High Cholesterol and Heart Disease
Ask the average American what he or she believes is the most common risk associated with heart disease and you’ll likely hear, “high cholesterol.” We’ve heard it from doctors, we’ve read about it in newspapers and magazines, and we’ve seen all the commercials for cholesterol-lowering drugs. With each new study, the accepted safe blood cholesterol numbers are getting lower and lower. It used to be that a total cholesterol count under 300 was acceptable, then 250, and now the American Heart Association recommends it be under 200.
This ever-decreasing figure, coupled with evidence suggesting that cholesterol is not the villain it’s been made out to be, has some physicians wondering if we are putting too much emphasis on cholesterol’s role in contributing to heart disease. In fact, some cardiologists and scientists adamantly are campaigning to stop our obsession with cholesterol and look at other factors that they say are being woefully ignored.
Cholesterol Defined
Cholesterol is actually a vital substance needed in every cell of the body as it is the chemical precursor from which the body produces bile acids, provitamin D3, male and female sex hormones, and adrenal hormones (hydrocortisone and aldosterone that regulates sodium and potassium balance). Cholesterol is needed to construct the important membranes which surround cells.
The body is able to manufacture cholesterol but is unable to destroy this substance. Cholesterol is removed from the body combined with bile acids. This removal is increased by dietary fiber, but greatly diminished in the absence of dietary fiber. Up to 94% of cholesterol and bile acids are reabsorbed and reused when dietary fiber is lacking.[1] This is one reason that low fiber diets may increase blood cholesterol levels. The body can make cholesterol whether there is any cholesterol in the diet or not. By removing all cholesterol from the diet, the blood cholesterol will only fall by about 20 percent to 25 percent. This is because your liver produces about 75 percent of your needed cholesterol, while the remaining 25 percent comes from food containing animal fats.
Some people have a genetic predisposition to produce more cholesterol than necessary (each day, the liver produces an average of 600 to 900 milligrams of cholesterol). Eating foods high in saturated fats, trans fats, and dietary cholesterol will also increase your blood levels.
Because cholesterol is insoluble in water, it is transported through the blood stream by lipoproteins, which act as carriers for the cholesterol. The two types of carriers are High-Density Lipoproteins (HDL) and Low-Density Lipoproteins (LDL). When you get your “LDL” or “HDL” cholesterol figures checked, it’s the number of these carriers that’s actually being counted in the blood test. The “total cholesterol” figure is derived from the sum of your HDL and LDL counts, plus the triglycerides (another form of fat made in the body), and Lp(a) cholesterol (a genetic variation of LDL).
Cholesterol is dissolved and kept in solution as a flowing liquid when there are adequate amounts of essential fatty acids. The melting point of cholesterol, where it would deposit on artery walls, is 300 degrees F. However, when the essential fatty acids (linoleic and linolenic) are present in sufficient quantity, the melting point of cholesterol falls to 32 degrees, which is below normal body temperature. Even in the presence of an arterial injury, cholesterol will have a more difficult time depositing with fibrin and platelets on an injured artery surface because the essential fatty acids have made the blood more fluid.
This is one of many important health reasons to make sure you are eating a diet rich in essential fatty acids, especially the Omega-3 fatty acids that are found in whole foods like nuts, salmon, seafood, and grass-finished beef.
Cholesterol Is Not A Major Cause Of Arterial Disease
Several factors appear to be of greater importance than cholesterol in causing arterial disease. Among these are the deposition of toxic metals in the lining endothelium of arteries, Vitamin C deficiency, excessive amounts of lipoprotein (a), inflammation in arteries, excessive clotting of blood, and homocysteine elevation (hyperhomocystinemia)[2].
Arterial Inflammation and Heart Disease
As you can see, not everyone in the scientific and medical communities is convinced that cholesterol plays a role in heart disease. They question the studies, arguing that there is no real proof to establish a causal link between lowered cholesterol levels and a decreased risk for atherosclerosis and vice versa. Many skeptics have joined to form the International Network of Cholesterol Skeptics. Founded in 2003 by Danish physician and researcher Dr. Uffe Ravnskov, the network seeks to collectively dispute the lipid hypothesis. While its members espouse divergent and even conflicting theories on what causes atherosclerosis and coronary heart disease, they remain united in their belief that cholesterol is not the culprit.
