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Cholesterol – Why We Can’t Live Without It

February 2, 2011

Written by Deanna M. Cherrone M.D., owner of Natural Health & Healing  a Functional Medicine  practice in Avon, CT.

Cholesterol is a fatty substance, also known as a lipid, which is found in every cell in the body. Although we often hear about the dangers of cholesterol, it is in fact vital  in the structure and functioning of our cells. The amount of cholesterol the body makes is directly related to the amount of saturated fats and trans fats consumed so diet can certainly affect cholesterol levels but, if the body needs cholesterol it will make more or recycle it on its own. That’s how important cholesterol is in the body.  Both high and low levels of cholesterol can adversely affect one’s health so cholesterol balance or healthy cholesterol levels is the goal.

Cholesterol is found in the cell membrane and assists in maintaining the fluidity and flexibility of that membrane. The cell membrane is where the exchange of information in the body occurs. Simply put, nutrients and oxygen go into cells; waste, toxins and carbon dioxide go out of cells. In order for this exchange to occur easily and efficiently the cell membrane must be permeable. When the cell membrane becomes stiff and rigid, vital nutrients are not able to pass into and out of cells as readily.

Cholesterol also transports substances once they are inside the cell membrane. It plays an important role in cell signaling which is how cells recognize and respond to their environment. For this reason, cholesterol is vital to tissue repair and immunity as well as maintaining a stable, constant internal environment within the cell known as homeostasis. In our nervous system, nerve cells are insulated by a sheath called myelin which is rich in cholesterol so cholesterol is also necessary for efficient nerve conduction within the body.

Cholesterol is the building block for hormone production in our body. It is needed to make the steroid hormones estrogen, progesterone and testosterone and the adrenal hormones aldosterone, cortisone and cortisol.  It is also needed to make the fat soluble vitamins A, D, E and K. In the liver, cholesterol is converted to bile which is stored in the gallbladder and then released as we eat to aid in the digestion of fats in the small intestines.

Cholesterol is found in animal fat. Eating a diet high in saturated fats and trans fats will cause cholesterol levels to rise. The main dietary sources of saturated fats include dairy such as cheese, milk, yogurt, chocolate and ice cream. Whole fat varieties obviously have more fat then low fat or nonfat but have less “fillers.” Red meat is higher in saturated fats, although grass fed beef has a lower saturated fat content and a higher omega 3 fat content. Grass fed beef is therefore a better choice when consuming red meat. Wild game such as bison, buffalo and venison is a better choice for the same reason. Eggs are also a source of cholesterol. The egg yolk which has all of the cholesterol also contains most of the nutrients. The egg white has no cholesterol and by weight is about ¾ water and ¼ protein. Poultry also contains saturated fat. The dark meat has more saturated fat, but it too has more vitamins and minerals than its white meat counterpart. The “other white meat,” pork, contains saturated fat but believe it or not, beef, poultry and pork have nearly the same cholesterol content and their saturated fat content is also not that different, with beef 38%, pork 35% and chicken 31%.  Chicken skin contains the most fat on the chicken and can be removed to reduce fat intake.

Trans fats which also cause cholesterol levels to rise are not found in nature. They are made in laboratories and are altered chemically from a cis to a trans configuration, hence the name. This chemical alteration makes the trans fats stiff and rigid which extends their shelf life but, in turn, makes cell membranes stiff and rigid when we ingest them. Inflexible cell membranes will not function well and when cells function poorly, symptoms and then dis-ease develop.  Dietary sources of trans fats include margarine and other butter substitutes, Crisco and other vegetable shortenings, pizza dough, pancake mixes, hot chocolate mixes, cake mixes, fried foods, chips, candy, packaged cereals, microwave popcorn, frozen dinners and a whole host of processed, packaged foods. It is best to avoid these foods entirely, but when packaged foods are eaten it is imperative that food labels be read. Any product which contains hydrogenated or partially hydrogenated oils should be avoided – even if the labels say there is zero trans fat.

Although diet can definitely impact cholesterol levels, more than 75% of cholesterol circulating in the body is made in the body. Cholesterol is made in every cell. The amount made depends on the cell type. For example, about ¼ of all cholesterol made in the body is produced in the liver where it is stored as bile and then released to aid in the digestion of fat in foods.  A higher percentage is also made in the reproductive organs, adrenal glands and intestines where cholesterol is important in hormone and vitamin production. Once ingested, cholesterol is absorbed in the intestines and transported to the liver where it is recycled. A higher intake of saturated and/or trans fats will reduce endogenous production of cholesterol in the body in its attempt to maintain cholesterol balance.

