High cholesterol and sunlight deficiency

With the last few posts having been focused on the big yellow orb in the sky, and with several papers focused on cholesterol scattered on my bedroom floor that I have every intention of writing up, tonight’s paper of the week, month, whenever…whatever… seems to form a nice bridge between the two themes.  And it is a bit of an old-school paper, dating back to 1996…

Sunlight, cholesterol and coronary heart disease

We investigated the relationship between geography and incidence of coronary heart disease, looking at deficiency of sunlight and thus of vitamin D as a factor that might influence susceptibility and thus disease incidence.

Sunlight deficiency could increase blood cholesterol by allowing squalene metabolism to progress to cholesterol synthesis rather than to vitamin D synthesis as would occur with greater amounts of sunlight exposure, and the increased concentration of blood cholesterol during the winter months, confirmed in this study, may well be due to reduced sunlight exposure.

In very simple terms, these authors are suggesting that given the common precursor between cholesterol and vitamin D [squalene], when there is insufficient sun exposure occurring to drive the reaction down the vitamin D production pathway, then it heads down the cholesterol production pathway instead, increasing total blood cholesterol levels.  Now the lipid hypothesis of coronary heart disease [CHD] would suggest that these high cholesterol levels are causative in the development of heart disease, hence cholesterol-lowering is a target of both dietary and pharmaceutical treatments.  But, according to the hypothesis of the authors here, high cholesterol levels are simply a marker for a lack of sunlight exposure, and it is this lack of sunlight exposure (and the link to vitamin D status), which is behind the development and progression of coronary heart disease.

The structural similarities of cholesterol and vitamin D and their common precursor led us to wonder whether a high level of blood cholesterol within a population might be a manifestation of sunlight deficiency.

Interesting…

They point to a few lines of evidence to support their take on things.  Firstly, that deaths from coronary heart disease are more common with increasing distance of residence from the equator.  Also, the death rate from coronary heart disease decreases with increasing altitude of residence…

These observations suggest that differential rates of sunlight exposure might be the common factor which determines susceptibility to coronary heart disease, the high levels of sunlight exposure at low latitudes and high altitudes being protective and the relative deficiency at high latitudes being responsible for a high incidence.

They also point to the lack of efficacy of interventions which have directly targeted cholesterol as evidence that cholesterol itself is merely a marker rather than a cause of CHD…

However the risk [of high cholesterol] to individuals without coronary heart disease is very small, and in such ‘normal’ people lowering blood cholesterol by drugs is of much less benefit…

Dietary manipulation aimed at reducing blood cholesterol has not shown any benefit…

The authors also make a reference to the much vaunted Mediterranean diet and its supposed cardioprotective effects, suggesting how it may not be the diet of the region that is cardioprotective, but rather the climate in which the olives and grapes grow in that is…

It is well-known that death rates from coronary heart disease are much lower in the Mediterranean countries of southern Europe than in the Atlantic fringes of north-west Europe, and it usually assumed that this is due to different dietary patterns reflecting local agriculture. Hence we in north-west England are advised to drink red wine and to add garlic and olive oil to our diets and at the same time to stop eating ‘fish and chips’. But whereas migration has an effect on mortality risk, the individual adopting the risk of the place to which he has migrated, people who migrate tend to take their dietary patterns with them.

Furthermore, the dietary manipulation that has been part of prevention trials of coronary heart disease has been very disappointing, and overviews of the many dietary primary prevention trials have shown that there is no overall benefit.  These observations suggest that agricultural production and local diet might not be the explanation of susceptibility to coronary heart disease in a given country, and we suggest that local agriculture is a reflection of local climate, sun exposure in particular, and that this is directly cardioprotective.

The authors here delve into an alternative potential cause of CHD and the mechanism for why sun exposure may be cardioprotective, with their alternative underpinned by our old foe – inflammation…

More recently sunlight deficiency has been thought to precipitate clinical tuberculosis in Indo-Asian immigrants into this country [UK]. That vegetarian Hindus are more at risk than Muslims suggests that the latter obtain some vitamin D from meat and fish, and it is suggested that vitamin D deficiency suppresses immunity.

There is a distinct possibility that coronary heart disease has a microbial cause and at present the low-grade respiratory pathogen Chlamydia pneumoniae is the chief contender.  We suggest that sunlight deficiency increases the opportunism of such an organism in the same way as with tuberculosis.

In much the same way that tuberculosis develops in those with low vitamin D status and therefore diminished immunocompetence, the authors are suggesting that coronary heart disease could have a microbial trigger, which is able to gain traction in a vitamin D deficient individual.  The geographical feature of sunlight might be protective by enhancing immunity.

