Chris Masterjohn (Part 2)by Matt Meinrod on August 24, 2010
Thanks again Chris for taking the time to do this interview with us. Since our readers know who you are now based on last month’s issue, let’s dive right in.
JOHN: So let’s talk cholesterol. Can you start by giving our readers some basics on what cholesterol is, and does in your body?
CHRIS: Thanks for having me back John, it’s always a pleasure.
Those are two great questions, because if you asked the average person on the street they’d more than likely tell you that cholesterol is something found in fatty animal foods and what it does in the body is clog your arteries and give you a heart attack. There’s been so much propaganda in the so-called “war on cholesterol” that most people don’t realize how essential cholesterol is to our health and that some people can actually develop a deficiency of cholesterol just like they can of any other nutrient.
Cholesterol is a fat-soluble substance that has a chemical structure very similar to vitamin D and all of the steroid hormones. You can get a sense of how many essential roles cholesterol plays in the body by looking at people who have an extreme level of cholesterol deficiency. There is a syndrome called Smith-Lemli-Opitz Syndrome (SLOS) that is caused by a genetic defect in an enzyme needed to make cholesterol. Most conceptions with two copies of the gene die spontaneously in the first 16 weeks of gestation. So the first thing we learn from this syndrome is that cholesterol is essential to life itself, and a healthy pregnancy and birth. About one in 60,000 children born in the general population have SLOS, however, and they suffer from deformities of the hands, feet, face, and internal organs, severe gastrointestinal problems, mental retardation, autism, hyperactivity disorders, self-injurious behavior and many other problems. Traditionally, the treatment for SLOS has been cholesterol-rich foods such as egg yolks and cream. Due to the gastrointestinal problems, however, SLOS patients have difficulty getting enough cholesterol from these foods, so the current treatment is actually an FDA-approved cholesterol supplement. And in fact dietary cholesterol improves all of the symptoms associated with SLOS.
So here we have something similar to a classical depletion-repletion study used to identify the function of essential vitamins and minerals, only the deficiency is caused by a defective gene instead of a highly purified deficient diet. The case of SLOS shows clearly that cholesterol is necessary for fetal development, digestive health, proper development of the skeletal system and the internal organs, and mental health.
So why are so many body processes dependent on cholesterol? To begin with, it’s the direct precursor to all of the steroid hormones. These include the sex hormones, such as testosterone, as well as adrenal hormones used to regulate blood sugar and mineral levels in the blood. It’s also a direct precursor to bile acids, which you need to absorb fats and fat-soluble vitamins from your food. A very close precursor to cholesterol is even converted to vitamin D in your skin. Cholesterol is also an essential component of all cell membranes, where it helps regulate the fluidity of the membrane and helps anchor proteins to certain areas of the membrane to facilitate communication between cells or across cell membranes.
In fact, this is one reason why the brain is so rich in cholesterol. Our brain only occupies 2% of our body weight, but it contains 25% of our cholesterol. One of the functions of glial cells — supportive cells in our nervous system — is to secrete a cholesterol-rich solution necessary for making the connections between neurons that are needed for learning and memory. In 2001, researchers showed definitively that the cholesterol in this solution was in fact the limiting factor for making these connections, called “synapses.” The neurons don’t just form connections, though. They have to make the right connections in the right places. In order to do this, they grow extensions called “neurites” that move in certain direction in response to certain stimuli. But in 2004, researchers showed that if you take some of the cholesterol out of the membrane of a neuron, it completely destroys its ability to respond to stimuli. The “neurites” lose their way. So it’s no surprise, then, that the brain hogs so much of our cholesterol — we wouldn’t be able to learn anything or remember anything without it!
JOHN: I know that many out there have heard that your liver can make cholesterol as needed, so why bother consuming it. Can you talk to that idea?
CHRIS: Our livers do indeed make far more cholesterol than we eat in the diet. There are still two important reasons we should eat cholesterol-rich foods. First, they are jam-packed full of other vital nutrients. Second, many people may in fact need some dietary cholesterol.
Egg yolks and liver are two of the foods richest in cholesterol. Liver is the king of all nutrient-dense foods, being extraordinarily rich in vitamin A, all of the B vitamins, many of the compounds receiving more attention only recently that you find in expensive supplements like carnitine and R-alpha-lipoic acid, and even a little bit of vitamin C. Egg yolks are a much less powerful but nevertheless well rounded multivitamin.
