High Cholesterol is the term used to describe a number of different disorders characterised by having high levels of blood fats in the circulation. The fats in the blood are mainly of 3 types, called high-density lipoprotein or HDL, low-density lipoprotein or LDL, and triglycerides. HDL is responsible for mobilising the fatty deposits in arterial walls and transporting them back to the liver, and is therefore regarded as “good” cholesterol, while LDL does the opposite and is therefore regarded as bad for us.
Triglycerides are produced as a result of the the digestion of fats present in our diets, and they consist of three fatty acid molecules combined with glycerol, (hence the name triglycerides.) It is one of the ways in which the body stores fat. The level of cholesterol – both HDL and LDL – and triglycerides circulating in the bloodstream depend on both our genes and our diet. High levels are thought to be a risk factor for the development of coronary heart disease, circulatory disorders and stroke, and a GP will want to reduce levels, usually by medication.
However, before you start taking medication, there is much that you can do with your diet to minimise your health risks, read the follow on article “The Cholesterol Myth”.
Cholesterol levels will usually be monitored as a matter of course by your GP.
Levels of 7.8 or more are considered to be high risk
6.5 to 7.8 moderate risk
5.2 to 6.5 average risk
5.2 or less low risk
You should be aware that the goal posts for cholesterol levels are moved from time to time! New research shows that cholesterol and it’s impact on heart health has been over-stated, and that the real culprit is homocysteine. However, the guidelines given below are relevant to maintaining good health of your circulatory system.
Nutritional Supplements that could help. (Refer to the individual supplement for cautions in use.)
|Supplement/Herb||What it does||Dosage|
|Niacin/lnositol||Lowers blood level of cholesterol by reducing cholesterol production in the liver.||500 – 1000 mg per day|
|Astaxanthin||Acts as a powerful anti-oxidant and may help regulate the ration of HDL and LDL.||4 – 8mg per day|
|Psyllium Husk Fibre||A soluble fibre which helps lower cholesterol levels.||2 – 6g per day with glass of water|
|Garlic||Antioxidant, lowers cholesterol, homocysteine and blood pressure and improves circulation.||80 – 160mg|
|Isoflavones||Helps prevent oxidation of cholesterol, reducing plaque formation and lowering cholesterol levels.||30 – 80mg per day|
Diet and Lifestyle Factors
Eat lots of garlic. Numerous studies have shown that it helps lower cholesterol.
Include oats, fruits and vegetables, complex carbohydrates, oil fish.
Cut out hydrogenated and trans fats found in processed foods.
Don’t smoke. Reduce alcohol so that you stay within the recommended guidelines of 14 units per week for women and 21 units per week for men. (One unit is equal to half pint of beer or lager, a pub measure of spirits or wine.)
Exercise at least 3 times a week and take time out to relax.
The Cholesterol Myth
Cholesterol is NOT the cause of heart disease. In recent years high cholesterol has become the epidemic illness of our times, it has such a bad name that being told you have high cholesterol is akin to being told you had bubonic plague in the middle ages!
Cholesterol is an important substance that’s used by the body in many ways. Eighty per cent of the cholesterol you have is produced within your own body – mostly by the liver. It’s transported from the liver via the blood stream to other tissues and then back to the liver.
Cholesterol is an essential component of every cell membrane in your body, that forms the walls of individual cells in all tissues, including blood vessels. You cannot live without cholesterol, that is why your liver makes it! Cholesterol is also a precursor to all of the steroid hormones and for vitamin D, which controls calcium in the body. You cannot make oestrogen, testosterone, cortisone, and a host of other vital hormones without cholesterol.
Cholesterol travels through the blood in minute packages mixed with large molecules called lipoproteins. Lipoproteins are themselves combinations of fats and proteins. Fats such as cholesterol don’t dissolve well in the blood stream, but become soluble when coated with lipoproteins.
High density lipoproteins (HDL) mop up excess cholesterol in the body and return it to the liver for re-processing. HDL is often called good cholesterol and raised amounts are thought to give protection against heart disease.
Low density lipoproteins (LDL) transport cholesterol from the liver to be deposited elsewhere in the body. LDL is often referred to as bad cholesterol because under certain conditions, e.g. very low vitamin B levels, it may deposit cholesterol in the lining of your arteries. Therefore medical science believes that the more LDL you have, the more likely you are to develop heart disease.
