By Dr. Mercola
The idea that high cholesterol causes heart disease is based on the premise that cholesterol is found in the plaque of people with coronary artery disease. But does that automatically mean that cholesterol itself is the root cause, and must be kept at a minimum to prevent plaque formation?
The answer is "no."
Missing from this hypothesis is the holistic understanding of how cholesterol operates inside your body, and why arterial plaques form in the first place.
Cholesterol is actually a critical part of your body's foundational building materials and is absolutely essential for optimal health.
As Dr. Robert Rowen points out in this interview, it's so important that your body produces it both in your liver and in your brain. Cholesterol is also the raw material for all of your steroid hormones and vitamin D. There's no doubt that you need it.
"Think about this for a second. Your neurons are making it for a reason," Dr. Rowen says. "Just logically speaking, if you take a statin drug, which poisons the enzyme HMG-CoA reductase... Hello? Your brain is not going to make the cholesterol that it needs, so you can expect – you can predict –that there's going to be a problems, years down the line, and we're seeing it now with statin drugs affecting the brain."
So what's the connection between cholesterol and heart disease?
If your body needs so much of it, what causes it to clog your arteries? The devil is in the details, as they say, and this is definitely true when it comes to cholesterol, because as Dr. Rowen explains, the cholesterol found in arterial plaque is not just any cholesterol, but oxidized, damaged cholesterol.
"There is an excellent research on animals where they fed animals plenty of cholesterol in their diet and they did just fine. But when they gave them even small amounts of tainted cholesterol, meaning oxidized cholesterol, within weeks it showed up in fatty streaks in their arteries," Dr. Rowen says.
"We know why now. There are receptors in the endothelial cells that are the lining of your arteries. There are receptors there for oxidized cholesterol. It picks it up, and it goes into the endothelial cells. The problem is that oxidized cholesterol does not look native to your macrophages, your immune system. It actually looks like bacteria. The macrophages move in to try and clean up what it thinks is bacteria, which is nothing more than oxidized cholesterol, and it creates a whole bunch of inflammation inside your arterial wall. The real culprit is oxidized cholesterol."
Where Does Oxidized Cholesterol Come From?
Oxidized cholesterol is introduced into your system every time you eat something cooked in vegetable oil. As soon as the oil is heated and mixes with oxygen, it goes rancid. Rancid oil is oxidized oil, and should not be consumed. This is why I constantly recommend avoiding all vegetable cooking oils, such as canola-, corn-, or soy oil, and replacing them with organic coconut oil, which remains stable and does not oxidize at higher temperatures.
"I am a proponent of eating far more uncooked food and certainly, zero foods cooked in oil," Dr. Rowen says. "I strongly urge [my patients] to eat more raw uncooked foods, because heat is damaging the oils, which in turn is going to damage the cholesterol and lead to vascular disease problem."
Another reason for avoiding vegetable cooking oils is that the majority of them (at least in the US) are made from genetically engineered crops; plus they're heavily processed on top of that. So not only do you have the issue of the polyunsaturated fats being oxidized, you also have these other toxic variables, such as glyphosate and Bt toxin found in genetically engineered corn and soy. Glyphosate is the active ingredient in the broad-spectrum herbicide Roundup, which is used in very large amounts on all of these crops. So there are a number of reasons for avoiding vegetable oils, but the fact that they're oxidized is clearly a high-priority one.
Why Statins Do NOT Promote Good Health
According to conventional medicine, there are two types of cholesterol:
- High-density lipoprotein, or HDL: This is the "good" cholesterol that helps to keep cholesterol away from your arteries and remove any excess from arterial plaque, which may help to prevent heart disease.
- Low-density lipoprotein, or LDL: This "bad" cholesterol circulates in your blood and is more prone to oxidation. According to conventional thinking, it can build up in your arteries and form plaque that makes your arteries narrow and less flexible (a condition called atherosclerosis). If a clot forms in one of these narrowed arteries leading to your heart or brain, a heart attack or stroke may result.
