Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest to Dr. Weyrich that may be of interest to the world wide audience. Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is published here. Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of non-free access journal articles for him to review on a topic. Constructive criticism is also welcome.


Overview of Dyslipidemia

Disruption of the fat and cholesterol balance in the blood is referred to as dyslipidemia. Various different components contributing to cardiovascular risk are discussed separately:

Conventional medicine has concluded that dyslipidemia is associated with increased risk of heart attacks. While diet and exercise play an important role in both the cause and treatment of dyslipidemia, conventional medicine relies heavily on avoidance of animal products containing cholesterol and the use of statin drugs to treat dyslipidemia.

While dyslipidemia has been shown to be a predictor of future morbidity and mortality associated with cardiovascular disease, and therefore merits serious attention, some scientists have questioned the proposed cause and effect relationship between dyslipidemia and all-cause mortality. Other nutritional parameters may be more important, such as body levels of vitamins A, C, and E [Gey1991], [Rogers2008, pg 30].

However, many alternative health practitioners (as well as some conventional medical doctors) believe that the use of statin drugs may be misguided, since cholesterol is an essential component of all cell walls, and the metabolic pathways blocked by statin drugs also produce CoQ10, a necessary component for the metabolism of mitochondria, as well as a variety of important hormones, including cortisol, estrogen, progesterone, and testosterone.

Furthermore, many alternative health practitioners (as well as some conventional medical doctors) believe that avoidance of foods containing cholesterol, such as eggs, may also be misguided, since the body is perfectly capable of making cholesterol from any dietary source of calories - carbohydrates, proteins, or fats. Instead, they believe that the focus should be on avoiding "bad fats" - trans-fats (margarine, partially hydrogenated oils), and fats from corn-fed animals.

Dr. Weyrich continues to evaluate available medical evidence related to the role of cholesterol in health and disease. However medical ethics requires fully informed consent from the patient, which requires that both sides of this controversial subject be presented to the patient and discussed. Dr. Weyrich summarizes below both sides of this controversy, and provides links to Amazon.com to purchase some of works that document the scientific evidence for the information below. As time permits, Dr. Weyrich will also enhance this web page with links directly into the PubMed database of scientific literature to support the information presented here.

Dr. Weyrich urges all patients who have been diagnosed with "high cholesterol" or who have been prescribed statin drugs to consider both sides of this issue and to discuss this information with your doctor. Dr. Weyrich also suggests that if your doctor is unwilling or unable to discuss both sides of this issue that you find a new doctor. Unfortunately Medicare refuses to recognize Naturopathic Medical Doctors, and it appears that doctors who will be approved by ObamaCare will be required to toe the conventional line and will not consider alternatives. Dr. Weyrich deplores the medical paternalism inherent in centrally planned government-sponsored health care, which he views as a breach of the doctor-patient relationship and a violation of medical ethics.]

Dr. Weyrich also wants to emphasize that there is no such thing as "one-size-fits-all" medical practice, and for some patients the conventional approach to treating dyslipidemia may be appropriate. You and your doctor should make an informed decision regarding your personal situation, after considering all of the information presented below as well as your unique biochemical physiology. No 12-person central committee can do this [although it appears a majority of voters want to let them try - but the buyer should beware - usually they get what they pay for].

Finally, Dr. Weyrich wishes to emphasize to his students that it is important for them to know what the conventional view is, as well as the alternative view, and to understand the evidence supporting each side. When taking exams, the "conventional" answer is probably the appropriate answer, unless the question clearly calls for an "alternative" answer. Medical ethics requires that doctors disclose both sides of the argument to patients. Support staff have a similar ethical obligation, but may be prohibited by law or company policy from disclosing information not provided by the doctor [this is what is called an ethical dilemma; in extreme cases it leads to what is called the Nuremburg defense].

