Issue 24 – June 2013

Cholesterol

The Low-Down On Cholesterol

It seems that everyone is talking about cholesterol these days, but do you really know what it is? What can you do to maintain healthy cholesterol levels?  Are high cholesterol levels really bad?  Or are they a sign of something underlying?

Cholesterol is a type of fat molecule that is carried around in the blood.  It is only present in animals.  It performs useful functions in the body and is a major building block for cells and many of your hormones, including oestrogen, testosterone and cortisol.  It is an essential component of cell membranes and it is synthesised in almost all human tissues.  The brain and central nervous system, connective tissue, muscle and skin account for about 75% of total body cholesterol.  We need cholesterol for these parts of our body to work properly.

Cholesterol is also important for the synthesis of vitamin D, as well as bile acids which aid in the digestion of fats.  Our bodies manufacture cholesterol but it can also be found in foods containing saturated fats.

Cholesterol is a healing agent.  When there are problems in the body such as inflammation, stress or hormone imbalances our liver will make more cholesterol to deal with this problem.  Keeping this in mind we can see that high cholesterol levels are not as much a problem in themselves, but rather an indicator or warning of something else going wrong in the body.  One of the main triggers for the body to make more cholesterol is inflammation, which in itself is a big cause of heart and vascular disease.  Simply lowering cholesterol levels ignores this underlying problem.

The Good vs. The Bad Cholesterol

HDL and LDL are letters that you may have seen before on a blood test, and it is important to review these to monitor your health.  But what do they mean?

Remember that cholesterol is actually a fat molecule and is only found in animals (so the labels on potato chip packets saying ‘No Cholesterol’ are kinda redundant) and when we consume it in a food from animal products we are consuming the cholesterol molecule as a whole, as ‘free cholesterol’.  When cholesterol is in our blood it has to be transported in particles called lipoproteins.  This is what we measure in blood tests.

In your blood test, your total cholesterol is made up of different types of cholesterol transport systems known as lipoproteins.  These lipoproteins have lots of different roles in the body.  While our understanding of these forms of lipoproteins is constantly evolving, the current view is that the two main types of cholesterol have different roles, and they are commonly known as the “good” and “bad” cholesterol.   These are the main types:

• High Density Lipoprotein (HDL) is called the “good” form of cholesterol.  Its role is to carry cholesterol from the tissues to the liver to be broken down and excreted.  It is thought that higher levels of HDL compared to LDL helps to decrease cardiovascular risk because HDL helps to keep LDL ‘in check’.  We should aim to get our HDL as high as possible to support our heart health.
• Low Density Lipoprotein (LDL) is often referred to as the “bad” form of cholesterol because it can “stick” to and narrow the arteries in the heart.  This increases the risk of the coronary artery disease known as atherosclerosis.  Most of the cholesterol in our plasma (blood) is carried on LDL where it transports cholesterol from the liver to body cells for use in cell membrane repair and the production of hormones and bile salts.  Higher levels of LDL are a warning sign of things going wrong in the body that can contribute to heart disease.

An interesting perspective on the thinking behind the terms ‘good’ and ‘bad’ cholesterol and the reason why cholesterol levels fluctuate in the body is well explained by Dr. Natasha Campbell-McBride:

Once again it seems that the conventional understanding of good and bad cholesterol is forgetting why cholesterol is being produced in the first place, and neglecting to address the underlying causes.  We need to find a happy medium behind the above interpreation and the conventional understanding of good and bad cholesterol.  LDL is not bad in itself but it can be made bad by other factors, and we should use it as a marker of other problems in the body.  We know that higher levels of HDL are associated with reduced levels of heart disease and it has a protective mechanism, preventing LDL oxidisation where it can be transformed by the immune system to a different type of cell which can cause problems – this is covered in more detail below.

Cholesterol and Diet

It is a common misconception that high levels of cholesterol are caused by a diet high in animal fats (meat, eggs and dairy).  Our diet has much less of an effect on your cholesterol levels than we have been led to believe.

Only 30% of people have increased blood cholesterol from increased cholesterol consumption.  The other 70% are protected by a regulating mechanism whereby the body produces less cholesterol when they eat more cholesterol, and produces more when they get less from food.

Cholesterol consumption has remained constant for the last 100 years while the incidence of cardiovascular disease has increased by 300%, indicating cholesterol intake cannot be the primary cause.  And if it was, why are doctors having little success in preventing cardiovascular disease based on this theory?

One of the ways we can understand the increased rates of heart disease is looking at the differences in society’s diet over time.  In the past fat and sugar consumption was lower, while vitamin, mineral, vegetable and unprocessed or ‘wholegrain’ intake was greater.  These changes are causing cholesterol to have a more damaging effect on our body.

