Cholesterol Confusion and Heart Disease
In recent years, studies examining the relationship between cholesterol and heart disease have shown some conflicting results. I often have patients confused about their risk of heart disease and how it relates to their cholesterol levels. More often than not, they are told they have high “bad cholesterol” and low “good cholesterol,” are recommended a statin drug, and not properly educated on what have been shown to be more important factors relating to heart disease, strokes, and heart attacks. This may cause undue anxiety, and certainly does not empower you to take real control of your health to truly minimize your risk. The truth is, cardiovascular disease (CVD) risk is different for men and women, there is additional testing that can be done, environmental factors play an extremely large role in heart disease, statins have many potentially serious side effects, and naturopathic medicine is very successful at lowering lipids and reducing/preventing heart disease risk.
Looking at several cultures over long-term studies, the direct link between high cholesterol and CVD or heart attacks has fallen short. France, a country known for its love of cheese, was on average higher in cholesterol but lower in heart attacks and strokes. Another 10-year study in Greece also failed to link increased cholesterol and CVD. We do know that total cholesterol > 320 does in fact increase stroke risk, and should be lowered, but statins aren’t your only option.
Gender makes a difference, too. In women, a lower HDL and high triglycerides are a higher risk for CVD than is high cholesterol or LDL. In men, high LDL (>130) is more associated with a heart attack than other lipids. Also, low testosterone is strongly associated with high cholesterol and triglycerides, and often is not checked in men with high lipids. In 50% of heart attacks, cholesterol wasn’t shown to be a factor! They were more commonly associated with poor nutrition, stress, weight gain, and environmental factors, all leading to increased inflammation. Diet is far more important than cholesterol levels for heart disease risk. And exercise is not only more important than cholesterol levels, but being unfit is a greater risk for CVD overall.
To get a better idea of what your true CVD risk is, advanced but simple blood tests can be done. The reality is much more complex than “LDL is bad, and HDL is good.” It’s about what type of LDL and HDL you have, and how much of each is present. Genetics also plays a role, and not just diet, as is usually suggested. A VAP (vertical auto profile) panel breaks cholesterol into fractions, appearances, and patterns, giving a much more accurate picture of what may or may not be a problem. This test goes beyond simply measuring total cholesterol, LDL, and HDL. An LPP (lipoprotein profile) appears to be even one step better. LDL particles can be large or small. The small, dense particles are what enter into artery walls and increase inflammation. With this kind of advanced testing, two people with the same LDL levels can be at completely opposite ends of the spectrum with regard to CVD risk. If your LDL levels are too high, please consider having advanced testing done.
Statins are often the first drug offered for high cholesterol, and while effective, they can be problematic, even harmful. Studies have shown that people taking statins have bigger and more complex plaques in their arteries, compared to those not taking them. And statins have not shown a benefit in women or anyone over 65 years old. The average number of people taking statins needed to prevent one heart attack is 200 people! The average number of people who have side effects is much less. Also, statins block CoQ10 production. CoQ10 is believed to be the key nutrient for making 95% of the body’s total energy! CoQ10 is a vitamin-like antioxidant found everywhere in the body, but is highest in the muscles, heart, kidneys, and pancreas. Imagine what can happen when these organs can’t make energy. We also need all the B vitamins, folic acid and vitamin C to make it, and often these vitamin needs aren’t assessed.
The list of side effects is distressing: statins deplete CoQ10, change, weaken or destroy muscles, decrease heart function, do NOT slow artery hardening, do NOT extend life in studies, may cause sudden total memory loss, increase cataract risk, suppress the immune system, are linked to cancer, may cause kidney and liver damage, increase Lp(a) LDL (increase the odds of a heart attack or stroke by 70% as a result), increase LDL free radical damage, decrease sex drive, and reduce hair growth, sleep, and brain and nerve function. Please consider your natural alternatives before risking these side effects.
