April 25, 2012

Cholesterol

The straight dope on cholesterol – Part I

Welcome to a topic near and dear.

Read Time 9 minutes

I’ve been planning to write at length about this topic for a few months, but I’ve been hesitant to do so for several reasons:

  1. To discuss it properly requires great care and attention (mine and yours, respectively).
  2. My own education on this topic only really began about 9 months ago, and I’m still learning from my mentors at a geometric pace.
  3. This topic can’t be covered in one post, even a Peter-Attia-who-can’t-seem-to-say-anything-under-2,000-word post.
  4. I feel a bit like an imposter writing about lipidology because my mentors on this topic (below) have already addressed this topic so well, I’m not sure I have anything to add.

But here’s the thing.  I am absolutely – perhaps pathologically – obsessed with lipidology, the science and study of lipids.  Furthermore, I’m getting countless questions from you on this topic.  Hence, despite my reservations above, I’m going to give this a shot.

 

A few thoughts before we begin.

  1. I’m not even going to attempt to cover this topic entirely in this post, so please hold off on asking questions beyond the scope of this post.
  2. Please resist the urge to send me your cholesterol numbers.  I get about 30 such requests per day, and I cannot practice medicine over the internet.  By all means, share your story with me and others, but understand that I can’t really comment other than to say what I pretty much say to everyone: standard cholesterol testing (including VAP) is largely irrelevant and you should have a lipoprotein analysis using NMR spectroscopy (if you don’t know what I mean by this, that’s ok… you will soon).
  3. This topic bears an upsettingly parallel reality to that of nutrition “science” in that virtually all health care providers have no understanding of it and seem to only reiterate conventional wisdom (e.g., “LDL is bad,” “HDL is good”).  We’ll be blowing the doors off this fallacious logic.

By the end of this series, should you choose to internalize this content (and pick up a few homework assignments along the way), you will understand the field of lipidology and advanced lipid testing better than 95% of physicians in the United States.  I am not being hyperbolic.

One last thing before jumping in:  Everything I have learned and continue to learn on this topic has been patiently taught to me by the words and writings of my mentors on this subject: Dr. Tom Dayspring, Dr. Tara Dall, Dr. Bill Cromwell, and Dr. James Otvos. I am eternally in their debt and see it as my duty to pass this information on to everyone interested.

Are you ready to start an exciting journey?

 

Concept #1 – What is cholesterol?

Cholesterol is a 27-carbon molecule shown in the figure below. Each line in this figure represents a bond between two carbon atoms.  Sorry, I’ve got to get it out there.  That’s it.  Mystery over.

All this talk about “cholesterol” and most people don’t actually know what it is.  So there you have it.  Cholesterol is “just” another organic molecule in our body.

 

Cholesterol molecule

I need to make one important distinction that will be very important later.  Cholesterol, a steroid alcohol, can be “free” or “unesterified” (“UC” as we say, which stands for unesterified cholesterol) which is its active form, or it can exist in its “esterified” or storage form which we call a cholesterol ester (“CE”).  The diagram above shows a free (i.e., UC) molecule of cholesterol.  An esterified variant (i.e., CE) would have an “attachment” where the arrow is pointing to the hydroxyl group on carbon #3, aptly named the “esterification site.”

Since cholesterol can only be produced by organisms in the Animal Kingdom it is termed a zoosterol. In a subsequent post I will write about a cousin of cholesterol called phytosterol, but at this time I think the introduction would only confuse matters.  So, if you have a question about phytosterols, please hang on.

 

Concept #2 – What is the relationship between the cholesterol we eat and the cholesterol in our body?

We ingest (i.e., take in) cholesterol in many of the foods we eat and our body produces (“synthesizes”) cholesterol de novo from various precursors.   About 25% of our daily “intake” of cholesterol – roughly 300 to 500 mg — comes from what we eat (called exogenous cholesterol), and the remaining 75% of our “intake” of cholesterol — roughly 800 to 1,200 mg – is made by our body (called endogenous production).  To put these amounts in context, consider that total body stores of cholesterol are about 30 to 40 gm (i.e., 30,000 to 40,000 mg) and most of this resides within our cell membranes.  Every cell in the body can produce cholesterol and thus very few cells actually require a delivery of cholesterol. Cholesterol is required by all cell membranes and to produce steroid hormones and bile acids.