It is important to remember that the body needs fat to function properly.  We have become a fat-phobic nation which ironically has increased obesity in this country. The addition of refined sugars and the number of food additives and preservatives that replace the fat in foods has contributed to our increasing waistlines and our increase in chronic disease. Fat is not the enemy. In fact, cholesterol is so much an integral part of the cell membrane and its functioning that we cannot live without it. Healthy fat intake is essential to good health.

If we examine the content of human breast milk we find it is very high in cholesterol with approximately 4 mg per fluid ounce. Cholesterol, by providing internal and external structural support to cells and neurons, allows for proper development of the brain and nervous system in a growing baby. Infant formulas (a processed manmade food) contain no cholesterol. The fat in these formulas comes mostly from vegetable oils and contains very small amounts of the essential fatty acids necessary for brain development. Corn-based formulas are particularly problematic. Processed food is not only making us fat, but it is also making us “stupid and crazy.”  Nature truly knows best and provides what our bodies need.

So what about cholesterol levels and lipid profiles? Cholesterol is minimally dissolvable in water. Because of this cholesterol is bound to lipoproteins for transport in the blood stream which is water based. Attaching to lipoproteins makes cholesterol hydrophilic (water loving) and therefore able to travel in the bloodstream to all the places in the body that need it. Lipoproteins are named based on their size. From largest to smallest are chylomicrons, VLDL, IDL, LDL and HDL. The two lipoproteins we commonly speak of are HDL (high density lipoprotein) and LDL (low density lipoprotein). Each lipoprotein type acts like a taxi carrying cholesterol to and from specific sites in the body. For example, LDL which is the major carrier of cholesterol in the blood stream takes cholesterol from the liver to any cell in need of cholesterol. HDL, on the other hand, carries cholesterol from the bloodstream back to the liver where it can be recycled. Because HDL takes LDL out of circulation it is often referred to as the “good” cholesterol.

LDL is often called the “bad” cholesterol because it can transport cholesterol into the artery wall leading to plaque formation. People often think it is the increased plaque in the artery that causes decreased blood flow to the heart resulting in a heart attack. In fact, as the artery narrows when plaque forms within it and blood is subsequently being pushed through this narrowed opening, the shearing forces that are created actually cause the plaque to rupture, eventually. Plaque rupture results in bleeding and subsequent clot formation (a natural consequence of bleeding in the body). It is the clot formation that stops blood from flowing to the heart.  If blood flow is not restored to the part of the heart which that artery supplies that part of the heart will die. This is why aspirin is given to patients who are having chest pain or a “heart attack,” as a means of thinning the blood and hopefully preventing that clot from forming. This is also why we use substances in the emergency room to dissolve the clot before damage to the heart is able to occur. This same scenario can occur in the brain causing a stroke and in the peripheral vascular system in your extremities.

Our knowledge is constantly evolving and we now know that it is more than just the LDL level itself that is important. We are now able to measure LDL size and buoyancy and these two factors are what determine how atherogenic (likely to cause plaque) LDL may be. Large numbers of small, dense LDL particles put you at increased risk of developing atherosclerosis whereas small numbers of large, buoyant LDL particles with no small, dense particles lowers your risk.

Total cholesterol levels on their own can be just as misleading as looking at total LDL levels can be. Total cholesterol is the sum total of the LDL, HDL, IDL (intermediate density lipoprotein) and VLDL (very low density lipoprotein) levels. Those patients with high HDL levels (greater than 60) and normal LDL levels may have elevated total cholesterol levels as a result of the high HDL. Similarly, patients may have a low HDL (less than 40) and a high LDL (greater than 100, 130 or 160 depending on your risk category) with a “normal” total cholesterol level. A low HDL can be just as problematic as a high LDL with regard to increasing one’s risk of cardiovascular dis-ease.  The confusing thing is that people with “normal” lipid levels have heart attacks so the numbers obviously only tell part of the story.

Poor blood sugar regulation and high cholesterol are two sides of the same coin when it comes to cardiovascular disease risk. A diet high in refined carbohydrates and processed foods results in high blood sugar levels. In response to these high blood sugar levels the body releases insulin from the pancreas. One of the body’s main goals is to maintain blood sugar levels within a very narrow range. Insulin binds to receptors on cells and allows blood glucose to enter the cells. When the body is repeatedly exposed to high blood sugar levels the need for insulin goes up. Over time the cells become overwhelmed by this excess glucose and stop responding to insulin. Insulin resistance develops. Insulin, as well as glucose, begins to accumulate in the blood stream eventually leading to the development of diabetes. High insulin levels also cause LDL levels to rise and HDL levels to fall further increasing the risk of cardiovascular dis-ease.

