Wednesday, December 16, 2009

Cholesterol- a different view

Here is something that you may not know. Cholesterol is found in every cell in the human body, all 60 trillion of them, as it is part of the cell membrane. It is also the base component for a number of hormones. Some of these hormones are involved in regulation of fluids and salt within the body. Others are involved with energy pathways and glucose metabolism whilst the third group are the sex hormones (estrogen, progesterone and testosterone).

So how did a molecule, which is actually essential for life, become public enemy number one? Good question. It basically goes back to the 1970s and various studies which looked at factors contributing to coronary artery (heart) disease. To cut a long story short, the idea took hold that cholesterol is bad therefore the levels in the bloodstream needed to be reduced. This was later modified to allow for lowering “bad” cholesterol (LDL) but not “good” or HDL cholesterol.

It wasn’t till the late 1980s when the first statin drugs appeared that the big push to lower cholesterol really took off. This of course was encouraged by the pharmaceutical industry, which makes billions of dollars from the sales of statin drugs.

However circulating cholesterol has never and will never be the problem. The problem is plaque (which may include cholesterol) building up on the artery (blood vessel) wall. This is why some people with high levels of cholesterol never have heart problems (including some French and Italian populations with very high levels) and as many as 40% of those with heart disease have none of the “official” risk factors including raised cholesterol.

The real cause of vascular disease (including heart disease) is slow inflammation. In this setting cholesterol may contribute to plaque on the vessel walls, which narrows the bloods vessel restricting (or stopping) blood flow but is not the primary cause.

Recent studies have now shown that lowering cholesterol does not equate to lowering heart disease. Two drugs were compared. What was shown was that whilst one group of people had their cholesterol lowered more than the other there was no difference in rates of heart disease.

Lets get back to our original question about cholesterol as public enemy number one. In the 1970s it was observed that LDL (bad) cholesterol was raised by saturated fat. It was (and still is) assumed that saturated fat is bad because it raises LDL and in turn LDL is bad because it is raised by saturated fat. This is a circular rather than cause and effect argument.

Hence it became case closed that cholesterol was bad and anything, which raised it, was bad and hence lowering it was good. A bit like in George Orwell’s animal farm “for legs good two legs bad”.
Now what is interesting is that statins seem to be associated with lower rates of heart disease. However these new trials, which used non-statin medications, might be suggesting that the primary benefit of statins may not be lowering cholesterol but some other effect.

There are many scientific studies, which raise questions over the widespread use of statin medications. This is from the perspective of side effects and costs but mainly questioning the assumed benefits. Not surprisingly the manufacturers fund most of the studies supporting statins. Like many pharmaceuticals, there is a role but not as big a one as they end up with.

So what is the bottom line here? Essentially cholesterol has been made into an ogre, which it is not. In the process billions of dollars worth of drugs have been sold for far less benefit to many of those taking them than the pharmaceutical companies would have you believe.

For the individual interested in their own health the solution as usual is simple. Eat mainly food which till recently was growing or moving around. Make water your main beverage. Minimize processed and packaged foods.

This together with the other 7 pillars is your best way of staying healthy and in turn not getting sick.

1 comment:

  1. The first step to getting your cholesterol under control is to have it tested. Once you know what your numbers are and mean, you can measure the success or failure of any cholesterol management program you follow.