The Cholesterol Myth
What Is Cholesterol?
Cholesterol is not a fat, but rather a soft, waxy, "fat-like" substance that circulates in the bloodstream. It is vital to life and is found in all cell membranes. It is necessary for the production of bile acids and steroid hormones and Vitamin D. Cholesterol is manufactured by the liver, but is also present in all animal foods. It is abundant in organ meats, shell fish, and egg yolks but is contained in smaller amounts in all meats and poultry. Vegetable oils and shortenings contain no cholesterol.
Cholesterol cannot dissolve in the blood, so your liver combines it with special proteins called lipoproteins to “liquefy” it. The lipoproteins used by the liver are either very low-density lipoproteins (VLDL) or high-density lipoproteins (HDL). (VLDL cholesterol is metabolized in the bloodstream to produce LDL, or low-density cholesterol.)
Note: HDL is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from arterial walls and disposing of them through the liver. LDL cholesterol is called "bad" cholesterol, because elevated LDL cholesterol is associated with an increased risk of coronary heart disease. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are considered by most doctors to be risk factors for atherosclerosis, while low levels of LDL cholesterol and high levels of HDL cholesterol (low LDL/HDL ratios) are considered desirable.
It is important to note that the liver not only manufactures and secretes LDL cholesterol into the blood, it also removes it. To remove LDL cholesterol from the blood, the liver relies on special proteins called LDL receptors that are normally present on the surface of liver cells. LDL receptors snatch LDL cholesterol particles from the blood and transport them inside the liver. A high number of active LDL receptors on the liver surfaces are associated with the rapid removal of LDL cholesterol from the blood and low blood LDL levels. A deficiency of LDL receptors is associated with high LDL cholesterol blood levels. But it is also crucial that the cholesterol which has been stored in the liver by the LDL receptors be regularly "flushed" to make room for “new” deposits, or the process comes to a standstill, thus causing levels to soar in the bloodstream.
In point of fact, the liver is responsible for over 80% of your cholesterol level. Diet accounts for less than 20%
The Cholesterol Theory of Heart Disease
According to the cholesterol theory of heart disease (and despite all that you may have heard, it is only a theory), LDL cholesterol in the blood combines with other substances such as cellular waste products, calcium, and fibrin (a clotting material in the blood) to form arterial plaque, which attaches itself to the inner lining of the arteries. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis. Arteries that supply blood and oxygen to the heart muscles are called coronary arteries. When coronary arteries are narrowed by atherosclerosis, they are incapable of supplying enough blood and oxygen to the heart muscle during exertion. Lack of oxygen to the heart muscle (ischemia) causes chest pain. Also formation of a blood clot in the artery can clause complete blockage of the artery, leading to death of heart muscle (heart attack). Atherosclerotic disease of coronary arteries (coronary heart disease) is the most common cause of death in the United States, accounting for about 750,000 deaths annually.
Causes of High Cholesterol
Again, according to the cholesterol theory of heart disease, both heredity and diet have a significant influence on a patient's LDL, HDL and total cholesterol levels. For example, familial hypercholesterolemia is a common inherited disorder whose victims have a diminished number or nonexistent LDL receptors on the surface of liver cells. The resultant decreased activity of the LDL receptors limits the liver's ability to remove LDL cholesterol from blood. Thus, affected family members have abnormally high LDL cholesterol levels in the blood. They also tend to develop atherosclerosis and heart attacks during early adulthood.
Diets that are high in saturated fats and cholesterol decrease the LDL receptor activity in the liver, thereby raising the levels of LDL cholesterol in the blood. Saturated fats are derived primarily from meat and dairy products and according to most doctors can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats and are on the medical "no-no" list. On the other hand, most vegetable oils are high in unsaturated fats. Unlike saturated fats, unsaturated fats do not raise blood cholesterol (again according to the theory) and can sometimes lower cholesterol. Olive and canola oil are high in monounsaturated fats, which may have a protective effect against coronary heart disease. Unfortunately, some vegetable oils are converted to saturated fats during a process called "hydrogenation" which can be required for food processing.
Note: The concept that you might have to flush cholesterol stored in the liver to make room for new cholesterol coming from the bloodstream did not make its way into the cholesterol theory of heart disease.
On May 15, 2001, the National Cholesterol Education Panel (NCEP) issued major new clinical practice guidelines on the prevention and treatment of high cholesterol levels in adults, lowering the target optimum level for LDL to less than 100. This was the first major update of the NCEP guidelines since 1993. The NCEP has predicted that the new guidelines will increase the number of Americans requiring treatment for elevated cholesterol levels (from 52 million to 65 million) and will nearly triple the number of Americans who will need to take cholesterol lowering drugs (from 13 million to 36 million).
But for many doctors, 36 million people under experimental drug therapy are not enough. Many “experts” are now pushing to set target limits for LDL to less than 80, which would mandate that tens of millions more Americans be on moderate to high doses of statin drugs for the rest of their lives – despite the fact that these drugs are known to cause significant liver damage.
