Six things I think you should know about LDL cholesterol

Does bacon deserve the health halo it now seems to have in light of what is becoming common knowledge about saturated fat? Mm. Good question, and it probably comes down to context. If we were to position bacon against Flora Proactive, then that changes the question somewhat: which is better for your health? I mean, one is designed specifically to lower low density lipoprotein (LDL), aka ‘bad’ cholesterol (something we’ve been told for years to strive for) and is ridiculously expensive; the other is … well, bacon. Due to its saturated fat content (or perceived saturated fat, it contains less than 50% of its fat from saturated sources), it is always the second food which people think of when it comes to elevating cholesterol levels and causing heart disease – the first being butter.

Many clients come into my clinic with a total cholesterol above 5 mmol/L and are told by their GP that they should bring their cholesterol level down by way of eating low saturated fat, low total fat and reducing animal protein in their diet. OR (worse) go on cholesterol lowering medication (why is medication worse? Check out here and here). There are many things contributing to a higher cholesterol level, and the risk this poses to you is based on many factors. I’ve covered some of these (and what you can do about it) previously.

Here are 6 things I found useful to know about LDL cholesterol. I’m not talking about particle size, particle number, patterning of particles or Apo A or B, reverse transport cholesterol etc. Keeping it kind of simple. If you know more than your average Joe about cholesterol this will likely be a bit elementary. Otherwise:

  1. Most studies and media reports that report a reduction of risk of heart disease when taking cholesterol lowering medication focus on the relative risk. Relative risk – takes a small effect and it amplifies it. This makes the medication look far more effective than it actually is. Let’s explore what this means:

If you have a clinical trial whereby 100 people are given a placebo drug* and 100 people are given the experimental drug, you might find that 2 people in the placebo group go on to have a heart attack (2%), 98 have no adverse events. In the drug-treated group, 1 person has a heart attack (1%), and 99 people have no adverse events. The difference is 1%, however the relative risk reduction is 50% and a much more impressive number, don’t you think? Those reporting in the media certainly do.

  1. We need cholesterol to synthesise naturally occurring steroids in our system. It is necessary for life. It is the substrate for every sex steroid, for vitamin D, to make new neurons and new synapses to consolidate memories. Many people think cholesterol is in our body solely to clog arteries, and the lower the better. This is not the case. For example, in some populations a low total and LDL cholesterol are linked to higher incidence of depressive symptoms. A low cholesterol level may also result in less synthesising of vitamin D in the body, lower hormone production and an impaired immune system.
  2. LDL is an innate part of the immune system. When there is damage to the artery, you have susceptibility to infection, and there is evidence of pathogens present in plaques. When there is damage to the artery and artery wall, resulting in atrophy, there is an infusion of white blood cells as well as LDL cholesterol which work together to promote inflammation (for healing purposes). Blaming LDL for creating damage is like blaming the fireman for creating a fire.
  3. There is NO level of LDL that is unhealthy. There is an assumption that LDL cholesterol is inherently atherogenic and that above a defined level it is dangerous – there is something about the LDL packaging of cholesterol that causes heart disease. That’s not the case, and some experts in the field believe there is no level of LDL that should be treated with a statin. Researchers reviewing the literature have found people with high LDL with no heart disease. The cut-off of 4mmol/L or 5mmol/L depending on your reference point is an artificial distinction that has been created to suggest LDL is inherently toxic to the heart and cardiovascular system. Now there are people who have a genetic predisposition to storing cholesterol, so they have an increased risk? Actually research looking at the lifespan of people with familial hypercholesterolemia (FH, a mutation in the LDL receptor whereby the end result is elevated LDL cholesterol) have found that, aside from a subsection of the population, there is normal lifespan, with just a small number of these people going on to develop heart disease. There are people who have other genetic variants which do result in build up of LDL cholesterol, and we don’t know enough to say that a very high LDL level is NOT dangerous – however the likelihood of harm will be increased with the presence of other risk factors for cardiovascular disease, such as high blood pressure or smoking.
  4. It is not LDL that is causing heart disease. Blood cholesterol (including LDL) is high in people consuming a higher fat diet. However, research shows that other biomarkers are not only fine, but can be improved when transitioning to a higher fat diet from the standard western diet. A recent paper found that people 60 years and older who have the highest LDL live as long or even longer than those with low LDL. They have lower rates of cancer and lower rates of infectious disease.
  5. If it’s not LDL cholesterol, then what is causing a heart attack? A critical trigger factor is coagulation. We rely on the coagulation factors in our bloodstream to create a clot when we become wounded and begin to bleed. However, our blood can clot without there being a wound. High stress, tobacco smoke, high blood sugar all trigger clotting mechanisms. It looks like this:
    1. In our artery wall, there are tiny arteries which feed to the inside of the artery (called vasovasorum).
    2. Vasovasorum are easily blocked or clogged by clots.
    3. If these can’t feed our artery wall, the wall essentially becomes hypoxic and the tissue dies.
    4. When the tissue dies, the LDL cholesterol comes in to repair it, and this happens repeatedly, causing the artery wall to become thicker and thicker until it chokes the artery.
    5. When you combine this thickening of the artery wall with something that might trigger clotting of the blood (such as high blood sugar, smoking or a stressful or emotional event etc), a clot will pass through the narrowed artery,
    6. The clot will eventually block the artery entirely and the result is a heart attack.
    7. None of this is caused by LDL cholesterol.

