Cholesterol and heart attacks are perhaps the most misunderstood topic in all of health care. And as a result, a lot of people get hurt and are suffering needlessly. And here are just some of the problems. We here forever that HDL is good, LDL is bad, High cholesterol is bad and that's just way too simplistic.

There's so much more to it than that. We hear that a statin drug could be necessary after we try diet and exercise without success. But the question is, what diet and what exercise are they trying? And very often people ask me. Where I see suggestions of natural remedies to lower cholesterol. But the question is are we sure we want to lower it.

Please keep in mind that I am not saying that a drug is never a good idea. I'm not saying that cholesterol can never be too high or out of balance. But there may be like 1% of people with a genetic defect with familial hypercholesterolemia, whereas that drug is the right thing for them.

But for the vast majority of people who get blanket recommendations of statin drugs. Because their cholesterol is too high, we need to understand a lot more. And even though I will defend higher cholesterol numbers. I'm not saying that higher is always better. And I am not saying that you should not get concerned about what your blood work. I think it's a bad idea to make a diagnosis on a single marker such as high cholesterol or high LDL. And if we then based on that diagnosis get a prescription for a chemical or medication. That will interfere with the function of the liver which we'll talk about and interfere with health. Then I believe we are doing some of the greatest disservice is to mankind.

We need to understand something about this molecule cholesterol. First of all, it's synthesized in every cell of your body that has a nucleus. That's basically every cell except red blood cells can make cholesterol, A lot of it is made in the liver and that's traditionally where we hear that cholesterol is made. Because the body makes cholesterol itself. If you eat less, then the body will make more. If you eat more, the body will make less. The body needs to have a certain amount of cholesterol. And the brain is one of the places that most dependent on cholesterol, 23% of all the cholesterol in your body is in the brain. And interestingly, the cholesterol molecule is too large to cross the blood brain barrier. So all of the cholesterol in the brain is manufactured in the brain, because it's that important. Cholesterol is necessary for many things and one of the most important is as a building material as a structural component. The cell membrane which is the surface by a layer of every cell in your body. 30% of the number of molecules in that cell membrane is cholesterol.

Why is that cell membrane so important? Because the cell membrane is the actual decision maker of everything in your body. Your body processes billions of bits of information, every second it's all about the cell membrane. Because the cell membrane is a barrier that determines what stays outside and what gets into the cell. And inside the cell is where you have your metabolism and your metabolic function and the manufacture of every hormone and protein and substance in your body. And cholesterol is a huge part of determining the properties of this cell membrane because there's a fine balance between rigidity and flexibility when you determine how the cell membrane works.

So cholesterol is critical for the function of that cell membrane. And where do you have the most important cell membranes that handle the most signals in the brain which has tons of cholesterol. And then when the brain needs to send the messages out to the periphery, when the central nervous system talks to the peripheral nervous system, which has millions of these electrical wires that go to every little part of your body, then it sends it along a nerve pathway called an axon. And this axon, it's just like electrical wires in your house basically that it needs a surface insulation. Just like your wires have that plastic coating. So does your axons and your nerves need an insulation. And that insulation is called myelin. That myelin is 27% cholesterol. And there is a severe disease called multiple sclerosis, which happens when this myelin is defective or gets attacked.

Cholesterol is also a precursor to bile. So when your gall bladder releases bile to dissolve fats to help you digest fats, bile consists mostly of cholesterol, it's also a precursor to steroid hormones. So a lot of your endocrine system, a very fine tuned communication system depends on cholesterol. So testosterone estrogen and progesterone are made from cholesterol and also cortisol.Cortisol is a stress hormone and too much of it on a chronic basis contributes to a lot of health problems, but it doesn't mean that we don't need it. It's still critical because if you can't have a stress response, then you're basically a sitting duck. That means you can't respond to the events of life and you might just be standing there, when the bus comes to run you over. So with all these functions of cholesterol. Do we really want to just shut it down? Do we really just unilaterally say that cholesterol is a bad thing. You have too much. Let's shut it down. There is no wonder that there's such dramatic side effects when we try to interfere with cholesterol.

