Cholesterol: The Good, the Bad, and the Ugly (3)

Part 3 of 3

Welcome back to the grand finale of our cholesterol journey. As we continue today, we pick up right where we left off. If you missed the first two segments, you can catch up here: and

How do fatty foods enter our bloodstream?

Fatty foods enter our bloodstream through a fascinating process. Our intestinal cells transform them into chylomicrons—think of these as miniature transporters, akin to vesicles designed for fat transportation. After a fatty meal, these chylomicron carriers ferry fats from our intestines into our lymphatic drainage system and then to the bloodstream, delivering essential energy to our cells.

Picture the lymphatic system as a vital drainage network within our body. Lymph vessels, resembling pipes, gather excess fluids from tissues, while vigilant lymph nodes act as diligent filtering stations. This meticulous process ensures our body remains healthy and free from waste. The journey of these chylomicron-packed transporters begins in our intestines, navigating through the lymphatic system to eventually reach our blood. It takes approximately 2-3 hours for them to emerge in our bloodstream and around 11-15 hours to be completely cleared.

Indulge as much as you desire – the fat on top is up to you!

The lymphatic system and blood circulation are intricately connected. Lymphatic vessels seamlessly merge with big veins that drain into the heart, facilitating the integration of lymph—now containing filtered substances, including fatty compounds—into the bloodstream. This integration ensures an efficient exchange of nutrients and waste between tissues and the circulatory system.

Integration of the lymphatic and circulatory systems.

The Good and The Bad Cholesterol, and the Redux

The classification of cholesterol into ‘good’ and ‘bad’ categories is based on the simplified explanation of the direction of lipoprotein flow within our bodies. Lipoproteins that move toward the liver, with the purpose of being eliminated as bile acids, are labeled as ‘good’ because they assist in removing excess cholesterol. On the other hand, lipoproteins, particularly LDLs, moving away from the liver are generally considered ‘bad cholesterol.’ However, it’s important to recognize that categorizing cholesterol in such binary terms is an oversimplification. One reason for this complexity is that an excessive accumulation of fats in the liver can lead to its greasiness, which is inherently undesirable. Pathologists have a term for this condition: fatty liver. If you’d like to dazzle friends at your next gathering, you can confidently utter ‘hepatic steatosis‘ out loud instead! How to practice pronouncing it? You can say, ‘stee-uh-tow-suhs.’ To remember what to say, just think of ‘stir the sauce!’ What sauce? A very thick and greasy sauce!” 

The labels of the good and the bad depend on which way they’re heading!

Types of Lipoproteins

Sorting various lipids and preventing them from mingling presents a bit of a challenge. This challenge arises from the natural tendency of fatty and oily compounds to attract each other, often blending or moving together in a distinctive hierarchical manner determined by their weight and size. To address this, different methods have been designed to separate various blood lipoproteins based on their weights and densities. Two classic techniques widely used by labs and health facilities for lipid separation are ultracentrifugation and electrophoresis. With that in mind, let’s now explore how medical scientists have categorized the lipoproteins responsible for transporting cholesterol in our bloodstream.

1. Chylomicrons

  • Size: Largest
  • Density: Lowest
  • Function: Transport dietary lipids from the intestines to cells. This is in my opinion the most important indicator of the greasiness of our most recent meals!

2. Very Low-Density Lipoproteins (VLDL)

  • Size: Large
  • Density: Low
  • Function: Transport triglycerides synthesized by the liver to cells. In my opinion, this is the most crucial indicator of unhealthy eating and lifestyle habits. Elevated VLDL levels are often associated with meals high in saturated fats, obesity, type 2 diabetes, insulin resistance, and, most importantly, physical inactivity. 

3. Low-Density Lipoproteins (LDL)

  • Size: Moderate
  • Density: Intermediate
  • Function: Carry cholesterol to cells; often referred to as “bad cholesterol”.

4. High-Density Lipoproteins (HDL)

  • Size: Smallest
  • Density: High
  • Function: Transport cholesterol away from cells to the liver for excretion; often referred to as “good cholesterol”.

