Why there's no good or bad cholesterol

This clip is from 276 ‒ Special episode: Peter on longevity, supplements, protein, fasting, apoB, statins, & more

In this clip, Peter discusses:

- Why “good” and “bad” cholesterol is inappropriate terminology
- The difference between HDL and LDL
- What basic lipid panels show us
- And more

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About:

The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.

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[alexm]

Agreed. However, if a doctor gave your explanation - how many of his/her patients would follow? Not many

[MikeKayK]

Except doctors who know their audience and understand that "good cholesterol and bad cholesterol" is about as much as the average person will understand, rather than going completely over their heads and leaving them 100% confused like this video will.

[saintedith]

Some time ago I read that LDL has 2 types, type A and type B, this differentiation usually doesn’t come in the blood tests. Type A is a light big molecule and type B is small and heavy, the type B is the one that gets trapped in arteries when these are sick, because when Arteries are sick the body calls cholesterol LDL to help resolve the issue, the problem is that if you have Type B LDL instead of helping it accumulates because the molecule size. In that lecture it also says that your arteries can become sick when your body is in constant inflammation, in theory if you have sick arteries but you have mostly LDL type A the risk of developin atherosclerosis is reduced because Type A can’t pass through the damaged arteries. Besides type B appears when your diet is bad, and usually that diet helps with inflamación. Not sure how correct all of this is.

[sdyjhhv]

I think it's dangerous to encourage people to look at this language as a "red flag" and potentially write off well-meaning doctors. Physicians use good and bad cholesterol as shorthand for HDL and LDL without having to explain the complicated mechanics that you're touching on here. As a medical student, I'm confident most of us can explain this to our patients if asked directly.

[Sandy-ofgq]

Why would it be a red flag to use these terms tho? It acknowledges the damage the LDL cholesterol does and HDL cholesterol does not 🤷‍♀️

[josephdunford]

My Dr told me to get off of Google when i asked him about what you just explained. It's frustrating.

[Mylada]

This is just a stupid point. So should I just start saying bad cholesterol carrier protein to my patients?

Everyone who needs to know knows. Those who do not still get the right idea. You want LDL as low as possible.

[zerocarbdoc]

These are measurements of need of Cholesterol so addressing the need for this additional cholesterol similar to measurement of white blood cells so understanding the recruitment of cholesterol is more important to address.

[MarkHarrison]

So strange that this is trigger point for you. It's literally just an abbreviated term. You went on to explain in depth what everyone assumed it was to begin with. LDL bad, HDL good.
Yes that's oversimplifying, but in very general layman terms, it's exactly what you said.

[DrMusicStarr]

Please discuss how NMR test can differentiate between bad and neutral LDL... especially for those doing keto diets. And thank you for this video, from a biochemist viewer 🤓

[gtm]

Circulating blood Cholesterol in of itself does not cause plaque to build up over time. Instead it’s the blood vessels which feed the arteries getting damaged and the underlying cells within the artery wall releasing their cholesterol that make their way towards inner wall of an artery.

[InfiniteQuest]

This is probably the worst take I have ever seen Dr. Attia have. So ridiculous to die on such a stupid hill.

[titanmaximum]

Cholesterol is cholesterol, how do you decrease the amount of LDL being used for transport vs HDL?

[RoseanneHenderson]

Ok, Understandable! BUT wat about HIGH and LOW cholesterol ?

[aprilj]

You have to keep things very “lay”for a lot of people. People are already overwhelmed at the office visit. Keep it simple.

[Sara-pblj]

This video seems a bit nitpicking. I had my annual physical and blood work panel done earlier this week. My doctor gave a brief overview of why we want high hdl/low ldl numbers and he did simplify things, but I wasn’t annoyed by it. It was a good basic overview that related the pertinent information. My My Chart results didn’t use the bad/good language but instead gave ranges for each category. I actually got flagged because my hdl is 62 and it was over the high range of normal 😏

[DadinWA]

if family practice/internal medicine/pediatricians could get more education as science has evolved, life would be a little less complicated and confusing. We look up to our medical community and if they aren't fully educated, it becomes really confusing. great video. thanks for sharing.

[scottk]

So there's no good cholesterol or bad cholesterol. But cholesterol in LDL is bad and cholesterol in HDL is good.

[chatGPT]

I mean, you seem to be nitpicking. In essence, HDL = good, LDL = bad still holds true. Or if you want to be picky, HDL = good carrier of cholesterol, LDL = bad carrier of cholesterol

[Scruffed]

I think some of the confusion about this is caused by the notion that having higher HDL-c will protect you or offset the harm caused by having a high LDL-c. That notion might have been popularized by the fact that there's a lot of epidemiological studies showing the triglyceride/HDL-c ratio as something that can predict risk of cardiovascular disease, as well as the fact that many popular Youtubers are promoting weight-loss diets that are high in saturated fats which increase LDL-c. Scientific studies in which HDL-c was directly targeted and increased showed no benefit to the intervention, while interventions focused on lowering LDL-c did show benefits. In other words, having a high HDL-c isn't "bad" or something to worry about, but if your LDL-c is very high, chances are that your ApoB (a better predictor of CVD) might also be high.