What really matters is keeping your clotting factors inactive until they are needed. Most people (unless they are haemorrhaging) don’t need their clotting factors on high alert all the time.

So, which is better for your health? IMO – while bacon may not be a health food, I’d choose it over the Flora (preferably free range, minimal added preservatives, along with an abundance of vegetables). Flora doesn’t have a lot going for it, TBH, and while it may lower your cholesterol level, how important is that really? If your cholesterol levels are high and you’re not sure of your risk, get in contact with someone like me who can work with you to address the lifestyle factors that might be driving up your cholesterol levels and contributing to health risk.

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This bacon isn’t preservative free, however it’s the only one I could see that had less preservatives and was free-farmed, so using it as an illustration. Henderson’s is free of preservatives but only select supermarkets carry their free-farmed variety FYI

 

Nigel’s diet… why so much meat?

Thanks to Nigel there was an explosion of interest in my blog post last week – and with it, a lot of questions around including certain foods in my recommendations. One I’d specifically like to address is the inclusion of animal protein (or red meat) in (what some viewed as) large amounts. Now for those who have been reading my blog for a while, this will be covering old ground as I know I’ve talked about elements of this previously. However Nigel’s documentary series has sparked much more interest in what to eat and, as the questions I got suggest, a lot of this information is new ground for many – so I’m happy to delve further into some of these issues and explain why I encourage the inclusion of red meat in the diet.

The first point to make here is that a whole-food/paleo diet (as I recommended Nigel eat) is not a meat heavy diet – it’s good to dispel that myth immediately. Sure, some doing ‘paleo’, include large amounts of meat at every meal at the expense of vegetables; however that is not what most people I know do. In fact, I eat more vegetables than some vegetarians I know. The inclusion of small amounts of meat or animal protein at each meal helps stabilise blood sugars and prevents overeating due to energy crashes. In addition, these foods contain complete proteins that are essential for the repair and rebuild of musculoskeletal tissue, they provide (amongst others) iron, zinc, iodine (fish) which are important for over 200 metabolic processes in the body important in brain, gut, liver and thyroid health, and deliver important antioxidants such as co-enzyme q 10 for heart health (and great skin!) Alongside these are the fat soluble vitamins (A, D, K) and essential fats (omega 3 fatty acids, monounsaturated fats and saturated fats) and cholesterol that form the backbone of many hormones and messenger enzymes that are responsible for delivering instructions throughout the body.