Cholesterol is not increased from the intake of cholesterol through our diet.  Remember that we have a regulating mechanism, and the body will make more cholesterol if it feels it is necessary.  Some examples of increased need for cholesterol may be if we have a hormone deficiency (cholesterol is the building block for hormones) or cell membranes require repair (if they’ve been damaged through inflammation or oxidation).  Heart disease is increasing because we are more inflamed, have more oxidation, and have more hormonal imbalances.  If we are eating too much sugar or omega-6 fatty acids (instead of omega-3) this causes inflammation and imbalances in our body.  Stress (a potent but commonly ignored cause of high cholesterol) can cause cortisol imbalances.  Too much intake of sugar and refined grains can contribute towards insulin resistance, liver and pancreas problems and can cause oxidation of our LDL.  When this happens we have an environment where plaque will be more likely build up in our arteries.

As I’ve already mentioned, cholesterol causes problems when it is oxidised.   When there is a lot of oxidised LDL, vLDL (very low density lipoprotein) is created.  These cells have a receptor which causes the  immune system to activate.  A type of immune cell called macrophages are produced which interact with the altered cholesterol molecule and then the problematic ‘foam cells’ are created.  If these foam cells accumulate they will eventually form plaque in the artery walls, which causes narrowing of the arteries and can lead to thrombus formation (blood clots).   This process is also very inflammatory, which can cause further damage to artery walls.  This can result in conditions such as heart disease, peripheral vascular disease and dementia.

Factors that increase levels of oxidised LDL include a diet high in trans fats (pastries, deep fried foods, potato chips), excess Omega-6 oils compared to Omega-3, excessive sugar intake, smoking, poorly managed diabetes and metabolic syndrome.  Having higher levels of HDL also helps to prevent foam cell formation, which is likely due to the association increased HDL in those with higher omega-3 and anti-oxidant stores.

Another form of LDL has been discovered in recent years which has also shown to be dangerous and problematic: MG-min-low-density-lipoprotein (MGmin-LDL).  This type of lipoprotein (cholesterol transport) is formed when sugar compounds attach to LDL cholesterol, causing it to become smaller and denser.  This form can easily get stuck on artery walls, which is where the problem lies.  Balancing blood sugar through diet, good management of diabetes and herbs and nutrients that support blood sugar levels such as chromium and Gymnema sylvestre (Gymnema) can be helpful for supporting healthy blood sugar levels, which will reduce the production of MGmin-LDL.

This oxidation of LDL helps us to understand why high cholesterol is a problem in some people and not in others.  It makes sense then that treatment should focus on not just lowering LDLs, but on preventing oxidation, modification and transportation of LDLs and fats into the foam cells that form the plaque in arteries.

Raising HDL should also be a priority because this is what will help our body to mop up the damage from LDL gone wrong.  There is no conventional medication for this but diet and lifestyle changes can help here.  We should aim for our HDL to get as high as possible.

Avoid low fat diets because this will lower your HDL and foods such as margarine or those that are ‘low fat’ or ‘skim’ often contain products that are bad for us and increase other risk factors for heart disease.  Yes that’s right – you’ve probably been told to cut out all fats from your diet, swap butter to margarine, drink low fat milk and eat low fat yoghurt… but these recommendations are outdated, flawed and has been disproven.  While fats are high in calories and some fats are altered through heat and oxidation (e.g. trans fats) becoming dangeous, the general fear of fats which was instilled into people over the last few decades in unnecessary and wrong.  The right type of fats to eat are covered below and in a previous article about fats here also in this video.

Essentially, eating cholesterol won’t raise your cholesterol but your diet can affect the way cholesterol behaves in the body and increase other risk factors for heart disease.

Cholesterol and Genetics

There are some people who have a genetic tendency towards having high cholesterol levels.  These people (and their parents) have higher than normal levels of LDL.  This occurs in approximately 1 in 300 Australians and causes up to 10% of early onset coronary artery disease that occurs before 55 years of age.  For these people they may have high total blood cholesterol levels irrespective of what they eat, and will require treatment.  This treatment will require an approach to clear excess cholesterol from the body, but should also focus again on the underlying causes.