Liver and egg yolks stand out as by far and away the best sources of choline and biotin. Many claim that biotin deficiency is extremely rare. One of the primary symptoms is spontaneous candida infection of the face. Many people, however, report successfully using biotin to fight off intestinal candida overgrowth, so maybe these people have a less severe state of deficiency. There is some evidence that biotin levels decline during pregnancy too, and need to be sustained in order to prevent birth defects. But choline — choline may be the most powerful weapon to boost mental health. Animal studies suggest that consuming choline at levels three times the minimal requirement during pregnancy and early development has a lifelong boost to brain power. Rats fed this huge amount of choline have a 30 percent increase in visuospatial and auditory memory, grow old without becoming senile, are better able to muti-task, and have a lower rate of “interference memory,” which is when old memories interfere with more recent ones — for example, if we go to the store and forget where we parked our car, this is often because we have parked at that store so many times that the memories interfere with one another. Choline protects against this type of forgetfulness.
The other reason to consume cholesterol is that, for some people at least, some amount of cholesterol is important for optimal health. Although only one in 60,000 children are born with SLOS, for example, which is an extreme form of cholesterol deficiency, one to three percent of the population carries a single copy of the defective cholesterol synthesis gene that causes SLOS. These people still make cholesterol, but a lower amount of it. There are hardly any studies on their health, but one study has suggested a much higher rate of violent suicide, which is consistent with other studies showing associations between low brian cholesterol levels and violent suicide. It’s also consistent with the tendency of full-blown SLOS patients toward self-injurious behavior. And this is only one genetic defect. Are there genes that could predispose someone to a moderate deficiency of cholesterol? We don’t know the answer, mostly because no one is asking the question.
For a long time it was thought that cholesterol does not cross the blood brain barrier, so it would be logical to assume that dietary cholesterol is worthless in cases like this. However, this is contradicted by the fact that cream and egg yolks, and even FDA-approved, pharmaceutical-grade cholesterol supplements, improve all of the brain-related mental symptoms of SLOS. Two very recent studies have basically disproven the concept in animals. One of them created a genetic defect in the ability of brain cells in mice to synthesize their own cholesterol. They found that when the brain was starved of cholesterol, stem cells started generating new blood vessels that were used to take up cholesterol from circulating blood. In another study, they inactivated a cholesterol transporter in glial cells. Glial cells are the cells that make cholesterol and then supply them to neurons so the neurons can make connections with each other — again, that’s how learning and memory occurs. When the glial cells could no longer supply cholesterol to the neurons, the neurons started taking up cholesterol from HDL particles in the blood.
So the end result is that when the brain is making enough of its own cholesterol, it is self-sustainable. But when the brain isn’t able to make all its own cholesterol, it needs cholesterol from the blood. So how many genes are there that decrease someone’s ability to take in cholesterol? Probably more than one. The safest thing is to eat a moderate amount of cholesterol-rich foods to obtain both vital nutrients like B vitamins and choline and to cover your bases just in case you’re one of those people who does best with some cholesterol itself provided in the diet.
JOHN: So in terms of adrenal hormones, would it be plausible to assume a low cholesterol diet could negatively impact Testosterone, Vit D, and insulin levels?
CHRIS: It is indeed plausible. In fact a study last year showed that a low dose of Lipitor (10 mg) decreased all the sex steroids — testosterone, estradiol, and sulfated DHEA — while it took a large-dose (80 mg) to decrease cortisol. So it may be the case that statins — or low dietary cholesterol for people who don’t synthesize enough — could compromise muscle growth by decreasing the testosterone-to-cortisol ratio. I think we will see some good studies on this coming out soon, but so far nothing definitive has been shown.
Insulin is not a steroid hormone so it is not likely to be directly affected, although a decreased level of vitamin D could compromise insulin function. Whether cholesterol levels directly affect vitamin D is an open question still, as the few studies that have tried to address it have been very poorly conducted. Cholesterol is not a precursor to vitamin D. Rather, 7-dehydrocholesterol, a close precursor to cholesterol is converted to vitamin D, and it’s actually synthesized in the skin independently, so it is not likely to be impacted by cholesterol levels in the blood. But it could be that some cholesterol-lowering drugs make it to the skin and prevent its synthesis. Again, there isn’t any good science to address this question at this stage of the game.
