The Complexities of Cholesterol
What do we really know about cholesterol? The lower the better, doctors have told us since the 1960s, when the “cholesterol hypothesis” became widely accepted as fact, and millions reluctantly gave up bacon and eggs for cereal with skim milk.
Despite shaky science, Americans were quick to accept the thinking that high cholesterol foods were the chief villain in the disease of atherosclerosis—the process whereby fatty deposits build up in arteries, hardening and narrowing them, eventually starving the heart of blood.
If we could just reduce our intake of cholesterol, less of it would build up, we were told. It made sense; if you avoid dumping grease down the kitchen sink, your pipes are less likely to clog.
Finally, cholesterol is getting a closer look.
Found in all animals (including
humans), cholesterol is a waxy
substance that is essential to creating
and maintaining healthy
cell membranes. While most cholesterol
is produced in the liver,
it is so crucial for cellular health
that virtually all cells in the body
The brain contains the highest
percentage of cholesterol, as
nerve cells require cholesterol
to form connections between
synapses. Research indicates
that cholesterol may also act as an antioxidant, protecting cells from damage.
Because blood is water-based,
and cholesterol is insoluble, it
must be carried through the
bloodstream inside water-soluble
particles called lipoproteins,
chiefly high density lipoprotein (HDL) and low density lipoprotein (LDL). LDL largely transports cholesterol from the liver to our tissues, while HDL
ferries “used” cholesterol back to the liver, where nearly all is recycled.
This “recycled” HDL cholesterol actually forms the basis for many important hormones, including the estrogen hormones, testosterone, and progesterone, as well as cortisol. It is also needed for the production of bile acids, which the body uses to digest food and to make vitamin D.
Dr. Sergey Dzugan maintains that deficiencies of the hormones produced by the body from cholesterol is THE reason for elevated cholesterol levels, because the body is gearing up and struggling to produce more of those deficient hormones. He has demonstrated repeatedly that cholesterol levels will indeed drop if the hormones are supplemented to normal levels. He believes that the correlation between high cholesterol levels and heart disease only exists because the deficient hormones are needed for cardiac health.
Despite medicine’s obsession with lowering dietary cholesterol, about 65% of the cholesterol in our bloodstream is produced by the body itself, with just 35% ingested from our food. This is why dieting often fails to lower cholesterol levels. The body can compensate for lower dietary intake of cholesterol by simply making more of it.
If cholesterol is so essential for basic cellular functions, how did we come to demonize it?
By 1950, nearly one out of every three men in the United States developed some form of heart disease before reaching the age of 60. Pathologists searching for the cause discovered that blood vessels of heart disease victims were often clogged with plaque and debris. Because cholesterol was at the mushy center of this plaque, it was thought to be the cause of the disease.
In The Myth of Cholesterol, Dr. Paul Dugliss explains that the evidence that drove this hypothesis surfaced in the 1950s in the form of population studies that showed:
- heart disease was more prevalent in some, but not all, countries where cholesterol levels were typically high
- individuals with a genetic mutation that causes very high cholesterol levels (over 300 mg/dL) were four to five times more likely to have heart disease than those with cholesterol levels around 180 mg/dL
- cholesterol drugs lowered the risk of heart attack.
The most influential figure in the spread of such population-based evidence was a researcher named Ancel Keys. In 1953, he published a paper showing that four to five times as many Americans die of heart disease as Italians. He blamed this statistic on the high saturated fat content of the typical American diet. To prove it, Keys compared heart disease and nutritional data from six countries, even though this data was available from 22 nations.
Using only his selected nations, Keys was able to show a clear relationship between high saturated fat intake and death from coronary events. Other researchers, in his day and later, pointed out that examining the data from all 22 nations roundly disproved this theory.
To answer his critics, Keys responded with the Seven Countries study, published in 1958, which followed a group of men in seven countries (again hand-picked by Keys) over a number of years to trace the links between cholesterol, fat, and heart disease. When comparing heart disease rates between these countries (such as rates for Finns versus Japanese), he found that saturated fat intake was indeed the best predictor of heart disease risk. This result was widely publicized and Keys’ prescriptions for a low-fat diet were incorporated into the 1961 dietary guidelines from the influential American Heart Association (AHA).
