Why having high cholesterol isn't always bad

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Why having high cholesterol isn't always bad

Posted on December 6th, 2007

Categories: triglycerides | statins | niacin | heart disease | cholesterol

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Lowering cholesterol can be harmful to your health.

Sound crazy? It’s true.

In fact, a recent study in “The New England Journal of Medicine” shows that even if your bad cholesterol (LDL) is under 70, statin drugs don’t protect you if your good (HDL) cholesterol is also low.

That’s obvious if you know the real cause of heart disease -- which is sugar, not fat.

It is sugar that drives the good cholesterol down and causes metabolic syndrome or pre-diabetes. That is the true cause of most heart attacks, NOT LDL cholesterol.

Why don’t you hear about this?

Well, there is no good drug to raise HDL.

Statin drugs lower LDL -- and billions are spent advertising them, even though they are the wrong treatment.

If you’re like most of the patients whom I see in my practice, you’re convinced that cholesterol is the evil that causes heart disease.

If you hope that if you monitor your cholesterol levels and avoid the foods that are purported to raise cholesterol, you’ll be safe from America’s number-one killer.

Why are you afraid of cholesterol?

Because for years, well-meaning doctors, echoed by the media, have emphasized what they long believed is the intimate link between cholesterol and death by heart disease.

If only it were so simple!

But the truth is much more complex.

Cholesterol is only one factor of many -- and not even the most important -- that contribute to your risk of getting heart disease.

First of all, let’s take a look at what cholesterol actually is. It’s a fatty substance produced by the liver that is used to help perform thousands of bodily functions.

The body uses it to help build your cell membranes, the covering of your nerve sheaths, and much of your brain. It’s a key building block for our hormone production, and without it you would not be able to maintain adequate levels of testosterone, estrogen, progesterone and cortisol.

Think cholesterol is the enemy? Think again.

Without cholesterol, you would die.

In fact, people with the lowest cholesterol as they age are at highest risk of death. Under certain circumstances, higher cholesterol can actually help to increase life span.

When I convey this simple reality to my patients, they often gasp.

==> Cholesterol Myths

Let me debunk another myth.

Although most of us have been taught that a high fat diet causes cholesterol problems, this isn’t entirely true.

Here’s why: the type of fat that you eat is more important than the amount of fat. Trans fats or hydrogenated fats and saturated fats promote abnormal cholesterol, whereas omega-3 fats and monounsaturated fats actually improve the type and quantity of the cholesterol your body produces.

Meanwhile, the biggest source of abnormal cholesterol is not fat -- it’s sugar.

That’s right, the sugar you consume converts to fat in your body.

The worst culprit is high fructose corn syrup. Consumption of high fructose corn syrup, which is present in sodas, many juices, and most processed foods, is the primary nutritional cause of most of the cholesterol issues we doctors see in our patients.

==> What Kind of Cholesterol Do You Have?

By now, many health-conscious people know that total cholesterol is not as critical as the following:

Your levels of HDL “good” cholesterol vs. LDL “bad” cholesterol
Your triglyceride levels
Your ratio of triglycerides to HDL
Your ratio of total cholesterol to HDL

What’s more, we now know that there are different sizes of cholesterol particles. Yes, that’s right. There are small and large particles of LDL, HDL and triglycerides.

What’s the most dangerous?

Small, dense particles act like BB pellets, easily penetrating the arteries. However, large, fluffy cholesterol particles are practically harmless--even if your total cholesterol is high. They function like beach balls and bounce off the arteries, causing no harm.

Is your cholesterol rancid? If so, the risk of arterial plaque is real.

Rancid or oxidized cholesterol results from oxidative stress and free radicals, which trigger a vicious cycle of inflammation and fat or plaque deposition under the artery walls. That is the real danger, when small dense LDL particles are oxidized they become dangerous and start the build up of plaque or cholesterol deposits in your arteries.

==> Prime Contributors to Cardiovascular Disease

Now that we’ve explored when and how cholesterol becomes more problematic, let’s take a look at other factors that play a more significant role in cardiovascular disease.

First of all, cardiovascular illness results when key bodily functions go awry, causing inflammation, imbalanced blood sugar reactions, and oxidative stress.

To control these key functions and keep them in balance, you need to look at your overall health as well as at your genetic predispositions, as these underlie the types of diseases you’re most likely to develop.

It is the interaction of your genes, lifestyle, and environment that ultimately determines your risks -- and the outcome of your life.

This is the science of nutrigenomics, or how food acts as information to stall or totally prevent some predisposed disease risks by turning on the right gene messages with our diet and lifestyle choices.

