Elevate Your Cholesterol Profile, Elevate Your Health

It’s interesting when I see a patient and go over their blood work. They’re always most concerned about one thing – their cholesterol. Other blood levels could be significantly out of normal range, but typically most are worried if their cholesterol level is high, or not. Medical doctors, the media, and of course the pharmaceutical industry has ingrained in each person (including children) the notion that cholesterol is bad and if you don’t lower it, you’re gonna die. Really? I’m doing everything I can to raise mine.

Who is dying from high cholesterol?

Cardiovascular problems, such as heart disease and heart attacks, are a major health problem in today’s societies – they’re the number one cause of death. Cholesterol is often implicated as a major player in these types of problems. High cholesterol may be a factor of an underlying problem, or it may just be a coincidence that one’s cholesterol is elevated due to other health problems, related or unrelated to the cardiovascular system. Typically, due to medical intervention, patients are already on cholesterol lowering medications yet they’re still having health problems, and definitely not living any longer. So if it was just all about high cholesterol causing heart disease and lowering cholesterol resolving these problems then there would be a major improvement in this healthcare crisis.

Cardiovascular disease is caused by a wide range of nutritional, lifestyle and environmental factors that result in inflammation that gets out of control. Sure genetics most likely have some factor, but minimal compared to the rest. The genetic link is typically a cop-out when someone doesn’t take control of their own health. Toxins, infections, excessive stress, lack of proper exercise and diet are far more damaging to the heart than high total cholesterol.

I’m not at all insinuating that high cholesterol is okay, but I am definitely saying that less is not necessarily better. There’s more to it than just that. Cholesterol just doesn’t shift to a dangerous level without other contributing factors. A poor diet and overall health lead to unhealthy cholesterol levels whether that’s low, (as mine were back in the early 1990s), high, or imbalanced. I’ll discuss this more in a bit.

Why do you need cholesterol?

I have been trying for years, decades actually, to raise my cholesterol. Finally after a more significant (call it strict if you like) change in diet, it’s happening and that’s a good thing. You see, low cholesterol is often much more dangerous than high cholesterol even though we’re led to believe that cholesterol is evil. A cholesterol level below 160 mg/dl is said to increase one’s risk of many cancers, stroke, neurological problems such as memory loss and dementia, and many other health problems ranging from digestive to hormonal. I often tell a patient that if they had to pick one, high cholesterol is better than low. Of course, a healthy level is best – which is based off the components that make up cholesterol as discussed below.

Some notable cholesterol functions:

• It acts as a precursor to vitamin D – low cholesterol means it will be more difficult to absorb this vitamin necessary for a healthy immune system, bones, and DNA. More on vitamin D here.
• It is the precursor to all steroid hormones such as glucocorticoids which control blood sugar, mineralcorticoids which regulate electrolyte balance and blood pressure, and sex hormones such as progesterone, estrogen, and testosterone.
• It is used to synthesize bile acids in the liver, which are important for the digestion of fats. These bile salts are then stored in the gallbladder.
• Cholesterol is found in every cell of your body and is a necessary component of a healthy brain that needs to store and recall memory, process ideas, and function at its highest level.

About 20 years ago my total cholesterol level dropped to 92 mg/dl. I was a student at the University of Miami, well known for its pre-med program. The leading physician at the student health center at that time thought I was extremely healthy; I had the “best” cholesterol level he had ever seen. As nice as he was, this unenlightened doctor did not realize that it was actually perhaps one of the worst he had discovered. I, at the time, knew no better and clearly didn’t know the dangers of such a low level. I was training hard, studying hard, and following the low-fat, high carbohydrate diet of the late 1980s-early 1990s.

Good, bad & ratios

Most of us know that cholesterol is made up of HDLs, LDLs, and VLDLs (which are mostly triglycerides). The HDLs tend to remove cholesterol from tissues so many think of them as the “good” cholesterol whereas the LDLs tend to deposit cholesterol into tissues, so we are told this is the “bad” stuff. In reality it is not that cut and dry, because there are also good and bad LDLs, and good and better HDLs.

