Does Cholesterol cause Coronary Heart Disease?

 

A medical doctor friend two days ago asked me if high cholesterol has anything to do with heart disease and how it really works in blocking the arteries?  I have already answered this issue many times in the past.

 I knew that neither cholesterol nor saturated fats was the cause of heart disease in 1964 when I was a postgraduate student of Professor John Yudkin MA, MD, PhD, FRCP, FRIC, FIBiol who was the Chair of Nutrition at Queen Elizabeth College, University of London.  See John Yudkin’s biography here:

https://en.wikipedia.org/wiki/John_Yudkin#Career

At that time the prevailing theory was saturated animal fats that caused elevated blood cholesterol that in turn caused coronary heart disease. John Yudkin’s greatest rival was Ancel Keys (1904 – 2004) who advocated saturated animal fats as the cause of coronary heart disease. Yudkin’s theory of sugar as pure, white and deadly was the root cause of death from heart disease that rocked the entire world and the medical community.

Below are two links that I wrote to two of my other medical specialist colleagues who asked the same, seeking my opinion about cholesterol and heart disease.  

https://scientificlogic.blogspot.com/search?q=cholesterol

The Truth about Cholesterol, HDL and LDL and Heart Disease here: 

https://scientificlogic.blogspot.com/search?q=The+Truth+about+Cholesterol%2C+HDL+and+LDL+and+Heart+Disease

 Cholesterol per sec is completely harmless. It is a pale-yellow substance, though waxy, it does not stick on to anything, let alone onto the coronary arteries of the heart. It is not soluble in water except in organic nonpolar solvents such as petroleum ether (pet ether), chloroform, ether, benzene, ethanol and methanol (alcohols). I have seen and touched very pure analytical grade cholesterol many times before when we were working in an analytical medical diagnostic laboratory.

Cholesterol is intentionally produced by the body for numerous biochemical and physiological functions such as for the brain and nervous system. It is needed to produce hormones, especially the corticosteroid hormones produced by the adrenal glands.

 It is the diet that partially determines the HDL and LDL cholesterols ratios and total amounts in the blood. It is the liver that synthesizes cholesterol from acetyl-CoA. We shall go into this later.

Most dietary cholesterol are neither HDL or LDL cholesterol except certain foods like eggs, dairy products, and certain types of meat that contain both HDL and LDL cholesterol. Most dietary cholesterol is just neutral cholesterol. It is the types and amounts of fat in the diet that help determine the quantity of triglycerides, the HDL, and LDL cholesterol ratios in the bloodstream.

Cholesterol-rich foods generally as already mentioned contain the normal cholesterol with the molecular formula C27H46O. It is neither called high- or low-density cholesterol.  But they can contribute to the production of both high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol levels in the body.

Cholesterol is synthesized by the liver through a complex series of enzymatic reactions, and its production involves multiple metabolic pathways. The primary pathway for cholesterol synthesis is known as the mevalonate pathway or the HMG-CoA reductase pathway. The key steps in cholesterol biosynthesis comes from acetyl-CoA formation.

This process begins with the conversion of acetyl-CoA, a molecule derived from the breakdown of carbohydrates, fats, and proteins, into a compound called acetoacetyl-CoA.

Then we have the HMG-CoA Formation in which two molecules of acetoacetyl-CoA combine to form 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) through the action of the enzyme thiolase.

Next comes the mevalonate formation where HMG-CoA is then converted into mevalonate by the enzyme HMG-CoA reductase. This step is often considered the rate-limiting step in cholesterol synthesis, and HMG-CoA reductase is the target of statin drugs, which are commonly prescribed to lower cholesterol levels.

Statin drugs are a class of medications commonly prescribed to lower LDL (low-density lipoprotein) cholesterol levels in the blood. LDL cholesterol is often referred to as "bad" cholesterol because elevated levels can contribute to the buildup of plaque in arteries, leading to atherosclerosis and an increased risk of cardiovascular disease.

Statins work by inhibiting an enzyme called HMG-CoA reductase, which plays a key role in the synthesis of cholesterol in the liver. By reducing the production of cholesterol, particularly LDL cholesterol, statins help lower overall cholesterol levels in the bloodstream.

In addition to lowering LDL cholesterol, statins may also have other beneficial effects, such as increasing high-density lipoprotein (HDL) cholesterol often referred to as "good" cholesterol and reducing inflammation.  We shall go into “good” and “bad” cholesterol a little bit more later.

It's important to note that the use of statins is typically recommended based on an individual's overall cardiovascular risk profile, and the judgement to prescribe statins is made by healthcare professionals. While statins are effective in lowering cholesterol and reducing the risk of cardiovascular events, they may also have side effects such as damage to the liver, and their use should be monitored and managed. Unfortunately, statins have been abused by health care providers through over prescribing.  For instance, statin prescriptions average a total annual cost of $24.5 billion in the US alone.

Back to the synthesis of body cholesterol, after the mevalonate formation where HMG-CoA is  converted into mevalonate by the enzyme HMG-CoA reductase, the next step in the synthesis of cholesterol in the body results in conversion to Isoprenoids where mevalonate undergoes a series of enzymatic reactions to form isoprenoids, such as farnesyl pyrophosphate and geranylgeranyl pyrophosphate and the formation of squalene in which Isoprenoids are then converted into squalene through a series of reactions. The squalene undergoes cyclization and modification reactions to form lanosterol, which is then further converted into cholesterol.

These are the biochemical steps how the body naturally produces its own cholesterol, and it could do this far more efficiently than the cholesterol we can eat through food.

The liver is a major site of endogenous cholesterol production. The amount of cholesterol produced by the liver varies among individuals. It is influenced by factors such as genetics, dietary habits, and overall health. On average, the liver synthesizes a substantial amount of cholesterol each day to meet the body's needs for cell membrane structure, hormone synthesis, and other essential functions. There are feedback mechanisms on the amount of dietary cholesterol intake and the endogenous turnover by the liver to keep the level of cholesterol in the blood under check and balance.

The impact of dietary cholesterol intake on blood cholesterol levels can vary from person to person. Even though dietary cholesterol does contribute to total cholesterol levels, the body's response to dietary cholesterol is complex. Some individuals are more sensitive to dietary cholesterol, while others are less affected.

Since cholesterol is not water soluble as already mentioned, for cholesterol to be transported through the bloodstream, which is water-based, cholesterol needs to be combined with proteins in the blood to form lipoproteins. These cholesterol-protein complexes vary in density, and there are two main types. Let’s talk about them in a bit more detail.

