Cholesterol & Heart Disease 

This is a HUGE subject. One I have tried to wrap my head around for the past year. Some of my family and friends grapple with elevated cholesterol numbers. This has led to questions and concerns about health and heart disease. I’m not sure if the reading and research I have done on the subject has left me more or less confused. I’m going to try to summarize some of the information that has stuck with me through all the reading and research.

Two camps: Those that believe The Lipid Hypothesis and those that don’t and would be considered “cholesterol skeptics”.

The Lipid Hypothesis: reductions in blood cholesterol levels will lead to reductions in heart disease risk. The lipid hypothesis is pretty much what we have been taught our whole lives – saturated fats increase cholesterol and cholesterol causes heart disease and early death therefore stop eating saturated fats. Go for a low-fat, high carbohydrate diet. (I don’t agree with this).

Cholesterol Skeptics: The cholesterol skeptics don’t believe that cholesterol has anything to do with coronary heart disease. They believe that cholesterol has been getting a bad wrap all these years. They will site many, many studies that they believe prove cholesterol’s innocence in relationship to coronary heart disease.

What camp do you fall into? I don’t think I fall into either camp completely. I’m probably closer to a cholesterol skeptic than a proponent of the lipid hypothesis. Having said that I do find cholesterol numbers interesting and I still like to work out equations using HDL, LDL and Triglyceride numbers in an attempt to evaluate heat disease risks (good primer on cholesterol numbers if you believe in that). It’s hard to walk away from something you’ve been told is true your whole life (I’m trying).

Cholesterol & Heart Disease, information that has stayed with me:

• There are many factors that may contribute to coronary heart disease.
• Some people have Familial Hypercholesterolemia (FH). This is caused by a genetic defect and it predisposes them to elevated levels of LDL (see the bottom of the post for more information about FH).
• Eating saturated fats from animal protein, butter, coconut oil, beef tallow and olive oil does not result in high cholesterol or heart disease
• LDL and HDL are not cholesterol. They are commonly refered to as cholesterol but they are lipoproteins.
• Cholesterol is important to the body. Almost every cell in our body uses cholesterol. Our physiological functioning depends on cholesterol. Lipoproteins transport cholesterol to the cells that need it.
• Stress, exercise and body weight can influence blood cholesterol levels. High cholesterol numbers aren’t necessarily dangerous but they may be an indication that something else is wrong.  (The Cholesterol Myths)
• HDL is considered “good cholesterol”. You want to see a high number on your cholesterol blood panel
• LDL is considered “bad cholesterol” but not all LDL are bad.
• Small dense LDL particles are bad and are associated with heart disease. Large fluffy LDL particles have nothing to do with heart disease and may even protect against it.
• When LDL particles oxidize bad things happen.
• LDL particles oxidize when they spend too much time in the blood (lipoproteins not moving the cholesterol through the blood fast enough).
• An LDL receptor that isn’t working properly doesn’t move the LDL particles through the blood fast enough to keep them healthy. “The liver packages the lipoprotein with a store of antioxidants that will be sufficient if the LDL transports the nutrients quickly, but if LDL receptor activity is poor, this nutrient transport is compromised, the oxidants within blood deplete the particle of its antioxidants, and oxidation ensues.” (The Daily Lipid)
• As LDL particles oxidize they become smaller and more dense.
• Small, dense LDL particles are the most likely to cause damage to the arterties
• The immune system creates Atherosclerotic Plaque to protect the blood vessel from the oxidized, toxic LDL particles. (The Daily Lipid)
• Low LDL receptor activity can lead to LDL oxidation and therefore to Atherosclerosis (hardening of the arteries). (The Daily Lipid)
• Statins reduce the risk of heart disease in middle-aged white males with established heart disease. Unclear if statins prevent heart disease in people who are initially heart disease free. (The Daily Lipid )
• Statins have many negative side effects and appear to “decrease the synthesis of coenzyme Q10, a compound that likely protects against heart disease”. (The Daily Lipid) (Chris Kresser)
• Hardening of the arteries (atherosclerosis) isn’t what causes heart attack and stroke. Heart attack and stoke happen when the plaque that is built up behind the lining of the artery wall ruptures. The rupture causes an obstruction that compleletly stops the flow of blood.
• Large fluffy LDL particles bounce through the artery like a big soft beach ball causing no damage. (Chris Kresser)
• Reducing small, dense LDL particles will help reduce the risk of damage to artery walls which will in turn reduce the risk of heart disease.
• “Eating saturated fat and cholesterol reduces the type of cholesterol associated with heart disease.” (Chris Kresser)
• “Replacing saturated fat and cholesterol with carbohydrates lowers “good” (HDL) cholesterol, raises triglyceride levels, and increases our risk of heart disease.” (Chris Kresser)
• Eat fewer carbohydrates (sugars and grain based carbohydrates) reduces small dense LDL, lowers trigycerides and increases HDL
• Exercise and weight loss also help reduce small dense LDL
• Crazy as this sounds, eating THREE eggs a day can reduce small LDL by almost 20% (Chris Kresser)
• Stop eating vegetable oils
• A regular cholesterol test  won’t tell you anything about small LDL. It doesn’t distinguish between small LDL and large LDL.
• Two test you can have done to measure your small LDL: LDL-S3 GGE Test and The VAP Test. Insurance may not cover these tests.
• Steps to prevent heart disease naturally: don’t eat vegetable oils, eat saturated fats from animal protein, ghee, coconut oil & olive oil. Eat less sugar and processed carbohydrates (grain based). Eat fermented foods. Take cod liver oil. Exercise. Maintain a healthy weight. Manage stress, have fun. (Chris Kresser)
• Smoking only makes things worse. Stop smoking.
• New study shows Women with high cholesterol live longer. Read the article.
• Dr. Uffe Ravnskov, M.D., Ph.D. claims there are many studies that prove “there is no relationship between the blood cholesterol level and the degree of atherosclerosis” – people with high cholesterol should be more atherosclerotic than people with low cholesterol but that isn’t the case. Read the article.

