Why High Cholesterol?
Believe it or not, cholesterol is your body’s soap! Your body runs on water, you are about 70% water, and when you eat fat or oil, it takes lots of soap for those dietary fats (saturated fats, trans fats, refined fats, high fat diet) to become soluble in the water environment of your body.1 If you are accustomed to washing dishes at home by hand, I am sure you find some fats harder to “wash” off your plates than others. Just realize that the fats that are the hardest to wash off your dishes are also the fats that will take the most cholesterol “soap” to dissolve in your body. Cholesterol dissolves the fats or oils you eat into the water environment of your blood. Hard fats, like animal shortening, hydrogenated vegetable oils and oils that have been browned by heating, are more difficult for the body to dissolve. These fats cause the liver to make more cholesterol “soap”. This ultimately results in increased blood stream cholesterol.234 The more fat of any kind you eat, the more cholesterol it will take for your body to process it. For each additional 1% fat you include in your diet, your total cholesterol will go up 11⁄2 points.5
Enterohepatic Circulation: The Liver Soap Cycle
The source of cholesterol “soap” is the liver, and the soap bottle or reservoir is the gallbladder. The cholesterol soap mixture is called bile. This bile is squirted into the small intestine when the need for soap is detected, i.e. fat in the digestive tract. This “soap” then tries to make the fat compatible with absorption into your water-based blood stream. The cholesterol component of the “soap” is re- absorbed in the small intestine and returned to the liver for processing. There are several things that can reduce “soap”/cholesterol in the system. Eat less fat, so less “soap” is called for. Eat more fiber, which will soak up some of the “soap” and carry it out in your stools so less “soap” is reabsorbed and returned to the blood stream and liver.
Eat more plants that are high in sterols.
These plant sterols compete with “soap” for re-absorption, thus reducing “soap” re-absorption.
Cholesterol In Many Forms
Cholesterol is cholesterol, but its packaging tells you its role. LDL or low density lipoprotein is the packaging marked for export form the liver to the tissues. HDL or high density lipoprotein is the clean up crew that takes cholesterol from the tissues back to the liver. LDL trucks it out into circulation and HDL retrieves it, removing it from the blood and tissues. As you might imagine low HDL is predictive of mortality form heart disease—without sufficient clean up crews working, junk piles up.6
Recently there has been discussion about the size of LDL and the impact of that size on health. Larger LDL particle size is associated with greater longevity.7 Smaller, denser, LDL particles have been shown to be associated with an increased risk of cardiovascular events.8 While all this size discussion makes for more laboratory testing, positive lifestyle approaches to heart disease risk factors can improve LDL particle size, which will reduce heart attack risks.9101112
The Fats We Eat
Trans-fat, a byproduct of hydrogenation of vegetable oils,13 increases the risk of high cholesterol by 65%.14 In one study, heart attack victims had 13% more trans fat in their cell walls.15 Trans fat lowers the “good” HDL-cholesterol more than saturated fat and decreases anti-oxidant activity in the body. This makes patients more susceptible to atherosclerosis and heart attacks. Additionally, trans fat increases the harmful LDL cholesterol.16 You may not be aware of where the trans fat in your diet is coming from. Sources of trans fat in the American diet by percentage include: cakes, cookies, crackers, pies, bread 40%; animal products 21%; margarine 17%; fried potatoes (like French fries and hash browns) 8%; Potato chips, corn chips, popcorn 5%; household shortening 4%; other (breakfast cereals, candy, etc.) 5%.17 Avoiding trans fat may take some investigation on your part.
The saturated fat found in milk, cheese, egg yolks, meat and sausage has an even more deleterious effect on cholesterol and coronary heart disease than trans fat.18 High saturated fat diet can raise total cholesterol by 23%.19 When cholesterol is a part of the diet, the total blood cholesterol will be worse if the other fats in the diet are saturated than if they are unsaturated.20 For example, because of its high fat and cholesterol content, 40gm of butter per day will raise
your cholesterol by 20 points.21 Palm oils differ little from other saturated fats in raising blood stream cholesterol.2223
Another factor, which is often overlooked, is the form of the fat or oil consumed. Refined oils absorbed early in the small intestine are esterified with cholesterol and enter the lymphatics to be deposited in the heart.
