Cholesterol & Heart Disease: An Unlikely Pair
Cholesterol, as most of you know by now, is blamed for causing heart disease. It seems obvious that this must be the case, after all, isn’t heart disease caused by collecting plaques made of cholesterol? And don’t people who eat lots of cholesterol-containing foods get heart disease more often? This is certainly what we have been led to believe, but it is just not true. I have recently read an amazing book called The Cholesterol Myths about this very issue.1 It was written by a Swedish physician named Uffe Ravnskov, MD. He has done a lot of digging and analyzing of the literature on this subject. He points out gaping holes in our understanding of heart disease and its relationship to cholesterol. I highly recommend reading this book.
Ravnskov shows that there is actually no relationship between cholesterol levels in the blood and heart attacks.2 About half of the people who have heart attacks have high cholesterol and half do not.3 In fact, studies looking at the coronary arteries of people who died from heart attacks found that only 16-50% had enough plaque buildup in their arteries to cause a blockage.4567 Also, two major studies have shown that bypass surgery does not increase survival rates of those with heart disease.8 Also, plaques are not even made of cholesterol, they are made of some cholesterol along with mutated smooth muscle cells and inflammatory material.
There are many tests that are more sensitive for heart disease, especially C-reactive protein, which is a marker for inflammation.9 Also worth mention are homocysteine, Lipoprotein a, and fibrinogen. That is not to say that lipid panels are useless; they are quite useful but not for the purpose of assessing risk for heart disease directly.
In an interesting theory, called the Myogenic Theory of heart disease, it is actually disease of the small blood vessels of the heart that cause the problem. They are not covered with cholesterol; they become inflamed and eventually get blocked constricting blood flow to the heart. As the muscle of the heart loses oxygen and nutrients, it cannot continue to create the energy needed using oxygen. It then starts forming lactic acid (just like when you exercise and build up lactic acid in your legs). Unfortunately, the heart cannot stop and rest as your legs can so the lactic acid continues to build. Eventually death of the tissue occurs, better known as a heart attack.10
The body has several methods of dealing with inflammation; the most common are antioxidants and cortisol. Antioxidants come in many forms including some our most important vitamins (A, C, E, and several B vitamins), flavonoids from the pigments of berries and some fruits, glutathione, cysteine, and even cholesterol. Cortisol is a potent anti-inflammatory made by the adrenal glands from cholesterol. This is why low cholesterol is actually a big problem.
If you do have high cholesterol, eating a diet of low-cholesterol foods will not help lower your blood cholesterol. Your body makes much more cholesterol than you can eat. If you stop eating cholesterol, your body simply makes more to overcome the deficit. Eating a diet high in cholesterol does not raise cholesterol in the blood. The body will make less so you will not have an excess. This is why diet is such a poor way of controlling cholesterol levels. Again, cholesterol is not the real problem for most people. Those with a rare condition called familial hypercholesterolemia are much more prone to heart disease; they have very high cholesterol levels in the 300’s or more. This is a different situation from the average person with elevated cholesterol.
The main cause of heart disease is more likely metabolic syndrome, or insulin resistance. With insulin resistance, your body must make more insulin to get your blood sugar under control. If this continues, you get type 2 diabetes. A high level of insulin actually causes inflammation especially to the lining of blood vessels. High insulin also increases inflammatory markers such as C-reactive protein (strongly associated with heart disease). We of course need to stop smoking. Nicotine causes much more damage to the small blood vessels than the large ones. High insulin also causes thicker blood and increases blood pressure. Insulin also stimulates the body to store energy as fat contributing to obesity, especially abdominal obesity.
Insulin resistance is the result of our sugar addicted, sedentary, stressful lifestyles while eating highly processed, nutrient depleted foods. I will be writing much more on insulin resistance. If you want to prevent heart disease, cancer, diabetes, and many other chronic conditions, then controlling insulin levels is the best way to accomplish this.
To avoid or reverse insulin resistance, we must live more like our ancestors. We need to exercise, expose ourselves to sunlight, get plenty of sleep, develop a spiritual practice, and eat real food including good fats and cholesterol.
You must eat traditional foods—that is, foods that our ancestors ate. Our ancestors ate whole foods that they could collect, hunt, or grow. Their foods were minimally processed since there was no food processing industry. They only ate fats and oils that were easy to extract such as olive, coconut, and animal fats. They ate only small amounts of sugar in the form of honey, syrup from sap, and fruit. Most ate very few grains as these require a lot of processing and many places do not have wonderful varieties of grain that grow wild. My recommendation is to eat three good meals per day consisting of proteins, good fats, and lots of vegetables. Carbohydrate intake should be based on the amount of exercise you are getting. If you exercise every day, you can have more carbohydrate to provide fuel. If you are not exercising, you need less fuel (carbohydrate).
In conclusion, we have to shift our focus away from cholesterol as the cause of heart disease and seriously look at insulin resistance. We have to change our ideas about nutrition and move away from processed food. We have to start spending time in the kitchen to prepare nutritious meals using local whole foods. We have to start moving and exercising. My favorite form of exercise is walking through the woods. It is very calming, a good workout, and allows me to connect with God and Nature. Take a field guide to learn about the birds and plants in your area. Take a journal and record your thoughts and experiences. My heart feels better just writing about it.
- Ravnskov, U. The Cholesterol Myths. New Trends Publishing: Washington, DC, 2000. ↩
- Ravnskov pg 47-95. ↩
- Ravnskov pg 52-53. ↩
- American Journal of Cardiology, 1998; 82:839-44. ↩
- Circulation, 1972; 49:1. ↩
- American Journal of Medical Science, 1960 240:701. ↩
- Circulation,1960, 22: 816. ↩
- Killip T. New England Journal of Medicine 1988 Aug 11; 319(6):366-8. ↩
- C-reactive protein and MI ↩
- http://www.westonaprice.org/moderndiseases/heart-attacks.html ↩