Notice that LDL and HDL are lipoproteins — fats combined with proteins. There is only one cholesterol. There is no such thing as a good or a bad cholesterol. Cholesterol is just cholesterol. It combines with other fats and proteins to be carried through the bloodstream, since fat and our watery blood do not mix very well.
Cholesterol is not the culprit!
We know that the majority of cholesterol in your bloodstream comes from what your liver is manufacturing and distributing. A number of research studies have shown that even when a normal diet is supplemented with 2 eggs a day (eggs being high in cholesterol) the blood serum level of cholesterol remained unchanged.
The amount of cholesterol that you eat plays little role in determining your cholesterol levels. Since we know that HDL carries cholesterol away from tissues, away from your arteries and back to your liver, we might ask ourselves why does the body do that? Why doesn’t your body get rid of this so-called harmful cholesterol by taking it to your kidneys or intestines to be excreted?
Cholesterol is returned to your liver so that it can be recycled, put back into other particles to be taken to tissues and cells that need it. Your body is trying to make and conserve cholesterol for the precise reason that it is vital for health.
What is the real culprit?
If you cut yourself, a chain reaction of events begins to heal the damage to the body. The damaged blood vessels constrict to reduce bleeding, enzymes are released to thicken the blood so that it can clot. Your immune system is activated to prevent viruses and bacteria from invading the cut. Other cells multiply to repair the damage so that you can heal. When the repair is completed you may have a small scar at the site of the injury.
We now know that a similar process takes place within the lining of your arteries in response to any damage which occurs. Arteries constrict, blood becomes more prone to clot, white blood cells are called to the area to absorb damaged debris, and cells adjacent to those damaged are told to multiply. Remember that one function of cholesterol is to keep your cell membranes intact and it is being transported to tissues as part of an inflammatory response that is there to repair damage. Ultimately, scars form inside our arteries which we call plaque. It is this constriction of the arteries and the “thickening” of blood which makes you at risk of high blood pressure and heart attacks. The coronary disease associated with heart attacks is now known to be caused from damage to the lining of the arteries.
When damage is occurring and repair is being initiated, cholesterol is being manufactured and distributed in your bloodstream to help you repair damaged tissue and keep you alive. If there is repeated damage, then it is necessary to distribute extra cholesterol through the bloodstream to repair that damage. So rather than trying to merely lower the cholesterol and ignore why it is there in the first place, it would seem to make more sense to reduce the extra need for the cholesterol, i.e. stop causing the damage to the artery walls!
American physician Ron Rosedale, MD says of cholesterol “Common sense would indicate that we should avoid the oxidation (rancidity) of cholesterol and fatty acids and not get rid of important life-giving molecules. Using the same conventional medical thinking that is being used for cholesterol would lead one to believe that doctors should reduce the risk of Alzheimer’s disease by taking out everybody’s brain.”
The fixation on cholesterol as a major cause of heart disease ignores real causes such as the damage (via glycation) that sugars such as glucose and fructose inflict on tissues, including the lining of arteries, causing chronic inflammation and resultant plaque. Glycation is the result of a sugar molecule, such as fructose or glucose, bonding to a protein or lipid molecule without the controlling action of an enzyme. It occurs mainly in the bloodstream to a small proportion of the absorbed simple sugars: glucose, fructose and galactose. The balance of the sugar molecules being used for metabolic processes.
A complex series of very slow reactions in the body lead to “advanced glycation endproducts” or AGEs. AGEs can interfere with molecular and cellular functioning throughout the body and the release of highly-oxidizing side products such as hydrogen peroxide. They are implicated in many age-related chronic diseases such as: type II diabetes mellitus due to beta cell damage, cardiovascular diseases due to damage to cell walls, Alzheimer’s disease, cancer, peripheral neuropathy, deafness and blindness.
Glycated substances are eliminated from the body slowly, which means that cells such as nerves, brain cells, eye crystalline, collagen, and DNA may accumulate substantial damage over time. Metabolically-active cells such as the glomeruli in the kidneys, retina cells in the eyes, and beta cells (insulin-producing) in the pancreas are also at high risk of damage. The epithelial cells of the blood vessels are damaged directly by glycations. Atherosclerotic plaque tends to accumulate at areas of high blood flow (such as the entrance to the coronary arteries) due to the increased presence of sugar molecules, glycations and AGEs at these points. Damage by glycation results in stiffening of the collagen in the blood vessel walls, leading to high blood pressure. Glycations also cause weakening of the collagen in the blood vessel walls, which may lead to micro- or macro-aneurisms; this may cause strokes if in the brain.