Low-Density Lipoprotein (LDL): LDL cholesterol is often referred to as "bad" cholesterol. LDL particles are denser and smaller. They transport cholesterol from the liver to the cells. However, if there is an excess of LDL cholesterol or if the LDL particles are damaged by oxidation such as from free radicals to become gummy and sticky, and this can contribute to the buildup of plaques on the intima or inner walls of arteries, leading to atherosclerosis. Foods high in saturated and trans fats, which are often found in animal products and processed foods, can raise LDL cholesterol levels to cause this problem, whereas fruits, vegetables and plant-based foods rich in antioxidants can short-circuit free radicals into harmless neutral molecules, thus preventing atherosclerotic plagues formation.

High-Density Lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol. HDL particles are larger and less dense. They help remove excess cholesterol from the bloodstream by transporting it to the liver, where it can be broken down and excreted from the body. HDL is considered beneficial because it helps prevent the buildup of cholesterol in the arteries. It is also less prone to become sticky through oxidation. Foods that are rich in healthy fats, such as certain oils, fatty fish, nuts, and seeds, can contribute to increased levels of HDL cholesterol.

The terms "low density" and "high density" refer to the comparative proportion of lipids (fats) to proteins in these lipoprotein complexes. LDL has a higher ratio of cholesterol to protein, making it denser, while HDL has a higher ratio of protein to cholesterol, making it less dense.

It is important to note that the relationship between dietary cholesterol and blood cholesterol levels is complex. For many people, dietary cholesterol has less of an impact on blood cholesterol than the types of fats consumed.

In recent years, research has indicated that the link between dietary cholesterol and heart disease is not as straightforward as once thought, and factors such as overall diet, genetics, and lifestyle play central roles. What is important is to limit the intake of sugar, saturated and trans fats and focus on consuming healthy fats to support heart health.

In short, and simply put in simple language, LDL cholesterol often referred to as "bad" cholesterol and high-density lipoprotein cholesterol or HDL cholesterol often referred to as "good" cholesterol may not be technically correct so to speak. LDL cholesterol may not be “bad” after all if a diet has a high content of antioxidants to deal with oxidative stress of the cells and on the intima of coronary and other blood vessels by damaging free radicals.

HDL merely picks up excess cholesterol in the blood and returns them to the liver where it's broken down and removed from the body. It is also less prone to oxidation and oxidative stress. That’s why they term HDL cholesterol as “good cholesterol”. It is the diet that partially determines the HDL and LDL cholesterols ratios and total amounts in the blood. It is the liver that synthesizes cholesterol from acetyl-CoA as already described in some details.

In summary, I have found no relationship between blood cholesterol and heart disease when our medical technicians analysed tens of thousands of blood samples at the Institute for Medical Research where I once worked as a Senior Medical Research Officer, and what clinicians wrote there in their requests for cholesterol analysis. The blood samples were taken from hundreds of government hospitals in East and West Malaysia. I have gone through these analytical data and have signed tens of thousands of these analytical and diagnostic reports for doctors in hospitals.

But I found no relationship between serum cholesterol and heart disease and heart attacks. Their requests were sent to us for support and confirmatory diagnosis.

But I could not do anything to tell them because the prevailing theory at that time was saturated animal fats and cholesterol that caused  coronary heart disease. So, I signed all their doctors' and government hospitals' requests and sent them back to the hospitals and let them do what they like that pleased them. 

 There was nothing I could do to change the mindset of doctors who insisted that high cholesterol was the culprit, and should be treated with statins when sugars, smoking, stress, free radicals were the wrongdoers.

 I was the only lone voice in the wilderness in Malaysia at that time, but numerous scientists and eminent physicians in the UK who were my mentors would have supported me.

It is only now that multiple voices from the scientific and medical communities are revealing the myth about cholesterol and coronary heart disease.

Here are just a few publications since 1998 with their scientific voices in support of my silent thoughts in the mid 1960’s    

Do I need to say more?

How this myth about cholesterol and heart diseases first started is here:

Cover Story | The Heart Study Heard Around the World: Origins of Framingham and its Continued Legacy

https://www.acc.org/latest-in-cardiology/articles/2014/08/19/09/23/the-heart-study-heard-around-the-world-origins-of-framingham-and-its-continued-legacy

The Framingham Heart Study and the Epidemiology of Cardiovascular Diseases: A Historical Perspective

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159698/

Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024687/

7 Myths About Cholesterol, Debunked

https://time.com/6287926/cholesterol-myths-debunked/

Cholesterol does not cause coronary heart disease in contrast to stress here:

https://www.tandfonline.com/doi/full/10.1080/14017430801993701

“The real truth about diet and cholesterol came out in a 1992 Archives of Internal Medicine article stating that, “in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol”. The author who said this was William Castelli who was the Director of the Framingham study at that time.

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review here:

https://bmjopen.bmj.com/content/6/6/e010401

From Framingham to Hunt 2: 60 Years Blaming the Wrong Culprit?

https://medcraveonline.com/JCCR/from-framingham-to-hunt-2-60-years-blaming-the-wrong-culprit.html

The US Government finally officially removed Cholesterol from Naughty List here:

https://www.linkedin.com/pulse/cholesterol-finally-officially-removed-from-naughty-list-barot#:~:text=The%20US%20government%20has%20finally,heart%20disease%20and%20clogged%20arteries.

Think this over and thank you for reading.

Lim ju boo 

Does Cholesterol Cause Heart Disease? here:

 Title: Re-evaluating Cholesterol: The Myth, the Science, and the Truth Behind Coronary Heart Disease

By Dr. Lim Ju Boo and Prof. MC Sage

On  Tuesday, August 17, 2021 I  singly wrote an article entitled: 

Does Cholesterol Cause Heart Disease? here: 

https://scientificlogic.blogspot.com/search?q=does+cholesterol+cause+heart+disease

Today, I am writing to answer this same question again, friends and the public asked over  and over again. 

This time I shall answer this age-old question again together with my senior most research partner Professor MC Sage. 

It is very unfortunate the gullible public believe in everything their doctors tell them, example "cholesterol causes heart disease, and you need to take the medicine (statin) I shall prescribe for you"   

Introduction

For decades, cholesterol has been demonized as the central villain in coronary heart disease. Public health campaigns, dietary guidelines, and medical prescriptions converged on a simple yet potent message: avoid cholesterol, reduce saturated fats, and lower your serum cholesterol to prevent heart attacks.

