Is Cholesterol a Villain?

What is Cholesterol and do we need to get rid of it?

Cholesterol has become a modern day enemy. It has been associated with heart disease, obesity, stroke, and general poor health. Pharmaceutical companies have launched enormous campaigns pushing cholesterol lowering drugs to millions of people. Doctors have followed their lead by telling their patients they need to lower their numbers and advise against eating cholesterol containing foods. However, many researchers are questioning this dogma and voicing their concerns. For the majority of patients, there still remains some confusion as to exactly what role cholesterol plays in disease. High cholesterol itself is not a disease. It is promoted as a risk factor in both heart disease and stroke but those patient populations don't always have high cholesterol. 

Let’s talk about fat. 

Cholesterol is a fat or a lipid. Lipids are the second most important macronutrient (second to protein) though they vary greatly in their structure and function. They contain only carbon, hydrogen, and oxygen. Lipids are more than just fuel for the body. They insulate, transport, and regulate many biochemical functions and are necessary for absorption of fat-soluble vitamins. There are four main categories of lipids: fatty acids, steroids, fat-soluble lipid vitamins, and terpenes. The most commonly known are triglycerides and their component fatty acids. These are the dietary fats; the salad oils and the animal fats. The main stream media’s push against fat has blurred the distinction between healthy essential lipids, unfavorable lipids, and what their effects on human physiology. “Although they (Eskimos) have one of the highest cholesterol diets in the world they also have one of the lowest incidences of cardiovascular disease” (Holford, 1999). 

We need to understand how dietary cholesterol effects us and what other factors are involved before we focus on eliminating the fats that contain it.

Steroids are large complex lipids. They all have a basic steroid structure, which is three six-carbon rings and one five-carbon ring grouped together. This structure is changed into thousands of unique steroid chemical combinations, one of which is cholesterol. Cholesterol is not intrinsically bad or unhealthy. “Cholesterol is an essential part of every cell structure and is needed for proper brain and nerve function” (Balch & Balch, 2000). It is involved in cellular membrane flexibility comprising up to 50 percent of all cell membrane lipids. It is involved in the biosynthesis of metabolic hormones, sex hormones, bile acids, and vitamin D. Low cholesterol levels are dangerous and can place people in a state of severe health risks such as hemorrhagic stroke. Most people, however, are worried about high levels of cholesterol (greater than 180 milligrams percent). The general public believes that a diet high in saturated fats containing cholesterol will create high levels of blood cholesterol which is not entirely accurate. “Cholesterol in foods does not cause a significant increase in a person’s normal level of blood cholesterol” (Ottoboni & Ottoboni, 2002). A closer look at how cholesterol is stored and metabolized can help us understand this surprising statement.

Cholesterol in the body is transported to the cells where it is either used or stored. The body favors a combination of free cholesterol and fatty acids. These esters of cholesterol are attached to a special kind of protein in the blood plasma and formulate lipid-protein molecules with differing density levels. LDL and HDL (low-density and high-density lipoproteins respectively) are measured to give us an idea of where the cholesterol is going. LDLs carry cholesterol into periphery which can increase the risk of depositing into the arteries. HDLs carry cholesterol away from the arteries for elimination which is why they are considered "good cholesterol." Synthesis of cholesterol occurs throughout the body but primarily by the liver (which is important to consider as cholesterol lowering drugs damage the liver). “Only 25 percent of our cholesterol comes from the foods we eat. We manufacture the rest in our liver” (Lipski, 2000). Production is determined by the body’s need required by its life processes. Ideally, no more than is needed is synthesized. Excess cholesterol is excreted by the liver into the small intestines where it joins our feces for elimination (which is why a high fiber diet can help remove cholesterol from the intestines). We should be able to maintain constant levels of blood cholesterol regardless of our dietary intake. Since cholesterol is mostly produced by the liver there is always a possibility of liver dysfunction when cholesterol levels are abnormal. It is crucial to comprehend that elevation of plasma cholesterol occurs when our system is stimulated to produce more cholesterol, not necessarily from consuming more cholesterol containing foods. “It is extremely important for people who have high cholesterol levels to understand that most cholesterol in the blood is manufactured by their own body’s biochemistry” (Ottoboni & Ottoboni, 2002). Instead of avoiding cholesterol in our diets, it is vital to avoid the agents that stimulate excess production of cholesterol from the liver.