Some of the factors that unbalance bodily health are under your control, or could be.

These include diet, nutritional status, stress levels, and activity levels. Key tests can reveal problems with a person’s blood sugar, inflammation level, level of folic acid, clotting factors, hormones, and other bodily systems that affect your risk of cardiovascular disease.

Particularly important are the causes if inflammation, which are many, and need to be assessed.

Inflammation can arise from poor diet (too much sugar and trans and saturated fats), a sedentary lifestyle, stress, autoimmune disease, food allergies, hidden infections such as gum disease, and even toxins such as mercury.

These need to be considered anytime there is inflammation.

Combined together, all of these factors determine your risk of heart disease. And I recommend that people undergo a substantive evaluation to see what their risk really is.

==> Zeroing in on Key Factors for Heart Disease

There’s no doubt about it, inflammation is key contributor to heart disease.

A major study done at Harvard found that people with high levels of a marker called C-reactive protein (CRP) had higher risks of heart disease than people with high cholesterol. Normal cholesterol levels were NOT protective to those with high CRP. The risks were greatest for those with high levels of both CRP and cholesterol.

Another predisposing factor to heart disease is insulin resistance or metabolic syndrome, which leads to an imbalance in the blood sugar and high levels of insulin.

This may affect as many as half of Americans over age 65. Many younger people also have this condition, which is sometimes called pre-diabetes.

Although modern medicine sometimes loses sight of the interconnectedness of all our bodily systems, blood sugar imbalances like these impact your cholesterol levels too.

If you have any of these conditions, they will cause your good cholesterol to go down, while your triglycerides rise, which further increases inflammation and oxidative stress. All of these fluctuations contribute to blood thickening, clotting, and other malfunctions -- leading to cardiovascular disease.

What’s more, elevated levels of a substance called homocysteine (which is related to your bodily levels of folic acid and vitamins B6 and B12) appear to correlate to cardiovascular illness.

Although this is still somewhat controversial, I often see this inter-relationship in my practice. While genes may play a part, tests done as part of a comprehensive evaluation of cardiac risk can easily ascertain this factor. Where problematic levels occur, they can be easily addressed by adequate folic acid intake, along with vitamins B6 and B12.

==> Testing

If you want to test your overall risk, you can consider asking your doctor to undertake the following tests:

Total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Your total cholesterol should be under 200. Your triglycerides should be under 100. Your HDL should be over 60. Your LDL should be ideally under 80. Your ratio of total cholesterol to HDL should be less than 3.0. Your ratio of triglycerides to HDL should be no greater than 4, which can indicate insulin resistance if elevated.
NMR Lipid Profile. This looks at your cholesterol under an MRI scan to assess the size of the particles, which can determine your cardiovascular risk. This is a very important test that can further differentiate the risk of your cholesterol and can be an important factor to track as your system improves and your cholesterol transforms from being small dense and dangerous to light and fluffy and innocuous.
Cardio C-reactive protein. This is a marker of inflammation in the body that is essential to understand in the context of overall risk. Your C-reactive protein level should be less than 1.
Homocysteine. Your homocysteine measures your folate status and should be between 6 and 8.
Lipid peroxides or TBARS test, which looks at the amount of oxidized or rancid fat. This should be within normal limits of the test and indicates whether or not you have oxidized cholesterol.
Fibrinogen, which is another test looking at clotting in the blood. It should be less than 300.
Lipoprotein (a), which is another factor that can promote the risk of heart disease, often in men. It should be less than 30.
Genes or SNPs may also be useful in terms of assessing your situation. A number of key genes regulate cholesterol and metabolism, including Apo E genes and the cholesterol ester transfer protein gene. The MTHFR gene, which regulates homocysteine is also important and may be part of an overall workup.
If you are concerned that you have cardiovascular disease, a high-speed CT or (EBT) scan of the heart may be helpful to assess overall plaque burden and calcium score. A score higher than 100 is a concern, and a score higher than 400 indicates severe risk of cardiovascular disease.

Stay tuned for next week when I will review how to lower your risk of heart disease and fix your cholesterol.

We’ll do this not by lowering the LDL, but by getting more light and fluffy LDL particles, which are protective and more HDL cholesterol, which is THE most important cholesterol.

Now I’d like to hear from you…

Have you been told that you need to lower your cholesterol?

If so, what were your told to do and how does that compare to what you’ve read here?

Does any of what you’ve read here come as a surprise?

Please click on the Add a Comment button below to share your thoughts.

To your good health,

Mark Hyman, M.D.

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