Whether it’s a friend or family member mentioning an article they recently read or the all too common occurrence of an advertisement about how drug A lowers bad cholesterol or food B raises good cholesterol, literally every day I come across someone talk about “good” and “bad” cholesterol. It’s frankly driving me crazy.

Because it’s been a couple months since my last post/rant on cholesterol, I figured it was time to get my thoughts out there again…

Rethinking Good & Bad Cholesterol

I’ve covered cholesterol in much more detail over the years than many people probably care to read but this simple idea about good and bad cholesterol, maybe more than anything else, has been one of the worst medical missteps in recent memory.

There is no such thing as good and bad cholesterol.

All cholesterol is the same. It’s all serving a necessary and vital purpose in your body. It is simply one little piece of the puzzle in an immense adaptive system for survival, growth and repair.

What people mistakenly call “bad cholesterol” is the cholesterol that’s carried in Low Density Lipoprotein particles. This “LDL cholesterol” was thought at one time to be the cholesterol that was deposited into your arteries and forms plaques. Therefore, in reductionist modern medical thinking, it must be bad. We also often saw higher levels of cholesterol carried in LDL particles in heart disease patients so that cemented the deal. LDL cholesterol is bad.

What people call “good cholesterol” is the same kind of cholesterol that’s carried in High Density Lipoprotein particles. This HDL cholesterol was thought to be the cholesterol that got picked up from your arteries and taken back to your liver to be recycled. We often saw higher levels of cholesterol in HDL particles in healthy people so that cemented the deal again. HDL cholesterol is good.

Therefore, in medical land, if you want to be healthy and protect yourself from heart disease, get that bad LDL cholesterol down and that good HDL cholesterol up. It’s that simple.

**Side note: It’s also very simple and convenient for companies like food and drug manufacturers to create and sell things that fit into this paradigm.

It’s Never That Simple

First things first. We are so far from understanding the intricacies and reasonings behind the human body it’s foolish to think we know what the body is doing or trying to do. We’re getting closer but that gets us in trouble very often when we jump to conclusions too early. We have got to stop presuming we “know” what the body is doing and then trying to fix it. We need to take a step back in everything about the body and the cholesterol situation is a prime example. Hypothesizing about the role of cholesterol is fine but saying we have it figured out is irresponsible and trying to control it is dangerous.

Secondly, if we look at the above logic that created bad and good cholesterol there’s big problem. It’s probably best shown in an analogy…

The 24 Hour Road Crew
The headquarters for the local road repair workers lies close to the heart of the city. This city considers their job so important that those workers actually live in the main building so that they can get up and go straight off to work without missing a beat. It also runs on 24 hour schedule so that there’s always people to repair any damage that pops up. Red buses come to pick up workers and take them to repair sites and blue buses pick them up and take them back home when they’re done. It’s actually quite an efficient system, although some times are a little busier than others. But all in all, the buses and workers do their job quite well.

The problem is, there’s been quite a stir lately over their work. Some city managers notice that the red buses are always dropping workers off at cracks in the streets and then they slow traffic down with the repair work and all the cones. They’ve even started calling them the “bad road crew” and even boo them when they see them in the red buses because they know they’re going out to do more repair work and cause delays. Thankfully, however, when the repair work is over they get picked up in blue buses and the same city managers call them the “good road crew” and cheer them on. Strange world they seem to live in where they can be called both bad and good all in a day, mostly due to the color bus they happen to be in at the time, but they still go about their work nonetheless because those streets need to be repaired.

To make matters worse, now the city managers, overwhelmed in their fear of a smooth running city, have gone a step further and are doing all these things to prevent workers from getting in the red buses and are trying to get more workers into the blue buses on the street. They are even setting up new guidelines at headquarters to limit how many workers can be out in the city. Considering it a success when they see less road workers out in the red buses in the streets, the city managers pat themselves on the back as having solved the problem despite the fact the roads aren’t getting repaired and the damage is actually adding up. Not only that, the road workers also used to help with other jobs throughout the city (such as the power plant, law enforcement, new construction and sanitation) and those departments are starting to fall behind without the extra help. It seems that the more the managers worry about the road crew and try to keep them from working, the worse the city is functioning. The workers keep thinking: why don’t they let us just do our job?

One worker, getting increasingly frustrated because the work keeps getting worse, steps up one day and says, “I know city management loves to try to solve problems and it’s an easy target to point fingers at the road crew but what if instead of blaming us and the buses for delays, why don’t we try to figure out why all the roads are getting run down and damaged in the first place? What’s causing all the work we have to go do? It seems to me that the answer lies less in managing the road crew and more what’s wearing down the streets so quickly and severely. Less road damage equals less buses and workers on the street and would also free us up to help more around the city, making everything more efficient. This might actually get to the root of the problem. How about that idea?”

The city management is still considering this radical idea and has yet to respond publicly… (although rumor has it a few of the more open minded administrators have leaked out that they agree with the worker’s idea but are having a hard time convincing the more close minded folks that still see the symptom as the problem)

So for now, the city folks go back to counting red and blue buses to diagnose how well their city is functioning.

Just Plain Old Cholesterol

Hopefully this little story shows how our current labeling of cholesterol isn’t very helpful. We can’t call cholesterol bad or good depending on it being in an LDL carrier or HDL particle because it’s all the same substance regardless of what transports it around the body. We also can’t call the LDL and HDL particles good or bad because they are simply carrying the cholesterol where the body needs it. It’s the same as saying the red buses are bad and blue buses are good. It misses the whole point.

Cholesterol is an adaptive response to what the body needs. The greater the need the more cholesterol we make. Instead of blaming the road crew (and then praising them when later) lets look at why the roads are getting damaged in the first place and we might end up getting somewhere.

The body’s adaptive response (and cholesterol system specifically) is really much more intricate than this simple analogy but hopefully it helps show why it’s foolish to keep talking about good and bad cholesterol.

Thanks for reading, have a great day!