I know it will take several generations before we get it out of our minds that cholesterol clogs our arteries. There has been so much research that has been done since the early flawed study from Ancel Benjamin Keys back in 1953, in which he incorrectly asserted that cholesterol clogs our arteries.
Since then, study after study, too numerous to mention here, has shown that lowering cholesterol has very little to do with lowering our risk of heart attacks.
The Lyon Heart Study from France demonstrated how changes in the diet and lifestyle were able to reduce deaths by 70% and to reduce cardiovascular deaths by 76%, all without lowering cholesterol at all.
The Nurses’ Health Study which analyzed 84,129 women and published in the New England Journal of Medicine found that 82% of heart attacks were attributable to 5 factors, none of which had anything to do with with high cholesterol levels. Factors such as avoiding smoking, alcohol, working out for at least a half hour a day, maintaining a healthy weight and eating a wholesome low-glycemic (low sugar) diet with fiber and plenty of omega-3’s (or good fats).
Researchers in Japan divided people into 3 groups, those with low cholesterol, those with cholesterol in the normal range and those with high cholesterol. Surprisingly those with the highest levels of cholesterol lived the longest and those with the lowest levels had shortened lifespans.
When Americans were consuming whole full-fat foods such as cream, butter, and raw milk from pasture-raised cows, the rate of heart disease was a fraction of what it is now. In fact, once we became afraid of cholesterol and banned these items from the diet in favor of vegetable oils, hydrogenated fats and trans fats such as margarine and Crisco, that’s when the levels of obesity, diabetes and heart disease skyrocketed.
So if cholesterol in general isn’t the culprit, what does clog our arteries?
Well, let’s back up a bit and look at how we test to see if we’re at a risk for heart disease. Blood work is ordered where they measure the total cholesterol, the HDL’s (which are considered the good guys) and the LDL’s (which are considered the bad guys), all of which they say increases our risk for cardiovascular disease.
Since we began looking at these parameters decades ago, new research has proven that this approach is no longer relevant and is actually incorrect. To see why, let’s first learn a little more about cholesterol and how important it is to help build our cell walls, nourish the nerve tissue and brain, and supply the raw materials for our adrenal and sex hormones.
First, cholesterol cannot travel in the bloodstream by itself. This is because it is hydrophobic, which literally means water (hydro) and avoiding (phobic). To move cholesterol through the blood stream you need to put it into a container which can transport it around. The container that the body uses to transport cholesterol is called a lipoprotein. We might call these lipoproteins “cholesterol” but in fact cholesterol is only a portion of the cargo that these lipoproteins carry around the bloodstream.
There are high density lipoproteins (HDL’s), low density lipoproteins (LDL’s), Intermediate density lipoproteins (IDL’S), and very low density lipoproteins (VLDL’s) that carry the cholesterol around.
As of now, 10 types of HDL’s and 13 types of subfractions of cholesterol have been identified. We can no longer think in such general terms as the LDL’s are the bad guys. It turns out that some of them are very light and fluffy and actually protect the arteries. It’s only the smaller, denser oxidized LDL’s which can dig into the arterial walls and start a whole inflammatory process that ultimately creates plaque.
So let’s back up a minute to discuss the artery wall, which is called the endothelium. The inside of the walls of your arteries are smooth muscle that expands when the heart beats. In other words the arteries are not stiff and hard but elastic and flexible.
The innermost layer of the artery walls is called the endothelium and this is where the damage is done which can lead to a heart attack.
Let’s also discuss what inflammation and oxidation means. Then we can pull all these puzzle pieces together so you can understand how plaque forms.
Inflammation results when you have an injury or an infection in an area — the immune system cells come to protect your body, and as the immune system cells are released in the area they create inflammation, which usually goes away after the injury or infection. But when inflammation becomes chronic then it can cause big problems such as diabetes, arthritis, cancer, respiratory diseases, pneumonia, chronic liver and kidney diseases and…heart disease.
