Dr Sebastian Liew: Cholesterol and Heart Health


Despite advances in modern medicine, heart disease remains the leading cause of death among adults in Singapore and in most advanced or developed countries.


From the perspective of conventional medicine, the main targets for preventing heart disease are treating high blood pressure, high cholesterol, lifestyle such as smoking and alcohol, and obesity.

Therefore, the emphasis has always been on diet and exercise. There is no doubt that such measures, when applied appropriately, will strengthen the heart. As mentioned in my book Leaf to Life, stagnation (of blood and lymph) is the mother of all diseases.

The present conventional thinking is that cholesterol is the cause of damage to the blood vessel walls, leading to atherosclerotic deposits. Therefore, lowering cholesterol is the primary measure to prevent heart disease.

In Chinese medicine, all mental illnesses are attributed to an imbalance in the heart.  In modern terms, we could say chronic stress leads to heart problems. (istock.com)

Judging from the feedback of my clients, statin drugs are often prescribed if levels of low-density lipoprotein (LDL, or the “bad cholesterol”) are high, regardless of favourable high-density lipoprotein levels (HDL, or the “good cholesterol”), or the total cholesterol-to-HDL ratio.

Statin drugs are known to deplete coenzyme Q10, which is necessary for the health of the heart and the immune system. Some of us would supplement with coenzyme Q10 and continue with statin drugs. But this does not solve the root cause of the problem.

Cholesterol is a fat-like substance produced by the liver, and it serves many critical functions in the body. Cholesterol is found in all the cells of the body.

It is also a vital component for making hormones, such as the sex hormones oestrogen and testosterone, and stress hormones such as cortisol. In fact, when your level of stress goes up (whether it is stress from work or family, air pollution, or insufficient sleep), your body will produce more cholesterol to cope with the stress.

Cholesterol is also needed to produce vitamin D, which is one of the most important vitamins needed for immune and hormonal health.


While high cholesterol is often cited as an important risk factor in heart diseases, studies have shown that more than half or people dying from a heart attack or stroke have low or normal cholesterol levels. 


We read cases where some people with none of the above risk factors die after collapsing at a marathon or just after a jogging session. Certainly, heart failure can be due to many causes other than high blood pressure and cholesterol.

It is important to note that the total cholesterol to HDL ratio (refer to your medical test report) tells you whether cholesterol is deposited into the tissues or broken down and excreted. The ratio of total cholesterol to HDL should not be higher than 4.2, and the LDL to HDL ratio should not be higher than 3.

Therefore, it is not so much the cholesterol level, but rather the balance between HDLs and LDLs and not forgetting other leading factors – chronic inflammation, high HbA1c (diabetic marker) and oxidation of LDLs (oxidative stress).

Pathophysiology teaches us that heart disease or atherosclerosis is a result of injury to the artery and blood vessel walls, leading to cracks and lesions. This injury can be due to many factors including:

– High blood pressure & low HDL cholesterol

– Infection

– Autoimmunity

– Tissue weakness as a result of deficiency of oxygenated blood

– Integrity of the blood vessel walls

– Oxidative stress, resulting in oxidized LDL cholesterol is one of the main contributors to ‘injury' to the artery walls.

– Chronic inflammation from poor diet and stress

– Poor circulation from lack of exercise or aging

– Lifestyle such as smoking

– Hyperhomocystinemia

– Insulin resistance (watch out for triglyceride levels)

– Deficiencies in the diet such as lack of vitamin C food and essential fatty acids

– Low thyroid activity (not necessarily shown in standard blood tests)

Therefore, the holistic way is to stabilise the artery walls by healing the ‘injuries', thereby decreasing the need for the increase in cholesterol production.

Do you notice that as you get older, your wounds do not heal as quickly? Imagine this is also happening in your body and blood vessel walls.


Phytotherapy offers a good option to heal or prevent ‘injuries', as many herbs and foods have wound healing properties and are demonstrated to strengthen tissues, heal ‘injuries', modulate inflammation, maintain healthy lipid levels, and promotes good blood circulation and oxygenation. 


Herbs such as amala, gotu kola, hawthorn, and rosemary are healing herbs for lifelong prevention of heart disease and unhealthy cholesterol ratio profile.  (Note: Do seek professional coaching in the use of herbs if you wish to embark on a natural healing approach.)

In my upcoming herb fest (www.theherbfest.com), I will demonstrate how to create home remedies to prevent heart attack and stroke. I will be teaching how to read your body for any possible heart problems.

There is much confusion about which foods are beneficial and which foods are detrimental to heart health. Eggs, butter, and meat are often demonised as they are high in cholesterol. I have seen many cases of high cholesterol profiles in lifelong vegetarians, and normal cholesterol profiles in mainly meat-eating individuals.


The fact is, it’s not the fats consumed that cause high cholesterol, but rather sugars, refined carbohydrates, high starch diet. This coupled with rancid fats (note: refined oils are often used in most restaurants and hawker foods) causes oxidation of lipids.


Our Asian diet typically has a lot of rice, noodles, and other refined flour foods.

In my opinion and from my years of observation, heart disease is usually caused by chronic stress.

Avicenna (980 AD-1037 AD), the famed Islamic physician, taught that the heart possessed a greater function than simply being a pump. To him, the heart is the seat of emotions such as grief, joy, revenge, anxiety, and pleasure.


Hildegard von Bingen (1098 AD – 1179 AD), the 12th century famed German herbalist and Christian mystic, pointed out that the heart “thinks”. It is the “thought factory”.


In Chinese medicine, all mental illnesses are attributed to an imbalance in the heart.  In modern terms, we could say chronic stress leads to heart problems.

This is an important point to note as a lot of attention is on cholesterol rather than the underlying cause, which could be emotional factors such as unforgiveness, unexpressed anger, unhappiness, and denying the feelings that come with life (this may explain why men are more prone to heart attacks than women).

Sebastian Liew is the first Singaporean medical herbalist and doctor of naturopathy accredited with the Naturopaths and Herbalists Association of Australia.  He has over a decade of clinical experience in treating and preventing diseases with phytotherapy (Western herbal medicine). He is also the author of the book Leaf to Life: Unlock nature’s secrets to true health. Visit his website at http://slnaturopath.com, or contact him by email at sebastianliew@slnaturopath.com.

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