But is cholesterol truly the cause of heart disease? Or is this one of the most profound misinterpretations in medical history? This article seeks to re-examine this question with a critical lens, combining firsthand analytical experiences, historical reflections, and rigorous scientific studies.

The Early Narrative: Cholesterol and the Framingham Heart Study

The Framingham Heart Study (FHS), launched in 1948, was instrumental in shaping our understanding of cardiovascular risk factors. Early analyses of FHS data did indeed find a statistical correlation between high total serum cholesterol levels and increased risk of coronary heart disease, especially among middle-aged men.

This correlation catalyzed the diet-heart hypothesis, most famously championed by Ancel Keys, who postulated that saturated fat intake raised cholesterol, which in turn caused heart disease.

In parallel, massive public health policies were enacted. The American Heart Association, USDA, and global health bodies issued strong guidelines to reduce cholesterol and saturated fat intake.

The Shift in Understanding: Later Phases of FHS and Beyond

As FHS continued over multiple generations and decades, later findings began to challenge the initial conclusions:

• Cholesterol levels were not predictive of heart disease in the elderly.

• A significant number of patients who experienced myocardial infarctions had normal cholesterol levels.

• Other factors emerged as stronger predictors: smoking, hypertension, diabetes, stress, sedentary lifestyle, and systemic inflammation.

In fact, Dr. William Castelli, a former director of the Framingham Study, famously stated:

"In Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol... and the people who ate the most cholesterol, saturated fat and calories were the most physically active and weighed the least."

(Source: Archives of Internal Medicine, 1992)

This marked a significant reversal of the cholesterol narrative.

My Personal Professional Observations and Experience

As a Senior Medical Research Officer at the Institute for Medical Research (IMR), Malaysia (1968–1994), I had the privilege and responsibility of signing tens of thousands of diagnostic reports on serum cholesterol levels.

Blood samples arrived daily from government hospitals across the country, from Johor Bahru in the south to hospitals near the Thai border in the north, including East Malaysia.

Our lab technicians and analysts found no consistent correlation between cholesterol levels and the clinical notes provided by physicians. Patients suspected of ischemic heart disease, angina, or myocardial infarction often had normal cholesterol levels.

We reanalyzed samples to rule out analytical errors:

• Repeated tests showed less than 1–2 mg/dL variation.

• Spiking experiments using known cholesterol amounts confirmed our accuracy.

• Cholesterol recovery analysis also validated our procedures.

We concluded the fault was neither with the patient nor the lab, but possibly with a flawed foundational theory still widely believed by clinicians.

Cholesterol: Biochemistry, Physiology, and Misconceptions

Cholesterol is not inherently harmful. It is a pale-yellow, waxy compound, essential for numerous physiological functions:

• Cell membrane structure

• Synthesis of steroid hormones (testosterone, estrogen, cortisol)

• Vitamin D metabolism

• Myelin sheath formation in nerves

The liver produces about 85% of the body’s cholesterol, tightly regulating blood levels through homeostatic feedback mechanisms.

Even consuming large quantities, e.g., 10 eggs a day (providing ~1860 mg cholesterol), barely shifts serum cholesterol, as the body adjusts endogenous production accordingly.

I have personally eaten two eggs daily for over 70 years and frequently consumed goat’s brain curry (high in cholesterol and choline) for 10 years, with no abnormal serum cholesterol nor any cardiovascular events.

Dietary Cholesterol: Revisions in Guidelines

The 2015 Dietary Guidelines for Americans (DGAC) officially removed cholesterol from the “nutrients of concern” list:

*"Available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol."

This marked a policy U-turn after decades of caution. Foods like eggs, butter, dairy, coconut oil, and liver were no longer demonized.

Even Dr. Steven Nissen, a renowned cardiologist, affirmed:

"We got the dietary guidelines wrong. They've been wrong for decades."

LDL, HDL, and Oxidation Theory

While LDL (Low-Density Lipoprotein) is labeled “bad” and HDL (High-Density Lipoprotein) “good,” this distinction is simplistic.

What makes LDL dangerous is oxidation:

• Oxidized LDL becomes sticky and gummy, adhering to the damaged intima of arteries, forming plaques.

• Free radicals, especially from stress, smoking, and poor diets, oxidize LDL, leading to atherogenesis.

Cholesterol itself, when pure, is neither sticky nor soluble in water. It requires lipoprotein carriers to travel in blood.

Stress, Inflammation, and the Real Culprits

Research increasingly points to inflammatory processes as the true cause of atherosclerosis, often initiated or aggravated by:

• Chronic psychological stress

• Elevated cortisol and adrenaline

• Oxidative stress and free radical damage

• Endothelial dysfunction

See this detailed article: "Why Reducing Stress is More Important Than Lowering Cholesterol" - 

https://www.stress.org/why-reducing-stress-is-much-more-important-than-lowering-cholesterol

Statins and the Pharmaceutical Industry

By the time the Framingham Study began softening its stance on cholesterol, statins had already flooded the market.

Drugs like atorvastatin, simvastatin, lovastatin, etc., were producing billions in revenue.

In 2002 alone, statin prescriptions reached USD 88 million. Today, they yield nearly USD 60 billion annually.

While statins lower LDL and reduce cardiovascular events in high-risk populations, their over prescription in healthy individuals has drawn criticism.

The US government and medical research bodies were slow to update guidelines, possibly influenced by powerful pharmaceutical interests. Doctors rarely read primary literature and instead rely on pharma sales representatives.

Emerging Research: Beyond Cholesterol

Many modern studies support a more holistic approach:

• Oxidative damage as the catalyst for plaque formation

• Calcium buildup and osteoblastic cell differentiation in arterial walls (see Hyo-Soo Kim, Seoul National University)

• Genetics, infections, gut microbiome, and dietary sugar play significant roles

Dr. John Yudkin (1910–1995), my former professor at Queen Elizabeth College, University of London, was one of the earliest to warn about sugar, not cholesterol. His book "Pure, White and Deadly" was prophetic, but dismissed at the time.

