Understanding Cholesterol and Cardiovascular Disease (Will Eating Eggs Cause a Heart Attack?) – Nutrition Crash Course Part 5 of 7
This is Part 5 of a 7 Part Nutrition Series. You can find the other parts here:
- Part 1: https://grahamtuttle.com/2021/02/the-big-3
- Part 2: https://grahamtuttle.com/2021/02/nutrition-101
- Part 3: https://grahamtuttle.com/2021/03/fats
- Part 4: https://grahamtuttle.com/2021/03/carbs
- Part 5: https://grahamtuttle.com/2021/05/cholesterol
- Part 6: https://grahamtuttle.com/2021/07/gut-health
- Part 7: https://grahamtuttle.com/2021/07/what-to-eat
Now that we’ve briefly covered carbohydrates and fats in relation to health, weight gain, and insulin resistance, let’s turn towards the topic of cholesterol and cardiovascular disease. This will wax a bit philosophically at the beginning (as I am prone to do) before getting into the weeds about physiological function and then I’ll wrap up with some tangible applications for you!
Put simply, cardiovascular disease refers to conditions that impact the heart and blood vessels. This generally happens when the blood vessels lose their elasticity and become occluded from the buildup of plaques. These plaques form when the inner lining of the blood vessels (called the endothelial glycocalyx) becomes damaged, resulting in the “scab” formation of calcium, cholesterol, and other substances found in the blood.
In the past LDL cholesterol and saturated fat have been blamed for this, but this is short sighted. While these substances do get pulled into plaque formation, they are not the cause. Cholesterol functions as a band aid that attempts to heal the injury to the arteries, LDL is simply the transport molecule that brings cholesterol to the site. This is like blaming ambulances for causing car crashes. Just because they show up at the scene does not make them the culprit. Additionally, if LDL and saturated fat were the cause, you would expect to see plaque formation in the veins, which does not happen. Mechanistically this does not make sense.
But I understand that this runs counter to the narrative you’ve heard most of your life (and that is still perpetuated today) that LDL cholesterol, the “bad” cholesterol, causes heart disease via plaque formation. To pick at this a bit, I always find it helpful to step back and think from first principles.
We can step back to think about the first law of thermodynamics which states that energy is neither created nor destroyed, only transferred. In nature, in order for energy to be transferred into creation, there needs to be a stimulus, or exploitable advantage to make it worthwhile. We can apply that to the body to find that every structure or function is there for a reason. Life requires energy. That’s quite literally what differentiates things that are alive from those that are not. Life uses energy for sustained homeostasis and development.
For instance, people don’t just put on muscle for no reason. While it would be nice, muscle is an adaptation to environmental stressors and gravity. And since that muscle requires continual energy to maintain, the body doesn’t hold onto it if the triggering stimulus is absent for long enough.
We can look at any observed outcome or situation as the response to something – a problem, an evolutionary advantage, or a remnant of a solution (i.e. vestigial structures). Evolution and life are guided by an intelligence that selects for survival. There is a reason you don’t see sick animals in the wild. Nature is perpetually at its best, healthiest, and strongest. If you were born with a subpar set of genetics or physical capacities, the predators will take care of you quickly.
And since everything requires energy, anything that is useful enough to be passed across multiple generations has some crucial value. Put another way, in nature, everything happens for a reason. Accidents and genetic polymorphisms do occur, but they only last the test of time if they are useful.
With this perspective we can ask the question of “why”?
If you ask most doctors or peer into the literature from the last 60 years, you’d get the idea that LDL is a horrible thing and the healthiest level you can have in your blood is zero. LDL cholesterol is blamed for causing heart disease, initiating atherosclerotic plaques, and high blood pressure. After decades of information that pushes this LDL receptor hypothesis, people have become terrified of it. All you need is one blood test showing higher than expected numbers and you’ll be advised to start taking a statin.
But this fear mongering misses the basic question of why this substance is present in the first place…
I’ll give you a little test to show how poorly these first principles have been followed when it comes to our understanding of cholesterol and human function… Tell me one positive function that LDL cholesterol provides for the body? I’ll wait.
My guess is that you can’t. Not because you’re dumb, but because this is literally never mentioned. In all the paranoia about removing animal products, saturated fats, and cholesterol from the diet, the fact that LDL cholesterol actually binds to and eliminated pathogens in the blood is completely missed. That’s right, LDL is key in supporting a healthy immune system. More to this, as we age, individuals with higher cholesterol levels have a lower all cause morality rate than those with low cholesterol levels.