Around the same time, results from perhaps the most famous of the population studies—the ongoing Framingham Heart Study—began to appear. The initial results supported one of their primary hypotheses: that elevated cholesterol levels contribute to an increased risk of cardiovascular disease. However, some practitioners question whether the Framingham study really did “prove” that link.
For example, in both the 1977 report and 1987 follow-up, the results indicate an association between high cholesterol levels and increased death due to heart disease among just one group—people under age 50—who comprise only five percent of all deaths related to heart disease. Not only did high cholesterol levels fail to raise heart disease risk for those over age 50, the 1987 data showed that participants who had reduced their cholesterol levels over the past decade actually had higher rates of death, from both cardiovascular problems and from all causes.
One notable distinction from the 1977 report has endured. The Framingham Heart Study gave the world a new standard of measuring cholesterol levels: total cholesterol readings would now be broken into “good” versus “bad” cholesterol.
By the late 1970s, new laboratory techniques allowed for the measurement of cholesterol carried within low density lipoproteins (LDL) to be compared to the amount of cholesterol found within high-density lipoproteins (HDL). In 1977, the Framingham researchers found that people with high levels of LDL tended to have more artery disease, while those with high levels of HDL typically had less artery disease.
The AHA then revised its recommendations to encourage the lowering of “bad” LDL while raising “good” HDL levels. Many clinicians now focus on getting patients to reduce LDL levels, even if they have no other risk factors for heart disease.
Cholesterol results should always be interpreted by a practitioner who is familiar with your overall health picture. In some cases, a high LDL level can be balanced with a high HDL level. Also, elevated total cholesterol or LDL could be a sign of defense against inflammation, infection, or cancer. In addition, HDL cholesterol levels can vary by as much as 40% within an individual. Dr. Dugliss offers a number of additional points to consider, including:
- Illness, drugs, seasonal variation and the position (sitting or lying down) in which the blood is taken can all affect the outcome.
- Levels must be drawn after 12-14 hours of fasting.
- Levels will be elevated in people with hypothyroidism.
- Synthetic derivatives of sex hormones and adrenal hormones can elevate cholesterol levels.
- Diuretic drugs can also increase cholesterol levels.
If your test results prompt your healthcare practitioner to encourage you to reduce your cholesterol levels, there are other medical conditions you may also want to explore:
- Dr. Broda Barnes notes that hypothyroidism often accompanies high cholesterol levels as we age, so he recommends testing for a thyroid deficiency before taking other steps to lower cholesterol. His experience has shown that correcting this deficiency often leads to a reduction of cholesterol concentration in the blood.
- According to Dr. Jens Möller, high cholesterol levels are not a cause of cardiovascular disease, but rather a symptom of poor circulation. Patients given testosterone experienced significantly lower cholesterol levels, which he attributed to improved circulation.
In fact, for many people, lowering cholesterol may not be the most important factor in reducing heart disease risk. As the AHA points out, age is the best predictor of risk: 82% of those who die from heart disease are over age 65. Gender, family history, smoking, hypertension, obesity, lack of exercise and diabetes are other significant risk factors. It also bears noting that a “risk factor” is not a “cause” of a disease, just something typically associated with it.
In 2003, a study published in both Circulation and the Journal of the American Medical Association reported on the risk factors for heart attack, as determined by an analysis of three large studies that followed patients for more than 20 years: the Chicago Heart Association Detection Project, the Multiple Risk Factor Intervention Trial, and the Framingham Heart Study. The authors discovered that for people under age 60, the best predictors for heart attack were smoking and hypertension. High cholesterol was among the least predictive factors.
Research has established that inflammation is a major contributor to the risk of cardiovascular disease. Widely publicized results indicate that lowering inflammation (as measured by reducing levels of C-reactive protein, or CRP) has proven to be far more effective in preventing heart attack than lowering cholesterol.
Results from the JUPITER trial show that statin therapy can significantly improve the cardiovascular health of patients with elevated CRP levels, even when their cholesterol levels are within normal ranges. However, physicians are cautious about prescribing statins to reduce CRP until the cause and effect is better understood. In fact, Dr. Brownstein contends that a healthy diet of primarily unrefined foods, adequate amounts of water, and 2000-5,000 mg/day of vitamin C will help prevent inflammation, without the adverse effects of statins.