And, of course, there are the usual assortment of FDA approved double blind studies to back these conclusions. In the past 10 years, clinical trials have “conclusively” demonstrated that lowering LDL cholesterol reduces heart attacks and saves lives. The benefits of lowering LDL cholesterol include:
- Reducing the formation of new cholesterol plaques
- Eliminating existing plaques
- Preventing rupture of existing plaques
- Decreasing the risk of heart attacks
- Lowering the chance of strokes.
So what's my problem? Quite simply, that cholesterol doesn't cause plaque to accumulate on arterial walls. If it did, why doesn't anyone ever have clogged veins – only clogged arteries? Think about that for a moment. If high levels of cholesterol promoted the formation of plaque and its accumulation on arterial walls, then why doesn't it accumulate on the walls of veins? And the answer is – because the problem is centered in the walls of the arteries, not in the cholesterol circulating in the bloodstream.
Challenging the Theory
To understand what I'm talking about, it's first necessary to understand the beneficial role that arterial plaque plays in the human body (yes, beneficial), because therein lies the key to understanding a key role that cholesterol plays. So what is the role of plaque? It is “repair cement” for arterial walls. That is to say, if there is any damage to the arterial wall, your body will whip up some plaque from the cholesterol, calcium, and fibrin in the bloodstream to repair the damage before the arterial wall develops a leak and you bleed to death internally. Cholesterol isn't part of the problem, it's part of the solution – to a different problem.
With that in mind, let's now look at some of the basic assumptions of the cholesterol theory of heart disease.
- Does eating a high cholesterol diet automatically lead to heart disease? Absolutely not. Look at the results seen on the Atkins Diet.
- Does eating a high saturated fat diet automatically lead to heart disease? Again, absolutely not. Consider the traditional Eskimo diet, probably the highest saturated fat diet in the world because of all the whale and seal blubber consumed. And yet Eskimos on that diet have virtually no heart disease – until they shift to a modern Western diet. The same positive results are seen with the Atkins diet with its high consumption of saturated fats. (Both diets, however, are associated with different problems long term. Eskimos, on the traditional diet, for example, have an extremely high rate of osteoporosis because their diet promotes high acid levels in body tissue.)
- Does lowering cholesterol in the diet automatically reduce cholesterol levels in the bloodstream? Not necessarily.
- Does lowering cholesterol in the bloodstream reduce the formation of new plaques? In many cases it does, but not necessarily for the reasons promoted. The primary reason may be that you've minimized the ability of the body to effect repairs. You haven't got rid of the problem – merely the ability of the problem to manifest one particular set of symptoms.
- Do the statin drugs (Advicor, Lescol, Lipitor, Mevacor, Pravachol and Zocor) reduce the incidence of heart attack and stroke? Yes, but as we will discuss shortly, probably not because of their ability to lower cholesterol, and not without significant side effects.
An Alternative Theory
I would like to propose now the “arterial damage” theory of heart disease. Quite simply, it says that since your body produces arterial plaque in response to arterial damage, excessive plaque build-up and the concomitant hardening and narrowing of the arteries is the result of excessive damage, scarring, and inflammation in the arterial walls. And why only the arteries and not the veins? Because, as we shall see shortly, arterial walls contain muscle tissue that is particularly susceptible to damage. Veins contain much less muscle tissue and are less likely to suffer damage.. So what causes damage or inflammation to the arterial walls? Well, among other things.
- High homocysteine levels. Homocysteine is an amino acid produced as a normal byproduct of the breakdown of methionine (from proteins), which is an essential amino acid acquired mostly from eating meat. Homocysteine generates superoxide and hydrogen peroxide, both of which have been linked to damage of the endothelial lining of arterial vessels. Studies have shown that too much homocysteine in the blood is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease.
- Too much Omega-6 fatty acid in the diet. The body converts linoleic acid, the primary fatty acid found in bottled vegetable oil, to arachidonic acid. The Cox-2 enzyme then converts the arachidonic acid to the hormone-like prostaglandin E2 (PGE2) and to the cytokines interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFa), all of which promote inflammation in the body in general, and in the arterial walls in particular.
- Eating high levels of meats and animal fat from grain fattened animals saturates the body with large amounts arachidonic acid. As a point of interest, the high levels of arachidonic acid found in most meat are accumulated from the conversion of Omega-6 fatty acids present in the grains used to fatten them. That means that only minimal levels of arachidonic acid are found in range-fed beef. Iif you can find it, range-fed beef is far healthier for you than the more common grain-fed variety.
- High acid diets. Diets high in meat, sugar, grain, and starch raise acid levels in body tissue – thereby making it hard for the body to clear the lactic acid that builds up in muscle tissue from normal muscle activity. This is a particular problem for arteries since the arterial wall contains muscle tissue (again, veins do not) so that the arteries can be contracted to even out blood pressure when changing position (from lying down to suddenly standing up, for example). The problem is that when the acid doesn't clear, it irritates, inflames, and scars the muscle tissue in the arterial walls.
