Why Say Yes to Cholesterol?

The challenge is grasping the idea that a half-century worth of research, science, information, recommendations, and best practices were and still are incorrect. New research is showing that Coronary Artery Disease (leads to heart attacks) may have more to do with inflammation than with high cholesterol. Cholesterol plays a fundamental part in building cellular membranes. It acts as an antioxidant and precursor to brain supporting molecules like Vitamin D as well as steroid-related hormones like testosterone and estrogen. The brain demands high amounts of cholesterol as a source of fuel, but neurons cannot themselves generate significant amounts. They depend on cholesterol that’s delivered in the bloodstream via LDL. LDL is not a cholesterol molecule at all – it is a vehicle for transporting life-sustaining cholesterol from the blood to the brain’s neurons. When cholesterol is low the brain doesn’t function optimally. 

The Fluff:  Umbrella in the Rain

It would not make much sense to fold up your umbrella in the middle of a rainstorm. Why? Because you would get wet of course. The umbrella serves as your “current” protection from the drops. Without it, we would become wet, cold, annoyed, et cetera and vulnerable to the elements of the storm. If someone walking by asked you for your umbrella you would gracefully reject his or her request. However, I am willing to bet that the look you would give them would be anything but graceful. It does not make much sense to give away the only item that provides you with what you need to be successful (i.e. staying dry). In this scenario, the item is tangible; something that we can touch and see. In other scenarios, the “item” may be intangible; something that we cannot touch or see.  Would your perspective change if there was a canopy just a few feet away or if you were just about to walk into your house? Would you give up your umbrella if there were other options of staying dry?  We hold onto things not because we necessarily have a personal attachment to them as much as we hold onto things because our actions are driven by what we know and what makes sense.

It is unfortunate that we go through life with minimal power over the decisions we make. It is a blessing and a curse that we have doctors to fix us, personal trainers to get us fit, and dentists to clean our teeth. Some doctors don’t keep up with the research, using antiquated biomarkers. Some trainers do not enforce proper movement patterns, leading to injury. Some dentists use dental amalgams, leading to heavy metal toxicity. The effects of all three can be detrimental to your health. We don’t question the methods as we just accept our fate. With little actual knowledge; therefore, you are left to trust and follow blindly. This personal unaccountability leads us to blame our genetic predispositions for our ailments. The blame should be placed on the individual who is not investing in their own health through gathering knowledge. We must accept that we are only as smart as the best information available to us or we must get better at self-experimentation aka Biohacking.

Bottom line before we begin:

  • The idea that aggressively lowering cholesterol levels will reduce heart attack risk is refuted!!!! The most important modifiable risk factors related to heart attack risk include smoking, alcohol, lack of aerobic exercise, increased inflammation, being over-weight, and a diet high in carbs. [2] (pg 99)

What most of us have been told about cholesterol:

  • Cholesterol is bad 
  • LDL is the bad kind
  • HDL is the good kind
  • If you want to lower your chances of heart disease lower your cholesterol, LDL, and avoid fat in your diet.

What you actually need to know:

  1. Why is cholesterol imperative to health?
  2. What’s the deal with LDL and HDL?
  3. When does LDL become a problem?

1). Why is cholesterol imperative to health?

  • It is a building block to make hormones (testosterone, estrogen, progesterone, DHEA, and cortisol), bile acids, and Vitamin D. It acts as an antioxidant and a precursor to important brain-supporting elements like Vitamin D and testosterone/estrogen. [2]
  • Cholesterol keeps the cell membrane strong, yet fluid, so cells can communicate with each other, keep important contents in, and keep unwanted particles out. [1] (pg8). Cholesterol forms membranes surrounding cells thus keeping cell membranes permeable and maintaining cellular waterproofing. This allows different chemical reactions can take place inside and outside the cell. [2]
  • Covering of your nerve sheaths
  • Builds brain cells. The ability to grow new synapses in the brain depends on the availability of cholesterol, which latches onto cell membranes so that signals can easily jump across the synapse. [2]
  • Without it, your body would not be able to make CoQ10, which can lead to neurological problems.
  • It is secreted by the liver into the bile ducts to help digest food.  Without cholesterol and bile salts, our digestion is poor and nutrients are not absorbed. [1] (pg7)
  • Most of the cholesterol we get from food is not absorbed by the body but passed in the stool. Your gut prefers to absorb the cholesterol made by your liver and passed into the bile to assist with digestion. [1] (pg3). The body creates about 2,000mg of cholesterol on its own from the liver. The body would much rather be spoon feed the cholesterol because the production of it is taxing.
  • Cholesterol offers a level of protection against free radicals. As we age, natural cholesterol levels generally increase in the body as well as free radicals. [2]

2). What is the deal with LDL and HDL?

