MHLbThoughts from the Chair: Why it might be time to take cholesterol out of the penalty box

Pick up just about any magazine related to health and fitness, and at some point or another you'll find an article about how to lower your cholesterol. This focus is part of long-time efforts to communicate the belief that cholesterol is bad and we need to do whatever we can to lower our total cholesterol – the lower the better is what I often hear. Keeping an eye on your cholesterol is obviously important, but hopefully I can share some new information related to managing cholesterol.

cholesterolCholesterol, and specifically elevated levels of cholesterol, has been linked to cardiovascular disease ever since the 1950's when researcher Ancel Keys released his Seven Countries Study, an epidemiological examination of the relationship between diet and coronary heart disease and stroke in different regions of the world.

From this study, the diet-heart hypothesis was postulated, basically stating that higher consumption of dietary fat was found to correlate with increased blood cholesterol levels and increased heart disease in the populations studied. The American Heart Association adopted this theory and then widely disseminated their belief that cholesterol and saturated fat in our diet will raise cholesterol in our blood. They went on to say that this metabolic situation then leads to atherosclerotic changes in the blood vessels that cause heart disease. Although the correlation they reported does not equate with causation, the low fat/high carb diet was born and we been impacted by it ever since.

cholesterol-checkAs a result, cholesterol got a bad rap. The fact is, cholesterol is actually a poor predictor of heart disease and heart attacks, and is comparatively insignificant in heart disease manifestation. The best predictor of risk for heart disease as confirmed in a Harvard study is your triglycerides-to-HDL ratio. Within this measurement system, a ratio under two is considered excellent while anything over four appears to indicate an increased risk of heart disease. As part of this model of prevention, you want to have your triglycerides under 100 and ideally under 70 to help keep the ratio and your risk low.

It turns out that cholesterol, around 70% of which is produced by our liver, is a very important molecule in our bodies and we rely heavily on its production and use for healthy daily living. Cholesterol is a necessary precursor for our bodies to make estrogen, progesterone and testosterone (our steroid hormones). It is also needed for the absorption of vitamin D and low cholesterol leads to memory loss and foggy brain syndrome. In short, cholesterol is needed for life.

So if cholesterol isn't the culprit it's long been positioned, what does cause heart disease? According to an extensive amount of medical research, it's inflammation, oxidative damage, stress and sugar! Stress and increased levels of blood sugars cause small damage to the linings of our blood vessels. The "bad" Low Density Lipoprotein (LDL) particles then get trapped at the site of the injury and repeated oxidative stress and inflammation turn this damage into plaque that in turn, leads to a narrowing of the arteries. he oxidative LDLs are the real problem, and yes, carbohydrates and especially refined sugars will lead to oxidized LDLs. Without inflammation and oxidative damage, it appears that the LDL particles actually don't create much of a problem at all.

To test for inflammation in your body, talk to your physician about measuring the amount of CRP (C-reactive protein) in your blood. CRP is produced by the liver and it rises in our blood when chronic inflammation is present in the body. To determine risk for heart disease you may also request a high-sensitivity C-reactive protein (hs-CRP) assay. Should everyone get this test? Based on other factors, the answer is no. For example, if your cholesterol levels are normal, if you have low triglycerides and if you have a good triglyceride-to-HDL level, there is no need.

But, if you score out of range on the cholesterol values, a serious discussion with your physician about further testing would be a good approach. Finally, and I'm speaking from my personal perspective, I would look to make some considerable dietary changes before I went the medication route for cholesterol lowering purposes. After all there is a growing body of evidence that the most effective way to lower triglycerides and raise HDL is through a low carb diet (reduced starches and sugars, processed carbs) combined with a strong focus on exercise. And the good news is that's a prescription we can all afford.

Stay healthy my friends,
Chair – My Healthy Lifestyle Employee Wellness Committee

(Editor's Note: In addition to serving as Chair for the Employee Wellness Committee, Daniel Ballin is the Administrator of Riverside's Therapy Group, Wellness and Outpatient Services and oversees all of Riverside's therapy services along with Riverside's Wellness and Fitness Centers in Newport News and Gloucester.)