The Truth about Cholesterol and Heart Disease
Updated: Aug 25
Cholesterol is a natural component in everyone’s blood that supports functions within the body. Your body naturally produces about 80-90% of your total cholesterol, and dietary cholesterol contributes to the other 10-20%. Since the body produces the majority of cholesterol in the body, mostly via the liver, it makes sense that it serves a specific purpose to:
Help synthesize hormones in our body, such as cortisol, progesterone, testosterone, Vitamin D and estrogen;
Control inflammation resulting from injury or irritation to body tissues.
Used to make bile acids in your liver, aiding in fat digestion.
It’s long been the fall guy when it comes to heart disease but it's only when the body - including your arteries - is inflamed that cholesterol becomes problematic.
Inflammation creates free radicals, which damages cholesterol and other fats. This activates the immune system and starts a cascade of events that ultimately creates plaques in the arteries, causing atherosclerosis.
In fact, the diet-heart hypothesis—which contends that eating cholesterol and saturated fat raises cholesterol in our blood and puts us at greater risk of heart disease—might be altogether wrong. More recent (and higher quality) evidence just doesn’t support the theory.
The truth is:
Eating cholesterol isn’t going to cause a heart attack.
Egg yolks are nutrient-dense and should be included in your diet.
Saturated fat is not the enemy everyone believes it to be.
So where does cholesterol fit into the risk of Cardiovascular Disease (CVD)?
Cholesterol is one piece of the puzzle comes when it comes to CVD and the first step in understanding your risk is to understand your labs. What is a healthy cholesterol level?
Low-density lipoprotein (LDL) cholesterol: This type of cholesterol, commonly known as “bad cholesterol,” can collect in blood vessels and increase your risk of cardiovascular disease (optimal: less than 130 mg/dL);
High-density lipoprotein (HDL) cholesterol: This type known as the “good cholesterol” helps reduce the buildup of cholesterol (optimal range: 50-90 mg/dL for HDL);
Triglycerides: Excess amounts of this type of fat are associated with cardiovascular disease and pancreatic inflammation and are high risk (optimal: less than 100 mg/dL);
Very Low-density lipoprotein (VLDL) cholesterol: not always measured on standard lipids panels, may need a particle size test, VLDL particles is high risk mainly carry triglycerides, another type of fat, to your tissues (optimal: less than 10-14 mg/dL).
Your total cholesterol/HDL-C ratio should be between 1 and 3, however your triglyceride/HDL-C ratio may be one of the better predictors of heart disease. That ratio should be below 2 – 4 is high and 6 is very high, significantly increasing the risk of heart attack.
Simply lowering your cholesterol shouldn't be the focus when trying to reduce your risk of heart disease, because cholesterol numbers alone don’t really correlate well to heart disease.
Here are some facts about lipids and your risk of disease:
Elevated triglycerides, not LDL, come with a four times greater risk of heart disease and stroke;
Low or below normal levels of HDL-- the "good" cholesterol -- in middle age may increase the risk of memory loss and lead to dementia later in life;
High LDL in itself is of no greater risk however VLDL, very low density lipid or smaller particle, is a higher risk. It oxidizes the most when the body is inflamed, increasing the risk of arterial plaque;
Half of patients with ideal cholesterol levels actually have dangerous plaque build-up and are at risk for a heart attack or stroke;
Statins only reduce the risk of having a heart attack or stroke from three or four percent to two percent. In many studies, the placebo had 1% less effect than statin use in heart attack occurrence.
A more comprehensive predictor of heart disease is one’s metabolic health and level of inflammation. “Metabolically healthy” is defined as:
The absence of metabolic diseases (obesity, type 2 diabetes, heart disease, stroke, kidney disease, and nonalcoholic fatty liver disease)
Having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications.
Together, these metabolic factors directly relate to a person’s risk for heart disease and stroke.
Studies have shown that metabolic syndrome is associated with higher risk of incidence of major cardiovascular events, cardiovascular and all-cause mortality… However only 12 percent of adults in the U.S. (1 in 8 adults) currently maintain ideal levels of all five risk factors affecting metabolic health without the use of medications. For the average adult, the National Institutes of Health defines the ideal levels of these factors as:
decreased central abdominal obesity
fasting blood sugar 70-100 mg/dL (heart disease risks increase rapidly at about 140 mg/dL)
blood pressure below 120/80
triglycerides below 100 mg/dL
high-density lipoprotein (HDL) cholesterol greater than or equal to 40 mg/dL for men and 50 mg/dL for women
Further testing to assess overall inflammation and risk include LPLAC2, MPO, Lp(a), and hs-CRP (all inflammatory markers), vitamin D, ferritin, lipid particle size, cardiac imaging and coronary artery calcium scans to measure calcified plaque in arteries.
Looking at the big picture, it’s clear that cholesterol alone is not a significant cardiovascular risk factor, but should be considered with other factors when making a risk assessment for CVD. Lifestyle plays a major role in the overall risk of CVD.
How to Lower CVD risk Naturally
The goods news is that many of these metabolic risk factors can be modified through lifestyle including low HDL-C, low vitamin D, blood glucose, high triglycerides, high serum ferritin, high total cholesterol, C-reactive protein, High LDL-P or apolipoprotein B.
Support the liver. Unexplained elevated cholesterol could indicate that the liver is damaged or is poorly functioning, and vitamin D deficiency is strongly linked to liver disease. The liver also plays a major role in glucose metabolism and blood sugar management. Supplement with vitamin D if deficient, and limit alcohol, refined sugar and processed foods to support a healthy liver.
Eat Real Food. Six trials examined the effects of vegetable oils and none indicated that replacing traditional animal fats lowered mortality. In fact, results of the studies suggested that this substitution increased the risk for cancer after 5 years and may heighten the risk for heart disease as well. Eating stable, natural fats such as butter and olive oil are better options.
Elevated triglycerides are a good sign of carb intolerance - meaning the body cannot handle the amount of sugar it’s ingesting. Whole, anti-inflammatory foods - like the “Paleo” diet - may be a useful starting template because many foods associated with inflammation are eliminated (eg, refined dairy products, margarine, industrial seed oils, refined sugar, and cereal grains).
Prioritize sleep People who are sleep deprived have a slower metabolism, which puts them at greater risk for poor metabolic health. Additionally, studies have shown that people who sleep < 6 hours on average are much more likely to develop high blood pressure, high cholesterol, diabetes and be overweight. However, 7-8 hours might be just the right amount of sleep since studies have also shown that sleeping > 9 hours per night increased the risk of developing coronary heart disease by 38% and the risk of stroke by 65%.
Exercise everyday. Regular physical activity has been shown to reduce the risk of metabolic syndrome and CVD. High-Intensity Interval Training (HIIT) may be more beneficial for improvement of cardiorespiratory fitness in hypertensive people. Exercise may help to increase HDL cholesterol.
Reduce inflammation. All of the above will help to reduce inflammation! Other lifestyle contributors to inflammation include smoking, poor gut health and stress. Smoking increases the formation of plaque in blood vessels while chronic inflammatory gut issues like constipation, diarrhea, IBS, and IBD increase the risk of CVD. And finally, last but not least, stress can trigger risk factors such as a resting heart rate above 100 BPM, increased blood pressure, chest pain, and heart palpitations.
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