JOHN: Ok, so dietary cholesterol is good, and may needed by some more than others depending on genetics, and liver is a great source, as is egg yolks. Ok, so here are a few questions I get all the time..over and over actually.
How easy is it to oxidize cholesterol when you cook eggs? I generally ask people to cook their eggs on low heat in virgin coconut oil, or avocado oil, and to rotate the way they are cooking their eggs to avoid allergies (scrambled, over easy, etc). Also, many people ask me how the body can use raw eggs as opposed to cooked eggs? Is there a difference in nutrient absorbtion and utilization either way?
CHRIS: It takes a long time to oxidize cholesterol. In the study where they found that oxidizing cholesterol increased its ability to cause atherosclerosis in rabbits, they heated the cholesterol for eight hours. No one cooks eggs for eight hours. Nevertheless, I think your recommendations make sense. Eggs contain some polyunsaturated fatty acids (PUFA) in addition to the cholesterol, which are very vulnerable to oxidation, and cooking them in an oil that is also rich in PUFA is going to aggravate the possibility of oxidation. These fatty acids are vulnerable to oxidation even within the body, but oxidizing them before consuming them can make the situation worse. So it is best to use stable fats dominated by saturated or monounsaturated.
Personally, while I LOVE omellettes, I often eat egg yolks raw. I just crack them into my hand and let the white flow between my fingers into the trash can or a bowl and pop the yolk into my mouth. I suspect that consuming raw egg protein in this way has a similar benefit to raw whey protein, which is a powerful booster of glutathione, the master antioxidant of the cell. I have not yet done enough research on this to make the claim for sure and the research on raw foods is sparse, but I and many other people simply feel better consuming some raw protein. There is some research, however, that raw egg whites can reduce the bioavailability of the protein, and this appears to be because they contain digestive inhibitors. They also contain a substance that makes biotin unavailable, and in fact this substance is only partially neutralized by cooking. Some people say, well hey, the egg yolk contains plenty of biotin, so why not eat it with the raw egg white. I think differently. If egg yolks are one of my two superfood sources of biotin, why not use them to get the extra biotin! So I will never consume raw eggs, but I do eat raw egg yolks often.
JOHN: Yes, definiely see the avidin warnings everywhere from eating raw egg whites. So here is something else that everybody wants to know about. How do you increase your HDL levels? For me personally, the more whole eggs I eat, the higher my HDL gets, and the lower my total cholesterol gets (as long as I keep refined carbs to a minimum). Your thoughts?
CHRIS: This may happen in some people, but statistically, on average, most people whose HDL-cholesterol goes up when they eat eggs also have increases in total cholesterol. Most people don’t have much of a change at all. Coconut oil is probably the most effective way to increase HDL-cholesterol and to increase the ratio of HDL-cholesterol to total cholesterol. Exercise also helps, and I believe that most things that increase LDL metabolism like good thyroid status would probably also improve this ratio to, which I’ll explain more below.
However, I think the first and most important thing to understand here is that HDL-cholesterol levels — in other words, the amount of cholesterol that is being carried in HDL particles within the blood — have an inverse correlation with heart disease risk, but there’s no definitive evidence that high HDL-cholesterol levels cause a low risk of heart disease. In order to begin to understand this, we first have to differentiate between the HDL particle and HDL-cholesterol. The numbers you get from your doctor called “HDL” or “HDL-C” are not the number or weight of HDL particles. They’re actually the amount of cholesterol being carried by HDL particles.
There’s definitely a statistical correlation between high HDL-cholesterol levels and low risk of heart disease. This just means there’s a general tendency for people with high HDL-cholesterol levels to be less likely to get heart disease, but it certainly doesn’t mean that everyone with low HDL-cholesterol gets a heart attack. The best predictor of heart disease risk is actually the total-to-HDL-cholesterol ratio. The higher, the more likely you are to get heart disease. The lower, the less likely you are to get heart disease.