Conventional and Alternative Medical Views Regarding Fats and Cholesterol
Conventional ViewAlternative View
Elevated LDL Cholesterol is associated with cardiovascular disease. The same studies that show an association between elevated cholesterol and cardiovascular disease also show that there is NOT an association between cholesterol and all-cause mortality. This is because there appears to be an inverse association between cholesterol levels and other diseases, such as cancer.
Elevated LDL Cholesterol causes cardiovascular disease. Association does not prove causality. There is a large body of evidence that suggests that cardiovascular disease and elevated cholesterol are both caused by a third factor, namely inflammation of the cardiovascular tissues. Efforts should be directed towards reducing the underlying cause (inflammation), rather than the effect (elevated cholesterol).
Statin drugs are an effective way to lower cholesterol levels. There is no doubt that statin drugs are effective in lowering cholesterol. However there is scant evidence that statin drugs actually reduce all-cause mortality. Furthermore, some research suggests that any clinical benefit derived from taking statin drugs is due to their mild anti-inflammatory properties, rather than to their ability to prevent the production of cholesterol. There are safer and cheaper ways to control inflammation.
Statin drugs are a safe way to reduce cardiovascular disease Statin drugs block the body's production of both cholesterol and Co-Q10. Both of these substances are essential to normal body physiology. Cholesterol is the starting point for the body's production of important hormones, including estrogen, testosterone, and cortisol. Co-Q10 is a critical component of the electron transport chain in mitochondria that is responsible for most cellular energy production, including in heart muscle. Furthermore, some research shows that cholesterol is a critical to the formation of new memory synapses, and there appears to be a link between statin drug use and Alzheimer Disease-like disorders.
The most important lab test for assessing cardiovascular disease risk is a blood-lipid panel to measure HDL, LDL, VLDL, and TG (e.g. a "lipid panel"). As discussed above, it is not clear that taking statin drugs is beneficial, so why bother doing a test that is used to justify prescribing statin drugs? Instead, another test should be run, which measures homocysteine in the blood. Elevated homocysteine levels have been shown to correlate better with cardiovascular disease than the LDL-cholesterol levels, and elevated homocysteine levels are also indicative of the inflammatory process that is thought to underlie both elevation in cholesterol and increase in cardiovascular risk. In most cases, elevated homocysteine can be easily treated with non-prescription vitamins - much to the pharmaceutical companies' chagrin.
The "lipid panel" measures cholesterol.The lipid panel does not directly measure cholesterol. Instead it measures the amount of several balls of proteins that can carry fats and cholesterol (lipids). These balls of protein plus the fats and cholesterol are called HDL (high density lipoprotein), LDL (low density lipoprotein), and VLDL (very low density lipoprotein). LDL and VLDL carry lipids TO cells in the body, and are considered "bad" cholesterol; HDL carries excess lipids FROM the cells back to the liver for elimination, and is considered "good" cholesterol. Generally speaking, increases in either "bad" fat intake or cholesterol will elevate levels of LDL and VLDL.
Total Cholesterol should be under 200. Total cholesterol is calculated by combining in a formula the HDL (high density lipoprotein), LDL (low density lipoprotein), VLDL (very low density lipoprotein), and TG (triglycerides). Since HDL is considered to be "good cholesterol" that REDUCES cardiovascular risk, people who have high HDL may have "normal" "bad cholesterol" but still exceed the total value of 200. There is no rational reason to treat such people with statin drugs.
The fact that persons who have the genetic disorder called Familial Hypercholesterolemia (in which the body makes an abnormally high amount of cholesterol) are at high risk for cardiovascular disease (CVD) proves that cholesterol is bad. However, other studies report that while the risk of CVD is increased in these patients, the risk of cancer is reduced. Furthermore, there is another genetic disorder that has also been studied, in which the body produces an abnormally LOW amount of cholesterol. These unfortunate patients fare far worse - thus showing that LOW cholesterol is worse than HIGH cholesterol. This is not surprising - as with most things, moderation is important.
Saturated fats are unhealthy.Numerous authors have pointed out that the original research that is usually cited in support of the assertion that saturated fats are unhealthy was invalid because it ignored conflicting data.
Because butter and coconut oil are saturated fats, they are bad fats. Even if some saturated fats are bad, it is important to distinguish between short chain, medium chain, and long chain fatty acids. Long chain fatty acids require LDL for transport in the blood, because they are highly hydrophobic. Short chain fatty acids are soluble in water and do not require LDL for transport. Medium chain fatty acids are somewhere in between. Butter is mostly composed of short chain fatty acids, and coconut oil is mostly composed of medium chain fatty acids.
Margarine is healthier than butter. Not even most conventional doctors believe this today, but they once strongly supported this idea. We now know that margarine contains trans fats that are unnatural and interfere with cellular membrane physiology.
Modern processed foods that contain hydrogenated oils are "trans-fat-free" This is not necessarily true. Manufacturers are allowed to claim "0-grams trans fat per serving", if there is less than 0.5 grams of fat (they are allowed to round down). If the serving size were increased, they might have to label the presence of the trans fats.
Poly-unsaturated fatty acids (PUFA) are the most healthy fats to consume. There is some evidence that olive oil, which is mostly made of mono-unsaturated fatty acids (MUFA), is healthier than PUFAs. However, it is not clear whether the difference is due to the number of double bonds in the fat molecules, or due to the chemical processing that PUFAs sold in the stores undergo that virgin olive oil does not, or due to the fact that the more double bonds in a molecule, the more susceptible the fat is to oxidation to form rancid products that are harmful.
A high-cholesterol diet causes cardiovascular disease. The landmark studies that are usually cited in support of this claim were done by feeding rabbits large amounts of cholesterol. Since rabbits are vegans and do not normally eat foods containing cholesterol, it is not surprising that they are not well adapted to consuming large amounts of cholesterol; However, humans are omnivores who have eaten animal products containing cholesterol from prehistoric times and would be expected to be far better adapted to a diet containing cholesterol. Furthermore, some scientists have suggested that the cholesterol fed to the rabbits may have been contaminated with oxidation products that are harmful.
Eating fat makes a person fat.Whenever a person consumes more calories than they burn, there will be a tendency for the body to store the excess as fat. However, fat in the diet promotes the release of "satiety" hormones that cause the person to feel "full" and therefore stop eating. In many cases a person eating fats early in the meal (for example a salad with olive oil and vinegar dressing) will want to consume fewer total calories.
Eating a low fat diet is the best way to lose weight.See the comments in the previous entry, but also consider that when the fat is taken out, something else is put in - usually more carbohydrates which tend to raise blood sugar levels. When the blood sugar goes high, the pancreas releases insulin, which tells fat cells to absorb the extra glucose from the blood and to store it as - FAT!!!!