- High levels of circulating immune complexes in the blood. Circulating immune complexes (CICs) are created when you eat complex proteins (usually from wheat, corn, and dairy) that cannot be digested thoroughly. They make their way into the bloodstream, where they are treated as allergens by the body and combined with antibodies, thus forming CICs. When the number of CICs climbs beyond the ability of the body to eliminate them all, they are deposited in the body's soft tissue, including the arterial walls, thereby triggering attacks by the body's immune system, which results in inflammation.
- Inflammation in general. C-reactive protein (CRP) is an inflammatory marker — a substance that the liver releases in response to inflammation somewhere in the body. Studies indicate that men with high levels of CRP have triple the risk of heart attack and double the risk of stroke compared to men with lower CRP levels. In women, studies have shown that elevated levels of CRP may increase the risk of a heart attack by as much as seven times. The statin medicines (Advicor, Lescol, Lipitor, Mevacor, Pravachol and Zocor) reduce levels of CRP. This may be more significant in accounting for the ability of these drugs to statistically lower the incidence of heart disease than the role these drugs play in lowering cholesterol levels.
Solutions to Lower Cholesterol Levels
- Avoid trans fatty acids like the plague. Hydrogenated and partially hydrogenated oils (the trans fatty acids) are the number one killer in the modern diet.
- Optimize the liver. Do a periodic liver flush that includes the use of lipotropic herbs such as dandelion root to flush accumulated fats and cholesterol from the liver and gallbladder.
- Lower homocysteine levels. While there is a considerable amount we do not know about homocysteine, we do know how to use nutritional supplements to reduce homocysteine levels. This is done through three independent routes: (1) using folic acid with vitamin B-12, (2) using trimethylglycine (TMG), and (3) through B-6. The first two work through a process called methylation, and the B-6 through transsulfuration. Such a combined approach can normalize homocysteine in 95% of the people studied.
- Optimize Omega-6 to Omega-3 ratios by eliminating bottled vegetable oils found in your supermarket, except for olive oil, and supplementing with fish oil and flax seed oil, which are high in Omega-3 fatty acids. Much of the problem with inflammatory disorders actually stems from a lopsided imbalance in dietary intake of the omega-6 and omega-3 fatty acids and the resulting cascade in pro-inflammatory activity. The ideal ratio is roughly 1 to 1; however, over the past 30 years, people from industrialized countries have replaced much of their dietary saturated fat (on the mistaken advice of their doctors and the media) with vegetable oil omega-6 fatty acids. Ratios of 20 to 1 and 30 to 1 are now not uncommon. From a biochemical standpoint, this sets the stage for major arterial inflammation. (See the October 21, 2002 newsletter.)
- A good antioxidant formula that contains OPCs, can help repair damage to arterial walls.
- Proteolytic Enzymes. This is one of the most important things you can do. The regular use of proteolytic enzymes can help eliminate CICs from the body, reduce overall inflammation, dissolve accumulated plaque, and repair arterial scar tissue. Although the evidence is purely anecdotal at the moment, we have seen extraordinary results using detox levels of this formula.
So, is there anything to worry about with high cholesterol levels? Yes, sort of.
- High cholesterol levels are indicative of other problems – sort of like the canary in the coal mine. Among other things, they can be a warning signal for:
- Liver problems
- Dietary imbalance
- High acid levels
- Chronic inflammation, which may be a factor in the onset of Alzheimer's and cancer in addition to heart disease
- High cholesterol levels and high levels of saturated fat in the blood "thicken" the blood. If the arteries are wide open, this is not a problem. But if the arterial walls have been narrowed or hardened, the thickened blood significantly increase the odds of a heart attack or stroke. Of course, there are a number of natural ways to thin the blood. Gingko biloba is a blood thinner, as is garlic, as are Proteolytic Enzymes (particularly nattokinase).
The trick, of course, is to take care of the problem, not the warning signal. Artificially suppressing cholesterol levels with statin drugs is a bit like feeling good about your car because you've disconnected your warning lights. Not very bright.
And if you're desperate to lower cholesterol levels without subjecting yourself to the side effects of the statin drugs, supplement with niacin and policosanol. Policosanol is a natural supplement made from sugar cane. It works by helping the liver control its production and breakdown of cholesterol, as well as being a powerful antioxidant that prevents LDL oxidation. Clinical studies show that policosanol is as effective as prescription drugs in lowering cholesterol levels, without their dangerous side effects. And, in addition, it reduces the inflammatory response in the arterial wall.
Just for Fun - Questions for Your Doctor
Remember, the cholesterol theory of heart disease is only a theory – a theory that is increasingly being discredited. For those of you who enjoy tormenting your doctor, or if you just want to see them get flustered and angry, be sure and ask them the following questions.
- If cholesterol is the main culprit in heart disease, why don't veins ever get narrowed and blocked?
- If high cholesterol foods are responsible for raising cholesterol levels, then why do people on the high-cholesterol Atkins Diet experience such a significant drop in cholesterol levels?
- Why do Eskimos who eat a traditional diet of almost pure saturated fat (whale and seal blubber) have almost a zero incidence of heart disease?
- If the liver is responsible for regulating up to 80% of my cholesterol levels, why would I want to take statin drugs for lowering cholesterol – considering that the number one known side effect of statin drugs is liver damage?