Many people hear the term "high cholesterol" and immediately feel concerned, especially when they see a test result showing a spike in LDL levels and the words "bad cholesterol" next to it. But the truth is... LDL isn't always the bad guy. Today, we'd like to share a new understanding of what cholesterol is, how important LDL is, and how we can protect ourselves from heart disease.

Cholesterol is not the enemy…if you know it well.

Many people mistakenly believe that LDL is cholesterol, but it is not. LDL (Low-density Lipoprotein) It is a protein that acts like a “transport vehicle” to carry cholesterol It is a type of fat that travels from the liver to various parts of the body.

High cholesterol: Don't just look at the numbers

Because the risk of heart disease does not depend solely on the amount of LDL, Dr. Pijak Wongwisit, a specialist from W9 Wellness, explains that the issue of "fat," particularly LDL, is more complex than we think, and there are three important points that he wants everyone to understand.

1. Most LDL does not come from the food we eat.

Many people think that eating a lot of it = high LDL, but in reality Most LDL is made by our own “liver”. Dietary fat affects triglycerides More than direct LDL

Factors that stimulate the body to produce more or less LDL include:

• heredity
• accumulated stress
• Poor quality sleep
• As we age, sex hormones decrease, which results in the liver being less able to eliminate LDL.

DiligenceMaintain hormonal balanceAccording to age, it helps balance body fat and reduce the risk of heart disease.

2. Chronic inflammation in the blood vessels, an invisible catalyst for danger.

High cholesterol is even more frightening if our body has it. chronic inflammation Hidden, especially the inflammation that occurs in Blood vessel wall Imagine our blood vessels as “water pipes”. If inside the pipes there are Scale or algae stains Island

• The pipe will be rough and uneven.
• Water is not flowing smoothly
• Waste or stains will easily stick.

In the body as well Inflamed and uneven blood vessel walls It will make it easier for LDL fat to stick, forming "fatty plaques" that build up until the blood vessels narrow or become blocked. The important thing is this type of inflammation. Often asymptomatic But it can be checked by checking the blood values. hs-CRP (high-sensitivity C-Reactive Protein) If this value is high without fever or illness, it means that the body may be experiencing silent inflammation, which is a warning sign to take care of your blood vessel health.

3. Don't just look at the numbers! Because the "quality" of LDL is more important than the "quantity".

When we have an annual health check, we usually get the following values: Total LDL For example, if the result is “LDL = 130 mg/dl” and you think it is within the normal range, but do you know that… People with the same total LDL may have different risk factors for heart disease.

The cause lies in the type of LDL that is hidden inside, in particular. Small dense LDL (sdLDL)

This one is more dangerous because

• It is very small (only 22–29 nanometers): it can easily penetrate the blood vessel wall.
• Easily oxidized: causes inflammation
• build Plaque Easy: Increases the risk of blood clots

Example: Two people have the same LDL = 130 mg/dl, but if one has higher sdLDL, then the risk of heart disease is many times greater.

Accurately check your high cholesterol with Advanced Lipid Profile

Typical lipid tests often only tell us “total values” like LDL or HDL, but in reality, heart disease risk is more than just numbers. Advanced Lipid Profile It will help doctors see

• Fat structure What type is it?
• LDL quality For example, is it small or large? 
• Is the number of particles large or small?

This information allows

• Accurately assess cardiovascular disease risk
• Decide whether or not to use the drug.
• Plan your health care more precisely and more accurately.

Who is it suitable for?

• People who have Family history of heart disease
• Diabetic patients or high blood pressure
• People who have Chronic high cholesterol
• Those who smoking or Not exercising
• Or even healthy people who want to know about “hidden risks”

Therefore, if you want to know the risk “seriously”, you have to examine more than the total LDL amount, such as checking Advanced Lipid Profile To clearly tell both the “structure” and “quality” of LDL.

How to balance cholesterol levels

Whether it's for heart health prevention or care, it's important to keep your cholesterol levels under control. This can be done with or without medication, as follows:

1. Use cholesterol-lowering drugs when the risk is high or cannot be controlled naturally.

If you have adjusted your behavior but your cholesterol is still high, or you are in a high-risk group, such as having heart disease, diabetes, high blood pressure, etc. Drug use Especially groups Statins It's also an effective option. In addition to lowering LDL cholesterol, research has found that statins reduce inflammation in blood vessels and may help reduce the death rate from heart disease in the elderly.

However, all medications have advantages and precautions. Precautions when using statins continuously for a long period of time include:

• Side effects on muscles: It may range from muscle aches or weakness (about 5-10%) to severe rhabdomyolysis (very rare).
• Effects on the liver: It may increase liver enzyme levels. It should not be used in people with severe liver disease and should be monitored for any unusual symptoms such as fatigue, loss of appetite, or jaundice.
• Hyperglycemia: Some research has found that statins, especially in high doses, may slightly increase the risk of developing type 2 diabetes.
• Neurological symptoms (some cases): Temporary memory loss or confusion may occur, which is rare and usually returns to normal when the medication is stopped.

Use of medication should be under the supervision of a doctor only.

2. How to naturally reduce high cholesterol (or do them together)

Foods you should eat

• Eat a diet that is primarily plant-based. Whole-food, Plant-based such as brown rice, whole wheat bread, various green vegetables, tofu, various types of beans
• Reduce saturated fat Such as fatty red meat, full-fat milk, palm/coconut oil.
• Avoid trans fats Such as margarine, baked goods, and fried foods.
• Reduce sweets High sugar and processed foods
• Add fiber For example, whole grains, vegetables, fruits, and nuts help reduce fat absorption and lower LDL levels.

Although LDL does not come directly from food, what we eat affects the liver's “LDL production.”

Exercise regularly

• Exercise type Anti-aging Or exercise that emphasizes moderation and sufficient stimulation of "hormones" for slowing down aging, such as muscle strength training (Resistance training) such as squats, push-ups, planks, along with aerobic exercise (Aerobic exercise) such as brisk walking, jogging, cycling, which can be done at home.
• Regular exercise increases levels of good cholesterol (HDL), which is like the “garbage truck” that carries excess cholesterol back to the liver for disposal.

Promotes the functioning of the “liver” to its full potential

• The liver is the center of all fat management in the body.
• Take good care of your liver's detox system, especially glutathione.
• It reduces the accumulation of homocysteine, a waste product that stimulates inflammation, preventing both heart disease and dementia.

Fortified with natural nutrients (must consult an expert)

Research has found that certain substances may help lower LDL, such as:

• Plant Sterols
• Niacin (Vitamin B3)
• Berberine
• Red Yeast Rice (Red Yeast Rice)
• Flaxseed
• Green Tea Extract

However, choosing a dietary supplement should always be done in consultation with a doctor or nutritionist to ensure suitability, safety, and to prevent potential interactions with other medications or supplements.

Good health starts with correct understanding.

Cholesterol isn't a distant concern, and it's not just about "bad fat." Understanding what LDL is, its role, and which factors increase your risk of heart disease is the first step in taking care of yourself comprehensively.

Annual health checkups combined with an Advanced Lipid Profile will give you a clearer picture of your internal health, know where your risks lie, and allow you to plan appropriately.

Phramongkutklao Hospital (3rd floor, Building A)

• Phone number: 092-9936922
• Line: @w9wellness
• Opening-closing hours: 08.00 – 17.00 hrs.

refer: NIH.gov; High Cholesterol and Natural Products, February 2024