A common scenario that plays out daily in Dr. offices around the country, and indeed, the world Is a typical discussion of one’s cholesterol levels at their annual check up. For a majority of folks they will be told that their cholesterol is high and the “bad” cholesterol,or LDL ,is also high. More often than not this results in a new prescription for a Statin. LDL or low density lipoprotein is what causes heart attacks by forming atherosclerotic plaques in your arteries, and it must be lowered, hence the Statin.
The belief that LDL causes Heart disease is based on the discovery of small, dense LDL particles that are highly oxidized found within specialized white blood cells called macrophages that are found in large numbers within atherosclerotic plaques.
If LDL is the direct cause of heart disease we would expect to see a linear relationship between the number of cardiac events and LDL levels. As LDL levels rise, so do the cardiac events. However, in reality, the number of cardiac events is normally distributed in a bell curve fashion, which is skewed to the left.1/3 of all heart attacks occurs in individuals with low or normal LDL levels.Equally interesting is the finding that individuals with high LDL, 190 or greater have extremely low incidences of heart attack.
The LDL Characterization as villain has come under increasing skepticism within certain circles. The question arose when it was noticed that in individuals who adhere to a low carbohydrate/ketogenic diet, there was improvement in all inflammatory markers of the blood but the LDL increased significantly. How is it that the body, when it is allowed to heal and regain balance, overproduces in abundance, a substance that will cause a heart attack and possibly early death?
An alternate hypothesis poses that the cause of plaque formation begins with an underlying chronic inflammatory state caused predominantly by hyperinsulinemia and hypertriglyceridemia. These are in turn caused by the standard American diet SAD, which favors low fat and high carbohydrate consumption.
Back to that discussion with your doctor about your cholesterol. What should be discussed is the importance of the ratio between your HDL and your triglycerides. A lipid profile where HDL is low and triglycerides are high will likely have a high LDL, but critically it will be a large quantity of small, dense, oxidized damaged LDL. Low HDL, and high triglycerides is a hallmark of metabolic syndrome. Conversely, high HDL, and low triglycerides is ideal and the LDL in this case will be predominantly of the healthy large particle (referred to as Buoyant) type. In this case, the higher the number of LDL, the better.
Dr. David diamond, a research scientist at the University of South Florida, In 2022 published a study showing that statin therapy is not warranted for a person with high LDL cholesterol on a low carbohydrate diet (https://pubmed.ncbi.nlm.nih.gov/35938780/). The study found the benefits of the low carb diet to be a decrease in weight/BMI, decreased inflammation, decreased small, dense, LDL particles number, decreased triglycerides, decreased lipoprotein a, decreased blood pressure, decreased blood glucose, decreased insulin, decreased hemoglobin A1c, decreased PAI – 1 (Plasminogen, activator inhibitor – 1),and an increase in HDL and large Buoyant, LDL. So an improvement of numerous biomarkers that are strongly (causally) associated with coronary heart disease and apparent reversal of metabolic syndrome, all at the cost of raising LDL. a pretty good trade off if you ask me.
LDL, beyond its function as a carrier for cholesterol, is an active participant in the immune system, targeting cancer cells, viruses, and bacteria.It also plays a role as an anti-inflammatory agent.The protein coat of LDL is peppered with vitamin E, and it serves as a powerful antioxidant. What likely happened prior to becoming oxidized and then consumed by the macrophage, the LDL went to the Inflammatory site within the arterial wall to work to repair the damage, only to become permanently damaged itself. It is for this reason Cardiologist Dr. Nadir Ali states LDL should be viewed as the injured fireman, not the arsonist.
Finally, back at the office, when your doctor prescribed that statin did he also mention there was a 6% chance that you’ll develop diabetes directly as a result of the medication? Or the numerous other serious side effects, such as lower testosterone levels and erectile dysfunction in males, impaired cognition In general, and worsening cognitive decline in those with dementia and Alzheimer’s Disease, decreased bone density, an increased risk of certain cancers, renal disease, and liver disease with long-term use?
Bottom line is simply get off the carbs, get off the statin and leave your hard-working, multifunctional and essential, LDL cholesterol alone. You’ll live a longer and healthier life.
