Advance Magazine for Physical Therapists and PT Assistants
Vol. 18 •Issue 5 • Page 62
Ranking ‘High Cholesterol’ – What if having high cholesterol really is not all that bad?
Two words that people don’t want to hear when they go in for a check-up are: “high cholesterol.”
It is “high cholesterol” that has been blamed for many health problems, including cardiovascular disease, diabetes and obesity. It is “high-cholesterol” foods that are to be avoided, and if one already has “high cholesterol,” it is cholesterol-lowering medications that are prescribed for this so-called problem.
“High cholesterol” has gotten a bad reputation over the past several decades. It has been portrayed by the media as some kind of villain that needs to be conquered—and many mainstream organizations still suggest that “high cholesterol” is a key underlying factor in many disease processes. However, what if “high cholesterol” really is not the evil monster it has been made out to be?
To better understand the concept of “high cholesterol,” a basic understanding of what cholesterol really is, where it comes from and what it is used for—it’s purpose—is needed. Simply put, cholesterol is a type of sterol (steroid alcohol) that is found within all cell membranes. In other words, cholesterol is a vital component of all tissues of the human body.
This fact alone should logically demonstrate that cholesterol cannot be as evil as it has been made out to be. In fact, cholesterol is one of the body’s best friends—the body cannot exist without it. After understanding this basic premise, is it any wonder why lowering cholesterol too much can cause health to significantly deteriorate—and even increase the risk of dying?
Besides acting as a form of cellular glue, cholesterol also serves as a precursor to all of the steroid hormones. The body cannot make pregnenolone, DHEA, estrogen, testosterone, cortisone and a host of other vital hormones without cholesterol.
Cholesterol is also imperative for the manufacturing of certain vitamins, such as vitamin D, as well as for the metabolism of fatty acids—even more proof that cholesterol may be more of a savior versus a scoundrel.
Let’s discuss where cholesterol comes from. Basically, cholesterol comes from two sources: the human body and from food that is put into the human body. The manufacturing of cholesterol within the human body occurs within the liver, and within the cells themselves—the cells will either make their own cholesterol internally, or use what the liver has already produced and sent to them via the bloodstream. The cholesterol that comes from dietary sources (food) is found within animal products, such as dairy, eggs and meat—there is no cholesterol found in non-animal products, such as fruits, vegetables, nuts, seeds or plant oils.
Of the two types of cholesterol, the cholesterol from food sources appears to play a minor role in determining total blood cholesterol level —although this type of cholesterol still receives most of the media attention.
Good’ and ‘Bad’ Cholesterol?
Simply put, there is just cholesterol, not “good cholesterol” or “bad cholesterol”—because both “types” of cholesterol are needed.
However, because the correlation of total cholesterol with heart disease—and with other diseases—was highly questionable, many years ago a stronger correlation was sought.
Consequently, the birth of so-called “good cholesterol” or HDL, and “bad cholesterol” or LDL, was conceived to better explain the link between cholesterol and poor health. HDL (“good cholesterol”) stands for high-density lipoprotein, and LDL (“bad cholesterol”) stands for low-density lipoprotein.
It is important to realize that both LDL and HDL are lipoproteins—fats that are combined with proteins.
Cholesterol needs to combine with fats and proteins to be carried through our watery bloodstream, since fat and our watery blood do not mix very well. However, LDL and HDL are forms of lipoproteins—they are not just forms of cholesterol.
LDL is often labeled as “bad cholesterol” because it is the type of protein that shuttles cholesterol from the liver toward the cells, and thus can increase blood cholesterol levels. HDL is often labeled as “good cholesterol” because it shuttles cholesterol from the blood back to the liver, and thus can decrease blood cholesterol levels.
However, if cholesterol is a life building substance, then why would any of it be bad? Why would the body shuttle an evil thing toward its cells, and/or back to its liver for recycling?
Why not just get rid of this ominous stuff?
The answer: Cholesterol is not a mistake in nature’s plan—but “good” and “bad” cholesterol may be erroneously accused for problems they do not totally cause.
There are many types of lipoproteins within the body. For example, LDL particles come in many sizes, and large LDL particles may not be as problematic as the smaller ones. The so-called “small dense LDL particles” are believed to be more of a problem because they can squeeze through the lining of the arteries, and if they oxidize—otherwise known as “turning rancid”—they can cause damage and lead to inflammation. Thus, you might say that there is “good LDL” and “bad LDL.”
There are different HDL particles as well—and some HDL particles may be considered better than others.
Therefore, knowing just the total cholesterol levels may not be that valuable—especially when the “normal range” that has been determined and accepted as true may really be inaccurate. Even knowing the LDL and HDL levels does not always tell the whole story. However, one thing is for sure—cholesterol, like other vital substances within the body, needs to be produced and regulated correctly in order for the body to work correctly.
What About Triglycerides?
Triglycerides are just another name for fat—and fat and cholesterol are not the same thing. Simply put, a person with “high triglycerides” has a lot of fat in his bloodstream. Triglycerides are generally measured when a person has fasted overnight. High fasting triglycerides are either from manufacturing too much fat, or using (burning) too little fat.
In other words, what “high triglycerides” indicates is that a person’s body is making too much fat, and/or the body is unable to burn fat correctly. This can become a major problem, as the inability to burn fat appears to underlie many chronic diseases, and may contribute to the rate of aging itself. Interestingly enough, if cholesterol levels are too low, the body’s ability to burn fat correctly will be impaired.
