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The Cholesterol Myth that is Harming Your Health
By
Dr Joseph Mercola
Cholesterol could easily be described as the smoking gun of the
last two decades.
It's been responsible for demonizing entire categories of foods
(like eggs and saturated fats) and blamed for just about every
case of heart disease in the last 20 years.
Yet when I first opened my medical practice in the mid 80s,
cholesterol, and the fear that yours was too high was rarely
talked about.
Somewhere along the way however, cholesterol became a household
word -- something that you must keep as low as possible, or
suffer the consequences.
You are probably aware that there are many myths that portray
fat and cholesterol as one of the worst foods you can consume.
Please understand that these myths are actually harming your
health.
Not only is cholesterol most likely
not going to
destroy your health (as you have been led to believe), but it is
also not the
cause of heart disease.
And for those of you taking cholesterol-lowering drugs, the
information that follows could not have been given to you fast
enough. But before I delve into this life-changing information,
let's get some basics down first.
What is
Cholesterol, and Why Do You Need It?
That's right, you do need
cholesterol.
This soft, waxy substance is found not only in your bloodstream,
but also in every cell in your body, where it helps to produce
cell membranes, hormones, vitamin D and bile acids that help you
to digest fat. Cholesterol also helps in the formation of your
memories and is vital for neurological function.
Your liver makes about 75 percent of your body's cholesterol,
and according to conventional medicine, there are two types:
1.
High-density lipoprotein, or HDL:
This is the "good" cholesterol that helps to keep cholesterol
away from your arteries and remove any excess from arterial
plaque, which may help to prevent heart disease.
2.
Low-density lipoprotein, or LDL:
This "bad" cholesterol circulates in your blood and, according
to conventional thinking, may build up in your arteries, forming
plaque that makes your arteries narrow and less flexible (a
condition called atherosclerosis). If a clot forms in one of
these narrowed arteries leading to your heart or brain, a heart
attack or stroke may result.
Also making up your total cholesterol count are:
·
Triglycerides: Elevated levels of this dangerous fat have been
linked to heart disease and diabetes. Triglyceride levels are
known to rise from eating too many grains and sugars, being
physically inactive, smoking cigarettes, drinking alcohol
excessively and being overweight or obese.
·
Lipoprotein (a), or Lp(a): Lp(a) is a substance that is made up
of an LDL "bad cholesterol" part plus a protein (apoprotein a).
Elevated Lp(a) levels are a very strong risk factor for heart
disease. This has been well established, yet very few physicians
check for it in their patients.
Understand this:
Your Total
Cholesterol Level is NOT a Great Indicator of Your Heart Disease
Risk
Health officials in the United States urge everyone over the age
of 20 to have their cholesterol tested once every five years.
Part of this test is your total cholesterol, or the sum of your
blood's cholesterol content, including HDL, LDLs, and VLDLs..
The American Heart Association recommends that your total
cholesterol is less than 200 mg/dL, but what they do not tell
you is that total cholesterol level is just about worthless in
determining your risk for heart disease, unless it is above 330.
In addition, the AHA updated their guidelines in 2004, lowering
the recommended level of LDL cholesterol from 130 to LDL to less
than 100, or even less than 70 for patients at very high risk.
In order to achieve these outrageous and dangerously low
targets, you typically need to take multiple
cholesterol-lowering drugs. So the guidelines instantly
increased the market for these dangerous drugs. Now, with
testing children's cholesterol levels, they're increasing their
market even more.
I have seen a number of people with total cholesterol levels
over 250 who actually were at low heart disease risk due to
their HDL levels. Conversely, I have seen even more who had
cholesterol levels under 200 that were at a very high risk of
heart disease based on the following additional tests:
·
HDL/Cholesterol ratio
·
Triglyceride/HDL ratios
HDL percentage is a very potent heart disease risk factor. Just
divide your HDL level by your cholesterol. That percentage
should ideally be above 24 percent.