Oils residing naturally in whole foods are digested and absorbed later in the small intestine as phospholipids and enter the portal circulation where they are conducted directly to the liver. Thus they have less of an impact on total blood cholesterol.26
Animal Product Consumption And Cholesterol
People who consume animal products every day experience higher cholesterols, and have on average, a total cholesterol of 255 mg/dL. Those who limit their consumption of animal products to once weekly have a total cholesterol of around 205 mg/dL.27 Compared to vegetarians, animal product users (meat, eggs and dairy) eat 50% more fat, have: 30% higher total cholesterols, have 42% higher LDL cholesterols, have 38% higher triglycerides, have 32% higher blood sugars, and are five times more likely to have high blood pressure.28 People who drink cow’s milk or eat dairy products such as yoghurt and cheese everyday have 7 mg/dL higher total cholesterols and 5 mg/dL higher LDL cholesterols.29 A diet with animal protein and low fiber intake has been shown to significantly increase cholesterol levels.30 Casein, the protein in milk, makes your liver produce more cholesterol.3132 People on a unrefined, high fiber, high carbohydrate diet have significantly lower LDL cholesterols than those on a refined carbohydrate diet or a low carbohydrate, high protein diet.33 On the other hand, substituting 30 to 50 grams of soy protein for animal protein in the daily diet produces a 13% reduction in LDL, 10% reduction in triglycerides, 9% reduction in cholesterol, and a 2.4% increase in HDL.34 This nutritional advice has also been shown to be helpful in cases considered to have a “genetic” predisposition to high cholesterol.35
Refined Foods For Refined People?
Refined (processed) foods tend to make your blood sugar rise precipitously—making it go very high at a very rapid a rate. We categorize foods by their effect on the blood sugar according to the “glycemic index”.36 Glycemic load quantifies the amount of a high glycemic food you eat. High glycemic index or load foods make your blood sugar rise higher and faster then low glycemic index or load foods. Most refined foods are high glycemic load foods. High glycemic load diets drive LDL cholesterol up and HDL down.3738 On the other hand, reducing the glycemic load, by eating more whole plant foods, has the affect to reduce LDL levels.39 We recommend a high complex carbohydrate diet, a diet without refined/processed foods.
Disease and Elevated Cholesterol
The more cholesterol, (the higher your average cholesterol), you harbor in your blood stream, the higher will be your risk of dying of a heart attack.40414243 In fact, one high blood cholesterol measurement in your lifetime can mean a higher risk of coronary heart disease the rest of your life!44 The more cholesterol you carry in your blood the sicker your heart becomes.45 When your cholesterol goes up cells lining the blood vessels, called macrophages, fill up with fat and contribute to plaque formation.46 When you lower the fat (cholesterol and triglycerides) in your blood it virtually halts the progression of lesions in your blood vessels.47 People with genetically low LDL live 5-12 years longer and almost never have heart attacks.4849 The more fat and cholesterol you tolerated in you blood stream the shorter your life will be.5051 Here are some numbers that illustrate increase in risk: Cholesterol above 280 mg/dL increases likelihood of angina 5 1⁄2 times.52
Cholesterol above 240 mg/dL increases the risk of death from heart attack by 350%.53 On the positive side, each 2 mg/dl drop in cholesterol reduces the risk of heart attack by 1%.54 One of the reasons for this rise in heart disease and fatal heart attacks with increased blood cholesterol, besides the obvious increase in atherosclerosis, is that when your cholesterol goes up it impairs the heart’s ability to form collateral blood vessels which could help you survive a heart attack.55
Triglycerides also play a role. Elevated triglycerides are associated with increased risk of heart attack and death.5657 Triglycerides greater than 200 mg/dL significantly increase the risk of stroke or transient ischemic attack.5859
Caldwell Esselstyn, Jr., MD, of the Cleveland Clinic has shown on angiography that blockages in coronary arteries can be reversed by changes in diet. “The optimal diet”, according to him, “consists of grains, legumes, vegetables, and fruit, with less than 10%-15% of its calories coming from fat.” He goes on to say that, “This diet minimizes the likelihood of stroke, obesity, hypertension, type 2 diabetes, and cancers of the breast, prostate, colon, rectum, uterus, and ovary.”60 Did
Medicare ever promise anything like that? This sounds like a real insurance program!