In fact, Dr. Ravnskov’s review of LDL studies suggested that LDL, the “bad” cholesterol, may be protective against infections within the body and their resultant inflammation—which Dr. Ravnskov and others believe may be the underlying catalyst in atherosclerosis.
“Most researchers in this field today agree that inflammation of the arterial wall is the start,” declared Dr. Ravnskov in a 2005 interview. “The crucial question is, ‘What starts the inflammation?’ When arteries become inflamed the body immediately starts a repair process to strengthen the vascular wall….atherosclerosis should therefore be considered as scars, remnants from a long life’s combat with [inflammation].”
Dr. Paul J. Rosch, president of the American Institute of Stress in Yonkers and a member of the International Network of Cholesterol Skeptics, and others not only believe that a high cholesterol level may not be bad for you—he says that his own research finds no evidence of elevated cholesterol levels contributing to coronary heart disease—but that a low cholesterol level may do more harm than good. Dr. Kendrick noted in his “Cholesterol Myth” article that studies show “after the age of 50, the lower your cholesterol level is, the lower your life expectancy.” And he pointed out that 90 percent of heart attacks occur after the age of 50. Dr. Rosch adds that some studies show that low cholesterol levels increase death from respiratory and digestive diseases and lowers resistance to infection.
The Immune System And The Inflammatory Response
Many experts now see inflammation as arising from an immune system response that’s out of control. When you catch a cold or sprain your ankle, your immune system switches into gear. Infection or injury trigger a chain of events called the inflammatory cascade. The familiar signs of normal inflammation — heat, pain, redness, and swelling — are the first signals that your immune system is being called into action.
In a delicate balance of give-and-take, inflammation begins when pro-inflammatory hormones in your body call out for your white blood cells to come and clear out infection and damaged tissue. These agents are matched by equally powerful, closely related anti-inflammatory compounds, which move in once the threat is neutralized to begin the healing process. Acute inflammation that ebbs and flows as needed signifies a well-balanced immune system. But symptoms of inflammation that don’t recede are telling you that the “on” switch to your immune system is stuck. It’s poised on high alert — even when you aren’t in imminent danger. In some cases, what started as a healthy mechanism, like building scar tissue or swelling, just won’t shut off. Currently there is no definitive test for inflammation — the best that conventional medicine can do is measure blood levels of C-reactive protein (a pro-inflammatory marker) and the irritating amino acid called homocysteine.
Over many years I have found that preventing or reversing inflammation is all about listening to your body. From that listening you can begin to learn first-hand what increases or reduces your body’s inflammatory response. You can cool your body’s inflammatory response and keep it healthier over time by taking one step at a time, at a pace that feels right for you. Adopting a healthy lifestyle is not a “diet”, it is not “all or nothing”. An anti-inflammatory lifestyle builds over time, and the longer you eat these foods and exercise on a regular basis, the better you feel!
The Anti-Inflammatory Lifestyle
1. The most important part of the anti-inflammatory lifestyle includes generous portions (70-80 percent of your plate) of deeply-pigmented vegetables (deep greens, bright orange, yellows, reds, and purples) to every meal for their fiber and natural anti-inflammatory compounds. Your dark greens like kale, swiss chard, mustard greens, arugula, and other are the backbone of healthy diet.
2. Add essential fatty acids (EFA’s) to your diet with grass-finished beef, free range eggs and poultry. As for fish, while its health benefits were once beyond compare, many species today contain high levels of mercury, PCB’s, and other toxins. With that unfortunate reality, experts suggest you significantly limit or avoid Atlantic varieties, and eat only wild Pacific or Alaskan salmon (unless organically farm-raised). Because toxins magnify as you go up the food chain, smaller species such as sardines, anchovies, and shellfish are still good choices.
3. Healthy Snacks include a handful of nuts and seeds, especially walnuts and freshly ground flaxseed, which are good sources of omega–3’s. Add apples, pears, blueberries, strawberries, raspberries, and blackberries for added crunch, fiber and anti-oxidant power.
