Introduction
Is cholesterol really the villain it's made out to be? Recent discussions in functional health circles suggest that the conventional narrative may be incomplete. In this post, I’ll explore insights from a fascinating YouTube discussion about the biophysics of heart disease featuring Dr. Stephen Hussey, interviewed by Dr. Max Gulhane, and connect them to my own health journey.
I was introduced to this discussion by my Brisbane-based Functional GP, Dr. Ravi Gornall (drravigornall.com.au), who has been instrumental in guiding me through optimising my health. This talk challenged conventional wisdom and offered a deeper perspective on how the body uses cholesterol. You can watch the full discussion on YouTube here.
Dr. Hussey’s book, "Understanding the Heart", delves deeper into these concepts, providing evidence and references to support his paradigm-shifting perspectives. For anyone wanting a comprehensive understanding of heart health, it’s an invaluable resource.
Key Takeaways from the Video
Cholesterol’s Role in the Body
Cholesterol is essential for:
Hormone production: It’s a precursor for vital hormones like testosterone and cortisol.
Cell membrane integrity: Cholesterol ensures that cell walls remain flexible and functional.
Repairing inflammation and oxidative damage: It acts as a transport molecule for fat-soluble nutrients and plays a role in healing.
The discussion emphasised that elevated cholesterol isn’t inherently harmful. Instead, it can reflect the body’s adaptive response to stress, inflammation, or injury.
Context Is Everything: Metrics Beyond LDL
Relying solely on LDL cholesterol to assess heart disease risk is outdated. More meaningful markers include:
Triglyceride-to-HDL ratio: This ratio indicates how well the body is managing fat metabolism. An ideal ratio is below 1.0.
Markers of inflammation: C-reactive protein (CRP), fibrinogen, and homocysteine provide better insights into cardiovascular risk.
Insulin sensitivity: Poor glucose regulation and insulin resistance are primary drivers of cardiovascular disease.
Example: My triglyceride-to-HDL ratio is 0.6, and my CRP is 0.5 mg/L, suggesting low inflammation despite elevated LDL (10.5 mmol/L or 405 mg/dL).
The Role of Inflammation in Heart Disease
The discussion argued that chronic inflammation and oxidative stress—not cholesterol—are the true culprits behind heart disease. When blood vessels become inflamed, cholesterol serves as a "patch" to repair the damage. Blaming cholesterol for heart disease is like blaming firefighters for being at the scene of a fire.
Atherosclerosis and Clotting: The Underlying Dynamics
Atherosclerosis (a condition in which the arteries become narrowed and stiffened due to the buildup of plaque on their inner walls. Plaque is made up of substances like cholesterol, fatty acids, calcium, and cellular waste products, which accumulate over time. This process can reduce or block blood flow, potentially leading to serious complications, such as heart attacks, strokes, and peripheral artery disease) was a key topic in the video, reframed as a process involving chronic inflammation and clotting rather than simply the accumulation of cholesterol. Dr. Hussey explained that when blood vessels are damaged or inflamed, clotting mechanisms are activated to repair the injury. This can result in plaque buildup over time if the underlying triggers, such as inflammation or oxidative stress, persist.
Hypercortisolism, a state of prolonged elevated cortisol levels due to chronic stress, was highlighted as a significant driver of vascular damage and clotting. Cortisol dis-regulation not only exacerbates inflammation but also contributes to insulin resistance, a well-established risk factor for cardiovascular disease.
Traditional Risk Factors Still Matter
While the discussion provided a fresh perspective, traditional risk factors were not dismissed. Conditions such as diabetes, smoking, and hypertension remain critical contributors to cardiovascular disease. These factors often worsen inflammation, oxidative stress, and insulin resistance, amplifying the risk of atherosclerosis.
Structured Water and the Quantum Lens
One of the more intriguing concepts discussed was the role of structured water in cardiovascular health. Structured water, also referred to as the fourth phase of water or exclusion zone (EZ) water, is believed to form within the body in response to specific environmental stimuli, such as sunlight and grounding.
Dr. Hussey highlighted the research of Dr. Gerald Pollack, whose work builds on the discoveries of Nobel Laureate Albert Szent-Györgyi. Pollack’s studies suggest that:
structured water enhances cellular and vascular function, improving blood flow and optimising energy utilisation. The sun, through its infrared spectrum, was emphasised as a key factor in energising structured water within the body.
Structured water’s role remains an area of emerging research, but its potential to reshape our understanding of cardiovascular health is an exciting frontier.
The Lean Mass Hyper-Responder Concept
During the discussion, the concept of a Lean Mass Hyper-Responder (LMHR) was mentioned. This term describes a specific subset of individuals who experience significant increases in LDL cholesterol when following a ketogenic or low-carb, high-fat diet. LMHRs typically share several key characteristics:
Low Body Mass Index (BMI): LMHRs are often lean, with a BMI that falls into the lower range.
Very low triglycerides (usually <0.8 mmol/L or <70 mg/dL).
High HDL cholesterol (often >1.55 mmol/L or >60 mg/dL).
Elevated LDL cholesterol (commonly >5.2 mmol/L or >200 mg/dL).
Active Lifestyle: Many LMHRs engage in regular physical activity or endurance exercise, influencing lipid metabolism.
