A Chapter from Spot On: Nutrition

Chapter Five
Patients should be advised to report promptly any unexplained and/or persistent muscle pain, tenderness, or weakness.
–Warning Insert for a popular Statin Drug

What is the heart?

It’s a muscle. And the fine-print disclaimer above is included in the packaging of cholesterol-lowering drugs for a couple of reasons. The first and most obvious is that we are a litigious society, so drug manufacturers must cover their asses. The second one, however, may surprise you. Cholesterol helps heal the body.

Cholesterol is so critical to health that your body readily produces it—making approximately a dozen eggs worth of cholesterol each day. In fact, only about 15% of cholesterol comes from the diet. The remainder is made from acetyl Coenzyme A in the liver and, to some extent, by other cells of the body. Yet, as a dynamic organism constantly working and turning over cells, even this amount is not sufficient. So the body does something that’s rather progressive for a species which is millions of years old: it goes green.

The body is extremely environmentally conscious when it comes to your biological terrain. It recycles key substances whenever and wherever it can. In the case of cholesterol, HDL transports this vital resource back to the liver so it can be used again. Thus, it’s become widely known as the “good” cholesterol. Of course, mainstream dogma has drowned a lot of victims in misinformation. There really is no such thing as “good” cholesterol. Likewise, the only reason cholesterol should be considered “bad” is if it somehow gets wasted, steals the keys to your car, and then totals it when trying to outrun the cops.

Cholesterol is just cholesterol.

To get to and from the various tissues in the body, cholesterol needs to have a chaperone of sorts. Not because you can’t trust it or it’s up to no good. It’s simply because oil and water don’t mix very well. Specifically, cholesterol is attached to different types of lipoproteins which all have various compositions. Categorized according to the ratio of lipids to protein—the higher the fat, the lower the density—the types of lipoproteins are listed below:

• HDL (high-density lipoprotein)
• LDL (low-density lipoprotein)
• IDL (intermediate-density lipoproteins)
• VLDL (very low-density lipoproteins)
• Chylomicrons (the lowest density lipoprotein)

Early into my indoctrination of politically correct nutrition, I translated the “H” in HDL as healthy to help remind me who the good guy was. I also believed that every good guy had to have a bad guy. And while I had been convinced that role was played by LDL, I wasn’t all that familiar with the other three lipoproteins (or, indeed, the term lipoprotein or I may have been able to figure out what the final “L” stood for….). But, looking at the bullet points above, it’s not too far fetched to assume that:

• HDL = Healthy
• LDL = Causes Atherosclerosis
• IDL = Related To The Ebola Virus
• VLDL = Very Likely Death Will Occur
• Chylomicrons = Will Explode Your Face Off If Consumed

So why haven’t most of us even heard of Chylomicrons? Ignorance may be bliss; but if there’s some highly combustible substance in the food we’re eating, I wanna know about it! Eventually I started poking around and asking questions. Then you know what I discovered? Those deadly chylomicrons contain hardly any cholesterol! Not even double digits! So that’s probably why they’re largely ignored. VLDL doesn’t matter either, because it’s only about 10-15% cholesterol. And IDL—the middle child of the five lipoproteins—has a proportion of cholesterol which is less than impressive. Thus, it really doesn’t warrant a lot of attention from doctors (besides, it’s not easily measured in a fasting blood test). LDL levels are what the medical community wants to keep in check. After all, even though almost 50% of all patients suffering from heart disease have normal levels of this lipoprotein, LDL is almost half cholesterol! And it’s all about cholesterol:

Cholesterol is the most highly decorated small molecule in biology. Thirteen Nobel Prizes have been awarded to scientists who devoted major parts of their careers to cholesterol. Ever since it was isolated from gallstones in 1784, cholesterol has exerted an almost hypnotic fascination for scientists from the most diverse areas of science and medicine….
--Michael Brown and Joseph Goldstein from Nobel Lectures (1985)

O.k. So let’s look at cholesterol then. But this time let’s do it from a non-traditional perspective—one which considers the merits of cholesterol and its role, if any, in the maintenance of a healthy human body.

In fact, cholesterol is essential for the health of any animal, human or not. Unlike plants which have a cell wall comprised of cellulose, the structural integrity of our cellular membranes relies on an adequate supply of cholesterol. See, one of the most interesting characteristics of cholesterol is it has amphipathic properties. In laymen’s terms, this means it contains both hydrophobic and hydrophilic regions. In laymen’s laymen’s terms, this means cholesterol has a portion which is “water-fearing” (which makes up the majority of the cholesterol molecule) and not soluble in water; and it’s also comprised of another portion which is “water-loving” and, therefore, water soluble. This unique yet absolutely critical dichotomy allows the cell membrane to be more resistant to pathogens which may harm the cell while also being open to vital nutrients involved in cellular functioning.