The American Heart Association (AHA) recommends keeping your total cholesterol below 200 mg/dL, but what they do not tell you is that total cholesterol level is just about worthless for determining your risk for heart disease, unless it is above 330. Additionally, the AHA updated their guidelines in 2004, lowering the recommended level of LDL cholesterol from 130 to less than 100, or even less than 70 for patients at very high risk. To achieve these outrageously low targets, you typically need to take multiple cholesterol-lowering drugs.
Statin drugs are very effective for lowering your cholesterol across the board. However, as mentioned earlier, they shut down your body's innate capability to create the cholesterol it needs for proper cellular- and brain function. Statins also prevent your body from generating sufficient levels of vitamin D from exposure to the sun, because the UVB rays in sunlight interact with the cholesterol in your skin and convert it to vitamin D. As Dr. Rowen explains, while statin drugs effectively reduce cholesterol values, they typically do not have an overall beneficial impact on health and longevity.
"Let's look at some of the statin studies," he says. "The relative risk is reduced. Here's the problem with medical studies, and statin is a really good example: Let's say, you have 100,000 people, and four people are going to get heart disease. Then you give a statin, and now only two do. They're going to say, "Oh my God! We have a 50 percent reduction in your risk for heart disease."
I took that a little bit out of proportion by using 100,000, but it's still a 50 percent relative risk—but your overall risk to begin with was negligible! It's stupid science. It's literally foolish, idiotic science... The absolute risk is not changed much at all, but relative risk is changed.
... What they also don't tell you is that while you might actually save somebody from a heart attack out of those thousands of people you have to treat, there's someone on the other end who gets toxicity, or maybe Alzheimer's disease, or maybe some other condition, from taking the drug.
The overall morbidity and mortality is unchanged.
All that drug companies and the FDA are looking for is what symptom or lab level you are suppressing. They're not looking at it for long-term outcomes. That's absolute failing of the American medical system, where all that you're doing is measuring to suppress a symptom or a lab value like cholesterol, and you are not looking at what happens to these people 10 or 15 years later, which is identical to the vaccine problem."
When Might a Statin Drug Be Advisable?
Contrary to conventional advice, very few people actually need a statin drug. Familial hypercholesterolemia is a genetic defect that can result in cholesterol levels above 330, and these people may indeed benefit from a statin drug.
"Yes, I do think that controlling the total cholesterol would be a benefit for those people," Dr. Rowen says. "They're few and far between, but they exist. But I would go with red yeast rice first, before I would [prescribe a] statin... because it has naturally-occurring Lovastatin in it – Mevacor. I would rather use that because it's a whole food. There are pretty good studies out there showing that whole red yeast rice not only helps protect you from that [high cholesterol], but animals also live longer when they're on it. Being a whole food, there may be a big advantage to it.
Always – whether you're using red yeast rice or a statin drug – be sure to take Coenzyme Q10 or ubiquinol, because the same enzyme that makes the cholesterol also participates with CoQ10 production.
... If their total cholesterol is over 300 or 330, I would consider the use of red yeast rice or a statin. That's the only time I would consider it. Other than that, I would look for ways to reduce the potential impact of toxic cholesterol metabolism... What I try to do first with my patients is to get them to clean up their lifestyle, so that what they're doing in their life will not have toxic effects on their apparently elevated cholesterol. I'm saying "apparently elevated" because I don't believe that God makes mistakes.
If you walk into me with a cholesterol of 240, I think that your body has that level for a reason. Maybe, just maybe, your body is crying for more vitamin D. It's asking your liver to make more cholesterol so that it can convert [vitamin D], or maybe your body wants more testosterone or another steroid hormone, so it's calling for more raw material.
I don't know how much I want to interrupt those processes with sledgehammers like statins. I would prefer to get your body not to oxidize the cholesterol by eliminating processed, refined foods. My mantra is "No fast, fried, refined, or processed foods." That's first on the list. Keep your diet 70 to 80 percent raw living food, and what you do with the rest – I don't care if you want to eat meat, chicken, fish, and eggs... just don't fry it. Eat all the meat you want within that 30 percent. The rest of it, try to keep it organic, not genetically engineered, unprocessed, and raw, so you're not destroying the fatty acids.
