The Cholesterol Myth

- Inflammation causes heart disease, not cholesterol

by Royce Bailey M.D., M.P.H., F.A.A.C.

“A new heart also will I give you, and a new spirit will I put within you: and I will take away the stony heart out of your flesh, and I will give you an heart of flesh.” Ezekiel 36:26

Heart Attacks

Someone has a heart attack every 30 seconds in the U.S. Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don’t get help immediately. It’s important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include: chest discomfort/pressure, squeezing, or pain; shortness of breath; discomfort in the upper body/ arms, jaw, shoulder, neck or back; nausea, vomiting, dizziness, lightheadedness or sweating. These symptoms can sometimes be different in women. What exactly is a heart attack? Most heart attacks happen when a clot/scab in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat (called an arrhythmia), that causes a severe decrease in the pumping function of the heart. A complete blockage that is not treated within a few hours causes the affected heart muscle to die.

Is All Cholesterol Bad?

Cholesterol is an essential component of cell membranes (walls). It also is required for the synthesis of estrogen, testosterone, adrenaline, cortisone, vitamin D and other hormones; as well as being one component in your bile acids that helps digest your fats. Even “bad” low density lipoprotein-LDL cholesterol is necessary for optimal health. Babies need cholesterol rich foods for development of their brains and nervous systems. We all have a genetically determined amount of cholesterol we produce. The problem is we eat extra cholesterol in cholesterol rich foods, which adds to our risk of disease and to our cholesterol number.

Free Radicals

Free radicals are chemical by-products of many reactions within the body called “oxidation.” They are called “free” in the sense that they damage cells, tissue and processes in the body without adequate control. People eat too much food that is oxidized or easily oxidized and it ends up in the wrong place, like the arteries of your heart. Researchers now understand how the arteries become plugged with lipid (fatty) material. Cooked cholesterol (only found in animal products) foods cause oxidation (rusting) of the blood vessel lining. An example is butter left out of the refrigerator for as little as 20 minutes causes it to oxidize. Then you wonder how you got heart disease. High fat, low fiber, high sugar diets (fast food or processed foods) promote oxidation. Free radical damage may be caused by cell toxins like tobacco and alcohol and a faulty response to stress; which adds even more to the risk of oxidation.

Trans Fats

Trans fats (anything hydrogenated, including hydrogenated soy) promotes the worst oxidation. New government labeling allows a product to place on its label “no trans fats” if it contains less than ½ a gram of trans fats per serving. Thus, if there is 10 servings in a package, there could be 5 grams of hidden trans fat in that product. Look on the ingredients label to see if it says the word ‘hydrogenated.’ If it does, avoid it.

Your Cholesterol Particle Size

So you can make a difference by your diet, in the type of cholesterol particles you have (fluffy beach balls-good or dense sand-bad). In some of my patients their cholesterol numbers (total cholesterol, HDL, LDL, VLDL, triglycerides) do not change significantly with diet and exercise and this causes them to be discouraged. Have your doctor check the cholesterol particle size and number after your aggressive diet change. You will see a big difference. The larger the particle (HDL and LDL) the less likely it will abrasion and get lodged between cells starting the inflammation process in your arteries. Current studies reflex a closer correlation for risk of coronary artery disease with the Non HDL Chol number then the LDL number. Non HDL Chol is your total cholesterol number minus your HDL number.

Saturated Fat

Contrary to popular belief, saturated fats do not cause heart disease.  Saturated fat can be made by your body into cholesterol, so moderation in all things applies here.  We need saturated fats, which are necessary for calcium to be incorporated into our bones.  Omega-3 fats are retained better in tissues in the presence of saturated fats.  Saturated fats promote healthy immune systems because of their anti-microbial properties that prevent the buildup of harmful micro-organisms in the digestive tract.  Some of the best sources of saturated fat are nuts.  Omega-3 fats are found in walnuts, pecans and brazil nuts.