Cholesterol and Stroke

The great fear behind high cholesterol is that if it is too high you will have a heart attack or stroke.  The way that this is meant to happen is that cholesterol clogs up in the arteries, and then causes a clot which breaks away, restricting blood flow in the heart causing a heart attack or in the brain causing a stroke.  This is a simplistic explanation and does not take into account all factors associated with stroke.  I highly recommend reading Chris Masterjohn’s article here.  Essentially, high LDL cholesterol levels can be implicated in stroke because higher LDL levels may be oxidised (remember that oxidised LDL is taken up by the immune system, macrophage cells specifically which is what causes plaque) but are only associated with ischemic stroke.  As cholesterol levels increase, the risk of hemorrhagic stroke decreases and the risk of ischemic stroke increases.

Cholesterol Medications

Conventional medicines approach to support health and reduce high cholesterol levels are statin medications.  While these may be necessary in the small portion of people who are genetically prone to having very high cholesterol levels, in the majority of cases statins are over prescribed.  This class of drugs have a high level of side effects, and as the knowledge of this increases more and more people are turning to natural treatment for cholesterol and heart health.

One of the most well known side effects of statin medication is muscle pain.  The way this class of medications cause muscle pain is by the breakdown of the muscle tissues.  While this is still not fully understood, research has found several mechanisms that may explain how statins can cause muscle pain:

     1.  Depleting your body of CoQ10, a nutrient that supports muscle function and energy production.  The importance of taking a CoQ10 supplement is fortunately becoming more accepted.

     2.  Altering the ability of skeletal muscle to repair and regenerate due to the anti-proliferative effects of statins.  One study found that Simvastaton reduced the proliferative ability of muscle cells by 50 percent at a dose equivalent to 40 milligrams.  This could clearly have a negative effect on your skeletal muscles’ ability to heal and repair themselves, and could lead to eventually becoming more or less incapacitated (2).

     3.  Activating the atrogin-1 gene, which plays a key role in muscle atrophy. (3)

Researchers at The University of Copenhagen have found that the depletion of coenzyme Q10 can cause lower energy production and muscle pain in those taking statin drugs for high cholesterol.   Muscle pain is a common side effect of statin treatment as it seems to affect the energy production in muscles and may be the direct cause of muscle weakness and pain. Almost 75% of physically active patients taking statins experience pain. (4)

Some research has even shown that taking statins may actually INCREASE your risk of heart disease, as an association of increased rate of coronary plaques was found in those taking statins. (5)

With so many people taking statins, and the risks of heart disease still alarmingly high it seems that focusing on reducing cholesterol with medications is not the answer.  Rather than just lowering cholesterol, we need to look at WHY our cholesterol is increasing.

Natural Support For Cholesterol

Treatment Aims:

• Reduce insulin resistance and balance blood sugar levels, by consuming less refined carbohydrates and sugar.
• Reduce inflammation by avoiding foods which can contribute to inflammation and supplement with anti-inflammatory herbs and nutrients.
• Reduce oxidation by eating foods rich in anti-oxidants, and taking anti-oxidant supplements.
• Support liver clearance of cholesterol.
• Support stress levels with lifestyle techniques and herbs and nutrients which support the adrenal glands, and nervous system.
• Address hormonal deficiencies such as Andropause and Thyroid dysfunction etc.

Natural therapies used in the arsenal against LDL oxidation, high blood cholesterol levels and cardiovascular disease include:

Supplementation with:

Polymethoxyflavones: Also known as PMFs, these natural antioxidant and anti-inflammatory compounds found in citrus peel assist in maintaining healthy cholesterol levels.

Research has shown that nobiletin and tangeretin, the phytochemicals found in PMFs, may assist in lowering LDL levels by reducing synthesis and increasing the clearance of LDL cholesterol.

Tocotrienols: Tocotrienols are members of the vitamin E family. These antioxidants also increase the clearance of LDL cholesterol and reduce the body’s production of LDL.

Krill oil: The oil from the crustacean, krill, has been shown to be beneficial for cholesterol balance, particularly by supporting HDL levels.

Fish oil: 2 g to 4 g of combined EPA/DHA has been shown to decrease triglyceride levels and is beneficial for heart health.

Depending on the individual further support may include: Coenzyme Q10, Vitamin C, Vitamin B3 (niacin/nicotinic acid), fibre, liver support (such as Cynara scolymus (Globe Artichoke), Silybum marianum (St Mary’s Thistle), Taraxacum officinale radix (Dandelion root)) Coleus forskohlii (Coleus) and Allium sativum (Garlic).

(Note that all of these remedies help to reduce cholesterol by addressing causes of high cholesterol such as with antioxidant and anti-inflammatory properties).