If you’ve been curious about the distance of the good from the bad, this chart is for you!

The Cholesterol Ratio

You may have heard that the total cholesterol number isn’t the most critical; instead, it’s the cholesterol ratios that truly matter. Let’s delve into this. Physicians use various ratios to assess heart health, such as LDL (bad cholesterol) to Total Cholesterol. Ideally, this ratio should be less than 2:5, indicating a healthier balance and lowering the risk of heart issues.

Another significant ratio is HDL (good cholesterol) to Total Cholesterol. Aim for a ratio over 1:5, signaling an effective way to clear cholesterol and defend against heart disease.

The triglycerides to HDL ratio reveal insights into metabolic health, ideally less than 2:1. Elevated triglycerides relative to HDL may suggest a higher risk of heart problems. As mentioned before, an excess intake of triglycerides often corresponds to a high-fat intake.

Understanding these ratios is key to evaluating heart health. Maintaining a low LDL to Total Cholesterol ratio and a high HDL to Total Cholesterol ratio fosters heart health. Regular check-ups and lifestyle adjustments are crucial for sustaining these optimal ratios.

How to Keep It All Straight?

The ‘L’ in LDL stands for Lousy, Lethal, and Lazy—why ‘Lazy’? Because it increases in the blood of inactive individuals! The ‘H’ in HDL stands for Healthy, Heartily, and Heavenly! But what about the ‘u‘ in ugly? Could it represent our ongoing unhealthy habits that transformed the youthful version of ourselves into someone burdened with excess fat and cholesterol? Can you think of a better word?

Before I proceed, it’s important to note that the mnemonic (memory-boosting) tips I’ve shared with you have been circulating among medical students for an extended period. As you may recall, I’ve underscored multiple times that we aren’t truly acquiring new knowledge; rather, we are recalling what has already been articulated. Our task involves infusing our unique perspectives into the extensive pool of existing information and asserting ownership over it. To infuse a little of my philosophical perspective into all this, it’s all already been given to us, we only choose and pick them the way that we like and then say: “this belongs to me!” But I tell you I just don’t want much fat to belong to me. How about you?

Do’s and Don’ts

Taking steps to support cardiovascular health is essential. It’s prudent to refrain from the excessive consumption of fatty foods, particularly those high in saturated and trans fats—known contributors to increased LDL cholesterol. These lipids are commonly found in items such as red meat, full-fat dairy products, and processed snacks. Opting for healthier fats, like those found in avocados, nuts, and olive oil, can contribute to improved heart health. Be mindful that dietary choices, overall lifestyle, and genetic factors all influence cholesterol levels. Consulting with a healthcare professional can provide personalized guidance.

Now, diving deeper into fats, let’s talk about trans fats. They are a type of unsaturated fat found in some processed foods, created through a process called hydrogenation, where hydrogen is added to liquid oils to make them more solid. Trans fats have been associated with various health risks, including an increased risk of heart disease. Many health authorities recommend minimizing their intake for better cardiovascular health. An example of trans fat is partially hydrogenated oil, often used in some margarines, snack foods, and baked goods. Checking food labels can help identify products containing trans fats, but many countries have implemented regulations to reduce or eliminate their use in processed foods.


Excess of seemingly beneficial substances, like cholesterol, can negatively impact our health. Our fascination with possessing and accumulating physical entities, including food, sometimes leads to detrimental consequences.

For those eager to explore further our innate desire to acquire and possess physical entities, I have written a blog post on the subject. You can explore it by following this link:

I strongly believe that individuals who can acquire much more material possessions, including food, yet exercise restraint through sheer willpower, have already cracked one of the most important secrets of holistic longevity.

Trust me, you don’t want to own this one!

Dr. Eftekar (Dr. E) is the founder and head coach of the Center for Conquest of Longevity and Northwestern Medical Review. A unique attribute of Dr. E is his well-rounded academic background that, in addition to the science of medicine, extends over several other disciplines such as physiology of aging and longevity, philosophy of science and medicine, and integrated kinesiology.

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