By Nadia Marshall
Why we worry about cholesterol...
The seeds of ‘cholesterol anxiety’ are something we all carry with us in our minds, either consciously or unconsciously. You may not be worried about your cholesterol levels right now but if you had a blood test and a bad report card, suddenly you would be worried, wouldn't you?
Why is that?
It all began in the 1950‘s with the ‘Lipid Hypothesis’ - the growing opinion that the consumption of meat and dairy products was responsible for rising rates of heart disease in the U.S. This hypothesis was put forward by epidemiologists who observed that rates of heart disease plummeted during WWII. They guessed that this was perhaps due to the rationing of meat and dairy products. Actual proof of the hypothesis was very thin even by 1977 when the U.S. Senate Select Committee on Nutrition and Human Needs endeavoured to change the diet of a whole population for the first time in history. They issued a set of dietary guidelines encouraging Americans to ‘cut down on their consumption of red meat and dairy products’. This statement prompted enormous criticism from the powerful meat and dairy industries, huge political fall out and, as a result, a permanent shift in dietary announcements.(1)
You may notice today that foods are still never mentioned in food marketing unless the announcement is to ‘eat more of something’. The ‘eat less of something’ announcements only ever relate to nutrients, not wholefoods. This is problematic because the science of nutrition is usually carried out on whole foods, not single nutrients and when it isn’t, it should be!
At about the same time, LDLs (low-density lipoproteins) were discovered. A few years later, in the mid-1970s, it was found that dietary fat raises LDL levels and that high LDLs correlate with cardiovascular disease. So it was concluded dietary cholesterol causes cardiovascular disease (6). And so, the tenuous connection between saturated fats and cholesterol contributing to heart disease and other chronic diseases came about and has changed the way we eat for the last 30 years. It has changed what our GPs have told us, and what pharmaceutical and food companies have sold us.... But is it all true??
Has eating ‘low fat’ made us any healthier?
In a word, no. Since the 1970s, Americans (and Australian’s) haven’t been eating less meat and dairy products but we have been eating less saturated fat and cholesterol. We have also been eating more low-fat, highly-processed, well-marketed foods produced by the food industry! We’ve also been eating more polyunsaturated fats, transfats, refined carbohydrates and high-fructose foods.
As a result of our new diets, we are fatter than we’ve ever been, obesity and diabetes have become epidemic and heart disease rates have increased (although mortality rates have decreased due to advancements in medical interventions)(1).
What does the science say?
In his book, “In Defence of Food”, Michael Pollan reports on a critcal review of by prominent nutrition scientists at the Harvard School of Public Health on types of dietary fat and the risk of coronary heart disease (CHD). The review found, "the amount of saturated fat in the diet may have little, if any bearing on the risk of heart disease, and evidence that increasing polyunsaturated fats in the diet will reduce the risk is slim to nil".(1)
As for the dangers of dietary cholesterol, the review found, "a weak and non- significant positive association between dietary cholesterol and risk of CHD." [Also,] although "a major purported benefit of a low-fat diet is weight loss,’ a review of the literature failed to turn up any convincing evidence of this proposition. To the contrary, it found some evidence that replacing fats in the diet with carbohydrates will lead to weight gain.”(1)
What we don't know yet...
Science has confirmed a link between high rates of cholesterol in the blood and the likelihood of heart disease. What is hasn't yet confirmed is whether high serum cholesterol in the blood is a cause of heart disease or a symptom of it.
One of the major roles of cholesterol in the body is the repair of damaged cells. It makes sense that a damaged heart or damaged arteries might lead to the presence of more cholesterol in the blood. This idea, called the ‘Response to Injury Hypothesis’, was first proposed in 1858 by Rudolf Virchow but not researched again until 1993! (2) Perhaps because noone stood to make any money out of such an idea?
Some more interesting science...
So much attention is given to the tenuous link between cholesterol and heart disease that its role in other diseases, like cancer, is overlooked. In the book, 'Fats Are Good For You and Other Secrets', Jon Kabara PhD writes, "people with especially low levels of cholesterol have higher rather than lower risks of disease".
He describes a 17-year study in Switzerland that found ‘men with the lowest levels of cholesterol have a 70% greater risk of stomach cancer after the age of 60, a 100% greater risk of lung cancer, a 307% greater risk of colon cancer and a 770% greater risk of prostate cancer by the age of 60!