Supporting Literature & References

1. Framingham Heart Study and its Legacy – ACC

2. Framingham Study – NCBI Historical Perspective

3. Dietary Cholesterol and Cardiovascular Disease – PMC

4. 7 Myths About Cholesterol – TIME

5. BMJ: No link between LDL cholesterol and mortality in elderly

6. Stress and Heart Disease – Taylor & Francis

7. US Government removes cholesterol from 'naughty list'

Conclusion

The once unchallenged view that cholesterol causes heart disease is now being re-evaluated. While cholesterol, particularly oxidized LDL, can contribute to atherosclerosis, it is not the primary cause.

The true culprits appear to be stress, inflammation, oxidative damage, dietary sugar, sedentary behavior, and poor lifestyle choices.

It is time the medical community reorients itself with updated science, reduces unnecessary prescriptions, and adopts a holistic model of cardiovascular care. The myth of cholesterol as the singular cause of heart disease must be laid to rest.

Signed with gratitude and scientific clarity,

Dr. Lim Ju Boo
Senior Medical Research Officer (Ret.)
Institute for Medical Research, Malaysia

Prof. MC  Sage
 Research Scholar and Scientific Partner

Does Cholesterol Cause Heart Disease?

 

 

https://www.tiktok.com/@mohanaturoholistics/video/7202991888549350683

https://www.youtube.com/watch?v=iQPfYghxXQI

 

Dear Dr (Mrs) N. Kandiah,

Thank you for requesting my comment on the article you sent below in parenthesis and in different colours.    

 “Pharma companies extracted USD 2 trillion from consumers in the name of cholesterol level treatment.   What a shame on medical research fraud and authorities. Their incompetency costed USD 2 trillion to people those who were fit and healthy.    *Cholesterol* is finally officially removed from Naughty List. The US government has finally accepted that *cholesterol* is not a _nutrient of concern_. *doing a U-turn* on their warnings to us to stay away from high-cholesterol foods since the 1970s to avoid heart disease and clogged arteries.   This means eggs, butter, full-fat dairy products, nuts, coconut oil and meat have now been classified as *safe* and have been officially removed from the _nutrients of concern_ list.   The US Department of Agriculture, which is responsible for updating the guidelines every five years, stated in its findings for 2015: "Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day.  

 "The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology).  The Dietary Guidelines Advisory Committee will, in response, no longer warn people against eating high-cholesterol foods and will instead focus on sugar as the main substance of dietary concern.   US cardiologist Dr Steven Nissen said: _It's the right decision_. _We got the dietary guidelines wrong. They've been wrong for decades_."   When we eat more foods rich in this compound, our bodies make less. If we deprive ourselves of foods high in cholesterol - such as eggs, butter, and liver - our body revs up.    

The Real Truth about Cholesterol. The majority of the cholesterol in you is produced by your liver. Your brain is primarily made up of cholesterol. It is essential for nerve cells to function.    Cholesterol is the basis for the creation of all the steroid hormones, including oestrogen, testosterone, and corticosteroids.    *High cholesterol in the body is a clear indication which shows the liver of the individual is in good health*   

Dr. George V. Mann M.D. Associate Director of the Framingham study for the incidence and prevalence of cardiovascular disease (CVD) and its risk factors states:  _Saturated fats and cholesterol in the diet are not the cause of coronary heart disease. *That myth is the greatest deception of the century, perhaps of any century*_   *Cholesterol is the biggest medical scam of all time* There is no such thing as *bad Cholesterol*   

So you can stop trying to change your Cholesterol level. Studies prove beyond a doubt, cholesterol doesn't cause heart disease and it won't stop a heart attack.   *The majority of people that have heart attacks have normal cholesterol levels. *   OUR BODY NEEDS 950 mg OF CHOLESTEROL FOR DAILY METABOLISM AND THE LIVER IS THE MAIN Producer. ONLY 15% OF CHOLESTEROL IS BEING DONATED BY THE FOOD WE EAT.    

 

If the fat content is less in the food we eat, our liver has to work more to maintain the level at 950 mg.   *If the cholesterol level is high in our body, it shows the liver is working perfect. *   Experts say that there is nothing like LDL or HDL.  ………….. ….. *Cholesterol is not found to create blocks anywhere in the human body*.   Please share the recent facts about CHOLESTEROL”  

 

 https://www.washingtonpost.com/news/wonk/wp/2015/02/10/feds-poised-to-withdraw-longstanding-warnings-about-dietary-cholesterol/utm_term=.1982832f86fa

 

Thank you for the post above.   

 

I have written many times in the past that cholesterol has nothing to do with heart disease, and neither egg, brain or liver food all containing high cholesterol have anything to do with high blood cholesterol, or with heart disease.

In fact, the homeostatic feedback mechanism of the liver can cause the liver to produce 10 times more cholesterol endogenously than all the cholesterol we can eat through food every day. 

This means the amount of cholesterol from food pales into nothing compared to what the liver can synthesize.   

 

For instance, one large egg contains about 186 mg of cholesterol all found in the yolk. Suppose we consume 10 eggs a day. The intake from 10 eggs alone amounts to 1860 mg.   

 

An adult weighing   68 to 82 kg should have about 4,500 to 5,700 mL. of blood.    Let us use 5 litres (5,000 mL) as an average for easy calculation for illustration.   

 

This implies that even if he eats 10 eggs a day, his dietary contribution from eggs would only raise his blood level of cholesterol by only 37 mg per 100 mL, not even wanting to consider that about 0.4 g (400 mg) of cholesterol is being excreted through the bile each day.   

 

I have eaten at least two eggs almost every day all my life since I was a child and until today at the age of 82, I have never had any high cholesterol or heart problems.   Furthermore, in 1969 when I started working at the Institute for Medical Research, for at least 10 years I used to go an Indian food stall behind Indian money lenders shop in Lebuh Ampang in Kuala Lumpur and have my favourite lunch of Indian curry goat’s brain cooked with curry and eggs there every day.   

 

But when I checked my blood level cholesterol, it was always normal, and its level has never been raised despite so much curried goat’s brains.  I have eaten daily for 10 years. 

 

I might have at the same time consumed a large amount of choline from the eggs and brain which is supposed to be excellent for the brain and nervous system?   Brain has the highest amount of cholesterol among all the cholesterol-rich foods like egg yolk and liver. I never till today have any problem with high cholesterol or heart disease all my life. 

 

In fact, eggs and brain food are very high in choline which is very essential for brain function and neurological development throughout life. See my write up attached on the benefits of eggs here:  

 

 http://flfam.org.my/files/Dr%20Lim%20Ju%20Boo%20presentation%20-Hen%20Egg.pdf

or here in alternative link:

https://taionn.blogspot.com/2017/09/dr-lim-ju-boos-slide-presentation-on.html

 

 When I was studying in London in 1964 my late professor, Professor John Yudkin who was a Professor of Nutrition, University of London already told us cholesterol does not cause heart disease, but refined white sugar does.   

