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The Cholesterol Myth
by Dr. David Ramaley

Perhaps one of the biggest health myths propagated in the United States is the correlation between elevated cholesterol and cardiovascular disease (CVD). Our nation has become obsessed with eating foods low in cholesterol and fat. Ask almost anyone, and they can tell you their cholesterol levels. Most likely you have a friend or relative taking a statin drug (Lipitor, Mevecor, Crestor, etc.) to lower cholesterol. Statin medications are the number-one-selling drugs in the world. Unfortunately, despite dozens of studies, cholesterol has not been shown to actually cause CVD. To the contrary, cholesterol is vital to our survival, and trying to artificially lower it can have detrimental effects, particularly as we age.

The whole discussion of cholesterol and CVD began in the mid-1950s when Ancel Keys, a professor at the University of Minneapolis, presented his Seven Countries Study on CVD. He compared data on cholesterol, fat and heart disease in seven countries and concluded that cholesterol and fat are indicators for CVD. However, according to cholesterol researcher Malcolm Kendrick, M.D., Keys chose seven countries whose data supported his theories. If Keys had chosen seven different countries, he would have discovered that higher levels of cholesterol and fat actually lower the incidence of CVD.

The Framingham study, which began in 1948, is one of the most extensive studies on CVD. It has tracked the medical history of over 5,200 residents of Framingham, Massachusetts. In 1979, the authors of the study concluded that there was a greater risk of CVD for those under 50 years old who had higher levels of total serum cholesterol. This finding further propelled the cholesterol myth. In 1987, however, according to the same authors, those residents over 50 years old whose cholesterol had decreased during the study experienced an increase in total mortality and CVD.

What can be said about elevated total cholesterol is that men under 50 years of age who are at very high risk for heart disease may benefit from lowering their cholesterol. But after the age of 50, the evidence shows the opposite. According to the Honolulu Heart Program and the Multiple Risk Factor Intervention Trial, those over 50 years old with the lowest cholesterol levels had the highest rate of mortality.

In fact, cholesterol is needed to make hormones. Without it we would not produce estrogen, progesterone or testosterone. It is vital for the functioning of nerve synapses and provides the structural integrity for our cell membranes. Cholesterol is used by the skin to help prevent water evaporation and to make our skin waterproof. Vitamin D is synthesized from cholesterol. And bile, used for fat digestion, consists mostly of cholesterol. The liver produces about 90 percent of the cholesterol in our bodies; only 10 percent comes from diet. If we eat too much cholesterol, the liver decreases the output of cholesterol.

In our myopic view of CVD and cholesterol levels, other important indicators are overlooked. Studies are showing that lab tests should be more comprehensive and include the following tests in addition to cholesterol levels:

Apolipoproteins: These are molecules that are found in the gut and liver. They carry cholesterol throughout the body, so they determine how much cholesterol is deposited in the tissues. I suggest measuring apolipoprotein A1 (the good stuff that carries the bad stuff away from the arteries) and apolipoprotein B (the bad stuff). Several studies have shown these to be much better predictors of heart disease. The ratio between apoA1 and apoB should be less than .70 and not greater than .73. This ratio is found by dividing apoB by apoA1.

Total High Density Lipoprotein/index: This measures the ratio of all types of cholesterol and is a more important indicator than just

Homocysteine: This amino acid can create scarring and irritation of the blood vessels, which can in turn lead to plaquing of the arteries. It is thought that close to 50 percent of cases of high blood pressure and 50 percent of heart attacks are due to elevated homocysteine. Ideally, you want levels below 9umol/L. If homocysteine levels are too high, take 800mcg per day of folic acid to reduce levels.

hsC-Reactive Protein: This is a measure of inflammation. If above 0.5mg/dl, then you need to discover the cause of the inflammation (e.g. infection, poor diet, stress, low vitamin D).

There is ample evidence to show that high-carbohydrate, low-fat diets that include polyunsaturated oils (canola, corn, soybean) dramatically raise the level of apoB and increase the risk for CVD. The best form of fat is saturated, such as that which occurs in some meats, coconut and eggs, and monounsaturated oil (olive), as well as fish oil. Since fish oil is the only one of these fats that you might take as a supplement, I recommend one gram or about one teaspoon per day. While everyone is different, the best way to prevent CVD is to keep blood glucose levels within the normal range and eat a variety of foods rich in vitamins, minerals, amino acids and phytochemicals: eggs, whole milk (raw if possible), fresh cheeses, fresh meats (beef and buffalo included), moderate amounts of raw nuts and seeds, moderate amounts of whole grains and, most important, lots and lots of green vegetables.I suggest reading The Great Cholesterol Con by Anthony Colpo (Lulu.com, 2006), which discusses the whole theory of a link between cholesterol and CVD, and gives helpful dietary advice.