The Cholesterol Dilemma
What to do about High Cholesterol!
The first thing I recommend is for you to make peace with cholesterol and seek to better understand this friend of yours.
Many people unnecessarily avoid egg yolks, shrimp, and red meat due to their cholesterol content. Scores of people take statin medications prescribed by their doctor to lower cholesterol, or don’t and wonder if they should. This article will attempt to shed some important light on the subject of cholesterol, help you avoid fat fear, and most importantly help you to achieve the best health possible.
What Cholesterol Is and Why We Need It
First of all, cholesterol is a fatty, waxy substance found in almost every cell in your body. It plays a key role in building and stabilizing cell membranes. But that’s not all.
Besides being needed for cell structure, cholesterol is also needed for a number of other critical processes. Dr. Jeffrey Bland, in his book The Disease Delusion, points out that cholesterol is very important for producing bile to digest fat, for metabolizing fat-soluble vitamins, and for making many hormones such as estrogen, testosterone, and cortisol, and that these products influence many things such as libido, the immune system, and how well one tolerates stress. He goes on to point out that cholesterol is also necessary for proper brain function and that low levels can affect mood and brain health. He states that studies show that there is an association with depression and even suicide with very low levels of cholesterol.
Agreeing with this, Dr. Daniel Amen, author of Memory Rescue, and a neuroscientist and psychiatrist, claims that a cholesterol level below 160 has been “associated with depression, suicide, homicide, and death”. On the flipside, Amen adds that higher levels of cholesterol are associated with a decreased risk for dementia!
Furthermore, Jonny Bowden and Stephen Sinatra M.D. in their book, The Great Cholesterol Myth, discuss that the human brain contains about one-fourth of all the cholesterol in our body, that the myelin sheath surrounding the nerve cells are about one-fifth cholesterol, and that cholesterol is critical for neuronal communication. They state further that cholesterol also plays a big role in fighting infectious diseases. Cholesterol fights infections by neutralizing toxins produced by bacteria in the bloodstream, and also the body makes vitamin D from cholesterol.
Interestingly enough, about 10% of the cholesterol in your blood comes from what you eat, the rest of it is made in your liver!
And in case you didn’t know, the scientific name for high cholesterol levels in the blood is hypercholesterolemia.
Cholesterol is Unfairly Maligned
It is important to note that high cholesterol is a symptom, not a disease (Kresser). And according to functional medicine thinking, it is not a primary cause of cardiovascular disease. Many, if not most, health experts in the functional medicine and alternative medicine world regard this to be true.
“Good” and “Bad” LDL Cholesterol
Different types of cholesterol are high-density lipoproteins (HDL), which are always considered good, and low-density lipoproteins (LDL). There are two main types of LDL’s; large, fluffy, harmless ones, and small, dense, dangerous ones.
Dale Bredesen, MD, who is the author of The End of Alzheimer’s and is an expert in neurodegenerative diseases, has an interesting take on cholesterol levels. Agreeing with others that cholesterol “is a key part of cell membranes, including brain cells”, states the problem is with damaged cholesterol and the small, dense LDL and oxidized LDL.
He gives the analogy of assessing the risk of cardiovascular disease by measuring total cholesterol being like “counting people in each home to estimate how many criminals there are”, then going on to say that some homes have a lot of people but no criminals, while others have only a few people but most are criminals. The number of criminals should be directly measured, and “not a guess from the total number of people”.
Eat Fat, Get Thin author Dr. Mark Hyman puts it another way when he describes large LDL particles as beach balls (lower risk) verses small LDL particles as golf balls (higher risk). If your doctor only measures the LDL, then it is impossible to determine the particle size and number, and therefore be unable to determine the true risk for cardiovascular disease.
It is also notable that “more than half of all people who are hospitalized with heart attacks have perfectly normal cholesterol levels”, (Bowden & Sinatra, 2012, p. 31)!
Causes for High Cholesterol
According to Chris Kresser in his Adapt Academy lesson on High Cholesterol and Heart Disease, there are a number of causes for high cholesterol levels. The two most common ones are genetics and metabolic dysfunction, specifically insulin and leptin resistance.
A few other potential, but less likely causes of high cholesterol are poor thyroid function, even subclinical; environmental toxins, especially heavy metals; chronic infections; and increased intestinal permeability, aka known as leaky gut.