 Prodessor John Yudkin here: 

 https://en.wikipedia.org/wiki/John_Yudkin

It was at the time when this theory that cholesterol causes heart disease was rampantly believed among doctors who influenced the lay public to believe the same. 

 

 When i was working in various Divisions - the Nutrition Division, Community Medicine, Epidemioloigy and Clinical Research  at the Institute for Medical Research (IMR) in 1968 - 1994, I used to sign not just one, ten, or a hundred, but tens of thousands of analytical reports on blood cholesterol levels in blood samples sent to us by tens of hundreds of government hospitals every day.   

 

They were sent to IMR from all over Malaysia, from East and West Malaysia, and from hospitals near the Thai border in the north to those in Johore and Johor Bahru in the south.   In our analysis we found no relationship between what the doctors wrote there in their clinical notes about patients suspected of having heart disease, ischemia and heart attack and their serum cholesterol levels There were 3 parties involved here: 

 

1. The Patient 2. The doctor 3. 

 

We, the analyst helping out the doctor   Initially, among the three parties we put the blame on ourselves first. We thought we were wrong due to an analytical error. However, when we saw what the doctor wrote there in their clinical notes did not tally with our findings, we requested our medical lab technologists to repeat the analysis.   The return results were the same each time for tens of hundreds of repeated analyses. 

 

The repeat results each time showed only one or two milligram per litre of blood difference from the original.   Not satisfied, we requested a recovery analysis to be done in case the analytical techniques were unreliable. We then used known amounts of pure cholesterol added into the blood samples, and the recovery amount was exactly the same as what we added. 

 

So there was no analytical error involved on our part.   So, there are only two remaining parties left: either the doctor's preliminary diagnosis was wrong, or the patient lied to the doctor.   In any case we did not see other investigations such as ECG to look for ST elevation, and cardiac enzymes such as myoglobin, troponin and creatine kinase being done by the clinicians which would have greatly helped us with the diagnosis.   

 

They only requested for serum cholesterol. So, we just did that, and, in most cases, we found no relationship between what the clinicians wrote there and our lab findings.  

 

I already knew by then John Yudkin was dead right, but I could not voice this out because of the very strong belief and mindset of the doctors who still believe cholesterol was the cause of their patient’s heart problems because of that very influential and famous longitudinal Framingham Heart Study that started in 1948 and is still going on till today on cohorts that initially found cholesterol caused heart disease. 

 But as the study was followed up years later, they found there were other factors such as diabetes, stress, high blood pressure, infection, sedentary lifestyles, obesity... etc. etc., that were the causative root causes of heart disease, and not just cholesterol. 

 

I already suspected there was no relationship at all between ischemic heart events and cholesterol by then, but I could not voice this out because of the very strong ingrained belief among doctors that high blood cholesterol was the cause.   

 

Then around 1970’s the Board of Directors of the same Framingham Heart Study issued  an official statement that cholesterol is not the primary cause of heart disease but other factors they later found were the  causes But by then the big drug companies have already capitalized on Framingham earlier study, and they started to produce their various types and generations of  statin groups of anti-cholesterol drugs such as atorvastatin fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin into the market. The amount of these statins prescribed rose to US $88 million in 2002 to US $ 60 billion annually due to such rampant beliefs among doctors and the lay public who believed the same.      

 

Unfortunately doctors hardly read medical journals and papers published on new discoveries but they just listen to drug salespeople who promote their products.   After all the big statins producing companies have already invested tens of US $ billion to produce these anti-cholesterol drugs, and hence they need to continue to push them to the doctors to get back their investments despite Framingham Heart Study earlier retraction.   

 

What can we do as they are so powerful financially to overpower the medical profession and brain wash them thoroughly with their drug of choice. We all in research and in the pharmaceutical industry know what is going on between the drug industry and the doctors as they work hand in gloves together.  

 

Numerous studies following the Framingham Heart Study also showed that many other factors such as stress, obesity, sedentary lifestyle, unhealthy food and harmful nutrition are the main causes of cardiovascular events, and not cholesterol. 

 

 Citing just one example will do, it was found that stress may be more important than cholesterol as the causation of cardiovascular disease, and this is explained below in No 1: 

 

1.       https://www.stress.org/why-reducing-stress-is-much-more-important-than-lowering-cholesterol

 

The second one is a video on "The Town of Allopath" highlighting the deception by drug companies to treat non-existing causes of disease.

 

2.       https://www.youtube.com/watch?v=5ZUPYZ2ICvU

 

The second one may also be accessed by typing "The Town called Allopath" directly into Google search. Thank you.

 

The release of harmful stress hormones such as adrenaline in the fight or flight response may be one of the causes.   When the stress “fight or flight” response episode is over, the stress hormone adrenaline breaks down and releases cascade of extremely damaging free radicals into the bloodstream causing extensive damage to all the cells, tissues, organs and systems in the body including the inner intima linings of the coronary blood vessels to the heart. This causes an inflammatory lesion in the coronaries to block blood flow to the heart. 

 

 This has completely nothing to do with cholesterol deposits as there are other deposits that cause atherosclerotic plaques to be formed as well.   What it actually does is, the free radicals as an singlet oxygen radical oxidizes the low density cholesterol in particular to make them become very sticky and gummy allowing other deposits to adhere to the already damaged intima of the coronaries, and this may compound to further damage 

                 

Atherosclerosis and cholesterol: 

 

Pure cholesterol monohydrate is a very pale-yellow substance practically insoluble in water (less than 0.5 mg/100 ml of water).

 

But it is slightly soluble in organic solvents such as ethanol (1.29% w/w at 20 °C), methanol, dimethylformamide (DMF), chloroform, and pet ether.

 

When pure cholesterol powder is touched with the fingers, it does not stick onto the fingers at all. It is neither gummy or sticky but just powdery to feel, and it floats in water.

 

Hence there is no reason why it must stick onto the inner surface of blood vessels to form a cholesterol plaque there unless oxidized by free radicals, especially the low-density lipoprotein cholesterol that may cause it to be gummy trapping other substances such as fibrin (from blood clotting), dead blood cell, fatty materials, calcium, etc to form an atherosclerotic plaque there. When plaque (fatty deposits) clogs your arteries, that’s called atherosclerosis. 