Cholesterol is also an essential element in the production of bile—another amphibathic substance made by the liver which helps to disperse fat molecules, making them more susceptible to the effect of the pancreatic enzyme lipase. Because let’s face it: what good is fat if you can’t digest it? And it’s digestion which allows the fat-soluble vitamins A, D, E, and K to work their health magic on the human organism.

Speaking of vitamins, D3 is synthesized by the action of sunlight (UV-B rays) on a precursor to cholesterol called 7-dehydrocholesterol. Though classified as a vitamin, D3 or cholecalciferol (as opposed to the form found in plant foods, D2 or ergocalciferol) actually works much like a hormone and has a myriad of health benefits which will be explored in a later chapter.

Additionally, dehydroepiandrosterone (DHEA), progesterone, testosterone—indeed, all of the body’s steroidal hormones use cholesterol as the structural basis from which they are made. Even cortisol with its potent anti-inflammatory properties requires cholesterol. A glucocorticoid, cortisol has gained infamy as the notorious “stress” hormone. But, trust me—you’d be a lot more stressed if your body couldn’t produce it.

A growing body of research suggests cholesterol may be the ultimate anti-oxidant, too (http://www.ncbi.nlm.nih.gov/pubmed/1937129). When levels are sufficient, cholesterol prevents arachodnic acid—an omega 6 fatty acid—from converting into pro-inflammatory mediators such as thromboxane (as in thrombosis) or leukotriene. One study noted:

Cholesterol presents some important characteristics generally ascribed to an antioxidant molecule: its presence in liposomes increases the vesicle resistance to oxidation and its oxidized forms are stable as they are unable to stimulate further propagation of peroxidation reactions. Moreover, the protective effect of cholesterol in liposomes is comparable to that of vitamin E, suggesting that cholesterol possibly acts by intercepting the peroxyl radicals formed during lipid peroxidation.

One study! What the hell good is one study? There’s a load of research out there which says the exact opposite. And besides—when’s the last time you saw an advertisement for cholesterol-raising medication?

I can’t really answer that last question as I don’t really watch a lot of t.v. (having no cable…and a life). But to your point about all the research, I agree that what’s out there is a load. And while your “studies” often cite entities with a financial agenda, my list of references includes a keen understanding of biochemistry and solid common sense. Yet if that’s not enough to satisfy your analytical side, perhaps this study’s conclusion will:

Lancet. 2001 Aug 4;358(9279):351-5.
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.
The association between reduction of cholesterol concentrations and deaths not related to illness warrants further investigation. Additionally, the failure of cholesterol lowering to affect overall survival justifies a more cautious appraisal of the probable benefits of reducing cholesterol concentrations in the general population.

Or maybe this one will:

Epidemiology. 1997 Mar;8(2):137-43.
Decline in serum total cholesterol and the risk of death from cancer.
The group with the highest decline in cholesterol displayed an excess risk for most cancer sites. These associations were more pronounced in subjects whose weight remained stable or decreased over time than in those who gained weight.

Or this one:

BMJ. 1996 Sep 14;313(7058):649-51.
Serum cholesterol concentration and death from suicide in men: Paris prospective study I.
Both low serum cholesterol concentration and declining cholesterol concentration were associated with increased risk of death from suicide in men.

This one might:

J Am Coll Cardiol. 2003 Dec 3;42(11):1933-40.
The relationship between cholesterol and survival in patients with chronic heart failure.
In patients with CHF, lower serum total cholesterol is independently associated with a worse prognosis.

Or how about this one:

Annals of Internal Medicine March 15, 1998 vol. 128 no. 6 478-487
Cholesterol and Violence: Is There a Connection?
A significant association between low or lowered cholesterol levels and violence is found across many types of studies. Data on this association conform to Hill’s criteria for a causal association. Concerns about increased risk for violent outcomes should figure in risk–benefit analyses for cholesterol screening and treatment.

And here’s another one if you need:

Scand J Prim Health Care. 2010 Jun;28(2):121-7.
Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up.
Participants with low serum total cholesterol seem to have a lower survival rate than participants with an elevated cholesterol level, irrespective of concomitant diseases or health status.

I’ve amassed quite the collection of scientific studies and could show you pages if you wanted, but where’s that going to get us—nowhere but another impasse. You’ve got your proof. I’ve got mine. And like the very arteries we’re all worried about, our ability to reason has gotten so clogged up we cannot seem to get unstuck. We’re so afraid that there could be more to the story we’ve been told, that to even entertain another point of view is incredibly dangerous. It’s like throwing a clot. And when a belief this big gets dislodged from what we’ve convinced ourselves we know, our ideology suffers a massive stroke and can never make a complete recovery.

But that’s good.