Diabetes or “high blood sugar” can also cause triglyceride levels to rise. Triglycerides (TG’s) are the predominant fat circulating in the bloodstream and are also a part of the lipid profile your doctor may ordering when he or she is assessing your cardiovascular dis-ease risk. TG’s are a major source of energy for the body. After a meal, any leftover calories are converted into triglycerides and stored in fat cells. When the body requires energy between meals, the hormone glucagon triggers the release of triglycerides from fat cells to provide this energy. We need triglycerides but high triglyceride levels can increase your risk of cardiovascular dis-ease and may also be a sign of a medical condition known as metabolic syndrome. Metabolic syndrome is characterized by high triglyceride levels, low HDL levels, high blood pressure, high blood sugars and/or insulin resistance and too much belly fat.  Having metabolic syndrome clearly puts you at increased risk of cardiovascular dis-ease.

We have all heard about how inflammation is a major “player” in the development of dis-ease. Inflammation is the body’s response to injury or infection. Belly fat is problematic not only because of its relation to elevated blood sugars and high lipid levels but also because this VAT (visceral adipose tissue) is metabolically active. It produces inflammatory cytokines (chemical messengers) which in turn cause inflammation. Clearly we are not meant to have fat surrounding our vital organs. This is perceived as “injury” in the body. With chronic tissue irritation and inflammation dis-eases like atherosclerosis can develop leading to eventual heart attack and stroke. Measures of inflammation in the body such as fibrinogen, high sensitivity cardio CRP and homocysteine can help to determine if inflammation can be increasing your risk of cardiovascular dis-ease and dis-ease in general.

Like everything in the body, balance is crucial. Having too much or too little of something can be problematic. The same can be said for cholesterol, even though conventional medicine would like us to believe that there is no cholesterol level that is too low. Low cholesterol levels less than 160 have been associated with depression, anxiety, increased suicide, increased aggression and violence, impaired brain function, stroke and vitamin D deficiency. Exposure of cholesterol in the skin to sunlight is what is responsible for producing vitamin D in the body. There are very few food sources of vitamin D so we need sunlight and cholesterol to have adequate circulating levels of vitamin D in the body. Lower levels of vitamin D can lead to decreased calcium absorption and eventual osteopenia and osteoporosis along with other dis-ease states such as MS (multiple sclerosis) and DM (diabetes mellitus).

Low cholesterol has also been associated with an increased risk of developing cancer. Fat soluble vitamins A, E and K are important antioxidant vitamins which bind free radicals which we know can play a role in cancer formation in the body. Without cholesterol there is decreased production and transport of these important antioxidant vitamins to help fight against cancer. We are always producing “abnormal” cells. We are fortunate that our bodies have in place multiple mechanisms in which to induce apoptosis (cell death) of these abnormal cells. We just need cholesterol and large amounts of antioxidant vitamins which come from ingesting colorful fruits and vegetables to assist in this process.

In Functional Medicine, we view high cholesterol not as a sign of a statin deficiency but as a sign of a possible underactive thyroid, a hormone imbalance, a nutritional deficiency or toxicity. It is not a sign for us to prescribe a statin drug. The approach we take is one of looking at your thyroid hormone levels, namely free T3, free T4 and TSH (thyroid stimulating hormone) and thyroid antibody levels.  If the body begins producing antibodies against the thyroid, over time the gland will scar and fibrose and not function optimally leading to an underactive gland. This antibody production is a sign that the immune system is “not happy” and we need to address it so we might prevent or slow the fibrosis of this very important gland. We test salivary hormone levels, namely, estradiol, estriol, estrone, progesterone, testosterone, DHEA-S, and cortisol as well as blood levels of pregnenolone – the grandmother hormone made from cholesterol that is needed to make all of the other steroid hormones in the body. We also examine and test the body for possible nutritional deficiencies and toxicity that may be playing in a role. We might even do heavy metal testing to assess body burden of these metals since we know that heavy metals can cause metabolic disturbances leading to elevated LDL and TG levels.

