Cholesterol

The Truth About Cholesterol

You could call the near-epidemic condition cholesterolphobia.

Cholesterol, along with saturated fat, have for decades been the bogeymen of heart disease. But for most people, dietary cholesterol probably doesn’t matter. In fact, worrying about the amount of cholesterol in your diet is as absurd as fretting about drinking too much water. Why? Because cholesterol is essential for health.

Cholesterol is a key building block of our steroid hormones, including estrogen and testosterone. Without cholesterol and steroid hormones, there would be no romance in the world, and you wouldn’t be able to have sex or make babies. You also need cholesterol to make bile, which enables you to digest fats, and to produce vitamin D. In fact, every cell in your body needs cholesterol to form part of its membrane, or cell wall. And the so-called “bad” low-density lipoprotein (LDL) form of cholesterol? You need it to transport the very important fat-soluble nutrients—vitamins A, D, E, and K, and coenzyme Q10 (CoQ10)—through the bloodstream and throughout the body.

Dubious Origins

The link between cholesterol (and saturated fat) and the risk of heart disease grew largely out of studies by the late Ancel Keys, Ph.D., at the University of Minnesota. Keys cherry-picked research to support his argument that cholesterol and saturated fat were causes of heart disease. Then, in 1977, a well-meaning Senator George McGovern (yes, a politician, not a nutrition expert) recommended that Americans adopt diets low in saturated fat and high in carbohydrates to lower the risk of heart disease. But diets high in refined carbs and low in fat increased the incidence of obesity, prediabetes, and type-2 diabetes—each of which boosts the risk of heart disease.

By the early 1990s, the medical community was quietly growing skeptical of the role of cholesterol as a cause of heart disease. Then cholesterol-lowering statin drugs hit the market, backed up by billions of persuasive dollars in marketing and advertising—and the cholesterol theory of heart disease was resuscitated. Sales of Lipitor®, the best selling of all the statin drugs, grew year by year, eventually topping out at $13 billion in annual revenues.

Even the strongest link between cholesterol—LDL, specifically—and heart disease has been sadly misunderstood. LDL is not inherently bad. It becomes unhealthy only when oxidized—that is, when damaged by hazardous molecules called free radicals. Oxidized LDL is really a sign of an antioxidant deficiency, which vitamin E and other nutrients can prevent and correct.

Dietary Issues, But Not Cholesterol

The ongoing obsession with cholesterol ignores the fact that heart disease has no single primary cause. Its etiology is multi-factorial. Abnormally elevated cholesterol is a symptom, a sign that something is wrong, but that doesn’t mean it is a cause. Eating foods with trans fats boosts cholesterol levels, and trans fats are known to increase the risk of heart disease. Aside from their own damaging effects, trans fats, found in processed foods, are also a marker of less-than-stellar eating habits. Stress and a lack of exercise raise cholesterol levels. Eating too many refined sugars and other types of processed carbs boosts blood cholesterol levels, along with triglycerides, a type of fat-sugar molecule linked to heart disease risk.

In fact, the majority of risk factors for heart disease directly or indirectly point to poor eating habits. Elevated blood levels of homocysteine reflect low intake of folate and vitamins B6 and B12—or all three nutrients. A high level of C-reactive protein is a sign of a pro-inflammatory diet (i.e., junk foods, refined carbs, sugar), not eating enough vegetables, being overweight, or having high blood sugar levels. Being overweight or obese, or having prediabetes or type-2 diabetes, are the leading risk factors for heart disease—and these conditions are all caused by poor eating habits.

No rational person can realistically believe that a cholesterol-lowering drug is a “cure” for eating unhealthy foods and being a couch potato.

Diet

There are two keys to healthy eating. One is eating a lot of vegetables—not just quantity but also a diverse selection of veggies, which will provide a broad range of antioxidants and other nutrients, including fiber. The other is eating mostly fresh foods and avoiding processed foods, including microwave meals and fast foods.

Physical activity

Don’t think of it as exercise. Rather, simply get moving. Walking is a superb form of physical activity. Take the stairs instead of riding an elevator for just a floor or two. Use hand weights to build up your arm muscles. Little by little, increase your level of physical activity.

Heart-Friendly Supplements

There are a number of dietary supplements that maintain and support good cardiovascular health—no statins needed. Some of them are listed below.

Omega-3s

Countless studies have found that a high intake of omega-3s—from fish or supplements—reduces the risk of coronary heart disease. The omega-3s are mild blood thinners, slow the heart rate, improve heart rhythm, and increase blood-vessel flexibility. [1] [2] Earlier this year, studies found that fish oils also reduce neurovascular stress—the type of emotional stress that can increase the risk of heart disease.[3] [4] Try 1-3 grams of omega-3s daily.