You can also do the same thing with your triglycerides and HDL
ratio.
Keep in mind, however, that these are still simply
guidelines, and
there's a lot more that goes into your risk of heart disease
than any one of these numbers. In fact, it was only after word
got out that total cholesterol is a poor predictor of heart
disease that HDL and LDL cholesterol were brought into the
picture.
They give you a closer idea of what's going on, but they still
do not show you everything.
Cholesterol is
Neither "Good" Nor "Bad"
Now that we've defined good and bad cholesterol, it has to be
said that there is actually only
one type of
cholesterol. Ron Rosedale, MD, who is widely considered to be
one of the leading anti-aging doctor in the United States, does
an excellent job of explaining this concept:
"Notice please that LDL and HDL are lipoproteins -- fats
combined with proteins. There is only one cholesterol. There is
no such thing as "good" or "bad" cholesterol.
Cholesterol is just cholesterol.
It combines with other fats and proteins to be carried through
the bloodstream, since fat and our watery blood do not mix very
well.
Fatty substances therefore must be shuttled to and from our
tissues and cells using proteins. LDL and HDL are forms of
proteins and are far from being just cholesterol.
In fact we now know there are many types of these fat and
protein particles. LDL particles come in many sizes and large
LDL particles are not a problem. Only the so-called small dense
LDL particles can potentially be a problem, because they can
squeeze through the lining of the arteries and if they oxidize,
otherwise known as turning rancid, they can cause damage and
inflammation.
Thus, you might say that there is 'good LDL' and 'bad LDL.'
Also, some HDL particles are better than others. Knowing just
your total cholesterol tells you very little. Even knowing your
LDL and HDL levels will not tell you very much."
Cholesterol is
Your Friend, Not Your Enemy
Before we continue, I really would like you to get your mind
around this concept.
In the United States, the idea that cholesterol is evil is very
much engrained in most people's minds. But this is a very
harmful myth that needs to be put to rest right now.
"First and foremost,"
Dr. Rosedale points out,
"cholesterol is a vital component of every cell membrane on
Earth. In other words, there is no life on Earth that can live
without cholesterol.
That will automatically tell you that, in and of itself, it
cannot be evil. In fact, it is one of our best friends.
We would not be here without it. No wonder lowering cholesterol
too much increases one's risk of dying. Cholesterol is also a
precursor to all of the steroid hormones. You cannot make
estrogen, testosterone, cortisone, and a host of other vital
hormones without cholesterol."
Vitamin D and
Your Cholesterol
You probably are aware of the incredible influence of vitamin D
on your health. If you aren't, or need a refresher.
Vitamin D Dose Recommendations
Age
Dosage
Below 5 years 35 units per pound
per day
Age 5 - 10 years 2500 units
Adults 5000
units
Pregnant Women 5000 units
WARNING:
There is no way to know if the above recommendations are
correct as the ONLY way to know is to test your blood. If you
have a health issue you most likely need 4-5 times the amount
recommended above. Ideally your blood level of 25 OH D should be
60ng/ml.
-----------------------------
What most people do not realize is that the best way to obtain
your vitamin D is from safe exposure to sun on your skin. The
UVB rays in sunlight interact with the cholesterol on your skin
and convert it to vitamin D.
Bottom line?
If your cholesterol level is too low you will not be able to use
the sun to generate sufficient levels of vitamin D.
Additionally, it provides some intuitive feedback that if
cholesterol were so dangerous, why would your body use it as
precursor for vitamin D and virtually all of the steroid
hormones in your body?
Other "evidence" that cholesterol is good for you?
Consider the role of "good" HDL cholesterol. Essentially, HDL
takes cholesterol from your body's tissues and arteries, and
brings it back to your liver, where most of your cholesterol is
produced. If the purpose of this was to eliminate cholesterol
from your body, it would make sense that the cholesterol would
be shuttled back to your kidneys or intestines so your body
could remove it.