Six Tips For Optimal Cardiovascular Performance

Take on these tips for eating and living to support healthy cholesterol and cardiovascular health:

• Follow the Mediterranean diet. People eating this diet rich in essential nutrients and antioxidants have the lowest rates of cardiovascular disease in the world.
• Eat good fats and Eliminate detrimental trans fats found in many fast foods, fried foods and packaged baked goods.  Cut down on sugary refined carbohydrates and processed food. These foods often contain ‘hidden sugars’ that can be converted to fat when supply is high.
• Weight loss.  If you are overweight, losing extra weight will help to lose the risk factors associated with cardiovascular disease. Your Practitioner can recommend a clinically-proven weight loss program and targeted supplements to assist healthy weight management.
• Get moving towards a healthy lifestyle. Exercise improves cardiovascular and overall health and supports your “good” cholesterol levels.  Move away from unhealthy habits such as smoking and excessive alcohol intake as they increase your cardiovascular risk.
• Address inflammation.  If you have increased levels of cholesterol, it is at least in part because of increased inflammation in your body. The cholesterol is there to do a job: help your body to heal and repair.  Some basic ways to support inflammation is to reduce inflammation by avoiding foods which can contribute to inflammation and supplement with anti-inflammatory herbs and nutrients.
• Balance hormones. Steroid hormones in the body are made from cholesterol: testosterone, progesterone, pregnenolone, androsterone, estrone, estradiol, corticosterone, aldosterone and others. These hormones accomplish a myriad of functions in the body, from regulation of our metabolism, energy production, mineral assimilation, brain, muscle and bone formation to behavior, emotions and reproduction. In our stressful modern lives we consume a lot of these hormones, leading to a condition called “adrenal exhaustion.”  Stress and hormone deficiency can cause the body to make more cholesterol.

With so many people taking statins, and the risks of heart disease still alarmingly high it seems that focusing on reducing cholesterol with medications is not the answer.  Rather than just lowering cholesterol, we need to look at WHY our cholesterol is increasing.

With the help of natural medicines and by following some key dietary and lifestyle recommendations, you can effectively manage your cholesterol levels. Call or email us today to get started on your journey towards improved cardiovascular health.

Further reading:

Cholesterol – Friends or Foe? : 

http://www.westonaprice.org/know-your-fats/cholesterol-friend-or-foe

Cholesterol and Stroke :

http://www.westonaprice.org/know-your-fats/cholesterol-and-stroke

Myths & Truths About Cholesterol

http://www.westonaprice.org/cardiovascular-disease/myths-a-truths-about-cholesterol

Dr Mercola articles on cholesterol:

http://articles.mercola.com/sites/articles/archive/2010/08/10/making-sense-of-your-cholesterol-numbers.aspx

http://articles.mercola.com/sites/articles/archive/2008/10/14/cholesterol-lowering-drugs-will-wreck-your-muscles.aspx

http://articles.mercola.com/sites/articles/archive/2009/08/06/statins-cause-muscle-damage.aspx

http://articles.mercola.com/sites/articles/archive/2010/08/10/making-sense-of-your-cholesterol-numbers.aspx

http://articles.mercola.com/sites/articles/archive/2010/06/12/unintended-statin-sideeffect-risks-uncovered.aspx

Cholesterol Explained (Video)

http://summertomato.com/cholesterol-explained/

The Truth about Fats

http://www.naturopathnsw.com.au/the-truth-about-fats

Works cited

[1] Campbell-McBride, Natasha. Cholesterol: Friend Or Foe? Weston A Price Foundation. [Online] May 04, 2008. [Cited: June 21, 2013.] http://www.westonaprice.org/know-your-fats/cholesterol-friend-or-foe.
[2] Society, American Physiological. Cholesterol-lowering drugs and the effect on muscle repair and regeneration. [Online] September 25, 2008. [Cited: May 26, 2013.] http://www.eurekalert.org/pub_releases/2008-09/aps-cda092308.php.
[3] The muscle-specific ubiquitin ligase atrogin-1/MAFbx mediates statin-induced muscle toxicity. Hanai J, Cao P, Tanksale P, Imamura S, Koshimizu E, Zhao J, Kishi S, Yamashita M, Phillips PS, Sukhatme VP, Lecker SH. 12, 2007, The Journal of Clinical Investigation, Vol. 117, pp. 3940-51.
[4] Simvastatin effects on skeletal muscle. Larsen S, Stride N, Hey-Mogensen M, et al. 1, s.l. : J Am Coll Cardiol, 2013, Vol. 61, pp. 44-53.
[5] Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry. Nakazato R, Gransar H, Berman DS, Cheng VY, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cury RC, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Maffei E, Raff G, Shaw LJ, Villines TC, Dunni. 1, 2012, Atherosclerosis, Vol. 225, pp. 148-53.

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