Cholesterol - the whys and wherefores
There is a general belief that a high fat diet results in high cholesterol, which results in arterial and heart disease. The evidence to support this theory is poor - the two largest culprits in arterial disease are refined carbohydrates (including sugars and fruit sugars) and high blood pressure from adrenalin - the stress hormone. The commonest cause of stress is rapidly falling levels of blood sugar, but any stress - lack of sleep, financial, emotional stress will also result in adrenalin.
Cholesterol is an essential molecule without which we would all be dead. It is an integral part of all cell membranes on which all metabolic activity takes place. Cell membranes are made up of one third polyunsaturated fat, one third saturated fat and one third cholesterol, of which 80% comes from the liver, 20% from diet. It is the raw material from which many essential molecules are made including hormones, in particular the adrenal and sex hormones, serotonin receptors (which help protect us against depression), vitamin D (through the action of sunshine on cholesterol in the skin - vitamin D is highly protective against heart disease and cancer), bile salts (essential for digesting foods) and so on. The highest concentrations of cholesterol are found in breast milk, where it is essential for infant nourishment and brain development.
Cholesterol comes into play in healing and repair of blood vessels. Blood vessels have a delicate lining and are at the mercy of turbulent blood flow. Turbulence is created where blood vessels divide and blood pressure is high. In this event the lining becomes damaged and has to be repaired. The first sign of repair is a fatty streak, then plaque formation and plaque stabilisation.
Cholesterol is a fat and can only be carried in the bloodstream wrapped up in a protein carrier. The problem is that at the site of healing there is potential for damage by oxygen (because the process of repair is carried out by the immune system, which produces free radicals when it is busy). If cholesterol becomes oxidised then it is damaging to blood vessels. LDL cholesterol is the oxidised version - often referred to as the "bad" cholesterol. HDL cholesterol is not oxidised (the technical term is "reduced"), hence often called the "good" cholesterol. A happy ratio of "good" to "bad" cholesterol is achieved by antioxidants, which keep cholesterol in this "reduced" state. These anti-oxidants are: paraoxygenase (PON 1 - interestingly this also protects against organophosphate poisoning!), glutathione peroxidase (needs glutathione and selenium), and superoxide dismutase - see Antioxidants.
So, do not be satisfied with just being told that your total cholesterol is whatever. There are two much more important results to know. The first is the ratio between so-called good cholesterol, HDL, and so-called bad cholesterol, LDL. Good HDL means good levels of PON 1. The second important factor is your level of frontline antioxidants - if these are good, then cholesterol is protected from oxidation.
The percentage of HDL cholesterol should be at least 20% of total cholesterol. People doing high fat stone-age diets I expect to run a percentage above 40. Saturated fat is good for arteries! See I was wrong - we should be feasting on FAT, says the Fast Diet author Dr Michael Moseley. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
This view suggests that a high cholesterol may be a symptom of arterial disease rather than the cause. It is only when LDL becomes oxidised into lipid peroxides as a result of poor antioxidant status that it may be directly damaging to arteries. See Antioxidants.
There is no doubt some people do have genetically high levels of LDL cholesterol (the "bad" one) and do suffer excessively from arterial disease, but this should only occur where there is poor antioxidant status.
This also explains why low fat diets do not reduce arterial disease - indeed they probably increase arterial disease because the right fats in the right proportion are essential for healthy membranes! We need saturated, polyunaturated fats, and cholesterol together with omega oils 6 and 3 in the proportion 4 to 1. See Phospholipid exchange and Brain fog - poor memory, difficulty thinking clearly etc.
Causes of a high total cholesterol with poor ratio
- Diet high in sugar and refined carbohydrate See Stone Age Diet - this is a diet which we all should follow and also see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Poor anti-oxidant status. See Antioxidants
- Vitamin D deficiency. Cholesterol is the raw material which, through the action of sunshine on the skin, is converted to vitamin D. If the body perceives the deficiency in vitamin D3, and this is almost universal in our low sunshine climate, then the liver pushes out more cholesterol so that when sunshine does land on the skin there is plenty of substrate for vitamin D3 to be made. Vitamin D3 deficiency is itself a major risk factor for arterial disease. See Vitamin D - most of us do not get enough
- The wrong sort of exercise. See Exercise - the right sort
- Borderline hypothyroidism. Indeed 30 years ago a raised cholesterol was almost routinely treated with thyroid hormones. See Hypothyroidism
- Vitamin B3 deficiency. B3 is essential for the metabolism of cholesterol and deficiencies are common. The converse is also true - high levels of vitamin B3 bring cholesterol levels down. The only problem is that the form of B3 (Niacin) which does this has a tendency to cause flushing. The body does acclimatise to this and so one needs to start off with small doses, such as 100mgs three times daily, and build up gradually.
