Cholesterol has gotten so much recent press that I feel it is a topic that needs to be addressed. Last month, a 6 year Finnish study of 9,000 men concluded that the cholesterol lowering medication, atorvastatin and simvastatin, increased the risk of Type 2 diabetes by up to 46% – the higher the dosage, the greater the risk. It appears that statins “increase a person’s insulin resistance” and also “impair the ability of the pancreas to secrete insulin.” And now, the Dietary Guidelines Advisory Committee (DGAC) is saying that “cholesterol is not considered a nutrient of concern for overconsumption.” So what is going on? Cholesterol lowering medication is causing a disease (diabetes) that can lead to a disease (heart disease) that it was originally trying to prevent? And we shouldn’t be concerned about having too much cholesterol in our diets? It seems that everything about cholesterol originally ingrained in our knowledge has done a complete 180. Let’s get the facts straight.
Cholesterol 101 – What is it and why do we need it?
- Cholesterol is not a fat, but a steroid alcohol that is not water soluble. Around 75% of the cholesterol in our bodies is produced in the liver while the other 25% comes from food.
- Cholesterol is essential for the production of all our cell membranes, bile acids (for digestion, fat metabolism, and elimination of cholesterol), sex hormones (such as testosterone, estrogen, progesterone), adrenal hormones (such as cortisol, DHEA, aldosterone), and Vitamin D (read more about Vitamin D here).
- It maintains structure in our cells and blood vessels, and regulates protein pathways for cell signaling and communication between all our cells.
- It is essential in our nervous systems, helping us with learning, memory, and cognitive function.
Our brains, which constitute only 2% of our body weight, contain 25% of the cholesterol in our bodies, and most of that 25% is made in our brains when we sleep. This is why babies sleep so much — while they sleep their brains are making more cholesterol to help them grow and develop. Infants and toddlers also need adequate amounts of cholesterol in their diets for proper brain development. For the elderly, it was found that those with high cholesterol in their brains had the best memory function, while those with low cholesterol had a higher risk for depression and even death! For all of us in between, it goes without saying that we also need cholesterol to function properly.
Ok, so now we have established that cholesterol is very important and ESSENTIAL to life.
If cholesterol is so good, why do statins even exist??
Let’s define the main components that make up cholesterol.
LDL – This is the “bad cholesterol” contributing to plaque build up in your arteries causing them to harden, also known as atherosclerosis. If a blood clot forms and blocks a narrowed artery, then a heart attack or stroke may result. However, what is not commonly known is that there is “good” LDL and “bad” LDL as well. According to Dr. Ron Rosedale, M.D.:
“LDL particles come in many sizes and large LDL particles are not a problem. Only the so-called small dense LDL particles can potentially be a problem, because they can squeeze through the lining of the arteries and if they oxidize, otherwise known as turning rancid, they can cause damage and inflammation.”
HDL – This is the good cholesterol that carries LDL away from the arteries and back to the liver where it is processed and eliminated.
Triglycerides – This is fat that contributes to atherosclerosis. It is caused by being overweight or obese, lack of exercise, alcohol, smoking, and a diet high in carbohydrates (more than 60% of total calories). High triglycerides are actually a higher risk factor than LDL for developing diabetes and heart disease. (You’ll see why in a second).
VLDL – Very low density lipoproteins are considered bad cholesterols.
Lipoprotein (a) or Lp(a) are made up of LDL plus a protein (apoprotein a). High levels of Lp(a) also contribute to diabetes and heart disease.
Total cholesterol (TC) is the sum of all the above components.
So how do statins work?
Statins block the synthesis of cholesterol by inhibiting an enzyme in the liver called HMG-CoA reductase. This enzyme is what controls the production of cholesterol in the liver.
The problem is that HMG-CoA reductase also makes CoQ-10 in our bodies which is a major energy source for our hearts and responsible for energy production in all our cells. Therefore statins also decrease CoQ-10.
Statins increase insulin levels in our bodies. Chronically elevated insulin levels can cause inflammation and ironically, heart disease. Isn’t this the reason why people are prescribed statins — to decrease heart disease? Elevated insulin levels may also cause high blood pressure, heart attacks, thyroid issues, Parkinson’s disease, Alzheimer’s and even cancer.
Statins increase the risk of diabetes because it raises your blood sugar levels. How? Excess sugar that you eat from a meal is shunted to the liver where it should then be processed and stored into cholesterol and triglycerides. If the cholesterol production is blocked, then the sugar is kicked out of the liver and back into your blood stream, raising your blood sugar levels, which increases your risk of diabetes. This is exactly what the researchers in Finland discovered in their study.
