CHOLESTEROL: AN ESSENTIAL WAXY LIPID
Despite being vilified by much of the "scientific" community since the 1950s (and the US government since 1980), cholesterol is used by the body for several essential metabolic functions, including…
• building/maintaining cell membranes (i.e. cellular integrity)
• supporting brain/neurological functioning (the brain holds ~25% of the body's cholesterol)
• producing neurotransmitters like serotonin and the sex hormones progesterone, estrogen and testosterone
• acting as a precursor to bile acids (which are required for proper digestion of fatty acids and absorption of fat-soluble vitamins) and
• the production of vitamin D (synthesized from 7-dehydro-cholesterol)
In other words, when you hear the word cholesterol, words like BRAIN/COGNITION, MOOD, HORMONES, DIGESTION and VITAMIN D should come to mind. One of the phrases that shouldn't come to mind is HEART DISEASE.
DIETARY CHOLESTEROL: ONLY RESPONSIBLE FOR 25% OF YOUR CIRCULATING BODILY CHOLESTEROL
Dietary cholesterol is found in high amounts in foods like beef liver, egg yolks, butter and cream, and is present in notable amounts in dark meat poultry, red meat, certain fatty fish (ex. sockeye salmon) and whole milk dairy products. Dietary cholesterol, however, only accounts for around 25% of the circulating cholesterol in the body and blood.
So where does most of the circulating cholesterol come from? While every cell CAN produce cholesterol, it’s the liver that produces the most- around 75% of the circulating cholesterol in your body (usually 1000-1500mg a day).
CHOLESTEROL: GUILTY BY ASSOCIATION
Cholesterol has been vilified because of its presence at the scene of the crime. Oxidized Low Density Lipoprotein Cholesterol (cholesterol with an LDL carrier) is often present in significant amounts in arterial plaque (along with things like white blood cells, fibrin, platelets and calcium). Again, one of cholesterol’s primary roles in the body is supporting cellular and tissue integrity. Stated simply, when LDL builds up on the arterial wall, it’s doing its job- supporting tissue integrity. The arterial walls are being damaged by things like excessive blood sugar, nutrient imbalances, systemic infections and excess free radical production and oxidative stress (which explains why the cholesterol in arterial plaque is often oxidized)...
Cholesterol, carried by LDL, is trying to “patch up” damaged vascular tissue.
Cholesterol is the main culprit in cardiovascular disease like good cops are the main culprit at crime scenes.
STEPS TO IMPROVE YOUR CARDIOVASCULAR HEALTH (AND REDUCE YOUR RISK OF HEART ATTACK, STROKE OR CARDIOVASCULAR DISEASE)
Step 1: Get the Right Testing (and try to find an integrative cardiologist)
Don't waste your time with a standard lipid panel. By itself it's not going to tell you much. Also, it's important to understand that high total cholesterol is not a causative factor in heart disease. Several studies have demonstrated this, including a 2012 study of more than 52,000 adults ages 20-74 that found that women with HIGHER cholesterol levels (>270mg/dl) had a 28% LOWER mortality risk than women with LOW cholesterol (<183mg/dl). Plus, half of all serious heart attacks occur in people with normal cholesterol levels (at least, as defined by the standard lipid panel). [1-4]
A Cardio IQ test (or lipid subfraction test) is much more relevant and can identify markers, like Lp(a), that are much more strongly correlated to CVD than simply high LDL.
Other lab tests to strongly consider include...
* A1c (tests blood sugar levels over 2-3 months; readings of 9-14 indicate elevated risk)
* CRP (tests systemic inflammation; often included in Cardio IQ test; readings >2mg/L indicate elevated risk)
* Blood calcium (which is included in CMP test; >10mg/dL indicate elevated risk)
There are other lab tests that have cardiovascular relevance, including fibrin, vitamin C, CoQ10, magnesium RBC, a complete iron panel and mitochondria markers. It should also be mentioned that an increasing amount of clinical data implicates pathogenic infection as a causative factor in cardiovascular disease (CVD), so a Complete Blood Count (CBC) and/or a GI Map Test (which can show intestinal parasite, bacteria and fungal markers) may also be applicable here.
The big take away with lab testing? High LDL levels by themselves are no cause for alarm. High LDL levels (especially lipoprotein(a) levels >20mg/dL), combined with high A1c, high CRP, high blood calcium and hypertension IS cause for alarm.
As far as other cardiovascular medical tests are concerned, I recognize that angiograms (cardiac, peripheral, CT) can offer extremely helpful digital imaging of the CV system, but I think there are some potentially serious side effects associated with the radioactive contrast agents used (as some clinical data documents).
I also prefer exercise-induced stress tests that monitor blood pressure and use EKG and ultrasound/echo to drug/chemical-induced stress tests and those that use radiocontrast agents (i.e. nuclear stress tests).
Step 2: Get Your Net Carb Intake Dialed In (often means reducing carbs for many people)
Several studies have linked high carbohydrate intake with an increased risk of CVD (and also found healthy dietary fats and saturated fats as not responsible for elevated CVD risk), including...
This 2009 review of data from >2900 participants from Framingham study...
This 2016 review of scientific literature on sat fat, sugar and CVD risk...
This 2017 review showing added sugars drive coronary heart disease...
This 2018 review of diet and CVD risk, including the PURE study of more than 135,000 patients...
