Friday, October 2, 2009

Express Course; Cholesterol

Translated and slightly modified by Helena Mathis from: Snabbkurs i kolesterol (blodfetter) by Andreas Eenfeldt, M.D.

The underlying reason for the low fat diet ideology is based on the theory that fat increases the cholesterol and high cholesterol generates heart disease.

But eating natural fat has never been proven to increase the risk of heart disease. In fact, many late studies, done in the 21st century, have shown that there is no health gain in lowering the intake of natural fats. On the contrary, it might even be dangerous to do so.

How dangerous is cholesterol?
Cholesterol as a key risk factor for heart disease has been heavily questioned by many, especially because cholesterol is a substance that we cannot survive without. Cholesterol is needed to protect our cells and to sustain normal hormone levels. And many of the people that suffer heart disease do not have high cholesterol levels.

A more modern view
It has been proven that the total number of the cholesterol is not a good reference to show a correlation between cholesterol and heart disease (with the exception of genetic deviation). There is a much more reliable risk analysis when looking at the different types of cholesterols.

Most of our cholesterol travels in our blood in small packages called lipoproteins with the largest being VLDL or Triglycerides > LDL > HDL; which is what most cholesterol tests will give you along with the total amount.

Triglycerides and LDL
Triglycerides and LDL is what many refers to as the bad cholesterol but there are very few that know it is crucial for keeping us alive. The only danger is if you get too much of some of them.

The fat we eat gets transported to the lever where it then gets packed into VLDL (triglycerides). These get released into the blood and bonds with cells in the body to supply energy or as cell building blocks. During this process the VLDL will shrink into a smaller size and will soon become LDL. Unless the LDL gets completely absorbed by a cell it will continue to decrease in size and can later be referred to as small-LDL. The smaller it gets the easier it will oxidize and get stuck on a damaged part in the endothelium (the blood vessel lining). And cholesterol can on this path contribute to heart diseases when added to other reactions in the body.

What is important and interesting to mention is that fat we eat is not the major reason we develop LDL cholesterol, but large amounts of fast carbohydrates like sugar and refined wheat is.

HDL
HDL is referred to as the good cholesterol and works by picking up the surplus of cholesterol in the blood and transports it back to the lever. A high level of HDL decreases statistically the risk of heart disease due to its capacity to remove small LDL that has gotten stuck in the endothelium.

The food that increases the HDL is saturated fats and fast acting carbohydrates decreases HDL.

Why have we been told a lie?
If carbohydrates gives you unhealthy types of cholesterol and fat gives you healthy cholesterol – why have we, for the past decades, been told by official authorities the complete opposite?! There are many reasons to this but the biggest basis is probably because focus was put on LDL very early as the biggest risk factor for heart disease.

They knew that saturated fat seemed to rise LDL cholesterol short term. Later there was medication in form of statins that showed to decrease both LDL cholesterol and the risk of heart disease.

All of a sudden it became very profitable to recommend people to control their cholesterol levels with statins. Pfizer’s Lipitor sold for 12.6 billion dollars in the year 2006; making it the world’s most profitable medicine. And why would they want to change this reliable cash cow?

The question is if this is not the biggest reason to why we are focusing on lowering our LDL levels as a main goal to stay away from heart disease. As new research shows, LDL comes in different sizes. The larger don’t seem to be that dangerous from what we know but are the easiest to detect because they are larger. De larger LDL particles such as VLDL increases when eating saturated fats, but the smaller more dangerous LDL particles increases when eating carbohydrates.

It is however much more profitable to sell statins to all people that have raised LDL levels than to those who just have raised small-LDL levels; as that number is probably significantly lower.

It is not only ironic but rather dangerous to accuse dietary fat to be the biggest reason for increased cholesterol levels and danger of getting heart disease. Dietary fat increases the larger LDL particles and the HDL particles – those particles that are good and necessary for us! This off course raises the total number of cholesterol showing again that the total number is far from reliable to use as a risk analysis.

If lowering dietary fats according to many heart healthy recommendations a normal person would increase their intake in fast acting carbohydrates to feel full. This on the other hand raises the small LDL particles that are hard to detect on a regular LDL test. And the carbohydrates also lower the protecting HDL particles. In the end this will most likely result in a lower total cholesterol level but with a VLDL, LDL, small LDL, and HDL quota that increases the risk of heart disease!

To eat less fat and more carbohydrates will lead to lower HDL levels and higher small LDL levels. High levels of triglycerides may be a sign of high levels of small LDL.

Prestige and Money
Many cholesterol researchers know all this very well. This is not new controversial news to them. Yet we don’t get to hear about it, why? One reason is that this goes against the older (and current) heart healthy low fat recommendations and it is hard for authorities to admit that they have been wrong all of these years. Unfortunately the human race pays for them to keep this secret with their lives.

Another reason is that the pharmaceutical companies don’t want to give up their market share of this huge cash cow and food producers don’t want to loose money on their very profitable low fat products. The result is that these new studies become disliked and companies that make profit of the old habits will oppose to result like these. And once again we are paying for it with our lives!

What about cholesterol in food?
Many times you hear that you should avoid eating too much cholesterol for example egg. The yolk has the highest cholesterol levels we know of today and is probably because it is needed to build up all the cells in the chicken. Even though we hear about restrictions in dietary cholesterol no one has been able to prove that less cholesterol in food gives better health.