- Iodine deficiency. See Iodine - what is the correct daily dose?
- Low levels of DHEA
- High levels of trans fatty acids in the diet
- Copper deficiency. There is an inverse relationship between cholesterol levels and copper - so the higher the copper in the blood (so long as it is in the normal range) the lower the cholesterol and vice versa. The best test of copper is to measure superoxide dismutase (SODase), another vital anti-oxidant, since this is a good functional test of copper (and, incidentally, also of zinc and manganese levels). Copper, Zinc and Manganese are required to synthesise superoxide dismutase.
A high cholesterol with poor ratio of HDL/LDL may be a symptom of arterial damage, that is to say, cholesterol is being mobilised for healing and repair. So anything which damages arteries will cause a secondary rise in LDL cholesterol. Things to consider would be:
- Dairy and carbohydrates - dairy is pro-inflammatory, refined carbohydrates are high glycaemic index. A Stone Age Diet helps prevents obesity and Diabetes . More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Exercise - the right sort
- Stress - lack of sleep, high adrenaline lifestyle resulting in high sugar levels.
- Poor Antioxidants status - results in excessive inflammatory reactions.
- Poisoning by heavy metals, pollution - damages artery walls directly.
- Wrong fats in the diet - see Phospholipid exchange
Any or all of the above could result in High blood pressure
The Problem with Statins
The interesting thing about statins is that they do reduce ones' risk of many diseases, but the degree to which they protect one is not commensurate with the degree with which they reduce cholesterol levels. We now suspect the reason why. Statins are vitamin D mimics - they look exactly like vitamin D and have many of vitamin D's beneficial effects. Vitamin D evolved because of sunshine which is markedly pro-inflammatory. By making vitamin D in the skin in response to the sunshine, and vitamin D is very anti-inflammatory, this allowed people to tolerate the pro-inflammatory effects of sunshine. This anti-inflammatory effect of vitamin D spreads through the whole body. Many degenerative diseases of ageing are associated with inflammation and vitamin D protects against this. Therefore it is highly protective against arterial disease, heart disease, cancer, autoimmunity (including multiple sclerosis and type I diabetes), neurodegenerative conditions, osteoporosis, allergies and so on, indeed any condition associated with inflammation.
The main problem with statins is that they inhibit two important enzyme systems. Firstly Coenzyme Q 10 - this is the most important antioxidant inside mitochondria and the main acceptor and donor of electrons. This means that mitochondria will go slow and the ageing process may be accelerated. There is now good evidence to show that poor mitochondrial function is a central part of chronic fatigue syndrome and this explains why statins almost invariably make patients with chronic fatigue worse.
Statins also inhibit formation of selenium based proteins such as glutathione peroxidase. This is one of the most important antioxidants in the blood and essential to maintain cholesterol in its desirable unoxidised state.
It is a combination of the above two factors which explains the devastating effect statins have on some people with muscle metabolism. People get obvious muscle soreness, stiffness, weakness and fatiguability. Heart muscle is little different from normal muscle so it is no wonder that the heart is also affected and theoretically this could result in heart failure.
Because statins interfere with antioxidant defences and energy supply they may be contributing to the epidemic of Alzheimer's disease we are now seeing. See Brain fog - poor memory, difficulty thinking clearly etc
- Phospholipid exchange
- Brain fog - poor memory, difficulty thinking clearly etc
- Exercise - the right sort
- Iodine - what is the correct daily dose?
- Stone Age Diet - this is a diet which we all should follow
- Vitamin D - most of us do not get enough
- High blood pressure
- The general approach to maintaining and restoring good health
- Ketogenic diet - the practical details
- My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Antioxidant status profile
- Thyroid profile: free T3, free T4 and TSH
- SODase (superoxide dismutase) studies
- Mitochondrial Function Profile
- Co-enzyme Q10
- The best website to see belongs to The International Network of Cholesterol Skeptics at THINCS. There you will read that a high cholesterol is highly protective against many degenerative diseases and a low cholesterol is a major risk factor for cancer.
- See paper by the American Geriatric society which concludes ": Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease" Cholesterol - low levels are bad for you!
- Cholesterol is vital for normal brain function - see article by Edward Kane 4 to 1 Oil - The Right Stuff.
- Dr Mercola is always worth reading! For his view on cholesterol also see Making sense of your cholesterol numbers
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