by Jonny Bowden, PhD, CNS
Since the early 1970s cholesterol has been painted as the primary culprit in cardiovascular disease. And from food to pharmaceuticals, an entire industry has sprung up over the past 30 years to help people drive their cholesterol down as far as possible. But here’s a fact that’s still surprisingly unknown to most of the population. And, even sadder, it’s still unknown to many doctors.
Are you ready?
Cholesterol doesn’t cause heart disease.
Cholesterol is a wax-like fatty substance that is produced in the liver and found in every cell in your body. It’s the parent molecule for your sex hormones—estrogen, testosterone, and progesterone. It’s also critically important for the brain. And it’s essential for thousands of physiological functions including the production of bile, the synthesis of vitamin D, and the creation and maintenance of cell membranes, nerve sheaths, and brain tissue. Cholesterol is so important that without it, you would die. Period.
Cholesterol is carried throughout the body via structures called lipoproteins, which are tiny packages made up of fat, protein, and cholesterol. There are two types of lipoproteins—and you’re likely already somewhat familiar with them. The first type is called low-density lipoproteins or LDL—also known inaccurately as “bad” cholesterol. (More on that in a moment). The second type is high-density lipoproteins or HDL.
In the “old” days—which, sadly, are not completely over—LDL was considered “bad” cholesterol because it was believed to be deposited on the arterial walls, causing plaque and ultimately heart disease. HDL, on the other hand, was traditionally believed to be “good” cholesterol because it was thought to shuttle excess cholesterol back to the liver to be excreted from the body.
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. LDLa, for example, is a large buoyant molecule that does little damage to the body, while LDLb is a nasty little atherogenic molecule associated with inflammation and oxidative stress. Meanwhile, one sub-type of HDL (HDL-3) may induce inflammation while another subtype known as HDL-2 is strongly anti-inflammatory. When it comes to LDL, you want much higher levels of LDLa and much lower ones of LDLb. And when it comes to HDL, you want higher HDL-2 levels than HDL-3. A test that’s been around for at least a decade—known as the Particle Test—can tell you exactly what types of cholesterol you have. It can also tell you your total number of cholesterol particles, which is turning out to be a better predictor of heart disease than merely knowing your LDL and HDL.
Quality vs. Quantity
Unfortunately, many people— including a number of doctors—continue to believe that high total and LDL cholesterol is the best indicator of impending heart disease. But a growing body of research suggests that unhealthy lipid levels may not be the best marker of a person’s risk of heart attack or stroke. In fact, over half of the people admitted to hospitals for coronary heart disease have perfectly normal cholesterol levels!
What’s more, cholesterol in the bloodstream is rarely a problem unless it becomes oxidized. Oxidized cholesterol can contribute to plaque build-up in the arteries. One study, which involved a group of elderly Belgians, found that higher levels of oxidized LDL significantly increased the risk of heart attack, regardless of total LDL levels.
As mentioned above, size matters as well. Size of particles, that is. Large, fluffy LDL particles (LDLa) travel easily through your circulatory system. But small, dense particles (LDLb) readily embed themselves into artery walls—and are four times more likely to cause coronary artery disease. There’s even a cholesterol-containing molecule that’s more of a risk factor than all the rest—lipoprotein(a) (also known as Lp(a), or pronounced L-P Little A. Lp(a) is a lipoprotein that’s rich in cholesterol, but it differs from regular LDL in that it contains an additional protein called apolipoprotein (a). Elevated Lp(a) is an important marker for the risk of developing heart disease.
Here’s how it works: Lp(a) is manufactured in the liver in response to an aging cardiovascular system and tiny fissures that develop in the lining of arterial walls. In an attempt to patch up these fissures, the body produces cholesterol and its relative Lp(a). The difference between the two, however, is that Lp(a) is many times more potent than regular LDL cholesterol in its patching ability and has a tendency to attract other Lp(a) particles. As Lp(a) particles build up, they form plaque that narrows the arteries and reduced blood flow—setting you up for a future heart attack. Lp(a) also promotes the formation of blood clots on top of newly formed plaque that narrows the arteries even more.
But the news about the quality of your cholesterol isn’t all bad. There is a trio of supplements that can improve both the quantity and the quality of your cholesterol.
Natural Supplements for Cholesterol
Used for centuries in Ayurvedic medicine, amla— also known as Indian gooseberry or Emblica officinalis—has been shown to lower both total and LDL cholesterol levels while increasing HDL levels. It’s so effective that one study in the Indian Journal of Pharmacology found that it worked just as well as the popular statin drug Zocor. But amla’s real value may lie in its ability to improve Lp(a). During a study which was published in the Journal of Herbal Medicine, 30 smokers were given either 250 mg of amla or a placebo twice a day for 60 days. Those taking the supplement not only experienced a better cholesterol profile, they also saw a significant improvement in their Lp(a). A prior study also found that amla reduced LDL oxidation.
Got Grape Seed?
Packed with natural polyphenols, especially oligomeric proanthocyanidin complexes (OPCs), grape seed extract boasts powerful antioxidant activity higher than either vitamin E or vitamin C. Studies have found that these polyphenols effectively protect LDL cholesterol from the oxidation process. Among 24 heavy smokers, age 50 or older, those who took a grape seed extract supplement twice a day had significantly less LDL oxidation compared to those taking a placebo after just four weeks. To get the most from your supplement, look for a grape seed extract with low molecular weight OPCs. The large OPC molecules—often called tannins—found in many grape seed extract supplements can’t protect against oxidation as they are too big absorbed.
Fish oil has a long and checkered history when it comes to cholesterol. That doesn’t mean it has a long and checkered history in general— its ability to lower triglycerides, blood pressure, and inflammation are well documented. But the effect of omega-3s on cholesterol are not conclusive.
While numerous studies suggest that regularly eating fish high in omega-3 fatty acids and taking supplemental fish oil can reduce total and LDL cholesterol—as well as triglycerides— some recent studies cast some doubt on the cholesterol-lowering powers of omega-3s. But as we’ve seen, simply reducing the total amount of cholesterol is not particularly important. Where fish oil shines is in its ability to foster large fluffy LDL particles. This was shown in a study of 647 high-risk cardiovascular patients that appeared in the journal Lipids in Health and Disease. LDL particle size was increased in those patients taking either 2g or 4g of an omega-3 supplement compared to the patients taking a placebo.
Unfortunately many fish oil supplements are highly refined and processed—and some contain oil that has oxidized. For a more effective fish oil supplement, buy from reliable companies that are known for rigorous testing, and have assays to prove the purity of their products. You can also look for products that use natural enzymes instead of heat or chemicals to extract the omega-3s from fish, a process known as vectorization, which retains the natural phospholipids and peptides from the fish.
Jonny Bowden, PhD, CNS (a.k.a. “The Rogue Nutritionist”) is a nationally known expert on weight loss, nutrition, and health. Dr. Bowden has a PhD in nutrition, a Master’s degree in psychology, and has earned six national certifications in personal training and exercise. He is a board-certified member of the American College of Nutrition, a member of the American Society for Nutrition, and a much in-demand speaker at conferences and events across the country.
Article originally published in Good Health Lifestyles magazine, Winter 2017, reposted with permission with minor edits.