Cholesterol Clarity

1. Cholesterol is essential for health, not the villain it's portrayed to be

Your body could not survive without cholesterol.

Cholesterol is vital. It plays crucial roles in cell repair, hormone production, vitamin D synthesis, and brain function. The body produces most of its cholesterol, with only about 15% coming from diet. Cholesterol's antioxidant properties can actually help protect against heart disease.

The cholesterol myth. For decades, cholesterol has been wrongly vilified as the cause of heart disease. This misconception stems from flawed research by Ancel Keys in the 1950s, which ignored contradictory data. The resulting low-fat diet recommendations and cholesterol-lowering drugs have not reduced heart disease rates.

Rethinking cholesterol levels. Normal cholesterol levels in heart-healthy populations are often higher than current medical standards. For example:

• Men: Total cholesterol up to 220 mg/dL
• Women: Total cholesterol up to 250 mg/dL
  Having cholesterol levels that are too low can be more dangerous than high levels, potentially increasing risks of cancer, depression, and cognitive decline.

2. Inflammation, not cholesterol, is the true culprit in heart disease

Without inflammation in the body, cholesterol would move freely through the body and never accumulate on the walls of blood vessels.

Understanding inflammation. Chronic inflammation, caused by factors like poor diet, stress, and environmental toxins, is the primary driver of heart disease. It damages arterial walls, leading to cholesterol accumulation and plaque formation.

Key inflammation markers:

• High-sensitivity C-reactive protein (hs-CRP): optimal level < 1 mg/dL
• Homocysteine: optimal level < 9 μmol/L

Addressing inflammation. To reduce inflammation and improve heart health:

• Adopt an anti-inflammatory diet (low in processed foods, sugar, and omega-6 oils)
• Manage stress through exercise, meditation, or other relaxation techniques
• Get adequate sleep
• Minimize exposure to environmental toxins

3. Low-fat diets and statin drugs may do more harm than good

Lowering cholesterol through drugs is a multibillion-dollar industry.

The low-fat fallacy. Decades of low-fat diet recommendations have coincided with rising rates of obesity, diabetes, and heart disease. When fat is removed from foods, it's often replaced with sugar and refined carbohydrates, which increase inflammation and negatively impact cholesterol profiles.

Statin risks. While statins effectively lower cholesterol, their benefits in preventing heart attacks are minimal for most people. Potential side effects include:

• Muscle pain and weakness
• Cognitive impairment
• Increased risk of diabetes
• Depletion of CoQ10, a vital nutrient for heart health

Rethinking treatment. Instead of reflexively prescribing statins for high cholesterol, doctors should focus on addressing underlying causes through lifestyle changes and consider advanced testing to assess true cardiovascular risk.

4. Carbohydrates and vegetable oils are the real dietary culprits

To me, an elevated cholesterol level is important for one reason and one reason only: It reflects that you are eating too much carbohydrate in your diet.

Carbohydrate impact. Excess carbohydrate consumption, particularly refined grains and sugars, leads to:

• Increased triglycerides
• Decreased HDL cholesterol
• Increased small, dense LDL particles
• Insulin resistance and inflammation

Vegetable oil dangers. Polyunsaturated vegetable oils (e.g., soybean, corn, sunflower) are high in omega-6 fatty acids, which promote inflammation when consumed in excess. The ideal omega-6 to omega-3 ratio is 1:1, but the modern diet often has a ratio of 20:1 or higher.

Dietary solutions:

• Reduce carbohydrate intake, especially refined grains and sugars
• Replace vegetable oils with healthier fats like olive oil, coconut oil, and animal fats
• Increase consumption of omega-3 fatty acids from sources like fatty fish and grass-fed meat

5. LDL particle size matters more than total LDL cholesterol

The size of the LDL particles is so much more important than LDL-C. You want to have mostly the big, fluffy Pattern A LDL particles, and less of the small, dense, B-B type Pattern B LDL particles.

