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Looking Beyond Cholesterol in Heart Health
By Jennifer Morganti, ND, Director of Education for NEEDS

Typically a discussion about cholesterol is in the context of how to lower it, suggesting it is a dangerous force that must be eradicated. However, cholesterol also serves extremely important functions in the body. It is critical to cell production, (as cell membranes are comprised of lipids), it is the foundation of hormone production, and it is necessary for the production of vitamin D through sun exposure. Cholesterol also affects the production of serotonin; in fact, excessively low cholesterol is linked with major depression and suicidal tendencies. Furthermore, HDL, the "good" cholesterol works to shuttle cholesterol away from the arteries to prevent atherosclerosis, and in fact it is so necessary that studies have shown that HDL levels under 40 create a significantly increased risk of developing coronary heart disease (CHD). Despite cholesterol's importance, some doctors are driving their patients' total cholesterol level below 150 and sometimes even close to 100 with the use of statin medications, all in the name of health.

Some research studies indicate that excessively low cholesterol levels may result in other health issues and increase mortality rates, and the level considered to be "healthy" (200) should be adjusted upwards. In a cholesterol study conducted in Japan, 11,869 people were monitored for almost 12 years. Their cholesterol was recorded and they were divided into one of four groups based on their total cholesterol levels. Those in the group with the lowest levels (<160) were shown to have significantly increased risk of hemorrhagic stroke and heart failure, excluding myocardial infarction, as compared to those with higher levels of cholesterol. They also found that there was not a significantly increased risk of those cardiovascular events in people with the highest levels of total cholesterol.1

So if it isn't all about total cholesterol as this and other studies suggest, then what are the major risk factors for cardiovascular disease, particularly atherosclerosis? One of the main concerns should be the factors that cause systemic inflammation, which can be measured in a lab test called CRP (C-reactive protein). Inflammation is a problem because it can damage the inner lining of blood vessels and cause damage. The role of cholesterol is to patch up the nicks and gouges that inflammation causes, but over time, too much cholesterol can accumulate in the vessels, building up plaque that develops into atherosclerosis.

Several factors can contribute to inflammation. Consumption of simple carbohydrates, such as sugar, refined grains, and even fruit will increase blood sugar levels significantly, causing glycation (the binding of sugar and protein), which increases free radical production and inflammation. Also cortisol, the hormone produced by the adrenals, is produced excessively under stress and increases inflammation. Another contributing factor to inflammation is the presence of bacteria or a low-grade infection. And the accumulation of toxins such as heavy metals and chemicals, which we have ALL been exposed to, will trigger inflammation.

Lowering inflammation with just a few easy steps will certainly improve cardiovascular health. Food is the foundation of an anti-inflammatory program, so be sure to consume lots of whole foods with complex carbohydrates, fiber, and protein, and minimize sugar. You can moderate cortisol levels with good stress-coping techniques, like exercise and meditation.

To lower inflammation, supplementation may need to be added to a healthy diet. Crucial nutrients often missing in the typical American diet are omega-3 fatty acids, derived from cold-water fish and plant sources such as flax oil and chia seeds. Much of the fats found in our diet (saturated fats and omega-6 fats) are pro-inflammatory because they are converted to certain types of chemicals which cause inflammation throughout the body. Omega-3 fatty acids are the only type of fat that are always converted to anti-inflammatory chemicals, so they are critical to balancing the other types of fat that dominate our diet. The most effective, non-toxic way to consistently boost omega-3 fatty acids is through supplementation of a high-quality fish oil, calamari oil, or krill oil. The dosage is two grams daily at a minimum; however, higher doses are indicated in the presence of inflammatory related diseases such as cardiovascular disease, any type of arthritis, and ulcerative colitis.

Another potent anti-inflammatory nutrient that has been in the spotlight recently is vitamin D. Like omega- 3 fatty acids, this is another nutrient that is frequently deficient in Americans, particularly those in the Northern latitudes where sunshine is limited in winter months. As mentioned previously, vitamin D synthesis is triggered by sun exposure and requires cholesterol as the foundation. Vitamin D is able to lower CRP levels and a study showed an inverse correlation between vitamin D levels and an inflammatory marker called TNF.2 Low vitamin D levels may predispose diabetics to atherosclerosis because it limits their ability to process cholesterol adequately, as shown in one study.3

Niacin is a wellresearched nutrient that lowers CRP and increases HDL, which has the important duty of ushering out the "bad" cholesterol that causes plaque.4 Niacin can cause itching or flushing, which is a redness and warmth that can be quite uncomfortable. Taking sustained-release niacin slows the rate at which the niacin is released into the body, helping to avoid a reaction. Niacin-Time, by Carlson is a 500 mg sustained release tablet designed to raise HDL.

Cholesterol is something you should keep your eye on, but it doesn't tell the whole story about heart health. Go back to the basics of a healthy diet, moderate stress levels, and consider a few supplements, and you should be able to keep your heart healthy!

1. J Epidemiol 2011;21(1):67-74
2. Journal of Inflammation 2008, 5:10
3. Circulation 2009, vol. 120(8);pp. 687-698
4. Postgrad Med. 2011 Mar;123(2):70-83

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