Welcome back to part II of our Fat Saga where we reveal Fat Offender #2: Cholesterol.
Cholesterol is the medical world's big, bad boogeyman. The very word induces an image of a shadowy killer lurking at the door. Is he there? Will he strike? It's enough to keep people up at night. Perhaps for good reason... perhaps not.
So today we're going to whip out our brightest flashlight and do some exposing. Is cholesterol the criminal we think he is? Is he to be feared? Let's dive in.
As always, we begin with the basics.
Because of its poor reputation, you may find it surprising that cholesterol has many vital roles in the body. At its most basic level, this substance (which actually is not a fat at all) is primarily manufactured by your liver, and is a major component of the human body machine. In fact, you can't even live without it. Here are some of its award-winning accomplishments.
Cholesterol provides the structural protective barrier for every cell in your body. It is used in the making of important hormones, in optimal brain function, in the creation of bile acids to help you digest food, and the transport of critical fat-soluble vitamins, to name a few. It is also a key player in our immune system's response to danger and injury, and the repairing of damaged cells. (Remember that one, we're going to come back to it.)
Pretty crucial, eh? Especially if you'd like to survive this life. So why the bad rap?
In the past few articles, I've covered some of the history behind the demonization of fat in general. Likewise, the boogeyman view of cholesterol really comes from a long chain of events in our history's journey of learning about the human body.
Once upon a time...
...the medical community was utterly convinced that cholesterol was the driving force behind heart disease (and many doctors still believe that today). This theory didn't just come out of thin air. Upon inspection, cholesterol was found heavily at the sites of blockages in patients who had died of heart attacks. The logical conclusion at the time was that cholesterol was the culprit.
We've all heard the analogy of our arteries being like pipes under a sink. When you pour fat down the drain, the sludge gets stuck along the walls of the pipe and eventually causes severe buildup and blockage to occur. So it was with your body's arteries, and the message was clear: Eat less saturated fat and cholesterol or eventually your arteries will clog, proper blood flow will be halted, and you'll die.
One of the first things researchers were surprised to learn, is that true to the body's way, cholesterol is another one of the many things tightly regulated within. Limiting dietary cholesterol wasn't working. This is because around 75% of the cholesterol we have at any given moment is created by the liver or even synthesized by the cells themselves. Cholesterol is so important, that the body doesn't leave it up to you to get enough. Only 25% is obtained through diet. What researchers found was that if you eat a lot of dietary cholesterol (found only in animal products such as meat, eggs, fish and dairy), your body will simply make less. If you eat less dietary cholesterol, your body will simply make more. In this way, the body regulates and uses only as much as is needed at any given time.
To further complicate matters, it came to light that there are multiple components of total cholesterol and its interaction with our cells, beginning with HDL and LDL. I'm sure you have heard the "good" cholesterol (HDL) versus "bad" cholesterol (LDL) banter within the health space or from your doctor. As research continued, all cholesterol was no longer deemed hazardous. HDL was pardoned, and we turned a critical eye to LDL as the driving force of heart disease. This concept is still being shouted from the rooftops.
But fast forward even more and we see that researchers are continuously baffled by "bad" LDL's behavior... sometimes high levels of LDL are associated with bad health and other times high levels of LDL are associated with good health. Left scratching their heads, scientists had to look even deeper, and when they did, even more players were found in the game--VLDL, sdLDL, IDL, Trigycerides, Apolipoprotiens and more. Really, it's enough to make your head spin.
So who is to blame for cardiovascular disease? What is actually going on?
Let's pause here for a second. Talk about heads spinning... It feels like we're stuck inside the Globe of Death. All the noise and all the opinions on how and when your most likely to die circling above you a ferocious speeds...
Dude. It's a wonder anyone has survived thus far without intimate knowledge of which particular fats and kinds of cholesterol particles are going to kill them. Can you even believe you're here right now? That you've come this far? Shocking.
Turns out, this amazing energy system surrounding cholesterol is much more dynamic than we ever knew, and our arteries don't resemble cold, steel pipes in the slightest.
The old, simplistic, static viewpoint just won't do.
I'll spare you the details of each player mentioned above and their roles in the body for now, but suffice it to say each one has an important function. Regardless, many cardiologists still believe the diet-heart hypothesis introduced by Ancel Keys in the mid-19th century --> that dietary fat, particularly saturated fat and cholesterol, causes heart disease. Begrudgingly and slightly adjusted to fit more modern research, this belief maintains that high levels of "bad" cholesterol, aka LDL, are the driving force behind heart disease. Which leads to the question, how can we lower it and thereby decrease one's risk of heart attack? (Spoiler alert: there is no shortage of Statin drugs that can do just that.)
In line with that particular theory, it's a good question. But here's a little insight, and then a better question.
I want you to try and stop thinking of cholesterol in good or bad terms. When we label natural foods or organic bodily functions as good or bad, we've immediately decreased our likelihood of discovering the truth.
