Help my cholesterol went up!

One of the more common concerns about diet containing higher levels of fat is the often noted rise in LDL and total cholesterol levels.  You can be kicking ass in literally every aspect of your health, things like low blood pressure, improved mood, lower body fat, better sleep, better lidido, skin, digestion and joint health and yet one little lab finding suddenly causes everyone to freak out and suddenly think you’re heading for a casket in the next 5 minute or sooner.

 
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Think about it, you are doing wonderfully by everything you can measure and then an elevated cholesterol reading suddenly has you thinking “Damn it, I’m going to die”!  Why is that and what is really going on? 

 

Well if you and your doctor have been paying attention to the last few decades, we’ve been repeatedly told that high cholesterol is associated with heart disease and as everyone knows heart disease is the number one killer.  Thus you’d better do everything possible to lower it as much and as quickly as possible!  Here eat this cardboard stuff and take this pills and maybe you can undo the damage that all that evil cholesterol has caused!

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You can now shut off your brain, take your statin, eat your tofu and kale salad and perhaps you don’t feel good anymore but at least you can take solace in the assumption that won’t be on the fast track to clutching your chest anytime soon. Yay, crisis averted, your doctor can check that box and the cute drug rep gal that sells the statins in the office will give him a high five and perhaps and extra smile and tell him how great a doctor he is.

 

But what if feeling great, having lower inflammation, being leaner and noticing you are almost aging in reverse is actually a good thing despite cholesterol going up.  What if isolated cholesterol reading are not that reliable as a predictor of disease when other things are working well.  What if people with normal or low cholesterol are dying of heart disease.  What if low cholesterol tends to put one at risk for dying early and of getting many other diseases like cancer or neurodegenerative diseases.  What if drugs like statins were associated with up to 100 times the risk of developing a horrible debilitating diseases such as ALS (or Lou Gehrig’s disease)

 

As it turns out, low cholesterol is associated with a number of cancers and neurodegenerative diseases. Huge percentages of people with “normal” cholesterol are having heart attacks, including those supposedly invincible vegans, in which heart disease is their number one killer as well.  Imagine spending your life eating a bunch of unsatisfying vegan food thinking you’re going to avoid heart disease only to have it kill you anyway.

 

Let me be plain. Cholesterol is a vital component of every cell in our body, 25% of our body’s cholesterol is devoted to our brain and central nervous system structure.  It is so crucial that our liver will make the vast majority of it.  It has also been shown that cholesterol is extremely variable and can change dramatically in the course of a few days based on diet or things like infection, disease or exercise.  The fact that an isolated cholesterol blood test taken once a year is used to inform decisions regarding health is in my view idiotic.  It indicates either profound ignorance, laziness or perhaps manipulation by pharmaceutical manufacturers on the part of your physician.

 

In isolation cholesterol is almost meaningless.  It can be high or low for both good and bad reasons.  Also their is no such thing as good cholesterol or bad cholesterol.  The  cholesterol found in HDL is the exact same cholesterol that is found in LDL.  How’s that for some news? There is emerging evidence that blood cholesterol levels can fluctuate fairly dramatically over a period of just a few days. 

 

Dave Feldman over at cholesterolcode.com is doing some very interesting work showing just how dynamic our bodies blood lipid transport system actually is, and notes about a 3-4 day pattern based on recent food intake.  In fact he has seen his LDL cholesterol change by as much as 100 points in just 1 week.  If that fact alone does not call into question of how useful is it as a marker I’m not sure what else will.  Imaging you stuck a thermometer outside on January 1st and decided that the temperature for the whole year was based upon that.  Essentially that is what we are assuming when we get our once a year cholesterol checked.

 

Remnant cholesterol is the residual cholesterol left behind and is equal to your total cholesterol minus HDL and LDL and it likely represents a better look at how the entire blood lipid system is operating and has shown to be a much better predictor of cardiovascular events than just about any other blood lipid marker.  The problem is that no drugs are available to modify it and so it gets very little attention.  I general a low remnant cholesterol is though to indicate low risk.

 

If your total cholesterol is high is that problematic? Maybe, but also maybe not.  The bottom line is we have to get past a black and white style of thinking and take things in context.  The difficulty is that putting something into context can take a lot of time and unfortunately your physician no longer has that luxury or even the incentive to do so.  The unfortunate reality of our modern healthcare system is it has become a big business with efficient throughout being the goal!  Let’s talk a little bit about glucose next time as I have a fairly vested interest in that subject as well!

 

Links: 

https://www.sciencedirect.com/science/article/pii/S0735109712055222

http://www.r3i.org/editorial-79

http://atvb.ahajournals.org/content/36/11/2133

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442317/

https://www.ncbi.nlm.nih.gov/m/pubmed/11502313/

http://circ.ahajournals.org/content/109/21_suppl_1/II-2

https://link.springer.com/article/10.1007/s40264-017-0620-4

 

 

 

Shawn Baker