Diet Changes For Better Cholesterol Numbers

Eat more fresh fruits (especially blueberries) and veggies (red veggies are high in Vitamin C). Eat more nuts, like walnuts (omega-3) and almonds (magnesium). Eat more seeds (for zinc and complete natural Vitamin E), like sunflower seeds and pumpkin seeds. Cook with extra virgin olive oil (made from the first pressing of ripe olives) containing oleic acid, a heart friendly cooking oil. Avoid cholesterol containing foods (meat, eggs, cheese and milk) which raise your cholesterol.

The Side Effects Of Statin Drugs

Cholesterol drugs, called statins, lower the bad LDL cholesterol and thus reduces heart attacks by as much as 50% and stroke by as much as 25%. They have, as do any drug, side-effects which include: muscle damage (rare), permanent liver damage (rarer), headaches, upset stomach muscle aches and rashes. Don’t take statins with grapefruit or its juice, because it increases the drug concentration and the risk of side-effects (even if you take a statin 24 hours after eating grapefruit). The statins work by limiting (amount depends on the specific drug) the product of cholesterol in the liver. Statins also reduce the production of CoEnzQ10, which may cause many of its side-effects. Lack of Co-Enzyme Q10 can increase your toxic level of homocyteine. I recommend 100 mg of CoEnzQ10 a day while taking any statins. Another reason, I believe, some people can’t take statin drugs is their body’s acid base balance is too acidic. Eating a more alkaline diet (the healthiest) suddenly allows these people to be able to take a statin drugs without side effects.

The Real Reason Statin May Benefit You

But, the reason statins reduce the incidence of heart disease may not be from their cholesterol effects at all, but is probably from their powerful anti-inflammatory and anti-oxidant effects that prevent cell and tissue damage. This is the reason they are being recommended to patients with diabetes and rheumatoid arthritis with normal cholesterol levels. You’ve heard the bad things about statins, what about the good things statin do?

Alzheimer’s Disease

Large observational studies have shown statins to lower the risk of Alzheimer’s disease by 30-70% and delays its onset. True Alzheimer’s is from a build up of amyloid proteins in the brain causing a glue-like non dissolvable plaque. The immune system detects these plaques and releases inflammatory molecules to destroy it. Continued attack on the cells causes damage to the surrounding brain cells without breaking down the plaque. Statins don’t help in Alzheimer’s by lowering the cholesterol number, but by reducing the inflammation that causes the damage to the brain.

Parkinsonism

Analysis of data of 1,684,810 patients showed a 49% reduction in the incidence of Parkinsonism when the patents took Zocor (simvastatin), but not Lipitor (avorvastatin) or Mevacor/Red Rice Yeast (lovastatin).

Cancer

Several studies have shown statins reduce colon cancer by 50%, prostate cancer by 56%, melanomas and breast cancer by 30%. Statins block the activation of an enzyme complex (proteasome) that breaks down proteins and thus block the growth of cancer cells. Statins may also block cell signals that can trigger continuous cancer cell division.

Glaucoma

Statins help improve the nutrition in the eye, by improved circulation and this then promotes better drainage, which lowers the pressure in the eye. Men that had been on statins for over two years had 40% less glaucoma and had a reduced risk of developing age related macular degeneration (which is the number one cause of blindness in people over age 65 in the U.S.).

Rheumatoid Arthritis

Statins reduce the rheumatoid arthritis flares, C-reactive protein and swollen joints after six months of treatment. Women with rheumatoid arthritis for at least 10 years increased their risk of a heart attack three fold. So even if your cholesterol numbers are OK, you may want to consider a statin.

Diabetes

The American Diabetes Association strongly suggests taking a statin as part of a complete treatment plan. Their guidelines recommend diabetics over the age of 40 and a total cholesterol greater than 135 to take a statin for the anti-inflammatory/cholesterol effect, because diabetics have a higher risk of silent heart attack and stroke.

