What is cholesterol? Firstly, despite what you have previously believed, cholesterol isn’t evil and in fact we can’t live without it. Dr Malcolm Kendrick writes in The Great Cholesterol Con, “Why do you think that an egg yolk is full of cholesterol? Answer: Because it takes one hell of a lot of cholesterol to build a healthy chicken.
It also takes one hell of a lot of cholesterol to build, and maintain, a healthy human being”. Although there are many more, let me give just two reasons why we need cholesterol. Later you will read about how vital it is to get out in the sun, as it provides an invaluable source of vitamin D - which among other things helps to prevent certain cancers. The vitamin D delivered by sunshine is actually created (synthesised) by cholesterol. And we would not be here at all without cholesterol, as it is a building block for most sex hormones.
However, while cholesterol is essential for life, some doctors believe that it can become dangerous, by assembling inside our arteries. Known as atherosclerosis, this is a disease in which plaque builds up inside our arteries (blood vessels that carry oxygen- rich blood to our heart and other parts of our body). It starts off with a gunk-like substance that can eventually calcify, making the arteries stiff and narrow. Nobody knows how long this takes, but it is believed to be a couple of decades. However, the most dangerous period seems to be before the arteries calcify. This intermediate stage is known as unstable plaque. These plaques don’t just build-up in arteries leading to the heart (the coronary arteries), but in many other areas of the body too.
When plaques build up in the carotid arteries in the neck they often break off into chunks and are carried in the arteries towards the brain. As they get into the smaller arteries they get stuck, and the result is often a stroke.
If we simplify it a little, there are four main cholesterol measurements we might get from our doctor:
- The good cholesterol (HDL – high-density lipoproteins)
- The so-called bad cholesterol (LDL – low-density lipoproteins)
- The ratio between our good and so-called bad cholesterol
- Total cholesterol
Lipoproteins are made of fat (a.k.a. lipo) and proteins. Our body produces three main types of lipoproteins: Very low-density lipoproteins (VLDL), low-density (LDL) and high-density (HDL). The amount of lipid (fat) in a lipoprotein is what affects its density. Fat is less dense and lighter in weight than protein and as a result LDLs contain more lipid relative to protein. Fundamentally, LDLs carry cholesterol into blood vessels, while HDLs transport them out of the body.
So the burning question is not what causes high cholesterol per se, but what causes the so called bad guy, LDL. It appears that it’s not by avoiding certain foods that are themselves high in cholesterol. It turns out that the biggest preventative measures we can take are to lose weight, exercise and avoid excessive levels of stress. I confess that when I was diagnosed with high levels of LDL cholesterol, I was the heaviest I had ever been and after launching a new company just several months before my medical examination, I was so stressed out, and working such long hours that I had no time to exercise. From personal experience I fully agree with the current thinking on the causes of elevated LDL cholesterol.
Dr Aseem Malhotra
I co-authored some original research with Malcolm Kendrick and 16 international scientists, where we looked at the association of the so-called bad cholesterol LDL, with heart disease in people aged over the age of 60. So, one: we found no association and two: strangely, there was an inverse association with death. In other words, the higher your LDL, the less likely you were to die. I remember when we published the paper, I wrote about it in The Telegraph and I talked about a lady who came to see me. She was in her early 60s, and when she walked into the consultation room, she was as white as a ghost. I asked her what was wrong and she said she was really worried because her doctor had told her that her cholesterol was high. I turned to her and said, congratulations, you are going to live longer. I explained everything to her, and she left the consultation reassured and happy.
Repeatedly you will hear at Health Results, that CARBS pile on the weight, and constantly scoffing rather than giving our body a break from eating prevents the body from going into self-repair mode so, indirectly, LDL is fuelled by CARBS and by not fasting. All that said, it appears obsessing about cholesterol levels, whether it be total cholesterol or bad LDL, might actually be barking up the wrong tree. A tree that is making the pharmaceutical industry super rich. Statin business is big business. It’s now a £23 billion industry, with more than 40 million people around the world currently being prescribed the drug.
An interview with cholesterol expert Barry Groves PhD, which can be found online, indicates that there is more evidence to support that an overall low cholesterol level is actually more harmful than overall high cholesterol. He cites recent research, which suggests that a low cholesterol increases the risk of numerous other diseases and, overall, leads to an earlier death. He explains that we are more likely to get infectious diseases, cancer or Alzheimer’s if our cholesterol is too low.
Here is another huge medical U-turn. Until recently, virtually the entire medical professional arrived at the same hypothesis about how to avoid cholesterol. The hypothesis went something like this: “When we consume too much food containing cholesterol, the cholesterol levels in our blood will rise too.” But the hypothesis is wrong. It is now believed that, just like eating fat does not make us fat, reducing our intake of cholesterol does not lower blood cholesterol. So avoiding eggs, prawns and meat, all of which are high in cholesterol, isn’t necessary even if you have a high cholesterol level (which might turn out to be a good thing anyway).
If you are already on statins for high cholesterol, one of the best things you could ever do for your health is to quickly go out and buy The Great Cholesterol Con, and form your own opinion whether the £23 billion statin industry may have led you up the wrong path. Or consider research carried out in 2009 that revealed how Switzerland had the highest levels of cholesterol in the world, but the 4th lowest rate of death from CVD. Or consider the ‘HUNT2 Study’ in Norway. A study of 50,000 people over 15 years actually found the opposite to what your doctor might tell you, in the fact that older people with a higher LDL lived as long, if not longer!
Dr Malcolm Kendrick
LDL, the so-called bad cholesterol, cannot penetrate the endothelium, which is the internal single lining of all blood vessels, including veins, arteries, small arteries, arterials and capillaries. And if it can’t get past the endothelium, then it can’t get into the artery wall, and therefore it can’t be the cause of heart disease. Now that’s a very simple idea, but I must have read 20,000 papers trying to understand the function and relationship of the endothelium and LDL and could it get through or could it not get through. I think a huge pack of wolves have been howling at the wrong forest.
Dr Aseem Malhotra
Scientists universally accept that trans-fats – found in many fast foods, bakery products and margarine – increase the risk of cardiovascular disease through inflammatory processes. But saturated fat is another story. The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades. Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks. Furthermore, the government’s obsession with levels of total cholesterol, which has led to the overmedication of millions of people with statins, has diverted our attention from the more egregious risk factors.
If you have very high LDL, or want to reduce it just to keep your doctor happy, then before making a lifelong commitment to funding the pharmaceutical companies, why not try eating more of the following foods:
- Oily fish
- Nuts (especially walnuts and almonds)
- Coconut and coconut oil
- Olives and olive oil
- Dark chocolate