Instead, it goes back to your liver.
Why?
Because your liver is going to reuse it.
"It is taking it back to your liver so that your liver can
recycle it; put it back into other particles to be taken to
tissues and cells that need it,"
Dr. Rosedale explains.
"Your body is trying to make and conserve the cholesterol for
the precise reason that it is so important, indeed vital, for
health."
Cholesterol
and Inflammation – What's the Connection?
Inflammation has become a bit of a buzzword in the medical field
because it has been linked to so many different diseases. And
one of those diseases is heart disease … the same heart disease
that cholesterol is often blamed for.
What am I getting at?
Well, first consider the role of inflammation in your body. In
many respects, it's a good thing as it's your body's natural
response to invaders it perceives as threats. If you get a cut
for instance, the process of inflammation is what allows you to
heal.
Specifically during inflammation:
·
Your blood vessels constrict to keep you from bleeding to death
·
Your blood becomes thicker so it can clot
·
Your immune system sends cells and chemicals to fight viruses,
bacteria and other "bad guys" that could infect the area
·
Cells multiply to repair the damage
Ultimately, the cut is healed and a protective scar may form
over the area.
If your arteries are damaged, a very similar process occurs
inside of your body, except that a "scar" in your artery is
known as plaque.
This plaque, along with the thickening of your blood and
constricting of your blood vessels that normally occur during
the inflammatory process, can indeed increase your risk of high
blood pressure and heart attacks.
Notice that cholesterol has yet to even enter the picture.
Cholesterol comes in because, in order to replace your damaged
cells, it is necessary.
Remember that no cell can form without it.
So if you have damaged cells that need to be replaced, your
liver will be notified to make more cholesterol and release it
into your bloodstream. This is a deliberate process that takes
place in order for your body to produce new, healthy cells.
It's also possible, and quite common, for damage to occur in
your body on a regular basis. In this case, you will be in a
dangerous state of chronic inflammation.
The test usually used to determine if you have chronic
inflammation is a C-reactive protein (CRP) blood test. CRP level
is used as a marker of inflammation in your arteries.
Generally speaking:
·
A CRP level under 1 milligrams per liter of blood means you have
a low risk for cardiovascular disease
·
1 to 3 milligrams means your risk is intermediate
·
More than 3 milligrams is high risk
Even conventional medicine is warming up to the idea that
chronic inflammation can trigger heart attacks. But they stop
short of seeing the big picture.
In the eyes of conventional medicine, when they see increased
cholesterol circulating in your bloodstream, they conclude that
it -- not the underlying damage to your arteries -- is the cause
of heart attacks.
Which brings me to my next point.
The Insanity
of Lowering Cholesterol
Sally Fallon, the president of the Weston A. Price Foundation,
and Mary Enig, Ph.D, an expert in lipid biochemistry, have gone
so far as to call high cholesterol "an invented disease, a
'problem' that emerged when health professionals learned how to
measure cholesterol levels in the blood."
And this explanation is spot on.
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.
Conventional medicine misses the boat entirely when they
dangerously recommend that lowering cholesterol with drugs is
the way to reduce your risk of heart attacks, because what is
actually needed is to address whatever is causing your body
damage -- and leading to increased inflammation and then
increased cholesterol.
As Dr. Rosedale so rightly points out:
"If excessive damage is occurring such that it is necessary to
distribute extra cholesterol through the bloodstream, it would
not seem very wise to merely lower the cholesterol and forget
about why it is there in the first place.
It would seem much smarter to reduce the extra need for the
cholesterol -- the excessive damage that is occurring, the
reason for the chronic inflammation."
I'll discuss how to do this later in the report, but first let's
take a look at the dangers of low cholesterol -- and how it came
to be that cholesterol levels needed to be so low in the first
place.
If Your
Cholesterol is Too Low …
All kinds of nasty things can happen to your body. Remember,
every single one of your cells needs cholesterol to thrive --
including those in your brain. Perhaps this is why low
cholesterol wreaks havoc on your psyche.