What about cancer and cholesterol? Elevated cholesterol and triglycerides significantly increase breast cancer risk.61 The risk of breast cancer rises 88% when one eats foods with cholesterol, 125% for high intake of animal protein, 143% for high saturated fat intake, and 169% if you eat more calories than you need!62 Pancreatic cancer is the fourth leading cause of cancer death with a five-year relative survival rate of less than 4%, making it one of the most fatal cancers.
Eating cholesterol increases the risk of pancreatic cancer 50%. Eggs, a rich source of cholesterol, increase the risk by 60%.63
Other disease risks escalate with cholesterol. Elevated cholesterol and triglycerides together with low HDL significantly increase the risk of autoimmune inflammatory arthritis like rheumatoid arthritis.64 High cholesterol is a significant risk factor for macular degeneration and resultant blindness.65666768 A cholesterol of 240 mg/dL increases the risk of macular degeneration by 80%.69 A cholesterol level of 220 mg/dL or more increases the risk of migraine by 280%.70 Having elevated cholesterol levels increases the risk of high blood pressure 90%.71 Even hypothyroidism can result from elevated cholesterol levels.7273
The brain and nerves are not happy when cholesterol increases. Hypertension and hypercholesterolemia work together to increase brain dysfunction.74 When rabbits, confirmed herbivores, consume cholesterol, they develop Alzheimer’s disease-like lesions in their brains.75 Patients with elevated LDL Cholesterol have a 106% higher risk of cognitive impairment.76 Obesity and high triglycerides produce cognitive impairment.77 Elevated triglycerides predict increased peripheral neuropathy in diabetics.78 Elevated cholesterol levels are significantly associated with major depression.7980 Lowering cholesterol levels through lifestyle changes, has been shown to decrease depression, hostility, and severity of psychological symptoms.81
Dietary Cholesterol: The Cholesterol Entering Our Mouths
When you eat cholesterol, eventually some of it will end up in you blood stream. It has been said, “we are what we eat.” However, cholesterol is the soap, so, while eating cholesterol does not raise the soap level dramatically like eating fats does, dietary cholesterol still results in increased blood stream cholesterol.82 Eating 100 mg of cholesterol per day can increase total cholesterol concentrations by 2.2 mg/dL.83 Most people eat far more than 100 mg of cholesterol per day.
What foods have cholesterol? Nearly all animal foods have some cholesterol in them, some have more than others. Plant based foods do not have cholesterol. This is because it takes a liver to produce cholesterol and plants do not have livers!
Fruits and vegetables, nuts and seeds, beans and grains do not contain cholesterol. One cup of 2% Milk has 18 mg of cholesterol. One half cup of ice cream has 29 mg, most of which is oxidized. One tablespoon of butter would have 31 mg, and 3 ounces of clams 57 mg. In a three ounce serving, chicken breast has 73 mg, pork 76 mg, sirloin beef 80 mg, oyster 84 mg, shrimp 165 mg, one large egg 213 mg, beef liver 410 mg, and beef brains, which often end up as animal shortening, 1697 mg.84 Your body does not need a dietary source of cholesterol, it makes its own, fresh.
