to heart disease needs to be considered too. 

Unfortunately, there are no symptoms of this until it’s too late, when signs of later stage hypercholesterolemia begin to appear like white plaques under the skin of the eyelids due to build-up of cholesterol around the skin (xanthelasma) and cholesterol deposits around the elbows and ankles (xanthoma).

Research has shown that Asians in general may be genetically predisposed to hypercholesterolemia and obesity. Furthermore, obese people generally have more inflammation in their bodies (detected by raised high sensitivity C-Reactive Protein (hs-CRP) in the blood stream).

A healthy lifestyle and a balanced approach of managing your dietary carbohydrates, fats and cholesterol is required to avoid overtreatment and frustration.

“Some people go out of their way to reduce their cholesterol but after 3 or 4 months of dieting they find that their cholesterol levels didn’t go down.  What is important is to know your risk factors. Cholesterol may only be a bystander but with the presence of other dangerous elements like obesity and inactivity, it then becomes an important ingredient in the development of coronary artherosclerosis. My advice is to practice a healthy diet and exercise regularly,” emphasises Dr Zubin.