How LDL Cholesterol Becomes Atherosclerotic Plaque

Here’s an interesting article about how high levels of LDL cholesterol end up causing atherosclerosis.

The body uses cholesterol for various purposes, and it has a system for transporting cholesterol in the bloodstream. Like fat, cholesterol doesn’t dissolve in water. To transport fat and cholesterol via the bloodstream, the body puts them in packages called lipoproteins. As the name suggests, a lipoprotein contains fatty substances (lipids) as well as some protein.

Not only do fatty substances like cholesterol fail to dissolve in water, they float on top of it. That’s because they are less dense than water. They are also less dense than protein. The lipoprotein particles that are largest and contain the most fat also have the lowest density. The “bad” cholesterol that people talk about is low-density lipoprotein (LDL). These are lipoprotein particles that carry fat and cholesterol from the liver to the rest of the body. LDL is like a wheelbarrow full of fat and cholesterol traveling from the liver to the rest of the body. In contrast, high-density lipoprotein (HDL) picks up the cholesterol from the tissues and carries it back to the liver. HDL is like a mostly empty wheelbarrow picking up fat and cholesterol and taking it back to the liver.

The article explains that cholesterol is always entering and leaving the intimal layer of the arterial wall. The cholesterol is brought in by LDL and is taken away by HDL. If the cholesterol is brought in faster than it leaves, it builds up to form a deposit called an atheroma. The more LDL there is in the bloodstream, the faster the LDL particles enter the wall of the arteries. The cholesterol is likely to build up into an atheroma if there isn’t enough HDL to carry the cholesterol back out fast enough or if the LDL undergoes some chemical change within the wall of the artery before it can be removed. Here’s an article that explains the kinds of chemical changes that can occur to the LDL while its inside the arterial wall.

Why does cholesterol build up in the intima of the arterial wall but not in other kinds of tissue? It’s because the concentration of LDL is far higher in the arterial intima than in any other tissue. The probable reason for this high LDL concentration is the fact that the arterial intima is not drained by lymph vessels. LDL particles are small enough to leak through the gaps between the endothelial cells that pave the inner surface of the artery. Then, they can diffuse throughout the loose structure of the arterial intima. However, they are too big to leak through the pores in the carbohydrate-and-protein meshwork of the medial layer. Thus, they cannot make their way through to the lymphatic system, which is highly efficient at carrying lipoproteins back to the bloodstream.
Photo by Oregon State University


Humans Are Starch Eaters









How Low Should Your Cholesterol Levels Be?






He Should Have Won the Nobel Prize!

In 1913, a Russian pathologist named Nikolai Anitschkow figured out the cause of atherosclerosis, which is the underlying cause of nearly all heart attacks and most strokes. He even published his findings in the major international medical journals of his day. He should have won the Nobel Prize. If people had recognized the importance of his work, millions of premature deaths could have been avoided.

By the late 19th century, pathologists knew that people who had died of heart attacks and strokes tended to have a lot of softy, fatty material stuck to the inner walls of their arteries. This material eventually hardens with the buildup of scar tissue and calcium deposits. The presence of this material is called atherosclerosis, which means hardening of the arteries. The material itself is called plaque.

In its early stages, atherosclerotic plaque looks and feels like cheesecake. In 1910, a German chemist named Adolf Windaus showed that like real cheesecake, atherosclerotic plaque is rich in cholesterol. Because of his work on the chemistry of sterols, Windaus won the Nobel Prize in chemistry in 1928.

As soon as Windaus published his findings about the cholesterol in plaque, Nikolai Anitschkow started an important series of experiments at the Military Medical Academy in St. Petersburg. Anitschkow dissolved some purified cholesterol in sunflower oil and fed it to some rabbits. Control rabbits got some sunflower oil without added cholesterol. The rabbits that got cholesterol in their sunflower oil got atherosclerotic plaque, but the control rabbits did not. To the naked eye and under a microscope, the plaque from rabbit arteries looked a lot like the plaque from human arteries.

Anitschkow and his coworkers discovered a lot of important things about atherosclerosis in those early experiments. As cholesterol researcher Jon Gofman argued,

If the full significance of his findings had been appreciated at the time, we might have saved more than 30 years in the long struggle to settle the ‘cholesterol controversy’ and Anitschkow might have won a Nobel Prize. Instead, his findings were largely rejected or at least not followed up. Serious research on the role of cholesterol in human atherosclerosis did not really get underway until the 1940s.