I’ve taken a broad-brush approach to the many benefits of including animal protein in the diet, but one thing I want to point out is that it’s not the eye fillet steak and the boneless, skinless, (tasteless) chicken breast that I’m talking about – the meat that is closest to the bone is the most healthy meat. Yes it’s fattier – but that’s a good thing (see above re: essential fats). There is beginning to be a trend of nose-to-tail eating now, making many of the offcuts of meat that were often binned now available to be purchased and used at the fraction of the price of an eye fillet steak (if people are willing to try them!). In New Zealand we have predominantly grass fed meat, which means we are largely protected from meat that has been grain fed. Grain fed cattle produces meat with a higher fat content but its fatty acid profile is not ideal – higher in omega 6 fats and higher intramuscular triglycerides (pro-inflammatory). The grain affects the health of the cattle, with more risk of infection and harmful bacteria which have downstream consequences to the quality of the meat we find in our food supply. While in NZ cattle are ‘finished off’ with grain, after a Twitter conversation I had the other week I believe the health consequences of this for us are negligible – though am happy to stand corrected!

And then there’s the issue of meat and cancer. And meat and heart disease. And meat and [insert health condition here that suggests you are a medium-rare steak away from certain death]. The problem with the media snippets most people are exposed to is that the finer (read: important) details are overlooked in amongst the rush to print that meat is as bad for you as smoking. Well (gasp) it’s not. Firstly, any research that suggests meat is adversely linked to any of the aforementioned conditions is association, not causational. These research studies cannot determine cause and effect and are not designed to do so. Secondly, many of the large trials asked participants to report their retrospective meat intake over a 6-10 year period once, in a questionnaire format (many people I know struggle to tell me what they ate last week). Thirdly, the distinction between actual meat and that which is found in a hamburger (for example) or even a meat sandwich in some cases is not made. There is a vast difference in quality between a rump steak and a sizzler (not to mention the latter is only around 45 percent meat and isn’t legally allowed to be called a sausage). People seldom eat a hamburger without a bun (this was before the advent of an ‘oxygen’ burger from Burger Fuel) and lumping a person who eats burgers five times per week (and upsizing with the fries and Coke) in the same category as someone who dines on eye fillet at a Pete Evan’s paleo restaurant five nights a week is problematic. Of course, I’m speculating here as to the overall diet quality of participants – but that’s all I can do as these important details pertaining to other nutrients known to affect health (i.e. processed refined carbohydrates, industrial seed oils) aren’t known. Many other lifestyle factors that contribute to poor health (such as a low level of physical activity, smoking, higher alcohol intake) are also seen in those with the highest intake of red meat and in some instances there wasn’t a linear relationship between meat intake and health (or death….) with the death rate falling in between those with the lowest intake and those with the highest intake (when split into groups according to overall consumption patterns.) These details mean little however when it comes to health reporting in the media. Nothing sells like sensationalism, and if we can draw parallels between red meat consumption and smoking then you don’t even need consumers to read the article to guarantee you’d have made an impact. Again, this is my Women’s Weekly overview; for a far more eloquent and in-depth critique of this, go to Zoe Harcombe’s review or Jamie Scott’s blog post discussing this issue.

Another big pushback against the inclusion of meat is from an ethical and sustainability perspective. Now I’m not at all suggesting that people who choose not to consume animal products based on their moral standpoint should reconsider. This is a judgement call I have no business in commenting on. However for others, thankfully the availability of free range meat now accessible at relatively cheaper cost is increasing. Demand also affects supply, and the more we ask for free range meat and eggs, the more the price will be driven down (especially considering its not essential to be choosing eye fillet for every meal). Another argument against encouraging meat consumption is that it’s not sustainable for the environment, with more demand for meat increasing the fossil fuel used to produce it, the water usage required and an increase in the methane emissions (and the carbon footprint). If we put it into perspective, most of what we do has a carbon footprint. Grain-feeding cattle may (or may not) be more resource intensive (and have a larger footprint) given what is necessary to grow the grains to be fed to the cattle as opposed to raising cows on a grass field. And promoting a vegetarian diet based on this argument is flawed given the resources required to feed the world on vegetables.

emissions

Turn your heating off a put on a jersey instead.

So that’s my stance on including animal protein (and red meat) in the diet. There are many reasons why people choose not to include red meat in their diet – but if they are based on optimising nutrient intake, protection from later chronic illness, or from a sustainability perspective, then perhaps reconsidering it wouldn’t go amiss.