Cholesterol levels are not lowered when you replace beef, lamb, or pork in the diet with chicken or fish. Why? Because poultry’s proportion of cholesterol is similar to that of red meat even though it contains less fat.85
Dietary Cholesterol and Disease
Dietary cholesterol together with elevated blood cholesterol dramatically increase oxidized cholesterol. Oxidized cholesterol results in increased whole body inflammation, atherosclerosis and plaque formation.8687 The more cholesterol you eat, the more calcified plaque you can expect in your coronary arteries.88 When you make cholesterol a part of your diet, it increases inflammation in: the lungs leading to asthma;8990 the liver leading to non-alcoholic fatty liver diseases and cirrhosis;919293 and the prostate leading to pain, enlargement and cancer.9495 Cholesterol in the diet can bring about permanent microscopic damage to the kidneys causing them to loose 6 times more protein in the urine than acceptable levels.969798 “But I was eating the extra animal products to increase my protein intake….” When you stop eating cholesterol, blood vessel inflammation actually does subsided and coronary artery plaques become more resistant to rupture.99
Need osteoporosis? A high-cholesterol diet stimulates bone resorption causing osteoporosis.100
Dietary cholesterol seriously decreases mental performance.101102 Six hours after consuming a high fat meal the brain oxygen falls below 70%. What’s more, it does not return to normal for 3 whole days— which means some people have never had fully functioning brains!103
Oxidized Cholesterol In The Blood
“Why me?” a gentleman in his late 50s asked me. My total cholesterol has always been around 140 and my HDL is usually very good. He had had a heart attack and cardiac bypass surgery and was now wondering what he could do to avoid a repeat. As I got to know the gentleman better it became very apparent that the source of his cholesterol included foods high in oxidized cholesterol such as ice cream, pizza, and processed foods, while his diet was not high in fruit and vegetables.
For the same cholesterol level, people who eat fewer fruits and vegetables have a higher risk of a fatal heart attack.104 This is because of the effects of oxidized cholesterol. Oxidized cholesterol can be stabilized by the anti-oxidants found in fresh fruits and vegetables.
My uncle died of heart disease at age 39. He was an anesthesiologist at the University of Texas. He left a wife and two teenage sons behind. His nightly supper: ice cream. Within 24 hours of eating oxidized cholesterol, rabbits and monkeys develop vascular lesions which, if not repaired, would lead to arthrosclerosis and heart attacks.105106107108 Common sources of oxidized cholesterol include custard mixes such as ice cream, pancake mixes, because dried eggs are included,109 Parmesan cheese, and any food where cholesterol, or oils for that matter, come in contact with air and/or oxygen.84110 Serum oxidized cholesterol markedly accelerates atherosclerosis.111112113 Arterial injury caused by oxidized cholesterol leads to arterial wall cholesterol accumulation and plaque enlargement.114
Cholesterol oxidized by the body is negligible compared to oxidized cholesterol obtained from the diet.115116 Oxidized dietary cholesterol increases blood stream cholesterol and is the predominant source of tissue oxidized cholesterol.117125
Oxidized cholesterol favors platelet clot and plaque formation.118119 The more LDL is oxidized, the more cholesterol it transports to the tissues. The more HDL is oxidized, the less cholesterol it removes from the tissues.120121 Oxidized cholesterol markedly delays the clearance of chylomicrons, which transport cholesterol from the intestine to the liver, from the blood.122 The more fast foods; cheese puffs, potato chips and hydrogenated fat you eat, the worse your cholesterol will be, both in oxidation and in quantity.123 Cheese contains high levels of oxidized cholesterol.124125 Compared to vegetable oils, butter and cheese are very atherogenic—causing heart disease.126 Frying, grilling, even just cooking foods with high cholesterol content, such as meat, egg yolk and full fat dairy products, creates massive cholesterol oxidation.127128 As prepared consumer foods are becoming increasingly popular, the consumption of higher levels of oxidized cholesterol in foods is inevitable. Processes, such as pre-cooking, freeze-drying, dehydration and irradiation, have all result in increased production of oxidized cholesterol. Factors known to oxidize cholesterol in foods include: heat, light, radiation, oxygen, moisture, low ph, pro-oxidizing agents, and storage of food at room temperature.129 Cigarette smoke increases LDL cholesterol oxidation and lipid per oxidation.130
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