Cholesterol Mythology

Did you know that there is a substance so necessary for our lives, we would last mere minutes without it? On the other hand, it can degrade our tissues quickly without multiple biologic systems of regulation and control in place. That paradox is essential oxygen.

Cholesterol is less lethal than oxygen but we have been inculcated that it can be a serious threat to our health. It is funny how vigilant we have been persuaded to be about the body. Let’s put things into perspective.

Bad Cholesterol

It is like a bad work of fiction. Enter the villain cholesterol . . . and to the rescue . . . a restricted low fat diet or the super heroic statin drugs. This story has been twisted so that the reference ranges for the standard blood tests regarding basic cholesterol testing are based on official ideals not mass-sampled statistics like all other tests.good-bad hdldl

LabCorp references

Low

High

Units

Total Cholesterol

100

199

mg/dL

LDL

0

99

mg/dL

HDL

> 39

mg/dL

Triglycerides

0

149

mg/dL

VLDL

5

40

mg/dL

Notice the nice rounded numbers. Total cholesterol below 100 is too low and 200 or more is too high. LDL above 100 is too high. HDL should be at least 40 and cannot be too high! Triglycerides are also rounded so that 150 is outside of the reference range but 148 is ok. Something is wrong with this picture.

LDL is said by the medical and media ‘echo chamber’ to be the bad cholesterol and HDL is said to be the good cholesterol. The fact is that neither one is cholesterol. LDL is an abbreviation for low density lipoprotein. HDL stands for high density lipoprotein. VLDL is for very low density. Lipoproteins are vessels or ‘boats’ that move cholesterol and triglycerides through the bloodstream.

Confused? Let’s start from the beginning. What is cholesterol and what is it good for?

Not unlike oxygen but arguably more complex, cholesterol is a molecule that is essential for life. It is a component of all animal cell membranes and is necessary for them to function properly. It is the parent molecule used to make necessary steroidal hormones like pregnenolone, progesterone, cortisol, DHEA, estrogen and testosterone. Cholesterol is also the precursor to Vitamin D that is created when sunlight (UVB) hits your skin. Bile salts, used to emulsify fats in the intestines, are made from cholesterol and other components.

Furthermore, most cells in the body can and do make cholesterol. It is used in cell signaling and is a part of the electrically insulative layer called myelin that wraps around nerve axons.

Working Hardcholesterol

From Dr. Peter Attia we learn:

Of this “made” or “synthesized” cholesterol, our liver synthesizes about 20% of it and the remaining 80% is synthesized by other cells in our bodies.  The synthesis of cholesterol is a complex four-step process (with 37 individual steps) . . . but I want to point out how tightly regulated this process is, with multiple feedback loops.  In other words, the body works very hard (and very “smart”) to ensure cellular cholesterol levels are within a pretty narrow band (the overall process is called cholesterol homeostasis).

The relevant point is that the body goes to great lengths to make cholesterol and to manage its quantity and use. It adjusts to whatever cholesterol is actually absorbed from the diet which, by the way, is not much. Does it sound like cholesterol is a bull in a china shop ready to wreck havoc on arteries?

As you can see cholesterol is good and necessary stuff. So what’s the problem? Unlike the picture in many people’s minds, cholesterol does not deposit itself on the inside of your arteries like the grease that coats the sewer pipes from a fast-food restaurant. So why is it bad sometimes?

Remember those lipoproteins such as LDL and HDL? This is how cholesterol and triglycerides (fats) are moved around in the bloodstream. Why? Blood is basically water with some minerals, proteins and cells suspended in it. Lipoproteins literally create a spherical ball that surrounds and carries many cholesterol and fat molecules through the blood like a cargo container. The higher the density the more cholesterol it carries but the less fat it carries. Also higher density particles are significantly smaller in size.

I would like to say it is that simple but it is not. There is no bad and good regarding these particles. They all have a purpose and a function. The biggest problem is that certain types of LDL (probably oxidized) particles can sometimes penetrate the endothelial cells (inside surface layer) of arteries and embed themselves with their cholesterol into the arterial tissue. This is dysfunctional and leads to an inflammatory cascade that involves the immune system. If the arterial wall swells, it reduces the flow of blood. If this festering area ruptures all sorts of garbage enters the bloodstream and can block arteries in the brain and other organs.

