Cholesterol is not the major culprit in heart disease or any
disease. If it becomes oxidized in can irritate/inflame tissues
in which it is lodged in, such as the endothelium (lining of the
arteries). This would be one of the numerous causes of
chronic inflammation that can injure the lining of the arteries.
However, many good fats are easily oxidized such as
omega-3 fatty acids, but it does not mean that you should
avoid it at all costs.
Common sense wold indicate that we should avoid the
oxidation (rancidity) of cholesterol and fatty acids and not
get rid of important life-giving molecules. Using the same
conventional medical thinking that is being used for
cholesterol would lead one to believe that doctors should
reduce the risk of Alzheimer's disease by taking out
everybody's brain.
In fact, cholesterol is being transported to tissues as part of
an inflammatory response that is there to repair damage.
The fixation on cholesterol as a major cause of heart disease
defies the last 15 years of science and deflects from real
causes such as the damage (via glycation) that sugars such
as glucose and fructose inflict on tissues, including the lining
of arteries, causing chronic inflammation and resultant
plaque.
Insulin and Leptin Resistance
Hundreds of excellent scientific articles have linked insulin
resistance and more recently leptin resistance to
cardiovascular disease much more strongly than cholesterol,
and they are in fact at least partially responsible for
cholesterol abnormalities. For instance, insulin and leptin
resistance result in "small dense" LDL particles and a greater
number of particles.
This is much more important than the total cholesterol
number. Because of particle size shift to small and dense,
the total LDL cholesterol could still be low even though the
number of particles and the density of the particles is
greater. Small, dense LDL particles can squeeze between the
cells lining the inside of the arteries, the "gap junction" of the
endothelium, where they can get stuck and potentially
oxidize, turn rancid, and cause inflammation of the lining of
the arteries and plaque formation.
Importantly, many solid scientific studies have shown a
mechanistic, causal effect of elevated insulin and leptin on
heart and vascular disease, whereas almost all studies with
cholesterol misleadingly only show an association.
Association does not imply cause. For instance, something
else may be causing lipid abnormalities such as elevated
cholesterol and triglycerides, and also causing heart disease.
This "something else" is improper insulin and leptin signaling.
Similarly, sugar does not cause diabetes; sugar is just
listening to orders. Improper insulin and leptin signaling is
the cause of diabetes. Likewise, cholesterol does not cause
heart disease, but improper metabolic signals, including
improper signals to cholesterol (causing it to oxidize) and
perhaps to the liver that manufactures cholesterol, will cause
heart and vascular disease and hypertension.
Removing cholesterol will do nothing to improve the
underlying problems, the real roots of chronic disease, which
will always have to do with improper communication, and the
generals of metabolic communication are insulin and leptin.
They are really what must be treated to reverse heart
disease, diabetes, osteoporosis, obesity, and to some extent,
aging itself.
Cholesterol; Wrongly Accused?
Before we can begin to talk about the real cause and
effective treatment for heart and blood vessel disease, we
must first look at what is known, or I should say what we
think we know. The first thing that comes to mind when one
hears about heart disease is almost always cholesterol.
Cholesterol and heart disease have been almost synonymous
for the last half-century. Cholesterol has been portrayed as
the Darth Vader to our arteries and heart.
The latest recommendation given by a so-called panel of
"experts" recommends that a person's cholesterol be as low
as possible, in fact to a level so low they say it cannot be
achieved by diet, exercise, or any known lifestyle
modification. Therefore, they say cholesterol-lowering drugs;
particularly the so-called "statins" need to be given to anyone
at high risk of heart disease. Since heart disease is the
number one killer in this country, that would include most
adults and even many children. The fact that this might add
to the $26 billion in sales of statin drugs last year I'm sure
played no role in their recommendation.
Or did it?
Expert Conflict of Interests
Major consumer groups think so. They found that eight of the
nine "experts" that made the recommendations were on the
payroll of pharmaceutical companies that manufacture those
drugs. Major scientific organizations have chastised medical
journals for allowing the pharmaceutical industry to publish
misleading results and half-truths. There is a major push
under way to force the pharmaceutical industry (and others)
to publish results of all of their studies, and not just the ones
that appear positive. The studies that showed negative
results would be forced to be published also.
