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  • From: "Tradingpost" <tradingpost@lobo.net>
  • To: livingontheland@lists.ibiblio.org
  • Subject: [Livingontheland] Cholesterol: The Good, the Bad and the Truth
  • Date: Sat, 04 Jun 2011 10:48:25 -0600


Cholesterol: The Good, the Bad and the Truth
Dr. Dean Ornish Medical Editor, The Huffington Post, Founder and President of
Preventive Medicine Research Institute
http://www.huffingtonpost.com/dr-dean-ornish/cholesterol-the-good-the-_b_870655.html

A recent large government study found that raising levels of HDL "good"
cholesterol using a drug did not reduce the risk of heart disease.

As The New York Times reported:

Patients taking the medicine along with Zocor had higher levels of H.D.L.
and lower levels of triglycerides, a fat in the blood. Despite these seeming
improvements, the patients fared no better and may have done slightly worse
than those taking Zocor alone. That is why the entire theory behind trying to
increase H.D.L. levels in patients with heart disease may need rethinking.

Why?

Many people, including most physicians, believe that HDL is "good
cholesterol" and LDL is "bad cholesterol." Therefore, anything that raises
HDL cholesterol is good.

It's not so simple. Not everything that raises HDL is good, and not
everything that lowers it is bad.
Think of HDL like the garbage trucks of your body. Your body makes HDL to
remove excessive cholesterol from your blood and tissues, a process known as
"reverse cholesterol transport." HDL transports cholesterol back to your
liver where it is metabolized and removed from your body.

Most Americans eat a diet that's relatively high in saturated fat, animal
protein, and cholesterol--i.e., a lot of "garbage." Those people who have a
lot of garbage trucks--in other words, who have high HDL levels--are more
efficient at getting rid of extra fat and cholesterol in their diet.

Your body's ability to make more garbage trucks (raise your HDL) is, in part,
genetically determined. Some people can make more garbage trucks than others.
As a result, they have a lower risk of a heart attack or stroke than those
who eat a high-fat, high-cholesterol diet who have lower HDL levels.

However, the relationship of HDL to risk of heart disease and stroke assumes
that people are not changing their diet or drugs. This relationship was first
noticed in Framingham, a town outside of Boston in which most people ate a
high-fat, high-cholesterol diet. Those people who had higher HDL levels had
lower rates of heart disease than those with lower HDL levels. More garbage
trucks, less garbage left behind.

But things get very different when you try to raise HDL levels, whether by
diet or by drugs.

Not everything that raises HDL is good for you. For example, if you increase
the amount of saturated fat and cholesterol in your diet, you may increase
your HDL because your body is trying to get rid of the extra "garbage" (fat
and cholesterol) by increasing the number of available garbage trucks (HDL)
if you are genetically able to do so. Eating a stick of butter or having a
cheeseburger will raise HDL in those who are able to do so, but that does not
mean that butter and burgers are good for your heart. They aren't.

This is a source of confusion in studies of the Atkins diet, in which HDL
increases along with LDL, so the net cardiovascular effect is considered a
wash. However, a report in The New England Journal of Medicine made it clear
that itÂ’s important to look at arteries, not just risk factors. It reported
that in animal studies, in which the arteries can be directly viewed, an
Atkins-type diet increased coronary atherosclerosis (blockages) mediated via
mechanisms that are not related to traditional risk factors such as HDL and
LDL. Arteries were clogged on the high-fat, high-protein, low carbohydrate
diet but clean on the low-fat, moderate-protein, high-carbohydrate diet.

Niacin will raise your HDL, and so will another drug, torcetrapib. Last week,
government scientists announced that niacin not only did not provide any
protection against heart attacks when taken with a statin drug in patients
with heart disease but also slightly increased their risk of stroke. Five
years ago, researchers found that torcetrapib actually increased the risk of
a heart attack, so they had to stop the study and take the drug off the
market.

Both drugs raise HDL by interfering with reverse cholesterol transport,
causing HDL to build up. It's like having a traffic jam of garbage
trucks--more trucks, but they don't work as well.

Not everything that lowers HDL is bad for you. If you change from a high-fat,
high-cholesterol diet to a healthy low-fat, low-cholesterol diet, your HDL
levels may stay the same or even decrease temporarily because there is less
need for it. When you have less garbage, you need fewer garbage trucks to
remove it, so your body may make less HDL. Thus, a reduction in HDL on a
whole foods, low-fat plant-based diet is not harmful.

We know this is true because instead of just measuring risk factors like HDL,
we measured what actually happens to the progression of coronary heart
disease in people who went on diets that were very low in "garbage"--i.e.,
very low in cholesterol, saturated fat, total fat, and refined carbohydrates
and high in fruits, vegetables, whole grains, legumes, and soy products.

Their HDL levels came down by 9 percent after one year, but their LDL ("bad")
cholesterol levels came down even more, by an average of 40 percent. None of
these patients was taking cholesterol-lowering drugs.

Even though their HDL levels decreased, these patients showed reversal of
their heart disease using state-of-the-art measures such as quantitative
coronary arteriography, cardiac PET scans, thallium scans, and radionuclide
ventriculography in randomized controlled trials published in leading
peer-reviewed journals. On average, they showed even more reversal of their
heart disease after five years than after one year. Also, there were 2.5
times fewer cardiac events such as heart attacks, bypass surgery, and
angioplasty in these patients.

A low HDL in the context of a healthy low-fat diet has a very different
prognostic significance than a low HDL in someone eating a high-fat,
high-cholesterol diet. People living in countries such as Asia that consume a
low-fat diet have low HDL levels yet among the lowest rates of heart disease
in the world.

So, rather than being concerned about how to raise your HDL, eat a whole
foods, plant-based diet--and spend a few minutes a day exercising,
meditating, and loving more. Heart disease is completely
preventable--today--in at least 95 percent of people simply by changing our
diet and lifestyle. We don't need a new drug or breakthrough technology; we
simply need to put into practice what we already know.





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