Of this “made” or “synthesized” cholesterol, our liver synthesizes about 20% of it and the remaining 80% is synthesized by other cells in our bodies.  The synthesis of cholesterol is a complex four-step process (with 37 individual steps) that I will not cover here (though I will revisit), but I want to point out how tightly regulated this process is, with multiple feedback loops.  In other words, the body works very hard (and very “smart”) to ensure cellular cholesterol levels are within a pretty narrow band (the overall process is called cholesterol homeostasis).  Excess cellular cholesterol will crystalize and cause cellular apoptosis (programmed cell death). Plasma cholesterol levels (which is what clinicians measure with standard cholesterol tests) often have little to do with cellular cholesterol, especially artery cholesterol, which is what we really care about. For example, when cholesterol intake is decreased, the body will synthesize more cholesterol and/or absorb (i.e., recycle) more cholesterol from our gut. The way our body absorbs cholesterol is so amazing, so I want to spend a bit of time discussing it.

In medical school, whenever we had to study physiology or pathology I always had a tendency to want to anthropomorphize everything. It’s just how my brain works, I guess, and understanding cholesterol absorption is a great example of this sort of thinking.  The figure below, from the Gastroenterology Journal, shows a cross-section of a cell in our small intestine (i.e., our “gut”) called an enterocyte that governs how stuff in our gut actually gets absorbed.  The left side with the fuzzy border is the side facing the “lumen” (the inside of the “tube” that makes up our gut).  You’ll notice two circles on that side of the cell, a blue one and a pink one.

[What follows is a bit more technical than I would have liked, but I think it’s very important to understand how this process of cholesterol absorption works.  It’s certainly worth reading this a few times to make sure it sinks in.]

Enterocyte cell

 

  • The blue circle represents something called a Niemann-Pick C1-like 1 protein (NPC1L1).  It sits at the apical surface of enterocytes and it promotes active influx (i.e., bringing in) of gut luminal unesterified cholesterol (UC) as well as unesterified phytosterols into the enterocyte.  Think of this NPC1L1 as the ticket-taker at the door of the bar (where the enterocyte is the “bar”); he lets most cholesterol (“people”) in.  However, NPC1L1 cannot distinguish between cholesterol (“good people”) and phytosterol (“bad people” – I will discuss these guys later, so no need to worry about it now) or even too much cholesterol (“too many people”). [I can’t take any credit for this anthropomorphization – this is how Tom Dayspring explained it to me!]
  • The pink circle represents an adenosine triphosphate (ATP)-binding cassette (ABC) transporters ABCG5 and ABCG8.  This complex promotes active efflux (i.e., kicking out) of unesterified sterols (cholesterol and plant sterols – of which over 40 exist) from enterocytes back into the intestinal lumen for excretion.  Think of ABCG5,G8 as the bouncer at the bar; he gets rid of the really bad people (e.g., phytosterols as they serve no purpose in humans) you don’t want in the bar who snuck past the ticket-taker (NPC1L1).  Of course in cases of hyperabsorption (i.e., in cases where the gut absorbs too much of a good thing) they can also efflux out un-needed cholesterol.  Along this analogy, once too many “good people” get in the bar, fire laws are violated and some have to go. The enterocyte has “sterol-excess sensors” (a nuclear transcription factor called LXR) that do the monitoring and these sensors activate the genes that regulate NPC1L1 and ABCG5,G8).

There is another nuance to this, which is where the CE versus UC distinction comes in:

  • Only free or unesterified cholesterol (UC) can be absorbed through gut enterocytes.  In other words, cholesterol esters (CE) cannot be absorbed because of the bulky side chains they carry.
  • Much (> 50%) of the cholesterol we ingest from food is esterified (CE), hence we don’t actually absorb much, if any, exogenous cholesterol (i.e., cholesterol in food).  CE can be de-esterified by pancreatic lipases and esterolases – enzymes that break off the side branches and render CE back to UC — so some ingested CE can be converted to UC.
  • Furthermore, most of the unesterified cholesterol (UC) in our gut (on the order of about 85%) is actually of endogenous origin (meaning it was synthesized in bodily cells and returned to the liver), which ends up in the gut via biliary secretion and ultimately gets re-absorbed by the gut enterocyte.  The liver is only able to efflux (send out via bile into the gut) UC, but not CE, from hepatocytes (liver cells) to the biliary system.  Liver CE cannot be excreted into bile. So, if the liver is going to excrete CE into bile and ultimately the gut, it needs to de-esterify it using enzymes called cholesterol esterolases which can convert liver CE to UC.
  • Also realize that the number one way for the liver to rid itself of cholesterol is to convert the cholesterol into a bile acid, efflux that to the bile (via a transporter called ABCB11) and excrete the bile acids in the stool (typically most bile acids are reabsorbed at the ileum).