I personally believe that I have found the underlying cause of heart disease or the principal cause of heart disease in this country. That's the fact that we are heating these essential fatty acids, these unsaturated fatty acids. We're oxidizing them, and we're taking them right into our body already rancid. I think that is one of the primary causes."
Markers for Heart Disease
Dr. Rowen does not treat total cholesterol levels, and neither do I. Rather, we look at the ratios between so-called good and bad cholesterol—the HDL and LDL—as well as your triglycerides. These are far more potent markers for heart disease. I have seen a number of people with total cholesterol levels over 250 who actually were at low heart disease risk due to their HDL levels. Conversely, I have seen even more who had cholesterol levels under 200 that were at a very high risk of heart disease based on the following additional tests:
- HDL/Cholesterol ratio: Divide your HDL level by your total cholesterol. This percentage should ideally be above 24 percent
- Triglyceride/HDL ratio: Divide your triglycerides by your HDL level. This percentage should be below 2
In my experience, high triglycerides specifically, and elevated cholesterol in general, is typically related to excessive consumption of grains and sugars. A high-fructose, high grain-carb diet contributes to insulin resistance, which will cause your liver to produce more cholesterol and more inflammatory LDL particles, raise your triglycerides, and increase your risk of metabolic syndrome.
Other heart disease markers Dr. Rowen recommends paying close attention to include:
- Ferritin levels, because iron participates in the oxidation of cholesterol
- Homocysteine levels, which can show potential deficiencies in crucial B vitamins
- Lipoprotein A (LPA), as it affects your blood coagulation
- 25-hydroxyvitamin D levels, and
- Blood viscosity
On Blood Viscosity and Heart Disease
Blood viscosity refers to the thickness of your blood. The thicker your blood is, the more pressure is needed to move it throughout your body—hence your blood pressure increases.
"That pressure and that thickness is going to cause sheer on the endothelial cells where blood vessels bifurcate, where your artery splits into two arteries," he explains.
A blood viscosity test will tell you how thick your blood is. It's not commonly used, but there are a few labs that perform it, such as Meridian Valley Lab in Washington. If your blood viscosity is high, it's recommended that you donate blood, as this will reduce it. Donating your blood will also reduce your ferritin (iron) levels. Certain nutritional supplements may also be helpful, such as vitamin E.
"You can use the already high-quality tocopherol supplements," Dr. Rowen says. "I would get mixed tocopherols with alpha and gamma, and not the delta… I also like tocotrienols, which might be a more active form."
As for whole foods, nuts and seeds are great sources of vitamin E, as well as essential fats, combined with natural antioxidants that protect their oils from rancidity. I personally eat about four ounces of raw organic almonds every day.
Another strategy that can help reduce blood viscosity is Earthing or grounding—the act of walking barefoot on the earth. The theory is that when you walk barefoot on the earth, it allows for the transfer of free electrons from the earth into your body, via the soles of your feet. It mediates inflammation in your body by improving the zeta potential—the pulse capacity of your red blood cells—which also helps reduce blood viscosity.
If You're on a Statin Drug, You MUST Take CoQ10
One in four Americans over the age of 45 are currently taking a statin drug. Unfortunately, few are aware of the need to take coenzyme Q10, or the reduced form, ubiquinol, along with it, to buffer against some of the most devastating side effects of the drug. Dr. Rowen also recommends taking it if you're using red yeast rice.
The reason CoQ10 supplementation is so important is because statins blocks the CoQ10 pathway, causing it to be depleted. CoQ10 is vital for cellular energy production—without it your cells simply cannot function. As your body gets more and more depleted of CoQ10, you may suffer from fatigue, muscle weakness and soreness, and eventually heart failure. Coenzyme Q10 is also very important in the process of neutralizing free radicals.
