Things you should know about cholesterol, your health and your skin health

Dr Vaswani who has recently joined Herborium and AcnEase Team is Board Certified Endocrinology and Metabolism Expert as well as Board certified in Clinical Nutrition. He completed his fellowship training at Yale University and was a research scientist at Brookhaven National Laboratories for two decades. He has a clinical practice in Garden City, New York where he specializes in hormonal and metabolic disorders. In addition, he has been immersed in herbal and Ayurvedic applications as alternative treatments for the management of number of health and wellness concerns and is a great proponent of Integrated and Customized medicinal and wellness approach that he shares with Herborium Team.

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Any introduction should begin by explaining the basics of the subject that will be discussed. When introducing the topic of cholesterol, it is a good start by understanding what the properties of cholesterol can do for you in a good way as well as in a bad way. Cholesterol belongs to the family of “fats” but is not the typical greasy substance that we usually associate with fat that we see in food. It is more of a waxy substance which is present in the cell membrane (outer layer of cells) in every cell in the body. Here is cholesterol’s first function, as an integral component of cell membranes where it sits in a double layer and controls the influx of nutrients into the cell and naturally prevents the inner fluid in the cell from leaking out. It also permits several enzymes that are responsible for normal body function to attach to the cell membrane and facilitate the transport of complex molecules. Thus, the cell membrane allows a bidirectional transport of essential nutrients into the cell as well as transport products made by the cell out to the blood stream. As an example, glucose transport into the pancreatic cells will trigger the release of insulin, which is transported through the cell membrane into the blood.

https://www.acnease.com/comparisontable.htm

Now think of the trillions of cells in the human body that are being constantly produced, broken down and replaced. Not to forget an equally staggering millions of new circulating red blood cells that enter and exit the circulation every single day and live for approximately 120 days before they are recycled. Therefore, you can understand the body’s need to make cholesterol is exceedingly high and a constant efficiency of production is required for cell life and function.

The main location to produce cholesterol is the liver. This organ supplies most of the cholesterol needed for all the cells in the body and more than enough to locally produce bile acids. In fact, the chemical composition of cholesterol was first identified in a gallstone, which is nothing but a collection of cholesterol crystals and other salts (called bile salts) that accumulate in the gall bladder under certain conditions. Bile is required for the absorption of fats, whereas the gall stones are an annoyance if they get impacted in the gall bladder.

Chemically, just like all fats, the structure of cholesterol is made up of three simple elements, Carbon, Hydrogen and Oxygen in a complex ring structure that allows the molecule to confer the properties we have described. It does not start as a ring structure but starts with a simple substance you are familiar with – vinegar, or chemically acetic acid. Acetic acid contains 2 carbons, and additional oxygen and hydrogen atoms and serves as the starting molecule in cholesterol synthesis.

Structure of acetic acid:

Starting with this simple two carbon molecule cholesterol is gradually built using a whole series of enzymes until it has reached a total of 27 carbons structure called Cholesterol:

Cholesterol is so called because it also belongs to a family of “sterols” the group of substances with the same common ring-like structure (depicted in the image above). These include sterols or steroid hormones made in the adrenal glands, the ovaries in females and testes in males. These specialized structures or organs in the body are also fully capable of synthesizing cholesterol from the basic carbon fragments because these hormones are essential for life and procreation. Thus, you can now realize the value of cholesterol in our daily existence. Further, cholesterol is eventually broken down into bile acids, which were mentioned earlier, and these bile acids are required to digest fats in the intestine and help to bring in the necessary fatty acids and other components that make up the “fat” family.

Cholesterol is also the starting point to produce Vitamin D, which is a hormone (to be discussed under a separate topic) and can be partially produced in the skin. Vitamin D has several functions in the body one of which is the transport of calcium from the intestines into the blood. Without Vitamin D calcium cannot gain access to the blood and therefore many supplements contain a combination of both Vitamin D and calcium. The skin, which is really the largest “organ” in the body is completely equipped (with the necessary enzymes) to transform the cholesterol and convert it to a form of vitamin D. The capacity for production of cholesterol is far lower than that of the liver. Of course, dietary consumption can also provide cholesterol needed by the body mainly in meats and dairy products.