Nevertheless, these findings back the growing notion that cholesterol, in and of itself, should not be the foremost concern when it comes to heart health. Instead, Dr. Paul Dugliss and others believe that inflammation is probably the real driver of cardiovascular disease. He explains that inflammation triggers an immune response that changes the chemical structure of cholesterol, basically “oxidizing” it.
The free radicals in oxidized cholesterol damage the arterial cells, provoking the immune system to respond. While this inflammatory response is intended to provide a temporary benefit, it ultimately results in the development of soft or “vulnerable” plaque that may rupture and/or promote blood clots. This type of plaque is potentially even more dangerous than the “hard” plaque that can build up over time, narrowing the arteries, because it is not easily detected.
In this way, cholesterol is certainly involved in heart disease; however, it plays a secondary role, and that role is now believed to be triggered by the effects of inflammation.
In 2000, Dr. Antonio M. Gotto, Jr., dean and medical provost of Cornell University Medical College, predicted that eventually 50% of the American adult population could be taking statin medications to reduce cholesterol. That prediction is nearing fruition.
As of 2011, approximately 40 million Americans were prescribed statin therapy—typically a prescription for life—making this class of drugs one of the most profitable ever. But are statins worth the risks?
In addition to the life-long financial burden, statin treatments can produce troublesome side effects, including headache, muscle and abdominal pain, weakness, and nausea. In his book, Malignant Medical Myths, Joel Kauffman, PhD, explains that statins work by blocking the enzyme required for the body to make cholesterol. However, statins also stop the production of other substances such as coenzyme Q-10, which is important for healthy heart muscle. “A typical user will observe pain in many joints, swelling of the legs, twinges in fingers and limbs, painful muscles, and weakness,” writes Kauffman, who notes additional side effects can include cancer, constipation, erectile dysfunction, liver and kidney damage, as well as memory problems. Sexual dysfunction is believed to result from the inhibition of steroid hormones derived from cholesterol, especially testosterone.
According to Dr. Sherry Rogers in Is Your Cardiologist Killing You?, statin drugs also lower zinc, which is involved in over 200 enzyme functions. Low zinc leads to early heart disease, Alzheimer’s, macular degeneration and DNA damage. Selenium is also depleted by statins, causing prostate and thyroid problems, as well as problems with the body’s ability to process toxins. Vitamin E, which has been shown to cut the risk of heart disease in half, is also depleted.
In Drugs That Don’t Work and Natural Therapies That Do!, Dr. David Brownstein argues that the benefits of statins may never outweigh the risks. He says long-term use of any drug that interferes with the body’s ability to manufacture critical substances such as cholesterol and coenzyme Q-10 is simply a bad idea, especially if there are much safer and more effective ways to lower the risk of heart disease.
Dr. Brownstein recommends losing weight, stopping smoking, and taking vitamin C and fish oil. He also promotes taking B vitamins to lower homocysteine levels because high levels are often associated with cardiovascular disease.
Some practitioners have found that niacin supplements can reduce excess LDL cholesterol, while at the same time raising HDL. Niacin also tends to reduce blood clots, potentially contributing to a lower risk for heart attack and stroke.
In Cholesterol Control Without Diet, The Niacin Solution, Dr. William B. Parsons points out that dietary control of cholesterol inevitably fails. However niacin or vitamin B 3 has been clinically demonstrated to reduce the incidence of heart attacks, strokes, cardiovascular surgery and hospitalization. Using niacin reduces LDL, triglycerides and total cholesterol, and increases HDL. None of the other drugs used for cholesterol can come close to these benefits.
In The Great Cholesterol Con, Anthony Colpo agrees that the effort required to substantially reduce cholesterol levels is probably not worth it; furthermore, the survival benefit of statins is unproven for women and most elderly people. “For many people,” he writes, “lowering cholesterol by 60 points (an arduous task that can require multiple drugs and lots of effort) only lowers the absolute risk of heart attack by 2 percent.”
