Rethinking Cholesterol

I’ve always had very low cholesterol, inherited I believe, though I’m not really sure from which side. I was first tested in 2006 when I was 29 and celebrated when I received the results. My total came in at a whopping 119 — 73 HDL (high-density lipoprotein) or “good” cholesterol, and 46 LDL (low-density lipoprotein) or “bad” cholesterol. Who wouldn’t celebrate that? My doctor praised my low numbers, saying I had nothing to worry about in that department. I wanted to brag to everybody I knew.

Ten years of number-boasting would pass before Drs. David Perlmutter, with his book, “Grain Brain,” and Dale Bredesen, and his book, “The End of Alzheimer’s,” would take the wind right out of my sails. If these two men are correct, then I — and it seems the American population in general — have been misled for a very long time when it comes to cholesterol. Both doctors claim, and offer plenty of scientific evidence to back up their claims, that cholesterol, including the “bad” LDL, is not the terrible monster most people believe. Well, at least LDL in its proper, healthy state isn’t bad. They say LDL is only bad once it becomes oxidized (more on the oxidation process very soon), which turns LDL particles small and dense, making them far more likely to build up on arterial walls. What causes this oxidation process? You guessed it, unhealthy diet – especially sugar/carb consumption – and environment, not enough or too much exercise and not enough sleep.

Bredesen says the mainstream method of testing cholesterol levels to determine cardiac risk is completely useless.

“The Hoola Hoop has a lot more to offer (it is, after all, an excellent way to exercise) than measuring cholesterol,” Bredesen writes in “The End of Alzheimer’s,” because many people with high numbers never experience cardiovascular issues while many others with normal cholesterol have “significant cardiovascular disease.” He then says that low rather than high cholesterol is associated with cognitive decline: “When total cholesterol falls below 150, you are more likely to suffer brain atrophy — shrinking.”

Well, crap.

Unspoiled, unoxidized cholesterol, the vast majority of which is produced by the body and not introduced through the foods we eat, is a key building block in all cell membranes and so is needed for healthy brain function, both Bredesen and Perlmutter say.

“The brain needs cholesterol to thrive,” Perlmutter writes in “Grain Brain.” “Cholesterol is a critical brain nutrient essential for the function of neurons… It acts as an antioxidant and a precursor to important brain-supporting elements like vitamin D, as well as the steroid-related hormones (e.g., sex hormones such as testosterone and estrogen). Most important, cholesterol is looked upon as an essential fuel for the neurons. Neurons themselves are unable to generate significant cholesterol; instead, they rely on delivery of cholesterol from the bloodstream via a specific carrier protein. Interestingly, this carrier protein, LDL, has been given the derogatory title of ‘bad’ cholesterol.”

So it turns out that LDL isn’t so bad after all. Go figure. Permutter says not only is LDL not bad, it also is actually not a cholesterol molecule at all.

“The fundamental role of LDL in the brain, again, is to capture life-giving cholesterol and transport it to the neuron, where it performs critically important functions,” he says.

A plethora of scientific literature is available proving that individuals with low cholesterol have brains that just don’t function as well as those with higher cholesterol and are at much higher risk for developing dementia and other neurological issues, Perlmutter says.

Again, crap.

So where does this leave me with my clearly too low cholesterol? What do I do now? The first step I took was in early 2017 to get my cholesterol tested again. I had read “Grain Brain” but not yet “The End of Alzheimer’s” at that time. Perlmutter does not elaborate on how to find out if your cholesterol has been oxidized. He instead provides a lifestyle plan to stop it from happening. My early 2017 test came back as 136 total — 71 HDL and 65 LDL. My total increased by 17 points with my LDL climbing 19 points and my HDL dropping two points. All in all I was happy with that; though I wish my HDL hadn’t dropped. Still, I believe I had made real progress in bringing that number closer to 150.

Nine months later, I read “The End of Alzheimer’s,” and Bredesen recommends specific tests to find out the level of oxidative stress happening in your body. Instead of just measuring total cholesterol broken down into only HDL and LDL, Bredesen says people should ask their doctor to test their oxidized LDL, small dense LDL or LDL particle number along with the inflammation marker test of high sensitivity C-reactive protein. From there, if numbers aren’t at optimal levels — and he says what those levels are in the book — they can be improved by following his lifestyle plan laid out in his ReCODE protocol.

I had already adopted Perlmutter’s recommended high-fat/protein, very low-carb diet plan before reading his book, and his plan closely mirrors Bredesen’s more in-depth Ketoflex12/3 diet. I believe this is the reason my cholesterol climbed – not because I was suddenly eating a high-cholesterol diet, but because I was creating a healthy environment in my body that encouraged its own healthy production of cholesterol. After all, Bredesen, Perlmutter and “The New Primal Blueprint” author Mark Sisson all stress that little to no correlation has been found between a high cholesterol diet and high cholesterol in the body.

I knew I was on the right track, but how was I to know whether or not my LDL was being oxidized at an unhealthy rate? I’d never heard of the tests Bredesen recommends, but I decided to ask about it at my next doctor’s appointment, which was this past July. She also had never heard of the tests or of the idea that LDL is only bad when oxidized. She basically said such tests were not available to me unless I went to some big city, where more options – and specialists – are available. I settled for the traditional cholesterol test along with the hs-CRP inflammation test, deciding I was already following Bredesen’s and Perlmutter’s recommended diets that prevent and reverse the oxidative process, and the inflammation test should give me a good idea of where I stand.

My results had me doing a happy dance once again. My total cholesterol climbed from 136 to 153 – 69 HDL and 76 LDL. I do wonder why my HDL has consistently dropped, but according to the goal ranges provided by my doctor, HDL shouldn’t be any higher than 60, so maybe its just normalizing. Either way, I’m not worried about it. I am thrilled that my cholesterol is now within optimal range for cognitive health.

Additionally, my hs-CRP test showed my inflammation levels were well below what Bredesen says is ideal for preventing Alzheimer’s – my level was 0.11 mg/dL and he recommends less than 0.9. And this was with a minor back injury that had occurred just a few days before my blood test, which may have elevated the number slightly. I plan to retest the hs-CRP at my next doctor’s appointment in a few months to see if I’ve been able to maintain such a low number and, of course, will continue to stay on top of my cholesterol. As for LDL oxidation, I think my diet and lifestyle are keeping it in check, as evidenced by my very low inflammation level. Perlmutter says oxidative stress is at the center of chronic inflammation, so I think that means I’m doing just fine. As far as I’m concerned, two more holes in Bredesen’s roof of 36 Alzheimer’s causes have been patched.

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