By: Paul Garcia DC
In my last post, I discussed how cholesterol is often misunderstood and considered a dangerous molecule or the root of all evil (at least when it comes to heart disease)! But in actuality, it’s a vital substance needed for life itself. I discussed the crucial role cholesterol plays in your physiology, how it’s a poor marker for heart disease and how low cholesterol is actually associated with higher mortality rates in most people. If you missed it you can read it here.
In part two of this series I will review why cholesterol has received this bad rap by explaining how it can change from a healthy, protective and life-sustaining nutrient into a potentially harmful or even deadly foe. Understanding this concept is the key to protecting your blood vessels and heart from disease. Failing to understand this will result in countless individuals being convinced to take dangerous cholesterol lowering drugs and suffering the unfortunate consequences.
What’s important to understand is that in it’s natural state (the way the body manufactures it) cholesterol has never been shown to “cause” heart disease. I know this fact may come as a shock to many, but there has NEVER been a published study proving high cholesterol alone causes heart disease.
Let’s look at it like this. I’m sure we can all agree that the chicken pox virus causes chicken pox. In fact, there has never been a case of the chicken pox where doctors were unable to find evidence of the chicken pox virus. However, this same argument can not be made in the case of cholesterol and heart disease. We know that only about half of all heart attack victims have high cholesterol, so obviously many people with normal or low cholesterol still develop heart disease. What’s even more surprising is there are plenty of people with significantly high levels of cholesterol that don’t have heart disease. So it’s not accurate to say that high cholesterol, by itself, causes heart disease. There has to be more to the story. Let’s talk about the missing piece to this puzzle.
Our body produces most of the cholesterol (at least 75%) in our blood at any given time and I would argue that it knows better than to manufacture a substance that could kill us. However, if something about cholesterol changes, like if it gets damaged or becomes “oxidized”, then all bets are off. That’s exactly what the scientific literature is showing, it’s the oxidized cholesterol that triggers heart disease.
Oxidation, in this case, refers to the chemical process by which fats in the body go bad or turn rancid. Just like a jar of vegetable oil will go rancid if left open and exposed to oxygen for too long, some fats in the body (like cholesterol) can go bad as well. When cholesterol becomes oxidized in the blood it has been shown to cause heart disease.
This study found the predictability for heart disease was 76% for individuals with high oxidized cholesterol (55% for men and 81% for women) compared with 20% (24% for men and 12% for women) for all other risk factors including total cholesterol, blood pressure, diabetes, and smoking. When high oxidized cholesterol and these other risk factors were combined, ninety-four percent of the subjects had cardiovascular disease (94% of the men and 100% of the women).
This one found that participants with high oxidized cholesterol had a 4.25 times higher risk of having a heart attack than patients with lower oxidized cholesterol. They concluded that “plasma oxidized cholesterol was the strongest predictor of coronary heart disease(CHD) compared with a conventional cholesterol profile and other traditional risk factors for CHD.”
This one and this one show just how oxidized cholesterol does it’s damage. Once cholesterol becomes oxidized it becomes pro-inflammatory, damages the blood vessel walls, and becomes capable of transforming white blood cells into foam cells, a major component of arterial plaque.
But if cholesterol does not become oxidized, if it remains in the natural state it was originally intended, it’s unlikely to result in any arterial damage at all.
Another factor we need to look at is the size of your cholesterol particles (or the proteins that carry cholesterol through your blood to be more accurate). Cholesterol, like all fat, is not water-soluble and does not dissolve in blood. This means it needs help getting circulated around the body. LDL and HDL (which you may have seen on a blood test) are lipoproteins that transport cholesterol through the blood like a taxi carries passengers. These lipoproteins are commonly referred to as the “good” and “bad” cholesterol, but this is not accurate because LDL and HDL are both absolutely necessary for normal physiology. What can be good or bad about LDL or HDL is their size. Each of these lipoproteins come in different sizes, some are small and dense and others are large and fluffy. The small, dense lipoproteins can more easily penetrate through the arterial lining and cause damage to the blood vessels walls (BAD), where as the large fluffy ones flow smoothly through the circulatory system without doing any harm(GOOD).
This study found that small, dense LDL particles are three times more likely to cause heart disease compared to normal LDL. Think of small, dense LDL like a baseball and large, fluffy LDL like a beach ball. Which one will do more damage if thrown at your head?
Another problem with small, dense LDL is that it’s more likely to oxidize. This study showed the smaller and denser the LDL is, the faster it becomes oxidized. And we know how bad oxidized cholesterol is!
So now we know that the small, dense and oxidized LDL cholesterol can cause harm and the large, fluffy LDL are perfectly safe and even essential for good health. The next question is what causes LDL to get small, dense and oxidized?
In part 3 of this series I’ll cover exactly what causes cholesterol to become oxidized, what leads to small, dense LDL particles and what you can do to prevent this from happening (you’ll love part 3 if you’re a fan of bacon and butter).
Please leave your comments and questions below and I will personally respond.