By focusing so fervently on lowering cholesterol, we are likely to miss a number of safe, proven opportunities to improve our cardiovascular health. This is especially true for healthy people, for whom lifestyle changes should always be the first course of action in promoting overall wellness.
Nowhere is this clearer than in our approach to diet. Tragically, the single-minded focus on lowering dietary cholesterol over the past 50 years has spawned a huge food industry promoting low-fat, yet high carbohydrate, processed foods. Kauffman and others note that high-carb diets tend to raise blood sugar, contributing to the development of obesity and diabetes, and often raise the amount of omega 6 and trans fats consumed, which are thought to raise inflammation.
In addition, “heart healthy” labels are often stamped on foods of questionable nutritional value, contributing to the decline in consumption of fresh fruits and vegetables, eggs and meat—real food containing the vitamins, minerals, enzymes and anti-oxidants our bodies need. In particular, Dugliss also writes, vitamin C, vitamin B6, vitamin B12, and folic acid are critical to the body’s ability to manage levels of homocysteine (high levels of which tend to contribute to atherosclerosis).
Reducing stress and optimizing emotional health may be one of the best things you can do. Depression seems to be the best predictor of a second heart attack. Dugliss writes that reducing stress and increasing exercise together provide the most protection from cardiovascular disease, while appropriate dietary changes can add a modest benefit.
A lesser known way to cut stress is by boosting the intake of niacin, a component of vitamin B3. In addition to its effects on cholesterol and heart health as discussed earlier, niacin supplements have been shown to lower the perception of stress, along with many of its physiological effects.
Dr. Richard Lippman, author of Stay 40 Without Diet or Exercise, says that it is important to recognize the risk factors that impact overall heart health, specifically low thyroid, chronic inflammation, excessive blood coagulation, elevated homocysteine, lack of vitamin D3, and hormone deficiencies including melatonin, testosterone, estrogens, cortisol, DHEA, progesterone, insulin, and human growth hormone.
The story of the “cholesterol hypothesis” provides many lessons, not the least of which is this: a disease of aging, like heart disease, cannot be prevented by tinkering with a single risk factor. As Dugliss puts it, “No pill can substitute for a healthy lifestyle. And that lifestyle must include a healthy diet, healthy movement, and mental and emotional well-being.”
- The Great Cholesterol Con by Anthony Colpo, (self-published), 2006.
- The Myth of Cholesterol by Paul Dugliss, MD, and Sandra Fernandez, MSPH; MCD Century Publications; Ann Arbor, MI; 2005.
- "Statins May Play Dual Role in Preventing Heart Attack and Stroke," by Madeline Ellis; Health News; November 10, 2008.
- Malignant Medical Myths by Joel M. Kauffman, PhD, (self-published), 2006.
- Hypothyroidism: The Unsuspected Illness by Broda O. Barnes, MD, and Lawrence Galton; Harper & Row Publishers; New York, NY; 1976.
- Cholesterol: Interactions with Testosterone and Cortisol in Cardiovascular Diseases by Jens Moller, MD; Springer-Verlag, Berlin; 1987.
- "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C- Reactive Protein" (aka JUPITER Trial) by Paul M Ridker, MD, et al; New England Journal of Medicine; Vol 359, Nov 2008.
- Drugs That Don't Work and Natural Therapies That Do! by David Brownstein, MD; Medical Alternatives Press; West Bloomfield, MI; 2007.
- "How to Treat Inflammation" by David Brownstein, MD at drdavidbrownstein.blogspot.com/2009/10/how-to-treatinflammation.html
- Niacin and Human Health Disorders by Robert D. McCracken; Hygea Publishing Co.; Fort Collins, CO; 1994.
- Stay 40 Without Diet or Exercise by Richard Lippman, PhD, (self-published), 2008.
- Is Your Cardiologist Killing You? by Sherry Rogers, MD; Prestige Publishing; Solvay, NY; 2009.
- The Magic of Cholesterol Numbers: A step away from the cholesterol-lowering drugs by Sergey A. Dzugan, MD and Konstantine S. Dzugan; 2011.
- Cholesterol Control Without Diet! The Niacin Solution by William B. Parsons Jr., MD; Lilac Press; Scottsdale, AZ; 2000.