Tuesday, 2 May 2006

High on Cholesterol

Should we really be worried about having a 'high' cholesterol level?

Raised cholesterol levels are seen as a risk factor for heart disease and statins are seen as the cure. I already knew that statins had side-effects so when I was told my cholesterol was too high I wanted to find out more.

What follows is not a medical act, a professional view, or a qualified opinion, merely a summary of information available on the web which I personally found convincing.

UK doctors consider a cholesterol level over 5mml/l (millimoles per litre) to be 'high' and an indicator of increased risk of heart attacks and strokes. In countries such as Switzerland and France the average cholesterol levels are higher than this but the incidence of heart disease and strokes is much lower than ours. In Russia the average cholesterol levels are much lower and yet the incidence of heart disease is much higher than ours.

How can this be?

Cholesterol is a fatty acid created by the liver and used throughout the body to generate new cells and create hormones. This is a natural and necessary function and without cholesterol we would die.

As fat is not soluble in our watery blood it must mix with a protein 'carrier' to form molecules of low density lipoprotein (LDL) for delivery to where it is needed. Unused cholesterol is then carried back to the liver via high-density lipoproteins (HDL) for recycling.

There is no good or bad cholesterol, just cholesterol and even if we had a cholesterol-free diet our bodies would still be creating it.

It is the physical size of the LDL particles which are of concern. If they are too small then they can get lodged between flakes of arterial plaque turning rancid over time to increase localised inflammation. In order for cholesterol to have this effect the arteries must already have plaque. Heart disease isn't caused by cholesterol but if you are already susceptible then it can make things worse: so could any fat in the blood such as omega-3 from oily fish!

We need to have more of the larger LDL particles to reduce our risk and we can do this with changes to our diet and so avoid harmful medication. Interestingly it seems that alcohol and saturated fats in the diet will actually increase the size of LDL particles. Sound familiar? Yes, just like the French diet!

The formation of plaque on arterial walls is in response to damaging toxins carried by the blood. Anything we ingest will at some point pass through the blood stream so could cause damage - including viruses and bacteria. Normally blood vessels will react to damage by becoming inflamed - which neutralises the toxins - then the inflammation dies down and the repair process starts. This process takes a matter of hours and is happening all the time.

Sometimes, however, the inflammation persists but the repair process still tries to lay down new cells. The inflammation will try to break down the new cells and it becomes a localised battle. Even if the repairs work, they are just covering inflamed areas (with plaque) and this can continue for many years. Eventually the loose plaque may be dislodged and cause damage as it moves through the blood stream. The end result can be strokes or heart attacks.

Although cholesterol may make things worse - as any oil in the blood stream could -it isn't the root cause of the problem. It seems cholesterol is getting a bad press.

Statins reduce the overall amount of cholesterol but they also have many side-effects such as dizziness, loss of muscle-mass, memory problems and lower bone-mass. There is also a risk of kidney damage. This is not surprising as statins are interfering with a natural and necessary process.

Some research indicates that statins can help prevent a second heart attack but there is little evidence that taking statins makes any difference to the risk of having the first heart attack. It seems that statins do not have an impact on the size of particles - just the overall volume - so these results are not surprising.

The threshold of 'high' cholesterol is variable and arbitrary yet it can lead to prescribed medication in the form of statins which can have serious side-effects. Having a high overall cholesterol level need not be bad news but taking statins nearly always is. Statins are not addressing any underlying problems some people may have but they could be giving false hope.

There are a lot of interesting sites out there and some of these are collected on this site.

Simon Hudson is an existential counsellor/psychotherapist in private practice. He writes occasional articles on personal matters on subjects which have affected clients.