Triglycerides are major transporters of dietary fat in the bloodstream – especially fat that has resulted from excess carbohydrates in the diet. On average, a diet consisting of 60% or more of carbohydrates can increase triglyceride levels as can heavy alcohol use. I’ll leave the determination of “heavy” up to you, but typically that means two or more drinks per night, sometimes less.

Your tissues need cholesterol or you will die; so not all LDLs are as bad as they’re made out to be. All cholesterol  particles can be either large or small. Ideally you’d like to have more large, buoyant HDLs and LDLs than small, and more small VLDLs/triglycerides than large. These can be measured through a more thorough lipid analysis, and are readily available today – click here for more info.  One sign that your LDLs are most likely large (good) rather than small (bad) is your HDL to triglyceride ratio. If your HDLs are at least one-half of your triglycerides, then you most likely have large LDLs. So for example, if your HDLs are 40 and your triglycerides are over 80, you have some work to do.

Another good ratio to look at is the total cholesterol to HDL ratio. Most lab reports say this ratio is normal if it is 5:1 or lower. That is still very high, and in my opinion you should shoot for 3:1, if not lower. So if your total cholesterol is 180 and your HDL is 60 that is good. If your total cholesterol is 250 with a  HDL of 100, LDL of 130 and triglyceride of 100 that is also good!

The LDLs really freak people out. I tell patients that it is almost impossible to pass a cholesterol test today. At least one result from the lipid panel is most likely going to be flagged. You’re destined to fail – healthy or not. You see, what has happened is that the LDL upper limit was dropped several years ago by most labs from 138 to 100. So now a LDL of say 125 is considered high, regardless of whether they are the small or large LDLs. Interestingly, around the same time this happened, the pharmaceutical industry was trying to get the upper limit of total cholesterol lowered from 200 to 190. That way, if your cholesterol level was 195, your doctor would recommend a statin medication “for your health.” This never happened, but the LDL was soon lowered – a whopping 38 points. Uncanny coincidence. So now a lipid panel of say 190 total cholesterol, 65 HDL, 105 LDL, and 100 triglycerides, (a triglyceride makes up 1/5 of the total cholesterol, so 100 = 20 of the total points), which is excellent, is flagged as having a high LDL. That’s not cool.

LDLs however are the big issue when it comes to heart health but it is the oxidized LDLs rather than LDLs per se that contributes to atherosclerosis and “cholesterol problems.” What causes LDLs to oxidize? Free radicals, unhealthy fats, and a high carbohydrate diet cause the oxidation.

Free radical damage is often the result of lack of antioxidants in the body, such as vitamins A, C, and E but perhaps more importantly are all the healthy antioxidants found in fruits, vegetables, and herbs. Vitamin D is also a very important antioxidant – and one that won’t be well utilized by a low cholesterol body. Coenzyme Q10 is a very an important antioxidant needed by the heart and for the body to make energy. Statins (cholesterol meds) block CoQ10 from being made naturally in the body, therefore increasing free radical damage and further oxidizing LDLs. The more stress one is under – physical, nutritional, and emotional – the more free radical damage your body will succumb to.

Unhealthy fats mean partially hydrogenated “trans” fats as well as all polyunsaturated vegetable oils – corn, soy, sunflower, safflower, peanut, cottonseed, and yes definitely canola. More on that here.

And yes high carbohydrates (refined sugar especially) will lead to oxidized LDLs. More on cutting the carbs here.

Oxidized LDLs cause the body’s immune system to respond by sending in specialized white blood cells to absorb the oxidized LDLs. This creates what are called foam cells which are not able to process the oxidized LDLs, so they ultimately grow then rupture, depositing a greater amount of oxidized cholesterol into the artery wall. This of course triggers more foam cells, continuing the cycle. Foam cells can accumulate and lead to atherosclerosis (inflammation in the vessel wall), a thrombus or emboli (properties of a stroke), from all the accumulated plaque (fats and cholesterol particles). The occlusion of small vessels results in ischemia and can also result in a stroke and myocardial infarction (heart attack).

The point here – small, dense LDLs are the problem because they’re easily oxidized. Once you get more and more oxidized, you’re in trouble.

