The Great Cholesterol Myth

great_cholesterol_myth_graphic_1815631625_588968144I attended a naturopathic medical conference this past fall, and the best lecture hands down was one given by Dr. Stephen Sinatra MD. The lecture was entitled: “Metabolic Cardiology: A New Nutrient Therapy for Cardiovascular Disease”. This lecture was inspiring and full of knowledge that I considered to be “truth” when it came to illness and disease. Much of the lecture contained information that coincided with the way I have practised medicine for the last few decades now. When information rings true, it just rings true. Scientific studies are important when trying to determine best plan of care, and so is plain old common sense. I just finished reading the book that Dr. Sinatra co-wrote with Dr. Jonny Bowden, PhD, entitled, “The Great Cholesterol Myth”. Dr. Sinatra also has a valuable and informative website called Heart MD Institute.

When a highly respected neurologist (Dr. Perlmutter of Grain Brain), and a highly respected cardiologist (Dr. Sinatra), are saying basically the same things regarding nutrition, the prevention of disease, and the role of cholesterol as it relates to illness, this information cannot be ignored. Both books provide reams of solid scientific studies that support each of their opinions and recommendations;  one from a neurological point of view, and one from a cardiovascular point of view.

From a metaphorical perspective, when the mind is open (brain/neurology) and the heart is open (cardiology), it is much easier to ascertain what is truth. As well, when scientific study after scientific study, shows similar findings in very different disciplines, truth is within reach. And from a physiological point of view, the brain and the heart are in constant communication like a “heart-brain hotline” as is described in “The Greatest Cholesterol Myth".  When a heart-mind connection is in sync, there is truth in them thar' hills.

If you or someone you love has cardiovascular disease, or you have a family history of heart problems, this is probably the most comprehensive and entertaining book you will ever read on the subject. I laughed out loud so many times while reading this book because the authors have a great sense of humour. They explain complex concepts in very simplistic language and in analogies that are really quite clever. I will never see a free radical the same way again, but only as a hormone-fuelled college sophopmore trying to hit on a couple who are in a stable relationship. The book is loaded with awesome analogies.

Here are some highlights from the book:

  • elevated cholesterol is a non-existent disease and the lipid hypothesis is a crock
  • regarding cholesterol, small dense LDL (type B) particles are the problem and saturated fat helps combat these dangerous molecules
  • Lp(a) (lipoprotein a) is one of the most devastating risk factors for heart disease and it is difficult to treat (i.e. no drug therapies address this risk factor)
  • sugar is the problem not fat;  in fact sugar, stress, inflammation and oxidation are the problems
  • the cholesterol measurements you get at your MD's office are outdated and of limited value
  • instead of getting the regular cholesterol measurements done, the following tests are far more valuable in assessing your cardiac risk profile:  LDL particle sizes, hs-CRP, fibrinogen, serum ferritin (iron), Lp(a), and homocysteine.
  • high levels of HDL ("good" cholesterol) mean nothing if you don't know if it's the good-"good" kind or the bad-"good" kind
  • high levels of insulin can increase your blood pressure and cholesterol, and insulin is related to sugar intake
  • many studies show that those with low cholesterol die sooner and experience many other problems

As well, an entire chapter is devoted to discussing and managing stress, since the stress response can save your life or kill you.  Stress and elevated cholesterol go hand in hand.  It's worth getting the book for this chapter on stress alone.

After reading the chapter on stress, there were 3 take home messages for me:  1)  meditation  2)  community, and  3)  creation of disease from the perfect storm.

Meditation.  For me, meditation has always been freakin' boring.  I've tried all kinds:  transcendental meditation, guided meditation, silent meditation, etc.  They are way too boring for me because my mind is always so active.  My friend Monika is in the process of completing a 10 day Vipassana meditation retreat, where she has been meditating all day long for 10 days in a row.  Can you imagine?!  In my mind, that would take incredible gumption and fortitude to do something like that.  Being thus inspired by my friend, and being thus reminded of Herbert Benson MD's work with "The Relaxation Response" (as discussed in chapter 8, "Stress:  The Silent Killer"), I have committed to meditate 20 - 30 minutes twice daily from here on out.  My New's Years resolution has begun early, because I know that the benefits that await me are enormous if I can persist with a regular disciplined meditative practice.

Community.  Again, I was reminded by the wonderful study done long ago in Roseto, Pennsylvania, where heart disease was shown to be much reduced in this town compared to the national statistics.  Even though the men in Roseto worked in underground mines, smoked, and ate foods fried in lard, they had strong family ties and were nourished by community.  Connection and community was the reason for the low incidence of heart disease in this town.  The sense of community, belonging, and support, cannot be underestimated when it comes to the promotion of great health.  I feel very blessed to be part of many communities;  my nuclear family, my extended family including friends and relatives (that put up with all of my boring blogs), my BV backpacking group, my naturopathic medical community, and the Bulkley Valley community where I live.  I am grateful for these connections.

Creation of disease from the perfect storm.  Sometimes toxic influences, - be they from food, or from water, or from air, - can be tolerated and adapted to.  Add stress into the mix, and illness takes on a whole new dimension and level of creation.  For more info, read about the frog experiment in chapter 8, or in this article from where the experiment derives.  (It's much more fun to read the chapter!)

The authors of the book also have a chapter on nutrient supplements for heart disease prevention and treatment.  This chapter is a very specific and excellent resource to use, should you ever need this valuable information.