So this knee jerk reaction to avoid “high” cholesterol is not only unfounded based on first principle thinking, but is also contributing to lowered health and increased fragility as we age.
But where does this narrative come from? Scientists and doctors aren’t dumb, after all! The issue is that the answer is not a black and white thing… Metabolic dysfunction and disease are rarely attributable to just one cause. And in this situation, disordered cholesterol and lipid profiles are definitely part of the equation, but as symptoms – not root causes.
Of course, it’s easy to blame pharmaceutical companies for swooping in with the quick solution in a pill, but that overlooks the fact that this was done in response to a problem. No one buys a solution to a problem that doesn’t exist, or at least that they don’t know exists. These companies reacted to the new epidemic of obesity, cardiovascular problems, and preventable metabolic disease.
For the first time in human existence, artificial food was plentiful, work was sedentary, and natural selection had been conquered through modern medicine. As a result, the evolutionary processes we evolved with over millions of years were thrown out of alignment. We were becoming fatter, less physically active, and less healthy. All of a sudden, the new killer epidemic was no longer infectious disease but rather an array of entirely preventable health conditions.
Under the microscopic lens of modern science, we made the mistake of becoming myopic in our approach. Ignoring the fact that the overly sanitized, suburbanized, and artificially colored world we lived in no longer matched that which our bodies developed in, we began to pick apart the molecules and markers in our blood that correlated to these unhealthy states. Over time we began to form a picture for what was happening.
When people were getting sick, their insulin response wasn’t working well, their blood lipid numbers were out of sync, they had higher blood pressure, lowered androgens, worse fertility, altered thyroid function, greater toxin exposures, elevated stress hormones, poor nutrient levels, and broad symptoms of inflammation in the gut, brain, and organs. Over the years doctors and researchers compiled these notes into a profile of what best demonstrated health compared to what signaled dysfunction.
It’s important to note that this is an amazing process. Over the decades, we’ve built an incredible base of knowledge and can address these issues at earlier and earlier stages. But I do want to point out that there are two fatal flaws that we’ve constantly fallen into over this time that have contributed to poor medical treatments and the current health crisis we are in.
First, when the study of disease is divorced from the first principle thinking of an evolutionary narrative (the “why” we talked about earlier), we aren’t able to figure out the root cause of the issue. Essentially, we compile libraries full of knowledge about a disease/syndrome without actually effectively addressing what to do about it. Put another way, we start managing the symptoms and trying to change the numbers instead of going back to solve the contributing factors that resulted in those symptoms.
Second, we rush too quickly to claiming the definitive answer – we think we’ve got it before we actually do. Every generation suffers from the same delusion of thinking their predecessors were idiots that have everything wrong. Need some evidence? Humanity has moved through periods of thought that the earth was flat, that witches float, and that cigarettes were healthy. We chronically rush to a judgement based on the “latest” science – even more so when the findings are controversial.
To be fair, this is propagated by the media’s desire for clickbait worthy headlines and oversimplified narratives in addition to the funding problem leading scientists to study and publish findings that will appeal to journals. If you’ve read any scientific writing in research papers or articles, you’ll notice a lot of uncertain words like correlated, association, and needs more study. The general public’s short attention span likes definitive words like cause, cure, and settled. Sadly, the money flows where attention leads, meaning that the journalists who report on these issues are incentivized to massage these narratives to fit what they think the lay person thinks and wants to read.
In terms of cholesterol and saturated fat recommendations, the emotional reaction to Ancel Key’s 7 Countries Study around 1960 was quick. The call to eliminate saturated fats, animal foods, and anything remotely close to cholesterol happened rapidly. Over the next 50 years we had the same story drilled into our heads from every “expert” source that eating animal food was the fast track to a heart attack. To put that into perspective, a “healthy” total cholesterol was thought to be around 300 in the 50’s. Today some doctors want that number at less than a third of that.
The halfhearted retreat from this absurd recommendation includes concessions that some cholesterol is good, like HDL, and that saturated fat is healthy (as long as it’s from plant sources!) To put this into perspective, the United States is one of the last major countries to remove a limit on cholesterol in the dietary guidelines. The paranoia crested and is finally turning back toward rationality. But the fact remains that many in the medical community do not want to retract their long-held beliefs and continue to advise people to take statins and avoid foods high in saturated fat and cholesterol.
So where does that leave you in regard to understanding your cholesterol? Of course, it’s an individual metric, but the major thing you can walk away from this knowing is that saturated fat and cholesterol are not the enemy. They are requisite components of a healthy diet and optimal function. Your body tightly regulates the amount of cholesterol that is absorbed from digestion, that is created by the liver, that is excreted, and that is present in the blood. If your numbers are floating higher and you don’t have one of the main four risk factors for disease (obesity, sedentary lifestyle, excess alcohol consumption, and/or smoking) then you’re fine.