Why were Anitschkow’s findings ignored? Because they couldn’t be repeated in dogs. As a result, many scientists assumed that the findings wouldn’t apply to human beings, either. That’s an idiotic assumption, because atherosclerosis is rare in dogs, which are natural carnivores. Anitschkow guessed correctly that dogs and other carnivores are good at excreting excess cholesterol. Human beings and rabbits are not. Tragically, no one listened, probably because they’d rather eat meat than rabbit food.


My Cholesterol Is Too Low for the Heart Attack Risk Calculator!






Weight and Cholesterol: When Average Is Abnormal

I just discovered that I’m normal, which means that I’m way below average. I’m 5 foot 5 inches tall and weigh about 125 pounds. That gives me a body mass index of 20.8, which is normal. Yet it also means that I’m skinnier than about 95% of the American women my age. To become officially overweight, I’d have to gain at least 25 pounds. To be as fat as the average American, I’d have to gain a total of 40 pounds. To qualify as obese, I’d have to gain a total of 50 pounds.

If you live in the United States, you have probably noticed that most of the people around you weigh more than they should. That’s because you probably know, more or less instinctively, what healthy people are supposed to look like. Unfortunately, we can’t automatically recognize that some of our other measurements, such as our total cholesterol values, are also wildly abnormal. That’s because nobody has an instinctive feel for what healthy blood values are supposed to be. It’s tempting to evaluate them by comparing them to the average values for our population, but how can we tell if the average value in our population is normal or abnormal?

The U.S. federal government’s “Healthy People 2010” guidelines regarded total cholesterol of 240 mg/dL as “high” and a level of 200 mg/dL as “desirable.” Yet people are still at risk for heart disease as long as their total cholesterol is above 150 mg/dL. The last time my blood was tested, my total cholesterol was 120 mg/dL. According to statistics from the Centers from Diseases Control and Prevention, my total cholesterol level is unusually low. More than 95% of the Americans in my age-group have a total cholesterol value that’s way higher than mine. Yet I suspect that my cholesterol levels, like my weight, are normal and healthy. It’s the average person who’s dangerously abnormal.

The numbers are staggering. People whose cholesterol level is “high” by American standards (over 240 mg/dL) have more than twice as much cholesterol in their blood as I have. The average American has a total cholesterol level of about 200 mg/dL. This means that even the average person has far more cholesterol in his or her blood than I do. No wonder their arteries are getting clogged!

My blood cholesterol level may seem amazingly low, but it’s about average for someone in rural China. In the late 1990s, the China-Cornell-Oxford Project found that the average total cholesterol level in rural Chinese people was 127 mg/dL. As a result, heart attacks were rare in China. Overall, American men were 17 times as likely as Chinese men to get a heart attack. American women were about 6 times as likely as Chinese women to get heart attacks.

In some areas of rural China, coronary artery disease was practically nonexistent. A population of a few hundred thousand people could go for a couple of years without anyone under age 65 dying of a coronary. Not one person. The study didn’t analyze the causes of death among the elderly, but there probably weren’t many coronaries among people over 65, either.

Why were cholesterol values and rates of coronary artery disease so low in China? The study showed that diet makes the difference. Overall, the Chinese were eating only about a tenth as much animal protein and three times as much fiber as Americans were eating. The less animal protein people ate, the lower their cholesterol values were, and the less likely they were to die of heart disease and various cancers. There didn’t seem to be any “safe” level of intake of animal protein. Eating even a small amount of animal protein produced a small but measurable increase in risk. On the other hand, the more vegetables people ate, the safer they were.

My cholesterol values look like those of someone from rural China because I eat no animal protein but lots of rice and other grains and vegetables and beans and fruit. Anyone who thinks that this kind of diet is boring or unsatisfying has simply never had dinner at my house.

I know from reading the scientific literature on nutrition that people in the United States could dramatically improve their health and increase their life expectancy by shifting from the standard American diet, with its heavy emphasis on animal protein and its heavy load of fat, to a diet based on unrefined plant foods. This simple correction in the diet would enable people to drop to a normal weight without counting calories or limiting their portions. It would practically eliminate heart disease and greatly reduce the risk of other diseases. So why doesn’t our government tell us about this?