There are a few problems with the idea that a high ratio causes heart disease. First, in some populations, the correlation does not exist. For example, on the island of Kitava the population has an average total-to-HDL-cholesterol ratio that should put them at “moderate risk,” meaning that some people have lower ratios and some people have higher ratios putting them at “high risk.” But the incidence of heart disease among that population is zero. Zilch. Nada. The second problem is that the only major experimental study attempting to demonstrate the causal role of this ratio failed miserably. This was the torcetrapib drug, which was designed specifically to block the transfer of cholesterol from HDL particles to LDL particles, and thus was very effective at reducing the total-to-HDL cholesterol ratio. But the drug wound up killing people left and right. To top it all off, there wasn’t even a correlation between decreases in the total-to-HDL-cholesterol ratio and decreases in arterial plaque.
Why is this important? Because a correlation between the total-to-HDL-cholesterol ratio and heart disease risk is an observation. In the scientific method, we don’t use observations to support ideas. We use them to brainstorm ideas, and then test those ideas experimentally. This was the first true test of the idea that a high ratio causes heart disease in humans and it failed.
My own theory is that the total-to-HDL cholesterol ratio is a marker for the amount of time LDL spends in the blood. There’s very clear evidence that LDL particles in a healthy state are cleared from the blood and metabolized rather than left in the blood for extended period of time, and that when LDL metabolism is compromised, heart disease risk goes up. This is because when LDL spends a long period of time in the blood, the polyunsaturated fatty acids (PUFAs) in its membrane become oxidized and they then become dangerous and toxic to the blood vessels. But another thing happens when LDL spends a lot of time in the blood — cholesterol is continuously transferred from HDL particles to LDL particles. So, all things being equal, when your total-to-HDL cholesterol ratio is high, your LDL particles probably aren’t being metabolized efficiently.
So we still want a low total-to-HDL-cholesterol ratio, but as the example of the Kitavans demonstrates, when all conditions are optimized, it’s not as important as we might think. Moreover, what we should be doing is developing commercially available and widely accessible tests for LDL oxidation, since that is probably the culprit really causing the disease, rather than the ratio itself. When we understand the true causes and have tests for all of them, we could probably completely ignore the ratio.
Nevertheless, the HDL particle — as opposed to the amount of cholesterol within that particle — does indeed protect against heart disease and this has been shown experimentally since the beginning of the 1980s. Towards the end of the 1970s and beginning of the 1980s, growing experimental evidence was showing that when LDL particles spend 24 hours exposed to the cells that line blood vessels, oxidation of PUFAs in the LDL membrane changed the LDL and made it become toxic to those cells. As a result, immune system cells would gobble up huge amounts of the LDL and convert into the “foam cells” found in atherosclerotic plaque. These findings were all in test tube systems. The researchers found that if they add whole blood to the system, the oxidation of LDL was prevented. Then they used HDL, which is a component of blood, and found it had the same effect. HDL is very rich in vitamin E, so they tried simply using vitamin E. And in fact, the vitamin E itself was just as effective.
Newer research has shown that HDL particles have a very specific role in delivering vitamin E to the cells that line blood vessels. This prevents these cells from generating free radicals that will oxidize LDL particles within the blood that come in close contact to them. When the LDL oxidizes, the blood vessel cells send out “help” signals to the immune system to make it come gobble up the oxidized LDL. Those cells stabilize themselves within the arterial wall and create an atherosclerotic plaque. But when enough vitamin E is supplied, the LDL does not oxidize and the blood vessel cells never send out those help signals and the plaque never forms. Granted, vitamin E isn’t the only factor within the complexity of the body and all of the different protective factors and toxins we are exposed to, but it is an important part of the picture.
So, do we want to raise our HDL-cholesterol? What we really want to do is increase the efficiency with which we metabolize LDL and increase the ability of HDL to transfer vitamin E to blood vessel cells. The total-to-HDL-cholesterol ratio itself is of much less importance. But since it is one of the few things we get back to the doctor that may indicate the efficiency with which we are metabolizing these lipids, and since most things that “improve” the ratio are healthful, then let’s go ahead and do those healthful things, as long as we don’t get to hung up on or obsessed about the ratio.
JOHN: Do you think high LDL levels are really indicator of potential issues down the road? I think I have read 10 different opinions on this in the last 10 books I have read..lol.