The typical disclaimer: I’m not a doctor so the onus is always on you to do your own research. My goal is to help you understand that we have massively messed up in this area. I will even go so far as to claim that many of the terminal neurological and metabolic diseases we are facing currently are in direct result to the replacing of animal foods, fats, and cholesterol with processed carbs, vegetable/seed oils, and grains in our diet. I’ll put it this way – we’ve followed the recommendations and our collective health has only gotten worse. How much more before we rethink the guidelines we are pushing?
Now, all of that preamble into how we’ve arrived here is fine, but it still leaves open the question of if not cholesterol and saturated fat, then what actually causes cardiovascular disease?
To start, we need to look at the mechanism that causes heart attacks, strokes, high blood pressure, and atherosclerosis. All of these diseases fall under the umbrella of cardiovascular disease, each with a unique set of symptoms. Ultimately, they all originate from the same problem – hardening arteries that lose pliability and function due to plaque formation over time. The location, severity, and onset of the plaque formation defines what type of particular disease you suffer from. To name a few of the most common examples:
- Coronary Artery Disease – Damage or disease in the major blood vessels.
- High Blood Pressure – Excessive force of the blood against the arterial walls.
- Cardiac Arrest (Heart Attack) – Sudden loss of heart function, breathing, and consciousness.
- Congestive Heart Failure – Chronic condition where the heart pumps blood ineffectively.
- Peripheral Artery Disease – Narrowed blood vessels limiting circulation to the limbs.
- Strokes – interruption of the blood flow to the brain, causing severe damage.
- Thrombi and Embolisms – Clots that block vessels, limiting or stopping circulation.
What do all of these have in common? They are the result of an interference with the normal blood circulation system. Essentially, any blockage, vessel pliability change, or disruption in the normal resistance of the circulatory system leads to severe problems. And as we discussed earlier, the arterial hardening, plaque formation, and narrowing of the vessels is happening for a reason – the body is responding to damage to the arterial lining, called the endothelium. Remember, LDL is the firefighter coming to the rescue, not the arsonist. The plaque formation and arterial narrowing is the band aid.
Instead of trying to fight the symptoms of these problems, if we really want to understand how to prevent cardiovascular disease the question to ask is what is causing damage to the endothelial lining in the first place?
Thankfully, this is something we know. Arterial lining injury happens in two ways:
- Environmental toxins or other stressors like smoking, high blood pressure, waste build up, or sickle cell anemia, actively cause damage to the cells that line the arteries.
- The repair mechanisms, mainly Nitric Oxide production, are interrupted
Essentially, something is either injuring the endothelium or something is preventing the healing process. In the worst situations, the irritant is also suppressing the healing mechanisms as is the case in free radical production from smoking, toxin exposure, and oxidized cooking oils.
Wait a minute… what are free radicals? If you’ll excuse a small excursion into chemistry here, free radicals are the result of unstable molecules that have lost an electron. The uneven number of electrons allows them to react easily with other molecules causing large chain chemical reactions. In the body, the most notable examples involve oxygen and are in the family of the Reactive Oxygen Species.
Now, if you’ve followed along through the earlier parts of this series, you’ll remember that I praised Reactive Oxygen Species for their valuable role in signaling satiety and preventing insulin sensitive adipose tissue. If they are so valuable, why are they causing endothelial damage? If they are damaging the blood vessels, wouldn’t you want to avoid anything that increases them?
That’s the mainstream philosophy – anything that causes free radical production is bad. But as we discussed earlier in this section, nothing happens in nature without a meaningful and worthwhile cause. Since Reactive Oxygen Species are produced naturally in the body, we can assume that there is a reason. In this case, free radicals (like ROS) are used as part of the immune system to fight pathogens, tumors, and prevent infections. Additionally, they are a vital part of the signaling pathways in the body.
One such signal is Nitric Oxide (a free radical) that triggers vasodilation, endothelial healing, prevention of thrombosis, and normal neural activity.
So what does this mean? Well, to start, it’s too reductionist to say that all free radicals are bad. If they were, the body wouldn’t make them. They serve a valuable role in the body. The problem comes when this natural production is overloaded by our environment and bad decisions. Smoking, toxin/heavy metal exposure, reheated cooking oils, fried foods, radiation, drugs, pesticides, and pollution are all exogenous sources of stress that cause free radicals.