There are various forms of cholesterol, and these are categorized by their densities, or how heavy (or light) they are. You will often hear cholesterol referred to as HDL (High Density Lipoprotein) or LDL (Low Density Lipoprotein) for instance. This is because they are transported with a specialized protein made in the liver to facilitate their transport in blood. Remember that cholesterol is after all a “fat” and it would float in the blood and not be transported easily. Therefore, it is packaged with these specialized protein structures to easily become soluble in the blood and get transported to the various tissues or locations where it is needed. The LDL-cholesterol is generally considered as “bad” cholesterol since this is the form of cholesterol being transported to tissues and organs and in certain tissues it gets deposited. HDL cholesterol is considered the “good” cholesterol since it is this molecule that transports the tissue cholesterol back to the liver to be metabolized.

So far, we have understood the good story of cholesterol, as to how useful it is to the body for various functions. It is also clear that cholesterol is required to be produced in the body to satisfy the high demand for it from every cell in the body. The dietary sources of cholesterol may only account for a maximum of 20% of the daily requirement. Obviously, the dietary amount will be much lower if a person is a vegetarian and even further reduced availability in the diet if the person is a vegan. Thus, there will be a heavy reliance on the liver to make the necessary cholesterol. Any organ can make cholesterol, but it is easier to rely on the liver, while the specific organs carry out their own functions.

Therefore, the focal point of control rests in the liver, which you can imagine to be a gigantic city of companies that are working to make things, fix things, remove toxins, and filter the blood, or transport various products and so forth. In every organization there is a boss that decides what is best for the company and the cells that regulate the production of cholesterol are no different Their “boss” is an enzyme that monitors the amount of cholesterol that is coming into the liver either for recycling or from the food intake. Once it has calculated the input, it will then figure out how much is going to be shipped out and then direct the production sites to produce the next batch. The key word here is “Go” keep producing until you hear from the boss who says “Stop” now.

Merrily continues to produce cholesterol because no one said they have to stop! Now you see that there is an abundance of cholesterol that is sitting in the liver, the warehouse is full so the next option is to ship it out. What better groups than to send it out at a discounted price to every organ that needs it (or even if it does not need it!!). Take it or dump it!! Thus, it can collect in the blood vessels of various organs such as the heart, the brain and causes atherosclerosis where the cholesterol accumulates in the blood vessels and can eventually block blood flow to the tissues.

https://www.youtube.com/watch?v=AqcdHmM29NE

Now in any given city there is usually a recycling or garbage collection department. The body is no different. Its main cholesterol cleanup “truck” is none other than the HDL which is the scavenger and grabs every available free cholesterol that it can find and brings it back to the liver for recycling. Remember the “boss” who was checking to see what came in? Here is the answer!!! The dietary cholesterol was in already and the supply from the HDL together determines how much NEW cholesterol is needed to be produced. You may have figured out by now that the drugs people take to lower cholesterol, like Lipitor will target how much cholesterol the body is making.

As we have discussed, food does play a certain role in the maintenance of cholesterol balance. It is left up to our choice of foods, which certainly depends on our dietary preferences, habits, or restrictions. One simple way to incorporate a “clean” food into our diet, one that would help to cleanse out some of the negativities of the “bad” cholesterol, is to make Avocado a part of our diet. This can be equated with a “magic food” rather than a “magic pill” that everyone in the world is seeking.

Avocado is a fruit of a tree grown in the tropical and subtropical regions of the world. Our supply of Avocado now comes from California. The fruit is a natural source of Vitamin C and fiber, all of which can either reduce the amount of cholesterol absorbed by the body or permit a better disposal of cholesterol. Additionally, the fatty acid composition made up predominantly of oleic acid provides a rich source of essential fatty acids, which can satisfy hunger and provide “good” fat calories.

A simple way to incorporate Avocado into a daily routine is to make it a staple in the salad, either sliced/diced as a fruit, or as I recommend to my patients, to make a slightly more “liquefied” guacamole and use this as a salad dressing instead of oil. Other ingredients like vinegar, spices can be added to suit the taste.

To conclude our introduction, we may add that to have a better understanding of the complex skin (and other related) disorders we need to grasp the fundamentals of how the bodily systems interact with each other. The building block of every cell is cholesterol and so the story goes on… so tune in to the next article that will help you to maintain healthy body and healthy beautiful skin.