How can fit athletes have elevated cholesterol and be at risk of heart attack and sudden death? What are the hidden risk factors for heart disease? Is high cholesterol a fat or a carb problem? And how can we lower cholesterol?
Andy, a 41-year-old ex-professional cyclist, maintained a high fitness level but presented with subtle symptoms of feeling lightheaded, dizzy, or faint, having brief palpitations and chest discomfort during or after exercise. He was very concerned, as his father had died of a heart attack in his 40s. His vital signs were normal, and his general examination was unremarkable.
However, Andy was devastated to learn that he had high total cholesterol at 7.11, LDL (bad) cholesterol at 5.61, low HDL (good) cholesterol at 0.93, and normal triglyceride at 1.2. Fasting insulin was high at 26 and haemoglobin A1C (measurement of blood sugar control over the last three months) was borderline at 5.9, inflammatory marker hs-CRP was high at 1.92 and homocysteine (vascular risk factor) was high at 28.
Considering the above results, Andy immediately had specialised cardiac tests. His CT scan showed a high calcium score at 352 (a marker of advanced heart disease), his left coronary artery was 35% blocked, and a carotid artery scan reported 42% blockage on the right and 27% on the left.
Genetic testing reported the APOE genetic variant, which is known to increase the risk of heart disease and dementia. Andy was very surprised to have high mercury, but this was expected with his nine silver (mercury) dental fillings and two root canal treatments.
Andy did not want to take statins, which his father had taken for a couple of decades, but it did not prevent him from dying of a heart attack. He wanted to take a holistic approach, to find and address the underlying causes of the disease and prevent acute events like a heart attack or stroke.
Your body needs cholesterol, but it will not depend on dietary cholesterol: every cell makes it. However, your liver produces more cholesterol from food (plant or animal), making carnivores, vegans and vegetarians equally at risk of high cholesterol and vascular disease. Your body makes about 80% of your daily requirement, leaving 20% to come from food. If you eat more cholesterol, your liver will make less, meaning it is impossible for a diet to be the cause of high blood cholesterol.
Concerns about cholesterol started in 1955 following President Eisenhower’s heart attack. The American Heart Association (AHA) concluded that dietary fat, namely LDL-cholesterol, found in arterial plaque, was the culprit. AHA recommended a low-fat diet, reducing dietary fat to less than 30% of daily calories and saturated fat to less than 10%. Cholesterol intake was reduced to less than 300mg daily, equivalent to three eggs weekly. Foods like meat, butter and eggs were demonised, and the gap was filled by carbs.
Further research introduced a family of cholesterol-lowering drugs, namely statins. These were not only prescribed to prevent heart disease, but also as a routine treatment for metabolic conditions like high blood pressure, diabetes, heart disease, stroke, and peripheral vascular disease.
The limitation of this conventional theory has been documented in ground-breaking studies that confirmed that most heart attack victims had a normal cholesterol panel. The severity of atherosclerosis (narrowing of arteries) did not matter as only 1-5% of cases had severe atherosclerosis. One study even showed that a low-fat diet could alter a healthy lipid profile into a heart attack and stroke!
Studies targeting the control of vascular risk factors like fat, glucose and blood pressure did not reduce mortality. Interestingly, one study (Jupiter) demonstrated that lowering LDL (bad) cholesterol had no effect, but lowering LDL and CRP (inflammation marker) did reduce mortality.
Further evaluation of modern heart disease treatment analysed the number of people needed to be treated to prevent one acute cardiac event (NNT.) The number was 83 patients for statin and 40 patients with stents. However, you needed only 30 patients on the Mediterranean diet to prevent one acute event! So, statins failed to prolong life, whilst 4 teaspoons of olive oil daily reduced death from heart disease, irrespective of body weight!
To lower heart attacks and strokes, functional medicine looks at upstream hidden factors, including oxidative stress, insulin resistance, stress, genetics, inflammation, and environmental factors, including toxicity. Other obvious factors include weight, BMI, blood pressure, blood sugar and cholesterol.
Vascular disease combines three processes – chronic low-grade arterial wall inflammation, oxidative stress, and LDL cholesterol oxidised (damaged) by oxidative stress.
High fructose corn syrup (HFCS) increases inflammation and oxidative stress. One study found that its consumption at a rate equivalent to 25% of daily calories for two weeks increased blood cholesterol and triglycerides. Triglyceride is a forgotten serious risk factor for vascular disease.
Going back to Andy
Andy admitted to drinking many sports drinks during his professional athletic career and to fuel his exercise afterwards. For the same reason, he had been following a high-carb diet, which included sugar and processed carbs.