In the book, 'The Great Cholesterol Con', Dr Malcolm Kendrick writes, "a low cholesterol level, especially after the age of 50, significantly increases your risk of dying". He cites a finding from The Framingham Study, the most influential and most oft-quoted study in heart disease research; that there is a direct association between falling cholesterol levels and mortality rate: namely, "a 1mmol/l fall in cholesterol levels is equal to a 429% increase in the risk of total mortality." He puts this in a real-life context, "if your total cholesterol were to fall from 5 to 4 mmol/l, your risk of dying would increase by more than 400 per cent. Not only that, but your risk of dying of cardio vascular disease would increase by 546%".
He then cites an Austrian study, one of the biggest and longest in history, where it was concluded, "in men, across the entire age range (from 20-95 years of age)... and in women from the age of 50 onward only, low cholesterol was significantly associated with all-cause mortality, showing signficant associations with death through cancer, liver diseases and mental diseases." He goes on to mention several more studies and concludes, "under the age of 50, your cholesterol level doesn't really make much difference to your risk of dying. However, if your cholesterol level starts falling, watch out. After the age of 50, a low cholesterol level is associated with a significantly greater overall mortality. The older you get, the more dangerous it is to have a low cholesterol level."
Cholesterol’s role in the body...
Jon Kabara writes, “from an evolutionary point of view, cholesterol is the most sophisticated molecule in our biological world, [is] not found in lower forms of life such as bacteria [and is] an essential component of more complex living beings.” He argues, “all evolutionary changes occur for a definite protective purpose or to gain biological advantage [and from a] teleological argument of evolution, biological systems would not make or require a substance that would be toxic or harmful to it.” Cholesterol plays a critical role in the body. It is the precursor of many substances essential to life including every sex and steroid hormone in the body as well as certain stress hormones; bile acids for digesting fats; cortisol for regulating blood sugar levels; and Vitamin D which is essential for calcium absorption and bone strength. It is also part of the structure of every cell membrane and the highest concentration of cholesterol is found in the brain.
Cholesterol is predominantly created in our livers, from amino acids, carbohydrates and fatty acids. In fact, only about 15% of the cholesterol in our bodies comes from our diets while some 85% is produced by the body.
And, when in balance, our super clever bodies are capable of regulating their own cholesterol levels. When we eat foods high in cholesterol, we produce a little less of it and when we eat less, we produce a little more. If we are consuming excess cholesterol through our diets, the body should technically be able to excrete the excesses. If it isn’t, it is likely our digestion is hampered in some way.... or our diets are genuinely terrible... or most likely both.
LDL vs HDL and testing
You might have heard of LDL vs HDL cholesterol. Actually LDL and HDL refer to lipoproteins that transport cholesterol, rather than cholesterol itself. LDLs are low-density lipo-proteins that carry cholesterol and other lipids to the cells of the body while HDLs are high density lipoproteins that carry cholesterol and other lipids from the cells of the body towards the liver.
The theory is that HDLs are ‘good’ because they take cholesterol out of the blood to be eliminated. LDLs on the other hand are considered ‘bad’ because if large amounts of LDLs are circulating there is a higher chance of fatty substances (not just cholesterol) being deposited on the arterial walls.
That is the theory that is yet to be proved, according to the Harvard School of Public Health. It is agreed that neither lipo-proteins are actually ‘good’ or ‘bad’ as they are both necessary.... but the ratio of the two is said to be significant.
But that's only part of the story. There are actually two types of LDLs. The first type are ‘Pattern A’ Large Buoyant LDLs which are harmless. The second type are ‘Pattern B’ Small Dense LDLs which are small, dense and don't float. These are supposed to be the bad guys - the ones that cause plaque build up in the arteries. But when you have a cholesterol test, your LDLs are measured together. So how do you know whether you have the more harmful ones? The trick is apparently in your triglyceride levels. If you have high LDLs and high triglycerides, you’re more likely to have the bad LDLs whereas if you have high LDLs and low triglyerides, then you most likely have the harmless type.(6)
Dietary fat only raises Pattern A Large Buoyant LDLs. The thing that raises Pattern B Small Dense LDLs is fructose. (6) This is interesting because sugar was rationed during WWII as well. Just saying...
