In the “old” days LDL was considered “bad” cholesterol . . . . HDL, on the other hand, was traditionally believed to be “good” cholesterol . . . The problem is, we now know that there are at least five different types of LDL and several different types of HDL, and not all of them behave the same way.
~ Jonny Bowden, PhD, CNS – Good Health Lifestyles (Winter 2017)
Co-Author With Stephen Sinatra, MD, FACC, The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease – And the Statin-Free Plan That Will
Are you concerned about preventing heart disease? Are you taking a statin drug (such as Lipitor, Zocor, Crestor) to manage your high cholesterol because you think that will protect you? Have you been experiencing any of these potential side effects of statin drugs: low energy; depression; memory loss; high blood sugar/diabetes; muscle weakness, pain, or fatigue; sexual dysfunction/low libido; or signs of cancer? If so, now is a good time to learn more about the role of cholesterol in the body, the true causes of heart disease, and natural means of preventing it through diet, lifestyle choices, and dietary supplements.
The REAL Important Facts About Preventing Heart Disease
The CDC reports that heart disease is the leading cause of death for people of most ethnicities in the United States. Unfortunately, contrary to the views of many medical experts and scientific evidence that was conveniently ignored for political expediency, conventional medicine, the USDA, and the American Heart Association, continue to follow the same entrenched cholesterol-fat-heart health guidelines established in the 1980s.
Fortunately, to the benefit of a fast-aging America, integrative medical practitioners have been calling for a re-examination of the scientific studies in order to get traditional medical opinion to turn the corner toward a more accurate, updated approach to heart health. In the early 1970s, when my peers viewed good nutrition as secondary to maintaining good health and mocked dietary supplements as ineffective, I regularly chatted with Dr. Stephen Sinatra (board-certified cardiologist, American College of Nutrition fellow, and former Manchester practitioner) to share what I was learning from the scientific literature about clinical nutrition. Dr. Sinatra was just then beginning to explore preventive medicine, but has since become one of this country’s top integrative cardiologists and a leader of this uphill climb. Below are some of the well-substantiated key points from The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease – And the Statin-Free Plan That Will, the thoroughly documented, layman-friendly book he recently co-authored with Jonny Bowden, PhD, CNS. I have also added a few of my own points, but much of the information from the book has provided the foundation of my clinical nutrition practice over the past two decades:
Cholesterol: Life can’t go on without it.
Almost every cell, the liver, and brain (accounts for 25% of all cholesterol in the body) manufacture it, and enzymes convert it to vitamin D, steroid hormones [sex hormones (estrogen, progesterone, testosterone), stress hormones (adrenaline, cortisol, norepinephrine)] , and bile salts for fat digestion and detoxification. The membranes surrounding cells and the structures within them consist largely of cholesterol. Only oxidized cholesterol threatens good health because it sticks to arterial walls and causes inflammation, the true cause of heart disease. Otherwise, the body uses non-damaged cholesterol to combat infectious toxins.
Conventional doctors’ outdated focus on lowering LDL (“bad”) cholesterol and raising HDL (“good”) cholesterol is misguided and dangerous. More recent science has shown that there are subtypes of LDL and HDL that do not all have the same impact on heart health:
- LDL-A – preferred big, fluffy molecules;
- LDL-B – atherogenic small, hard, dense molecules more likely to become oxidized;
- HDL-2 – anti-inflammatory, large, buoyant;
- HDL-3 – poorly understood, potentially pro-inflammatory, small, dense. Moreover, aggressive lowering of LDL does not even reduce arterial calcified plaque
When evaluating a patient’s cardiovascular health, doctors should conduct at least some of these key tests:
- LDL Particle Size (Optimal: pattern A profile);
- hs-CRP – (Optimal: .8mg/dL)- an inflammation marker directly associated with overall heart and cardiovascular health;
- Interleukin – 6 (Optimal: less than 12.0 pg/mL)- a precursor to CRP that provides an earlier warning of inflammation;
- Serrum Ferritin (Ideal: Women < 80 mg/L – Men < 90 mg/L) – stored iron in the blood is highly prone to oxidation;
- Lp(a) – a serious risk factor that is difficult to treat; Lp(a) promotes inflammation, blood clot formation, and plaque build-up;
- Fibrinogen (N 200-400 mg/dL) (FiF/Clauss method) – test determines the stickiness of blood;
- Homocysteine (Optimal: 7-9 µmol/L) – damages artery wall function, and promotes inflammation and thrombosis;
- Coronary Calcium Scan (Agatston Test) (Minimal Arterial Calcification < 10; Extensive Calcification > 400)
Diet: Doctors Sinatra and Bowden introduce three important but controversial points about heart-healthy dietary choices. First, science has well-established that, in most humans, there is practically no connection between the cholesterol consumed in food and the amount of cholesterol found in the blood.