Etiology of Dyslipidemia

Hypothyroid conditions have also been strongly associated with dyslipidemia, and treatment of underlying hypothyroidism has been found to be very effective in addressing dyslipidemia and reducing associated diseases [Barnes1976], [Barnes1976], [Starr2005, pg 10].

Furthermore, evidence suggests that in many cases, dyslipidemia is a direct result of a diet that is too high in simple carbohydrates and too low in blood-sugar-stabilizing fats and protein, and to a lack of regular exercise.

Concerns have been raised that antihypertensive drugs such as diuretics and beta-blockers may contribute to dyslipidemia have been raised [Ames1976], [Day1979], [Rogers2008, pg 14], [Tanaka1976], [Waal-Manning1977].


Treatment of Dyslipidemia

In one study, treating underlying hypothyroidism resulted in a reduction in total cholesterol of between 25 and 200 points in over half the patients treated [Starr2005, pg 10], [ Gelb1977].

At least one study shows that a 60% fat diet is more effective in improving dyslipidemia and losing weight than a 30% fat diet. As summarized by Dr. Starr, the results of the study reported by Duke University in 2002 are as follows [need reference]:

% Fat in dietWeight loss #% Change HDL% Change TG
60%30 #+11%-49%
30%20 #0%-22%

In conclusion, avoidance of dietary animal fats may be counterproductive in avoiding dyslipidemia. On the other hand, correcting hypothyroidism appears to benefit dyslipidemia. Since high insulin levels are associated with fat accumulation, a low glycemic index diet combined with moderate exercise appears to be critical.

Furthermore, the evidence presented begs the question of whether dyslipidemia should even be treated as a therapeutic target at all. After discussion of the information presented on this web page, and after signing a consent form stating that the patient is aware of the conventional approach as well as its alternatives, Dr. Weyrich will be happy to provide a patient with an alternative treatment plan consistent with the individual patient's biochemistry and physiology.


Hypotheses regarding Dyslipidemia

The liver is very metabolically active and consumes large amounts of ATP energy. As a result, the liver is sensitive to mitochondrial dysfunction such as occurs in hypothyroid conditions. In addition, myxedema in the liver may interfere with the liver's secretion of bile into the canaliculi by compressing the canaliculi [Hertoghe1914], [Starr2005, pg 139].

References for Dyslipidemia