Living Well I'd never heard my friend Jim sound that scared before...
Jim is a former pro athlete. I first met him 40 years ago while visiting my brother in Wisconsin. We've stayed in touch for years...
Unlike a lot of my friends, Jim (not his real name) had never called me for any medical wisdom. However, he eventually had to face the medical establishment. And his doctor's diagnosis upset him: high cholesterol, time to start a lifetime of medication.
Jim called me soon after his diagnosis.
He felt like his heart was a ticking time bomb, like he could suffer a heart attack any day.
Most of my friends are now in their 50s and 60s. Like clockwork, they go to the doctor for a checkup, and most of them leave with a prescription for a cholesterol-lowering statin medication.
It infuriates me to think of another doctor just treating a lab value instead of the person. After a few more friends called me this year with questions about cholesterol levels, I realized how clueless many doctors still are about the biochemistry of cholesterol and the causes of heart disease. And if doctors don't know, most patients have no idea.
As I've said repeatedly, when it comes to your health, nobody will look out for you better than yourself. So today, we're going to discuss exactly what this dreaded "cholesterol" molecule is... why it's not the villain your doctor makes it out to be... and what really causes most heart attacks.
Let's start with the basics...
Cholesterol is a type of fat molecule that our bodies need and our livers produce naturally. Cholesterols make up the membranes around our cells, form many of our important hormones (like testosterone), and make the liquids (bile) that break down our food.
You're likely familiar with cholesterol testing. It's a blood panel your doctor might request every few years. The guidelines from the CDC and the physician reference portal UpToDate recommend testing every four to six years, unless you have risk factors that need more frequent monitoring.
Your cholesterol screening will report the following measures:
Your doctor will probably focus on a single number – your "total cholesterol." That number reflects your HDL, your LDL, and one-fifth of your triglycerides.
Triglycerides are a type of fat in your body. Although not technically a type of cholesterol molecule, they're measured as a part of your total cholesterol. And like cholesterol, your liver makes triglycerides when you eat certain foods. The purpose of triglycerides is to create fat stores to be used as energy.
High levels of triglycerides cause severe inflammation, particularly in the pancreas. But you can lower your triglycerides the same way you would your cholesterol – with simple lifestyle changes.
Typically, a "normal" total cholesterol reading is 200 mg/dL or lower. Between 200 and 240 mg/dL is "borderline"... which means if you fall in this area, lifestyle modifications are recommended as your first line of defense...
Remember that cholesterol is only one small possible factor modern medicine promotes as the main cause of heart disease. Some other, more important factors include smoking... family history of heart disease... being overweight, especially carrying excess weight around midsection... age (65 and older)... high blood pressure... inactivity... and stress.
What infuriates me the most is that many people don't understand having high cholesterol does not mean you will have a heart attack. We know this from one simple fact: More than half the people who suffer heart attacks have perfectly normal levels of cholesterol.
Yes, if you have levels in the 300s and higher, it's likely you have genes that incorrectly make cholesterol and put you at risk... especially if it coincides with the other risk factors above. But it isn't the cause of heart disease. Your body is producing the molecules as a way of protecting itself.
As mentioned in the table earlier, one form of cholesterol, LDL, forms plaques in your arteries. Over time, these plaques can build up and lead to blockages. These can cause heart attacks and strokes. But the reason those plaques are there in the first place is that cholesterol is doing its job.
The cholesterol plaques are a sign of disease, not the cause.
The true cause of heart disease is inflammation.
Inflammation causes tiny cracks and fissures in our arteries. When these little breaks happen, our immune system recognizes the disturbance and signals cholesterol to "patch" the broken area. That patch is made from cholesterol and other molecules.
For years, doctors believed those plaque buildups were the root cause of heart disease. If you had too much cholesterol, it would "stick" to your arterial walls and cause these buildups. If you lower the cholesterol, the theory went, you'd lower the number of plaques and risk of heart disease.
In fact, simply lowering your cholesterol (or having low cholesterol to start with) does not mean you won't have a heart attack.
Over the past few years, a few studies looked into inflammation. In a massive 2012 study published in Nature Genetics, 170 researchers worked through the data of 190,000 people with heart disease. They concluded that inflammation was the cause of arterial plaques – not that cholesterol made the plaques, which then triggered inflammation, as is more widely believed.
Another 2017 study took it a step further. In that study from the New England Journal of Medicine, researchers ran a randomized double-blind study on more than 10,000 patients who had experienced a heart attack. (Remember, a randomized study is the gold standard for research.)
Half received a placebo and half received an anti-inflammatory drug. The drug did not lower anyone's cholesterol levels. However, those who received the anti-inflammatory drug saw significantly lower rates of any recurring heart problems, including heart attacks.
Chronic inflammation comes from chemicals in cigarette smoke, eating the wrong foods, obesity, and a sedentary lifestyle. Sound familiar? It's a vicious circle: The same risk factors for heart disease are the causes of inflammation.
You can find out what your inflammation score is through a test called a C-reactive protein screen, or CRP. Higher results mean you have more inflammation. That dramatically increases your risk not only of heart disease and heart attack, but also problems like diabetes and even Alzheimer's.
Here's my takeaway: If you have high cholesterol, talk with your doctor about the other risk factors. Get your inflammation score. Then make a plan to start with some simple lifestyle changes that are proven to lower your numbers and protect your heart by reducing inflammation.
Don't fall for the pressure to start on a lifetime of questionable medications when what's more important is making these lifestyle changes.
What We're Reading...
- More on the 2012 study and the 2017 study.
- Something different: What Ridley Scott's Alien can tell us about office life.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
June 4, 2019