Cholesterol and Satan (I Mean Statins)

Statins are known as HMG-CoA reductase inhibitiors – they stop the synthesis of a compound called mevalonate from being formed. Mevalonate is the precursor of cholesterol, but also the precursor of squalene and coenzyme Q10 (ubiquinone), as previously mentioned.

Statins, other than blocking how cholesterol and other compounds are made, are touted as beneficial as some studies show they greatly increase the amount of nitric oxide made by the blood vessel lining which results in stroke reduction and its residual neurological effects.Some also say that statins protect against stroke by increasing the body’s ability to dissolve blood clots independently of both nitric oxide and cholesterol. Of course, as mentioned previously, you can significantly lower your risk of stroke by limiting your number of oxidized LDLs. Additionally, nitric oxide is made naturally in high amounts in healthy individuals with adequate protein intake (via the amino acid arginine) and proper cofactors (primarily manganese and vitamin B6).

The Lancet recently published a study saying how safe and effective statins are. These studies often come out to reassure doctors and patients that “all is good.” This one is no different. You can see the study here. The participants in this study either had already had a heart attack or some other form of cardiovascular disease or a condition that would place them at high risk. Also they looked at cancers and non-vascular mortality, not “health.” Oh yeah, it’s worth mentioning that one of the two researches received funding from several drug companies that make statins and has been on drug company advisory boards and even received a honoraria from Pfizer.

How about Pfizer? They make Lipitor, the top-selling drug in history, which lost its patent on November 30, 2011. What a sad day. They pulled in $11 billion worldwide for Lipitor sales last year. Now that some new generics have taken 63% of sales recently they’re down to just a measly $4 billion on the drug, if sales stay up. Speaking of money – here’s an interesting preview of a film called “$29 Billion Reasons to Lie About Cholesterol”. Remember Crestor was pulled off the market (2004 I believe) after being linked to kidney failure. It’s back on the market with that nifty little black box warning. Ever read one of those? Nobody has.

So do you go on a statin if your cholesterol is too high or you’re at some cardiovascular health risk? Personally I think most are putting themselves at more of health risk by doing so, but of course I’m not saying you should stop your medication if you’re on one, but you should understand what they do and really look into why one has been recommended to you. I’ve seen patients on statins for cholesterol levels well below 200, but their doctor thinks “lower is better.” I’ve seen many patients on them who have had pain and fatigue (shoulder pain is very common from statins) yet their doctor tells them to push through it. Many still have pain after they get off the meds.  I even saw a guy who was on a statin to “prevent a heart attack” because his family member, a smoker, had a heart attack. Really. The statin brought his cholesterol down from the 170s to the 120s. These are scary, but true stories. High cholesterol is not the primary cause of heart disease and statins don’t decrease this risk for most people. Statins do however impair vitamin D metabolism and CoQ10 production as previously mentioned, as well as squalene production.

Squalene accumulates at the greatest concentrations in the skin, where it has a vital role as a free radical scavenger, preventing the harmful effects of the degeneration of fats. Adequate concentrations of squalene in the skin prevent oxidative damage from ultraviolet light. Squalene is also a substance that protects people from cancer, so yeah squalene is important. You may have heard of claims that “sharks don’t get cancer.” This is because squalene is super high in shark liver oil. I don’t know if sharks get cancer and I don’t think you should go shark hunting. But you should naturally keep your squalene levels high.

As a sort of side note – I think it’s rather comical that medical doctors think they’re protecting their patient by checking the liver enzymes (AST & ALT) when they prescribe a statin. The liver has to detox these meds and of course cholesterol is made in the liver but there are often functional problems (detoxification impairments) long, long before the enzymes become elevated. I’ve never seen a person taking a statin have elevated liver enzymes yet I’ve seen plenty of them with adverse statin reactions (“side-effects”) – pain, fatigue, and memory problems are the most common.

