January 30, 2017

Cholesterol Part I

Is cholesterol the problem? Or just a response to the bodies inflammation and infectious issues? Why do we need cholesterol? Is the cholesterol you eat the issue or the type that your body makes?

For years we have been told that cholesterol is the root cause of the heart disease known as coronary artery disease and that reducing it will stop the problem. The truth of the matter is far from that simple as I will lay out in the coming pieces.

As you well know, this is an issue that is close to my heart. I have always wanted to know the true root cause of these issues. The first keys to answering this question come from what cholesterol is and the studies that discuss the function of cholesterol and lipids in the human body.

Cholesterol is a critical piece of the following vital cellular structures: steroid hormones, all cell membranes, bile acids and vitamin D. We obtain cholesterol when we consume animal products. Plants do not have cholesterol. They have a special sterol called a phytosterol. Cholesterol is produced in all mammalian tissues but primarily in the liver in response to low cholesterol levels in the bloodstream. Cholesterol is transported around the body in lipoproteins like the LDL or low density lipoprotein. I like to think of these proteins as cholesterol carrying cars. Current dogma states that the number of cars or the LDL-P (particle number) appears to be a key measurement in heart disease risk.

The LDL protein is called the bad lipoprotein/cholesterol. I find it hard to believe that anything in the body is inherently bad or good! No way does God put a bad thing in our body. The volume of a particle could convert it to an unbalanced state which makes it unhealthy. That I believe. I think that this is truth.

Let's try and prove it.

The hypothesis: cholesterol and lipoproteins like LDL are inherently good and necessary unless they become unbalanced either through genetics or lifestyle choices.

For context reread this earlier piece on heart disease.

The first study was done in 1998 by Dr. C. Iribarren from Kaiser Permanente and was published in the Journal Epidemiology and Infection. They found that there was an inverse relationship between total cholesterol levels and infections that required hospitalization or were acquired in the hospital. In other words, if your cholesterol level gets too low, (current American Academy of Cardiology, AAC, recommendations), you can suffer more disease of the infectious type. Many cardiologists are recommending that an LDL cholesterol level should stay less than 70.

"It is true that high total-C is a risk factor for coronary heart disease, but mainly in young and middle-aged men. If high total-C or LDL-C were the most important cause of cardiovascular disease, it should be a risk factor in both sexes, in all populations, and in all age groups. But in many populations, including women, Canadian and Russian men, Maoris, patients with diabetes, and patients with the nephrotic syndrome; the association between t-C and mortality is absent or inverse; or increasing t-C is associated with low coronary and total mortality."(6)

Let us say for arguments sake that the above is true. What percent of heart attack victims have abnormal cholesterol levels according to the American Academy of Cardiology at the time of diagnosis? The answer is a shocking 25 - 50 %only!!!! Why the need to drive down cholesterol at all? This is based on a few studies that show improved outcomes in a select group of patients that have had a previous heart attack and other risk factors.

Let's go back to why these particles exist in the first place.

This is the key to unraveling this story: It turns out that the carrier lipoproteins like LDL and HDL cholesterol are an ancient part of our innate immune system that have an important function in fighting infection. We have always used these lipoprotein cars to clear infectious material before they can do damage. The evidence to follow will show how the Kaiser Permanente study makes sense.

This article from England has a nice review of the available literature at the time of publishing regarding infections. (6)

To be continued:

Staying alive despite my genetic risks,

Dr. M

(1) https://www.ncbi.nlm.nih.gov/books/NBK326741/
(2) https://www.ncbi.nlm.nih.gov/pubmed/12381342
(3) https://academic.oup.com/qjmed/article/96/12/927/1533176/High-cholesterol-may-protect-against-infections
(4) http://newsroom.ucla.edu/releases/majority-of-hospitalized-heart-75668
(5) http://www.onlinejacc.org/content/63/25_Part_B/2889
(6) https://academic.oup.com/qjmed/article/96/12/927/1533176/High-cholesterol-may-protect-against-infections
(7) http://www.salisburypediatrics.com/patient-education/dr-magryta-s-newsletter/176-cardiometabolic-disease
(8) http://www.salisburypediatrics.com/patient-education/dr-magryta-s-newsletter/150-literature-review