We have long been told to cut down on animal fat in our diets, in order to reduce the risk of heart disease. However, human beings have been eating saturated fats (from animals) for centuries. Saturated fats and cholesterol actually work together to support cell walls giving them strength and stability.
Breast milk contains saturated fats because they are essential to the health of a growing baby supporting kidney function, growth and immune function. We are told to either eat a low fat diet or polyunsaturated fats. The problem with polyunsaturated fats lies in the fact that they have a different molecular structure to saturated fats and are a poor substitute when it comes to “building” cell walls. As cell walls become weaker, more cholesterol is needed to “patch them up” and so the blood cholesterol levels go down. This is why polyunsaturated fats are promoted as “lowering cholesterol levels.” Polyunsaturated fats also go rancid easily on exposure to air, heat and light. This oxidisation forms cell-damaging free radicals.
Trans fatty acids (TFAs) are structurally closer to plastic than fat. TFAs are formed when liquid polyunsaturated vegetable oils are converted into solid saturated fats, usually by hydrogenation. The process involves extracting soy, corn, cotton or rapeseed oils at high temperatures, mixing it with nickel oxide, then injecting it with hydrogen gas in a high pressure, high temperature reactor. Chemicals then remove the nickel and dyes, bleach and emulsifiers are added to improve the product’s appearance. Hydrogenated oils are added to processed foods to give them the luxurious “mouth feel” of fats and a long shelf life; they’re also a cheap bulking agent.
TFAs are found in many other foods besides margarine and shortening, including fried foods like french fries and fried chicken, doughnuts, biscuits, cakes, pastries, sweets, chocolate, soup, dips, salad dressings, ice cream and crackers. Typical french fries have about 40 percent trans fatty acids and many popular biscuits, cakes and crackers range from 30 percent to 50 percent trans fatty acids. Doughnuts have about 35 percent to 40 percent trans fatty acids.
Trans fat is known to increase blood levels of low density lipoprotein (LDL), or “bad” cholesterol, while lowering levels of high density lipoprotein (HDL), known as “good” cholesterol. It can also cause major clogging of arteries, type 2 diabetes and other serious health problems, and was found to increase the risk of heart disease. Many food companies use trans fat instead of oil because it reduces cost, extends storage life of products and can improve flavour and texture.
In order to avoid trans fats in your diet, look for hydrogenated or partially hydrogenated fat on food labels.
Heating changes the molecular structure of any oil. For light sauteing of food use sesame oil, pistachio oil, hazelnut oil or olive oil. For frying or browning food use coconut oil, palm oil or lard. When frying always put the oil in a cold pan and raise the temperature gradually.
Homocysteine is a normal breakdown product of the essential amino acid methionine. High levels in the blood may irritate blood vessels leading to atherosclerosis (blockages in the arteries); cause cholesterol to change into oxidised low-density lipoprotein, which is also damaging to the arteries; cause the blood to clot more easily than it should increasing the risk of blood vessel blockages.
Homocysteine is normally broken down into the antioxidant protein glutathione or turned back into methionine for use by the body. These processes require adequate amounts of B vitamins, magnesium, zinc and folic acid in the diet. When these nutrients are not available, homocysteine builds up and reaches the levels which are toxic and damaging to health. Many nutritionists believe that our modern diet which relies heavily on processed foods is the main cause of high homocysteine levels.
Diet and Lifestyle factors
Cut out: saturated fat and trans fats found in processed foods
Sugar, refined carbohydrates, fried foods, excessive consumption of red meat alcohol and smoking.
Vegetarian sources of protein as vegetarian diets are associated with a lower incidence of cardiovascular disease. Eat oily fish such as salmon, tuna, sardines, herring, mackerel at least 3 times a week. Make sure you eat at least 5 portions of vegetables and fruit daily. Eat nuts and seeds, whole grains and fibre.