Less is often not better when it comes to cholesterol

Sure you still need a lot of HDLs and healthy LDLs, but ultimately you need cholesterol. For years after coming off my 92 mg/dl cholesterol plummet, my total cholesterol level hovered between the 130-150 range. My HDLs were always around 50, so that was good, and my triglycerides were always between 70-90 – also good. My LDLs in the 60-80 range – also good. But overall – too low! So back in August 2011 I changed my already very healthy diet to one that was even more healthy for me. I had been eating a diet approximately 55-60% carbohydrate, 20-25% protein, and 20-25% fat. The fat was mostly extra virgin olive oil, butter, nuts, and seeds as well as some fish oil. In August I adjusted to approximately 10-20% carbohydrate, 20-25% protein, 60-70% fat. Additionally, for fats, I significantly reduced my nuts and seeds and added in a lot of coconut oil and coconut milk, more butter, avocados, and a lot of eggs, (pasture raised of course from my 12 hens). In the carbohydrate category I almost completely eliminated all grains with the exception of some corn, rice, and sweet potatoes which I eat on hard intensity or long duration exercise days – this amounts to anywhere from 0-4 times a week. The majority of carbohydrates are from vegetables and some fruit. Oh yeah, 80% dark chocolate too. Did I develop cardiovascular disease? Nope. For the first time ever my total cholesterol hit 170. My HDLs went up over 50% to 78 and my triglycerides dropped even lower to 48 while my LDLs stayed at 82. That’s great to see. And if you’re following, notice that my HDLs, which ideally should be at least one-half of the triglycerides, are actually 1.6X MORE than the triglycerides. What I’ve done is decrease my risk of cancer, stroke, and dementia. Now where was I…

So what’s it all come down to? Diets high in saturated fat and cholesterol don’t cause heart disease. Check out the cool video below to learn even more than what I have here. Actually it’s the high carbohydrate diets and so-called “heart healthy” vegetable oils (corn, soy, canola, safflower, peanut, etc) that are linked to heart disease, cancer and most all diseases. A diet high in carbohydrates and inflammatory oils increase LDLs and oxidize them – and that can cause atherosclerosis.

How to naturally lower or raise cholesterol to a healthy level for you

Are you, “unable to control your cholesterol with diet and exercise”?  What does that even mean? Most doctors don’t exercise or eat well and they sure don’t how to prescribe it. So they fall back on the “diet and exercise alone aren’t enough” motto and recommend a statin. Proper exercise and a healthy diet can do wonders for your health and your cholesterol. That doesn’t mean you cut out all the fat from your diet and get up from your desk a few times a day to walk to the water cooler. Here are some recommendations with the concept that maintaining heart health is about keeping inflammation at bay.

• Remove all refined sugar (that includes juice) and grains from your diet. Triglyceride levels quickly drop with a low carb diet. Check out the Paleo Diet and Two Week Test here to get started.
• Oatmeal? What a joke. Does Wilford Brimley look healthy to you?
• Exercise! Aerobic exercise is a great way to start especially if you’re already on a statin (or any med for that matter). Strength training may be beneficial for you too.  More here. It may be advised for you to have a stress test before engaging in any physical activity. Then again, if you don’t move and engage in some physical activity, isn’t that hazardous to your health?
• Eat a lot of organic vegetables – the more the better. Sorry, corn and potatoes are not veges.
• Keep the fruit to 1-2 servings a day; more only if you exercise intensely or for a long duration.
• Eggs don’t raise cholesterol. Actually, they most likely will lower it. Make sure they’re pasture raised. Butter, heavy cream, avocados, and my favorite – coconut milk & oil. Eat them up, yum.
• Ditch all the trans fats and polyunsaturated vegetable oils – more here and here.
• Consider a fish oil supplements too – not a rancid brand from Sam’s Club but one such as Nordic Naturals.
• More on inflammation here.

Still want to pop that statin pill? Remember that the CoQ10 you’ll deplete prevents atherosclerosis by reducing the accumulation of oxidized fats in blood vessels. It also can lower high blood pressure, regulate the rhythm of your heart, and improve chest pain and exercise toleration if you have angina. You can get CoQ10 naturally from red meat (grass fed), but it’s tough to eat enough. You’ll lose more CoQ10 over the age of 40 and with exercise too so if you take a statin then you’ll quickly become depleted. A general recommendation is 200mg a day. But hey – remember – I’m not your doctor. If your current doctor won’t work with you in your quest to become healthy then go find one who will. It’s your heart and your health.