Anatomy & Physiology

What has cholesterol ever done for us?

It’s National Cholesterol Month! It was probably created (who does decide these things?) to raise awareness to the ‘dangers’ of cholesterol. Today I’d like to make a plea for cholesterol – probably not what National Cholesterol Month is meant to be about, but here goes …

What comes to mind when you hear the word “cholesterol”? Most likely eggs, bacon, lard, clogged arteries, heart attack, stroke. Something along those lines.

Now for a list of positive associations …

Anything?

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Cholesterol has had a really bad rap over the last 60 years or so, so much so that hardly anyone can think of anything good to say about it. So, is cholesterol a dangerous substance that somehow accumulates in our arteries, only to kill us in the end? What is it? Where does it come from? What does it do?

 

What is cholesterol?

Cholesterol is a lipid, a waxy substance produced in the liver and all body cells except nerve cells, but there is a special type of brain cells that makes cholesterol, too, because the body’s cholesterol cannot cross the blood-brain barrier. “So, hang on,” you might say “the body makes it? If it’s so bad for us, why?” Exactly. The body does of course produce lots of substances that are bad for us – waste products that occur in normal metabolism and that need to be detoxified -, but cholesterol is not one of them. It has a purpose, several actually, and it is a vital substance.

 

What does cholesterol do?

Cholesterol is a component of every single cell membrane in the body. It is like a wedge that holds cell membranes together, giving them both stability and the fluidity they need to function. Cholesterol is needed to repair existing cells as well as to make new ones. Any kind of trauma, injury or surgery triggers an increase in cholesterol production, because it is needed for repair.

All steroid hormones, for example cortisol, oestrogen and testosterone as well as neurotransmitters, are made from cholesterol, and so is vitamin D. Steroid hormones regulate energy production, metabolism, hydration, reproduction, behaviour and emotions, the formation of brain, muscle and bone. All rather important … Vitamin D is needed to make healthy bone, protects us from cancer and heart disease, high blood pressure and arthritis.  

The brain makes up 2% of our body weight, but contains 25% of the body’s cholesterol. The substance is part of the myelin sheath, the fatty insulation of nerve cells and allows them to transmit impulses. They would not function without cholesterol.

Cholesterol is a major component of bile, an emulsifier made in the liver that is needed for the proper digestion of fat.

Cholesterol is even involved in immune function. It is found in high concentration in ‘memory cells’ – those cells of our immune system that ‘remember’ a pathogen encountered before. They recognise it and raise the alarm, triggering an immune response.

 

Can cholesterol be too low?

Smith-Lemli-Opitz Syndrome (SLOS) is a rare genetic condition affecting cholesterol synthesis – children born with this are severely disabled and have a low life expectancy as the brain is underdeveloped. Somewhere between ‘too high’, ‘healthy’ and ‘death’ there has to be a ‘too low’, you would think.

Low cholesterol may contribute to forgetfulness, disorientation, confusion – often seen as normal signs of ageing. The American astronaut and NASA doctor Duane Graveline experienced retrograde amnesia when his cholesterol had been lowered by statin drugs. He was temporarily unable to remember his home address, recognise his wife and children, or remember his job. He stopped taking the drug and his brain function returned to normal. Dr Malcolm Kendrick has written about Dr Graveline on his blog.

Studies have found higher rates of death from unnatural causes (suicide, manslaughter, murder) in people with low cholesterol levels (⩽165 mg/dl or 4.2 mmol/l) (1).  

What’s more: Elevated cholesterol levels appear to be protective in older people. A 2017 systematic review of the literature (3) found that high LDL cholesterol is inversely related to mortality in people over 60 years of age, meaning: the higher your LDL once you’re over 60, the longer you live. This is most likely – as more than a dozen of the reviewed research papers found –because LDL binds to and inactivates a broad range of microorganisms and their toxic products. In other words: Cholesterol protects the elderly from infectious diseases. The full text of this review is available online. Click here to read it.

Considering how vital cholesterol is for life, it stands to reason that it can indeed be too low. Low cholesterol is associated with a number of diseases, but is most commonly caused by statin drugs. It’s not easy to find literature on where the bottom line is, but what little research there is puts it at around 4.0 mmol/l (2, 3). 

So there you have it. Cholesterol is not all bad. In fact it seems to be more good than bad.  

Just in time for National Cholesterol Month, Dr Mark Hyman welcomed British cardiologist Dr Aseem Malhotra on his podcast “The Doctor’s Pharmacy” this week. It’s not all about cholesterol, in fact it is more about bias in research - the two cover a lot of ground - but either way it’s worth having a listen. Click here for the podcast.

If you would like to learn more about cholesterol, here’s a handy reading list of books that take a critical view on the current paradigm.

 

(1) Psychosomatic Medicine 2000;62 - Epidemiology 2001 Mar;12:168-72 - Annals of Internal Medicine (1998;128(6):478-487), The Journal of the American Medical Association (1997;278:313-321)

(2) Nago et al (2011): Low cholesterol is associated with mortality from stroke, heart disease, and cancer: the Jichi Medical School Cohort Study. Journal of Epidemiology 2011:21(1):67-74.