 

Concept #3 – Is cholesterol bad?

One of the biggest misconceptions out there (maybe second only to the idea that eating fat makes you fat) is that cholesterol is “bad.”  This could not be further from the truth.  Cholesterol is very good!  In fact, there are (fortunately rare) genetic disorders in which people cannot properly synthesize cholesterol.  Once such disease is Smith-Lemli-Opitz syndrome (also called “SLOS,” or 7-dehydrocholesterol reductase deficiency) which is a metabolic and congenital disorder leading to a number of problems including autism, mental retardation, lack of muscle, and many others.

Cholesterol is absolutely vital for our existence.  Let me repeat: Cholesterol is absolutely vital for our existence. Every cell in our body is surrounded by a membrane.  These membranes are largely responsible for fluidity and permeability, which essentially control how a cell moves, how it interacts with other cells, and how it transports “important” things in and out. Cholesterol is one of the main building blocks used to make cell membranes (in particular, the ever-important “lipid bilayer” of the cell membrane).

Beyond cholesterol’s role in allowing cells to even exist, it also serves an important role in the synthesis of vitamins and steroid hormones, including sex hormones and bile acids.  Make sure you take a look at the picture of steroid hormones synthesis and compare it to that of cholesterol (above). If this comparison doesn’t convince you of the vital importance of cholesterol, nothing I say will.

One of the unfortunate results of the eternal need to simplify everything is that we (i.e., the medical establishment) have done the public a disservice by failing to communicate that there is no such thing as “bad” cholesterol or “good” cholesterol.  All cholesterol is good!

The only “bad” outcome is when cholesterol ends up inside of the wall of an artery, most famously the inside of a coronary artery or a carotid artery, AND leads to an inflammatory cascade which results in the obstruction of that artery (make sure you check out the pictures in the links, above). When one measures cholesterol in the blood – we really do not know the final destination of those cholesterol molecules!

And that’s where we’ll pick it up next time – how does “good” cholesterol end up in places it doesn’t belong and cause “bad” problems?  If anyone is looking for a little extra understanding on this topic, please, please, please check out my absolute favorite reference for all of my cholesterol needs, LecturePad. It’s designed primarily for physicians, but I suspect many of you out there will find it helpful, if not now, certainly once we’re done with this series.

 

To summarize this somewhat complex issue

  1. Cholesterol is “just” another fancy organic molecule in our body, but with an interesting distinction: we eat it, we make it, we store it, and we excrete it – all in different amounts.
  2. The pool of cholesterol in our body is essential for life.  No cholesterol = no life.
  3. Cholesterol exists in 2 formsUC and CE – and the form determines if we can absorb it or not, or store it or not (among other things).
  4. Most of the cholesterol we eat is not absorbed and is excreted by our gut (i.e., leaves our body in stool). The reason is it not only has to be de-esterified, but it competes for absorption with the vastly larger amounts of UC supplied by the biliary route.
  5. Re-absorption of the cholesterol we synthesize in our body is the dominant source of the cholesterol in our body. That is, most of the cholesterol in our body was made by our body.
  6. The process of regulating cholesterol is very complex and multifaceted with multiple layers of control.  I’ve only touched on the absorption side, but the synthesis side is also complex and highly regulated. You will discover that synthesis and absorption are very interrelated.
  7. Eating cholesterol has very little impact on the cholesterol levels in your body. This is a fact, not my opinion.  Anyone who tells you different is, at best, ignorant of this topic.  At worst, they are a deliberate charlatan. Years ago the Canadian Guidelines removed the limitation of dietary cholesterol. The rest of the world, especially the United States, needs to catch up.
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431 Comments

  1. Lowering cholesterol, sugar and stress by Yoga and Acupuncture

    —by Paramjit S Tappia and Yan Jun Xu, Winnipeg, Canada, CV network 2013

    Elevations in LDL-cholesterol, obesity and stress are major cardiovascular disease risk factors (1). Due to the side effects of a number of pharmacological agents, the potential of Yoga and acupuncture on cholesterol levels as alternative therapies has been explored, particularly in the Western world. Yoga is an ancient type of mental and physical exercise originating in India, and has been reported to reduce oxidative stress, body weight and blood cholesterol. Acupuncture has been used in China to treat a variety of diseases since about two thousands years ago. In ancient times, people used a sharp stone to pressure some points for pain relief. Subsequently, acupuncture has been found to be effective in the reversal of coma and stroke as well as for the treatment of chest pain, irregular heart beat, hypertension and other conditions including asthma and insomnia.