Achieve and maintain your ideal body weight and take regular exercise. Stop smoking
Suggested further reading:
- Cholesterol truths
- Impact on health
- Mediterranean Diet
Low cholesterol levels have been shown to worsen patients with congestive heart failure, a life-threatening condition where the heart becomes too weak to effectively pump blood. Statin drugs have been shown to also cause nerve damage and to greatly impair memory. One reason that statin drugs have these various serious side effects is that they work by inhibiting a vital enzyme that manufactures cholesterol in the liver. However, that same enzyme is used to manufacture Coenzyme Q10, which is needed to transfer energy from food to our cells to be used for the work of staying alive and healthy. You can think of CoQ10 as being like the sparkplug in a car engine which ignites fuel to produce energy. Bear in mind that the heart is a big muscle, designed to pump oxygenated blood round the body and it’s easy to see why depriving it of CoQ10 is not a good idea.
Statins were hailed as the new wonder drugs to prevent everything from heart disease to Alzheimer’s. But new evidence from a Finnish doctor shows that statins don’t lower cholesterol at all. The pharmaceutical companies have done more “research” and found (coincidentally) that statin drugs have anti-inflammatory effects. Therefore we’re advised to stay on our cholesterol-lowering drugs because now they work by reducing inflammation. Aspirin reduces inflammation for a lot less money, as does vitamin E, fish oil, and dietary changes, without the side effects of drugs.
The UK became the first country in the world to make a statin available to anyone without a prescription. Healthy people are advised by leading medical experts to buy a statin drug called “Zocor Heart Pro”, from their chemist and to take it for the rest of their lives if they are at mild to moderate risk for heart disease. Zocor Heart-Pro is aimed at those who are at 10 to 15 per cent risk of having a heart attack within 10 years. People who fall into this “moderate risk” category include all men over the age of 55, some men between 45 and 55 and women over 55 who have an additional risk – for example, a family history of early heart disease, who are overweight, who smoke or who are of South Asian origin. An estimated seven million people are at moderate risk.
As you can see, simply being male and over 55 means that you fall into the moderate risk category! Making statins directly accessible to people at moderate risk has wide, though by no means unanimous, medical support. The evidence suggests that lowering cholesterol may not be a good idea. This, for instance, is the conclusion from a long-term trial involving 8000 men, published three years ago in the Lancet: “long-term persistence of low cholesterol concentration (in the elderly) actually increases the risk of death.”
Pharmaceutical companies claim that statins save 6,000 lives a year in the UK and that their side-effects are mild and rare. Those of the seven million people who don’t have heart disease, but do take Zocor, will be told that trials show it can reduce the risk of heart attack by around 30%. You might think a 25% to 30% risk reduction makes it worth taking statins. However, it is manipulation of the statistics that gives an artificially inflated advantage to taking statins.
Heart attacks among healthy people are quite rare, so on average in trials about 4% of those in the placebo group have heart attacks, compared with around 3% in the statin group. That is indeed a drop of 25% but it is also a mere 1% fewer heart attacks. It’s amazing how statistics can be presented in a way that is really quite misleading!
Sadly, taking statins as a prevention does not increase life expectancy. In studies, the total number of heart attacks dropped slightly but the risk of dying from other things went up slightly, so overall life expectancy stayed the same.
The U.S Food and Drug Administration was forced to disclose, under the Freedom of Information Act, the number of adverse reactions (over 40,000) and deaths (over 400) attributed to statins. Side-effects include headache, nausea, vomiting, constipation, diarrhea, rash, muscle pain, and weakness. Statins are commonly related to muscle problems such as myopathy, myalgia, and rhabdomyolysis. NASA astronaut Dr. Duane Graveline was prescribed the statin Lipitor (atorvastatin) after a heart attack. After 6 weeks on the drug he lost his memory for 6 hours. Later he lost it completely for 12 hours. 100s of examples of statins causing “transient global amnesia” exist.
Statins are prescribed for long periods of time and are commonly used for elderly patients, which in turn raises the safety concerns with statins. Already taking a number of medications for other health conditions, elderly patients are prone to drug–drug interactions and drug–health-condition interactions. Safety concerns with statins are causing hesitation among regulatory agencies in America to make them available without supervision of doctors as OTC medications, yet in the UK statins are available to patients without prescription.
Consultant cardiologist Graham Jackson, editor of the International Journal of Clinical Practice says “This is one huge experiment. Those who buy statins at the pharmacy are being used as guinea pigs.”
The Consumers’ Association said no specific clinical trials had proved that selling the product over the counter was effective in the target population. It also said that the real reason behind the switch was that simvastatin lost its patent protection in May 2003. Selling statins over the counter simply enables the makers to continue to raise revenue in this lucrative market worth billions of pounds.