(3) Ravnskov et al (2017): Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open 2016;6:e010401. doi: 10.1136/bmjopen-2015-01040 (Free Full Text)

(4) Hamazaki T, Okuyama H, et al (2015): Towards a Paradigm Shift in Cholesterol Treatment. A re-examination of the Cholesterol Issue in Japan. Ann Nutr Metab 2015:66 Suppl 4:1-116. doi: 10.1159/000381654

(5) Lv YB, Yin ZX et al (2016): Serum Cholesterol Levels within the High Normal Range Are Associated with Better Cognitive Performance among Chinese Elderly. J Nutr Health Aging. 2016 Mar;20(3):280-7. doi: 10.1007/s12603-016-0701-6. (Free Full Text)

(6) Mufti RM, Balon R, Arfken CL (2006): Low cholesterol and violence. Psychiatric Services

(7) Ravnskov, Uffe (2003): High cholesterol may protect against infections and atherosclerosis. Qjm 96.12 (2003): 927-934. 

(8) Ravnskov U, McCully KS, Rosch PF (2011): The statin-low cholesterol-cancer conundrum. QJM (2011): hcr243

 

 

 

 

Be the one who skips across the finish line

There's good news: Life expectancy is steadily increasing. Modern medicine is so good now that it is possible to keep us alive for longer than ever. The bad news is: Healthy life expectancy is not increasing.

According to data published by Public Health England in July 2017, life expectancy in the UK is now 79.5 for men and 83.1 for women. Healthy life expectancy however, is 63.1 and 64.4 respectively. 19.0 years less for men and 16.1 years less for women. As life expectancy is increasing, but healthy life expectancy is not, we are spending more and more time of our life sick.

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By the time we hit 65, 40% of us are going to have at least one chronic illness: heart disease, stroke, type 2 diabetes, hypothyroidism, depression, dementia, arthritis, and cancer are just the most common ones. How thrilling is it to know that we’re going to live longer, but that we’ll spend a significant chunk of that time in pain?

The human body is an amazing thing. It takes a lot (a lot!) of punishment without complaining and works hard day and night – particularly at night though – to repair the damage we do to it and at least maintain us on a reasonably healthy level. That works really well for many, many years. But there is a point when that repair and maintenance begins to slow down. It is usually only then that we start noticing, and from my own observation I would say that that is at around age 40.

Most of my clients are over 40 and it’s not as if I wouldn’t be happy to see younger clients, it’s just that their diet and lifestyle hasn’t caught up with them yet. When you’re young, you can cope with short nights – whether that time was spent studying, partying, looking after a baby or working long-hours in a stressful job. Our body takes it all: junk food, eating on the run, smoking, drinking and even recreational drugs barely leave a mark (that we can tell). Injuries, like broken bones and torn ligaments, heal quickly and we get back on our feet in no time.

But once we hit our late 30s or early 40s the cracks are beginning to show: Suddenly there is a spare tyre around our middle that didn’t used to be there. Where did that come from? We haven’t changed anything! Anxiety, depression, insomnia, tinnitus, thyroid malfunction, high blood pressure, achy joints, hormonal imbalances, fertility problems, sexual dysfunction, and constant, leaden tiredness suddenly appear.

We’re feeling like cr*p, but at this point we are still looking at a good 20 or 25 years of a working life that is not going to let up. We are still expected to turn up at the same time every day and work hard, be efficient, be brilliant, make a contribution for at least 8 hours a day – as we always have. Once we get home, there is still housework to do, kids – or at this stage parents – to look after, bills to pay, friends to be seen, and just stuff to do. We simply do not have time to collapse on the sofa or crawl into bed to recover for another day.

Meds will help us through: anti-depressants, acid blockers, statins, beta blockers, thyroid hormone, HRT, metformin – once we hit 45, most of us are on at least one or two of those. While prescription drugs may be necessary, they are not going to fix anything, they’ll merely tide us over. All drugs come with side effects, which sometimes require another drug to deal with.

At retirement age, we have finally paid off the mortgage, the children have their own families, we’re not responsible for anyone but ourselves anymore. This is the time to spend the day just the way you like it: socialising with friends, cycling, gardening, volunteering, heck, you could even downsize, buy a camper van and go travelling.

However, if we even make it to retirement, 40% of us merely limp across the finish line, only to then collapse (statistically) and succumb to at least one chronic illness. We might not have the inclination or be in good enough shape to do any of the stuff we had planned.

But that’s old age for you, right? That’s what happens. It’s to be expected that by age 45 we’ve got to be on two or three meds. It’s normal to lay down extra fat and be achy in the morning and tired in the evening. That’s what happens when you age.

Well, actually no, it isn’t. We have come to accept all this as normal, because it is so common. It’s not inevitable though. It is our diet and lifestyle choices that have brought us to this point, and diet and lifestyle are what is going to turn it around for us. Obviously, the sooner you get into healthy habits the better, but it’s never too late!