One of the main causes of inflammation is oxidation. Metal which is rusting or an apple which turns brown once it is sliced are both examples of oxidation. Atoms have electron pairs which orbit around them, but every so often one of the electrons get loose. The atom with the unpaired electron, known as a free radical, can inflict enormous damage upon your cells and DNA as they frantically search for an electron they can pair with again. The free radicals that come from oxygen, known as oxygen free radicals are the most deadly and damaging kind.
Antioxidants such as vitamins, minerals and many plant chemicals help to neutralize the free radicals limiting the damage they can do to your body. Squirting lemon juice on the apple slices to prevent them from browning is an example of an antioxidant, which comes from the Vitamin C contained within the lemon juice.
Now, back to the endothelium. It is just one cell thick. If your LDL becomes oxidized it becomes highly reactive and can damage the artery wall by burrowing into the wall and creating inflammation. The non-oxidized LDL just travels through the bloodstream not bothering anything, and is harmless.
So again, the LDL floats around in the bloodstream delivering cholesterol to the cells that need it. But some of the LDL that’s damaged by oxidation infiltrates the endothelium or the wall of the artery which begins the process of inflammation.
Once the immune system notices this damaged oxidized LDL, it sends cells known as monocytes to the scene releasing chemicals called cytokines, many of which are highly inflammatory. This causes the lining of the blood vessels (the endothelium) to secrete sticky little molecules called adhesion molecules that act like glue. If inflammation isn’t stopped in its tracks they’ll release a whole new set of toxins into the walls of the artery, eventually causing what is known as the fatty streak because it is a streak of yellow inside the artery wall which vascular surgeons can actually see during their operations on the arteries. The body tries to contain this fatty streak by building a wall to hold it in. If the cycle is not stopped the fatty streak grows into what is known as plaque. At this point a blood clot might develop to contain everything or calcium could deposit into the affected area.
You don’t need to memorize all these steps, but by now you should be able to glean from this information that it isn’t the amount of cholesterol which is the important number to note, but the types of particles you are harboring.
We need to change the testing of cholesterol from one where we are only looking at the total cholesterol, the HDL, and the LDL’s to one which looks at the actual types of LDL particles and if they are oxidized or not. Some of the forward thinking cardiologists are looking at the very small density LDL’s as these are the ones that are usually prone to oxidation and can burrow into weakened areas of the endothelial lining.
Other tests which might be important are dividing your triglycerides by the HDL cholesterol. A number of 3 or greater could be more of a predictor of heart disease than just the cholesterol numbers.
Some are looking at the fasting insulin tests and your insulin resistance because it is felt that sugar plays a large role in developing heart disease since it adds to the stickiness of the LDL’s.
The state of the art test for cholesterol is the NMR particle test, also known as the NMR Lipo-Profile. This test doesn’t just tell you how much HDL and LDL you have, it tells you what kind of LDL. It identifies how many of the LDL particles are small and dense, which are capable of causing plaque, and how many are big and fluffy and far less damaging.
Testing for C-Reactive Protein (CRP) is another test you might want to get since CRP is a marker for inflammation that is directly associated with heart and cardiovascular health.
Also test for fibrinogen. Fibrinogen is a protein that determines the stickiness of your blood by enabling your platelets to stick together. You need good levels of fibrinogen to stop bleeding if you’ve been injured but you don’t want the levels to be too high since it could affect both the circulation of your blood and could create unwanted clotting if the levels are too high. Normal levels are between 200 and 400 mg/dL.
And you might not realize that testing ferritin is also important. This is because while we want sufficient levels of iron to prevent anemia, believe it or not if the iron levels get too high it could create problems. This is because iron is very susceptible to oxidation. Iron metal when left in the rain rusts very quickly. In other words, it oxidizes. This is usually more of a problem in men since women lose a lot of iron each month with their menstrual cycles, but it is something post-menopausal women should take a look at. That’s why you should never take supplemental iron or even multivitamins with iron unless your blood work shows an iron deficiency. A 1992 study by Finnish researchers who examined ferritin levels in 1,900 men demonstrated that those with high levels of ferritin were more than twice as likely to have heart attacks than those with normal levels.