One large study conducted by Dutch researchers found that men
with chronically low cholesterol levels showed a consistently
higher risk of having depressive symptoms.
This may be because cholesterol affects the metabolism of
serotonin, a substance involved in the regulation of your mood.
On a similar note, Canadian researchers found that those in the
lowest quarter of total cholesterol concentration had more than
six times the risk of committing suicide as did those in the
highest quarter.
Dozens of studies also support a connection between low or
lowered cholesterol levels and violent behavior, through this
same pathway: lowered cholesterol levels may lead to lowered
brain serotonin activity, which may, in turn, lead to increased
violence and aggression.
And one meta-analysis of over 41,000 patient records found that
people who take statin drugs to lower their cholesterol as much
as possible may have a higher risk of cancer,
while other studies have linked low cholesterol
to Parkinson's disease.
What cholesterol level is too low? Brace yourself.
Probably any level much under 150 -- an optimum would be more
like 200.
Now I know what you are thinking: "But my doctor tells me my
cholesterol needs to be
under 200 to be healthy." Well let me enlighten you
about how these cholesterol recommendations came to be. And I
warn you, it is not a pretty story.
This is a significant issue. I have seen large numbers of people
who have their cholesterol lowered below 150, and there is
little question in my mind that it is causing far more harm than
any benefit they are receiving by lowering their cholesterol
this low.
Who Decided
What Cholesterol Levels are Healthy or Harmful?
In 2004, the U.S. government's National Cholesterol Education
Program panel advised those at risk for heart disease to attempt
to reduce their LDL cholesterol to specific, very low, levels.
Before 2004, a 130-milligram LDL cholesterol level was
considered healthy. The updated guidelines, however, recommended
levels of less than 100, or even less than 70 for patients at
very high risk.
Keep in mind that these extremely low targets often require
multiple cholesterol-lowering drugs to achieve.
Fortunately, in 2006 a review in the
Annals of Internal Medicine
found that there is insufficient evidence to support the
target numbers outlined by the panel. The authors of the review
were unable to find research providing evidence that achieving a
specific LDL target level was important in and of itself, and
found that the studies attempting to do so suffered from major
flaws.
Several of the scientists who helped develop the guidelines even
admitted that the scientific evidence supporting the
less-than-70 recommendation was not very strong.
So how did these excessively low cholesterol guidelines come
about?
Eight of the nine doctors
on the panel that developed the new cholesterol guidelines had
been making money from the drug companies that manufacture
statin cholesterol-lowering drugs.
The same drugs that the new guidelines suddenly created a huge
new market for in the United States.
Coincidence? I think not.
Now, despite the finding that there is absolutely NO evidence to
show that lowering your LDL cholesterol to 100 or below is good
for you, what do you think the American Heart Association STILL
recommends?
Lowering your LDL cholesterol levels to less than 100.
And to make matters worse, the standard recommendation to get to
that level almost always includes one or more
cholesterol-lowering drugs.
The Dangers of
Cholesterol-Lowering Medications
If you are concerned about your cholesterol levels, taking a
drug should be your absolute last resort. And when I say last
resort, I'm saying the odds are very high, greater than 100 to
1, that you don't need drugs to lower your cholesterol.
To put it another way, among the more than 20,000 patients who
have come to my clinic, only four or five of them truly needed
these drugs, as they had genetic challenges of familial
hypercholesterolemia that required it..
Contrast this to what is going on in the general population.
According to data from Medco Health Solutions Inc., more than
half of insured Americans are taking drugs for chronic health
conditions. And cholesterol-lowering medications are the second
most common variety among this group, with nearly 15 percent of
chronic medication users taking them (high blood pressure
medications -- another vastly over-prescribed category -- were
first).
Disturbingly, as written in
BusinessWeek early
in 2008, "Some researchers have even suggested -- half-jokingly
-- that the medications should be put in the water supply."