It has, however, been showed that about 80% of the cholesterol found in our body is made by our body (mostly in the lever). If we eat less cholesterol the body will make more, if we eat more cholesterol the body will make less. The dietary cholesterol has pretty much no impact of your health and there is probably safe to not care of how much of it is consumed.

How should I read my cholesterol results?
Total Cholesterol – is in the most cases a very poor measurement all by itself. Most often the recommended levels are 200 or lower. About 70% of people between 30 and 50 have higher levels than 200, and about 90-95% of people older than 50 have levels over 200. (Good for statin selling business).

Triglycerides (VLDL) – A low number is good. A high number depends mostly on high intake of carbohydrates. The recommendation is 150 or lower. Over 200 may be a sign of metabolic syndrome and is a threat to your heart health.

HDL – A high number is good, natural fats increases HDL. Low levels leads to higher risk of heart disease, dietary intake of many carbohydrates decreases HDL. Men should strive for a number over 35 and women a number over 45, the higher the better.

LDL – Most often is the recommended number for LDL between 100 and130. But this is, as we have previously discussed, a hard number to interpret. The small LDL particles are the dangerous ones but also the particles that will not show up accurate on the LDL result. If your HDL is high and your triglycerides are low than that would show that most of your LDL particles are bigger and safe and your number could safely be larger than 100-130. If your HDL is low and your triglycerides high then your LDL particles are most likely a formation of many small particles and are dangerous to you and your LDL should be lower than 100-130.

Total cholesterol / HDL – A low number is good. This is easy to measure and is more recommended to use as a risk analysis for heart disease than just the total number of cholesterol, the LDL alone, triglycerides, and LDL/HDL.

The blood test of the future
As you have probably noticed there are controversies over the way to measure cholesterol and prove relationship between that and bad health. Luckily there is a much more reliable method to measure the small dangerous LDL particles than to measure triglycerides and LDL levels: Every LDL particle have one protein composition called apolipoprotein B and HDL have one protein composition called apolipoprotein A1.

By measuring the Lp(B) we get to know the total amount of LDL particles, small LDL included! By knowing your apolipoproteins you can measure the apo-quota: Lp(B)/Lp(A). This is probably the best way of measure blood fats to use it in risk factor analysis for heart disease.

Suggested quotas for men are under 0.7; 0.7-0.9 is ok but not excellent, over 0.9 means increased risk. Recommended quotas for women are under 0.6; 0.6-0.8 is ok but not excellent, over 0.8 means increased risk.

So does increased risk in this case mean that a healthy person needs medicine like today? No, the first treatment should always be change of lifestyle. If it is not enough, after trying for 6-12 months and there are other risk factors involved, not until then should statins be considered. One good lifestyle change is to start eating LCHF.

Statins
Statins are most often used to lower blood fat levels, example of statin drugs are Simvastatin and Lipitor. Statin drugs work by slowing down the enzyme (called HMGR) that produces cholesterol in the body resulting in lower levels.

The outcome of using statins is that the cells get starved with too little cholesterol and have to start using the LDL cholesterol that exists in the blood. First the body has to produce something called LDL-receptors that get attached to each cell membrane. The LDL particle will later attract to the LDL receptor and the cell will absorb the LDL particle and receive the cholesterol it needs that way.

The point with statins is to induce a deficiency of cholesterol in the cells of the body so that they will use the LDL cholesterol from the blood, and the number of LDL cholesterol in the blood will decrease.

The most interesting thing is that the body can do this transformation by itself, without the help of statin drugs! The HMGR enzyme production is related to blood insulin levels and insulin levels are directly triggered by eating fast acting carbohydrates… Let’s take it the other way…

When eating carbohydrates your insulin levels will go up fast in order to try to take care of all the sugar. Parts of the carbohydrates will be absorbed by the body and used as energy and the carbohydrates that the body can’t use right away will be stored as fat. When the body gets too much carbohydrates then what it can absorb the insulin level will spike. At the same time the high insulin level will call for an increase in HMGR enzyme resulting in a higher cholesterol production. Did you get that?

Eating fast acting carbohydrates > High insulin levels > Spiked HMGR enzyme > Faster cholesterol production > Cholesterol staying in the blood stream longer and can develop small LDL easier > Risk for heart disease

Solutions

So there are really two solutions on the issue with the risk of heart disease. One is simply to take statin drugs for the rest of your life and watch out for side effects. The other is to decrease your intake of sugars and other fast acting carbohydrates such as pasta, bread, soft drinks, juices, and dried fruit. This will also promote a lower risk of inflammations just as statin drugs are said to do. The back side of taking statin drugs (except for the side effects) without changing your lifestyle is off course that the body will always crave the sugars as its main source of energy, causing your blood sugar constantly go up and down, which often results in overweight.

Off course there are some people at very high risk that might not have time to waste and may have to do both for a while until the levels are manageable.

I will always vote for the natural way what way you choose it entirely up to you!

2 comments:

  1. Gary Taubes' book about "Good Calories, Bad Calories" convinced me.

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  2. Jim, I am right there with you. That book is amazing!!! It should be a requirement for all people in the health industry to read it - no better yet EVERYONE should read it!

    Another good book related to this is: "Our Daily Meds" by Melody Petersen.

    Thanks for you comment and have a wonderful day

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