 

Hyo-Soo Kim of Seoul National University and his team characterized different types of cells that play a role in calcium accumulation in blood vessels. 

 

 They reported the novel concept that immature, stem-cell like cells have the potential to become either osteoblasts or osteoclasts, and that a drug can push these cells toward becoming osteoclasts instead of osteoblasts.   

 

Their study offers new insights into how calcium builds up in the walls of blood vessels during advanced stages of atherosclerosis and paves the way for long-sought therapeutic strategies to combat this common problem. To study the cause of calcium build-up in vessel walls, Kim and his team focused on calcifying progenitor cells—immature cells that can turn into specialized cells capable of either promoting or reversing calcium accumulation (osteoblasts or osteoclasts, respectively). 

 

They isolated these cells from the aortas of mice and sorted them into two groups. Both groups originated from bone marrow—spongy tissue found inside bones—and expressed a cell surface protein called stem cell antigen-1 (Sca-1), but only one group expressed another cell surface protein called platelet-derived growth factor receptor alpha (PDGFRα). 

 

 Moreover, both types of cells had a tendency to turn into osteoblast-like cells and thereby promote atherosclerotic calcium build-up. But cells expressing both Sca-1 and PDGFRα were more committed to the osteoblastic lineage, whereas those expressing only Sca-1 were bidirectional:   they could also become osteoclast-like cells.   

 

The findings suggest that these bidirectional cells could be targeted by new therapies that shift their fate toward the osteoclastic lineage, thereby preventing calcium accumulation in blood vessels. 

 

 Their study did not show any cholesterol being involved in plaque formation. Hope this comment helps answer your article and question you sent. 

 

Jb lim

Subject: The Great Cholesterol Lie

Summary: Without inflammation, cholesterol would not accumulate in wall of blood vessel and cause heart disease

A Heart Surgeon Admits Huge Mistake!

By Dwight Lundell, MD

Part 1 of a 2-part article (see part 2 below)

We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong.. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific fact.

I trained for many years with other prominent physicians labeled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statins
medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated -- it is quite simply your body's natural defense to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process, a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity. Let me repeat that. The injury and inflammation in our blood vessels is caused by the low fat diet that has been recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

In Part 2 of this two-part article, I'll discuss which foods cause inflammation, how those foods trigger the inflammatory process, and the foods to eat that will cure inflammation.

Part 2

By Dwight Lundell MD 02/06/2009

Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. Let’s say you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.

Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing
the body to respond continuously and appropriately with inflammation.

While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived to declare war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.

How does eating a simple sweet roll create a cascade of inflammation to make you sick?

Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works. When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.

What does all this have to do with inflammation? Blood sugar is controlled
in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator — inflammation in their arteries.

Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6’s are essential – they are part of every cell membrane controlling what
goes in and out of the cell — they must be in the correct balance with omega-3’s.

If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation. Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.

There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation-causing omega-6 fats like corn and soybean oil and the processed foods that are made from them. One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labeled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.

[Ed. Note: Dr. Dwight Lundell is the past Chief of Staff and Chief of Surgery at Banner Heart Hospital, Mesa, AZ. His private practice, Cardiac Care Center was in Mesa, AZ. Recently Dr. Lundell left surgery to focus on the nutritional treatment of heart disease. He is the founder of Healthy Humans Foundation that promotes human health with a focus on helping large corporations promote wellness. He is the author of The Cure for Heart Disease and The Great Cholesterol Lie]

Comments by visitors to Dr Lundell’s article ‘The Great Cholesterol Lie’

1. OH no!!!!! no!! This article added on to more confusion regarding the causes of coronary heart diseases!! What about taking the so called OMEGA eggs, soft boiled or sunny side over? What about prawns and crabs?? Scallops and throw in with sotong? Is there anyone out there care enough to provide a more rational and down- to -earth and more localized explanation / suggestions / comments or argument that may be of help?

A worried Perry

Date: Fri, 26 Jun 2009 13:38:42 +0800
Subject: The Great Cholesterol Lie help

2. Hi all,

After reading this it is still better to go easy on the LARD and 'chee yau char’ when you eat Char Kueh Teow though lard is NOT process oil! Hahaha! Carry on eating Bak Kut Teh with ease of mind!

CHM

3. Dear Dr Lim,

Sorry have to consult your expert opinion again. Could I get a copy of your Keynote Address and your presentation on the Definition of Health you presented at the Health and Wellness Seminar of the Malaysian Senior Scientists Association.

I would also like your paper on ‘The Physiological Basis for Weight Management & Stabilization’ you also presented at the seminar. Kindly also seek your expert view on Dr Lundell’s article ‘The Great Cholesterol Lie’

Thank You & Best Regards,

CK Cheong

4. Dear Dr Lim,

We would like you to comment on the above article ‘The Great Cholesterol Lie’ by Heart Surgeon Dr. Dwight Lundell e-mailed to you earlier. We would appreciate your qualified professional opinion on this health issue as all along nutritionists and cardiologists have put the blame on cholesterol as the cause of coronary arterial disease. Your expert comment please!

Thanks.

Dr KM Tan and colleagues

Dr JB Lim replies below:

Thank you to all of you for your questions and e-mails.

It is very difficult for me to explain why eating high cholesterol foods like brain, liver, eggs, prawns DO NOT cause your blood cholesterol to be elevated permanently. The explanation is very lengthy, and requires a technical understanding of liver biochemistry, and I don’t intend to start on this. This belief that high cholesterol foods cause high blood cholesterol and heart disease was very popular in the 1940’s – 1950’s but it is now out of fashion to talk about it. Advances in nutritional science have debunked this myth.

Nevertheless very briefly, high cholesterol foods may cause a mild and temporary rise in blood cholesterol lasting for only a few hours post digestion stage. This effect will go away a few hours later, only to rise again at night.

But this nocturnal rise in blood cholesterol has nothing to do with any high cholesterol foods you have taken earlier. It is due to your own liver producing them in high amounts at night when you are asleep. In fact the liver can produce its own cholesterol to meet your body’s need 10 times better than all the cholesterol you can eat through foods during the day.

Hence it is no longer a fashion to say that eating foods high in cholesterol causes high cholesterol in the blood or heart disease. It is the type or nature of the oil you consume or use them for cooking that is far more important. By this I mean saturated oils from animal fats such as lard or tallow, or trans-fatty acids from hydrogenated margarine, or saturated oil from coconut oil that you need to avoid, but not eggs, liver etc.

