by
Robert W Ruess, MD Certified, American Board Thoracic and Cardiovascular Surgery Practitioner, Institute for Functional Medicine
As a Cardiac and Vascular Surgeon I have been dealing with heart disease [blockages in the arteries suppling blood to the heart] and vascular disease [the same process involving major arteries in the body] most of my professional life. What I have observed is that the general public, through no fault of their own, has a failed understanding of cholesterol and its role in the body’s elegant biochemistry.
Before we take a dive into these waters it is wise to put out some definitions so that all who read this are on the same page.
Atherosclerosis is the process of plaque development in the arteries which can build up and partially or totally block the involved vessel. When this blockage prevents oxygen from getting to the heart muscle, that muscle can be damaged or killed—this is known as a heart attack. This same process can occur in the brain or any other organ. Without oxygen reaching them, the cells will die.
Cholesterol is a type of fat [lipid] which indeed, can be found in arterial blockages. The body has many important uses for cholesterol. It needs to be distributed throughout our tissues. The problem is that the blood stream is water-based, and fats do not mix well with water. To solve this dilemma, the body provides us with a unique transportation system. It attaches a protein molecule to the cholesterol [fat], making a water soluble combination molecule that can easily be transported in the blood stream. These combination molecules are called lipoproteins and are what your doctor and others refer to as “cholesterol levels” in the body. These lipoprotein levels can be measured in a blood Lipid Panel and are referred to as Total cholesterol, LDL, HDL, and VLDL. VLDL is the lipoprotein that transports most of the triglycerides [another type of fat] in the blood stream. Triglycerides are also measured when your doctor orders a Lipid Panel.
The cholesterol myth began back in the 1950s when Ancel Keys published his “7 Countries Study”. This blockbuster epidemiologic study showed what appeared to be a clear correlation between Total Cholesterol and LDL [the “bad” cholesterol] and the incidence of heart disease. This concept was almost universally accepted by the medical community and subsequently the general population. This concept persists yet today. It is a myth.
The 1st crack in this theory is the realization that the Keys study, like ALL epidemiologic studies, shows association but not CAUSATION. The second problem with this study is that when his raw data was examined, several major concerns arose. It turns out that Keys studied 22 countries and not 7. The countries that he arbitrarily eliminated did not fit his hypothesis. He also studied several indigenous groups, such as native Eskimos, the Masai tribe, and the Kitavan Polynesians. He excluded them as outliers. Interestingly, they had very high LDLs and the Eskimos routinely had total cholesterols over 300, but had ZERO heart disease. This would have been quite difficult to explain had this data had been included in the study. It was not. Keys “cherry picked” his data.
Over the years there have been many studies to refute the concept that that LDL is truly a “bad” cholesterol. Almost all prospective interventional studies have shown no causative relationship between LDL/cholesterol and heart disease.
Its interesting to reflect that all during my medical school instruction and beyond, LDL and high cholesterol have been vilified as causative in atherosclerotic blockages. Never mentioned was the fact that LDL is the backbone of our immune system. Never emphasized was the fact that cholesterol composes about 25% of our brain tissue; or that cholesterol is critical to the structure of every cell wall in the body; or that the cholesterol molecule is the basis of almost every single hormone made in the body.
Think about this. If LDL is so bad, isn’t it ironic that Mother Nature has played a cruel trick on the human species. Over millions of years of evolution Mother Nature has developed a fat which is so important and critical to both human development and immunologic protection–only to have this same fat turn around and attack us as we age, causing heart and vascular disease. Does this make sense?
As a Functional Medicine practitioner, I do not concern myself or my patients about their cholesterol levels—unless they are too low or unless their LDLs are overloaded with dense particles. Instead the focus is on the real causes of arterial blockages. These, not usually addressed issues, are why heart disease has remained the #1 killer of older Americans for the last 50+ years.
Sid Lawrence says
I found it interesting that all the advertisements sidebar concern lowering ones cholesterol levels by eating! It takes guts to stand up to mainstream medicinal preaching in the manner you have chosen. Bravo Dr. Ruess.
Greg Ferra says
What are the real causes of arterial blockages if not cholesterol?
Terry Jacks says
Calcium, sugar, and inflammation.
Armin Sutterlin says
National and global epidemics of ego bloating, ignorance, dumbing down, belief entrapment, fake knowledge, destruction of blue planet, emotional stress, belief entrapment, Proverbs 16:18, Proverbs 13:24
David Zeleniak says
Thank you for the insightful article, Dr. Ruess. I especially appreciate your critique of studies where conclusions result from “cherry picked” data and/or association vs causation. As a side note, the often cited, decades old “China Study” comes to mind from the vegetarian community where data is excluded from non-vegetarian populations that are quite healthy as compared to vegetarian communities since the narrative doesn’t fit.
I always relied on cholesterol metrics as my measure of heart health, so your article piqued my interest. A few years back, I purposefully lost 70 lbs over a 9 month period or 30% of my body weight. At that time, my total cholesterol was 255, HDL at 45 & LDL at 170. Triglycerides were at 310, my resting heart rate was near 80 bpm & I was in terrible condition.
Following my 9 month weight loss, total cholesterol dropped 30%, HDL about the same, but LDL dropped almost 40% to 105. Triglycerides dropped by 60% to 125 & my resting heart rate dropped to below 60 bpm. I focused on moderate to vigorous aerobic exercise throughout the 9 month period. It seems obvious the changes in my blood metrics were causation, not association.
Pre-weight loss I was in terrible shape physically, mentally & emotionally. It was the blood test that showed me the high cholesterol levels that truly shocked me into action. I am, as are many, goal-oriented so having tangible targets truly saved my life. I’m not overly dramatic when I say it was life changing and those tangible targets are what I live by today.
Thank you for your article, Dr. Ruess. As I continue into my “Senior” years, I track many personal health metrics & your article has certainly provided me with other ways to evaluate my personal health. I’m glad to see you’re in Mesquite & you’ll be seeing me at some point in the future. – Thanks again. – Dave Z
Armin Sutterlin says
Dear Dr. Ruess,
Thank you for using Functional Medicine. My wellness journey is such a long personal story that might take a whole book to explain.
Over a period of many years I had a total accumulation of 60+ different symptoms of ill health. Some symptoms/conditions were chronic, while others came and went, or kept returning. Before beginning to turn my health around, my suffering reached the point that I thought I was going to die. And was hoping that it would be soon.
One day, during my “end time,” a stranger phoned me from out of the blue. During our 45 minute phone conversation a young, cheerful, girlish voice bluntly and briefly mentioned that I was poisoned. What I heard in her voice caused me to immediately believe her.
Later I learned that her entire family had been severely poisoned. Everyone was forced to be more or less house-bound to survive and while attempting to become healthier again. Functional Medicine was largely responsible in helping them recover a reasonable level of wellness.
Various aspects of Functional Medicine also helped me to recover the best of health.
Thank you, Doctor, for sharing your wisdom.
Armin Sutterlin says
Disclaimer: I am not a doctor or any kind of health practitioner; only an involuntary lab rat.
Lack of oxygen to the brain, including what’s left it, can also be caused by synthetic chemicals. One sign of many can be foggy thinking, like forgetting where you parked, leaving your credit/debit cards after paying, and other memory problems about things that you automatically and instinctively have done for years. Naturally, that statement excludes conditions of dementia, Alzheimer’s and many other health conditions, like PTSD, which unfortunately many combat veterans have suffered. May God bless them.