Dr David McGrath

Spine Physician

MB BS (Hons) FAFOM, RACP, FAFMM
Master of Pain Medicine

All About Cholesterol

There is abundant evidence that high cholesterol is not a problem. (low cholesterol is a problem)
This seems strange for those of us ,in the west, where this idea has been promulgated.
Many reputable scientists around the world, have openly criticized the "cholesterol heart hypothesis" or the more general "heart diet hypothesis".
For a complete analysis of this misconception readers are referred to
The International Network of Cholesterol Skeptics

The sadnes of this idea is;
1. Good diets are being replaced with inferior diets in order to lower blood levels
2. Animal fat consumption is being lowered, leading to increased consumption of either carbohydrates or polyunsaturated fats. This is a double negative. Animal fats, in addition to providing good quality energy, are high in fat soluble vitamins, necessary for health. Carbohydrates are insulin producing and can dispose us to diabetes. Polyunsaturated fats, are unstable, readily oxidised, create free radicals,and are implicated in cancer.
3. Dangerous drugs are being utilised to lower something, that should not be interfered with.

If you are confused, discuss it with your doctor in depth. The issue is likely to remain topical for many years to come. I am personally happy to ignore cholesterol levels as irrelevent.

The General Idea
1. Much of the degraded material in atheromatous plaque (blood vessal damage) is oxidised cholesterol. Ergo, cholesterol is the cause of artery disease.
2. A fatty particle in the blood, known as LDL, carries most of the cholesterol to tissues. Another fatty particle, HDL, takes cholesterol away from tissue back to the liver. Hence we have "good" and "bad" cholesterol.

The Evidence
1. Some people with a genetic abnormality (LDL receptor defect ) AND consequant very high cholesterol developed early artery disease. In other words, the genetic problem is the cause of artery disease and high cholesterol.This is a major blunder. (see cause and effect articles) Association is not cause.
2.The few prospective studies that show a minor positive correlation, with high levels of cholesterol, have the same problem. Poor glucose clearance (insulin resistance) for instance, will concurrently, raise blood cholesterol and insulin levels, which does give artery disease.

The Major Evidence Against
1. People with high cholesterol live just as long, or longer, than those with normal values.
2. People with low cholesterol die earlier

FAT PHYSIOLOGY

Lipoprotein Physiology	Physiology	Content
Chylomicrons	Carry fat and vitamins from GIT into lymph and blood stream Disappear after several hours from eating	Triglycerides Fat Soluble Vitamins Cholesterol Transport Proteins (B48)
GIT VLDL's	Carry fat and vitamins from GIT as with chylomicrons Rapidly disappear after a meal	As with Chylomicrons
Liver VLDL's	Made in liver from glucose, proteins and HDL's	Different Transport proteins from GIT VLDL's (B100)
IDL's	Degraded liver VLDL's	Loss of fat
LDL's	Degraded IDL's	Further loss of fat
HDL's	Transport cholesterol from damaged tissues, back to the liver. Change from HDL-1 through to HDL-4, with a change in shape, structure,density	Cholesterol and proteins

Confusing Terminology
1. Liver VLDL's are often called "Triglyceride" as they contain most of it, after a fast
2. LDL's are often called "cholesterol" or "bad cholesterol" because that's where most of it exists
3. HDL's are often called "good cholesterol"

Physiology Summary
1. Cholesterol is carried with fatty particles called lipoproteins.
2. Cholesterol is a vital component of membrames, and is supplied to tissues from the liver and GIT, to other tisues by LDL's
3. Cholesterol is recycled back to the liver for re-processing in HDL particles
4. The ratio of cholesterol carried by LDL/HDL is around four. ("bad"/"good" ratio)
5. Some people have higher levels of cholesterol than others. Important chemicals in the body are usually, highly regulated and controlled.
6. Sometimes the LDL/HDL ratio is disturbed, and could be a sign of physiological stress
7. Sometimes the level of VLDL's in fasting are high, suggesting poor clearance of fat (Triglyceride)after a meal, or the need to produce more than usual.
8. Disturbances from normal values, might be a sign of energy dysregulation (fat,protein,carbohydrate balance)
9. Cholesterol is a vital component, throughout the body
10. There is no dose-response relationship to blood levels and artery disease. This is certainly true for other measures, such as CRP and ESR, reflecting disease states. Higher is worse. Both low and high cholesterol can be a reflection of disease. We should all have a level of around 5.5 mmol/l, if we are to believe the prevailing view. (thought to be "high" )
11. It is also strange that disease might correlate with a fasting specimen, when the levels fluctuate wildely during the day, as we consume meals.

Fatty Diet
1. Less liver VLDL's are produced, and hence lower levels of LDL's.
2. Higher levels of HDL's because less of them are being converted to VLDL's

Carbohydrate Diet
1. More VLDL's and hence "Triglcerides" due to glucose conversion to fat in the liver
2. More LDL's or more "bad cholesterol"
3. Less HDL's due to liver consumption, needed for production of VLDL's

What's this have to with artery damage ?
Nothing, except that cholesterol is found in fatty plaques, when the artery has been damaged.
Cholesterol is a rather useful bandage !
There are much better candidates for the development of atherosclerosis, such as
1. Excess monosachharides (glucose,fructose,galactose) causing Insulin resistance and excess glycation of proteins.
2. Abnormal REDOX balance,leading to oxidation of chemicals, including cholesterol
3. Blood flow damage
4. Abnormal clotting mechanism
5. Toxic poisoning from heavy metals
6. Poor micronutrient balance or insufficiency (vitamins, trace elements)

Is Anything Worth Measuring?
There may be some important information to be gained by measuring, fasting glucose and triglyceride. This would give possible insight into energy regulation. Low cholersterol is an indicator of fragile health.

Pehaps this is the bottom line !
1. Japanese eat very little fat and suffer fewer heart attacks than us.
2. Mexicans eat a lot of fat and suffer fewer heart attacks than us.
3. Chinese drink very little red wine and suffer fewer heart attacks
than
us.
4. Italians drink excessive amounts of red wine and suffer fewer heart
attacks than us.
5. Germans drink beer and eat lots of sausages and fats and suffer fewer
heart attacks than us.
6. The French eat foie-gras, full fat cheese and drink red wine and
suffer
fewer heart attacks than us

CONCLUSION: Eat and drink what you like. Speaking English is apparently
what
kills you.

(to be continued)