A review The Great Cholesterol Myth

Jonny Bowden, PH.D., C.N.S. & Stephen Sinatra, M.D., F.A.C.C.

Why You Should Be Skeptical of Cholesterol as an Indicator of Heart Disease

  • Cholesterol is a minor player in heart disease.
  • Cholesterol levels are a poor predictor of heart attacks.
  • Half the people with heart disease have normal cholesterol.
  • Half the people with elevated cholesterol have healthy hearts.
  • Lowering cholesterol has extremely limited benefits.

Dr. Jonny – Before becoming a nutritionist he worked as a personal trainer at Equinox gyms.  He started to question the theory of a low-fat diet for weight loss and improved health when it didn’t work for clients.  He then started advising clients to eat a low-carb, high-fat diet (including saturated fats) and saw them feel better, lose weight, decrease triglycerides, and improve other measures that indicated heart disease as well.

Dr. Sinatra – a paid consultant to some of the biggest manufacturers of statin drugs, lecturing for hefty amounts of money.  He soon changed his mind when he saw total cholesterol numbers in his own patients as low as 150 mg/dL develop heart disease.  Dr. Sinatra also found that life can’t go on without cholesterol, a basic raw material made by your liver, brain, and almost every cell in your body.  Enzymes convert it into vitamin D, steroid hormones, and bile salts for digesting and absorbing fats.  Cholesterol makes up a major part of the membranes surrounding cells and the structures within them.  The brain is rich in cholesterol and accounts for about a quarter of all the cholesterol we have in our bodies.  Lower levels of cholesterol is linked to poorer cognitive performance.  Dr. Sinatra says that it is quite clear that those who benefit the most from lowering their cholesterol levels are middle-aged men who already have heart disease.

Nurses Study- conducted by Harvard University, the study has followed more than 120,000 females since the mid-1970s to determine risk factors for cancer and heart disease.

“Eighty-two percent of coronary events in the study…could be attributed to lack of adherence to these five factors…

  1. Don’t smoke.
  2. Drink alcohol in moderation.
  3. Engage in moderate-to-vigorous exercise for at least half an hour a day on average.
  4. Maintain a healthy weight (BMI under 25).
  5. Eat a wholesome, low-glycemic (low-sugar) diet with plenty of omega-3 fats and fiber.

“Cholesterol is Harmless!”

  • The theory that fat and cholesterol cause heart disease became widely accepted despite much evidence to the contrary.  This evidence deserves to be reexamined.  The case needs to be reopened.
  • Many doctors did not agree with the cholesterol myth and questioned the science upon which it was based.
  • The studies up which the cholesterol myth was based were later found to be problematic.
  • The adoption of the cholesterol myth by mainstream organizations and the government had a strong political component to it.

Cholesterol Basics

Cholesterol is a waxy substance, technically a sterol – that is an important constituent of cell membranes.  The vast majority of cholesterol in the body is make in the liver, while the rest is absorbed from the diet.

Cholesterol is the basic raw material that your body uses to make vitamin D; sex hormones, and bile acids needed for digestion

Cholesterol travels in particles called lipoproteins, the most common of which are high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

What is HDL?

Old School

HDL is considered “good” cholesterol because it helps remove so-called “bad” cholesterol, LDL.  When measured, HDL levels should be as high as possible, preferably 60 milligrams per deciliter of blood.  Maintaining a healthy weight, physical activity, and a diet that includes healthy fats like olive oil are believed to keep HDL levels high.

New School

HDL is much more tightly controlled by genetics than LDL.  All HDL is not the same.  HDL-2 particles are large and buoyant and the most protective.  HDL-3 particles, on the other hand, are small and dense and may be inflammatory.  HDL-2 is anti-inflammatory and anti-atherogenic.  HDL-3, on the other hand, is poorly understood.  You want to have higher levels of HDL-2 than HDL-3.  The “New School” generally agrees that higher levels of HD are desirable, but research is concentrating on the function of HDL subtypes rather than the total amount.

What is LDL?

Old School

LDL is “bad” cholesterol because it can build up in the arteries, impeding blood flow.  Its levels should be kept low.  Current standards are 100-129 mg/dL, with lower than 100 being the target for those at risk for heart disease, and lower than 70 being the target for people at very high risk.  Too much saturated fat in the diet, inactivity, and being overweight are considered to raise LDL levels.

