Cholesterol: Let’s Clear the Confusion

High cholesterol causes heart disease right?

Another case where an over simplification of science has come back and caused more harm than good.

What is cholesterol?

Cholesterol is a waxy yet essential blood lipid that has a vital role in the body’s metabolism and brain function,  it is required by almost every cell in the our bodies. It has a vital role in the body’s metabolism and brain function, therefore some cholesterol is required for optimal physical and mental functioning. It is also has a role in building hormones including oestrogen and testosterone, maintaining the integrity of cell membranes, and aiding in the absorption of vitamins.

Good vs Bad Cholesterol

We have all heard this:

  • HDL (High Density Lipoproteins) = is commonly referred to as the “good cholesterol”. HDL is considered to be beneficial as it transports cholesterol from the blood stream to the liver where it removed from the body.
  • LDL (Low Density Lipoproteins) = is commonly referred to as the ‘bad’ cholesterol. Excess LDL will increase the risk of clots due to the build-up of plaque on the inner walls of the arteries.

Recent research suggests that estimates of LDL particle number or concentration (LDL-P) is a better predictor of CV risk than LDL cholesterol (LDL-C). Basically this means that a larger number of smaller LDL particles will increase the risk of atherosclerosis (plaque in arteries narrowing and hardening them) when compared to fewer but larger LDL particles for a given total cholesterol concentration it is less the concentration of LDL in the blood but a better predictor is LDL particle size in the blood.

  • LDL-C which measures the concentration of cholesterol transported by LDL in the blood
  • LDL-P which measures the number of LDL particles in the blood

LDL-C tests have been the primary method of measuring LDL in the blood. It is cheaper Because the LDL-C measurement is a measure of the amount of cholesterol being carried in LDL, it is not a reliable measure of LDL particle concentration. For example: small, dense LDL particles have much less cholesterol than large, buoyant LDL particles. But it is these small, dense LDL that are more atherogenic. This has led to the concept that the overall number of LDL particles may be more predictive of cardiovascular risk.

Why is particle sizes and patterns Important?

LDL can be broken into two types:

Type A LDL= Large fluffy particles that “look like cotton balls and does do much damage”.

Type B LDL= Small, hard, dense particles which becomes oxidised and angry, sticking to the endothelium and creating inflammation.

So you really need to know your particle size and how many of Type A or Type B you have. Knowing your total LDL will not be as helpful, as knowing the particle size

 

The best predictor of Heart disease

There is no need for a in depth lipid panel you can get a great predictor of heart disease from a basic lipid panel. Total-to-HDL cholesterol is a ratio of total cholesterol triglycerides to HDL cholesterol. The cholesterol ratio is calculated by dividing your total cholesterol triglyceride number by your HDL number. The ratio is considered to be able to indicate the different levels of heart disease risk and has been shown to be the best predictor of cardiovascular disease risk.

Your total-to-HDL cholesterol ratio should be between 3 and 4 (according to New Zealand Health guidelines) to ensure healthy cholesterol levels and a substantially reduced risk of heart disease.

 

So how does this apply to HFLC?

The “bad science” that got us into this mess of believing that fat causes heart disease, have all been proven to be inaccurate and flawed. The main two are Ancel Keys Seven Countries Study (discussed in previous post: Food Pyramid: We Got It Wrong!), and the China Study. Low fat diets have been shown to be worse for our health in almost every way! Going low carbohydrate high fat leads to better health outcomes, disease prevention and longevity.

Consuming healthy fats raises your level of Type A fluffy particles, while eating more sugar raises the Type B angry little particles. Inflammation is what we should be concerned about as it is the leading cause  of heart/ chronic disease today. What Is causing the inflammation? You guessed it, high carbohydrate diet, high insulin level, processed foods, smoking and alcohol.

 

Improve your HDL Count

A split coconut, coconut cream and coconut oil in a bottleBoth Luric acid and (found in high quantities in coconut oil) and stearic acid (found in high quantities in animal fats) has shown to increase total-to-HDL cholesterol ratio more favorably than carbohydrates.

In other words, if you really want to impact your total HDL it is advantageous to restrict carbohydrates and get a majority of your calories from animal fats, coconut oil, and unsaturated fats like fish, nuts, avocado, and olive oil. One of the best ways to incorporate all of this into one diet plan is by following a high fat low carbohydrate or ketogenic diet.

 

Statins

Statins are a class of lipid-lowering medication, their ‘benefits’ have been grossly exaggerated while the side effects have been under-reported. There is even a class action taking place in America against statin drug companies for under-reporting side effects (muscle damage, memory loss, decreased immunity and diabetes). Statins have also been shown to decrease level of Co-enzyme Q10, a vital enzyme for energy transfer which is causing the muscle pain and damage and may be contributing to heart disease!

 

Other factors to consider:

  1. Chronic Inflammation and Stress

Both Inflammation and stress illicit similar physiological mechanisms/processes. Cholesterol levels are upregulated to bring the necessary nutrients to our tissue to assist them to heal and recover. If your stress/inflammation is not regulated and stays chronically elevated, your cholesterol level may persiantly stay high. This is typically due to a variety of lifestyle factor; diet, poor sleep etc

  2. Hypothyroid Related Issues

Thyroid hormones and cholesterol levels are intimately linked. In fact, thyroid hormone has a powerful influence on LDL receptor expression. The response is so substantial that it stimulates the LDL receptors in our liver and sex hormone-producing glands to soak up the LDL cholesterol in the blood like a sponge.

The reverse is true when our thyroid hormone levels are low. Our LDL receptors become less responsive. Resulting in excessive LDL cholesterol remaining in the blood for an extended period of time. The longer the LDL remains in the blood the more vulnerable it becomes to damage. This damage triggers plaque building process in blood vessels, increasing the probability of heart disease

 

Summary:

  • Cholesterol is required by almost every cell in the our bodies. It is essential that we are able to manufacture it
  • Over simplified method (HDL= good; LDL=Bad) creating confusion leading to poor recommendations in an attempt to minimise heart disease.  
  • Total-to-HDL ratio is more reliable predictor of heart disease than total cholesterol levels. Total-to-HDL cholesterol ratio should be between 3 and 4 to ensure healthy status.
  • High fat low carbohydrate or ketogenic diet, contrary to popular belief actually has a profound benefit on improving cholesterol levels
  • This is something that everyone should monitor at minimum once per year or if you are like me a passionate about performance get this checked along with other key biomarkers on a quarterly basis, to ensure you are functioning at a high level

 

References:

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Brinkworth, G. D., Noakes, M., Buckley, J. D., Keogh, J. B., & Clifton, P. M. (2009). Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. The American Journal of Clinical Nutrition, 90(1), 23–32. https://doi.org/10.3945/ajcn.2008.27326

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