The Issue | Setting the Stage | The Questions | References | Print This Page

The Issue

Cholesterol has been a hot topic in medical news these days. Over the last ten years, conventional medicine has waged a war on cholesterol which rivals the war on drugs and costs nearly as much as the war in Iraq. The question is how necessary is this war? Conventional medicine asserts that cholesterol is the cause of heart disease and stroke which should be brought under control at all costs. The more time I spend in my acupuncture/herbs/nutrition practice, the more I question the foundations of this assertion.

Most of what happens in conventional medicine is “evidence based” these days. This means that research studies, published in peer-reviewed journals, form the basis for setting standards of care for all medical conditions. Most of what happens in Chinese Medicine is based on an empirical understanding of physiology, which is the result of several thousand years of observational learning. Observational learning generally does not involve isolating variables and creating double blind placebo-controlled studies to “prove” what is going on, and is considered by the conventional medical community to be less valid than controlled studies.

There are many issues with using “medical evidence” as the foundation for care, and considering observations less valid. The primary issue as I see it is that human beings do not live in a laboratory where their environments, diets, and lifestyles are controlled. We go out and live our lives, and our bodies respond to multiple stimuli at the same time, mostly functioning in the background without our awareness until something is profoundly wrong enough for us to take notice. We eat what we eat, we exercise when we do, we smoke and drink alcohol, we reproduce, we go to work, we get stressed out, we have complex interpersonal relationships. We rarely control any of these variables in day to day life unless there is some compelling reason (say, eliminating alcohol from a diet because of liver disease) to do so. Something which has been “proven” in a research study with closely controlled variables may no longer hold true when the subject is not controlled and all of those isolated variables suddenly interact.

Cholesterol research and policy regarding management of “high” cholesterol has turned out to have an enormous body of research studies, and requires far more depth of information than is practical for a single news-letter article. In fact, the literature search could probably keep two full time research associates busy for a year! Thus, this is my pet project for 2010. This month’s article sets the stage, and each edition of my newsletter will include another installment. My intention is that by the end of the year you will have a greater understanding of the medical, social, political, and economic issues driving the war on cholesterol, and will be better able to make informed decisions about how you chose to manage your risk of cardiovascular disease. back to top

Setting the Stage

The number of people I see who are taking cholesterol-lowering medication is simply astonishing. Many of these individuals have limited risk factors, and started with serum cholesterol levels of 220 or lower. Some were offered “lifestyle management” solutions before being given medication, some were not. As I delved deeper into the study of functional medicine, I learned a few things about cholesterol which have led me to start asking questions. Here’s what I’ve learned:

1. Cholesterol is manufactured in our bodies by our livers. If our bodies make it, we need it!
   
   
2. Cholesterol is essential for our bodies to manufacture Vitamin D. Low levels of vitamin D are associated with increased risk of many cancers,  heart disease, stroke, and a whole host of other conditions. (click here to see my article Vitamin D Deficiency in the United States)
   
   
3. Cholesterol is an essential building block for estrogen, testosterone, serotonin, dopamine, and acetylcholine. These hormones and neurotransmitters are critical for mood, memory, reproduction, and overall health.
   
   
4. Cholesterol levels below 160 are associated with increased rates of depression, suicide, and violent behavior. (3,5)
   
   
5. Elevated blood cholesterol levels ARE associated with increased risk of cardiovascular disease and stroke.
   
   
6. I couldn’t find any studies which provided a minimum cholesterol level for our bodies to manufacture hormones, neurotransmitters, or vitamin D. Essentially, there is no published research out there which defines the bottom end for healthy cholesterol levels. (And if any of my readers can dispute this with some published studies, I’d love for you to prove me wrong and forward links to them!)
   
   
7. Conventional medicine sets 200 as the maximum cholesterol level for cardiovascular health. This level is published in the National Cholesterol Education Program (2), which seems to set the standard of care for medical management of cholesterol levels. I have not been able to find studies which have formed the basis for this “magic” number, nor have I been able to locate a reference list for the National Cholesterol Education Program. I’m sure it exists somewhere, but in three months of looking I have yet to find it!
   
   
8. Statin drugs (the primary medications used for lowering blood cholesterol) are one of the most frequently prescribed classes of medication in the US. Spending on statin drugs has increased by 156% from 2000-2005, with 2005 spending topping $20 billion. In Britain, 1 in 3 people over the age of 45 is on a statin medication. (6)
   
   
9. Statin medications have a host of nasty side effects which often do not get associated with the medication when patients present symptoms. Side effects can include muscle pain (which may be severe), neuropathy, memory loss, mental confusion/brain fog, and others. While many patients do just fine on these medications, the number of people who are severely affected is significant and some of the side effects can last for as long as a year after stopping the medication. (4)
   
   
10. Attempts at getting Americans to reduce the saturated fat and cholesterol in their diets have lead to a huge array of low-fat, low-cholesterol “food products” and designer fats. These engineered foods represent another multi-billion dollar industry, and the health impact of consuming “foods” which do not exist in nature is not widely understood.
    
    
11. I have had several patients come to me in the last two years who were told their cholesterol is too high with total cholesterol levels at 160 or less.
    
    
12. The top three causes of death in the US are coronary heart disease, cancer, and the US health care system (including surgical complications, drug side effects, infections during hospitalization, and medical errors). Cerebrovascular disease (stroke) is #4. (1,7) Cardiovascular disease is a big and legitimate concern for many people, and minimizing risk factors is an important way to reduce the risks of developing cardiovascular disease. back to top

The Questions

All of this digging has led me to ask some fundamental questions which I will answer as fully as possible over the coming year. These questions include:

1. Where did the magic number of 200 as the maximum “healthy” level for serum cholesterol come from?
   
   
2. What if the hypothesis that cholesterol in the diet causes elevated cholesterol in the blood is wrong?
   
   
3. What if saturated fat in the diet has no effect on blood cholesterol levels?
   
   
4. What if elevated blood cholesterol is not a CAUSE of heart disease, but an early warning sign?
   
   
5. We constantly hear about cholesterol levels being too high, but is it possible for them to be too low?

I’m sure there will be more questions as I dig deeper into my research for this series of articles. Meanwhile, if your cholesterol levels are creeping up and your doctor is encouraging you to consider medication, I urge you to do some of your own digging, call me and talk about it, and consider your alternatives before deciding on a specific course of action. I will never tell you to not take a medication prescribed by your doctor, but I will certainly give you questions to ask, side effects to be aware of, and potential alternatives which may be viable options for you depending on your risk factors. Every individual is different, and medication may be the most appropriate option for some people. I encourage you to take responsibility for your own health and make informed decisions based on your personal risk factors.

Stay tuned…watch for a discussion about the links between cardiovascular disease and cholesterol in my next newsletter! back to top

References

1. American Heart Association. Cardiovascular Disease Statistics. 2006

2. Evidence-based guidelines for cholesterol management. National Cholesterol Education Program. 2001.

3. Can Your Cholesterol Be Too Low? WebMD, June 26, 2000

4. Golomb, Beatrice A.; Evans, Marcella A. Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism. Am J Cardiovasc Drugs. 2008;8(6):373-418. 

5. Low Cholesterol, Depression Linked To Early Death. Medical News Today, 11 Feb 2009

6. Spending Soars for Cholesterol-Fighting Statins. The Ledger.com June 29th, 2008.

7. Starfield, Barbara MD, World Health Education Initiative. 2000. back to top