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  Cholesterol as the Polar Opposite of Triglycerides
  

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By: Martin Errenst, M.D.
1.  Introduction:

Cholesterol, or to be more accurate, its concentration in the blood and in foods, is a recurrent topic in both the scientific and the popular press. The image presented is that of a harmful substance that causes disease and shortens life. Yet others will say that the cholesterol discussion is the invention of an industrial lobby to boost the sale of cholesterol-free margarine and plasma cholesterol level-reducing agents. Cholesterol thus is at the heart of the egotistical interests of industrialists on the one hand and consumers on the other.

Cholesterol also holds a central position in the evolution of chemistry and the physiology that has developed from it since the 18th century. Taking this as our starting point, an attempt will be made to show an image of cholesterol that does not have egotistical interest at the heart of it but lets the situation speak for itself. A helpful method is to look for polarities, since comparison of opposite but related objects lets them throw light on one another. There is no need then to draw on external criteria that have nothing to do with the matter. To do this here, cholesterol is considered in relation to fats as polar opposites among the lipids (i.e. fat-soluble substances). Fats and cholesterol are related not only because they have lipid character but also because of many physiological relationships; some of this will be considered below. On the other hand it will be shown that they are also polar opposites.

Everyone knows about fats, especially vegetable fats and oils, and we may therefore begin by characterizing them. Cholesterol, a substance generally known only as a slogan, can then be described in its polarity to the properties of fats.

2. Triglycerides

Fig. 1. Fatty acid composition of vegetable oils in relation to external temperatures


Everyone knows fats and oils, for instance in the kitchen, where vegetable fats play a major role. A vast variety of fats and oils with different qualities may be described. Even the widely used sunflower oil, olive oil and palm oil offer a broad spectrum of qualities. Palm oil is solid at room temperature,insensitive to heat and therefore used for frying and deep frying. Olive oil has its own taste and odor; it is liquid at room temperature but solidifies in the refrigerator or when the room temperature is lower in winter. Sunflower oil also has its own aroma and only solidifies at temperatures below 0°C. Linseed oil may be added to the range. It only solidifies if the temperature is markedly below 0°C and is sensitive, easily going rancid and needing protection from heat and light.

These fatty oils, as they are called, have to be distinguished from the volatile oils which pharmacists identify by the fact that drops applied to filter paper evaporate completely, whilst fatty oils leave a fat stain. Volatile oils are thus more inclined to evaporate, intensely addressing themselves to the sense of smell. Combustibility, a characteristic also of fatty oils, has here reached explosive and spontaneous combustion level. Volatile oils are not nutrients,like fats, but have pharmaceutical actions. At the other end of the scale,waxes, also not nutrients, are solid lipids that only melt at temperatures higher than fats do and are chemically more inert. Whilst volatile oils thust end towards the gaseous and waxes to the solid state, natural vegetable fats are generally fluid. Both waxes and fats do not melt or solidify at a sharply defined temperature but in a fusion interval. In the case of fats this covers a range from -15 to 40°C, which is the temperature range in which higher organisms are able to live.

Some of the many different qualities of fatty oils are evident in the different fatty acids that can be liberated and isolated from fats by saponification. Every natural fat contains a large number of different fatty acids. One is usually dominant and this usually owes its name to the fat concerned - oleic acid from olive oil, linolic and linolenic acid from linseed oil. Saponification also liberates hygroscopic sweet-tasting glycerin, a constituent found in all fats, which chemically distinguishes them from waxes.

The fatty acid composition of fats is primarily determined by the plant species that has produced them. Apart from this, environmental conditions,especially temperature, have a marked effect on the fatty acid composition (Fig. 1). Vegetable fatty oils are an important part of our diet, which means that we are all the time taking in this rich variety of substance qualities with natural foods. Two fatty acids - linolic and linolenic acid - are only produced by plants and essential to humans, for whilst the human organism is unable to produce them it does need them. Fats of animal origin are clearly also important for nutrition. Milk fats in particular offer a great variety of fatty acids. (7) Apart from carbohydrates fats are the main basis of energy metabolism. They go through physiological "combustion" in the organism, so that their substance quality is destroyed.