Count yourself lucky that you probably do NOT need to take
cholesterol-lowering medications, because these are some nasty
little pills.
Statin drugs work by inhibiting an enzyme in your liver that's
needed to manufacture cholesterol. What is so concerning about
this is that when you go tinkering around with the delicate
workings of the human body, you risk throwing everything off
kilter.
Case in point, "statin drugs inhibit not just the production of
cholesterol, but a whole family of intermediary substances, many
if not all of which have important biochemical functions in
their own right," say Enig and Fallon.3
For starters, statin drugs deplete your body of Coenzyme Q10
(CoQ10), which is beneficial to heart health and muscle
function. Because doctors rarely inform people of this risk and
advise them to take a CoQ10 supplement, this depletion leads to
fatigue, muscle weakness, soreness, and eventually heart
failure.
Muscle pain and weakness, a condition called rhabdomyolysis, is
actually the most common side effect of statin drugs, which is
thought to occur because statins activate the atrogin-1 gene,
which plays a key role in muscle atrophy.
By the way, muscle pain and weakness may be an indication that
your body tissues are actually breaking down -- a condition that
can cause kidney damage.
Statin drugs have also been linked to:
·
An increased risk of polyneuropathy (nerve damage that causes
pain in the hands and feet and trouble walking)
·
Dizziness
·
Cognitive impairment, including memory loss
·
A potential increased risk of cancer
·
Decreased function of the immune system
·
Depression
·
Liver problems, including a potential increase in liver enzymes
(so people taking statins must be regularly monitored for normal
liver function)
And recently a possible association was found between statins
and an increased risk of Lou Gehrig's disease.
Other cholesterol-lowering drugs besides statins also have side
effects, most notably muscle pain and weakness.
Are Cholesterol Drugs
Even Effective?
With all of these risks, the drugs had better be effective,
right? Well, even this is questionable. At least, it depends on
how you look at it.
Most cholesterol lowering drugs can effectively
lower your cholesterol numbers,
but are they actually making you any healthier, and do they help
prevent heart disease?
Have you ever heard of the statistic known as NNT, or
number needed to treat?
I didn't think so. In fact, most doctors haven't either. And
herein lies the problem.
NNT answers the question: How many people have to take a
particular drug to avoid one incidence of a medical issue (such
as a heart attack)?
For example, if a drug had an NNT of 50 for heart attacks, then
50 people have to take the drug in order to prevent one heart
attack.
Easy enough, right?
Well, drug companies would rather that you not focus on NNT,
because when you do, you get an entirely different picture of
their "miracle" drugs. Take, for instance, Pfizer's Lipitor,
which is the most prescribed cholesterol medication in the world
and has been prescribed to more than 26 million Americans.
According to Lipitor's own Web site, Lipitor is clinically
proven to lower bad cholesterol 39-60 percent, depending on the
dose. Sounds fairly effective, right?
Well, BusinessWeek
actually did an excellent story on this very topic earlier this
year,
and they found the REAL numbers right on
Pfizer's own newspaper ad for Lipitor.
Upon first glance, the ad boasts that Lipitor reduces heart
attacks by 36 percent. But there is an asterisk. And when you
follow the asterisk, you find the following in much smaller
type:
"That means in a large clinical study, 3% of patients taking a
sugar pill or placebo had a heart attack compared to 2% of
patients taking Lipitor."
What this means is that for every 100 people who took the drug
over 3.3 years, three people on placebos, and two people on
Lipitor, had heart attacks. That means that taking Lipitor
resulted in just one fewer heart attack per 100 people.
The NNT, in this case, is 100. One hundred people have to take
Lipitor for more than three years to prevent one heart attack.
And the other 99 people, well, they've just dished out hundreds
of dollars and increased their risk of a multitude of side
effects for nothing.
So you can see how the true effectiveness of cholesterol drugs
like Lipitor is hidden behind a smokescreen.