The chapter on nutrition does not lay out a blow-by-blow diet plan as found in "Grain Brain", but specifically states the Do's and Dont's (or the "Eat it" and "Dump it") of managing healthy eating.  The ideas are very similar in both books:

  • go wild on the veggies, especially green leafies and cruciferous vegetables
  • berries, and other fruits in moderation
  • nix the sugar, processed carbs, processed junk, processed meats, trans fats and omega-6 oils
  • nix the pastas, breads, cereals, cookies, cakes, doughnuts, pastries, white rice and crackers
  • go heavy on the olive oil
  • wild Pacific salmon, grass-fed beef, nuts, dark chocolate, tumeric and red wine are good to go

The differences in both books regarding nutrition are small.  While Sinatra and Bowden acknowledge that gluten sensitivity may be problematic for some people, Perlmutter takes fire and aim at gluten.  Sinatra and Bowden like beans, but Perlmutter, less so, because of the carb load.  Perlmutter's self assessment questionnaire lists not drinking wine as a risk factor for neurological problems, and while Bowden and Sinatra acknowledge the benefits of polyphenols found in red wine for cardiovascular health, they also state that if one does not drink, now is not the time to start!  Thank you Dr.'s Bowden and Sinatra.

So instead of resorting to getting my neurological and cardiovascular health-fix from booze, I've decided to get my concentrated red wine polyphenols in capsule form.  This capsule also contains 100 mg of an antioxidant that both the 'Grain Brain' and 'The Great Cholesterol Myth' believe to be fabulous for the brain and the heart respectively.  That anti-oxidant is called trans-resveratrol.

Regarding fats, all three authors like saturated fat, monounsaturated fat, and omega-3 fatty acids, and don't care much for omega-6 pro-inflammatory fats.  Perlmutter drives the message home with much more gusto and goes out on a limb to recommend a high healthy fat diet.  And obviously, being a neurologist, he would.  The brain loves fat way more than the heart does.  However, "The Great Cholesterol Myth" has the following chart on page 75, which, along with avoiding sugar and junk completely, is the most important nutrition suggestion in the whole book (IMHO):

Screen shot 2013-12-11 at 8.34.05 AM

(I hope I'm not infringing on any copyright issues since I copied it from

Anyway, there you have it.  If I have changed one thing in my diet, it is eating much, much more of these healthy fats on a daily basis.  (That is, eating more saturated fats, even more monounsaturated fats and more omega-3 fatty acids, and not eating any omega-6s).

Regarding eggs, dairy and poultry, Sinatra and Bowden don't say much.  Perlmutter highly and regularly recommends eggs, as well as goat cheese and some hard white cheeses.

Like I've said many times on this website before, one size does not fit all.  After common sense basics and perhaps some food intolerance/sensitivity testing, personal experimentation regarding what works best for each person trumps just about everything.

The last topic I'll cover is statins.  (These are minimally useful drugs, unlike other useless cholesterol-lowering drugs like fibrates).   I'll try not to belabour this topic, suffice it to say the following:

  • if you are on a statin drug or your doctor wants to put you on a statin, read this book first
  • statins are way over-rated and can cause lots of problems;  the reason they work for a select few is not because of their cholesterol-lowering effect, but because of their anti-inflammatory properties
  • statins prescribed for children, the elderly, and for most women, is bad medicine
  • statins reduce the life-giving molecule called cholesterol, that is needed for so many crucial functions in the body
  • if you must take a statin, make sure you're also taking Coenzyme Q10 100 mg twice daily, and Vitamin D as measured by blood tests
  • Canada is much more on the ball than is the US when it comes to not prescribing statins for the primary prevention of heart disease (i.e. a person who has high cholesterol but has never had a heart problem before)

Here's what Dr. Sinatra says on his website regarding those people who could benefit (though not necessarily will benefit) from statin drugs:

"I stand firm by my opinion that statins should be prescribed only to men and women with advanced cardiovascular disease, and who do not have diabetes, and individuals with genetically-based high LDL cholesterol that can hasten coronary artery disease. For these people, the benefits outweigh the risks, but it is mostly for the therapeutic anti-inflammatory value of statins and not any cholesterol-lowering effect."

That is exactly what I believe also.

The new guidelines for the treatment of cholesterol to reduce heart disease as put forth by the American College of Cardiology will have more physicians prescribing more statins to more people.  Sheesh!!  What a freakin' disaster-waiting-to-happen that will be - for both brain and heart, - not to mention the immune system, joints, muscles, sexual function, etc.

Canada has it bang on though, thank God.  In his article entitled "It's time to question the new guidelines on cholesterol drugs", health journalist Andre Picard reminds us that Canada has not adopted these new guidelines.  Yay Canada!!  In this new article in BMJ, "Should people at low risk of cardiovascular disease take a statin?", it is plainly obvious that the benefits do not outweigh the risks.

In reading both the "Grain Brain" and "The Great Cholesterol Myth", I have changed my thinking on a few things.  I'm not going to brag about my 'perfect' cholesterol levels anymore, that range anywhere between 3.6 - 4.4 mmol/ (140 - 170 mg/dl).  No.  I am now actually aiming for much higher cholesterol levels, and even though dietary cholesterol does not create a huge impact on overall levels, it can have a minimal influence.  After reading both books, I have dramatically increased the volume of my healthy fat consumption using the foods in the chart above.

The last change I'm going to make, is to stop asking patients to get their cholesterol levels checked by their primary care physicians.  I will start doing tests myself, measuring values that are of significance to cardiovascular risk prevention, like LDL small density particles, oxidized LDL, Lp(a), Apolipoproteins A & B, homocysteine, hs-CRP, plasma Coenzyme Q10 and red blood cell magnesium levels.  I had done this in the past very sporadically and infrequently, but now I know, that it's the only reasonable way to go.  Here's a sample report:

Screen shot 2013-12-15 at 10.53.50 AM

I will start this coming Monday, beginning with myself and Bill.

Cholesterol is really a beautiful molecule and the demonizing stories created around it are akin to the evil villain myths of yesteryear.