    Recently it has been found that acupuncture is also effective for the control of blood lipids, glucose and oxidative stress. A literature review of 220 publications conducted by Peplow and Bater (2) has revealed that acupuncture with electrical stimulation (electro-acupuncture) can control elevations in blood sugar in obese women. In animal studies, electrical stimulation (15Hz) for 30-60 minutes is required for positive results. From the literature available on Traditional Chinese Medicine books, Zhongwan, Zusanli, Yishu and Geshu acupuncture points appear to be most frequently used for diabetic patients. Liang and Koya (3) reviewed acupuncture literature between 1979 and 2009; it was evidenced that acupuncture can reduce insulin resistance, hypertension, metabolic disorder, obesity and improve blood lipid profile. Furthermore, frequently used acupuncture points were Zusanli, Fenglong, Tianshu, Neiting, Sanyinjiao, Quchi, Qihai, Zhongwan, Guanyuan, Yinlingquan and Pishu.

    Siu et al (4) have reported that electro-acupuncture is able to lower oxidative stress by stimulation of the Zusanli point. It appears that electrical stimulation at low frequency (2 Hertz), 30 min/day for 4 weeks yields beneficial effects. It is pointed out that different frequencies of stimulation can exert different effects. The underlying mechanism of acupuncture is that stimulation of different points release different neuropeptides and hormones. In addition, it has also been suggested that resistance of nerve fibres and electrical signals are altered in different disease that can be re-balanced by acupuncture. Acupuncture and yoga promote well-being and health and have the potential to be used as a complimentary therapeutic regimen to improve blood lipid and glucose profiles as well as attenuate oxidative stress.

    References

    1. Adameova A, Xu YJ, Duhamel TA, Tappia PS, Shan L and Dhalla NS. Anti-atherosclerotic molecules targeting oxidative stress and inflammation. 2009; 15: 3094-3107.

    2. Peplow PV and Baxter GD. Electro-acupuncture for control of blood glucose in diabetes: Literature revies. J Acupunct Meridian Stud 2012; 5:1-10.

    3. Liang F and Koya D. Acupuncture: is it effective for the treatment of insulin resistance? Diabetes, Obesity and Metabolism. 2010; 12:555-569.

    4. Siu FKW, Lo SCL, and Leung MCP. Effectiveness of multiple pre-ischemia electro-acupuncture on attenuating lipid peroxidation induced by cerebral ischemia in adults rats. Life Sciences. 2004; 75:1323-1332.

  2. I lost 26 pounds 154 to 128 lbs and my cholesterol went from 190 to 274 and my ldl went up as well. It occurred during menopause. I am not a fan of statins. Both my father and grandmother developed diabetes about a year after taking statins. Can you give me any advise?

  3. In view of the 10 to 1 gradient between concentrations of LDL in plasma and interstitial fluid, a level of LDL-cholesterol in plasma of 25 mg/dl would be sufficient to nourish body cells with cholesterol. This is roughly one-fifth of the level usually seen in Western societies. Several lines of evidence suggest that plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl. In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels. Second, the LDL level in newborn humans is approximately 30 mg/dl, well within the range that seems to be appropriate for receptor binding. Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl.

  4. Although I know the main issue is high chlesterol, is there any chance all this could be be used to study how to increase cholesterol levels on children with learning delays, autism, etc, and very low cholesterol levels?