  • LDL is not a cholesterol molecule at all – it is a vehicle (carrier protein) for transporting life-sustaining cholesterol from the blood to the brain’s neurons (cells). Our cells want to accept cholesterol into themselves. We need LDL to accomplish this task. Also, the brain demands high amounts of cholesterol as a source of fuel (the brain also needs glucose as well), but neurons cannot themselves generate significant amounts. Again, they depend on cholesterol that’s delivered through the bloodstream via LDL. Any remaining cholesterol in the blood will be transported back to the liver through HDL, where it is then recycled or eliminated. LDL carries cholesterol but the amount will vary. Increasing the amount of LDL cholesterol is NOT the same as increasing the amount of LDL participles. Simply put: LDL cholesterol is a carrier protein that delivers cholesterol to neurons. Fun Fact: High LDL makes it easier to put on muscle. It makes you more resilient to certain kinds of poisoning. [5]
  • LDL and HDL are part of a class of Lipoproteins which are a combination of lipids and proteins. These structures allow fats to be transported in the bloodstream. They are essentially a bus that carries around passengers safely inside. The BUS itself is based on the quality of the HDL or LDL. Some of the passengers carried around the body through LDL and HDL are cholesterol, COQ10 and Vitamins A, D, E, and K. There are different types of Lipoproteins LDL, HDL, VLDL, IDL, and chylomicrons.
    • In general, the quality of the bus matters, while the passengers are innocent bystanders.
  • LDL carries cholesterol, phospholipids, and triglycerides. The surface of the LDL contains a molecule called Apo B-100. This protein supports the structure of the LDL, helps enzymes function, and assists the LDL when parking in the tissues to drop of the cholesterol, phospholipids, and triglycerides. The LDL molecule also contains another surface protein called Apo E. There are 3 variants for ApoE -2,3,4. The 2’s & 4’s are associated with increased cardiac risk while 3 and 4 are associated with increased risk of dementia. Phospholipids are critical for the cell membrane function. Triglycerides are a major source of energy for the body, especially for the heart and muscle function. This a case where some are good, more is worse. [1] (pg13)
  • HDL is a scavenger that picks up excess cholesterol from around the body and brings it back to the liver for reprocessing. This process is called reverse cholesterol transport. HDL actually pulls cholesterol from the inflammatory cells in the vessel wall. HDL delivers cholesterol to organs that create hormones and perform other cellular functions. HDL helps to inhibit oxidation of tissues and LDL, inhibits inflammation, inhibits blood clotting, and inhibits LDL and inflammatory cells from adhering to the endothelial membrane. HDL is active in our immune system to fight off infections. HDL size is also very important with the large, fluffy HDL associated with decreased risk. Sugar is the main culprit leading to dysfunctional HDL. HDL2b is the form that has scavenged the most cholesterol from around the body, including the plaque. [1] (pg17)

3). When does LDL become a problem?

  • Oxidized LDL is the issue because it no longer delivers cholesterol to the brain. LDL molecules become oxidized when sugar molecules attach themselves to LDL. This changes the molecule’s shape, rendering it less useful while increasing free radical production.
  • **Food for thought: Oxidation occurs naturally in the body so cholesterol provides a level of protection against it. [2]** The foods we consume contribute to the oxidation process. Cholesterol provides a level of protection against them. Vitamins A, C and E (which are fat soluble) donate electrons to free radicals and helps prevent damage.
  • LDL particles that have become oxidized are a major concern due to inflammation because your body sees oxidized LDL as invaders- hence, increasing inflammation. Your cells will otherwise use the cholesterol, while any remaining cholesterol in the blood will be transported back to the liver through HDL, where it is then recycled or eliminated. [4].
    • Small, dense particles (LDL – Type B) act like BB pellets, easily penetrating your arteries. When small, dense LDL particles are oxidized they become dangerous and start the buildup of plaque or cholesterol deposits in your arteries.
    • Small, dense particles start off as large and fluffy but float around the body too long. If the LDL is loaded with triglycerides from carbs/sugar it will continue to circulate and become smaller and prone to oxidation.[1]1(pg15)
    • Large, fluffy LDL particles (LDL Type A) are practically harmless. They act like beach balls and bounce off the arteries, causing no harm.

