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Understanding Cholesterol

We have all seen the commercials for statin drugs like Lipitor and Zocor, ads that prod us to ‘ask your doctor’ if these medications are right for us. The message is simple: if your cholesterol is high, you are a heart attack waiting to happen, and if you take these medications, you’ll be around to see your grandchildren grow up. Drug companies are spending a lot of money on direct-to-consumer advertising for these meds, and it’s working: sales of statins are higher than ever, and there is talk of making them an over-the-counter medication, so you don’t even have to ask your doctor.

A number of very important pieces of information have been omitted from the public dialogue with regard to cholesterol, and there are a number of misconceptions out there. Let’s see if we can clear them up.

Misconception #1: Cholesterol is bad, and must be lowered

In the late 1960’s, it was found that high blood levels of cholesterol were associated with a higher incidence of heart attacks. Everyone was then encouraged to ‘know their number’, and drug therapies have since been developed to manage that indicator. Over the years, and especially recently, it has been shown that, while lower cholesterol may result in fewer heart events, it increases the risk of other health problems. Cholesterol levels below 140 carry a higher risk of colon cancer, while levels below 130 see prostate cancer rates rise significantly.

Cholesterol is a vitally important molecule in our bodies. Hormones such as estrogen, testosterone, progesterone, and cortisol are made from LDL cholesterol (the so-called 'bad' fraction of cholesterol). Vitamin D is made from cholesterol – blood flowing near our skin’s surface is irradiated by sunlight, altering the cholesterol in the blood, the first vital step in production of this important vitamin. Deficiency of vitamin D, long known to be the ‘strong bone’ vitamin, has been associated with Multiple Sclerosis (MS) and Seasonal Affective Disorder (SAD), a winter-induced form of depression.

Cholesterol has been found to be an antioxidant in the brain, preventing damage that can lead to Alzheimer’s and other neurodegenerative diseases like Parkinson’s Disease. Recent research at Johns Hopkins has shown that seniors with the highest levels of cholesterol have the lowest incidence of Alzheimer’s! (1)

The optimal cholesterol number is probably between 160 and 200, but a much more important value is total cholesterol divided by HDL (‘good cholesterol’). This number should be below 4, and optimally below 3.2. So if your total cholesterol is 240, and your HDL is 75, your ratio is 3.2, and there is no cause for concern.

Misconception #2: To lower cholesterol, stop eating eggs

Ninety percent of the cholesterol in your body is made by your body, mostly in the liver. The trouble with avoiding all cholesterol-containing foods is that many of these foods contain substances that are necessary to good liver function. Eggs, while high in cholesterol, also contain lecithin, a fat emulsifier, which helps the liver handle fats (lecithin is very heat-sensitive, so eggs are best eaten soft-boiled or poached).

I often see patients who are trying to reduce their cholesterol levels. They usually tell me that they are attempting to eat only low fat foods. Upon further discussion, it comes out that out of their frustration (and hunger), they often end up eating a fair amount of snack foods filled with refined carbohydrates, especially sugar. This usually drives their blood cholesterol higher.

Misconception #3: If I take statin drugs, the only thing that will change is my cholesterol level

Statins have a number of unpleasant side effects, including muscle pain, cognitive impairment, and liver damage. The Prosper study found a 25% increase in cancers in those participants taking statins.(2)

Some people with very high cholesterol should take statins because the dangers of taking them are outweighed by their high risk of heart attack. In most cases, however, a much more effective way of lowering high cholesterol is to manage blood sugar and insulin levels and improve liver function. This is best accomplished by:

  1. Limiting intake of refined carbohydrates like white sugar, white flour and white rice. These altered foods cause a rapid rise in blood sugar, followed by a rise in insulin levels (insulin is the hormone, made in the pancreas, that helps move sugar from the blood into the cells). High insulin levels cause your body to make more triglycerides (blood fats) and more cholesterol. Elevated insulin also causes inflammation in the linings of your arteries, making them much more likely to form the plaques that lead to high blood pressure, heart attack and stroke.

  2. Improving the quality of fats that you eat, avoiding trans fats altogether. Olive oil has been shown to reduce ‘bad’ cholesterol and increase ‘good’ cholesterol. While fine to cook with, it’s also great added to vegetables, soups, etc., after cooking. Omega-3 oils from flax and fish are invaluable for improving brain, digestive, and immune function. People with the highest levels of DHA, a fatty acid found in fish, have a 70% lower incidence of Alzheimer’s Disease.

  3. Eat enough high-quality protein, preferably from naturally-raised meat (grass-fed is best), poultry, and wild-caught fish. ‘Enough’ varies from person to person, with athletes needing more for muscle building.

  4. Eat more vegetables. Many of the compounds found in vegetables (and fruits) aid the liver in its 700 known functions, one of which is eliminating cholesterol from the body. The quarter of the population that eats the most vegetables has half the cancers of the quarter of the population that eats the least vegetables.

  5. Exercise as often and as much as is reasonable for your age, health, and fitness level. Exercise has been shown to increase HDL ‘good’ cholesterol. A good goal is an hour 3 to 7 times per week.

The suggestions mentioned above have been producing good health in humans for thousands of years. Match this against medications pulled from shelves on a regular basis for previously unseen side effects.

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