O.k., sorry, that’s a long list and I’m not sure it makes anything clear. Here is what it says to me. Don’t be afraid of saturated fats. I really don’t think they are the “big evil” (see my post on coconut oil). I do believe the things to stay away from are sugar, processed carbohydrates and vegetable oils. Eat healthy, whole, organic, nutritionally dense foods – yum. If you think you might have FH you should probably be working with a doctor. Exercise and don’t smoke!

Here is an interesting article called “The Cholesterol Myths”. Scroll down the page a little and you’ll find a list called “here are the facts”. There are 9 items. Each item links to a more information about that “fact”. The last on the list is The Benefits of High Cholesterol. Interesting.

Chris Masterjohn and Chri Kresser write a lot about cholesterol. Good information from both can be found here: ChrisKresser.com/heartdisease, The Daily Lipid, and Cholesterol-And-Health.com

I’m still trying to understand it all. That’s all any of us can do. Everyone is different. We all have a different history when it comes to heart disease. I hope the information (and links) I provided will increase understanding of the topic and perhaps persuade those of you that need more information to continue to look into it. If you have questions or would like me to dig into a specific aspect of this post please let me know. I would be happy to do the research.

Below are definitions of terms you may encounter when discussing cholesterol and heart health.

Lipid

Another word for “fat”. “Cholesterol and triglycerides are lipids. Lipids are easily stored in the body. They serve as a source of fuel and are an important constituent of the structure of cells.” ()

Lipoprotein

A lipoprotein is a combination of a cholesterol and a protein that circulate through the body and carry cholesterol from the liver and small intestine to other tissues and cells in the body that need it. Lipoproteins are charcterized by their density: HDL is high density lipoprotein, LDL is low density lipoprotein. (references: About.com, )

Atherosclerosis

Hardening of the arteries or more precisely a focal accumulation of lipid, smooth muscle cells, foamy macrophages and eventually, cholesterol crystals under the surface lining (endothelium) of the artery (not along the artery wall like a kitchen drain pipe). Over time, this accumulation can form an elevated plaque (under the surface lining of the artery wall) that protrudes through (breaking) the lining and into the artery reducing blood flow. If the protruding plaque ruptures blood flow can become completely obstructed causing a heart attack.

Familial Hypercholesterolemia (FH)

A rare, inherited condition that is characterized by extremely high LDL cholesterol levels, or “bad” cholesterol, in the blood. Familial hypercholesterolemia, or FH, can cause atherosclerosis and heart disease at an early age. (About.com)

A genetic defect in the LDL receptor which causes severe elevations in total cholesterol and low-density lipoprotein (LDL). There are two kinds of FH, heterozygous and homozygous. Heterozygous means you have one inherited defective gene. Homozygous means you have two defective genes, inherited from both the mother and father.

Having two defective genes is very rare, about 1 in 1,000,000 people have this. People who are homozygous for FH can develop atherosclerosis (plaque build up in the arteries) and coronary heart attacks in infancy. Most people are at risk for heart disease after age 60. If you have two defective copies of the LDL receptor (homozygous FH) your risk changes from age 60 to between ages 0-30 years.  You are almost guaranteed to die from a heart attack early in life. (The Daily Lipid)

If you have one defective gene (more common, 1 in 500 people) your risk of developing heart disease happens between the ages of 30 – 60. “Early detection and aggressive management to lower the LDL level helps prevent or slows the progression of coronary atherosclerosis.” (MedScape Reference)

Dr. Uffe Ravnskov, M.D., Ph.D. believes people with FH lives as long as people without FH and they are more disease free because their high cholesterol levels protect them from infectious disease. Read More.

Eat Well, Feel good

Amy White, Functional Nutritionist

I’m Amy a board certified holistic nutritionist, certified functional nutritionist and lifestyle practitioner and certified Life Coach. I help women in midlife understand the changing needs of their body so that they can stop dieting and lose weight permanently. At 56 I live what I teach. Don’t believe the story that your best years are behind you. They are not. Your best years are just starting!