Pressing Questions:

  1. What is cholesterol?
  2. What do the numbers say?
  3. How does sugar affect cholesterol?
  4. How did cholesterol myth begin?
  5. Why didn’t the cholesterol myth shift? Why didn’t the mindset shift once more information became available?
  6. What about statins?
  7. What is a lipoprotein?
  8. What is the liver’s connection to cholesterol?
  9. Is there a link between LDL and saturated fat?
  10. What is VLDL?
  11. What is a Triglyceride?
  12. Does Size Matter?

1). What is Cholesterol?

  • Fatty substance (molecule) in the body that serves many vital functions.
  • It is made by all mammals.
  • It is made up of 3 elements: Carbon, Hydrogen, and Oxygen (CHO).
  • Does not mix well with water. Mixes well with fat.
  • It is carried around our bodies by LDL and HDL.
  • Animal cells contain cholesterol, which is why animal sources contain cholesterol.

2). What the numbers say:

  • 75% of people who have heart attacks have normal cholesterol.
  • Older patients with lower cholesterol have higher risks of death than those with higher cholesterol.
  • The Swiss and Spanish have higher average cholesterol than Americans but have less heart disease.
  • High cholesterol is associated with better memory function and can extend longevity. 1/5 of the brain by weight is cholesterol. [2] (pg 76,79)
  • In a study, it was found that lower naturally occurring total cholesterol levels are associated with poor performance on cognitive measures, which place high-demand on abstract reasoning, attention, word fluency, and executive functioning. People with the highest cholesterol levels performed better on cognitive tests than those with lower levels. When cholesterol is low the brain doesn’t function optimally. People with lower cholesterol have a greater risk for neurological problems from depression to dementia. [3] (pg 186)
  • Once cholesterol gets to about 240 then the chances of heart disease are increased due to other upstream effects. 

3). How sugar/carbs affect cholesterol:

  • Insulin released by the liver in response to sugar and carb ingestion stimulates the HMG-CoA reductase enzyme to produce excess cholesterol. Take home point: Decreasing sugar intake is one of the best ways to control excess cholesterol produced in your body. [1]
  • Refined carbs and sugars drive:
    • HDL cholesterol down
    • Triglycerides up
    • Creates small, dense cholesterol particles which are what is really damaging to our health.
    • Metabolic syndrome or prediabetes –> which is the true cause of most heart attacks, not LDL cholesterol.
    • Increase body fat in the form of triglycerides.
  • The more you increase the consumption of carbs while also limiting fat, your body has to work harder to create cholesterol to sustain brain and cognitive function.
  • Eating carbs increase glucose. The liver takes glucose and transforms it into fat (triglycerides) for temporary storage. They are fused to proteins and to the cholesterol that forms an outer cell membrane of the particle. Cholesterol and the protein are the vehicles of transportation and the triglycerides are the cargo. This resulting LDL has very low density because triglycerides are lighter than the cholesterol and protein causing it to be less dense. The liver then secretes this triglyceride-rich VLDL into the blood and the VLDL delivers the cargo of triglycerides around the body. If triglycerides are hard to come by (low cal or low carb), the droplet of protein and cholesterol will be small ones. These IDL particles will be less dense than LDL but denser than VLDL. The IDL will end their life as large LDL. The risk factor of heart disease is lower because the liver had fewer triglycerides to dispose of initially. A low-fat diet may lower LDL but will raise VLDL. Triglycerides shoot up on a low-fat diet while falling on a high-fat diet. The fat in the blood would clear up if put on a low carb diet (157, good cal, bad cal). However, when cultures eat high carb diets but low calories it may counteract the triglyceride-raising effect. (158, Good Cal, Bad Cal). Having patients with high triglycerides eat low fat would only make the condition worse. Low carb diets help lower VLDL and triglycerides and cholesterol levels. Eating more carbs may lower HDL cholesterol.
  • Low-fat diets have been associated with dementia while higher fat diets have been shown to prevent it. There is an abundance of research showing that carbs cause brain aging while fat prevents it. Your brain is 60% fat, and much of it is made of omega-3 fats and cholesterol. When you eat a low-fat diet, you are starving your brain. Fat is critical for your brain. Lack of fat in the diet has been linked to neurodegenerative disease; mental disorders such as depression, suicide, and aggressive behavior; ADD and autism; stroke; and trauma. [6] (pg62)