So if cholesterol may not be the most significant factor related to CVD, what else do we need to consider? Environmental causes of free radical damage are, in fact, more strongly associated to CVD, heart attacks, and strokes. Industrialization of our food industry has taken the nutrients out of our foods. The refining process to make white flour, bread, and rice removes the protective antioxidants from our grains. This also occurs when we refine what were considered to be “good” oils, like corn oil, and links them to heart disease. Over time, our soils have become depleted of nutrients, and so have our foods. The addition of sugar and high fructose corn syrup into everything, use of trans fats, availability and low cost of greasy, fried, and fatty foods, and increase in tobacco and alcohol use since the beginning of the 20th century all create bodywide free radical damage, inflammation, CVD and strokes.
Water filtration systems often remove valuable magnesium from our water. Fluoride in water can cause hypothyroidism, and increase lipid levels. Pesticides and herbicides create toxic foods and serious free radical damage. Plastics used to package our foods, heating foods, and drinking hot liquids in plastics leach harmful chemicals as well. Heavy metals, mercury and lead especially, are linked to high blood pressure, heart disease, and cancer. Heavy metals come from our parents while in the womb, polluted fish, industrial cities, water sources, and cigarette smoke, among others. It’s easy to see the direct impact our environment, agriculture, industry, and lifestyle have on our health. And once you are properly educated on these environmental and dietary causes of CVD, reduction, and prevention of risk is easily achieved.
Ultimately, most of what goes on with our health has to do with how we live our lives now. Most of preventive medicine has to do with living your life in a truly balanced, healthy way. Let’s start with diet. Eating a Mediterranean diet is 2.5-3 times more effective than a statin in preventing CVD and deaths. In general, a vegetarian diet high in fiber is extremely effective at lowering all lipid levels and CVD risk. It also reduces food costs and saves natural resources. Soy has been shown to decrease total cholesterol and LDL, but was not shown to affect HDL, triglycerides or blood pressure. If your triglycerides are high, a low carbohydrate diet will be most beneficial. Eating fish 2-3 times per week had the most significant effect on lowering triglycerides and increasing HDL. Decreasing red meat intake is desired; but IF you eat it, buy organic, grass-fed, grass-finished meat to get the healthy fats, which are not present when these animals are fed grain the few weeks before slaughter. Substituting “safe” fish, hormone- and antibiotic-free poultry, low-fat dairy products, and nuts are great alternatives for red meat. Walnuts are the only nut high in omega 3 oils, and were shown to lower total cholesterol and LDL. Eating all berries, and brightly colored foods high in antioxidants also works to stop CVD and free radical damage. Washing or peeling fruits and highly sprayed vegetables will decrease your pesticide exposure. Proper education on the most and least sprayed foods will help guide you to know which you need to buy organically, and which ones you do not.
Vitamin and mineral repletion is equally important. Unrefined salt, like Celtic or Himalayan salts are high in minerals like calcium, magnesium, and potassium, which are often low. Vitamin C works exactly the same way as statins. Studies show that when vitamin C levels are low, cholesterol increases, and vice versa. Vitamin C promotes CoQ10 production and lowers Lp(a), the LDL particle most associated with heart disease risk. We do not make vitamin C, it must come from the diet. Vitamin D deficiency is associated with higher lipids, heart disease, and diabetes. Glutathione, selenium, and alpha lipoic acid are very potent antioxidants. Vitamin E protects cholesterol from free radical damage, which causes inflammation and plaques to form. Not all forms of vitamin E are created equally, so speak to a naturopath before supplementing.
Regular exercise does everything we could ask for: lower cholesterol, triglycerides, and LDL, and increase HDL. Stress coping mechanisms and reduction are necessary as well. Proper weight loss, individualized dietary and nutritional counseling, addressing food sensitivities, and providing support for smoking cessation and moderate alcohol use are several other aspects that need to be addressed for true heart health. Avoiding sources of heavy metals, solvents and pesticides, and detoxification if needed, will also reduce free radical damage and CVD risk.
Knowing that cholesterol may be only related to 50% of cardiac events, what if you’re in the other 50%? Genuine diet and lifestyle modification, weight loss, stress reduction, and avoidance of environmental toxins will then make all the difference, not only in maintaining healthy cholesterol levels, but in preventing bodywide inflammation known to be the cause of CVD. Don’t hesitate to learn more about healthy preventative measures and safe drug alternatives from a naturopath today.