How does high carb intake drive CVD? In essence: excess carb intake -> high blood sugar -> glycation -> damage of vascular tissue -> buildup of oxidized cholesterol, fibrin, platelets, calcium, etc. -> CVD disease -> increased risk of heart attack, stroke or early death.
Step 3: Don't Worry About Consuming Healthy Foods High in Cholesterol
Remember, dietary sources of cholesterol only account for around 25% of the total circulating cholesterol in your body. The liver's response to injury in the body and blood vessels is THE major determining factor in serum cholesterol levels (and addressing blood sugar, insulin, free radical/oxidative stress, inflammation, calcium/magnesium ratios and infection issues will help regulate those levels).
So what's this mean? It means that most people don't need to limit their intake of dietary cholesterol from healthy sources. Organic or pasture-raised egg yolks, grass fed butter and cream, organic dark meat poultry, grass fed red meat, wild caught sockeye salmon... go ahead and have some! (and feel good about it)
Step 4: Consider Therapeutic Doses of Heart Healthy Supplements
Items here include...
* Citrulline (which can increase nitric oxide levels in the blood vessels, thereby improving circulation)
* EPA/DHA (these omega 3 metabolites from fish oil can help mediate inflammation levels)
* Vitamin B3 (specifically nicotinic acid, which has been shown to boost HDL levels)
* Vitamin C (the body's chief water soluble antioxidant, vitamin C helps control excess free radical production that can lead to cellular and tissue damage)
* CoQ10 (another antioxidant that's a major player in mitochondrial and heart health)
* Vitamin K2 (plays a vital role in maintaining healthy calcium levels in the blood and bones)
* Magnesium (performs several essential functions, including soft tissue relaxation and vasodilation, and is a counter balance to calcium's contractile effects)
* Potassium (helps promote kidney health and healthy blood pressure levels)
* MSM and garlic (two sulfur containing supplements that help promote collagen production and soft tissue health)
* Nattokinase (a proteolytic enzyme that "eats" excess fibrin, which can accumulate in vascular plaque)
* Curcumin (a potent and well studied anti-inflammatory)
The health of the intestines and gut microbiome, as well as the liver, have also been tied to cardiovasccular disease, so supporting your gut flora with supplements like probiotics and prebiotics, and supporting your liver with supplements like choline, TUDCA, silymarin, NAC, betaine anhydrous (aka TMG) and taurine may also be therapeutic here. [5-38]
Step 5: Practice a Heart-Healthy Lifestyle
* Healthy Sleep (7-9 hours of quality sleep a night) [39-40]
* Healthy Exercise (frequent habit of low risk exercise types [including strength and cardiovascular component], performed at low to moderate intensity and moderate duration) [41-43]
* Healthy Physical Activity (trying not to sit for >6 hours a day if possible) [44-46]
* Healthy Stress Management Habits [47-48]
* Not Smoking [49-51]
Step 6: Avoid Statins
Why avoid the class of drugs that contains THE most prescribed drug in America (Lipitor)? While statins have some anti-inflammatory effects (which make up for the bulk of their therapeutic effect, NOT their inhibition of cholesterol from the liver), statins also...
* lower heart-essential CoQ10 levels by up to 40%
* contribute to fatigue and muscle pain/myalgia
* are linked to nerve damage [those who use statins for >2 years have 4-14 fold increased risk of neuropathy]
* cause cognitive and memory problems in 90% of users
* ironically, increase the risk of heart failure
* drastically increase the risk of developing diabetes [52-62]...
Step 7: Research, Read Up and Reach Out to Holistically-Trained Professionals!
There are some great resources out there regarding the truth about cholesterol, statins and heart disease. I'd give special mention to Dr. Stephen Sinatra, an integrative cardiologist who's website and books are a treasure trove of helpful and clarifying information...
* Dr. Stephen Sinatra, Integrative Cardiologist (www.drsinatra.com)
* The Great Cholesterol Myth (2012) by Jonny Bowden, PhD and Dr. Stephen Sinatra, M.D.
* Cholesterol Clarity (2013) by Jimmy Moore and Dr. Eric C. Westman, M.D.
* The Sinatra Solution: Metabolic Cardiology (2015) by Dr. Stephen Sinatra, M.D.
And of course working with a health professional who's properly educated on what a smart, holistic, integrative, evidence-based approach to heart health entails is always a wise choice. Feel free to reach out to me at firstname.lastname@example.org if you have any questions.
5 http://circ.ahajournals.org/content/108/17/2154 (kidney disease as risk factor for CVD)
8 www.ncbi.nlm.nih.gov/pmc/articles/PMC3575935/ (2013; vascular effects of dietary nitrates)
14 www.nature.com/articles/ejcn201134 (artificial/industrial transfat vs ruminant/natural transfat)
17 https://www.ncbi.nlm.nih.gov/pubmed/17705685 (2008)
18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523006/ (2015)
19 https://www.ncbi.nlm.nih.gov/books/NBK541036/ (2019)
29 www.bmj.com/content/346/bmj.f1378 (potassium intake & CVD)
30 https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1524-6175.2002.01728.x (potassium intake & CVD)
33 www.altmedrev.com/archive/publications/7/1/22.pdf (2002; sulfur's applications in medicine)
36 https://www.nature.com/articles/srep11601 (2015)
37 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372539/ (2017)
38 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/ (2018)