Another good test to get is the calcium score test which is basically a CT scan of the arteries. It will tell you if you have any plaque build-up in the walls of your arteries and exactly how clogged they are. But keep in mind, if they are clogged the latest research shows that statin drugs don’t actually unclog the arteries. All they do is lower cholesterol. In my practice we have three powerful treatments for scrubbing out the arteries which have proven to be highly successful when our patients retest their arteries with another calcium score test after their treatments.
There are other tests your cardiologists may decide to run, such as homocysteine, Interleukin-6, F2 Isoprostanes, myeloperoxidase (which measures inflammation and the tendency to form plaque), oxidized LDL, the PLAQ test which measures how likely the plaque is to rupture, the 9p21 test which measures susceptibility to inflammation and the KIF-6 test, a genetic test which if found, dramatically increases the risk for coronary heart disease.
As you can see, there are a lot of new tests out there, and it’s up to your cardiologist to see which tests are right for you. I am mentioning these here to show you all the recent advances in the field of coronary artery disease and to point out the fact that testing just total cholesterol, LDL, HDL and triglycerides is very antiquated and tells us very little we need to know about whether or not we are a candidate for a heart attack.
But most important of all is how do we minimize the oxidation of the LDL’s in the first place? Well, that’s easy for us as we have always recommended these guidelines in Ayurveda: avoid cigarette smoking, pesticides, too many pharmaceuticals and processed foods. Too many toxins traveling through the liver can heat it up and if it becomes hot and angry it can oxidize the foods you eat instead of processing them in the usual way. Which means that even good foods can become toxic to the body and initiate an inflammatory response. This is why I use several herbs in my practice to cool the heat in the liver, clean it out, and regenerate the liver cells so that the liver becomes more intelligent and doesn’t oxidize the food when it comes into the body. This is also why we teach the patients a healthy diet and teach them how to do correct Ayurvedic cleansing to keep the level of inflammatory toxins down.
One of the ironic things is that the very oils which doctors told us to eat because they contain no cholesterol such as the vegetable oils, margarine, trans and hydrogenated fats, are responsible for causing heart attacks since they form a compound very close to plastic which can clog our arteries and damage our liver very quickly. And even more ironically, ghee, or clarified butter, which has always been highly recommended in Ayurvedic medicine, and is pure cholesterol, prevents plaque buildup in the arteries.
And here’s another big one: Avoid refined white sugar. Sugar is sticky which can gum up the works and damage the artery walls. Plus if you eat too much sugar your insulin constantly goes up to try to lower the sugar in the bloodstream. Normally your insulin takes the sugar out of your blood and deposits it in the muscle tissue. When you exercise and move your muscles your muscles will use the sugar thereby keeping the blood sugar low. But if you are sedentary most of the day, the sugar remains there in the blood and after a while your muscles can no longer hold any more sugar. So they resist the insulin’s efforts to deposit the sugar into them. This is called insulin resistance and as a result your blood sugar goes up as it now has nowhere to go. High blood sugar also causes inflammation in the lining of the arteries which is why diabetics can easily develop heart disease.
So we have these two big issues: oxidation and inflammation, and insulin resistance and high blood sugar, both of which cause stickiness in the blood.
Please learn how to change your diet, take good care of your liver, eat healthy fats, limit your exposure to sugar and other chemicals, and learn how to detox. By doing so you should be able to avoid plaque buildup as you age. And remember, it’s not the amount of cholesterol, but whether or not you are oxidizing the fats on your own or if you are eating the dangerous trans fats, and hydrogenated oils which will surely clog up your arteries since they are one molecule removed from plastic.
It’s important to learn this because you might wind up on a statin drug if a doctor sees your cholesterol is high. And the side effects of the statin drugs are much too dangerous to be taken in such a haphazard way if you really don’t need them, which the majority of the population doesn’t. Many of our patients have high cholesterol and their arteries are very clean with no plaque. And I’ve seen people with low cholesterol have heart attacks. That’s why I’m sharing this information with you. We need to change the way we test for clogged arteries. And the first way is to test more accurately than just testing the total cholesterol, the HDL and the LDL cholesterol.
I hope you found this information useful as you try to keep your heart healthy be keeping your arteries clean.