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Cholesterol tends to be misunderstood in two different ways. One common misunderstanding is that somehow cholesterol "clogs the pipes" and accumulates inside arteries when cholesterol levels are too high. This isn't the way the process of atherosclerosis, or the hardening of arteries, works. 

The way cholesterol is misunderstood is failing to account for the fact that cholesterol is just part of the problem. It accumulates in fatty streaks on the linings of arteries, and it becomes food for the kind of white blood cells that fight bacterial infection, the macrophages. This isn't a bad thing. Feeding white blood cells is a beneficial outcome for cholesterol. Usually, this is not a problem, but sometimes a macrophage, which is a relatively large white blood cell, gets "stuck" in a part of an artery exposed to higher pressure, usually where the artery bends, or where the artery has been injured by infection or blunt force.

When a macrophage gets stuck, it eventually dies. Then other macrophages come along to remove it, but they also get stuck. Finally a mass of dead macrophages can form a sticky mass on the lining of the artery, but it doesn't "harden" unless there are certain changes in blood chemistry. 

Moreover, it isn't every kind of cholesterol that can get stuck in the lining of arteries. In fact, it isn't even all LDL or "bad" cholesterol that can get stuck in the lining of the arteries. It's only cholesterol that is in a kind of transitional state between LDL (low-density lipoprotein, that occurs in big, fluffy pieces) and HDL (high-density lipoprotein, that occurs in small, compact pieces) that is a problem at all. The reason doctors don't actually measure the kind of cholesterol that can actually cause a problem is that it is easier and less expensive to estimate (and it's only an estimate) LDL levels.

Cholesterol alone isn't enough to cause atherosclerosis. That's why some people, like me, may have a heart attack when they have low cholesterol. Other people don't have a heart attack when they have high cholesterol.

Another part of the puzzle is antioxidant levels in the bloodstream. Even if you have high LDL, and high levels of the artery-clogging, atherogenic kind of LDL, you don't get atherosclerosis with a piling up of macrophages. This depends on a kind of chemical "homing signal" that macrophages make. Not everyone's body makes the same amount. Even after all the macrophages have clumped at a site of injury in the arterial wall, they don't necessarily turn into a hard, calcified plaque unless you are also indulging in trans-fats and excessive sugars.

The bottom line is, cholesterol is important, but it's not the only important thing in keeping your arteries clear. 

Here's what you need to do (this is do as I say, not do as I in fact did, as I know better now):

  • Don't worry so much about total cholesterol as LDL cholesterol. It's your LDL level that needs to be in line, even more than your total cholesterol level. 
  • Don't guess about where you have "high cholesterol" or not. Get a blood test. Be aware that cholesterol levels can fluctuate by time of day you take the test. If you aren't fasting when you have blood drawn for the test, your cholesterol levels may be about 10 percent higher.
  • Don't rely on diet to lower your cholesterol. Your body only gets about 15 percent of all its cholesterol from food. This means that you can only lower your cholestero levels about 15 percent by diet. You could consume no cholesterol at all, and not necessarily have healthy cholesterol levels. You could eat lots of eggs and not necessarily raise your cholesterol level, because the digestive tract can only absorb about the equivalent of the cholesterol in a single egg per meal, or even less.
  • Limit your intake of saturated fat and sugars. This helps to maintain your blood chemistry so that soft cholesterol doesn't turn into dangerously hard plaque.
  • Don't eat too much of anything. Excess "calories" become triglycerides, which also aggravate cholesterol issues.
  • Exercise, but emphasize resistance training. The kind of exercise that does the most good for lowering cholesterol levels is weight lifting. It's about 50 times more effective than aerobic exercise. It's still a good idea to walk 10,000 steps a day, but for maintaining circulation through all your blood vessels, not for lowering cholesterol.
  • When you have attempted these changes for several months, get another cholesterol test. If your levels are still high, then talk with the doctor about medication.

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