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Cholesterol- rebel but not a cause

Cholesterol. The death molecule. Or not.

Anyone and everyone has heard one thing or another about cholesterol. Apparently it kills us by blocking our arteries in a process called atherosclerosis where “plaque” builds up in the walls of our blood vessels. Little bits of this plaque can break off and get lodged in the smaller blood vessels of the heart or brain and lead to heart attacks and strokes. This effect is obviously deadly, but the cause may be more complex than blaming it on Mr Cholesterol in the kitchen a knife.

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Cholesterol is a naturally occurring waxy compound similar to fat. It is made and metabolised in the liver and has many important roles in the body that include development, repair, maintenance of cell membrane structure and fluidity and making various hormones. It is also an important part of our own production of vitamin D. Cholesterol however needs a taxi to get around our blood and is transported by lipoproteins such as LDL and HDL, as well as others that you may be less familiar with such as VLDL and chylomicrons. These various taxis are the same thing but different. They vary in size and function, essentially different size taxis that can carry different amounts of cholesterol and fats to different stops in the body. They are ranked according to their density i.e. Low Density Lipoprotein = LDL. The density is just the the number of passengers relative to the size of the car. LDL is believed to be the “bad” one because it carries cholesterol from the liver around the body. Conversely HDL, the “good” cholesterol, takes cholesterol back to the liver to be metabolized. By measuring the number of the different taxis in our blood we can determine our cholesterol profile.  It has been shown that a raised total cholesterol, LDL (particularly oxidised LDL) and blood triglyceride (fat) level are markers of heart disease and a raised HDL is supposed to be beneficial to lowering the risks of heart disease. My opinion, based on published research, is that it is extremely unlikely that these compounds act as a primary cause but it is acceptable to consider that they are markers of ill health. Don’t shoot the messenger, but follow the paper trail. For this reason it is worth knowing your “cholesterol” levels or more accurately your lipid profile. This is the amount of total cholesterol, HDL, LDL and triglycerides in your blood. A finger prick test can test your total cholesterol which should be below 5mmol/L, a venous blood test is needed for the whole profile.

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From the flawed hypothesis of cholesterol’s causal effect on health over the last 30 years the debate on how to lower cholesterol has been rife.

  • The blame found its way to fats, and in particular saturated fats, because fats resemble cholesterol and are linked to the same taxi ride so it must be the cause, right? Wrong. Recent reviews on data question this and fail to show the link.
  • Then it must be the cholesterol that we eat from eggs et al. that gives us high cholesterol. No, studies debunked that one too. In fact the animal products that contain cholesterol do not effect our levels much at all because our liver is quite capable of controlling production and metabolism to suit our intake.
  • There does appear to be a more definite link however between hydrogenated or trans fats and our cholesterol levels.
  • Research is however not conclusive as to the the effect of all the other fats on heart disease let alone your cholesterol, for this reason I will always promote a variety and moderation of all natural fats in the diet.

Mainstream “experts” and various health bodies have made generalized recommendations on possibly misleading information and research, some of which is backed by multimillion dollar statin producing or sugar-coated companies. I don’t want to sound like a conspiracy theorist so I will maintain my discretion on this and encourage logic.
Fat intake has reduced drastically over the last 20 years, statin use as therapy for lowering cholesterol has increased greatly, heart disease and mortality (death) has increased. Make sense?
Are we just trying to lower cholesterol or address the cause of heart disease?

Statins are a group of medicines that prevent cholesterol synthesis thereby lowering your cholesterol levels in the blood. There has been recent controversy over a Cochrane review which offers caution to widespread use of statins in low risk patients. Another recent Oxford meta-analysis argued more accurate results from their report indicating improved health outcomes but it seems this medication is most beneficial in very high risk patients or those with a history of heart disease.

Anyway, what is of more concern is what is actually causing heart disease and responsible for markers such as “cholesterol” to be raised. Well it is quite possible that inflammation is the key and recently this is starting to gain more support. Inflammation is a generalised or localised defense response to foreign or harmful compounds in your body. It is an important function but an exaggerated response impacts the health of our tissues that make up our organs, blood vessels and all the other nuts and bolts. An exaggerated response means more inflammation from a smaller episode, a simple spark causing a runaway fire. It is thought that inflammation, along with other issues (high blood pressure, obesity, smoking, lack of exercise and stress) causes weaknesses to develop in our strained arteries that subsequently require repair or reinforcement, thus the build up of “plaque” which is why we produce more cholesterol. Interestingly statins also reduce production of some inflammatory compounds which could also explain benefits on heart disease?

The big dietary culprits impacting inflammation are processed foods, added and refined sugars, hydrogenated fats and an imbalance in the type of fats in our diets. This last point is an important one because our diet these days is dominated by omega 6 polyunsaturated plant based fats, usually at the expense of other fats including omega 3 fats. This imbalance effects our inflammatory response significantly because these omega 6’s are precursors for more inflammatory soldiers whereas omega 3’s are more like peacekeepers, they fight when necessary without dropping bombs. Much of our ready-made and processed food is high in oils from soy or corn that is loading us full of omega 6’s. They are used as a cooking medium, added to increase shelf life or provide fat for other production purposes. A recommended ratio in the diet of omega 6’s to omega 3’s is about 3:1, a typical Western diet may be between 10 and 18:1! Add to this the usual culprits of added sugars or some form of fructose or corn syrup and we have the ingredients from Elm Street. At the expense of avoiding saturated fats (which have no conclusive effect on cholesterol) we have replaced natural products with cheap plant based oils and sugars. We do not eat enough oily fish rich in omega 3’s and we get insufficient monounsaturated fats from champions like olives, canola, avocados, red meat, pork and nuts.

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Is knowing your cholesterol valuable? Definitely. Having a raised cholesterol is treatable based on your overall health status and risk. Diet can play an important role but beware of false advice. Regardless of your cholesterol levels eat well, eat a variety of fresh, unprocessed foods and limit added sugars. Balance and moderation.

To have your cholesterol or blood pressure checked, or for a dietary analysis, have a look at the ASSESSMENTS page.

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