Or in some cases, not hidden at all.
Zetia and Vytorin: No
Medical Benefits
Early in 2008, it came out that Zetia, which works by inhibiting
absorption of cholesterol from your intestines, and Vytorin,
which is a combination of Zetia and Zocor (a statin drug), do
not work.
This was discovered AFTER the drugs acquired close to 20 percent
of the U.S. market for cholesterol-lowering drugs. And also
after close to 1 million prescriptions for the drugs were being
written each week in the United States, bringing in close to $4
billion in 2007.
It was only after the results of a trial by the drugs' makers,
Merck and Schering-Plough, were released that this was found
out. Never mind that the trial was completed in April 2006, and
results were not released until January 2008.
And it's no wonder the drug companies wanted to hide these
results.
While Zetia does lower cholesterol by 15 percent to 20 percent,
trials did not show that it reduces heart attacks or strokes, or
that it reduces plaques in arteries that can lead to heart
problems.
The trial by the drugs' makers, which studied whether Zetia
could reduce the growth of plaques, found that
plaques grew nearly twice as
fast in patients taking Zetia along with Zocor (Vytorin)
than in those taking Zocor alone.
Of course, the answer is not to turn back to typical statin
drugs to lower your cholesterol, as many of the so-called
experts would have you believe.
You see, statins are thought to have a beneficial effect on
inflammation in your body, thereby lowering your risk of heart
attack and stroke.
But you can lower
inflammation in your body naturally, without risking any of
the numerous side effects of statin drugs. This should also
explain why my guidelines for lowering cholesterol are identical
to those to lower inflammation.
How to Lower
Inflammation, and Thereby Your Risk of Heart Disease, Naturally
There is a major misconception that you must avoid foods like
eggs and saturated fat to protect your heart. While it's true
that fats from animal sources contain cholesterol, I've
explained earlier in this article why this should not scare you
-- but I'll explain even further here.
This misguided principle is based on the "lipid hypothesis" --
developed in the 1950s by nutrition pioneer Ancel Keys -- that
linked dietary fat to coronary heart disease.
The nutrition community of that time completely accepted the
hypothesis, and encouraged the public to cut out butter, red
meat, animal fats, eggs, dairy and other "artery clogging" fats
from their diets -- a radical change at that time.
What you may not know is that when Keys published his analysis
that claimed to prove the link between dietary fats and coronary
heart disease, he selectively analyzed information from only six
countries to prove his correlation, rather than comparing all
the data available at the time -- from 22 countries.
As a result of this "cherry-picked" data, government health
organizations began bombarding the public with advice that has
contributed to the diabetes and obesity epidemics going on
today: eat a low-fat diet.
Not surprisingly, numerous studies have actually shown that
Keys' theory was wrong and saturated fats are healthy, including
these studies from Fallon and Enig's classic article
The Skinny on Fats:
·
A survey of South Carolina adults found no correlation of blood
cholesterol levels with "bad" dietary habits, such as use of red
meat, animal fats, fried foods, butter, eggs, whole milk, bacon,
sausage and cheese.
·
A Medical Research Council survey showed that men eating butter
ran half the risk of developing heart disease as those using
margarine.
Of course, as Americans cut out nutritious animal fats from
their diets, they were left hungry. So they began eating more
processed grains, more vegetable oils, and more high-fructose
corn syrup, all of which are nutritional disasters.
It is this latter type of diet that will eventually lead to
increased inflammation, and therefore cholesterol, in your body.
So don't let anyone scare you away from saturated fat anymore.
Chronic inflammation is actually caused by a laundry list of
items such as:
·
Oxidized cholesterol (cholesterol that has
gone rancid, such
as that from overcooked, scrambled eggs)
·
Eating lots of sugar and grains
·
Eating foods cooked at high temperatures
·
Eating trans fats
·
A sedentary lifestyle
·
Smoking
·
Emotional stress
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