  5. Hi Dr. Attia, (I have sent this same letter to some lipid specialists but I think I should rather hve sent it to you. Here goes. just know in my knower that even with these specialists we will be given a lowfat diet regimen and statins. I have the disease, so do my 2 sons. My eldest son just had quintuple bypass at 34. My heart is broken. My mother has it and she’ll turn 83 this year. I also don’t have CVD. BUT, I went onto KETOGENIC diet in 2012 and for the first time in my life my total cholesterol came down to 6. Even on lots of lipid lowering drugs (NO, we cannot tolerate statins – we certainly WILL die on them – we get rhabdomyolises on it) my numbers never went lower than 8.8. NEVER. THUS I feel that our ilk have been left out with true research. They’re thinking like Ancyl Keys that eating fat is deadly for us, whereas my own GP told me that the blood can’t lie! AND, when my son tell them he can’t tolerate statins, they shrug their shoulders and say, “well now that’s a great pity”. I am quite cross and I need some diet science aimed at us! I do believe it lies with keto dieting. AND, very quickly too my cholesterol plunged on this diet! But my boys! I need them to live and not get sick on the only thing on offer and that horrible low fat diet. Sorry to be so abrasive, but I’m sick to death of this disease. I don’t care any longer if I die or not, but my sons OMG!
    ps I daresay too, that the motherload of these people are here in South Africa. They count among white Afrikaners, Ashkenazi Jews and strangely enough, our Indian population. I doubt very much whether we count as 1 in 500 – over here I wouldn’t be surprised if it’s 1 in every 40 or 50 people. My mother is surrounded by 4 other old ladies (strangers) in her retirement village who also have it. Of course, the men are not in that village, since they never MADE it!

  6. Very interesting! I have just come from a wellness checkup and was told that my “bad” cholesterol (triglyceride levels) was too high and pravastatin was prescribed to me. So, I came directly to do a little more research – before buying the drug! Just from the side-effects of the drug, make me question using it, now I see I need more research/education to learn the real issue of my cholesterol.
    Thank you.

    • Actually it is my “calculated LDL” is too high, which apparently means my HDL and triglycerides are too low. Will keep reading to learn if the provastatin (pravastatin?) is warrantied as prescribed.

  7. Question: what percentage of cholesterol in eggs is esterified?

    I have read that “the vast majority” and “the majority” of cholesterol we eat is esterified (and hence we excrete it unless our body decides we need more and un-esterifies it. But does that mean 51% or 90%? Specifically with eggs – which I have taken to eating several of each day, what percentage of cholesterol in eggs is esterified?

  8. Can you tell me where I could find documented proof that Canada removed the limitations of dietary cholesterol. My dad has had high cholesterol for years, had bypass surgery done on both his legs and his heart and has been on statins for as long as I can remember. He blindly follows the advice of his cardiologist and if he even sees butter in my house, he starts to lecture me and since my last blood test showed that I had high cholesterol, it won’t get any better. Great article by the way! It really confirms a lot of the research that I’ve been checking out, like Framington, Massachusetts and others. I really do believe that if you do some research and follow the money trail, you really find the truth.

  9. Hi Peter,
    You may know everything about cholesterol but your mastery of Roman Numerals is a bit off, check your chapter numbering above….

  10. Everywhere I read that the quantity of dietary cholesterol does not affect the level in the blood. But in all discussion sites people say that after going paleo their cholesterol shoots up – mine did (TC), from 150 in 2010 to 220-240 and the last 260 in 2014. So maybe more than 20% experience this. Of course all other things improve but people are still contemplating limiting high cholesterol foods like eggs, liver, butter, red meat, cheese – all good things.

    • Two years ago I was diagnosed with Hashimotos disease and high cholesterol. I didn’t take the statins because of side effects, but did start thyroid med. To address cholesterol I began a low carb diet. Three weeks later my lipid panel was normal and three weeks after that I was diagnosed with Guillian Barre Syndrome. I recovered about 90% of muscle strength and have some residual tingling in hands and feet. I followed no particular diet during recovery, but ate more meat than usual. After GBS I fell back into a high carbo diet and felt awful. I’m back on a low carb diet, feel MUCH better, but have some lingering concern that my GBS was somehow related to the low carb diet. My doctors say it’s not possible and I find nothing “in the literature” relating GBS to diet. Have you ever heard of any such relationship?

  11. What about those with the apoe4/3 or apoe4/4 variant following a high-fat ketogenic diet? My understanding is that LDL levels rise to compensate for the lack of uptake in the brain.

    I can foresee two outcomes: brain has enough, total LDL drops or brain never has enough, LDL always goes up. Considering LDL particulate size matters, would the diet be a net benefit regardless?

    • ApoE 3/4 and 4/4 are complicated, and their management deserves its own post at some point. The clinical implications are clear. The optimal dietary strategy is less clear, though I have my very strong bias.

