If Cholesterol Clogs The Arteries, Then Why Isn't It A Major Component Of Arterial Plaque

Fair enough question is it not?

For decades we have been told that cholesterol and saturated fat clog our arteries like grease in a drainpipe, but if that was the case, then you would expect arterial plaque to be a big blob of cholesterol.

Have you ever wondered what it is really made up of?

I did a bit of investigating, and this is what I found...

Arterial plaque is made up of the following:

-Fibrin

-Platelets

-Red blood cells

-White blood cells

-Cholesteryl esters

-Free cholesterol

-Phospholipids

-Oxidized phospholipids

-Triglycerides

-Lipoproteins

-Macrophages

-Foam cells

-Smooth muscle cells

-T lymphocytes

-Dead cell debris

-Collagen

-Elastin

-Proteoglycans

-Fibrous scar tissue

-Calcium salts

-Other minerals

'Ah!' I can hear you say, 'I see cholesterol in that line-up'.

Yes, it does factor, but the biggest percentage of arterial plaque is composed of:

-Collagen

-Elastin

-Smooth muscle cells

-Calcium.

Lipids (Fats and fat like substances such as cholesterol) make up just 20-40% of a plaque. Of this, it CAN be true to say that the sterol cholesterol is a major component. But if we are talking about the total volume of arterial plaque, then saturated fat and cholesterol amount to very little.

Why the science story isn't the whole truth

To pick the truth apart, we need to head back to the 1950s and look at research conducted by the physiologist Ancel Keys, as he was the one that introduced the lipid-heart hypothesis. Keys conducted the famous 'Seven Countries Study' which he claimed showed that populations with higher saturated fat intake had higher average cholesterol levels and more deaths from coronary heart disease. What Keys failed to state was that the original study was on 22 countries, but their data didn't fit with his narrative and therefore he didn't include them in the results.

In other words, he cherry picked the data, and the countries with high saturated fat and low rates of heart disease were omitted.

Tobacco to sugar. How Fat became the villain

At the same time that bullish Keys was promoting his flawed hypothesis as 'proof' of heart disease, the risks of smoking were surfacing and the tobacco companies wanted to divert the blame.

They had a convenient villain...fat!

And as smoking rates fell and regulations tightened, tobacco companies invested heavily in sugar and processed food, using the same marketing tactics that they used with tobacco. This helped normalise sugar and ultra processed food in the diet, and demonise saturated fat and cholesterol. The UK was one of the first countries to adopt official guidelines on cholesterol and saturated fat, based on Keys hypothesis.

Which makes the current (non evidenced based) guidelines a load of old nonsense. Non evidenced based, because no randomised controlled trials have ever been conducted on the 'Eatwell Guide' or it's predecessor the 'Eatwell Plate'.

Public Health England (PHE) reference RCTs to only support the principles of the guidelines, but not the actual proportions specified.

What are 'clogged arteries'?

Arterial plaque is not a blob of cholesterol, It is a scar like build up of blood clots from repeated damage to the glycocalyx (the non stick lining of your blood vessels) It makes as much sense to avoid food containing saturated fat & cholesterol, as it does to avoid collagen, or calcium (major components of plaque).

Which leaves us with the question...

If sat fat doesn't cause heart disease, and 'clogged arteries' are the result of repeated damage to blood vessels and clotting, what causes this damage?

The following are some factors that damage this barrier:

Pharmaceuticals such as:

-Ibuprofen and other NSAIDs (anti-inflammatory drugs)

-Omeprazole and other PPIs (drugs for reflux)

-Steroids and chemotherapy agents

Lifestyle factors:

-Chronic stress

-Poor sleep

-High cortisol

-High pollution

-Lack of sunlight (UV and near infrared exposure stimulates nitric oxide, supporting vasodilation and endothelial health)

However, one of the biggest causes of heart disease is vascular damage from insulin and blood sugar spikes.

Within 6 hours of raised blood sugar, the glycocalyx is damaged. This non-stick coating has many essential functions, including preventing blood clots, controlling and supplying nutrients to the cells, and clearing away waste products and pathogens. If you damage the protective barrier, blood cells and clotting factors stick, small clots form, and this repeated scarring leads to blood clots and heart disease.

If you want to reduce your risk, focus on fixing these factors.

Till next time,

Ali xxx