Does Your Cholesterol Need Medication?
Updated: Sep 23, 2020
Let us take a dive into the controversy of how and when to treat cholesterol. Let us try not to confuse the topic of heart disease and clogged arteries by interchangeably calling it “cholesterol management.” The western model focuses on the broken diseased parts (in this case, clogged arteries) and renders a treatment for it. The eastern approach focuses on giving the body the right pieces to correct itself , and in this case, prevent clogged arteries. There is a place for both prevention, wellness, AND disease treatment.
Cholesterol is a compound that is primarily manufactured in the liver that has been efficiently constructed to provide the base for our cell walls and create the substrate for 40% of our brain protection and myelin sheathing to help electrical signal conduction. Cholesterol also is the foundational compound of sterols to create our sex hormones (estrogen, progesterone, testosterone), vitamin D, and to make bile in the liver to break down our fats. It also is a precursor for cortisol, our stress hormone. Cholesterol was discovered in the 1700s and contains the derivation of chole (bile) and sterol (“solid”), literally interpreted as “solid bile.” There were a lot of hypotheses over time regarding cholesterol, testing of it, its implications when present, and its interpretations when it creates disease.
We need to be clear about cholesterol versus lipoproteins. When we talk about HDL and LDL and many other varieties (VLDL, chylomicrons), we are talking about cholesterol carriers that are made up of proteins (to help keep them water soluble in blood), cholesterol, and other lipids to transport them to tissue for different functions and manufacturing of the hormones, etc. So, when we talk about good and bad cholesterol, we need to state that all cholesterol is good, but these lipoprotein carriers have been nicknamed based upon current knowledge. Currently we have HDL, LDL, VLDL, chylomicrons that we can measure. We can further breakdown LDL (“bad cholesterol”) into a fractionated particle analysis. This measures how fluffy and buoyant they are versus small and bee-bee like. Even more specifically we now can measure moieties on the LDL lipoprotein to figure out if a patient is genetically more apt to cause artery damage. These are the Lp (a) or apo B portions that help stratify how high risk a patient may be to develop blocked arteries. I use this testing frequently to prove to patients that a medication may not be needed for preventive purposes.
Why has cholesterol itself gotten such a bad rap?
Atherosclerosis, which is the medical term for clogged arteries, was discovered in the early days as having a lot of cholesterol in the areas of blockages. As a reminder of the anatomy of a blocked artery we now know it to be made up of an area of traumatized artery, fibrin clotty material, “foam cells” and a cholesterol band-aid on top of the whole area. As some of my colleagues and experts in cardiology describe cholesterol, it is ‘found at the scene of the crime but is not the perpetrator.’ And, so eloquently noted that ‘you can’t blame firemen for being at the fire.’ There are many reasons why an artery can get traumatized. Most commonly are the free radicals released and caused from smoking. A bad diet, hypertension, elevated sugars (the red blood cells get sticky and spiky from the sugar) and high triglycerides floating in the artery create the trauma and sticky clots that ultimately create blockages and atherosclerosis.
If we can remember that cholesterol is an innocent bystander and we are measuring the lipoproteins, most of our risk reduction to prevent blocked arteries should focus on sugars (controlling diabetes), hypertension, obesity, and smoking.
Since the early discovery of the cholesterol found in the plaque, discoveries were made to lower cholesterol and as early as the 50's and 60's niacin and fibrates were made. Statins came into play in the 70's. Statins very potently and indiscriminately lower total cholesterol, LDL lipoproteins, etc.
So, if the Western disease model was 100% correct that cholesterol caused heart blockages and atherosclerosis, then statins would prevent heart disease and heart attacks very effectively. WRONG!
Many who suffer from heart attacks have normal cholesterol levels. Statins used preventively do not help women nor most young men much at all for heart disease prevention. Statins do have a secret capability and that is to behave as an anti-inflammatory and to a degree, a bit of a blood thinner. Evidence shows that statins will work quite well in a middle-aged male who already has plaque build up in his arteries. Rare genetic familial dyslipidemias may benefit on a case by case basis. These are compelling indications for use when a big gun is needed. Building evidence for diabetic patients a low dose statin could prevent heart disease with the theory that a diabetic already has endothelial disease (minor plaque buildup) by nature of the sticky spiky sugared up red blood cells traumatizing the artery walls. Stay tuned for more robust studies on this.
So, what are the downsides of statins? MANY!
Statins deplete CoQ 10 (ubiquinol), an enzyme critical for the mitochondrial “batteries” in our cells to generate energy. The muscle, and keep in mind the heart is a muscle, heavily relies on cellular energy. Depleting CoQ10 depletes the muscle's capability of contracting well. In the attempt to prevent a blockage, we have now created a detriment to the heart muscle itself, potentially contributing to heart failure in which the heart muscle peters out. Statins wipe out so much cholesterol that hormone levels decline (testosterone in men), vitamin D levels decline, myelin and brain insulation declines and now the brain is set up for dementias, poor function, and memory impairment. Statins have a high rate of muscle breakdown, pain, and muscle atrophy. This is not advised in the elderly population.
Statins can cause liver inflammation, neuropathy, and depression. Can we just simply agree that we were not born with a statin deficiency?
Natural ways to manage your artery health and cholesterol include:
· Stop smoking
· Keep weight fit and trim
· Manage sugars
· Stress reduction in any capacity to help keep blood pressure low including meditation
· Fish oil, mostly importantly the DHA component, to keep arteries compliant
· Improving sleep: grounding, melatonin, blocking excessive emf (electromagnetic frequencies), magnesium, 5-HTP
· Emotional states have been studied to its effects of heart health.
· Social activities that enjoy intimacy and connections with others will improve heart health.
· High plant-based diets, ketogenic, low-carbohydrate, non-processed foods
· Vegetables do not clog arteries!
There is no cholesterol that is bad. There are a few lipoprotein pieces that may put you at risk for blocked arteries. The health of your arteries is within your own power to change and improve.