 Hello everyone, this is Dr. Ahmet Ergin. I'm an endocrinologist and I'm a diabetes education specialist. Now we are going to talk about today LDL cholesterol. As you all know, LDL cholesterol, or any cholesterol by any means, is important in treating your overall health including your diabetes. So if somebody is treating your diabetes and not paying attention to your cholesterol, that's a huge problem. As we discussed in previous videos, that if you actually are just treating your glucose numbers and you are letting your cholesterol raise, then you are going to have the cardiovascular problems, which is heart attacks and strokes, and that's the exact thing we want to avoid. So yes, we want to improve insulin resistance. Yes, we want to improve blood sugar levels. But we definitely want to make sure that your cholesterol remains within goal. And LDL cholesterol is something that a lot of people do not understand. Now, when you see your cholesterol panel, you will see that you actually have multiple things reported in your cholesterol test. And you look at that and you see total cholesterol, you see HDL cholesterol, LDL cholesterol, and triglycerides. So here is how cholesterol is typically calculated. So basically, as you can see, it is a calculation method in most cases because we know that they all work together. Now, LDL refers to a low-density lipoprotein. So lipoproteins are basically proteins that allow the fat molecules to travel in your blood. Remember, if you see fat and water together, what happens? They separate, right? They don't really mix in well. So that's why these proteins create a spherical structure to be able to transport cholesterol and triglycerides. So basically, that's why we call them lipoproteins. So LDL is low-density lipoprotein. HDL is high-density lipoprotein. VLDL is very low-density lipoprotein. And then we even have ultra-low-density lipoproteins, which are chylomicrons, which comes through your diet. Now, the basic function of these lipoproteins, and especially the LDL, is transport triglycerides to your tissues. Because bottom line is, the fat you eat in your diet has to go to your tissues to be used, right? So as a result, the cholesterol, especially in your diet or whatever that's produced by your liver, has to be transported to tissues. Now, cholesterol is very important because every cell, every membrane we call that, every membrane around the cells are made of cholesterol. So we are basically made of cholesterol. Now, how does too much cholesterol actually kill you at the same time? Isn't that weird? Yeah, it is. You know, actually, too much of anything can kill you. You can actually kill yourself with water. You can make anything toxic if it is too much. Now, how do you know it is too much? Yeah, that has been a debate of scientific studies, the topic of scientific studies, and we are still debating certain things. And if you look at the blogs and like for regular people discussing about cholesterol, I see a lot of funny things that people are debating. But the truth is, there are actually a lot of cholesterol topics, even among scientists, are still debatable. That's why I want to raise some shine into this topic so you can be better informed instead of getting confused between what you see and what you watch. So LDL cholesterol, they say it's a bad cholesterol, right? Why is it bad? Who said that LDL is bad? LDL is not a bad cholesterol. It is what it is. You have LDL cholesterol in your blood and it has a function. The problem happens when LDL is too much. So the problem is the LDL molecule carries triglycerides and then after the triglycerides are basically dumped to whatever it needed to be dumped for, you know, for that transport purposes. And then you have an LDL that basically has some cholesterol and then it's just hanging around in the blood. Now, what happens sometimes when the LDL is too much, it gets under the blood vessel wall. I'm going to here show you how this cholesterol, the bad LDL, the bad cholesterol, the LDL gets under your blood vessel wall and creates the accumulation. Now, as you can see, these yellow things that are trying to go right here sees yellow particles going under your endothelial lining. Endothelium can be damaged from a variety of things. So this could be your blood pressure. It could be too much sugar, too much insulin, smoking, high blood pressure. All these things will damage the arterial wall. As you see here, there is a damage right here. Now, that damage definitely allows the cholesterol to go under. Now, as we discussed, the LDL, when it's hanging around in your blood because of too much cholesterol made by your liver or too much cholesterol that you're eating, and then they do their function but they're not picked up by the liver, they end up going under your endothelial lining and that creates an inflammation. And once that inflammation happens, then you are in trouble. Now, why does that happen? Why do they still hang around in your blood? Now, the problem is in your liver and in your tissues, normally LDL also should be engulfed, which means that it has to be removed once the function is