The big difference here is that some sources of free radical production are naturally occurring in the body like mitochondrial metabolism (that makes the ROS we spoke about in part 4 and 5), inflammatory processes that fight infection and pathogens through phagocytosis and peroxisomes, exercise, heat, cold, and sunlight exposure.
While all of these are considered oxidative stressors, there is a big distinction between those your body expects, produces, and can handle, and those that cause an overload of damage to the body.
You might have heard the term “Antioxidants” before. This refers to substances that inhibit oxidation (the loss of an electron) by giving the unstable atom an electron. Essentially, they plug the hole that’s causing the highly reactive molecule. These occur naturally from responses to environmental stressors like heat, cold, sunlight, and exercise, and from food sources such as the polyphenols that occur in some plants. There is a lot of marketing for these that promises everything from cancer reduction to anti-aging treatments. The research on artificially created antioxidants is not promising.
As with everything, there is a balance. Too many antioxidants impair the body’s natural free radical production levels and increases the risk of cancer. Remember, free radicals are part of your body’s immune system! This is why I’m not an advocate of supplementing with antioxidants ad nauseum through plant polyphenol sources.
Think of it this way – if you’re living in the world and participating in the natural activities of life, evolutionarily speaking, you would be exposed to the natural stressors that trigger glutathione production (the most powerful antioxidant in our body) like exercising, eating nutrient dense animal foods, sun exposure, heat, and cold. You also wouldn’t be throwing off this system with undue chronic stress, alcohol consumption, poor sleep, and sedentary lifestyles.
Essentially, your body would be handling these free radicals with ease. But when we remove these natural pathways, add in highly oxidized vegetable/seed oils, smoke, stress out, drink alcohol, and live in a perpetually air-conditioned world of 72 degrees, we miss this benefit.
So, does that mean you should start eating a bunch of antioxidant rich fruits and vegetables? While they can help, ironically, these foods trigger glutathione production as a defense mechanism in response to the polyphenols. Essentially, these substances are actually plant toxins meant to dissuade animals from eating them. In the same way that alcohol is processed as a toxin, these substances trigger a hormetic stress response (a small damage that leads to a positive response from the body getting stronger, like exercise).
I’ll break this down further in part 6, but to answer the question that just popped up – yes, there is a spectrum of toxicity where some plants are more harmful to us than others. Yes, we’ve evolved to tolerate several vegetables. And no, I’m not saying that all plant foods are bad, just that the beneficial response to these is not exactly what most people think and that you can overdo it!
There is undoubtedly some benefit from these, but not more than the result of naturally occurring environmental oxidative stresses you should be experiencing. Let me put it this way – fruits are seasonal, exercise/sun/temperature extremes are year-round. Use these antioxidant foods as a supplement when in season, but don’t fall down the rabbit hole of overdoing it with excessive intake.
But let’s pull back to the main goal of this article. How do free radicals impact cardiovascular disease?
Simply put, these reactive molecules, when present in excess outside of the body’s normal production, cause large chain reactions that damage organs, tissues, and interfere with normal function. In the case of blood vessels, these irritate the endothelium, which trigger an inflammatory and healing response. This signals for LDL particles to deposit cholesterol to the damaged areas, leading to plaque buildup. Normally, this resolves as the arteries heal, and the plaques reduce, and life goes on. But in the case of prolonged exposure to these free radicals, the damage outpaces the healing capacity, causing overly permeable blood cells that lead to infection and disease.
Normally, in response to damage or higher areas of pressure, Nitric Oxide (NO) signals for endothelial support by preventing clotting, dilating the vessels, initiating cell growth. Anything that inhibits Nitric Oxide signaling or synthesis impairs this process. To put the importance of NO into perspective, Drugs that stop NO from being produced in the endothelium are used to kill cancerous tumors. While that’s good for cancer treatments, when our NO production is inhibited, we experience cardiovascular disease.
So, what inhibits Nitric Oxide Production? The same list of offenders that cause free radical production… Smoking, heavy metal exposure, environmental toxins, elevated blood glucose levels, widespread inflammation (from stress, infection, or inflammatory foods), and prolonged high blood pressure. You starting to notice a theme here?
One other factor that’s important to note is that hypertension (high blood pressure) exacerbates the whole problem. Anything that’s putting extra pressure on the system as a whole is accelerating the onset of disease by impeding recovery and pumping the irritants through the cardiovascular system faster and with more force. If you keep the big picture in mind, we’re not talking about one off events. Cardiovascular disease is the result of repeat incident over a long period of time. It’s a battle of deterioration of your body’s health against the increasing tide of toxins and inflammation brought on by poor lifestyle and dietary choices. Eventually, the body can’t keep up.