Furthermore, even if you manage to eat a lot of cholesterol, say 10 eggs a day which is about 3,500 mg of cholesterol, the liver is able to throw out at least half of it everyday through the bile. The liver will compensate by balancing its body output (endogenous) of cholesterol with the amount you have taken through food (exogenous), to stabilize the level in the blood. That is why unlike blood sugars, blood cholesterol do not rise up and down sharply after a meal. The liver keeps this in check.

Yes, fish oil containing omega 3 fatty acids do lower your blood cholesterol. Eating a lot of fatty fish, especially the belly part is healthy as it is cardio-protective. Again, the chemistry why this is so, is highly technical in any attempt to explain. But you may find the explanation given in advanced textbook of nutrition, biochemistry or nutrition biochemistry. Check them out.

This is my very brief answer to your question. Full explanation involves complex and lengthy biochemistry, and it is not necessary to go into that for education purposes for the housewives and lay public

Regards

JB Lim

Thank, CK Cheong, for consulting the expert advice of Doctor and Nutritionist JB Lim. I really valued reading that controversial coronary / food articles on the net can actually lead to tremendous stress!

And thanks Dr Lim, for taking the trouble and valuable time to explain in the simplest of terms and avoiding all the medical jargons...!!

For your info, I have undergone angioplasty with a 22mm stenting done but two years later, its was completely occluded. The cardiologists advised an immediate off-pump CABG with a double artery graft taken from my wrist - 4 yrs ago)

I am under regular medication of aspirin, irbesarstan SR & atorvastatin, plus many self -administered food supplements like omega fish oil, milk thistle, vit.E and even glucosamine and a few others!

After the CABG, my nutritionist put me on a strict diet and i missed all the high cholesterol food esp. sea food and my favorite soft boiled eggs for yrs.. The unbelievable thing is I immediately gave up smoking 100% after being a heavy chained smoker for 30 yrs!! -- haha, ck, now you know why i gave up smoking!!!

If according to that article, and yr invaluable explanation, I can occasionally deserve a sumptuous meal of crabs and what not!!

So, CK, the next time I visit you in KL, lets go for sea food instead of roti canai!! Invite Dr Lim along!

*Dr. Lim, one more worried question? Do the drugs I take, esp. atorvastatin, does it cause harmful side effect like affecting libido?

** by the way, any one in my situation is sure to be gullible to all sorts of 'professional advice' from the "street doctors" esp. direct sales people on their miracle health food/products.... and i am a regular victim!!

Thanks again,

Still worried, but lesser!

Perry

Role of Cholesterol: Its Not Bad After All

A friend of mine sent us through a WhatsApp group this video about cholesterol as something bad for health and for the heart. It is an interview by Esha Chopra, an Indian actress and screenwriter to her father Dr Alok Chopra who is a cardiologist. He spoke about the functions of cholesterol in the body here:

https://www.instagram.com/taseer60/reel/DCsk_0yNxqJ/

After hearing what Dr Alok Chopra said, I decided to add more to what he explained, more than just the role of cholesterol in the body. It is always associated with something bad for health that causes cardiovascular diseases.

Let me first of all put the record straight. Cardiovascular is not about heart attack only. The nature of cardiovascular diseases is multifactorial. It is a group of diseases involving the heart and its blood vessels. They include coronary heart disease – a disease of the blood vessels supplying the heart muscle, cerebrovascular disease – a disease of the blood vessels supplying the brain, peripheral arterial disease – a disease of blood vessels supplying the arms and legs, rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria, congenital heart disease – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth, and deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Neither is cardiovascular disease caused solely by high blood cholesterol. In fact, cholesterol is needed and has a functional role in the body such as it helps build the structure of cell membranes that control what enters and leaves cells.

Cholesterol has its structural, hormonal, and metabolic functions such as it supports tissue repair, serves as a precursor for hormones such as oestrogen, testosterone, and adrenal hormones, and plays a critical role in synthesizing vitamin D

Cholesterol also helps produce bile acids, which in turn helps the body digest fat and absorb nutrients. It helps create bile in the liver as Dr Chopra explained

Cholesterol also helps the body's metabolism work efficiently.

 Low -density lipoproteins (LDLs) although always dubbed as the “bad cholesterol” too have its function in the body. LDLs are the primary carriers of cholesterol in blood because their main role is to deliver cholesterol to both peripheral and liver cells.

Low- and High-Density Cholesterol:

Let me explain a little bit more about Low-Density Lipoprotein (LDL) Cholesterol. 

LDL cholesterol is often termed "bad cholesterol" because high levels can lead to harmful health consequences. Some of the reasons are:

1.      Transport Function and Plaque Formation:

LDL's primary function is to transport cholesterol from the liver to tissues for cell membrane formation, hormone production, and other needs.

When there is excess LDL in the bloodstream, it can deposit cholesterol in the walls of arteries. This leads to the formation of atherosclerotic plaques, which narrow and harden the arteries (atherosclerosis).

2.      Inflammatory Response:

The cholesterol deposits trigger an immune response, leading to inflammation in the arterial walls. This exacerbates the damage and contributes to the progression of cardiovascular diseases.

3.      Oxidation of LDL:

Oxidized LDL is particularly harmful. It attracts white blood cells, which engulf the cholesterol to form foam cells. These cells accumulate and contribute to plaque formation, further increasing the risk of blockage.

Health Risks:

Elevated LDL levels are strongly associated with an increased risk of

1. Coronary artery disease (CAD) 

2. Heart attacks 

3. Strokes 

4. Peripheral artery disease

High-Density Lipoprotein (HDL) Cholesterol - The "Good" Cholesterol:

HDL is considered "good cholesterol" due to its protective effects on the cardiovascular system. Here are some of the reasons:

Reverse Cholesterol Transport:

HDL plays a crucial role in removing excess cholesterol from tissues and arterial walls. It transports this cholesterol back to the liver for processing and excretion via bile.

Anti-Inflammatory Properties:

HDL has anti-inflammatory effects, reducing the risk of inflammation in the arterial walls and protecting against atherosclerosis.

Antioxidant Effects:

HDL prevents the oxidation of LDL, reducing the formation of oxidized LDL, which is a major contributor to plaque development.

Cardiovascular Protection:

Higher levels of HDL are associated with a reduced risk of cardiovascular diseases because it helps maintain arterial health and prevents cholesterol build-up.