4. Fresh herbs such as basil oregano, cilantro, garlic, and ginger and turmeric contain bioflavonoids and polyphenols that limit free-radical production in the body, as well as increase flavor and improve digestion. Many are easy to grow and help you to create amazingly simple and delicious meals bursting with flavor!
5. For cooking purposes my oil of choice is unrefined organic coconut oil, and for dressings it’s a high quality first cold pressed extra virgin olive oil, which is high in oleic acid, an omega–9 with anti-inflammatory polyphenols.
Eliminate Foods That Cause Inflammation
The most important thing that you can do to reduce inflammation in your body, and reduce your chances of developing heart disease, is to eliminate foods that cause inflammation. Most polyunsaturated vegetable oils like safflower, sunflower, corn, peanut and soy, are high in linoleic acid, an omega-6 essential fatty acid that the body converts into arachidonic acid, another omega-6 fatty acid that has a predominantly pro-inflammatory influence. For most people, high-carb, low-protein diets are inflammatory. Refined sugar and other foods with high glycemic values jack up insulin levels and put the immune system on high alert. Short-lived hormones inside our cells called eicosanoids act as pro- or anti-inflammatory compounds depending on their type. Eicosanoids become imbalanced — that is, skewed toward pro-inflammatory — when insulin levels are high. As if this weren’t enough, high insulin levels activate enzymes that raise levels of arachidonic acid in our blood.
I know how hard it can be to say no to the many foods that turn the body’s inflammatory dial up high. Number-one on the list of offenders would be trans fats — hydrogenated oils. Next would be the sugars, refined carbohydrates, and gluten-containing foods that we often crave when our systems are off-balance. These and many other additives and preservatives are well hidden in processed convenience foods, making them very difficult, but not impossible, to avoid.
You will also need to steer clear of known allergens, and be aware of increasing food sensitivities as well. Gluten, eggs, dairy, soy and nuts are some of the most common dietary irritants. To help you identify sensitivities that could be causing you problems, follow an elimination diet, avoiding a substance for two weeks, then reintroducing it for a day or two. Yes, it can be tough at first to make changes like this, but the payoff is huge — it can make a tremendous difference in how you feel in a surprisingly short period of time. Tipping the balance — away from pro-inflammatory, toward anti-inflammatory — can take place almost overnight.
Adopt healthy habits and get some physical activity every day!
Fuel your body with natural anti-inflammatory agents and keep your joints flexible and well-nourished by exercising every day. Start slowly with a five-minute walk and build your stamina. I recommend at least 30 minutes of activity, five times a week. Exercise is a great way to counteract stress, especially when combined with deep breathing — as with yoga or tai chi. These exercises are appropriate for all ages and at all levels, increasing balance, strength, and flexibility.
Go out and play! Or, stay in for a change and get away from it all. Whatever it is that most relaxes you, simply do it: find some time to relax. If you live with chronic stress, investigate meditation or biofeedback therapies to learn the relaxation response. Talk therapy can also help people navigate through their emotional minefields. Often your church or fitness center will advertise support groups or community-building events. This is one way you can share emotional burdens (and we all have them!) with willing listeners. All of these activities can calm inflammation by lowering cortisol, your stress hormone.
Get plenty of rest — it’s the perfect inflammation antidote. You need to sleep between seven and nine hours a night to give your body time to heal from the previous day’s demands. A good night’s sleep can undo the effects of the inflammatory response, so don’t undervalue the simple act of going to bed on time. Invest in the bed and bedding you find most comfortable: some individuals swear by a lambskin mattress covers, others by feather beds, and some will have nothing but a 100% cotton futon. Remember, you are worth it.
Further Steps To Reduce The Causes Of Inflammation
Break your bad habits. Substances like alcohol, caffeine, and nicotine place a heavy burden on your system, so eliminate them or at least moderate your intake. One of the fastest ways to reduce inflammation is to stop smoking and using stimulants. Try quitting for a week or two and see how good you feel. That will encourage you to quit forever. If that doesn’t work, find a support group or professional help and keep trying until you quit.