To better understand how this works, let’s look at some of the causes of high blood pressure:
- Obstructive Sleep Apnea – Poor sleeping patterns that over activate the sympathetic nervous system by triggering an adrenal response and prevent REM sleep. This adrenal response (adrenaline) constricts blood vessels and speeds up the heart rate.
- Kidney Disease/Dysfunction – If the kidneys aren’t filtering blood well, the volume of blood stays high and the toxic wastes aren’t removed, causing irritation to the endothelium.
- Chronic Stress, Adrenal Tumors, and Adrenal dysfunction -This leads to stress hormone overproduction and an overly psychologically aroused state.
- Hypothyroid Dysfunction – Lowering heart contractility and ventricular filling leads to lowered Nitric Oxide production and damage to endothelial cells causing plaque formation and increased stiffness. The lowered immune function can’t stop the inflammation.
- Hyperthyroid dysfunction – The increasing heart contractility and ventricular filling caused by higher blood volume from increased renin-angiotensin-aldosterone release leads to excessive arterial compliance and vasodilation. The decreased resistance causes arterial stiffness.
- Inactivity, Stress, Alcohol, Smoking, Medications, and Drugs that interfere with normal nervous system function and hormone release.
- Obesity – More blood vessels mean more blood which stresses the main arteries.
Notice how each of these isn’t intrinsically linked to cardiovascular function, yet in the absence of good health, the cardiovascular system is what suffers. Essentially, your blood vessels bear the brunt of your bad decisions. While it’s not realistic to blame any one factor as the “cause” of cardiovascular disease, it should be apparent by now that the whole system flows together.
So, what can you do about it?
To start, eat real food. If it wasn’t around 100 years ago, there is a good chance it’s not the best for your body. Real food means animal foods, fruits, and vegetables. I’ll break this down further in part 7. But if you just start by getting the worst offenders out of your diet (corn, soy, wheat, vegetable/seed oils, and processed/refined sugars) you’re going to be well on your way. Cholesterol and saturated fats are the caloric basis of the foods we evolved eating (meats, organs, and animal products). You ABSOLUTELY need them in your diet for optimal health and nutrition.
Improve your lifestyle. Get outside in the sunlight and breathe fresh air. Exercise, sweat, and take some cold showers. These are all essential for stimulating your body to produce the natural antioxidants that clean up the waste systems in your body. Also, these are physical solutions to the stresses you face. Your body wasn’t designed to deal with chronic psychological stresses year-round. Positive lifestyle choices help you to manage stress effectively.
Get rid of the toxins in your life. This should go without saying but STOP SMOKING. Cut out toxic people. Move out of congested and polluted areas, if possible. Limit alcohol consumption. Don’t use plastics to eat out of or heat food up in. Get fresh water that doesn’t have heavy metals. Don’t eat foods fried in reheated vegetable/seed oils that are most certainly heavily oxidized. Avoid bright lights at night that impair your sleep… The list could go on.
But what if your cholesterol numbers are high? Should you be worried? High LDL in and of itself is not a problem. High LDL in the presence of a high fat diet is expected – your liver doesn’t need to pull LDL out of the blood system to produce more cholesterol, so the LDL levels float a bit higher while VLDL, triglycerides, and blood glucose levels are low.
Alternatively, High LDL as a symptom of underlying inflammation along with poor lifestyle choices and a bad diet is a problem. Remember the unholy triad (sedentary lifestyle, high Omega 6 fatty acid intake, and excess processed/refined carbs)? This is the foundation of all metabolic disease and results in high triglyceride levels, high VLDL cholesterol levels (used to transport those triglycerides), and visceral fat gain.
The reality is that you can’t simply use the LDL particle count as your only metric for health. This has been the oversimplification of the last 70 years in our medical system and has led to over prescription of statins and fearmongering about animal foods, saturated fats, and cholesterol. LDL is not the enemy! So when you get your blood work back, if your LDL is high but other markers are normal/low (like VLDL, HR-CRP, Homocysteine, Fasting Insulin, and Triglycerides) you are doing just fine.
To summarize this whole article, the key takeaway is that health is the result of several systems working together. Becoming obsessed over the symptoms of illness is missing the point. While it’s helpful to understand the mechanisms, it’s much more effective to control the inputs of diet, lifestyle choices, and exercise that allow your body to function optimally.
Remember, our bodies evolved to function just fine in nature over millions of years. “Better living through science” is a recent invention and not always an improvement.
Read part 6 here, all about gut health and inflammation!