  12. Dietary cholesterol does not effect blood level cholesterol – not true. Chris Masterjohn reckons 80% of people are not effected by dietary cholesterol and based on my personal experience I would say he is correct. When I eat eggs and or lambs liver my cholesterol shoots up, when I cut them out it returns to normal

  13. If cholesterol enters the system mainly via the liver, then how do I enhance that to end up with optimal cholesterol levels? How do I keep cholesterol out of places it does bot belong?
    Can I achieve these goals without statins and/or other drugs?

  14. Hello Peter,
    My mother has just made her blood test done, and she was very depressed by the level of cholesterol she had. I told her not to stress out. She doesn’t speak English, so I want to translate your posts on this topic into Russian, so she will be able to get this knowledge.

    There is also a very good site about Low-Carb-High-Fat (LCHF) diet, which tries to debunks the myths about lipids, carbs, cholesterol etc. Is it possible to post the translation of your posts on this website? With all references, of course.

    Regards,
    Laura

    • Don’t worry about it, my mother was 90 years old and her doctor had her on statins!! The human body does not produce toxins, only metabolized byproducts which are excreted. Chol and all of it’s derivatives are produced for a reason. THE BODY NEEDS THEM. 40-60% of chol is used by the brain. That’s why cognitive disorders (memory loss, dementia) are listed as one of several side effects! Just remember that in spite of all of the rhetoric, genetics are the source of the problem not Lipids (chol, LDL, HDL, etc). See my lengthy response on this subject with todays date on the blog site. Just so you’ll know. I’m a medical biochemist.

  15. Shouldn’t you edit your statement that cholesterol is only produced by organisms in the animal kingdom? Cholesterol is found in much smaller amounts in various plants.

    Maybe you should also clarify the statement that 25% of our cholesterol comes from what we eat, considering that those who choose not to eat animal products are getting only a miniscule percentage of their cholesterol from what is eaten.

  16. I love this latest (and completely legit) knowledge about cholesterol. It’s high time someone gave us the truth for our high tails. Thanks Dr. Loop.

    Statin therapy, and the institutionalization for it is a very grotesque conspiracy involving the drug companies, the FDA and other medical institutions, including those who don’t know the truth. Some involved are not directly involved in the conspiracy.The FDA and the drug companies are manipulating science and physiology with incomplete and false research, passing it off as legitimate. And main-stream Doctors have to accept it as something real. But it is fraudulent and lacks a scientific foundation. If you look up the right kind of researchers they will prove this to you. Our modern day Cholesterol/Heart disease research paranoia is bogus. This is happening because it was discovered in the late 80’s (I don’t have documented proof, but rather hearsay, from a reliable source) it was discovered that artificially induced “free radicals” caused by toxins found in drugs and medications are also triggering off heart attacks and strokes. And if the general public knew this it would put the drug companies out of business, or at least in their proper place. (See Craig Bowman’s “Cholesterol Miscast As Villain In Fight Against Heart Disease” & google Dr. Matthew Loop).

    Statin therapy is actually being used as a diversion for the drug companies to create the appearance that heart disease is entirely “natural causes”, so they use a natural substance in the body to blame it on – “cholesterol.” When in truth the drug companies themselves are largely responsible for heart attacks and strokes. Cholesterol is nothing but a scapegoat. It has also been recently discovered that large amounts of “Homocysteine” in the body causes the inflammatory stage of heart dis-ease, “inflammation.” And we are not hearing any of the legitimate studies, such as this, in the main-stream media. It all centers around the myth on national TV. And the FDA refuses to dislodge the fallacies because of the money involved.

    Certain pre-med and other medical students are actually being taught, in some schools, that coronary and arterial plaque build-up is almost 100% cholesterol. An absolute lie. Even the teachers believe it. But nothing could be further from the truth. Read Craig Bowman’s article. American people who have plaque removed from their bodies are not allowed to see it. But Craig is a Canadian. He knows better. He explains it. The cholesterol/heart disease paranoia is the biggest medical fraud in the history of mankind. It’s a multi-billion dollar cover-up. The drug companies and FDA have several legislators in their pockets.

    Spiritually speaking, that one element of grace left in Pandora’s box will suffice for us all. Let’s trust in our own higher powers. That’s all the hope we need. In the book of Revelation it tells us that the adversary is allowed to rule and control this world. God allows it all to happen. Our collective societal karma must be able to unfold by itself, on its own, so mankind can realize his mistakes and see his lack of conscious light. Mankind is asleep. But some day all will be well.- Vernon

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