4). How did cholesterol myth begin?

  • The early 1950s: Reminder: Available science and technology drives research and their related findings.
  • During this time, physicians were only able to measure total cholesterol. There was no available way of measuring triglycerides, lipoprotein size and amount, and many other biomarkers for heart disease.
  • Scientist John Gofman hinted at the idea that there is more to the cholesterol story but technology at the time was limited or expensive.
  • In the 60s, Gofman was able to measure the density of lipoproteins. It appeared from the outset that high LDL was correlated to patients who suffered from atherosclerosis. However, we now know that LDL does not reflect the amount of cholesterol that is in our blood.  Cholesterol and LDL don’t necessarily rise and lower together. He began to theorize that LDL and triglyceride levels were stronger correlates of heart disease than cholesterol.  

5). Why didn’t the cholesterol myth shift? Why didn’t the mindset shift once more information became available?

  • Ancel Keys scared America into believing that cholesterol and heart disease were linked together. To question this paradigm was to go against what the government was disseminating to the country, what doctors were telling us, and what America was feeding us. Gofman had an uphill battle that would prove to be too steep to conquer. Why would America switch its newly adopted stance on combating heart disease on a theory that could be just as incorrect?
  • According to the Framingham Heart Study, the largest and longest-running population-based study in the US, an LDL of 100 carries the same risks as an LDL of 160 mg/dl. Going above 160 only slightly increases the risk of heart disease. [1] (pg 14)

6). What about Statins?

  • Statins are drugs used to help lower cholesterol. They work by limiting the liver’s ability to make cholesterol. This allows LDL levels to drop. Unfortunately, if you deprive cholesterol in the brain you are affecting neurotransmitters affecting data processing and memory functions. [3] (pg 93,95)
  • Although statins may help lower total LDL, there is often very high LDL particle numbers and very small LDL particles sizes in these patients, which is the pattern most associated with heart attacks. [6](pg107)

7). What is a lipoprotein?

  • Lipoproteins are the particles that shuttle cholesterol and triglycerides through circulation throughout the body.  Amongst the different types of lipoproteins, HDL, LDL, and VLDL were the ones that told us more about the heart disease story. However, cholesterol tells us little about these lipoproteins.

8). The Livers connection to Cholesterol

  • The liver is responsible for detoxification, manufacturing proteins and fats, storage and breakdown of sugar, digestion of food, and making cholesterol. Your body makes about 2,000mg of cholesterol a day. Very low cholesterol is a bad sign that your liver is not functioning and is associated with cancer risk and death. [1] (pg3)
  • An example of how the liver communicates with the body to produce cholesterol is seen through testosterone supplementation. Testosterone supplementation is well known to reduce LDL. When supplementing with testosterone your liver does not see the need to produce cholesterol for testosterone production. The testes cry out for cholesterol when the body wants to produce testosterone. The liver then makes it and packages it up in the LDL carrier.  [1] (pg4)
  • The liver gets signaled to produce cholesterol when the body needs it for a particular function. Cholesterol gets made and delivered throughout the body through LDL, whether to the testes for sex hormone production or glands for cortisol production. External use of testosterone limits the need for the liver to produce cholesterol because the testes are not asking for it, which, as a by-product, lowers LDL. I suggest that LDL may also be influenced by our bodies need to make cortisol because in order to make cortisol our bodies would need cholesterol, which would need LDL to transport it from the liver that has to make it. Low testosterone may be due to either a signaling issue from the brain to the testes or the testes to the liver or liver production dysfunction, all inhibiting cholesterol being sent to the testes.  