CHRIS: An indicator? Yes, statistically, high LDL-cholesterol levels predict the risk of cardiovascular disease, especially in younger populations. The older you get, the less important they become in predicting disease risk, and when you get over 75-80 or so, they lose their predictive value and in some studies among elderly high LDL-cholesterol levels even begin to predict a lower risk of disease.
Do high LDL-cholesterol levels cause disease? I don’t think so. The scientific evidence for this concept is extremely poor. In fact the evidence suggests high levels of LDL-cholesterol in and of themselves do not cause disease.
On the other hand, the body of scientific evidence showing that the oxidation of the LDL particle contributes to cardiovascular disease is pretty enormous. So the LDL particle is indeed an essential character in the story, although it isn’t the villain as it’s often made out to be.
JOHN: This is great information that I am sure our readers will love. So can you give us some dietary tips on how we can eat to assist the body in metabolizing LDL – what would be your top 3-5 tips?
CHRIS: The first and main thing you want to do is boost your thyroid status. The LDL receptor, which is what brings the LDL particle into the cell and clears it from the bloodstream, needs to be activated by thyroid hormone. Hypothyroidism can lead to very high total and LDL-cholesterol levels, but in fact boosting your thyroid status will help you metabolize LDL more efficiently even if you don’t have any grounds for a hypothyroidism diagnosis.
The main nutrients you need to make enough thyroid hormone are protein (especially the amino acid tyrosine), iodine, and selenium. I’m sure your readers know where to get protein! Iodine is found in many foods but it’s very dependent on the soil. A potato from one area of the country can have 100 times as much iodine as a potato from another part of the country. So the only reliable source of iodine is seafood, since minerals get lost from the soil to the ocean and not the other way around. Any seafood will supply a good amount of iodine, but seaweed provides enormous amounts of iodine. You can cook seaweed as a vegetable or you can even buy it in many Asian sections in a shaker, like salt or pepper, to use as a seasoning. Liver, seafood, mushrooms, and genuinely Brazilian brazil nuts are all good sources of selenium. You also want to eat enough food. If you need to lose weight, focusing on using exercise to create a caloric deficit instead of eating less will help keep your thyroid in good shape.
In addition to eating the right things to make thyroid hormone, we also need to avoid thyroid toxins, which are also called “goitrogens.” These come from both the environment and from the diet. Since they are all “halogens” like iodine, they can all interfere with iodine metabolism and increase our need for iodine. Lots of types of pollution and environmental toxins can damage the thryoid, but the most significant of them are chlorine, fluoride, and bromine. Chlorine is found in swimming pools, bleach, and in many areas the drinking water. If it’s in your drinking water, then you’re also inhaling and bathing in chlorine vapors when you take a shower. Fluoride is added to toothpaste and many water supplies. We get exposed to bromine in all kinds of ways environmetnally — the most toxic form is as a fire retardant that has been added to mattresses, carpeting, furniture, and many other products we are in daily contact with. Fluoride might be the worst of these, since it seems to be better at getting into the thyroid gland. In any case the more we avoid all of them the better. Bromine is probably the hardest to avoid. Many people argue that we need to take iodine supplements due to the toxic load of these chemicals. I think the jury is still out on exactly how much iodine we need, but it is true that high-dose iodine can help detoxify these bad guys from the body, which should be done with medical supervision and testing if you think you might need to try such a detox.
Thyroid toxins can also be found naturally in the diet. Cruciferous vegetables, the cyanide-releasing compounds many people on internet sites are calling “vitamin B17,” soy, and millet are prime examples. These foods are not bad foods, but they must be prepared properly and eaten in moderation. In the case of cruciferous vegetables and soy, the main thing we can do is consume extra iodine in the diet. If we go way overboard and consume unheard of amounts, say we are drinking gallons of broccoli juice, then iodine will not help, but in a realistic scenario, all these foods are doing is increasing our need for iodine. In the case of these “B17” foods, which include cassava (tapioca) and a lot of fruits in the rose family like most of our common berries, apples and pears, we need not only iodine but plenty of protein and vitamin B12 to help detoxify the cyanide properly. If you’re eating an apple a day, this isn’t an issue. But if you are eating very bitter breeds of these foods or eating the seeds and pits of the fruits — which some people are saying we should do to prevent cancer — it becomes an issue. It’s mostly an issue, however, for people who are deriving the majority of their calories from something like cassava. In such a case, you can get into serious trouble if you aren’t eating enough protein and B12. In the case of millet, it’s a bit different. Millet inhibits every step of thyroid metabolism and iodine cannot protect against it. The only thing you can do to protect yourself from millet is eat it in moderation. And although the opposite is true with cruciferious vegetables, traditional processing of millet including cooking it actually makes it worse. Raw millet is the form least toxic to the thyroid.