It could be that lowering cholesterol might not be as healthy
as we are being told. More and more studies are coming out
showing just how unhealthy lowering cholesterol might be,
particularly by the use of statin drugs. In particular, statin
drugs have been shown to be harmful to muscles, causing
considerable damage. A common symptom of this damage is
muscular aches and pains that many patients experience on
cholesterol-lowering drugs, however most do not realize that
these drugs are to blame.
Hmm...isn't the heart a muscle?
Statin Drugs Actually Increase Heart Disease
Indeed, low cholesterol levels have been shown to worsen
patients with congestive heart failure, a life-threatening
condition where the heart becomes too weak to effectively
pump blood. Statin drugs have been shown to also cause
nerve damage and to greatly impair memory. One reason
that statin drugs have these various side effects is that the
work by inhibiting a vital enzyme that manufactures
cholesterol in the liver. However, the same enzyme is used
to manufacture coenzyme Q10, which is a biochemical
needed to transfer energy from food to our cells to be used
for the work of staying alive and healthy.
Statin drugs are known to inhibit our very important
production of coenzyme Q10. Importantly, while many
cardiologists insist that lowering cholesterol is correlated
with a reduction in the risk of heart attacks, few can say that
there is a reduction in the risk of mortality (death). That has
been much harder to show. In other words, it has never been
conclusively shown that lowering cholesterol saves lives. In
fact, several large studies have shown that lowering
cholesterol into the range currently recommended is
correlated with an increased risk of dying, especially of
cancer.
No Such Thing as Good and Bad Cholesterol
Because the correlation of total cholesterol with heart
disease is so weak, many years ago a stronger correlation
was sought. It was found that there is so-called "good
cholesterol" called HDL, and that the so-called "bad
cholesterol" was LDL. HDL stands for high-density lipoprotein,
and LDL stands for low-density lipoprotein. Notice please that
LDL and HDL are lipoproteins--fats combined with proteins.
There is only one cholesterol. There is no such thing as a
good or a bad cholesterol. Cholesterol is just cholesterol. It
combines with other fats and proteins to be carried through
the bloodstream, since fat and our watery blood do not mix
very well.
Fatty substances therefore must be shuttled to and from our
tissues and cells using proteins. LDL and HDL are forms of
proteins and are far from being just cholesterol. In fact, we
now know there are many types of these fat and protein
particles. LDL particles come in many sizes, and large LDL
particles are not a problem. Only the so-called small dense
LDL particles can potentially be a problem, because they can
squeeze through the lining of the arteries and if they oxidize,
otherwise known as turning rancid, they can cause damage
and inflammation. Thus, you might say that there is "good
LDL" and "bad LDL." Also, some HDL particles are better
than others. Knowing just your total cholesterol tells you very
little. Even knowing your LDL and HDL levels do not tell you
very much.
A mistake that is rarely made in the hard-core sciences such
as physics seems to be frequently made in medicine. This is
confusing correlation with cause. There may be a weak
correlation of elevated cholesterol with heart attacks,
however this does not mean it is the cholesterol that caused
the heart attack. Certainly gray hair is correlated with getting
older; however one could hardly say that the gray hair
caused one to get old. Using hair dye to reduce the gray hair
would not really make you any younger. Neither it appears
would just lowering your cholesterol.
Perhaps something else is causing both the gray hair and the
aging. Even if elevated cholesterol and heart disease were
significant (which I question), perhaps something else is
causing the elevated cholesterol and also causing the heart
disease.
Let's look a little more at cholesterol, or as Paul Harvey was
fond of saying, "the rest of the story." First and foremost,
cholesterol is a vital component of every cell membrane on
Earth. In other words, there is no life on Earth that can live
without cholesterol. They will automatically tell you that, in
and of itself, it cannot be evil. In fact, it is one of out best
friends. We would not be here without it. No wonder lowering
cholesterol too much increases one's risk of dying.
Cholesterol also is a precursor to all of the steroid hormones.
You cannot make estrogen, testosterone, cortisone, and a
host of other vital hormones without cholesterol.
Cholesterol is the Hero, Not the Villain
It was determined many years ago that the majority of
cholesterol in your bloodstream comes from what your liver
is manufacturing and distributing. The amount of cholesterol
that one eats plays little role in determining your cholesterol
levels. It is also known that HDL shuttles cholesterol away
from tissues, and away from your arteries, back to your
liver. That is why HDL is called the "good cholesterol;"
because it is supposedly taking cholesterol away from your
arteries. But let's think about that:
-Why does your liver make sure that you have plenty of
cholesterol?