The paradigm for coronary heart disease in recent years has been along the lines that it is mainly self-induced through cigarette smoking and dietary misbehaviour, together with some family tendency or ill-defined genetic problem. The paradigm has been that coronary heart disease is ‘multifactorial’ and in some people effectively caused by one factor and in other people, by something else. We wish to challenge the traditional paradigm…

We propose that coronary heart disease is a specific disease with a specific cause which is probably a microbe and perhaps Chlamydia pneumoniae. We suggest that the rate of progress of the disease process can be modified by accelerating and inhibiting factors. We suggest that high blood cholesterol and cigarette smoking are accelerating factors of coronary heart disease but are not initiating factors. We propose that Vitamin D, or possibly one of its photometabolites, is an inhibiting factor, slowing down the rate of progress of disease. Other inhibiting factors are anti-oxidants such as Vitamin C and selenium, and it is clear that free oxygen radicals can increase the rate of progression of the disease.

So a very interesting hypothesis indeed.  Especially when many of the other arguments around cholesterol – particle size, oxidised cholesterol, etc., are added to the picture.  As mentioned, I have a few more cholesterol papers that I want to write-up, and I’ll certainly be taking a slightly different view of them in light of this paper.  I really have no idea when I’ll get to blog these other papers – along with other priorities, we are getting dangerously close to the Ancestral Health Symposium, where I have to get myself sorted to wow an audience there.  In the meantime, for the cholesterol geeks who just can’t quite get enough of the waxy stuff, check out the very excellent cholesterol series from Dr Peter Attia.

27 thoughts on “High cholesterol and sunlight deficiency

  1. Excellent post!

    I think Vitamin D is the missing piece in many “paradoxes” out there. This furthers the argument that no matter if we go into an omnivorous, herbivorous or carnivorous diet, as long as you eat it under the sun.

    1. I was actually thinking about this today, Lauren. It is assumed that it is vitamin D which is offering the cardioprotective effect. What we cannot assume, however, is that swallowing large amounts of pre-formed vitamin D will offer the same level of protection. In may in fact be something to do with the conversion of cholesterol precursors to vitamin D which enhance the immune processes. And it may not be either. But we cannot be too reductionist with it and just assume the end product is what we need to get the same effect.

      1. Mmm, I think that conversion process is probably key. If both are high the conversion process would be circumvented, no? Thus leaving lipids high with no place to go?
        Just saw a notice on a paper out of Zurich about calcium supplements raising the risk for MI if taken alone and in large-ish doses. This buffet-style nutritionism is going to kill a lot of people. http://heart.bmj.com/content/98/12/920
        Also, fun abstract: http://www.ncbi.nlm.nih.gov/pubmed/22398934

      2. Well, then don’t (just) take a pill: the idea (for now) is that it is the sunlight (making Vitamin D, and maybe not just Vitamin D) is what helps. Surely the next step is to see if it is vitamin D or something else from the sunlight. And the idea is that the body is making those lipids for a reason, and the reason may be in part because there is not enough vitamin D. Or maybe the idea is that those lipids have a role to play. It is an interesting beginning.

    2. Healthy Eskimos didn’t see much sun but got a decent amount of Vit D from food. This may point to the importance of Vit D itself so supplementation seems like a smart move.

  2. This has to be the most interesting approach in decades: Suppose, for a moment, that sunlight is necessary for heart health? And it is effective? Better and cheaper than any drug? And all you have to do is lie in the sun for a few minutes a few days each week?

    1. Yes it is interesting, combine this alternative with the paleo-diet which is better and cheaper overall than the standard diet, and Big-Agra and pharmaceutical companies with their minions in medicine are absolutely done for.

      It would be a revolution in the health & wealth of humans and the planet, if enough people were to act on information such as this, osit.

  3. Could even be that vit D/cholesterol is an index of sun exposure (yes already mentioned) and maybe it’s the circadian regulatory effect of bright light, allowing more restive (anti-inflammatory) sleep. Etc.

  4. Granted cholesterol is the precursor for vitamin D, it is also the precursor to CoQ10, pregnenolone (other steroids), etc. Sunlight will also stimulate the production of these other protective factors as the red light in sunlight increases respiratory chain activity in mitochondria. Some may argue that it is the red light that carries the most benefit and is why, in winter months, illness, depression, autoimmunities, etc. increase. Vitamin D is no doubt beneficial, but is only one single consequence of human exposure to sunlight. One also has to view it in the context of Ca and Ph metabolism as well and the effects of these two minerals on health. There is too much to say here, but these were my two cents.

  5. I think that looking at previous cultures in which cardiovascular disease was virtually absent, and seeing that these cultures occurred very near and very far from the equator, must be considered.

    Friggin typos.

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  7. As I read the paper, I was thinking to myself that hours of daylight probably trends with actual exposure but doesn’t guarantee it (as a child I spent way too much of my summer break in front of an Atari and playing D&D in basements.) The bit with the gardens was a nice gesture in that direction… I wonder if there is a study that is more centered on the participant’s exposure… perhaps using profession.

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