Cholesterol: Wrongful Conviction?

It’s both uplifting and unsettling when a citizen has been freed from prison after a wrongful conviction has been overturned. The uplifting part is of course that someone is free that should have never been incarcerated to begin with. Conversely, the unsettling part is that an innocent person went to prison and lost out on their freedom. Cholesterol has been convicted of health crimes, namely causing heart disease, but some physicians and researchers are doing their part to overturn this conviction. Cholesterol may not be the evil villain you’ve heard so much about. In fact, “more than half the people hospitalized with heart attacks have perfectly normal cholesterol levels and about half the people with elevated cholesterol levels have perfectly normal, healthy tickers.” This according to renowned cardiologist Dr. Stephen Sinatra and, famed clinical nutritionist, Dr. Johnny Bowden in their book, The Great Cholesterol Myth. The real culprit of heart disease and many other health crimes is inflammation (dun dun duuun).

Let me back up a bit first, and let’s meet cholesterol with fresh eyes. Cholesterol is a waxy substance that is an important constitute of cell membranes. Cholesterol is necessary for life and is the basic raw material that your body uses to make Vitamin D, sex hormones (e.g. estrogen, progesterone, and testosterone), and bile acids for digestion. In fact, cholesterol is so critical to many functions that a level of 160 mg/dl or less has been linked to depression, aggression, cerebral hemorrhages, and loss of sex drive. The majority of cholesterol in the body is made in the liver while the rest is absorbed from the diet. So, if you eat less cholesterol than what your body needs, the liver amps up production. Conversely, if you eat a lot of cholesterol the liver decreases production. Of course, it’s possible to consume more cholesterol than the body needs, but the Farmington Heart Study found there was virtually no difference in the amount of cholesterol consumed on a daily basis by those who went on to develop cardiovascular disease and those who did not.

Cholesterol travels in low-density lipoproteins (LDL) and high-density lipoproteins (HDL). You’ve probably heard LDL referred to as “bad cholesterol” and HDL referred to as “good cholesterol.” Of course, it’s not that simple, as there are different types of HDL and LDL. For instance, HDL-2 is large and buoyant and the most protective, whereas HDL-3 particles are small and dense and may be inflammatory. A researcher at University of Chicago, Dr. Angelo Scanu found that the HDL of people with chronic diseases such as rheumatoid arthritis and diabetes is very different than the HDL of healthy individuals even when their overall HDL blood levels were similar. So, before you rest easy because you have high HDL blood levels, consider talking to your doctor about additional testing. LDL-A is also a fluffy and buoyant molecule that doesn’t hurt anything, unless it becomes damaged by oxidization. Whereas, LDL-B is small, hard, dense molecule that promotes atherosclerosis. So, unless your provider is taking a deeper dive on your lab work you may not know how much of each lipoprotein is circulating in your body and how much of it is oxidized, which is critical information. To that point, if you’re interested in learning more about what blood tests best predict your heart disease risk, I recommend looking at the Cleveland Heart Labs website.

How do I know all this, I read a lot about heart health and in particular cholesterol. Not just because I’m nurse, but because I have Heterozygous Familial Hypercholesterolemia. Which is a big word for an inherited cholesterol disorder. You see, this genetic defect essentially renders the liver ineffective at keeping LDL in-check, which means I have crazy high LDL levels. Not only that, I have lots of the small hard dense LDL particles (LDL-B) that promotes atherosclerosis. So, for many years I’ve seen cardiologists that specialize in lipid disorders and/or preventative cardiology. As such, I have huge panels of labs done which evaluate levels of inflammation and LDL oxidization, and key nutritional markers (Vitamin D, CoQ10, Fatty Acids) among other things that have a role in cardiovascular disease. And, in case you’re wondering, I’ve also had a calcium coronary scan and carotid ultrasound and have no visible disease, despite the genetic cards I’ve been dealt, which goes to show how powerful lifestyle factors can have!

So, if you’re wondering now what you should and shouldn’t eat to protect your heart. Let’s start with sugar, as it’s the number one (yes #1) dietary contributor to heart disease and contributes to inflammation in the artery walls. To that end, let me share a humorous yet poignant story that’s free from medical jargon from the, Great Cholesterol Myth that sums up the role of sugar and how insulin resistance take place, which sets the stage for a nasty domino effect.

You wake up late, stress hormones coursing through your body. One of the things stress hormones do is send a primitive signal to the brain that it’s time to fuel up for an emergency. So, you run out the door and stop at Starbucks for a sweetened latte and a “low-fat” bran muffin that contains a gazillion calories. Your blood sugar takes off like the Challenger. The pancreas says, “Uh-oh” better send in the big guns this time, the guy’s gone mad, there’s sugar all over the place!” And it produces a bucketful of insulin to try to start bailing all that sugar out of your bloodstream and get it to the muscle cells pronto! Except the muscle cells aren’t having it. “What do you need all this sugar for?” they ask. “This guy’s just going to sit around all day pushing a computer mouse, and when he goes home, he’s going to sit on the couch and play with the clicker.” So, the muscle cells begin to resist the effects of insulin. “We’re good,” they say, “go somewhere else.” Insulin now has no choice but to take its sugary payload to another location, and guess where it winds up? Your fat cells, which happily welcome it in. At first…..until the pancreas can no longer keep up with demand.

Normally insulin has an anti-inflammatory effect, but when you are insulin resistant, those chronically high insulin levels actually promote inflammation and cardiovascular problems. One of which is raising your triglycerides and blood pressure. There is actually a collection of disease strongly influence by insulin resistance and the acronym it’s been given, ironically, is CHAOS; which stands for: coronary disease, hypertension, adult onset diabetes, obesity and stroke.

It’s all a bit overwhelming isn’t it? And, I’ve barely scratched the surface by only introducing a few of the characters that make up the heart disease story. Yet, I do hope you’re thinking that cholesterol may not be the villain in this healthcare tale after all. Stay tuned for the next chapter on heart disease to see how this story plays out. In the meantime, let me give you the cliff note version of preventing heart disease. So, grab a pen and jot down the following, which are research backed recommendations put together by Dr. Sinantra and Bowden.

  • Ask your doctor for the following tests: LDL particle size, Hs-CRP, Fibrinogen, Serum ferritin, Lp(a), Homocysteine, Interleukin-6, Coronary calcium scan.

  • Eliminate these foods: Sugar, soda, processed carbs, trans fats, processed meats, excess vegetable oils

  • Eat more of these foods: Wild salmon, berries and cherries, grass-fed meat, vegetables, nuts, beans, dark chocolate, garlic and turmeric, pomegranate juice, green tea and red wine, extra-virgin olive oil.

  • Make these lifestyle changes to reduce stress: Meditate or practice deep breathing, express your emotions, play, cultivate intimacy and leisure, and enjoy your life.

Coaching Corner

  • What challenges do you face in reducing your risk of heart disease?

  • How does your lifestyle impact your risk of heart disease?

  • What obstacles to lifestyle changes have you run into in the past?