New School

All LDL is not the same.  LDL-A is buoyant, fluffy molecule that does no harm whatsoever as long as it is not damaged by oxidation.  LDL-B is a small, hard, dense, molecule that promotes atherosclerosis.  A pattern of high LDL-a is the most beneficial.  Blood test today can also measure the number of LDL-A and LDL-B particles.  The most important cholesterol particle of all, which conventional tests do not focus on is Lp(a).  It is a very small, highly inflammatory particle that is thrombogneic.  In a healthy body, low Lp(a) levels aren’t much of a problem.  Lp(a) circulates and carries out repair and restoration work on damaged blood vessels.  However, the more repairs you need on your arteries, the more Lp(a) is utilized.  Lp(a) concentrates at the site of damage, binds with a couple of amino acids within the wall of a damaged blood vessel, dumps its LDL cargo, and starts to promote the deposition of oxidized LDL into the wall, leading to more inflammation and ultimately to plaque.  Also, Lp(a) promotes the formation of blood clots on top of the newly formed plaque, which narrows the blood vessels further.

Dietary Advice

Old School

Eat less than 300 mg cholesterol a day and eat less than 10 percent of calories as saturated fat.

New School

The effect of dietary cholesterol on blood (serum) cholesterol is very variable and individual, and for most people, though not all, the effect of dietary cholesterol on serum cholesterol is insignificant.  Saturated fat raises cholesterol, but it raises overall HDL cholesterol and the good part of LDL cholesterol (LDL-A) far more than it raises the bad part of LDL cholesterol (LDL-B).  There is no evidence that support a direct relationship between saturated fat and heart disease.

Inflammation:  The True Cause of Heart Disease

  • Cholesterol is the parent molecule for sex hormones (estrogen, progesterone, and testosterone) as well as vitamin D and bile acids needed for digestion.
  • The only time cholesterol is a problem is if it’s oxidized (damaged).
  • Damaged or oxidized LDL cholesterol sticks to the lining of the arteries and begins the process of inflammation.
  • The true cause of heart disease us inflammation.
  • Inflammation is initiated by damage from free radicals (oxidative stress).
  • The concept of “good” and “bad” cholesterol is outdated.
  • There are several types of LDL (“bad”) cholesterol and several types of HDL (“good”) cholesterol.
  • It is far more important to know whether you have pattern A or pattern B LDL cholesterol profile than to know your total amount of LDLs.
  • A cholesterol level of 160 mg/dL or less has been linked to depression, aggression, cerebral hemorrhages, and loss of sex drive.

Types of Inflammation

 

Acute inflammation- when you stub your toe, get a splinter in your finger, or a rash on your skin.  It can be visible and uncomfortable as well as painful.  The swelling, redness, and soreness you experience as a result of acute inflammation are all natural accompaniments to the bodies healing process.

Chronic Inflammation- flies beneath the pain radar, and has no obvious symptoms.  Chronic inflammation is a significant component of virtually every single degenerative condition, including Alzheimer’s, diabetes, obesity, arthritis, cancer, neurodegenerative diseases, chronic lower respiratory disease, influenza and pneumonia, chronic liver and kidney diseases, and especially heart disease.

Oxidation

If you have ever left apple slices out on the counter and they turned brown that is oxidation.

When free radicals get loose in the body they go around inflicting lots of damage on your cells and DNA.

Sugar:  The Real Demon in the Diet

  • The number one dietary contributor to heart disease is sugar, which is a far greater danger to your heart than fat.
  • Sugar contributes to inflammation in the artery walls.
  • Sugar is the missing link among diabetes, obesity, and heart disease.
  • High sugar intakes drive up the hormone insulin, which raises blood pressure and increases cholesterol.
  • Sugar and processed carbs raise triglycerides, which are an important and independent risk factor for heart disease.
  • When sugar in the bloodstream sticks to proteins, it creates damaging and toxic molecules called advanced glycation end products, or AGEs.
  • This same process also damages LDL, contributing to inflammation and ultimately to heart disease.
  • Hypertension, high levels of triglycerides, and a high ratio of triglycerides to HDL are all better predictors of heart disease than cholesterol.  Sugar, or more specifically fructose, raises every single one of these measures.
  • Fat raises LDL cholesterol, but it raises the big, fluffy, harmless particles (producing the desirable pattern A profile) and lowers the nasty little BB gun-pellet LDLs that actually do cause heart disease.  Sugar has the opposite effect, increasing the number of really bad LDL molecules (producing the harmful pattern B profile) and decreasing the number of harmless ones.  High levels of sugar and insulin damage those nasty little LDL particles, making them far more likely to start the process of inflammation.
  • If you accept our theory that inflammation, not cholesterol, is at the “heart” of heart disease, it’s worth pointing out that the metabolic effects of sugar are highly inflammatory to your artery walls.

