The Cholesterol Controversy
By Sarah Axtell, ND • May 7, 2012
The majority of people associate high cholesterol with high fat diets and an increased risk of heart disease. This has given eggs and saturated fat a bad reputation. Lipitor and other cholesterol-lowering medications are routinely prescribed, and some researchers even joke that they should be put in the water supply.
But this not a joking matter- you need cholesterol for optimal health. If you have too much cholesterol, this may be a sign that you have something else going on, notably the process of inflammation. Merely looking at the total cholesterol number is an over-simplification and is not an accurate assessment of your heart disease risk. Here are some basics of cholesterol and accurate testing for heart disease risk…
The Importance of Cholesterol
Cholesterol plays a vital role in the development of hormones. It is also necessary for proper brain health. The majority of the brain is comprised of fat and cholesterol. When cholesterol is severely restricted, memory and cognition can be compromised. Cholesterol also lubricates cells, allowing communication among them to be more efficient.
Common Myths About Fat and Cholesterol
Myth #1: Eating saturated fat and cholesterol-rich foods will cause cholesterol levels to rise and make people more susceptible to heart disease.
Truth: Dietary cholesterol contributes very little to cholesterol levels in the blood. Many studies show no relationship between diet and cholesterol levels. In fact, as Americans have decreased saturated fat and cholesterol-rich foods, rates of heart disease have gone up.
Myth #2: Cholesterol causes atherosclerosis, or hardening of the arteries.
Truth: Cholesterol has little to do with the disease of atherosclerosis. Measuring total cholesterol is an antiquated approach to assessing one’s heart disease risk. It is now possible to characterize and measure the various lipoproteins (lipid carrying proteins) in the bloodstream that cause injury, atherosclerotic plaque accumulation and eventually heart attack and stroke. It’s not about cholesterol- its about the particles that cause atherosclerosis, such as small LDL.
Myth #3: High fat foods increase triglycerides (a type of fat in your blood).
Truth: Dietary fats are composed of triglycerides. While increased intake of fats deliver greater quantities of triglycerides into the liver and bloodstream, it also shuts down the body’s own production of triglycerides. The net effect is little or no change in triglyceride levels. Low fat diets (high carbohydrate diets) are notorious for increasing triglyceride levels. This is because carbs stimulate insulin, which in turn triggers fatty acid synthesis in the liver. The liver produces fats and then sends triglycerides out into the bloodstream.
So if saturated fat doesn’t increase cholesterol, what does?
While I don’t consider total cholesterol a useful marker for determining heart disease risk, I don’t merely ignore it. When I see high cholesterol, I always ask myself, “What is irritating this person and making their body feel the need to increase cholesterol production as a result?” You can think of cholesterol as a band-aid or a patch to the blood vessels. Cholesterol acts as a protective barrier to the blood vessel when there is underlying inflammation in the body. Examples of inflammation-producing factors include food allergies (ie, gluten), chronic infections, or heavy metal toxicity. My goal is to determine what the source of the underlying inflammation is and help accordingly. Evaluating total cholesterol levels in the blood and treating the numbers is of little use.
Measuring Heart Disease Risk- Bigger is Better when it comes to LDL Size
As stated above, measuring cholesterol tells you little about your heart disease risk. More than half the people who die each year of heart attacks have normal or low levels of cholesterol. Other markers must be assessed to determine heart disease risk.
You are probably familiar with the breakdown of the “good,” HDL, vs. “bad,” LDL, cholesterol. This is oversimplified and must be further broken down. There can be small LDL particles and big LDL particles. The small LDL particles are undesirable, for they linger for longer periods of time in the bloodstream, causing atherosclerotic plaques. In fact, small LDL particles are estimated to increase your heart attack at least 3 fold.
The composition of diet has a very powerful influence over whether or not your body produces small or big LDL particles. Foods that increase triglycerides, such as carbohydrates, trigger blood sugar and insulin spikes, which increase the amount of small LDL in the body, thus increasing plaque build up in your arteries.
Summary: Anything that provokes an increase in blood sugar will also provoke small LDL particles. Anything that keeps blood sugar from increasing, such as proteins, fats and reduction of carbs reduces small LDL particles.
Conditions Associated with Heart Disease
- Small LDL particles
- Lipoprotein a
- Oxidized LDL
- Blood sugar abnormalities
- Vit D deficiency
- EFA deficiency
- Inflammation (heavy metal toxicity, food allergies- wheat and dairy are two most common)
- High fibrinogen
- Vitamin K deficiency
How can I tell if I have small LDL and thus an increased risk of heart attack and stroke?
Talk to your naturopathic or medical doctor about the following:
- Standard cholesterol panel
- low HDL chol ( <40mg/dl in men, <50mg/dl in women)
- high triglycerides (TGs) (>100 mg/dl in men and women)
- TG:HDL ratio
- Specific Particle Testing: Lipoprotein testing, VAP, NMR
- Body Shape and Diet- Excess abdominal weight and a diet over dependent on carbs
For more reading on the myths of cholesterol, see this blog post by Dr. Mercola.
Sources: Wheat Belly, by William Davis, MD
Weston A. Price Foundation
Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.