How do I know if I’m at risk for heart disease?
If you visit your PCP or cardiologist, they will check your lipid profile to assess your risk for heart disease. The old school of thought is that your total cholesterol should be 200mg/dl or lower and under 150mg/dl if you already have heart disease. Your HDL should be over 40mg/dl, your LDL should be under 100mg/dl or under 70mg/dl for high risk patients, and your triglycerides should be under 150mg/dl. (Note: The lipid panel should be done fasting.)
Better and more accurate indicators of your risk for heart disease is using the following criteria according to Dr. Joseph Mercola:
1) HDL/Total Cholesterol Ratio : Divide your HDL by your Total Cholesterol and multiply by 100. This should ideally be 24% or higher. If your ratio is 10% or lower, then you are at significant risk.
2) Triglyceride/HDL Ratio: Divide your triglycerides by your HDL. This should ideally be under 2.
I’ll use my own numbers to illustrate 1 and 2 above.
TC = 194 HDL = 68 LDL = 116 Triglycerides = 61
My HDL/TC ratio is 68/194 x 100 = 35% > 24%
My triglyceride/HDL ratio is 61/68 = 0.89 < 2
As you can see from the ratio calculations, LDL is not even a factor considered in assessing heart disease risk. This indicates that lowering LDL does not have as much influence in lowering your risk as raising HDL and lowering triglycerides levels do.
3) NMR lipoprofile: This test measures the “bad” LDL levels discussed above, the “smaller more damaging LDL particles.” These particles can cause inflammation and are also connected with insulin and leptin resistance.
4) Check your fasting insulin: Normal insulin levels are under 5, but should ideally be under 3.
5) Check your fasting blood sugar: Those with a fasting blood sugar of 100-125mg/dl have almost 3 times the risk for heart disease than those with levels under 79mg/dl.
6) Waist to hip ratio (waist measurement/hip measurement) is a much better indicator than Body Mass Index (BMI) because BMI underestimates obesity rates by not accurately measuring your visceral, or belly fat. An ideal ratio for men is under 0.8. For women, the ideal ratio should be under 0.7. A ratio over 1 for men and over 0.85 for women is considered high risk.
7) Iron levels: Excess iron levels can potentially damage blood vessels, increasing the risk for heart disease. Check your ferritin levels and make sure they are under 80mg/dl. The best way to get rid of excess iron is donating blood.
Should I take statins if I am at risk or already have heart disease?
I rarely, if ever, prescribe statins. And if a patient comes to me on a statin, I will usually take them off the statin and use diet, supplements, and herbs to treat them. The only benefit that has been seen with statins is with middle-aged men who already have documented heart disease (according to cardiologist Dr. Stephen Sinatra) or those born with a genetic defect called familial hypercholesterolemia which prevents them from normalizing cholesterol levels (these patients come in with extremely high numbers: TC >300 and triglycerides > 400). Even then, your total cholesterol levels do not need to be lowered below 150mg/dl nor does your LDL need to be below 70mg/dl. Lowering your cholesterol to these levels puts you at risk for cognitive issues including depression (low cholesterol levels may indirectly link to lower serotonin levels in the brain since cholesterol is needed in nerve cell membranes for serotonin receptors to work properly), memory loss, and Alzheimer’s dementia (with low HDL levels as a risk factor). Instead, use the ratio calculations above to make sure your lipid profile is in the optimal range.
Another valid reason to take the lowest dose of statins, if you must take them, is because there have been hundreds of studies (900!) validating the damaging side effects from statins including muscle pain, cognitive loss, neuropathy, anemia, frequent fevers, cataracts, and sexual dysfunction. In addition, studies have shown that lowering cholesterol levels with statins don’t lower mortality rates from cardiac related deaths but actually increase the mortality of cancer. Researchers now also believe that high LDL levels are not the culprit of heart disease risk since those people dying from heart related diseases had the lowest levels of cholesterol ever (i.e., the 3 year mortality rates of heart attack patients with low LDL were twice as high)!
Also, if you are taking a statin — you must supplement with at least 100mg of CoQ-10 daily (if not 200-300 mg) as this is depleted in those taking statins. And if you are over 40, it is better to supplement with the ubiquinol form of CoQ-10 (more about this later).
Coming soon: I’ll talk about effective ways to improve your cholesterol health and prevent heart disease. For now, be comforted in knowing that eating foods high in cholesterol and saturated fats such as eggs and uncured bacon, as well as foods high in unsaturated fats such as avocados are a step in the right direction towards these goals.
What does your cholesterol profile look like?
In health and wellness,