Cholesterol - The Good and the Bad

Cholesterol, a waxy, fat-like substance, has been known to medical science since the early 18th century when French chemist François Poulletier de la Salle first identified it in gallstones. Later in the 19th century, it was isolated and named cholestérine by Michel Eugène Chevreul. Since then, researchers have come to understand that cholesterol is not inherently harmful—in fact, it is a crucial element in human biology.

Produced naturally by the liver, cholesterol plays multiple vital roles: it helps form cell membranes, aids in the production of hormones like estrogen and testosterone, and is essential for synthesizing vitamin D. It also contributes to bile acid formation, which allows the body to digest and absorb fats. In short, cholesterol is indispensable. Problems arise only when its balance in the bloodstream tips unfavorably.

Because cholesterol cannot dissolve in blood, it travels in particles known as lipoproteins. Detecting imbalances is relatively straightforward with a blood test called a lipid panel. This test measures:

• Total cholesterol – the sum of all cholesterol in the blood.

• LDL cholesterol (low-density lipoprotein) – commonly referred to as “bad” cholesterol.

• HDL cholesterol (high-density lipoprotein) – the so-called “good” cholesterol.

• Triglycerides – another form of fat in the blood that, when elevated, can increase cardiovascular risk.

The results are interpreted in relation to risk factors such as age, sex, genetics, diet, lifestyle, and overall health. Regular cholesterol checks are advised for adults every 4–6 years, but more frequent testing is recommended for those with heart disease risk.

Cholesterol itself is neither “good” nor “bad.” The distinction arises from the lipoproteins that transport it:

• LDL (Low-Density Lipoprotein): Known as the “bad” cholesterol, LDL can deposit excess cholesterol on the walls of arteries, forming plaques. Over time, these plaques narrow arteries, stiffen them, and may lead to heart attack, stroke, or peripheral artery disease.

• HDL (High-Density Lipoprotein): Dubbed “good” cholesterol, HDL does the opposite. It acts like a cleanup crew, carrying cholesterol away from arteries and back to the liver for elimination. Higher levels of HDL are linked with reduced risk of cardiovascular events.

The ratio of LDL to HDL, rather than the sheer number alone, is what doctors often emphasize when assessing risk.

While high cholesterol is more common with age, it is not solely an “older adult” condition.

• In the young: Children and teenagers can develop high cholesterol, particularly if obesity, diabetes, or a family history of familial hypercholesterolemia (a genetic disorder) is present. Early buildup of arterial plaque has been documented even in teenagers, signaling that prevention must begin in youth.

• In the old: Aging naturally changes metabolism and blood vessel elasticity. As decades pass, the cumulative impact of dietary habits, smoking, sedentary lifestyles, and genetic predispositions becomes evident. The elderly are at much higher risk for cardiovascular complications from high cholesterol.

Thus, cholesterol is a lifelong issue, requiring awareness at all stages.

• Mediterranean Diet: Rich in olive oil, nuts, fish, vegetables, fruits, and whole grains. It boosts HDL and lowers LDL.

• High-fiber foods: Oats, beans, lentils, apples, and barley help trap cholesterol in the digestive system before it reaches the bloodstream.

• Fatty fish: Salmon, mackerel, and sardines contain omega-3 fatty acids that improve heart health.

• Plant sterols and stanols: Found in fortified foods, these compounds reduce absorption of cholesterol in the intestines.

• Western Diet (fast foods, processed snacks, red meats, fried foods): High in trans fats, saturated fats, and refined sugars, this diet is strongly associated with increased LDL.

• Excessive dairy and butter: Full-fat dairy products, when consumed heavily, contribute to high LDL.

• Processed baked goods: Commercial cookies, pies, and pastries often hide dangerous trans fats, even when labels appear “healthy.”

Essentially, diets loaded with trans fats and refined carbohydrates are the worst offenders, while those emphasizing plants, fiber, and lean proteins are protective.

Cholesterol affects men and women differently across the lifespan.

• Men: On average, men tend to develop high cholesterol earlier than women. This partly explains why men have a higher incidence of heart attacks in midlife.

• Women: Thanks to estrogen, premenopausal women usually have higher HDL levels. However, after menopause, LDL levels tend to rise significantly, often matching or surpassing those of men.

This distinction means that men must be cautious earlier in life, while women must become particularly vigilant after menopause.

Cholesterol is not an enemy but a vital ally—when kept in balance. Its history in medical science reveals how something essential to life can also contribute to disease. Through regular detection, an understanding of “good” and “bad” cholesterol, and proactive diet and lifestyle adjustments, individuals can manage their cholesterol levels at any age.

For both men and women, from youth to old age, the lessons are clear: avoid the worst dietary culprits of trans fats and heavily processed foods, embrace fiber-rich and Mediterranean-style diets, and remember that cholesterol health is a lifelong commitment.