Vitamin E

The principal fat-soluble antioxidant in the body, vitamin E protects against the free-radical oxidation of LDL cholesterol. People who eat a lot of unhealthy fats (e.g., trans fats and vegetable oils) have a higher risk of LDL oxidation and therefore need more vitamin E. Try 200 to 400 IU of natural-source vitamin E.

Antioxidants

In addition to vitamin E, a diverse selection of antioxidants can help reduce the risk of coronary heart disease. For example, in one recent study, researchers found that a high intake of antioxidant flavonoids was associated with a 72 percent lower risk of death from vascular disease in women.[5] Try a multi-antioxidant supplement.

B Vitamins

Several B vitamins, including folic acid, B6, and B12, are needed to regulate a fundamental biochemical process known as methylation. When these nutrients are in short supply, blood levels of homocysteine (a byproduct of methylation) can increase and damage arteries and other blood vessels. Try either a B-complex supplement or a multivitamin (which contains the B complex).

Magnesium

This essential mineral plays key roles in more than 300 different biochemical processes in the body, including the regulation of heartbeat. In a new study, researchers at the Harvard University School of Public Health determined that high blood levels of magnesium are associated with a 30 percent lower risk of developing cardiovascular diseases, including ischemic heart disease.[6] Try 300-400 mg daily.

Vitamin D

Researchers at Massachusetts General Hospital found that people with low levels of vitamin D were 62 percent more likely to experience a heart attack, heart failure, or stroke. In addition, people with low vitamin D levels were twice as likely to have hypertension, compared with people who had the highest levels of the vitamin.[7] Try 4,000-5,000 IU daily.

Coenzyme Q10

This nutrient is needed to produce energy in heart cells (and all other cells in the body). In a Danish study of people with heart failure, CoQ10 reduced the risk of serious cardiovascular problems and death by about half.[8] Try 100-300 mg daily of CoQ10, or half that amount of the ubiquinol form of the nutrient.

Vitamin K

Calcium deposits in the walls of blood vessels can lead to arterial calcification, which contributes to hardening of the arteries. The risk of arterial calcification increases when a person is deficient in vitamin K (particularly the K2 form of the vitamin), because the vitamin regulates where calcium is deposited in the body. In a study at Tufts University, Boston, researchers asked 388 healthy men and postmenopausal women to take multivitamins with and without 500 mcg of vitamin K for three years. People getting the extra vitamin K benefited from 6 percent less arterial calcification.[9] Try 500 mcg of vitamin K1 or 150 mcg of vitamin K2 (MK-7 form). Do not take vitamin K if you take the drug Coumadin® (warfarin).

The Truth About Statins

Statin drugs, such as Lipitor® and Crestor®, may be among the most dangerous drugs prescribed. They work by inhibiting an enzyme, HMG-CoA reductase, which the body uses to make cholesterol. But by interfering with this enzyme, statins also block the production of two other crucial substances, squalene and vitamin-like coenzyme Q10 (CoQ10). Squalene appears to offer protection against at least some types of cancer.[10] Meanwhile, CoQ10 is needed to make energy in every cell of the body, including heart cells. One of the risks of low CoQ10 levels is heart failure, in which the heart cannot muster sufficient energy to pump blood.

The most common side effect of statins is myalgia, or muscle pain. By conventional medical estimates, myalgia and myopathy (a general term for muscle disease) develop in 10 percent of statin users, but the actual number is probably higher. In one study, more than half of the subjects suffered statin-induced muscle damage.[11] [12] According to some research, microscopic signs of muscle damage occur within days of taking statins.[13] Bear in mind that the heart is a muscle.

Rhabdomyolysis, which is a wasting away of muscle, occurs less frequently than myalgia but it is far more serious. Its symptoms range in severity, from mild to serious muscle pain and weakness, and may also include dark-colored urine from the breakdown of muscle. Statin-induced rhabdomyolysis is sometimes called “statin myopathy.”

There’s evidence that these side effects of statins are related in large part to the suppression of CoQ10 production. The drug companies have been aware of the risks of statins since 1990, which is when Merck, maker of the statin drug Zocor®, was granted two patents for using CoQ10 in treating statin-related myopathies.

There are still other problems with statins. They increase the risk of developing type-2 diabetes, possibly by interfering with liver function.[14] (The liver and pancreas work together to regulate blood sugar.) Statins reduce the health benefits of exercise, and they affect memory as well.[15] [16] A new study also found that statins likely negate the health benefits of omega-3 fish oils.[17]

If you’re still concerned about your cholesterol levels and want a natural and safer alternative to a statin drug, consider these supplements:

Red yeast rice extract

This product, obtained from a type of yeast that grows on rice, contains trace amounts of a naturally occurring statin that appears safe. Try 600 to 1,200 mg daily.