Sometimes it’s necessary for something to die before something new can be born. Ideas can be reincarnated into enlightenment. But that evolution can only begin with an open mind—one which allows in thoughts that challenge us; stress our belief system enough to stimulate adaptation.

My transformation began back in college as an aspiring bike racer looking for an edge. The prevailing thought among the endurance community at the time was high carb/low fat. And I was the poster child for that dietary dogma. In one of my classes, we analyzed the macro nutrient profile of my typical daily food intake and found it was incredibly lopsided:

Carbohydrate: 87%
Protein: 7%
Fat: 6%

Now, the testing grounds for that nutritional strategy happened to be the local USCF race scene. And while I won’t say it was failing miserably, I will admit that I wasn’t happy with the results. The analogy I was living far too often of getting chewed up and spat out the back of the pack eventually got me to question my diet. So I started tweaking what I was putting into my body. Pasta was traded for protein. Skim was replaced with whole. And as the proportion of carbohydrate in my diet decreased, my performance increased exponentially.

My results that season were good enough to earn me an invite to the Olympic Training Center in Colorado. But, unfortunately, they weren’t good enough to get my coaches to challenge the status quo. Walking into the cafeteria of the OTC, I was bombarded by cereals and grains and pastas galore. The only things more emaciated than the food selection were the athletes themselves. Still, all the cyclists were incredibly strong. And the coaches were adamant their nutritional protocol worked. Ignoring my own instincts, I got in line fast so I wouldn’t get dropped.

But that’s exactly what happened when I went to Belgium that summer. I would say I was hanging on for dear life across the cobbles of Flanders, but I was suffering too much. Life is less than endearing with the taste of rubber in your mouth. And the racing was so hard and intense I couldn’t seem to keep my tongue off my front wheel. After the first couple of weeks, I simply wasn’t recovering. I went from barely squeezing in to the money to getting shelled like a rotten oyster.

Then one day we raced twice—a road race in the morning followed by a time trial that afternoon. As usual, I sucked in the first event and went to the hotel’s dining hall to tap off my depleted glycogen stores. Other racers from various countries were there, and I looked around for any I knew or who might speak English. As I scanned the room, I noticed what the majority of riders had on their plates and almost gagged. Steaks—most of them rather rare—sat atop beds of rice being dyed pink as the cyclists cut into their meat. They devoured their food with two hands and rarely paused to look up, eating as fast as they raced. Their elbows were out like they were protecting their place in the peloton. Not that I was a threat to any of their meals. My coaches had driven a nutritional doctrine so deep inside of me that I was convinced I was going to hammer these gluttonous carnivores in the time trial later that day.

Yet once again I ended up being the nail.

A few more poundings like that and the coffin lid to my cycling dreams was securely in place. I began to wonder what I was even doing over in Europe. What was I spending all this time and energy for? I missed my girlfriend. I missed going to the movies. I became skeptical of everything I’d sacrificed over the past couple of years until I realized what I really needed to question.


It was high time I put high carb to rest. It wasn’t working for me. If I could put it out of its misery, perhaps I could end mine. And if it didn’t work out, at least I’d move so far in one direction that I’d realize I was going the wrong way.

That was one of the best moves I’ve ever made. Not only did my body respond, but my thought process changed, as well. On a “new” diet, my cycling results encouraged me that I could make a living racing bikes, and I turned pro. And while that career was short lived, I learned to embrace these transformations of thought on every level of my life. Now when I find ideas which are well past their expiration date, I do the only thing that’s truly healthy for me—I throw them out. And I hope I’ve convinced you to do the same.*

*Apparently some long set beliefs are expiring as I write this. A friend/client of mine posted the following on my Facebook wall: “Andrew Johnston, they finally caught up to you.” http://www.forbes.com/…/new-us-guidelines-will-lift-limits…/ If you’ll follow the link, it takes you to an article about the 2015 Dietary Guidelines for America in which they reveal the long standing limitations on daily cholesterol intake are being removed. Specifically, the report states “Cholesterol is not considered a nutrient of concern for overconsumption.” Well, I’ll be! I don’t know if I’d say they actually caught up with me but I am impressed. Next thing they’ll figure out is that the world isn’t flat...

1 comment

Mark Gobbel

Ordered “Spot On” today. I remembered how much I liked your organized thought and style! Looking forward to reading! ….might have a slight issue about water fluoridation, but I know all dogmas need to be reexamined from time to time. What my class was taught in the middle 70’s: " F ion replaces OH ion in the hydroxyapatite (sp) of the enamel during tooth bud formation." It was like mantra. That’s why the staining, in areas where natural levels were high, ( Utah) is permanent. Topical F is topical…only works on surface. …anyway, once we’re grown, hopefully 1 ppm in water isn’t hurting us! So, I look forward to reading! I think we will be hearing more backtracking on cholesterol, too. See you later, Mark Gobbel

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