As a general guideline, if you're on a statin drug, you need to take at least 100-200 mg of ubiquinol or CoQ10 per day. If you already have symptoms of statin damage, such as muscle pain, take anywhere from 200 to 500 mg a day. There are no reported side effects of CoQ10 supplementation.
Tips for Optimizing Your Cholesterol Without Drugs
Your body NEEDS cholesterol—it's important in the production of cell membranes, hormones, vitamin D and bile acids that help you to digest fat. Cholesterol also helps your brain form memories and is vital to your neurological function.
"Please don't live in fear of your raw cholesterol number," Dr. Rowen says. "Unless it's around 300 or higher, I don't believe that it's going to be indicative [of heart disease risk]."
The goal of the guidelines below is not to loweryour cholesterol as low as it can go, but rather to optimize your levels so they're working in the proper balance with your body. Seventy-five percent of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin level, you will automatically optimize your cholesterol. This is why my primary recommendations for safely regulating your cholesterol have to do with modifying your diet and lifestyle as follows:
- Reduce, with the plan of eliminating, grains and sugars in your diet. It is especially important to eliminate dangerous sugars such as fructose.
- Consume a good portion of your food raw.
- Make sure you are getting plenty of high quality, animal-based omega 3 fats, such as krill oil. New research suggests that as little as 500 mg of krill per day may lower your total cholesterol and triglycerides and will likely increase your HDL cholesterol.
- Replace harmful vegetable oils and trans fats with healthful fats, such as olive oil and coconut oil (remember olive oil should be used cold only. Use coconut oil for cooking and baking)
- Include fermented foods in your daily diet. This will not only optimize your intestinal microflora, which will boost your overall immunity, it will also introduce beneficial bacteria into your mouth. Poor oral health is another indicator of increased heart disease risk.
- Optimize your vitamin D levels, ideally through appropriate sun exposure as this will allow your body to also create vitamin D sulfate—another factor that may play a crucial role in preventing the formation of arterial plaque.
- Exercise regularly. Make sure you incorporate high intensity interval exercises, which also optimize your human growth hormone (HGH) production.
- Avoid smoking or drinking alcohol excessively.
- Be sure to get plenty of high-quality, restorative sleep.
"The simplest thing you can do, and the most powerful, is to clean up your diet first," Dr. Rowen says. "Eat more raw, uncooked, living foods organic, grown around you, ripe when in season – ancient Chinese wisdom...
Get exercise. Exercise can overcome – I'm not going to say anything – but a lot. We know that people have eaten toxic diets for years, including a lot of cooked foods. When they get exercise, it can overcome a lot of that. These are things that cost absolutely nothing for you to do. I like your concept of eating fermented foods, keeping your mouth clean. The so-called antioxidants, particularly vitamin E or the natural vitamin E's, are good. Especially if you can get it in your food, these don't cost anything.
I assure you that in most cases, if you start doing these things, you'll see that your cholesterol drops. Mine is 175. My triglycerides are 100 or less. I use triglycerides as a marker, because the higher that is, it tells me the more refined carbohydrates you're eating. The more refined carbohydrates you're eating, the more insulin you're going to have. The more insulin you have, the bigger your belly... [I]nsulin drives all those carbohydrates into fat, which generates inflammation (which is the same inflammation that might come out of your mouth).
These are the things that you can do that don't cost a penny, and can alter your health dramatically."
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About Dr. Robert Rowen
Dr. Robert Rowen is a Phi Beta Kappa graduate of the prestigious Johns Hopkins University. He also attended the University of California in San Francisco. He was originally board certified in both family practice and emergency medicine, as well as the American Board of Clinical Metal Toxicology. (After being recertified, he later allowed those certifications to lapse, as he doesn't believe they're pertinent to his current work.) Dr. Rowen has been involved in complementary or integrative medicine since 1983, and was instrumental in creating the first statutory protection for natural medicine in the United States in the state of Alaska, in 1990. He's presently the editor-in-chief of Second Opinion, which is a printed national newsletter, and he's also still seeing patients in Santa Rosa, California.