cholesterol

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

 

 

 

 

Gotta love fat

Park that notion that fat is bad. It is not. In fact, most of us aren’t eating enough of it. Fat can help you lose weight, protect against heart disease, absorb vitamins and boost your immune system.

Here’s why fat is essential in the body…

  • It’s a concentrated energy source.   Gram for gram, fat is twice as efficient as carbohydrates in energy production. Or in other words: fat has twice the calories of carbohydrates or protein, and here lies the problem: If we believe that a calorie deficit (calories in < calories out) is required for weight loss, then obviously the easiest way to achieve that is by reducing fat.
  • Fat can be an energy store. Excess fat is stored for future energy production (excess calorific intake). We can only store very little carbohydrate and no protein.
  • Protection – internal (visceral) fat protects your internal organs, like the kidneys and spleen. Too much of it is not desirable though, because we now know that this kind of fat secretes pro-inflammatory chemicals, making us sick.
  • ‘Subcutaneous adipose tissue’ (that’s code for the fat that you can feel by pinching your skin) helps to maintain normal body temperature and provides padding. Who wants to sit on their pelvic bone?
  • Fats regulate inflammation, mood and nerve function.
  • Every cell membrane in our body is made of fat – the brain is 60% fat. Without fat, there is no life.
  • Many hormones are made from fat. These are known as steroid hormones and they govern stress, sex, and immune function.  
  • Fats are actually essential for survival (experiments on rats in the 1920s showed that, then fat was removed from the diet they died).
  • Fat is the preferred fuel for muscles and the heart. The brain can also burn fat for fuel.
  • Essential fatty acids are required for healthy skin, healthy cell membranes, healthy nerves, healthy joints and to help with absorption of fat-soluble vitamins A, D, E and K.

In the world of nutrition “essential” means: We need to eat it, our body can’t make it. There are essential fats (omega-3 and omega-6), there are essential amino acids (building blocks of protein), but there are no essential carbohydrates. Do you think there’s a clue there?

How did fat get such a bad name?

Fat has got a bad reputation. Over the last 70 years low-fat products have been marketed as the saviour of our health. And the message from governments and the media was – and largely still is – that, when eaten, fat gets stored as fat in the body and puts us at greater risk of heart disease. However, when it comes to the human body, things are hardly ever that simple, and they are not in tis case either.

Part of the problem, of course, is that we use the same word for the fat we don't want (on the hips, around the middle and so on) and the fat we eat. Our current dietary guidelines imply that if we don’t eat (much) fat, we won’t get fat. Have a look around you and check how well that is working for us. If you listened to The Food Programme this week you will have heard Prof. Louis Levy of Public Health England (the people behind the Eatwell Guide) say:

The real thing about the Eatwell Guide is that it’s there to help people understand what a healthy diet is. What it won’t do is make you eat it.
— Prof. Louis Levy, Public Health England

So there we have it: If you are overweight or obese, suffer from diabetes and/or heart disease then evidently that’s your own fault. If only people would do as they're told already, we would not have a major public health crisis. Yet, statistics show that we actually have listened: We are eating less meat and butter, buy a lot more low-fat products than we used to and base our diets around carbohydrates – just as instructed. I see it in clinic every day: Clients tell me that they do follow a healthy diet, they are cutting the fat off their meat or avoid meat altogether - let alone butter or cream - and always go for low-fat yoghurt, cheese, hummus and guacamole. But it's not working! Obesity researcher Zoe Harcombe has taken apart the SACN report Prof Levy quotes in the interview. If you would like to read it, click here, but the gist is that the evidence Public Health England claims to have based the Eatwell Guide on does not actually hold up.

The demonisation of fat began when an American scientist called Ancel Keys produced the first ‘evidence’ linking saturated fat to heart disease in 1953. He based his scientific opinion on observational data of heart disease, death rates and fat consumption in six countries (ignoring statistics from a further 16 countries because they contradicted his hypothesis) and assumed a correlation between heart disease and eating fat. (As an aside, when another scientist looked at the same research, this time considering all 22 countries’ data, no correlation was found. The data is still available and what researchers now find is that there is actually a much stronger correlation between sugar consumption in all of the countries! A possibility that Keys did not even consider.)

Although there might have been correlation between saturated fat consumption and heart disease (there was a relationship), it was not causal (didn’t actually cause the situation).

A further study on rabbits compounded Ancel Keys’ hypothesis: The rabbits were fed cholesterol (which doesn’t normally form a part of their 100% veggie diet) and went on to develop fatty deposits in their arteries. And then, guess what happened? Poor bunnies!

Governments (and their health care agencies) across the world began advocating a low fat diet on the basis of this flawed research.  They told us to fill up on bread, rice, cereals and pasta, and opt for low-fat or no-fat alternatives wherever we could. And we did. 

Soon, the food industry jumped on board to create products that better satisfied this new advice. They replaced saturated fats with ‘healthier’ vegetable oils, like margarine and shortening – ironically trans fats are now one of the few fats research shows are linked to heart disease. The biggest problem is that, when you remove the fat from foods, you need to replace it with something else to make those foods palatable – and this replacement is sugar. This was a really bad move.