9). Link between LDL and saturated fat

  • If you eat a long chain saturated fat, the LDL particle count will go up. If those go up, but your HDL also goes up, your triglycerides drop, your homocysteine drops, your Lp-PLA drops, and your C-Reactive protein drops then the particle increase may not be an issue [5]
  • If LDL-C is damaging arteries, by definition, you’ll have an enzyme, Lp-PLA2 that will be expressed from the damaging of your arteries.

10). What is VLDL

  • VLDL is a particle that carries triglycerides in the blood while most of the cholesterol is found in LDL. VLDL particles are known for the transportation of triglycerides but also carry cholesterol and so contributing to total cholesterol in the circulation. As a result, elevated cholesterol is just along for the ride when triglycerides are high.  VLDL has two properties: strong negative correlation to HDL and it was elevated in heart disease patients. VLDL is more likely to cause plaque buildup because they can fit more easily through damaged areas of the arterial wall. They may cause structural changes in the protein making it easier to adhere to the artery wall and they remain in the bloodstream longer, thus having the opportunity to do more damage and are more easily oxidized.

11). What is a triglyceride?

  • They are molecules of fat found in food and produced in the liver. They are broken down in the intestine and easily absorbed. The liver packages them to use as energy or stored as fat. They travel through our bodies in LDL and HDL. The more sugar, carbs, and excess calories we consume, the more they are available to store as fat. As they travel through the body, they are removed and the particles get smaller and become damaged. The small, damaged LDL particles are the ones that are easily incorporated into the blood vessel wall and into the coronary plaque. (PC 18)
  • “The vast majority of triglycerides are carried by chylomicrons (the lipoprotein particles in your that gut makes right after a meal) and VLDL, which your liver makes from recycled fats. These plump nutrient carriers want to deliver their cargo into your hungry cells. But like all lipoproteins, they cannot do the job all alone. They need a special enzyme – think of it as a dock worker – to pick the fatty acids up and carry them into the cell. A study done in 1990 showed that sugar interferes with the function of this enzyme. So if you have high blood sugar, that sugar may shred lipoproteins coats beyond recognition, or simply rip them off the particle’s back. If the particles ever do make it to the cellular dock, sugar keeps them from completing the delivery. With so many barriers to getting nutrition into hungry cells, it’s no wonder people with diabetes feel hungry all the time (Deep Nutrition, 156)”

12). Size matter. We want large, fluffy LDL. We don’t want Small, dense LDL

  • Large, Fluffy: Healthy LDL particles can deliver the fat they are carrying efficiently. They enter the bloodstream, do a delivery job or two (which reduces their size), and are then easily recognized by the liver, which plucks the little particles out of circulation and refills them with more cholesterol and lipid suppliers, making them big again.
  • Small, Dense: When the liver can’t recognize the smaller, partially empty lipoprotein because the particle’s protein coat has been damaged by oxidation. These smaller, orphan particles are now forced to wander through the bloodstream looking for a home until the same oxidative process that damaged their coats forces them to precipitate out of circulation and onto the delicate surfaces of your arterial walls (Deep Nutrition, 157)

Big LDL can be recognized by the liver while small ones can’t.

Sources:

  • [1] Paleo Cardiologist
  • [2] Grain Brain
  • [3] Brainmaker
  • [4] Death By Food Pyramid
  • [5] Dave Asprey Podcast #324
  • [6] Eat Fat Get Thin

Extra:  Tips to lower cholesterol without statins?

  • Cut out sugar and refined carbs
  • Eat healthy fat, veggies, and proteins
  • Exercise
  • Manage stress and sleep
  • Supplement with: 1000mg omega 3 (EPA/DHA) 2x/day PGX, Red Rice Yeast 600 mg 2x day, 2000 IU vitamin D3 2x/day- With vitamin K2, 2-4 capsules of glucomannan 15 min before meal with water, Niacin, and B3
  • Most the of cholesterol we get from food cannot be absorbed, about 25 percent of the cholesterol in our body comes from the food we eat and 75% is synthesized by the body. The body tightly regulates the amount of cholesterol in the blood by controlling internal production.