The Truth about Fat:  It’s Not What You Think

  • Saturated fat has been wrongfully demonized.
  • Saturated fat raises “good” (HDL) cholesterol.
  • Saturated fat tends to change the pattern of your “bad” (LDL) cholesterol to the more favorable pattern A (big, fluffy particles).
  • Several recent studies have shown that saturated fat is not associated with a greater risk for heart disease.  One study from Harvard concluded, “greater saturated fat intake is associated with less progression of coronary atherosclerosis, whereas carbohydrate intake is associated with a greater progression.”
  • In the Nurses’ Health Study, refined carbohydrates were independently shown to be associated with an increased risk for coronary heart disease.
  • Omega-6 fats, vegetable oils are pro-inflammatory.
  • The balance between omega-6 and omega-3 is far more important than saturated fat intake is.
  • Low-fat diets work because they reduce omega-6 fats, not because they reduce saturated fat.

The vegetable oils we’ve been told to use instead of animal fats are actually turning out to be as bad as, or worse than, the original saturated fats (such as lard) that they replaced, just as margarine turned out to be far worse than butter.

The Statin Scam

  • The benefits of statin drugs have been widely exaggerated, and any benefit of these drugs has nothing to do with their ability to lower cholesterol.
  • Statin drugs deplete coenzyme Q10, one of the most important nutrients for the heart.  A deficiency can cause muscle pain, weakness, and fatigue.
  • The brain depends on cholesterol to function optimally.  Cholesterol helps stimulate thinking and memory.
  • Statin drugs lead to a reduction in sex hormones, as shown by several studies.  Sexual dysfunction is a common (but underreported) side effect of statin drugs.
  • Statins interfere with serotonin receptors in the brain.
  • There are troubling indicators that statin drugs may be associated with a higher risk for cancer and diabetes.
  • Statins should not be prescribed for the elderly or for the vast majority of women, and they should never be prescribed for children.
  • Research show that (with rare exceptions) any benefit from statin drugs is seen only in middle-aged men with documented coronary artery disease.

Help Your Heart With These Supplements

  • Coenzyme Q10.
  • D-ribose is one of the components of the energy molecule ATP, which the body uses to power all activity.
  • L-carnitine supplementation after a heart attack increases survival rate and makes it less likely you will suffer a second heart attack.
  • Magnesium relaxes the artery walls, reduces blood pressure, and makes it easier for the heart to pump blood and for the blood to flow freely.
  • Omega3s especially from fish lower the death rate from heart disease.  They also lower triglycerides, resting heart rate, and blood pressure.  Omega3s are highly anti-inflammatory.
  • Other supplements worth considering include vitamin C, curcumin, resveratrol, and cocoa flavanols.

Stress:  The Silent Killer

  • Stress contributes to every disease known.  And it can slow or prevent recovery.
  • When you are under stress, your adrenal glands produce stress hormones, known as “fight or flight” hormones.  The main stress hormones are cortisol and adrenaline.
  • An excess of stress hormones can crate metabolic havoc and inflammation, and contribute to heart disease.  When stress persists, the abundance of cortisol begins to promote hardening of the arteries.
  • Stress causes the overproduction of platelets in the blood, which can then clump together and ultimately create a clot called thrombus.  When a thrombus blocks an artery to the heart, you have a heart attack.

Putting it all Together- A Simple and Easy Blueprint for a Healthy Heart & Life!

  • Eliminate:  sugar, soda, processed carbs, trans fats, processed meats, and excess vegetable oils.
  • Eat more:  wild salmon, berries and cherries, grass-fed meat, vegetables, nuts, beans, dark chocolate, garlic & turmeric, green tea, extra-virgin olive oil.
  • Reduce stress:  meditate or practice deep breathing, express your emotions, play, cultivate intimacy & pleasure, and enjoy life!

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