When Cholesterol Becomes a Problem
When cholesterol becomes “oxidized,” it can irritate—and eventually inflame—the tissues in which it is lodged, such as the lining of the arteries (a.k.a. the endothelium). If this inflammatory process is allowed to continue on a chronic basis, scar tissue forms; inside the arteries this is often called “plaque.”
Therefore, it would make more sense to avoid the factors that promote oxidation (rancidity) of cholesterol inside the body—as well as the consumption of oxidized cholesterol products—by living and eating in a more healthful manner, as opposed to trying to lower or rid the body of this important health building substance.
The continued fixation on cholesterol as a major cause of heart disease and other diseases may be a big mistake, as it defies many years of scientific research—and it appears to violate nature’s plan as well.
When there is excessive damage occurring in the body, especially on a chronic basis, it will be necessary for the body to distribute more cholesterol through the bloodstream to help repair this damage—which may give rise to “high cholesterol.”
Therefore, it would not seem very wise to merely lower cholesterol levels in the body, and forget about why it became “high” in the first place.
It would be smarter to reduce the extra need for the cholesterol by addressing the reason why the excessive damage was occurring—and thus help prevent “chronic inflammation”—which may be more of the real culprit in chronic disease.
The Role of Hormones
The body has its own way of regulating or “controlling” its cholesterol levels. One of these mechanisms is via its hormones—especially insulin, glucagon and leptin—which all appear to play an important role in the regulation of cholesterol. These hormones, when out of balance, are also largely involved with diseases, such as diabetes, cardiovascular disease and obesity—not a coincidence.
It would only make sense that Mother Nature equipped the body—when treated correctly—with a means to regulate its own metabolic processes, including managing its hormone and cholesterol levels, which are all part of the same regulatory pathway. Therefore, factors that cause a person’s hormones to become out of balance may also lead to cholesterol levels that are out of balance as well.
It appears that genetics does play a role in determining a person’s cholesterol levels. However, if cholesterol is not really the bad guy, and if total blood cholesterol is not the most important factor to be concerned with, then genes may be receiving erroneous blame for a person’s health problems—which are really being caused by other factors (e.g., poor diet, lifestyle). Genes, like cholesterol, are not evil, and they serve a useful purpose—and when functioning properly, just like cholesterol, they serve the body’s highest good.
As mentioned before, cholesterol is a beneficial agent used by the body to build and repair tissues—as well as to metabolize certain nutrients, and manufacture important hormones and vitamins needed to maintain optimal health and well-being.
So, how does cholesterol apply to rehabilitation? Simply put, proper rehab can’t exist without it. When the body undergoes an initial stage of healing, cholesterol may be in higher demand—giving rise to “high cholesterol”—to help repair cellular damage.
If this natural process is interfered with, via cholesterol lowering drugs or some other means, the healing processes of the body can be delayed. In other words, “high cholesterol” may actually be the treatment, as opposed to something that needs treatment.
Therapists should, therefore, be aware that patients taking cholesterol-lowering medications may have much slower rehab times. Although it is not within the scope of practice for physical therapists to tell patients whether they should or should not take a certain medication, they can educate patients about the potential side effects a certain medication can have—and how it may impact the rehabilitation process, as well as their overall health.
More studies are coming out showing just how unhealthy lowering cholesterol might be—particularly by the use of statin drugs. In particular, statin drugs have been shown to be harmful to muscles, including the heart muscle, by causing considerable damage. A common symptom of this damage is muscular aches and pains, including chest pains, which many patients experience while on these cholesterol-lowering drugs. Statin drugs have also been shown to cause nerve damage, impair memory and lead to other health problems as well.
One reason that statin drugs have these various serious side effects are that they work by inhibiting a vital enzyme that manufactures cholesterol in the liver. However, this same enzyme is used to manufacture coenzyme Q10, a biochemical needed to transfer energy from food to cells that is used for the work of staying healthy, as well as staying alive.
Keeping a Balance
It has never been conclusively shown that lowering cholesterol saves lives. In fact, several large studies have shown that lowering cholesterol into the range currently recommended may lead to an increased risk of dying, especially of cancer. Low cholesterol levels have been shown to worsen patients with congestive hear failure, lead to mood disorders, cause neurological problems and significantly impair health in other ways.
Therapists can encourage patients to review available literature and provide them with reliable resources, so that patients can become more educated, accountable and make conscious choices that will serve them best.
Therapists can, and should, make sensible dietary recommendations to their patients as well—ones that do not cause cholesterol levels to become way out of balance.
One final thought on “high cholesterol”: Therapists performing “high cholesterol” screenings should seriously consider what they are really screening for—a “symptom of a problem,” or a “symptom of a solution to a problem.” It could be that lowering cholesterol might not be as healthy as we are told. Cholesterol, like other vital substances within the body, needs to be produced and regulated correctly in order for the body to work correctly.
References are available at www.advanceweb.com/PT. Select “References” on the left menu bar.
Dr. Samuel A. Mielcarski is an expert in the field of rehabilitation. He has more than a decade of rehab experience and is currently licensed as a physical therapist in Georgia and Florida. He has also earned an advanced specialization in “performance enhancement” with the National Academy of Sports Medicine, and is a member of the American Physical Therapy Association (APTA).