Beta-sitosterol

This plant-sourced compound reduces absorption of cholesterol from the gut. Try 1.3 to 3.6 grams daily.

Pantethine

Related to the B-vitamin pantothenic acid, this supplement can also reduce cholesterol levels. Try 200 to 300 mg, three times daily.

Magnesium

A lack of this essential dietary mineral can sometimes result in high cholesterol levels. Try 300 to 400 mg daily.

Niacin

This particular form of vitamin B3 lowers total cholesterol and LDL cholesterol—and unlike drugs it also raises HDL cholesterol.[18] Note that niacin causes an intense flushing sensation that lasts for about one hour after consumption. Try 500 to 1,000 mg daily.

Coenzyme Q10

Finally, if you are taking a statin drug, it is very important to take CoQ10 or its ubiquinol form, especially if you have had side effects from the statin drug. [19] [20] Try 100 to 300 mg daily.


References

[1] Leaf A, Xiao YF, Kang JX, et al. Membrane effects of the n-3 fish oil fatty acids, which prevent fatal ventricular arrhythmias. Journal of Membrane Biology, 2005;206:129-139.

[2] Walser B, Giordano RM, Stebbins CL Supplementation with omega-3 polyunsaturated fatty acids augments brachial artery dilation and blood flow during forearm contraction. European Journal of Applied Physiology, 2006: epub ahead of print.

[3] Carter JR, Schwartz CE, Yang H, et al. Fish and neurovascular reactivity to mental stress in humans. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 2013;304:R523-30.

[4] Xin W, Wei W, Li XY. Short-term effects of fish oil supplementation on heart rate variability in humans: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 2013;97:926-935.

[5] Ivey KL, Lewis JR, Prince RL, et al. Tea and non-tea flavonol intakes in relation to atherosclerotic vascular disease mortality in older women. Br J Nutr, 2013:1-8: epub ahead of print.

[6] Del Gobbo LC, Imamura F, Wu JHY, et al. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition, 2013:doi 10.3945/ajcn.112.053132.

[7] Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation, 2008;117:503-511.

[8] Mortensen SA, Kumar A, Dolliner P, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure. Results from the Q-SYMBIO study. European Journal of Heart Failure, 2013;15, S20: # 440.

[9] Shea MK, O’Donnell CJ, Hoffmann U, et al. Vitamin K supplementation and progression of coronary artery calcium in older men and women. American Journal of Clinical Nutrition, 2009;89:1799-1807.

[10] Rao CV, Newmark HL, Reddy BS. Chemopreventive effect of squalene on colon cancer. Carcinogenesis, 1998;19:287-290.

[11] Mohaupt MG, Karas RH, Babiychuk EB, et al. Association between statin-associated myopathy and skeletal muscle damage. Canadian Medical Association Journal, 2009;181:E11-E18.

[12] Mohaupt MG, Karas RH, Babiychuk EB, et al. Association between statin-associated myopathy and skeletal muscle damage. Canadian Medical Association Journal, 2009;181:E11-E18.

[13] Baker SK, Tarnopolsky MA. Statin myopathies: pathophysiologic and clinical perspectives. Clin Invest Med, 2001;24:258-272. {Note chart on p 261}

[14] Huupponen R, Viikari J. Statins and the risk of developing diabetes. BMJ, 2013: doi http://dx.doi.org/10.1136/bmj.f3156

[15] Mikus CR, Boyle LJ, Borengasser SJ, et al. Simvastatin impairs exercise training adaptations. J Am Coll Cardiol, 2013: doi pii: S0735-1097(13)01403-4. 10.1016/j.jacc.2013.02.074.

[16] Kraft R, Kahn A, Medina-Franco JL, et al. A cell-based fascin bioassay identifies compounds with potential anti- metastasis or cognition-enhancing functions. Disease Models & Mechanisms, 2012; 6 (1): 217 DOI: 10.1242/dmm.008243

[17] de Lorgeril M, Salen P, Defaye P, et al. Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3? BMC Med, 2013: doi 10.1186/1741-7015-11-5.

[18] Carlson LA. Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. Journal of Internal Medicine, 2005 Aug;258:94-114.

[19] Langsjoen PH, Langsjoen AM. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. BioFactors, 2003;18:101-111.

[20] Langsjoen PH, Langsjoen JO, Langsjoen AM, Lucas LA. Treatment of statin adverse effects with supplemental coenzyme Q10 and statin drug discontinuation. BioFactors, 2005;25:147-152.