The Balance Between LDL and HDL:

The ratio of LDL to HDL is critical in assessing cardiovascular health here:

1.      High LDL and low HDL: Increased risk of plaque formation, heart disease, and strokes.

2. Low LDL and high HDL: Protective against these conditions.

Key Takeaways are:

1. LDL cholesterol becomes harmful when its levels are high, leading to cholesterol deposits, arterial damage, and cardiovascular disease.

2.HDL cholesterol is beneficial because it removes excess cholesterol from the bloodstream, has anti-inflammatory and antioxidant effects, and protects the arteries.

Plaque formation due to oxidative stress and free radical oxidizing LDL-cholesterol is taken up by macrophages and deposited in atheromatous plaques that develop into atherosclerotic lesions.

LDLs have apoB-100 as their sole protein constituent, which interacts with LDL receptors on target cell surfaces. The LDL-receptor complex is then taken up into the cell where LDLs are degraded, and cholesterol is released. This, in turn, regulates the amount of cholesterol produced by the cell. Cholesterol taken up by peripheral cells redistributes to various cell membranes and in this way, becomes involved in metabolic reactions.

Having explained the above, however, the longitudinal cohort Framingham Heart Study (FHS) that started in 1948 initially found that high cholesterol was a risk factor in cardiovascular disease. But later as the study continued longitudinally among the cohort population, it was shown that other factors are also the precipitating factors, not just high cholesterol. They include high blood pressure, unhealthy eating patterns, smoking, physical inactivity, or unhealthy weight. Researchers also know that these conditions can affect people differently depending on a patient’s sex or race. These findings are important because they are behavioural risk factors of heart disease and stroke.

Hence, we also need to consider behavioural patterns of individuals at risk such as unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Amongst environmental risk factors, air pollution is an important factor. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risk factors” can be measured in primary care facilities such as in any government or private health clinics in Malaysia. An elevated HDL-cholesterol level indicates an increased risk of heart attack, stroke, heart failure and other complications. Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. A variety of coloured fruits and vegetables not only are rich in a variety of antioxidants, but some of them are very salicylates or salicylic acid (aspirin) that thins the blood and lowers the risk of heart attacks.

Vegetables rich in salicylates include broccoli, cauliflower, cucumber, mushrooms, radishes, spinach, and zucchini. Vegetables from the nightshade family, like brinjals, and peppers, also contain salicylates. So are tomatoes, apples, grapes, oranges, avocado, berries, cherries, grapes, peaches and plums including most tropical fruits  that are very high in salicylates

Many herbs and spices contain salicylates. Examples of salicylate-rich spices include thyme, rosemary, curry powder, paprika (a spice made from dried and ground red peppers), chilli and garam masala.

Not only salicylates or aspirin is cardio-protective, but studies have shown that salicylates in curry powder colon cancer protective. 

In Malaysia, the Chinese have the highest incidence of colon cancer, followed by the Malays, lest are the Indians whose diet is mainly curries that contain a lot of salicylates.

Most cardiologists would prescribe low doses (100 mg) of aspirin as a prophylactic against heart disease. A standard tablet aspirin contains 300 mg of acetyl salicylic acid. 

 Health policies that create conducive environments for making healthy dietary choices affordable and available, as well as improving air quality and reducing pollution, are essential for motivating people to adopt and sustain are also important. 

 Unfortunately, doctors concentrate only on cholesterol, such that they rampantly continue to prescribe all these statin drugs to reduce blood cholesterol ignoring the patient lifestyle and other more important factors such as free radicals damage. There is over-reliance on statins and the pharmaceutical industry's influence

Despite the availability of high-quality research, there remains a concerning reliance on pharmaceutical materials provided by drug companies, which may inadvertently bias clinical decisions. Often doctors are highly influenced by the pharmaceutical companies to prescribe out-of-date remedies that have nothing to do with their patients’ disease, such as using statins rampantly given for high cholesterol whether or not their patients are at any risk of any cardiovascular disease.

It is concerning that some clinicians may overlook the wealth of knowledge available in peer-reviewed medical journals, potentially limiting the integration of the latest research into clinical practice. The root causes such as lifestyles are never addressed. Clinicians should revisit their approach through published research papers.

Research papers published in medical and scientific journals do not come cheap. Each study can cost anything between RM 100,000 in Malaysia to several hundreds of thousands or millions of US dollars in the United States or elsewhere and they take the combined efforts of multidisciplinary medical and scientific teams many, many years to study especially in longitudinal studies, lesser time in cross-sectional studies.

Maintaining a healthy balance involves lifestyle choices such as a balanced diet (rich in fruits, vegetables, and healthy fats), regular exercise, and avoiding smoking. If needed, medications like statins or other lipid-lowering drugs may be prescribed by healthcare professionals.

Instead, they are highly influenced by the pharmaceutical companies to prescribe out-of-date remedies that have nothing to do with their patients’ disease, such as using statins rampantly given for high cholesterol whether their patients are at any risk of any cardiovascular disease. The root causes such as lifestyles are never addressed.

References for further reading:

Saturday, December 16, 2023

Does Cholesterol cause coronary heart disease?

References on Cholesterol, LDL/HDL, CVD, and the Framingham Heart Study

Here’s an overview and suggested resources:

Cholesterol Functions and Types (LDL & HDL):

Cholesterol is essential for:

Cell membrane structure: It maintains fluidity and integrity.

Hormone production: Precursor for steroid hormones like oestrogen, testosterone, and cortisol.

Bile acids: Helps digest fats.

Vitamin D synthesis: Crucial for calcium metabolism.

LDL ("Bad" Cholesterol): Transports cholesterol to tissues. High levels can lead to plaque buildup in arteries, increasing the risk of cardiovascular disease (CVD).

HDL ("Good" Cholesterol): Removes excess cholesterol from tissues and arteries, transporting it back to the liver for excretion. Higher HDL levels are generally protective against CVD.

Framingham Heart Study:
This landmark study, begun in 1948, explored risk factors for CVD, identifying key contributors like high cholesterol, hypertension, smoking, and obesity.

Framingham Heart Study Website: 

https://www.framinghamheartstudy.org

Article: “LDL vs. HDL Cholesterol in Cardiovascular Risk” (PubMed: 10.1016/j.amjmed.2020.06.020)

NIH on Cholesterol:

 https://www.nhlbi.nih.gov