over. However, as we age especially, the LDL receptors are unfortunately down-regulated. In this case, your liver is not really picking up all the LDL from your blood. So you have this bunch of LDL, jobless LDL, and potential problem. And then this LDL basically, just running around in your system and finding a place to go. What do you do when you don't have a job? You're just trying to hang out and trying to find some time to kill, right? That's exactly what LDL does. Now, also, let's say you have no jobs and you end up meeting some bad friends. What happens when you have bad friends and you have no job? That's not a good combination, right? So when LDL meets the bad friends, which are triglycerides and your... Think about this, triglycerides are the bad friends and HDL is the good friends. So when there's not a lot of HDL in your system, when there's a lot of triglycerides, that LDL that has just dumped the cholesterol and has nothing else to do and it's not picked up by the liver is just going to mess with different things. And one of the things that the LDL does is getting under the blood vessel ball. It's like getting those sneaky, you know, how does criminals go into this places where there's no cops and they're trying to get some business going. The same thing, the LDL goes under your arterial wall and they think that they can sneak under there and spend some time. Now, the problem is your body is smart. So we call them macrophages or typically macrophages are the first defenders for infections, for cancer, etc. But they get alerted anytime there's something fishy going on. And they will go and bite on this LDL. You're not supposed to be here. Get the hell out of here. So and then when that happens, of course, there's going to be a fight. This is going to be like a gang fight between the LDL and macrophages. So the macrophages eventually there will be some casualties in the macrophages. And then those macrophages will start screening inflammation. They're going to like help call, help call. The next thing you know, there's a bunch of police cars coming in, which means that other macrophages are platelets. And then that's how the plaque formation happens in your arteries. So you basically your body is creating that inflammation within itself because of these lazy LDLs who have nothing else to do. They're running in your blood. They're too much. And they have bad friends. So what is the moral of the story? The moral of the story is that don't just look at your LDL. Yes, LDL elevation is directly correlated with cardiovascular problems. But LDL doesn't do it by itself. You have to look at your HDL if the HDL is low, which means which is basically less than 44 men, less than 54 women. And actually more than 60 is considered protective for cardiovascular disease. And triglycerides, if your triglycerides are more than 150 milligram per day as leader, that is another reason for, to be careful for your LDL levels. So the same LDL can be more detrimental if your HDL is low and triglycerides is high. So right now I invite you to check your cholesterol. Not right now, after the video. Check your cholesterol levels and see where you're standing. Now what is the LDL goal? Well, it depends on your age and so forth. But if you are kind of middle age and you have diabetes or high cholesterol or already or I'm sorry, if you have high blood pressure, diabetes, the problems that comes with metabolic syndrome like abdominal obesity, stuff like that. If you have problems like that, you need to keep your LDL below 100 milligram per day as leader. Now, how do you know that your LDL does not have bad friends, which are, you know, your triglycerine HDL? Of course, you have to look at your triglyceride levels and your HDL levels. Now HDL we talked about, triglyceride levels we talked about. But there is also a general way of understanding if your LDL is with safe friends or with not so safe friends. That is called non-HDL cholesterol. That means that your total cholesterol minus HDL. So you should keep that number below 130 milligram per deciliter so that your LDL is in safe hands. So non-HDL cholesterol is also corresponds to what we call ApoB. Now ApoB molecules are the ones that carry all the bad cholesterol and they are the ones who are the bad guys. So not just LDL but VLDL, IDL and things like that you probably never heard of are also part of this bag. So the gang, which is the molecules that are very low density, they do not have a lot of triglycerides but they have a lot of cholesterol in them and they can induce an immunological reaction as we discussed with the macrophages and so forth. And that is what typically happens that leads to cardiovascular disease. So number one is we have to improve the insulin resistance, reduce triglycerides levels and HDL. Now there are a lot of ways to do that and we will talk about that in the next video. I hope that video helped you guys and if it did please make sure that you give a thumbs up, share this video and subscribe. Guess what? We will have a lot more videos that will be directly pertinent to you and to your family and to your friends. Have a wonderful day.