Sports drinks and the Western diet of sugar and processed carbs are high in HFCS and caffeine. Genetic tests on Andy confirmed a caffeine gene (CYP1A2) variant, which meant slow caffeine processing. This can result in its accumulation and could be the reason for Andy’s palpitations and chest discomfort. However, Andy’s problem was bigger than that.
People assume fruit sugar (fructose) is safe, since, unlike glucose, it does not raise blood sugar or cause glucose spikes. Fructose is processed directly by the liver to produce uric acid. A normal person can have a certain amount of fructose in fruits and vegetables without any adverse effects. This is because these also contain vitamin C, which helps the kidneys to filter the bi-product uric acid into the urine. However, high uric acid in predisposed individuals can cause kidney stones.
But crucially, HFCS is produced from corn by chemical reaction. It does not contain vitamin C, so the resultant accumulation of uric acid causes insulin resistance (IR) “through the back door.” This means that your cells become less sensitive to insulin, the hormone that opens the gate for sugar to come in.
Worsening IR pushes your pancreas to produce increasing amounts of insulin to overcome metabolic blockage. High insulin triggers cellular division and growth. To make more cells, you require more cholesterol to build the cell walls.
Therefore, high insulin turns on the enzyme HMG CO reductase, which switches the liver to produce more cholesterol to build the new cells. This is the underlying cause of Andy’s high cholesterol. Lowering his insulin levels would bring cholesterol down within the normal range.
High cholesterol can be caused by stress, heavy metal toxicity like mercury, and in patients taking prescription drugs like steroids, cytotoxic and heart (diuretics, B-blocker, amiodarone) drugs.
Besides his family history and the HFCS-induced metabolic derangement, Andy had physical and mental stress related to his athletic career and heavy metal toxicity related to his dental amalgam.
How do you lower high cholesterol?
You need to reduce inflammation and improve insulin sensitivity so that more glucose enters cells to lower insulin levels and cholesterol. The action plan is to adopt a high-fat, low-carb, moderate-protein diet. This should be high in fibre from fruits, vegetables, beans, nuts, and seeds, with no sports drinks or commercial juices. Andy had to reduce the duration and intensity of his training and practise deep or Wim Hof breathing, meditation, and enjoy Epsom salt baths in the evening, enhancing sleep quality.
Beans are an excellent carb option (great for fuelling exercise) because they contain 76% carbs, 21% protein and 33% fat. People in the blue zones, the longest-living and healthiest people in the world, eat beans daily.
Healthy fats can be found in fish, butter, eggs, nuts, seeds, avocado and coconut. These options reduce appetite and food intake, lower insulin levels and accelerate fat-burning and weight loss.
The cheap seed oil contains omega 6, a pro-inflammatory fat that changes when heated to trans (toxic) fat. Coconut, butter, or avocado oil are better options. The optimal omega 6 to omega 3 ratio is 4:1.
Andy’s progress in one year
Within a year, Andy felt much better and had gained little weight. His insulin and inflammatory markers were down to normal range fasting insulin 5, hs-CRP 0.56, Homocysteine 8, HbA1C 5.1, LDL- 987. His last Cholesterol was 5.2, BP < 120/80 with no medication. Andy is fully satisfied, and his GP is reassured. We are awaiting a repeat of the CT scan and carotid Doppler.
Statins are an effective drug to lower cholesterol but at a high cost. Side effects include a 50% risk of diabetes, a 100% risk of dementia, disabling myositis (muscle pain and weakness), and deranged liver function. Statins cause problems due to nutrient deficiency, including lethargy due to COQ10 deficiency (necessary for energy making), weight gain due to L-Carnitine deficiency (necessary for fat burning) and Omega 3 (anti-inflammatory.)
High cholesterol is not a fat problem; it’s a carb problem. The HFCS in sports drinks and processed carbs increase your liver’s cholesterol production, obviously raising your cholesterol.
So, my friends, cholesterol remains a central cause of heart attacks, the number one killer of mankind. I hope you can now see how to start lowering your cholesterol today. As always, please ask any questions in the Comment section below – and please subscribe to the newsletter so that you don’t miss further vital information. Thank you!
Signs of heart problems during exercise
Sudden cardiac death in athletes
Fructose consumption increases the risk of heart disease
Consumption of fructose and high fructose corn syrup increases post prandial triglyceride, IDL- cholesterol, apolipoprotein B in young men and women
Dietary fructose and glucose differentially affect lipid and glucose homeostasis
High dietary fructose: direct and indirect dangerous factors disturbing tissue and organ functions