-Why is HDL taking cholesterol back to your liver?
-Why not take it right to your kidneys or intestines to get rid
of it?
It is taking it back to your liver so that your liver can recycle
it; put it back into other particles to be taken to tissues and
cells that need it. Your body is trying to make and conserve
the cholesterol for the precise reason that it is so important,
indeed vital, for health.
One function of cholesterol is to keep your cell membranes
from falling apart. As such, you might consider cholesterol as
your cells' "superglue." It is a necessary ingredient in any
sort of cellular repair. The coronary disease associated with
heart attacks is now known to be caused from damage to the
lining of those arteries. That damage causes inflammation.
The coronary disease that causes heart attacks is now
considered to be caused mostly from chronic inflammation.
What is Inflammation?
Think of what happens if you were to cut your hand. Within a
fraction of a second, chemicals are released by the damaged
tissue to initiate the process known as inflammation.
Inflammation will allow that little cut to heal, and indeed to
keep you from dying. The cut blood vessels constrict to keep
you from bleeding too much. Blood becomes "thicker" so it
can clot. Cells and chemicals from the immune system are
alerted to come to the area to keep intruders such as viruses
and bacteria from invading the cut. Other cells are told to
multiply to repair the damage so that you can heal. When the
repair is completed, you have lived to be careless another
day, though you may have a small scar to show for your
troubles.
We now know that similar events take place within the lining
of our arteries. When damage occurs to the lining of our
arteries (or even elsewhere), chemicals are released to
initiate the process of inflammation. Arteries constrict, blood
becomes prone to clot, white blood cells are called to the
area to gobble up damaged debris, and cells adjacent to
those damaged are told to multiply. Ultimately, scars form,
however inside our arteries we call it plaque. And the
constriction of our arteries and the "thickening" of our blood
further predisposes us to high blood pressure and heart
attacks.
So Where Might Cholesterol Fit into All of This?
When damage is occurring and inflammation is being initiated,
chemicals are being released so that the damage can be
repaired. One could speculate that to replace damaged, old
and worn-out cells, the liver needs to be notified to either
recycle or manufacture cholesterol, since no cell, human or
otherwise, can be made without it. In this case, cholesterol is
being manufactured and distributed in your bloodstream to
help you repair damaged tissue and in fact, keep you alive.
If excessive damage is occurring, such that it is necessary to
distribute extra cholesterol through the bloodstream, it would
not seem very wise to merely lower cholesterol and forget
about why it is there in the first place. It would seem much
smarter to reduce the extra need for cholesterol--the
excessive damage that is occurring, the reason for the
chronic inflammation.
So Why Take Cholesterol-Lowering Drugs?
The pharmaceutical companies thought that you might think
that. They went back to the drawing board. They did more
"research" and found (coincidentally) that statin drugs had
anti-inflammatory effects. Therefore, we're currently being
told to stay on our cholesterol-lowering drugs because they
now work by reducing inflammation and perhaps not even by
reducing cholesterol, and in fact perhaps in spite of it. Aspirin
reduces inflammation for a lot less money. So does vitamin
E, fish oil, and dietary changes without the dangers of drugs
and having many other benefits instead.
What About Triglycerides?
Triglycerides are just medical terminology for fat. A person
with high triglycerides has a lot of fat in the bloodstream.
Triglycerides are generally measured when a person has
fasted overnight. High fasting triglycerides are either from
manufacturing too much, or using (burning) too little. In
other words, what high triglycerides are telling you is that
you are making too much fat and you are unable to burn it.
This indeed is a major problem. The inability to burn fat
underlies virtually all of the chronic diseases of aging, and in
fact may contribute to the rate of aging itself.
As such, one might think that the control of fat burning and
storage might be very important in heart disease and the
other diseases of aging such as diabetes, obesity,
osteoporosis, and even cancer. Indeed, this appears to very
much be the case. The two hormones that to a major extent
control our ability to burn and store fat, insulin and leptin,
appear to play a major role in all of the chronic diseases of
aging.
By: Ron Rosedale, M.D.