Poor diet is perhaps the most important concern when it comes to high cholesterol. Dr. Hyman, in his book Eat Fat, Get Thin, referring to the harmful small LDL’s, says that, “The main factor that stimulates your liver to produce these small, dense cholesterol particles…is sugar and refined carbohydrates”.
Stress can also cause a rise in LDL levels according to Dr. Bland, stating that stress is a “major agent of cholesterol imbalance”.
Helpful Lab Tests
When dealing with high cholesterol, appropriate blood tests to ask your doctor for are a lipid panel and LDL particle size; c-reactive protein (CRP), which is an inflammation marker; ferritin (measures stored iron), and homocysteine, also an inflammation marker; hemoglobin A1c (HbA1c) – this measures how much sugar/carbs you have been eating over the past three month; and Vitamin D. These all give your doctor much more pertinent information to work with than just a lipid panel. Some functional medicine and naturopathic doctors like to order even more tests, but in my opinion, the ones I listed give a pretty good picture of what is going on without getting too crazy and expensive.
What are the Optimal Levels
Although opinions vary a bit on optimal lipid values, there is still much of a consensus among the functional medicine and naturopathic doctors. The following is an example of purported healthy values by a few practitioners.
Dr. Amen contends that the optimal level for total cholesterol is 160-200 mg/dL.
Dr. Hyman likes triglyceride levels to be less than 100 mg/dL, and HDL levels to be greater than 60 mg/dL. He also likes to see the ratio of triglycerides to HDL be 1:1 or 2:1 and the ration of total cholesterol to HDL be less than 3:1.
Cate Shanahan, M.D. maintains that the most important blood test to measure heart disease risk is the triglyceride to HDL ratio and says that 3.5:1 is desirable, but 1:1 ratio is optimal. She would also like to see triglycerides less than 100, and vitamin D in the 50-100 ng/mL range. Dr. Amen agrees with this vitamin D range.
What About Statins to Manage High Cholesterol
Statins are a class of drugs that are prescribed to lower cholesterol levels. Some of the ones commonly prescribed and that you might be familiar with are Lipitor, Zocor, and Crestor.
According to the Mayo Clinic, statins work by blocking “a substance the liver needs to make cholesterol” which causes your liver to remove cholesterol from your blood” instead.
Hyman, as well as many others, maintains that statins work because they lower inflammation and act as antioxidants. That may sound good, but they also have side effects, and these results can be obtained by a healthier diet and lifestyle changes.
Kresser contends in his e-book The Diet-Heart Myth that, according to research, statin drugs can have dangerous side effects and, for most people, do not reduce the risk of death.
Furthermore, a Swedish study done in 2011 showed that the use of statins did not prevent heart attacks or decrease deaths from cardiovascular disease. However, it should be noted that other studies have shown that statins can help prevent heart attacks in men who are less than 70 years old who have already had a heart attack. In those who have not had heart attacks, there seems to be no benefit to taking a statin (Hyman, 2016).
Speaking about statin benefits, Dr. Sinatra states that, “I still prescribe statins – but only on occasion, and almost exclusively to middle-aged men who’ve already had a first heart attack, coronary intervention (e.g. bypass, stent, angioplasty), or coronary artery disease”.
Side Effects of Statins
Many people are affected by side effects from statins that range from being uncomfortable, lowering the quality of life, and reducing aspects of health to much more serious outcomes.
Side effects of statins include memory problems, confusion, liver damage caused by inflammation, increased risk for diabetes type 2 because of blood sugar disregulation, muscle pain, and muscle damage including a very serious, possibly deadly kind called rhabdomyolysis.
In addition, Dr. Amen warns that statins deplete important nutrients such as omega-3 fatty acids, l. carnitine, and coQ10 enzyme, which is needed for energy production. Statins also lower all cholesterol levels, even HDL, and upsets serotonin balance, thereby decreasing energy and alertness.
The Mayo Clinic also states that people who are more at risk from statin use:
Have smaller body frames
Have kidney or liver disease
Drink too much alcohol
Take multiple cholesterol medications
Age greater than 64
Exercise too vigorously for their condition
So What is the True Cause of Heart Disease
The true cause of heart disease is from oxidation and inflammation related to excess carbohydrate intake, excess insulin production, excess polyunsaturated fats (PUFA’s), smoking, stress, lack of sleep, and over exercising. Hyman maintains that the worst culprit in causing bad LDL cholesterol levels and elevated triglycerides is high fructose corn syrup (HFCS), with the next worst being trans fats, and hydrogenated fats.