Low-Carbohydrate, High-Fat Diets: The phenotype is most commonly observed in individuals following ketogenic or low-carb diets, suggesting the diet itself plays a role in this lipid profile.
Efficient Fat Oxidation: LMHRs rely heavily on fat for energy, leading to increased LDL particle circulation as part of the energy transport system.
Insulin Sensitivity: Low fasting insulin levels and excellent glucose regulation are often present.
A 2022 case study by Norwitz et al. (2022) further supports the existence of the LMHR phenotype, demonstrating that lean individuals with low triglycerides and high HDL may experience extreme increases in LDL when restricting carbohydrates. The study also highlighted that this phenomenon is not necessarily linked to high saturated fat intake but instead appears to correlate with lower BMI and metabolic energy demands. Notably, a subject in the study maintained extremely high LDL levels (~545 mg/dL or ~14.1 mmol/L) for over two years without showing any evidence of atherosclerotic plaque on a coronary CT angiography.
For LMHRs, the key is to assess cardiovascular health using a more comprehensive framework, including:
Triglyceride-to-HDL ratio: A low ratio (e.g., <1.0) suggests good metabolic health.
Inflammatory markers: Ensuring CRP and other markers are within a healthy range.
Overall metabolic function: Fasting insulin and glucose levels are critical metrics.
For individuals like me, who follow an animal-based diet with elevated LDL but excellent triglyceride-to-HDL ratios and low inflammation, this concept provides reassurance that cholesterol elevation alone is not necessarily harmful.
Applying These Insights: A Look at My Bloodwork
Recent Pathology:
Cholesterol: My LDL is elevated, but my triglyceride-to-HDL ratio and CRP suggest low inflammation. This aligns with the idea that my body is in a state of efficient fat metabolism rather than at cardiovascular risk.
Metabolic Markers: My fasting insulin is 4 mU/L (low-normal), indicating excellent insulin sensitivity.
Based on my bloodwork, I likely fall into the category of a Lean Mass Hyper-Responder, as my elevated LDL, low triglycerides, and high HDL align with this unique metabolic phenotype often observed in active, low BMI individuals (like me) following lower-carb diets. This underscores the importance of evaluating cardiovascular risk using a broader context rather than focusing solely on LDL levels. Future studies may shed light on the underlying mechanisms and implications of this phenotype.
Dietary Choices:
Following an animal-based diet, I prioritise nutrient density while avoiding processed foods that trigger inflammation. This approach has kept my triglycerides low (0.9 mmol/L or 80 mg/dL) and HDL high (1.38 mmol/L or 53 mg/dL), further supporting metabolic health.
Lifestyle Lessons:
The discussion reinforced the importance of mitigating oxidative stress. Practices like proper sleep, stress management, sunlight exposure, and grounding can all enhance cardiovascular health.
Practical Insights: How to Apply This Knowledge
1. Understand Your Labs:
Learn to interpret markers like LDL, triglycerides, HDL, CRP, ESR, and fasting glucose together for a comprehensive picture of your health.
2. Don’t Fear Cholesterol (In Context):
If your inflammation markers are low and your triglyceride-to-HDL ratio is optimal, elevated cholesterol may not be a cause for concern.
3. Prioritise Anti-Inflammatory Practices:
Focus on nutrient-dense unprocessed whole foods, such as pasture-raised eggs, grass-fed meats, wild-caught fish, in-season fruits and vegetables.
Avoid exposure to environmental toxins (chemical and electromagnetic).
Incorporate mindfulness, meditation, or other stress-reduction techniques.
Optimise sleep to support recovery and repair.
Work with your body’s natural hormonal circadian rhythm (wake at sunrise, sunlight through the eyes, sleep when it’s dark)
4. Work with a Functional GP:
Find a knowledgeable functional GP, like Dr. Ravi Gornall, who can guide you through comprehensive testing and personalised interventions.
5. Partner with a CAM Practitioner:
Consider collaborating with a complementary and alternative medicine (CAM) practitioner to bridge nutrition and lifestyle gaps. If this resonates with you, you can book a consultation with me.
Conclusion
This discussion helped me reframe my understanding of cholesterol and cardiovascular health, not as isolated issues, but as part of a broader interplay between our biology and environment. Cholesterol’s nuances, alongside sunlight, movement, and connection to the natural world, remind us that the human body is designed to thrive when fully and dynamically engaged with life.
On a meta level, these ideas underscore what it truly means to be human: to go outside, to move, to experience the world, and to follow your excitement. By aligning with the rhythms of nature and taking a proactive approach to health, we not only support our physical well-being but also nurture our sense of vitality and purpose.
I’d like to thank Dr. Ravi Gornall for recommending this thought-provoking discussion. It’s given me a new lens through which to view my health journey and has reinforced the importance of looking beyond conventional metrics.
If you’re curious to learn more, I highly recommend checking out Dr. Hussey’s book, "Understanding the Heart," and watching the full discussion here.
References
Hussey, S. (2022). Understanding the heart: Surprising insights into the evolutionary origins of heart disease-and why it matters. Chelsea Green Publishing.
Gulhane, M. (Director). (2024, February 1). Biophysics of Heart Disease & Why Atherosclerosis is NOT a Cholesterol Problem | Dr Stephen Hussey [Video recording].
Norwitz, N. G., Soto-Mota, A., Feldman, D., Parpos, S., & Budoff, M. (2022). Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.830325