Worse yet, our government is still urging people to eat animal protein. Although the Healthy People 2020 goals supposedly “reflect strong science,” their dietary advice flies in the face of what we learned from the China-Cornell-Oxford study. In particular, the Web site says the following: “Americans with a healthful diet consume a variety of nutrient-dense foods within and across the food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources.” Since we know from the China-Cornell-Oxford study that eating animal protein is the major contributing cause of our major cause of death, and that there’s no safe level of intake of such foods, why in the name of good common sense is our government saying that a diet that includes these foods is healthful?


What’s Next, an Atherosclerosis Acceptance Movement?

The Hidden Danger of the “Fat Acceptance” Movement

You know the old saying, “If something is too good to be true….” Well, the “fat acceptance” movement is telling people something that sounds too good to be true. They are insisting that people can be “healthy at any size” and sometimes even that being overweight is healthier than being slim. They’re wrong, and the smarter and more educated people among the “fat acceptance” movement should know better. They “cherry pick” misleading findings from a few studies and ignore a vast scientific literature on the effects of diet on health. Such behavior is sickening, and the advice they give is dangerous.

Here’s the simple truth: excess body fat is only one of the possible bad effects of eating the wrong kind of food. Eating too much fat and too much animal protein can send you to an early grave even if you are thin and exercise a lot. The classic example is Jim Fixx, author of The Complete Book of Running, a 1977 bestseller that launched the running boom. Fixx had claimed that his grueling exercise regimen, which had enabled him to lose 60 pounds, allowed him to eat as much as he wanted of whatever he wanted. When I read that in his book, I thought, “But what about cholesterol?” So I was saddened, but not surprised, when Fixx dropped dead at age 52 of a heart attack while running. To my disgust, the media reacted to his death by asking whether running was good or bad for you, ignoring the obvious dietary angle to the story.

The simple truth is that eating the wrong kind of food can kill you, even if it doesn’t make you fat. Another simple truth is that you can’t outrun cholesterol. As a member of the high-IQ club Mensa, Fixx should have been smart enough to figure that out before it was too late. Unfortunately, he believed what he wanted to believe, and ate whatever he wanted to eat, and in the end it killed him.

As I mentioned, obesity is only one of the bad effects that is likely to result from eating the standard American diet–not just the heavily processed “junk food” that everyone knows is bad for you, but the meat and dairy products and eggs and fish that the US Department of Agriculture has been encouraging us to eat.

Collectively, the bad effects of eating the standard American diet are called “Western diseases.” This is because medical doctors who had been trained in Europe and the United States were stunned to find that these health problems, which were common back home, were rare to nonexistent in Asia and Africa. Besides overweight and obesity, they include heart disease, diabetes, various cancers, arthritis, varicose veins, multiple sclerosis, etc. etc. etc. Western diseases were (and still are) the major causes of death and disability in the United States and Europe because people there eat too much animal protein and too much fat. These diseases were rare in Asia and Africa because the populations were eating a low-fat, largely plant-based diet. A monumental study of nutritional epidemiology in China ( showed in detail how closely the consumption of animal protein and fat were linked to many of these diseases. The less animal-based food and fat people ate, the healthier they could be.

The good news is that if you eat the diet that will protect you against the other “Western diseases,” your weight problem will solve itself. People who eat a low-fat (<10% of calories) diet based on unrefined plant foods rapidly become heart-attack-proof (total cholesterol, <150 mg/dL) and can prevent and even reverse many of the other Western diseases. It’s hard to stay fat when you are eating a truly healthy diet. When overweight Americans switch to a low-fat, purely plant-based diet, they lose weight easily without having to count calories or limit their portions. They can eat to their hearts’ content and still stay slim. The “fat acceptance” advocates overlook that obvious fact.

The “fat acceptance” advocates are right that thin does not equal healthy. But they are wrong when they say that you can be healthy at any size. Rather than wasting their time trying to make people feel better about being fat, they should work toward educating people about a truly healthy diet, which will enable people to improve their own health and maintain a desirable weight without feeling hungry. The activists should also use their political clout to improve the nutrition curriculum at medical schools, which has been shown repeatedly over the past 40 years to be inadequate.

On one point, I do agree with the fat acceptance advocates. I think that people should be treated with respect regardless of their size and state of health. However, I feel that overweight people deserve to be told the truth about how their weight affects their health and about how their food choices affect both their health and their weight.


How Low Should Total Cholesterol Be?

Below 150 mg/dL, According to Dr. Caldwell Esselstyn