LDL particle types:

• Pattern A: Large, buoyant, and generally harmless
• Pattern B: Small, dense, and potentially dangerous

Why size matters. Small, dense LDL particles can easily penetrate arterial walls, leading to plaque formation. They are also more prone to oxidation, which triggers inflammation and further damage.

Advanced testing. Traditional cholesterol tests only measure LDL-C, which doesn't distinguish between particle types. Advanced tests like NMR LipoProfile provide a more accurate assessment of cardiovascular risk by measuring:

• Total LDL particle number (LDL-P)
• Small LDL particle number
• LDL particle size

Optimal levels:

• Total LDL-P: < 1000 nmol/L
• Small LDL-P: < 200 nmol/L

6. Triglycerides and HDL are crucial markers of heart health

To derive the biggest benefits for your cardiovascular health, you want your HDL cholesterol at 70 mg/dL or higher, which is more than what mainstream experts recommend. Anything below 50 should be cause for concern.

Triglycerides. High triglycerides are strongly linked to cardiovascular risk and are primarily driven by carbohydrate consumption.

• Optimal level: < 100 mg/dL (even better: < 70 mg/dL)
• Conventional "normal" range (< 150 mg/dL) is too high

HDL cholesterol. HDL helps remove excess cholesterol from the body and protects against heart disease.

• Optimal level: > 70 mg/dL
• Conventional "normal" range (> 40 mg/dL for men, > 50 mg/dL for women) is too low

Triglyceride-to-HDL ratio. This ratio is a powerful predictor of heart disease risk and insulin resistance.

• Optimal ratio: < 2:1
• Calculated by dividing triglycerides by HDL

To improve these markers:

• Reduce carbohydrate intake
• Increase healthy fat consumption
• Exercise regularly
• Lose excess weight

7. Advanced tests provide a more accurate picture of cardiovascular risk

Progressive lipidologists are more concerned with LDL particles, ApoB, and the more modern technology for measuring lipoproteins.

Beyond basic lipid panels. Advanced tests offer a more comprehensive assessment of cardiovascular risk by measuring:

1. Apolipoprotein B (ApoB): Reflects total number of atherogenic particles
2. LDL particle number (LDL-P)
3. Small LDL particle number
4. Lipoprotein(a): Genetic risk factor for heart disease
5. Oxidized LDL: Directly contributes to plaque formation

Additional important markers:

• High-sensitivity C-reactive protein (hs-CRP): Measures inflammation
• Homocysteine: Linked to increased cardiovascular risk
• Fasting insulin: Indicates insulin resistance

Interpreting results. These tests provide a more nuanced understanding of cardiovascular risk, allowing for more targeted interventions. They can help identify individuals at risk even when traditional lipid panels appear normal.

8. Nutrition and lifestyle changes are the best ways to improve heart health

People need to realize that good health isn't in a pill. Changes in lifestyle, such as smoking cessation, reducing consumption of sugar, stress control, and exercise, in conjunction with eating natural fats, including butter, with full-fat cheese, grass-fed beef, nuts, vegetables, and dark chocolate, are the best prescription for great health.

Dietary recommendations:

• Reduce carbohydrate intake, especially refined grains and sugars
• Increase consumption of healthy fats (saturated, monounsaturated, and omega-3)
• Eat whole, unprocessed foods
• Include plenty of non-starchy vegetables

Lifestyle interventions:

• Regular exercise (both aerobic and strength training)
• Stress management techniques (meditation, yoga, deep breathing)
• Adequate sleep (7-9 hours per night)
• Sunlight exposure for vitamin D synthesis

Supplements to consider:

• Omega-3 fatty acids (fish oil)
• Magnesium
• Coenzyme Q10
• Vitamin D

By focusing on these nutrition and lifestyle factors, most people can significantly improve their cardiovascular health without resorting to medications. However, it's important to work with a knowledgeable healthcare provider to develop an individualized plan based on your specific risk factors and health status.

Last updated: November 19, 2024