Again, the most important point here is that these foods should be eaten in moderation and we need to make sure we get enough iodine for balance. I’m not out to demonize any of these foods.
Eating certain types of fiber has been shown to increase the LDL receptor, and the reason is probably that some fiber helps carry bile out of the system, our liver takes up more LDL to make bile acids. This may have other benefits, like helping to carry out toxins released into the bile. I haven’t seen studies on it, but eating bitters, and thereby stimulating bile release, may help too — in addition to helping digest and absorb fat and fat-soluble nutrients.
The other main thing we can do to keep the LDL receptor function well is to protect ourselves from oxidative stress, which means eating a diet rich in antioxidants from fresh and raw foods of both plant and animal origin, avoiding environmental toxins, avoiding polyunsaturated vegetable oils, and getting our saturated fat from butter, coconut oil, cocoa butter, macadamia nut oil, and other good fats.
JOHN: and 3-5 tips on how we can eat to ensure we can better delivery of Vitamin E to blood vessel cells via HDL? Or is all this genetic???
CHRIS: When LDL gets oxidized, it’s in contact with oxidants in the blood, oxidants from these cells that line the blood vessel, and of course these oxidants have to actually reach the LDL particle. So we really want to enrich all three compartments with antioxidants. In the LDL particle, the most important antioxidants are probably vitamin E and coenzyme Q10, which is found in all foods but is most abundant in heart meat. Yes, actually eating, say, buffalo heart instead of a hamburger. There are lots of antioxidants important to the blood, but the most important one is vitamin C. You can get vitamin C, of course, from lots of fresh fruits and vegetables, especially when they are raw or minimally cooked. You can even get a small amount from liver.
At the level of the cell, all these same antioxidants are important. In addition, it’s going to make it’s own antioxidants. These include glutathione, the master antioxidant of the cell, and several enzymes. The enzymes use selenium, zinc, copper, manganese, and heme iron as cofactors. But the big boy here we should be most concerned about is glutathione. The limiting factor we need to make glutathione is the amino acid cysteine. Undenatured whey protein, as you’d find in a high-quality protein supplement or raw milk products, is a great way to provide bioavailable cysteine. We can also make it if we have enough vitamin B6, which we get especially from animal products, with liver topping the list as usual. Bananas are also a good source of B6. But the role of HDL providing vitamin E is also incredibly important. The main thing here, of course, is to boost our vitamin E levels. They will naturally wind up in our HDL particles and our HDL particles wil deliver them to our blood vessel cells.
Vitamin E, of course is found in vegetable oils but these are also very high in PUFA , and over the long run, PUFA actually deplete us of vitamin E. So we want to consume vitamin E from oils like palm oil and grass-fed animal fats, and get lots of little doses of vitamin E from fresh foods of all kinds. Coconut oil doesn’t have any, but coconut oil will help reduce our vitamin E requirement since it is so invulnerable to oxidation. It has the opposite effect of PUFA.
Finally we do NOT want to take alpha-tocopherol supplements. If you do take a vitamin E supplement, it should also contain gamma-tocopherol. Both forms are important, and both are found in the diet. But alpha-tocopherol supplements will rapidly and dramatically deplete gamma-tocopherol levels. So we need to take a balanced supplement or rely on whole, fresh foods. Whole, fresh foods are always the best choice.
JOHN: Awesome – that is great info that our readers can actually apply to their plans! Once again, the information you have provided has been excellent. From our readers, and from myself, keep up the great work, and we look forward to talking again soon! Be sure to visit Chris on facebook, on www.westonaprice.org, and also on his website www.cholesterol-and-health.com where he posts more valuable information that we can all learn from!!
CHRIS: Thanks John, it’s a great pleasure to be on your site. I look forward to interacting with your readers on mine, and to be back here again sometime soon!