We have been ‘good’! People around the world have listened to the low-fat recommendations since the 1970s and put them into practice. And it is from that point onwards that obesity, diabetes and heart disease really took off. Go figure!

More on Stress from the Inside

A few weeks ago, I wrote about the body’s stress response, or “fight-or-flight” response. The article described what happens inside the body in a situation of immediate danger – the alarm phase. The changes I described are mainly due to the stress hormone adrenaline. It triggers a cascade of mechanisms designed to save our life. The effects of adrenaline are very short lived.

Another stress hormone, cortisol, kicks in right after adrenaline. It is produced in order to continue fighting the effects of a stressor long after adrenaline has worn off. Cortisol stimulates the conversion of protein into glucose to ensure that the body has a sufficient supply of energy even after the emergency stores of glucose have been depleted. For the same reason, it also continues to inhibit the functioning of insulin and sustains the changes to the cardiovascular system – among others elevated blood pressure and a fast beating heart – that are designed to transport oxygen and glucose to those cells that need them most in an emergency situation. Cortisol also helps us deal with emotional crisis, performing strenuous task and fighting pain and infection.

This is all extremely useful in an actual dangerous situation. Although physical danger is undesirable, it doesn’t normally go on forever. When it is over we can start recovery – again with the help of cortisol, which stimulates appetite and has anti-inflammatory properties. Eventually, all is well again and we move on.

Yet, today’s stressors are different. We are – luckily! – rarely under physical threat these days, but most of us are stressed, some of us often, some of us all the time. What this means is that our adrenal glands, where stress hormones are made, have to continuously churn out those hormones, with hardly any break, and in the long run, this can have serious consequences. If cortisol is constantly or very frequently present in the blood stream:

  • Blood pressure is high.
  • Insulin function is impaired, which over time can lead to diabetes II.
  • The heart beats fast and works overtime.
  • We are on high alert, which interferes with concentration and can contribute to anxiety.
  • Digestion is erratic at best.
  • Fertility is on hold, because as far as the body can tell this is not a good time to procreate.

This is clearly not good! Prolonged stress really is not just tiring, unpleasant and a matter of the mind. It affects the whole body and can be at the root or at least a contributing factor to a whole host of chronic illnesses.

Stress is often seen as “busyness to an unpleasant degree”, but having to rush around all day long is not the only and not the worst stressor by far. Technically, almost any change in our environment is a stressor: hot or cold, physical trauma such as illness or injury, stimulants such as caffeine, alcohol, cigarettes and sugar, environmental toxins (including exhaust fumes, pesticides, chemical exposure from furniture, cosmetics etc.), even exercise, if excessive. Then there are emotional stressors, like bereavement, divorce, bullying, job loss, debt and more.

Apart from the effects continuous stress hormone secretion has on the body, it also affects the adrenal glands, where they are made. For one, these little glands that sit on top of each of your kidneys, have other jobs as well. They make a wide range of other hormones besides stress hormones, too. If the adrenal glands are busy making stress hormones for a long time, this takes up most of their capacity and other hormones fall by the wayside. Remember: acute stress is meant to be a priority (and short-lived), so all efforts are diverted to them.

Stress hormones also hog the “raw materials” other hormones need: Cortisol and ultimately the sex hormones progesterone, oestrogen and testosterone are made from a hormone called pregnenolone, which in turn is made from cholesterol. If all the pregnenolone is diverted towards the production of cortisol, this will have a knock-on effect on sex hormone levels: think premenstrual syndrome (PMS), polycystic ovary syndrome (PCOS), fertility, libido and more.

Co-factors required for other hormones, too, are going towards the production of stress hormones. Stress uses up vital vitamins and minerals that will be missing elsewhere.

If stress persists over years and years, the adrenal glands can wear out and struggle to produce any hormones at all. You’d feel very tired and exhausted to the extent where even sleep does not refresh you enough, struggle to concentrate, and might even experience depression. It is possible to recover, but it may take a long time. After all, it took a long time to get to this stage, too.

So, what to do? Watch this space! While you wait, you may want to subscribe to Nutrilicious News. Tomorrow's contains a yummy stress-busting recipe, which is easy to make, as always. There'll also be a breakdown of what it is that combats stress in this particular recipe.

If you suffer from stress and its physical manifestations, if you are suffering from stress-related illness, why not book a personal health and nutrition programme with me at The Body Matters in Leigh-on-Sea, Essex?

Sugar is the new fat

For more than 60 years now, we have been told to limit our fat intake or – better still – to avoid it altogether, because not only does fat make you fat, it also causes heart disease. It turns out though, that obesity rates have gone up ever since. Is that because still nobody is listening to nutrition advice? Not at all! People did listen: We now eat a lot less fat than we used to, especially of the saturated kind. The shops are full of low-fat products, we’re buying lean meat – preferably poultry –, skimmed milk and skinny lattes. And yet, heart disease is still one of the two leading causes of death in the UK alongside cancer.

