Busting the “bad” cholesterol myth

Most of us seniors have grown into adulthood “knowing” that total cholesterol levels over 200 “cause” premature death from cardiovascular disease.  Like most medical facts, the truth is complex, nuanced and dependent on multiple variables.  It is intuitively obvious that cardiovascular disease is more complex than the number 200.  I hope we can agree on that.  I have a family of Finnish patients who are hearty athletes (the type that skin up the mountain for spring skiing long after the lifts are closed) and they all have total cholesterol in the 600s.  The idea that cholesterol levels directly contribute to premature (before age 65) cardio-vascular disease (CVD) started in a small town in Massachusetts in 1948.  The Framingham Heart Study is a long-term, ongoing cardiovascular study on residents of that town which began with 5,209 adult subjects and has been conducted in three generations of participants. The study has been used to identify risk factors for cardiovascular disease. One of the myths that the study debunked is that the higher your cholesterol, the shorter your lifespan. In fact, in the Framingham Study, the people who actually lived the longest had the highest cholesterol.

That is not to say that high cholesterol is never a problem.  But it’s more complicated than just cholesterol — it’s also cardiac tone (fitness level) and positive outlook (protective) and access to good nutrition and clean water.  The initial phases of the Framingham study showed a slight correlation between high total cholesterol and premature CVD, which was later reversed with higher numbers of participants and more sophisticated data analysis.  However, the pharmaceutical industry, which excels in the “silver bullet” approach to health, latched onto this potential target for CVD (a huge market, since CVD is the leading cause of death in the US, second only to cancer).  The era of statins was ushered in starting in the late 1990s and Lipitor (atorvastatin) has the dubious distinction of being the first drug to be dubbed a “blockbuster,” earning Pfizer worldwide sales of more than US$12 billion a year for many years until the patent expired.

Our brains are largely made of cholesterol, an important molecule without which there would be no mammalian life.  Cholesterol is produced in the liver and has many critical functions.  For example, every cell of the 3 trillion plus cells in a human body is surrounded by a double layer of cholesterol to protect the internal environment of the cell, including the nucleus with our DNA master print for tissue repair and rejuvenation, the mitochondria which pump out energy, and the filtering/cleansing effects of the cytoplasm.  This is why folks taking statins long term have a higher risk for cancer.  If cholesterol production in the liver is hampered, there will not be enough to repair cell walls, and they become more permeable to toxins and other agents of disease.  Further, cholesterol is the “mother hormone” from which all our steroidal hormones directly derive: progesterone, testosterone, estrogen, cortisol.  Which is why taking statins absolutely lowers testosterone levels.

There really is no such thing as “good” or “bad” cholesterol.  The so-called good cholesterol, HDL (high density lipoprotein) collects fat from around the body and brings it back to the liver through the bloodstream to be reprocessed.  The so-called bad cholesterol, LDL (low density lipoprotein) delivers fresh cholesterol out to the body where it is needed for brain and cell wall repair, production of myelin sheath around nerves, hormone production, and more.

Think of cholesterol as a liquid band aid.  It goes where it needs to go to improve cellular and tissue integrity, and to make our hormones.  The way high cholesterol can contribute to cardiovascular disease is when it becomes atherosclerotic plaque.  The reason nutritionally oriented healthcare professionals are constantly admonishing you to eat your fruits and vegetables (especially the veggies) is because the rainbow array of healing pigments, as well as vitamins, minerals, and fiber in vegetables are critical to keeping the interior of our arteries nice and smooth.  Every night during deep sleep, tissue repair occurs.  This includes the inner lining of our blood vessels which can get a bit dinged up by microbes or improperly digested food or heavy metals.  Cholesterol lays down a smoothing layer to try to prevent the insides of our arteries from turning into Velcro.  However, if we persist in not eating veggies or don’t get enough sleep or have high stress, the vessels will get tacky and eventually start to attract not only cholesterol but also calcium and bacteria.  It’s kind of like the plaque on your teeth (calcium and bacteria), but vascular plaque also contains cholesterol.  Which is why it was targeted in the silver bullet fashion over 25 years ago.   Sadly, that concept is not only too simplistic but has caused damage through increased rates of cancer, and more rapid progression to dementia.  Remember your brain is largely made of cholesterol.

There is one type of cholesterol that is emerging as a true risk factor: Lipoprotein A.  Folks with high Lp(a) have a 3 times greater risk for aortic stenosis, a 3-4 times greater risk of heart attack, and a 5 times greater risk for coronary artery stenosis.  This can be measured, and tends to be genetic, and the reason you haven’t heard much about it is because there is no drug (yet) to reliably lower Lp(a).  Nevertheless, judicious lifestyle remains the best bet for your goal of healthy longevity.