The therapies that are then employed are customized depending upon the individual findings of the above testing. Patients always like to bring up their genetics as predisposing them to their high cholesterol. Our genetic makeup is definitely important in determining which dis-ease states we may be more likely to develop. However, we now know that we can control which genes get turned on in the body and which genes get turned off based on how we live our lives. We have control of our health. This concept is largely responsible for the development of “lifestyle” medicine or therapeutic lifestyle change (TLC as I fondly refer to it). Thyroid dysfunction, hormone imbalances, nutritional deficiencies and certainly toxicity can all be “treated” with TLC. High cholesterol is a signal that something or things are “not right” in the body. It is a wake up call asking us to change the way we eat, look at our sleep habits, alter our response to stress, move every day in a way that supports health rather than being sedentary. This is what high cholesterol is telling us to do.

When we examine cultures in the world where there is extreme longevity we see common threads.  These people are active! They are involved in very strenuous physical activity, either through their work or daily routines such as walking long distances and swimming. These people do not sit in front of televisions or computers for long periods of time. They are outside exposed to sunlight and fresh air, not fluorescent lights and recycled air. They eat local foods that come from nature that they prepare at home. They do not eat man-made foods manufactured in a laboratory or at the nearest fast food restaurant. They take their time savoring their modest portions of food and enjoy the company of the people who they share their meals with. They do not eat “super size me” fries or big gulps as they are driving in their car to get to a business meeting. If we examine these cultures closely we can see the folly of our ways. We are literally killing ourselves with, or for the sake of, convenience.

So what can we do…

Eat healthy fats – small wild cold water fish (locally caught is best); 1 egg per day including the yolk (this will not raise cholesterol); increase omega 3 fats in diet with walnuts, ground flaxseed, flaxseed oil and fish oil; eat more avocado, nuts and nut butters, seeds and seed butters; use extra virgin coconut oil or butter/ghee to cook with; and consume olives and first cold pressed extra virgin olive oil daily.

Avoid trans fats.

Avoid farm raised fish which are low in omega 3’s and high in PCB’s.

Avoid large fish such as tuna, swordfish and mahi mahi and bottom crawlers which are high in mercury.

Limit omega 6 fats from corn oil, sunflower oil and safflower oil.

Increase fiber in your diet – ground flaxseeds, rice bran, fruit, vegetables, nuts, seeds, whole grains (which does not include wheat).

Replenish your body with 84 minerals and trace elements by adding small amounts of Himalayan salt.

Avoid MSG, Splenda, artificial sweeteners, nitrates, food additives and preservatives.

Avoid low fat or fat free versions as they often have increased refined sugars and unhealthy additives.

Avoid processed foods and refined carbohydrates – bread and pasta are processed foods.

Limit/eliminate caffeine and alcohol.  Women should not have more than ½ glass of wine per day.

Avoid carbonated beverages especially sodas and pasteurized juices. Fresh squeezed juices in moderation.

Consume 9-10 servings of colorful fruits and vegetables every day. Supplement as needed.

Support healthy digestion by supplementing with a probiotic and, if needed, a digestive enzyme with each meal.

CoQ10 is very supportive of cardiovascular health and regulating cholesterol levels. Fish oil can lower triglycerides.

Exercise!  Exercise! Exercise! Aerobic Interval training/Strength training/Yoga or some other type of exercise that improves flexibility and balance – helps to lower LDL, raise HDL and lower TG levels.

Maintain a healthy weight with portion size/exercise/sleep/stress management.

Address toxin exposure in personal care products, mercury amalgams and plastics.

Boost immune function. Treat infections. Reduce inflammation.

Rebalance hormones with bio-identical hormone replacement therapy.

Maintain healthy blood sugars and cortisol levels by eating the right foods every 3-4 hours.

Ask your PCP to check your VAP cholesterol profile to assess LDL particle size, high sensitivity CRP levels and homocysteine levels.

Change your health by changing your life and have fun doing it!

Resources: Healthy At 100, The Crazy Makers, Over the Counter Natural Cures, Food and Nutrients in Disease Management

Written by Deanna M. Cherrone M.D., owner of Natural Health & Healing  a Functional Medicine  practice in Avon, CT.

Possible callouts: (says Deb)

Fat is not the enemy. The addition of refined sugars, as well as food additives and preservatives that replace the fat in foods has contributed to our increasing waistlines and our increase in chronic disease.

In Functional Medicine, we view high cholesterol not as a sign of a statin deficiency but as a sign of a possible underactive thyroid, a hormone imbalance, a nutritional deficiency or toxicity. It is not a sign for us to prescribe a statin drug.

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