And what about LDL & HDL? We've heard that their LDL is bad,HDL is good but they are just doing their job. LDL is a low density lipoprotein. It's a carrier that contains a little bit more cholesterol than the HDL does and therefore its job is to deliver cholesterol when the body needs it when appropriate. The HDL is high density lipoprotein. So it has a lower percentage of cholesterol. So therefore it tends to attract, It collects and returns cholesterol.So if the body has to have LDL or cholesterol delivered. Then it would seem like a really good thing to have some LDL to deliver, that right? And if the body needs HDL to collect. Then that would seem like a really good thing. The appropriate amount of LDL and the appropriate amount of HDL is a good thing. It's not that LDL or HDL is good or bad.

What we want to be concerned with is the properties the state the health of these particles and what hat we want to watch is small LDL. When the LDL is large and fluffy. There's nothing wrong with it. There are no ill health effects. But when it gets small, It is because it's damaged by inflammation and by oxidative stress. So the small LDL also it is a bad thing in a sense that it indicates that something is wrong. But the small LDL itself is just a victim of inflammation and oxidative stress.

What is the cause of inflammation and oxidative stress? It is sugar toxins and excess free radicals. Excess is key to understand that oxidative stress is necessary to produce energy. Free radicals is necessary as a result of producing energy and performing metabolism. But when things get out of balance and we have all these things in excess. That's when we have a problem. But I really want to reinforce this that we want to stop calling LDL bad. Because LDL shows up after the problem. when we have oxidative stress, LDL is delivered to repair the damage. It's like we see the fire department at the scene of an accident. And we say that evil fire department is there causing accidents again.No, they showed up after and they're trying to help the victim. Because the victim indicates that something bad happened. But LDL and HDL are both good things just like these first responders are.

And when the blood work comes back with a cholesterol over 200 then it's almost a knee- jerk response for a lot of practitioners to recommend a statin drug. So what do statins do, there are a couple of things we'll talk about. But one of the things that really important to understand is that can up regulate the number of LDL receptors on the liver. So the liver recycles these LDL particles and on the surface of an LDL particle there is something called an APOB protein that can be recognized by these receptors and then the liver recycles these LDL.

So the statin drug increases the number of receptors. And now we can start recycling these LDL. But here's the thing, it is only the large and the fluffy the buoyant LDL that's healthy that get recycled.So we reduce the total number of cholesterol of LDL cholesterol by reducing the fluffy buoyant LDL. But it is the oxidized damaged LDL that we're trying to get rid of . This has a damaged APOB protein. So the receptor can't recognize it. So no matter how much we up regulate the receptors, there is no change to these oxidized LDL. So we could make an argument that we're still doing a good job because if we re absorb more of the fluffy LDL then there will be less LDL overall in total to get oxidized in the future. But what really happens that's more important is that we change the ratio. We'll talk more about that. We the ratio of the oxidized to the buoyant, the small to the large LDL that ratio goes up and gets much worse. And this is one of the more important indicators for heart disease.

So even though the statin drug will reduce the total number, it will make the ratio worse. The small LDL does damage in many ways. First of all, it's an indicator of damage because if we have a lot of small LDL. We know that there's a lot of oxidative stress and inflammation. But furthermore this inflammation and oxidative stress, it can create damage or cracks in the inside surface and the intimacy of the blood vessel. And if you notice that this plaque here is not inside the opening, that's not inside the lumen of the blood vessel, it is between the surface layer and the muscular wall. So the surface layer the inside has to crack. It has to get more loose so that these particles can get through and create these plaques and the small particles will slip through the cracks much easier. The large fluffy ones don't tend to do that and the other problem the small LDL cannot be recognized by the receptors, So when we have a build up of these and they slipped through . Then we need for someone else to take care of them and this is where the immune system comes in. You have white blood cells called macrophages, they're like little pac man's and they follow these small particles in through the cracks or wherever these small LDL's are. But if they've gone through these cracks behind the intimacy. Now, that's where they hang out and that's where the immune cells go. And now they gobble up as many of these little LDL's as they can and then when they're full. Now, they have contained the LDL's. But they've turned into foam cells and that is basically what the plaque is.

