Dr. Sarah Myhill, MD, is a UK-based fatigue specialist focused on nutrition and preventive medicine. This article, from her educational patient website, was updated in June 2009.*

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There is a general belief that a high fat diet results in high cholesterol, which results in arterial and heart disease. This is a myth put about by the food and pharmaceutical companies to promote low fat foods and cholesterol lowering drugs.

There isn’t a scrap of evidence to support this theory – indeed the single largest culprits in arterial disease are sugars and refined carbohydrates.

Cholesterol is an essential molecule without which we would all be dead. It is the raw material from which many essential molecules are made, including:

• Hormones, in particular the adrenal and sex hormones,

• Vitamin D (which is highly protective against cancer and heart disease),

• Serotonin receptors (which help protect us against depression),

• Bile salts (essential for digesting foods), and so on.

The highest concentrations of cholesterol are found in breast milk, where it is essential for infant nourishment.

Cholesterol comes into play in healing and repair of blood vessels.

Blood vessels have a delicate lining and are at the mercy of turbulent blood flow. Turbulence is created where blood vessels divide and blood pressure is high. In this event the lining becomes damaged and has to be repaired.

The first sign of repair is a fatty streak, then plaque formation and plaque stabilization. This process involves LDL (‘bad’ cholesterol) and HDL (‘good’ cholesterol). Simplistically:

• LDL lays down the fat,

• And HDL carries fatty lumps away.

• It is the ratio between the two which is important.

So do not be satisfied with just being told that your total cholesterol is whatever – the important result is the ratio between the good cholesterol and the bad cholesterol. [Roughly, above 60 mg/dL HDL and below 100 LDL is desired. Determined by a Lipid Profile Test(1)] The first clue that this may be a problem is the total cholesterol, but in every case one needs a breakdown.

Causes of a high total cholesterol with poor ratio include:

1. Borderline Hypothyroidism

Indeed, 30 years ago a raised cholesterol was almost routinely treated with thyroid hormones. See “Hypothyroidism.” [Thyroid Profile Test(2)]

2. Vitamin D Deficiency

Cholesterol is the raw material which, through the action of sunshine on the skin, is converted to vitamin D. If the body perceives the deficiency in vitamin D3 – and this is almost universal in our low sunshine climate – then the liver pushes out more cholesterol so that when sunshine does land on the skin there is plenty of substrate for vitamin D3 to be made.

Vitamin D3 deficiency is itself a major risk factor for arterial disease. [25-Hydroxy Vitamin D Test, aka 25(OH)D.]

3. Vitamin B3 Deficiency

B3 (niacin) is essential for the metabolism of cholesterol, and deficiencies are common. Niacin is found in high protein foods, milk, mushrooms, greens, ‘enriched’ breads/cereals. The converse is also true – high levels of vitamin B3 bring cholesterol levels down. The only problem is that the supplemental form of B3 which does this has a tendency to cause flushing. The body does acclimatize to this, and one needs to start off with small doses such as 100mgs three times daily and build up gradually.

4. Copper Deficiency

There is an inverse relationship between cholesterol levels and copper – so the higher the copper in the blood (so long as it is in the normal range) the lower the cholesterol, and vice versa. Copper rich foods include nuts, split peas, liver, meat, butter. The best test of copper is to measure superoxide dismutase [SODase Test(3)], since this is a good functional test of copper and incidentally zinc levels. Zinc, associated with immunity, fertility, behavioral health, is obtained in meats, nuts, egg yolk and is often low in vegetarians or people on low protein diets. See “Trace elements in food – How much you have to eat to get your RDA.”

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A high cholesterol with poor ratio of HDL/LDL may be a symptom of arterial damage.

That is to say, cholesterol is being mobilized for healing and repair. So anything which damages arteries will cause a secondary rise in LDL cholesterol. Things to consider would be:

• Diet. Dairy is pro-inflammatory, refined carbohydrates are high glycemic index. Try a Stoneage Diet, which emphasizes vegetables, nuts & seeds, meat, fish and eggs, low carb fruits such as berries. A Stoneage Diet helps prevent obesity and diabetes.

• Stress – lack of sleep, high adrenaline lifestyle, lack of exercise.

• Poor antioxidant status. Results in excessive inflammatory reactions. See “Antioxidants and Free Radicals – What They Are and What They Do.”

• Poisoning by heavy metals, pollution – damages artery walls directly.

Any or all of the above could result in high blood pressure. See “A Primer on Blood Pressure.”

The Problem with Statin Drugs

The main problem with statins is they make too much money for drug companies and therefore are mindlessly promoted. The interesting thing about statins is that they do reduce one’s risk of many diseases, but the degree to which they protect one is not commensurate with the degree to which they reduce cholesterol levels. We now know the reason why.

Statins are vitamin D mimics – they look exactly like vitamin D and have many of vitamin D’s beneficial effects.

Vitamin D evolved because sunshine is very pro-inflammatory and vitamin D is very anti-inflammatory. Ability to make vitamin D in the skin in response to sunshine allows people to tolerate the inflammatory effects of sunshine. This anti-inflammatory effect spreads through the whole body.

Many degenerative diseases of ageing are associated with inflammation, and vitamin D protects against this. Therefore it is highly protective against arterial disease, heart disease, cancer, autoimmunity (including multiple sclerosis and type I diabetes), neurodegenerative conditions, osteoporosis, allergies, and so on.

However, statins inhibit two important enzyme systems.

• Firstly statins inhibit formation of Coenzyme Q 10. This is the most important antioxidant inside the mitochondria (cellular energy factories), and the main acceptor and donor of electrons. If Coenzyme Q 10 formation is inhibited [Coenzyme Q 10 Test(4)] this means that mitochondrial function will go slow and the aging process will be accelerated. There is now good evidence to show that poor mitochondrial function is a central part of chronic fatigue syndrome, and this explains why statins almost invariably make patients with chronic fatigue worse. (See the recent article by Dr. Myhill and colleagues, “Chronic Fatigue Syndrome and Mitochondrial Dysfunction.” In conjunction with this work, they developed a Mitochondrial Function Test(5).)

• Statins also inhibit formation of selenium based-proteins such as glutathione peroxidase. This is one of the most important antioxidants in the blood.

It is a combination of the above two factors which explains the devastating effect statins have on muscle metabolism in some people. People get obvious muscle soreness, stiffness, weakness and fatigability.

Heart muscle is little different from normal muscle, so it is no wonder that the heart is also affected, and this can result in heart failure. In fact there is now good evidence to suggest that it is statins that are responsible for the epidemic of heart failure due to heart muscle disease that we are now seeing clinically.

Related Tests

Individuals in the UK can, with a doctor’s referral, directly order many diagnostic tests by obtaining kits from and mailing samples to Dr. Myhill. See test list and details.

1. Cholesterol and fats in the blood – the Lipid Profile

2. Thyroid profile: free T3, free T4 and TSH – Lab 21

3. SODase (superoxide dismutase) – Acumen Labs

4. Co-enzyme Q10, Biolab

5. Mitochondrial Function Profile. Until further notice, not available to non-UK residents owing to limited capacity.

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* Dr. Sarah Myhill, MD, is a UK-based fatigue specialist focused on nutrition and preventive medicine. This information is excerpted with kind permission (article 363, updated June 2009) from her educational website (DrMyhill.co.uk) ® Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198. For ME/CFS patients, a special feature of Dr. Myhill’s site is her free 179-page online book – “Diagnosing and Treating Chronic Fatigue Syndrome.”

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.