Second, stable saturated fat is far less threatening to cardiovascular health than unstable, potentially carcinogenic polyunsaturated fat (vegetable oils). While saturated fat is mildly inflammatory and may contribute to insulin resistance, polyunsaturated fats are far more easily oxidized (especially when re-heated) and thus more readily yield disease-provoking free radicals. Doctors Sinatra and Bowden write that studies have proven:
“saturated fat . . . does in fact raise overall cholesterol levels but its effect is still more positive than negative, because it causes HDL levels to go up more than LDL levels. Even more important, saturated fat has a positive effect on the particle sizes of both LDL and HDL, making more of the big, fluffy, benevolent particles and much less of the small, dense, inflammatory particles. (It’s called shifting the distribution of LDL particles.)”
Third, sugar [especially fructose (except that found in whole foods) and high-fructose corn syrup], rather than saturated fat and cholesterol, is the top dietary contributor to heart disease. It raises its three key predictive measures, namely hypertension, high triglycerides, and high ratio of triglycerides to HDL (2 = healthy, 5 = heart disease risk).
A heart-healthy diet thus EXCLUDES:
- Sugar (soda, juice, energy drinks; empty-calorie sweets);
- High-Glycemic and Processed/Packaged Carbohydrates [pasta, bread, rice, potatoes, cereal (except oatmeal)];
- Trans Fats (partially/hydrogenated vegetable oil) (in fast food, non-dairy creamers, margarine, baked goods mixes, instant soups, chips, crackers);
- Pork, Lamb, Ordinary Beef (see Beef below), and Processed Meats (contain high sodium and nitrates; includes traditional hot dogs, cold cuts, sausage, bacon);
- EXCESSIVE Omega-6 Fats (eliminate oils such as Wesson, Crisco, corn/safflower/soybean/canola) – balance in 1:1 ratio (or no higher than 4:1) with omega-3 fatty acids (fish/fish oil supplements, flax seed oil, chia seeds); restaurants generally use vegetable oils to fry, sauté, and bake;
- Dairy and Gluten (pro-inflammatory; difficult to digest; common allergens/sensitivities
A heart-healthy diet INCLUDES:
- Fish [at least 2 times/week; especially wild Alaskan salmon (contains omega-3 fats, astaxanthin, and potassium), sardines, herring];
- Whole-Food Complex Carbohydrates [(especially berries (contain anti-inflammatory anthocyanins); modest amounts of fruit (especially cherries); vegetables (5-9 half-cups/day; especially cruciferous, dark green leafy, and avocados; anti-inflammatory; contain antioxidants and flavonoids)];
- Organic Grass Fed Beef (if beef can’t be avoided) (not raised with the antibiotics, steroids, and hormones in feedlot-raised, factory meat) – contains lower omega-6 fats and a healthy amount of omega-3s;
- Nuts (1 ounce, 5 times/week; especially almonds, walnuts, Brazil nuts; high in L-arginine, antioxidants, and monounsaturated fats);
- Beans/Lentils (1/2 to 1 cup at least 4 times/week; high in fiber, antioxidants, folic acid);
- Dark Chocolate (1-2 squares, 4-6 days/week; minimum 60% cacao);
- Healthy Drinks: Decaffeinated Green Tea (detoxifies; contains polyphenols and anti-cancer EGCG); Pure Pomegranate Juice; Red Wine (very moderately, and the only choice ONLY if alcohol can’t be avoided);
- Healthy Recipe Ingredients: 100% Pure Extra-Virgin Olive Oil (artisan quality preferred); Fresh Crushed/Chopped Garlic; Turmeric
- Diet modification is a critical first step to preventing heart disease, but there is so much more to this story. Watch for Part 2 of this article, which will detail the heavy down-side of taking a statin drug (the conventional, over-prescribed cholesterol-lowering remedy widely deemed critical to ensuring heart health), and the dietary supplements and other lifestyle choices that can set you on the path to true, long-term cardiovascular wellness.The statements in this article have not been evaluated by the Food and Drug Administration and are not intended to take the place of a physician’s advice. The natural remedies discussed herein are not intended to diagnose, treat, cure or prevent any disease.Submitted by Michael Dworkin, PD, CCN, a Registered Pharmacist and State Certified Clinical Nutritionist (CT Cert. No. 232), with J. Erika Dworkin, Certified Lifestyle Educator and Board Cert. Holistic Nutrition (Cand.). Co-owner of the Manchester Parkade Health Shoppe (860.646.8178, 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com), Pharmacist Dworkin has been guiding patients since 1956. Erika is available to speak to groups.All statements in this article are research-based and references are available upon request.