LDL doesn't just magically appear on the stage as the ultimate antagonist in a plot against the health of your heart. It has a whole host of important jobs and when it has completed its work, it is reabsorbed by the liver. For example, you can think of LDL as a bus that drives various nutrients around the body to each cell as needed. In another sense, you can think of LDL as a bodyguard--a protective player in our immune system as it is able to neutralize disease-causing pathogens. And those are only two of its many functions.
How then can LDL, responsible for so much positive housekeeping in the body, be the driving force behind heart disease? That doesn't make any sense.
So when you get your blood drawn and your LDL cholesterol numbers come back elevated for what we have deemed "normal", the best question to ask is why. The answer may reveal a cause for concern, and it may not. Why would you have elevated levels of LDL or total cholesterol? Here are some ideas worth considering...
Could it be you have a deeper issue going on that your cholesterol is trying to mitigate? A fire somewhere that it's trying to put out? After all, why else would the demand for more LDL go up? Cells asking for more help, or the immune system's call to evaluate danger and aid in healing... Another way to think of cholesterol is as a first responder--the firemen tending to some fire or accident within the body. Do we blame the first responders for the accident because they are at the scene when we arrive? No. We have to do a little investigating to find out what happened and why they are there to begin with.
In other cases, the system itself has gone haywire. Corruption within, if you will. Just as a crooked cop can cause a lot of harm, sometimes LDL particles become damaged and oxidized during circulation and cause their own wake of destruction. This can include taking part in arterial damage. (*Note: one of the primary drivers of damaged LDL particles is insulin resistance, which I discuss here.)
"It's not the cholesterol that is the problem but rather the system that manages it in the body, which can become dysfunctional. This is why cholesterol measures can correlate loosely with disease." -Ivor Cummings & Jeff Gerber-
The distinction is important as each individual may have a different root cause needing to be addressed. The point is that labeling aspects of cholesterol as good or bad is not productive. Blaming dietary cholesterol for heart disease is to gravely misunderstand what is happening within. And most importantly, measurements of LDL given to you by your doctor are very poor indicators of your coronary health.
Many healthy, fit people have passed their blood tests with flying colors only to drop dead of a heart attack unexpectedly. Others fail their blood tests, go to have stents put into their arteries, and come to find out there was no blockage whatsoever. It's been a shit show of guessing from the very beginning.
What's worse, if you guess wrong and you take drugs that force your LDL cholesterol down, you may not have enough of the basic building blocks needed to operate properly. Your brain function could take a hit. Your sex hormones could take a hit. Your immune system could take a hit. In this case, if you prevent a heart attack but cause another major health problem in return, was it really worth it? At the first sign of distress, we need to be asking better questions.
What is a more efficient way to approach cholesterol and heart health? Glad you asked.
Current research suggests you may be able to glean some accurate indication of risk when taking your eyes off LDL numbers and putting them onto HDL and triglyceride numbers. More specifically, the ratio of your total cholesterol to HDL, and the ratio of triglycerides to HDL. Your doctor can tell you what numbers he thinks are optimal. Even so, I don't think we should put all our eggs in this basket. While cholesterol numbers may indeed indicate a problem, cholesterol itself is not the problem. We have to dig deeper.
Beyond your routine blood draw, there is a very specific action you can take to get to the bottom of it all. It is the most reliable evaluator of true heart disease risk that we have to date: a Coronary Artery Calcium (CAC) scan. It's a simple CT scan of the heart showing exactly how much calcium buildup you have in your arteries. It is a summary of your inflammatory history. While it is not standard procedure, it is widely available, inexpensive, and eliminates all the guesswork. For more information on this scan and it's scoring methods, I highly recommend looking into the work of Ivor Cummins.
The bottom line is this: Cholesterol is not the big, bad boogeyman.
Let us learn from our past mistakes and not make conclusive statements based on so many assumptions. After all, what will we learn tomorrow? It's important to zoom out and take a look at all the factors involved. What role does your genetic predisposition play? Do you smoke? Do you get enough good quality sleep on the regular? How much stress do you have in your life? Are you experiencing any nutritional deficiencies, particularly in fat-soluble vitamins A, E, D & K? Do you absorb a lot of toxic input from your diet or your environment?
The book Eat Rich, Live Long by Ivor Cummins and Jeffry Gerber, MD offers enlightening information on how lifestyle impacts cholesterol and overall heart health. Get yourself a copy.
Oh, and always come back to that better question... Why. Asking it gets you closer and closer to the solid foundations of health. This is root-cause thinking... something we're not big fans of, are we? Root-cause thinking takes work. It takes critical thought, trial and error, peeling off layers of preconceived ideas, humility, intentionality... Things we don't want to spend our time on. Instead we'd rather have quick answers that make it so much easier to lay blame and then wash our hands of it so we can move on to the next thing. But the results of this carelessness can easily set us on a darkened path toward a complicated and slow death. So don't fall victim to the "easy" way out. If you do, you'll find it's not so easy after all.
Stick around, my friends. We're about to wrap up this Fat Trilogy by taking a closer look at PUFA's (poly-unsaturated fats) and their very real affects on our bodies. Are they the innocents of the fat world? Or the guilty?
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