Non Statin Prescription Cholesterol Reduction

Other ways to lower your cholesterol number besides statins, diet and exercise include prescription: cholestyramine (Questran, Cholestid), niacin (Niaspan), fibrates (Lofibrate, Tricor, Antara, Lopid), omega-3 (Lovaza, formerly known as Omacor), Welchol and Zetia.

Natural Ways To Lower Your Cholesterol

Many people can reduce their cholesterol numbers by cutting out animal products (meat, eggs, milk and cheese), exercising, avoiding products made with coconut and palm oils, eating more fiber (oat bran, oatmeal and raw foods, etc). Few people can lower their “bad” cholesterol number to the recommended level (70 or below), for those at high risk, without a statin drug (Lipitor, Caduet, Vytorin, Crestor, Zocor, Pravastatin, Lescol, Levostatin, Mevacor, etc.). Natural herb remedies for cholesterol do lower the cholesterol number some, but do they change the particle size of the cholesterol components? The literature is not clear on this relatively new issue.

Best Cholesterol Lowering Herbs

Here are some suggestions for reducing your LDL cholesterol via supplements. There are over fifty on the internet. Start with one supplement at a time, adding others one by one, until your desired LDL is met. Unfortunately, long-term use of any herb can be as toxic as prescription meds and just as costly. See your health care professional before starting any herbal program!!!

Artichoke (Cynara scolymus), taken as a tincture with water three times a day, lowers LDL “bad” cholesterol by almost 23%.

Garlic (Allium sativum), two to four raw cloves daily, chopped up and added at the end of cooking or to salads, lowers LDL by 11.4% and increases particle size.

Guggul (Commiphora mukul), one 25mg cap three times a day until cholesterol is normal. Guggul lowers LDL by 12.5%. Not for long term use. All three herbs can be taken together. Take them for at least two weeks to see results.

Tocotrienols, alpha, beta, delta, gamma, are forms of vitamin E. Take 200mg at dinner. Any other vitamin E supplement should be taken in the morning, so that it doesn’t interfere with the tocotrienols. Good sources of vitamin E include all seeds (pumpkin and sunflower) and almonds.

Policosanol/guggulipid. It is a sugarcane extract/herb combination. Take 500 mg with breakfast and dinner.

Policosanol and vitamin E have a blood thinning effect. Don’t use them if you regularly use aspirin, plavix, other non-steroidal anti-inflammatories (NSAIDs), (like aleve, motrin, etc) or warfarin (coumadin).

Inositol hexaniacinate, a timed release niacin that, unlike other niacin supplements, does not cause flushing and is not toxic to the liver. Take 600 mg with each meals (3x/day).

Red Rice Yeast is nature’s “statin” and is levostatin (identical to Mevacor). Take two 600 mg tabs twice a day. You must watch for muscle aching and liver abnormalities just like a prescription statin. The side effects are the same as prescription statins.

Reference:

“Heart Attack,” National Heart, Lung, and Blood Institute

BottomLine, “Your Diet,” and “These Cholesterol Drugs,”August 1, 2004:16 and December 1, 2004:9-11.

Sica, R., “Natural Ways To Lower Your Cholesterol,” Bottom Line, October 15, 2004; 2.

Neustaadter, R, “The Cholesterol Myth,”Letsliveonline.com, Feb 2005:22.

“Your Guide To Great Living,” Letsliveonline.com, Feb 2005:38-40.

Fotuhi, M., “The Memory Cure: How To Protect Your Brain Against Memory Loss And Alzheimer’s Disease,” McGraw Hill, 2002.

Marks, S., “Prostate And Cancer, “ Perseus, 2002.

Abel, R. Jr, “The Eye Care Revolution,” Kensington, 1999.

New England Journal Of Medicine, “Statins And Cancer,” May 26, 2005:online edition.

Wolozin, B, “Superior Results With Longterm Zocor,” BioMed Central (BMC) Medicine. Reported in BottomLine 10/1/07:7.