Methods of Lowering Cholesterol for USMLE Step 1



As I was studying for the USMLE, I learned something interesting and this is a concept tested in the USMLE Step 1. You will also encounter a situation like this when practicing medicine since Americans love their unhealthy burgers and fries. As you know cholesterol cannot be broken down by the body like other molecules. Fats, carbohydrates, amino acids can all be burned by our bodies but cholesterol cannot and this is why cholesterol is a big health concern. Too much cholesterol in our bodies can lead to atherosclerosis which can lead to heart attack. So as I was studying, this system in getting rid of cholesterol is so interesting that I had to type it up from the top of my head and I know I will remember this for my long term memory because it’s so interesting.

Glucose from sugars such as carbohydrates converts to Acetyl CoA which then converts to Cholesterol and finally converts to Bile Acid. Bile acid is released from the liver to the intestines and it’s used to emulsify all the fat we consume for digestion in the intestines. However, bile acid is recycled back to the liver by albumin and so there is no reason for cholesterol to be essential. Too much cholesterol does not get used to make bile acid and it stays in the blood stream and it causes many problems such as atherosclerosis because cholesterol is not needed. So to help someone with cholesterol the individual is given Cholestyramine, which will bind with bile acid to be excreted out of the body and so the body will need floating cholesterol to create more bile. In order to create more bile it will pull cholesterol from the blood stream and make use of it which will lower the cholesterol concentration.

Another natural way to rid the body of cholesterol is eating a high fiber diet.  So when your mom told you to eat your vegetables, she was telling you that for your own good.  A high fiber diet also works in a similar fashion to wash out the cholesterol.  However, one must do so before the cholesterol becomes plaque in the arteries of the heart, because after that happens then it's not possible to reverse the problem without a risky open-heart surgery.

There are other methods to help individuals with high cholesterol level but it comes with side effects such as using statin drugs which inhibit HMG-CoA reductase which is the key enzyme in synthesizing cholesterol. However, HMG CoA reductase also creates Farnesyl PPi which is a key component in synthesizing CoQ enzyme. If you stop CoQ enzyme from synthesizing then you stop the Electron Transport Chain, which is a major pathway in the mitochondria. The liver and the muscles have a lot of mitochondria which works continuously in metabolism. To counteract the CoQ enzyme deficiency when using statin drugs, CoQ 10 supplement can be used to provide the body with the necessary CoQ enzyme.

I hope this post gave you an idea of how you will need to think after the 16 months in Bonaire. If you didn’t know don’t panic just take your time and study till you fully understand the concept.


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