Now let's understand a little bit more about the mechanisms of statin drugs because anytime you have high cholesterol they want to prescribe a statin. So we want to understand what's actually happening in the body. So does a statin drug medication reduce the total amount of cholesterol. Yes, absolutely it does. And one way is that it up regulates the receptors we get more of the recycling. But it does not reduce the small LDL. So even though it reduces the total and the LDL, it doesn't reduce the kind that we try to get rid of.

So I just want to emphasize that over and over. It's so critical. But the main way that the statin does its work is through something called the mevalonate pathway and here's how that works. When the body makes cholesterol, it starts out with a substance called HMG-CoA reductase. and then through a number of different steps that I don't bother with the details in the end the body ends up with cholesterol. So the names here are not important. I just want you to show that there's a number of different steps and we end up with cholesterol. But once we take a statin, once we take a medication to lower cholesterol and to block the production, then we knock out a lot of this HMG-CoA reductase and when we do that. Of course, we also knock out the end result of that pathway which is cholesterol. But there's one more detail and that is there's another product from a component halfway down called CoQ10. And the CoQ10 also gets knocked out to a large degree to probably whatever percentage we reduce cholesterol by we're also going to reduce CoQ10, bcause they're part of the same pathway.

What does CoQ10 do? It is one of the enzymes that the mitochondria used to produce energy. So 95% of our energy of all the energy used by every cell in your body depends on CoQ10. So anytime that you block the production of CoQ10, you're also blocking some of the production of energy. So if you have to be on a cholesterol medication for whatever reason or if you're working to get healthy. So you can have that discussion with your doctor. At the very least you want to make sure that you supplement quite massively with CoQ10 probably at least 300 milligrams a day.

And cholesterol medication are very controversial. Because they have a much higher rate of side effects than just about anything else out there. And here are some of those SAMS stands for Statin-Associated muscle symptoms and in increasing severity it starts with myalgia which is muscle pain, then we have muscle disease. We have myositis which is muscle inflammation. Now the disease is so bad that we start breaking some cells and they spill an enzyme called creatinine kinase.

So now it means the muscles are breaking down more than they should. And the worst version of this is called rhabdomyolysis. And "rhabdo" means striated or skeletal muscle "myo" means muscle and "lysis" means it's basically melting that your muscles are just disintegrating. This is completely disabling and sometimes fatal.

So if the muscles don't work and they're not firing right then the joints are going to get unstable and suffer and get inflamed as well. Statins have also been associated with type 2 diabetes with neurological problems with neurocognitive effects and cognitive. You want to think focus memory, intelligence also hemorrhagic stroke, bleeding stroke, bleeding in the brain, hepatotoxicity that you're interfering so much with the liver, that the liver gets toxic, and the kidneys can also get toxic, and there's many more conditions.

So lots of side effects are observed but they keep saying that they are unclear about the mechanism. But we do know that it interferes with the production of CoQ10. So we will have a loss of energy. So whatever body parts. Whatever organs used the most energy are probably going to be the ones to suffer the most. And those would be the brain, the heart, the liver and the muscles because they our hire metabolically active than most other tissues. And other than that cholesterol medications are so beneficial because after all, they lower cholesterol, right? But I hope you see by now that just looking at one number and saying we need to lower cholesterol in itself is not the goal.

Here's something that will hopefully get your attention. In a study, they found that lipophilic statins which is a subclass the type most common class of statin drugs more than doubles the risk of dementia, one of the most devastating conditions. One of the things that people are the most afraid of is to lose their whole personality and their cognition. These medications can more than double.And this was from the society of nuclear medicine and molecular imaging in 2021 annual meeting. So they did some pet scans which is sophisticated brain imaging. They found a substantial decline in metabolism, substantial decline in energy production and activity in the posterior cingulate cortex. That is the first place to lose function to have decreased function when people have early Alzheimer's.