“Carbohydrates in general, and fructose in particular, stimulate the production of cholesterol” (Ottoboni & Ottoboni, 2002). Unless a person has familial hypercholesterolemia, dietary changes should be addressed first (instead of drug therapy) in order to prevent or reduce high cholesterol levels.

Sucrose (table sugar) is a disaccharide containing glucose and fructose. This form of fructose is unfriendly and bypasses glycolysis, which is basically the process that turns sugar into usable energy. Instead, this fructose is channeled into a number of biochemical pathways and becomes an end product known as acetyl CoA. Too much acetyl CoA overloads another metabolic process called the krebs cycle and is deferred to a part of the body where insulin from the pancreas is involved. A greater consumption of sugar stimulates more insulin which creates two new pathways for the removal of excess acetyl CoA. One pathway synthesizes body fat. The other turns into HMG CoA which triggers the production of cholesterol.

“The bottom line is that excess sugar and refined carbohydrates in the diet, not the saturated or cholesterol content of food, are the major cause of high cholesterol levels in the blood” (Ottoboni & Ottoboni, 2002).

The most effective approach to the reduction of cholesterol is to eliminate (or greatly reduce) foods that quickly turn into blood sugar. Glycemic index refers to the rate at which food turns into blood sugar. Charts and books are easily obtained listing foods by their glycemic index. The lower the index, the less likely it is to stimulate insulin secretion and ultimately begin cholesterol synthesis. It is also important to limit quantities of any carbohydrate containing foods. Fruits and vegetables are low index carbohydrate foods that transport essential nutrients (vitamins and minerals) into the body making them an ideal source of energy and nutrition. Carbohydrates themselves are nonessential because our bodies do not need them for survival (our bodies can produce glucose internally). Our carbohydrate consumption should only increase in direct proportion to our activity level. If you run marathons, you can increase your quantity of low glycemic index carbohydrates without negative effects. The average person, however, is mostly sedentary and requires very little extra carbohydrates to sustain healthy energy levels. If too little carbohydrates are eaten (a rare situation) then valuable protein stores (muscle) will be sacrificed for energy. “The minimum amount of carbohydrates needed to spare protein has been estimated to be 20 calories of carbohydrates for each 100 calories of diet, which translates to 20 percent of the diet” (Ottoboni & Ottoboni, 2002). Stick with fruits and vegetables and add only small quantities of complex carbohydrates (like grains) for personal satisfaction.

Modern agriculture is mass producing fruits and vegetables with lower nutrients. A basic supply of vitamins and minerals helps the body to self regulate many processes including balancing cholesterol metabolism. It would be good insurance to begin taking a whole foods multivitamin, mineral, vitamin C, and B complex supplements. “Once again, multivitamin and mineral programs are highly effective at achieving this ideal cholesterol balance” (Holford, 1999).

Additional foods that have been found helpful in lowering cholesterol are apples, bananas, carrots, cold-water fish, garlic, grapefruit, and olive oil. “Carrot juice helps to flush out the fat from the bile in the liver and this helps lower cholesterol” (Balch & Balch, 2000). Cayenne, goldenseal, hawthorn berries, and spirulina have been shown to lower cholesterol, but seek advice from a professional before beginning any supplement program.

Statin drugs reduce cholesterol levels by blocking the last biochemical pathway for the end product of sugar, acetyl CoA, into HMG CoA. This prevents the trigger of cholesterol synthesis but instead channels all excess acetyl CoA into production of body fat. These drugs make it more difficult to lose weight and do not address destructive eating habits. A good strategy is to address dietary changes first. Use drug intervention as a last resort and only after cholesterol levels have been brought down as much as possible by diet. Perhaps, at that point, drugs will not be needed. 

“The body will not make excess cholesterol or body fat if there is not excess carbohydrates in the diet to stimulate the process” (Ottoboni & Ottoboni, 2002).

So put aside your pastas, breads, potatoes, and rice. Leave your sweets for special occasions only. Absolutely throw away those soft drinks and especially beware of anything made with high fructose corn syrup! Read labels and eliminate products with sugar added or with a high carbohydrate count. Your vitality is in your hands. If you use this information and take action, you will increase your health and ultimately the quality of your life.