Is it then because people are not taking their cholesterol medication? They are. It’s just that there is no relation between cholesterol levels and heart disease. If you are interested to learn more about this, you could start with this brilliant article by nutritionist and researcher Zoe Harcombe.

Fat has been thoroughly vindicated. It does not cause heart disease, it does not even make us fat, or at least not to the extent that we’ve been told. Yes, fat does have more than double the calories of carbohydrates – even sugar – and protein. However, a calorie is not a calorie, it’s not that simple. Also, fat is an essential component of our diet. Every single cell in our body is held together by a cell membrane that consists of fat, cholesterol and protein. The brain consists almost completely of fat and cholesterol. Fat is a carrier for important nutrients, such as the vitamins A and E. Vitamin D is made in our skin - from cholesterol. Fat and cholesterol are the building blocks of many hormones. Fat keeps your skin and hair supple and your joints moving. We need fat in our diet. It has a purpose, a job to do in your body. It’s not until those needs are met - or if the fats that are coming in are the wrong kinds of fat – that fat will be stored as fat.

What we don’t need in our diet at all is sugar. Sugar contributes to heart disease and obesity much more than fat does. Sugar is the simplest form of carbohydrate and while our cells use glucose (a type of sugar) for energy, we do not need to eat sugar to secure our supply of glucose. The body converts carbohydrates into glucose during digestion. So, a nice slice of wholemeal bread, some beans, a bowl of porridge, or even the carbohydrates from green vegetables, will supply all the energy our body needs. Eating actual sugar is not a requirement.

Thousands – or even just hundreds – of years ago sugar was also hard to come by. The only sugar there was was that from fruit, roots and honey (and of course sugar cane, if you lived in a tropical environment). Fruit and roots were seasonal, not always available, and honey first had to be found. Fat, on the other hand, was always consumed, coming from meat – animals were eaten almost completely! -, oily fish, eggs, nuts and seeds. We have a taste for sugar in order to encourage us to find it for energy. But how many apples can you eat in one sitting? One? Two? Yet, a 250 ml glass of apple juice contains approx. six apples and 25 g of sugar – which is exactly the same as the same amount of cola.

Today, sugar is everywhere. There are the obvious sources: fizzy drinks, juices, jam, chocolate, sweets, cakes, and biscuits. Then the less obvious ones: bread, salad dressing, fruit yoghurt, ketchup, mayonnaise, brown sauce, baked beans, chilli sauce, peanut butter, breakfast cereals, flavoured milk and water, and especially low-fat products. If you take away the fat, you’re taking away flavour, and sugar is used in order to make low-fat foods palatable. Note also, that in the process of digestion, white rice, white bread, white pasta turn into sugar very quickly and then have the same effects. The way these carbohydrates have been processed means that some that part of the work normally done by your digestive system’s job has already been done, and they are fast broken down into glucose .

This omnipresence of sugar in almost everything we consume means that we are eating vastly more sugar than we are designed to tolerate. We should not eat more than 30 g = 7 teaspoons of sugar a day, children need to eat less. It’s very easy to eat more than that. A lot more. Many of us consume 20, 30 or 40 teaspoons a day without even realising it. The brilliant documentary “That Sugar Film”, which was released on DVD in the UK at the end of July, shows how easy it is to over-consume sugar through ‘healthy’ foods alone. Dried fruit? Full of sugar. Agave syrup? Almost pure fructose, which is even worse than glucose. Yoghurt, fruit juice, cereals …

But is sugar really so bad for us? Yes, is the short answer. If you watched Jamie Oliver’s documentary “Sugar Rush” last week, you’ll have learned that every day, small children have a number of teeth (not just one!) extracted under general anaesthetic as a result of sugar consumption, mainly through fizzy drinks. You’ll know, that children are now diagnosed with diabetes II, a disease that is entirely lifestyle related and was once something people got in old age. You’ll also have learned that each year in the UK, there are 7,000 amputations due to diabetes. That’s 130 every week.

Apart from ruining our teeth and giving us diabetes, sugar makes us fat and tired. It affects our hormone levels, promotes inflammation – and thus heart disease – as well as cancer, sugar is addictive, and fructose in particular overloads the liver and can cause non-alcoholic fatty liver disease.

For more information on fat, cholesterol and heart disease I recommend watching the documentary “$tatin Nation”, or read Dr Malcolm Kendrick’s book “The Great Cholesterol Con”.

For more on sugar: Jamie Oliver's documentary "Sugar Rush" will be on All Four for another 25 days. I also recommend Dr Robert Lustig’s TEDx Talk “The Elephant in the Kitchen” or if you have more time than 22 minutes his 90-minute-talk “Sugar: The Bitter Truth”.

If you would like to reduce your sugar intake, but don't know where to start, why not join one of my zest4life Programmes in Leigh-on-Sea. If you prefer 1:1 attention, you could book a 12-week zest4life Programme with me and see me in clinic at The Body Matters in Leigh-on-Sea, Essex.