Here's another study from neurology 2005 and they found that when we look at the risk of dementia. They was a longitudinal study. They followed people from many years as they were aging and at 70 years old, they looked at the people with the overall lowest cholesterol, not because they were taking a medication or anything. They just looked at what are their cholesterol levels and they compared the lowest group to the highest group. And they found that there were 69% less dementia In the people with the highest cholesterol. They followed this along and when these people were 76 years old, they found that there was 80% less dementia in the people with the highest cholesterol. And in the 79 year old group, it was still a 55% less dementia.

So what this means is that cholesterol is neuro protective, It protects you against dementia. And now you may be thinking well maybe I have to sacrifice my brain a little bit as a trade-off for better heart health. They often claim that it is beyond the shadow of a doubt that it's very clear that cholesterol medication reduces cholesterol and reduces plaque ng and heart disease and that may or may not be true, depending on what study you look at. But what if you're just lowering cholesterol and then dying from something else? So, when we look at all cause mortality, dying from for any reason.

But here's the one I hear the most still. Because people, they go low carb, they cut out the sugar, they start improving their health, they feel better and then they're still scared. Because someone tells them that a low carb, high fat diet will raise your cholesterol and they specifically say that you can't eat all that meat and all that butter because saturated fat will increase your LDL.

Is that true? Well, maybe I think there is maybe a correlation that saturated fat will increase. But what we see is that it increases the fluffy LDL, the buoyant harmless LDL. And what happens with sugar carbohydrates and processed seed oils. These are the things that cause inflammation and oxidative stress. They will increase the small LDL. So even if you eat saturated fat and have a higher total level of LDL, what we're concerned with is what percentage of the LDL has been damaged.

Now the thing to understand, I want to make it again that you have to cut the carbohydrates low enough to dramatically reduce insulin. You can't go from 60% carbohydrate to 30% carbohydrates and call that low carb. Because you're still making too much insulin. And now with all that insulin, you still can't burn through that saturated fat. You have to lower sugar, eliminate sugar and lower the carbohydrates enough that there's a significant change in your insulin. Now that saturated fat is good for you.

If you have a headache or a digestive problem, 1000 different people with a headache could have 1000 different root causes. So we're not addressing the headache, we're addressing the root cause. And that is the only way that we can create long-term change. And when they tell you need to get on a cholesterol medication? If you still have high cholesterol after trying diet and exercise.

So which diet are they talking about? Because if you don't understand the things we talked about in these post chances are that what you have tried have been heart healthy diets recommended by the mainstream, who are low fat, lean meats, lots of fruits, grains and seed oils. And while you're much better off, if you eat this from whole food rather than eating sugar and fast food for most people, it's still not enough to make a big difference because you're not reducing insulin enough to turn around that metabolic syndrome.

Also, we want to understand what exercise are they talking about. Because people usually have the mindset of no pain, no gain. So if you go and you join the so-called boot camp in the gym at five in the morning where they try to exhaust you as much as possible in 45 minutes. That may be the exact opposite of what you're trying to do to burn fat, because these bootcamps will put you into a lie collis into an anaerobic metabolism where you break down sugar. And when you break down the sugar, you're gonna get cravings for more sugar and more carbohydrates and you're going to drive up your cortisol, you're gonna break down muscle and you're gonna create more stress and more inflammation if you do that wrong. So again, there may be a very small percentage of genetic defects that could benefit from a cholesterol medication. But don't jump on one until you have done the correct diet and exercise for a while and you understand what you're trying to change.

But here's what still happens a lot. They say I feel amazing, my weight, my glucose, my A1c, my insulin values, my triglycerides, my HDL, my small LDL, my VLDL, my sleep and pain there all better. But I'm still worried, because my cholesterol is high. Now all I want is to bring my cholesterol down. How do I do that? And the answer is you don't. If all of these other values are better, you are getting healthier. I'm not saying that there is a number where you don't have to worry. But 200, 250, 300, 350 are probably totally fine. If everything else looks good. If it's 500, 700, 1000, then I don't know. Then you need to have a discussion with somebody. So if you're in doubt get with your doctor.

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