Measure Me

First, what is really measured by blood testing?

The most common and inexpensive cholesterol testing actually measures:

  1. Total cholesterol in all of the lipoproteins [TC]
  2. Cholesterol in HDL particles only [HDL-C]
  3. Total triglycerides [TG]

Using various assumptions the following values are calculated (not measured):

  1. VLDL cholesterol = [TG/5]
  2. LDL cholesterol  = [TCHDL-CTG/5]

apo-bVAP testing is sometimes used as an additional measure of cholesterol status, however, VAP tests do not report the number of LDL or HDL particles just the size of those particles. The curious thing is that the number of particles is the only testing that has been correlated with cardiovascular disease. This is done using NMR spectroscopy. Of course all this extra testing is at a substantial cost compared to the dirt cheap common tests.

Again quoting Dr. Attia:

If you were only “allow” to know one metric to understand your risk of heart disease it would be the number of apoB particles (90-95% of which are LDLs) in your plasma.  In practicality, there are two ways to do this:

  1. Directly measure (i.e., not estimate) the concentration of apoB in your plasma (several technologies and companies offer such an assay). Recall, there is one apoB molecule per particle;
  2. Directly measure the number of LDL particles in your plasma using NMR technology.

If this number is high, you are at risk of atherosclerosis.  Everything else is secondary.

Does having lots of HDL particles help?  Probably, especially if they are “functional” at carrying out reverse cholesterol transport, but it’s not clear if it matters when LDL particle count is low. In fact, while many drugs are known to increase the cholesterol content of HDL particles (i.e., HDL-C), not one to date has ever shown a benefit from doing so.  Does having normal serum triglyceride levels matter? Probably, with “normal” being defined as < 70-100 mg/dL, though it’s not entirely clear this is an independent predictor of low risk. Does having a low level of LDL-C matter?  Not if LDL-P (or apoB) are high, or better said, not when the two markers are discordant. [LDL-P is the particle count ~ John]

So basically nobody gets useful testing done to measure cholesterol. The reference ranges of blood lipids are fixed so that many older adults are outside of ‘normal’. This is why statin drugs are commonly prescribed to those that do not fit the current standard of medical ‘normalcy’. In fact, statins have only been shown to offer only a very slight positive effect when they are given to someone that has already had an ‘event’ – heart attack or stroke – and have not been shown to be beneficial as in living longer. As a matter of fact, statins and/or a low-fat diet can be very problematic for some people.

Riddle Me This

So if cholesterol is necessary and good, what is the source of the problem that leads to heart attacks and stoke? The clue is found in the use of the C-reactive protein (CRP) blood test. This measures a protein that is indicative of systemic (body-wide) inflammation. Many cardiologists use this as a preferred predictor of risk. If lipoproteins are subjected to inflammatory bio-chemicals and excessive oxidation then LDL is altered and becomes a wildcard for the body. It is that simple for most people.

There are certain drugs and the vitamin niacin that will raise HDL but forcing the HDL to be at a higher level does not necessary change inflammation or nullifies stress factors that ‘light the fuse’ of the LDL bomb. HDL will naturally become higher when inflammation is lessened and saturated fats are included in the diet.

Lifestyle and diet are key to reducing inflammation. If you keep hitting your finger with a hammer it is not going to heal. If you keep eating inappropriate foods and stressing yourself through poor daily habits, over-reactive emotions, exposure to bright light at night, constant exposure to EMF fields, not drinking enough quality water, etc. you will not repair and heal at a cellular level as you should every night when you are asleep. As tissues and organs decline in function, we get older physiologically until a serious crisis strikes.

side3

The CARTOON version of what happens in your arteries!

Lots of people get killed by cars each year. Do we blame the cars or the drivers? Both are involved. Cars can fail in some mechanical way. That is not a common cause of accidents. Usually it is the driver or drivers that are at fault. It is funny how we call them auto accidents. What we blame for a problem seems to reveal our bias. Cholesterol happens to be more convenient than looking at our behavior (Sugar Linked To $1 Trillion In U.S. Healthcare Spending – Forbes). You do have a choice.

YouTube video:  AHS12 Peter Attia, MD — The Straight Dope on Cholesterol

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