Arteries become clogged when the endothelium, the one-cell-thick layer that lines the arteries, becomes damaged by inflammation and oxidation. To put it as simply as possible, the endothelium secrete sticky molecules to repair the damage caused by oxidized LDL’s, which contributes to the forming of a plaque from foam cells. This continues to grow with more inflammation instigated by oxidation, and can result either in a rupture, a clogged artery, or a blood clot (Bowden & Sinatra).
Dr. Hyman contends that the biggest risk for heart disease is what he calls “diabesity”: insulin resistance and blood sugar problems caused by over-consumption of processed carbohydrates and sugar. He also blames inflammation, which he says can be caused by a sedentary lifestyle, a poor diet, food allergies to things like gluten and dairy, stress, toxins, and even hidden infections such as gingivitis.
Alternative Treatments for High Cholesterol
The good news is that lifestyle and dietary changes can dramatically reduce the risk for cardiovascular disease and improve important lab numbers that measure lipids and inflammation.
The general consensus in the non-vegan/vegetarian world is that low-carb Paleo and Mediterranean Paleo diets are very effective for lowering cholesterol in addition to lifestyle changes such as not smoking, and getting adequate exercise and sleep.
In his book, The Great Cholesterol Myth, Jonny Bowden advises that sugar, soda, processed carbohydrates, trans fat, processed meats, and vegetable oils be eliminated from the diet. He also advocates eating more of the following foods: wild salmon, berries/cherries, green tea, nuts, grass-fed meat, beans, dark chocolate, lots of vegetables, garlic, turmeric, and extra-virgin olive oil.
In addition, making lifestyle changes to reduce stress such as meditation, deep breathing, laughing, massages, sex, cultivating intimacy, expressing emotions, and playing are also very helpful (Bowden & Sinatra, 2012). They also cite a study conducted by Harvard University, the Nurses’ Health Study that followed more than 120,000 women.
This study identified five factors that lowered the risk for heart disease significantly. They include 1) No smoking, 2) Alcohol in moderation, 3) Maintain a BMI under 25, 4) Eat a nutritious, low-sugar diet, high in fiber and Omega-3 fats and 5) Moderate-strenuous exercise for 30 minutes daily.
Pantethine, a natural substance (a derivative of vitamin B-5), is a supplement that can be bought over-the-counter (OTC), and has been found to significantly improve lipid profiles. It lowers LDL, lowers triglycerides, raises HDL, and reduces plaque formation in the arteries by enhancing the removal of cholesterol in the arteries. Furthermore, pantethine has no known adverse effects. It may take a dose of 450 milligrams twice daily for a few months for significant results (Kresser).
Per Sinatra and Bowden, other supplements that are helpful are niacin, vitamin C, resveratrol, cocoa, and curcumin. However, Dr. Sinatra calls magnesium, l. carnitine, CoQ10, and D-ribose the “Awesome Foursome” for their cardiovascular protective qualities.
Incidentally, shrimp and lobster are high in cholesterol, and raise LDL levels, but it also raises HDL’s, so Dr.Hyman claims one offsets the other, thus causing a neutral effect. Interesting! Rather random, I know, but I wanted to throw this tidbit in somewhere.
As you can see, the topic of cholesterol is a complex issue and not without differing opinions. Conventional medicine on one hand is quick to put people on statins, while the other camp is more likely to advise diet and lifestyle changes first, and use statins sparingly.
If you are interested in better understanding cholesterol and the role it plays in health, I highly recommend that you read The Great Cholesterol Myth. It is chocked full of great information and the newest edition the latest research information and has many heart healthy recipes.
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Disclaimer: I am not a medical doctor and this post is not meant to take the place of advise given to you by your own health provider. Please get medical attention if you have any concerns or any alarming symptoms. This post expresses the authors opinion.
You might also be interested in reading these other articles I wrote:
Amen, D. (2017). Memory Rescue. Carol Stream, IL: Tyndale Momentum.
Bland, J. (2014). The Disease Delusion. New York, NY: Harper Wave.
Bowden, J. & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.
Bredesen, D. (2017). The End of Alzheimer’s. New York, NY: Avery.
Hyman, M. (2016). Eat Fat, Get Thin. New York, NY: Little, Brown and Company
Kresser, C. Adapt Academy e-book: Clinician’s Guide to High Cholesterol and Heart Disease
Shanahan, C. ( 2017). Deep Nutrition. New York, NY: Flatiron Books.