So, what is it that makes us sick and old?

1. Stress

More than anything else lifelong stress sets us up for chronic illness. Over the time of our lives, most of us are exposed to a lot of psychological and physiological stress. For many, this starts even in childhood and while humans have remarkable resilience, it can catch up with us in middle age.

2. Diet

We still treat diet as an optional factor in health. Yeah, healthy eating is all well and good, but who has time or money for that? We’re busy people and shoving a burger into our mouths during a 15-minute lunch break is just going  to have to do. Or it could be a bag of Wotsits, or a stack of digestives. Anything is sustenance, right? Wrong. Do this for 20 years and you’ll no longer be able to ignore the consequences.

3. Alcohol, smoking and recreational drugs

Obviously.

4. Overweight and obesity

The most damaging thing excess body fat does for us is that it fuels inflammation. Temporary inflammation is a good thing and vital. When the immune system finds something wrong, it springs into action and deals with the problem. There will be redness, swelling and pain for a few days, but then we’ll get better. Chronic inflammation is silent and much less noticeable, but unfortunately chronic: It doesn’t stop. Fat cells, and particularly visceral fat (the fat on the inside) promote chronic inflammation, which is at the root of most chronic illness we experience when we are older.

Address these issues now – whatever your age – and make sure that you are going to be one of those people who skip across the finish line into retirement, ready to face their freedom!

What is the appendix for?

One of the most interesting fields of research for me right now is the microbiome. New research in the area comes out every day and the more we learn, the more scientists realise we don’t know.

Although not all bacteria and other microbes have yet been identified – let alone everything they do – we do now know that diversity is key to good health: the more different species there are, the healthier the individual. Hunter-gatherers have a much, much more microbiome than we do in the Western world, and we get many diseases that are unheard of in primitive cultures, e.g. Crohn’s disease.

appendix, appendicitis, microbiome, gut flora, immune system

Appendicitis - infection and inflammation of the appendix - is so common that everyone knows someone who has had it and has had an appendectomy as a result, an operation that probably saved their life.

For as long as we’ve known that this little dead end in our gut exists, doctors and researchers have been wondering what it is for. It was thought to be vestigial, like the coccyx (tailbone) or erector pili (the muscles that make hair stand on end) and body hair. In fact, if you google ‘vestigial organs’ you’ll find the appendix at the top of the list. It is thought not to do anything much, because no purpose has been found and, more than anything, people without one live on without suffering any negative consequences at all.

For other vestigial organs we can find out what there purpose might have been if we look back at our ancestors or closely related species, such as the great apes or monkeys. Our ear muscles, for example, don’t do much anymore, but monkeys use them to twist their ears in different directions, to pick up the sound of approaching danger sooner. Vestigial organs usually have shrunk and/or atrophied: they’re there, but unable to do anything anymore. When it comes to the appendix, however, it appears that apes and humans have a larger and better developed one than monkeys – which suggests that the appendix must be doing something useful.

Most people never get appendicitis, but 6% do, and that’s a lot of people. Of those who do get it, 50% survive it without an operation. Because it’s so common, appendectomy is now routine surgery. So without any medical help, 1 in every 32 people would be wiped out by appendicitis. If it was that dangerous an organ that doesn’t appear to serve any particular purpose, you would expect that over millennia evolution would have made us lose it, not promote it.

It wasn’t until 2005 that it crossed one American scientist’s mind, that perhaps the appendix was a reservoir for bacteria! In order to come up with this idea, there first had to have been knowledge of the gut flora and immunity. The appendix is filled with bacteria, antibodies and lymphatic tissue. Why?

We have more of the same all along the gut, but if we a struck down with infection and disease that causes severe diarrhoea, e. g. cholera, we will lose our gut flora and antibody protection in a very short space of time. Add to that these days enema before colonoscopy or antibiotic treatments. We’ll end up with a very clean gut indeed! But as we now know that is not a very good way to be.

The appendix appears to provide a save haven for bacteria during any such attack, and it is from here that bacteria emerge to recolonise the gut once the threat has passed. So, while we can live without an appendix, there is great benefit in having one. And by the way: appendicitis is another disease that is extremely rare in developing countries. Could the fact that we are so prone to it also have something to do with our Western lifestyle?

For further reading: Rob Dunn - The Wild Life of our Bodies, Harper Perennial, 2011.

Happy Gut - Happy You!

The digestive system is the least talked about and probably our most underrated organ, and yet it truly is the foundation of good health. While I cannot guarantee that a healthy gut will make all your troubles go away, I can safely say that true health will remain out of reach if the digestive system is not working well.

Eat for your skin!

Most of us have been plagued with acne at some point in our lives. In most cases, this was during puberty and it resolved itself once our hormones calmed down and normalised. For many, however, acne can continue into adulthood or even appear for the first time later in life. In adults, acne is not so likely to resolve itself and it is necessary to take a look at one's diet. Read on to find out how hormones and diet affect your skin.