In the book, 'The Great Cholesterol Myth', it says, "..it turns out that fat, especially saturated fat, decreases the amount of these small, dense LDL particles while the widely recommended low-fat diet increases their number. The opposite of the small dense LDLs are the large fluffy LDL particles which are not only not harmful but are actually healthful. But the LDL-lowering drugs lower those too".
The Ayurvedic view...
In Ayurveda, excessively high LDL cholesterol is seen as a cellular intelligence disorder, or more specifically, a metabolic disorder. (7) It is believed to be a warning sign that your Agni (or digestive fire) is imbalanced. This imbalance is usually caused by eating too many difficult-to-digest foods including: excessively sweet food, excessively heavy, cold or dry foods; processed food and stale food; poor food combinations and from other factors that can hamper Agni – such as high stress, no exercise etc.
When Agni is compromised, particularly in the liver, so too is the body’s ability to digest and eliminate excess cholesterol – leading to the build up of undigested cholesterol and other fats in the body. In this way, high LDL levels can be interpreted as a symptom of poor Agni and high Ama (i.e. toxins or undigested food wastes). Interestingly, the description of Pattern B Small Dense LDLs corresponds quite closely to the description of Ama.
If you have very high LDL levels and see an Ayurvedic practitioner, they may recommend decreasing your intake of certain fats (especially transfats), but also sugar (particularly processed sugar and fructose) as well as processed foods generally.
At the same time, they will recommend dietary and lifestyle practices that will improve Agni, reduce Ama and balance your cellular intelligence. They may use specific herbs to aid the process and recommend certain spices in your cooking. Surprisingly, they may also recommend you use ghee (a saturated fat) as your cooking oil of choice. This is because ghee, of all the fats and oils available, is believed to be the lightest, most easily absorbed and metabolized, most Agni-promoting and most appropriate for all constitutions. There are also some scientific studies demonstrating that ghee actually reduces LDL levels.
In terms of Ayurvedic home remedies, fenugreek is great for reducing LDL cholesterol. Soak 1/2 tsp of fenugreek seeds in water overnight. In the morning add 1 tbsp of Aloe Juice and 1/4 tsp of turmeric and consume before breakfast.(7) Garlic is also good for reducing cholesterol so use it regularly in your cooking (cooked garlic is best). (8)
The results are in....
When you next have your cholesterol tested, make sure it is a fasting-test (for better results) and includes a triglyceride test... and when you get the results, make sure you consider the ratio and the triglycerides, not just the individual numbers. Also, consider thinking about your cholesterol in a different way.... your body may be producing larger amounts of cholesterol as a response to stress or injury in the body.
If your LDLs are said to be a little high, but your ratio and triglycerides are fine, don’t freak out. If your LDL levels are high, your triglyceride levels are too and your ratio isn’t great, still don't freak out. Just consider it may be time to explore ways to improve your digestion, reduce stress in your life and eliminate your intake of processed sugar.
You may feel pressured to take pharmaceutical medicines (especially if you have other risk factors for heart disease). By all means, follow your Doctor’s advice but don’t think of high cholesterol as a ‘life sentence’. There's always another way.
Consider working with an Ayurvedic Practitioner for specific dietary recommendations and herbal preparations to reduce ama and improve the cholesterol digestion and elimination capacity of your liver. In this way, you can bring your body back into balance and you most likely won't need to rely on pharmaceutical medications indefinitely.
**Always consult your trusted healthcare practitioner before making any decisions about medication. Also, check out some of the books below for more detailed and specific information, including (3) and (4).**
References:
1. “In Defence of Food” by Michael Pollan
2. “Fats Are Good For You and Other Secrets” by Jon Kabara PhD
3. "The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How To Avoid It" by Dr Malcolm Kendrick
4. "The Great Cholesterol Myth: Why Lowering Your Cholesterol Won't Prevent Heart Disease and the Statin-Free Plan That Will" by Stephen Sinatra and Johnny Bowden
5. Essential of Human Anatomy and Physiology” By Elaine Marieb
6. “The Bitter Truth” http://www.youtube.com/ watch?v=dBnniua6-oM (from 0.30.10-0.39:09)
7. “The Complete Book of Ayurvedic Home Remedies” by Vasant Lad
8. “Ayurvedic Medicine: The Principles of Traditional Practice” by Sebastian Pole
A New View of Cholesterol
