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The Cholesterol Myth
by Dr. David Ramaley

Perhaps one of the biggest health myths we have been taught in the United States is the correlation between elevated cholesterol and cardiovascular disease (CVD). Our nation has become obsessed with eating foods low in cholesterol and fat. Ask almost anyone and they can tell you their cholesterol level. Most likely you have a friend or relative taking a statin drug (Lipitor, Mevecor, Crestor, etc.) to lower cholesterol. Statin medications are the number-one-selling drug in the world. Despite dozens of studies, however, cholesterol has not been shown to actually cause CVD. To the contrary, cholesterol is vital to our survival and trying to artificially lower it can have detrimental effects, particularly as we age.

The whole discussion of cholesterol and CVD began in the mid-1950s when Ancel Keys, a professor at the University of Minneapolis, analyzed fourteen different countries and their dietary habits. Instead of using the data from all of the countries, he chose just seven countries and concluded in his Seven Countries Study that saturated fat and cholesterol is the cause of CVD. On the other hand, according to cholesterol researcher Malcom Kendrick, M.D., if had used the statistics from the other seven countries the data would have revealed that higher levels of cholesterol and fat actually lower the incidence of CVD.

The Framingham study, which began in 1948, is one of the most extensive studies on CVD. It tracked the medical history of over 5,200 residents of Framingham, Massachusetts. In 1979, the authors of the study concluded that there was a greater risk of CVD for men under 50 years old who had higher levels of total serum cholesterol. This finding further propelled the cholesterol myth. In 1987, however, the same authors concluded just the opposite of the original findings and found that those same residents over 50 years old whose cholesterol had decreased during the study experienced an increase in total mortality and CVD. The same conclusion was also drawn in the Honolulu Heart Program and the Multiple Risk Factor Intervention Trial. This is not to say that some people may benefit from lowering cholesterol and taking a statin, but it is a very small percentage of the population.

Cholesterol has many health benefits. It is needed to make hormones such as estrogen, progesterone and testosterone. It is vital for the functioning of nerve synapses and provides the structural integrity for our cell membranes. Our brain is 60% fat and of that 30% is cholesterol. Cholesterol is used by the skin to help prevent water evaporation and in our lungs for oxygen absorption. Vitamin D is synthesized from cholesterol. Our gall bladder needs cholesterol to make bile for fat digestion. The liver produces about 90 percent of the cholesterol in our bodies and only 10 percent comes from diet. If we eat too much cholesterol, the liver will naturally decrease the output of cholesterol. Most research is showing that the images we see in pictures of an artery clogged with fat is actually due to the oxidation of cholesterol and an imbalance in vitamins D, A and K2.

When checking our lipids (cholesterol) here are a few labs tests I recommend. Most of these can be ordered by your healthcare provider and are a better predictor of your cardiovascular risk.

Total High and Low Density Lipoprotein Index or VAP test: This measures the ratio of all types of cholesterol and is a more important indicator than just total cholesterol. It is a very detailed test and breaks down the subunits of each lipoprotein. This is becoming a very common test now.

Oxidized LDL and /or HbA1c: This measures the amount of your LDL that has been damaged by free radicals and inflammation. Hemoglobin A1c (HbA1c) is a measurement of your blood sugar over 60 days but also correlates well with oxidized LDL. Research shows that even slightly elevated blood sugar can create a sticking of the cholesterol and create more plaque. Inflammation in the body and not your cholesterol is the real culprit of CVD. I highly recommend the HbA1C test as this is very common and easy to order.

Apolipoproteins: These are molecules that are found in the intestines and liver. They carry cholesterol through the body, so they determine how much cholesterol is deposited in the arteries and how much is removed. I suggest measuring apolipoprotein A1 (apoA1) that pulls cholesterol off the arteries and apolipoprotein B (apoB) that deposits cholesterol on the arteries. Several studies have shown these to be much better predictors of heart disease. The ratio between apoA1 and apoB should be less than .70 and not greater than .73. This ratio is found by dividing apoB by apoA1. If you cannot get both of these tests done then at least get your apoB measured as this also measures the oxidized amount of LDL in your body.

Homocysteine: This amino acid can create scarring and irritation of the blood vessels, which can in turn lead to plaque formation in the arteries. It is thought that close to 50 percent of cases of high blood pressure and heart attacks are due to elevated homocysteine. Ideally, you want levels below 9umol/L. If homocysteine levels are too high, take 800mcg per day of folic acid and 1,000 mcg of B12 to reduce levels. I suggest taking the activated forms called methylfolate and methylcobalamine that can be found in most stores now.

hsC-Reactive Protein (hs-CRP): This is a measure of inflammation. If above 0.5mg/dl, then you need to discover the cause of the inflammation such as infection, poor diet, stress, low vitamin D, unhealthy gut bacteria and toxins.

Triglyceride/HDL ratio: This is an excellent marker and appears on all standard blood tests. Ideally a 2:1 ratio or less of triglyceride to HDL is best. For example if your triglyceride level is 100 you want your HDL to be at least 50. The closed the two numbers come together the better, such as 60:60.

While everyone is different, the best way to prevent CVD is to keep your blood sugar in a healthy range and lower your inflammation. You can do this by eating a variety of green vegetables, avoiding foods high in refined carbohydrates and decreasing unhealthy polyunsaturated oils (canola, corn, soybean, safflower and cottonseed) that raise your levels of apoB and oxidized LDL.

The best fats to consume are certain healthy polyunsaturated and saturated types. The healthy polyunsaturated oils contain Omega 3 and monounsaturated fat such as fish, flax, hemp, walnut, olive and avocado. I recommend at least 1,000 - 2,000 mg of fish oil per day. The best saturated fats come from pasture fed animals such as butter, lard and eggs (see Pasture Fed Meat article). Coconut oil is another healthy saturated fat that promotes better brain function.

I suggest reading The Great Cholesterol Con by Anthony Colpo, which discusses the whole theory of a link between cholesterol and CVD and gives helpful dietary advice. You can use the websites ravnskov.nu and WestonaPrice.org as well as watch Chris Masterjohn on YouTube.