Fatty oils are thus characterized as substances available in great variety in nature that offer differentiated qualities perceptible to the senses. We have distinguished them from the volatile oils and waxes, identifying them as nutrient lipids that are nonvolatile, with their melting point in the -15 to 40°C range.

3.  Cholesterol

Fats have been known to man from early times. Fats and flour (cereal grains) are the staple foods of settled people and part of their culture and religion.The whole of the Mediterranean landscape is given its character by the olive tree which was sacred to the Greeks. The founding of Athens involved the goddess Athena giving the people an olive tree. Cholesterol on the other hand had to be discovered by scientific means in more recent times. The history of its discovery begins in the second half of the 18th century (1769-1789) when French chemists investigated and described the waxy consistency of gall stones. This history of cholesterol is essentially based on the paper by Neuhausen. (29) At the beginning of the 19th century (1815-16) Chevreui described the cholesterol he had isolated from gall stones as a substance in its own right. He distinguished it from waxes and fats because of its high melting point (147.5°C) and because it could not be saponified by boiling in lye to produce soap, a fatty acid salt (v. s.). Chevreui gave cholesterol its name from Greek chole = bile and stereos = solid.

It was not until 1932, a century later, that Windaus finally established the molecular structure; Woodward then synthesized it in 1951. Cholesterol thus followed the whole evolution of our modern chemistry in which matter is weighed, a chemistry given its original foundation by Lavoisier at the end of the 18th century, exactly at the time, therefore, when cholesterol was first discovered. The names of many renowned scientists are connected with it,and few substances have seen so much eager effort as cholesterol. M. Brown and J. Goldstein who received the Nobel Prize for physiological studies connected with the substance in 1985, referred to the role of cholesterol in the history of science in their Nobel lecture, saying that cholesterol was the most distinguished small molecule. Thirteen Nobel Prizes were given to scientists who had devoted a great part of their life's work to cholesterol. (37) The physiology of cholesterol began to be studied in the mid-19th century, when simple color reactions had been developed to detect it. It then proved possible to detect cholesterol in practically all human tissues and secretions and in pathological growths. Two opposing views soon emerged. On the one hand young, developing tissue was found to be rich in cholesterol, the conclusion being that cholesterol was important for "formative" processes.(5) On the other hand North American scientists in particular draw a picture of cholesterol where the emphasis is on its occurrence in conjunction with pathological phenomena such as gall stones. Flint referred to cholesterol as a "sinful"substance as early as 1862. (17)

In the early 20th century these opposing views became more acute. On the one hand it was found that cholesterol counteracted hemolysis, i.e. the dissolution of erythrocytes, caused by saponins and the venom of bees,spiders or snakes, thus being medicinal. (31, 44) On the other hand a connection was found between cholesterol and tumor growth. Cholesterol promoted tumor growth in animals experiments, (32) and the fatty tissue of cancer patients was found to have elevated cholesterol levels. (42) Experiments were also done from which it was wrongly concluded that cholesterol cannot be produced inhuman or animal organisms but has to be taken in with the food. (13, 14)

The idea of cholesterol as a harmful substance had thus been born. On the basis of it, attempts were made to explore the connection between food cholesterol and atherosclerotic changes. It had been known for some time that atherosclerotic changes relate to high cholesterol levels. Rabbits were thus given cholesterol suspended in oil in addition to their vegetable diet which, of course, contained practically no cholesterol. After 4-8 weeks all tissues had been infiltrated with cholesterol. (2) Rabbits, being completely herbivorous, are not used to foods containing cholesterol. The same experiment gave negative results with rats, naturally carnivorous and therefore used to foods containing cholesterol. (29) This also raises the question how far the experiment done with rabbits applies to humans who are accustomed to a mixed diet. In spite of this, the concept of cholesterol in foods being harmful dominated the discussion for a long time. It was only in the 1970s that experiments on human subjects showed that the cholesterol level of foods has only a limited effect on cholesterol levels. (29, 21,43,23)

On the other hand cholesterol was also considered and used medicinal lyas a general roborant, for anemia and infectious diseases. These uses never gained real significance, however. (29)

It is remarkable how long it took for the idea that cholesterol is produced in the human organism to be accepted. Systematic investigations of the cholesterol balance in 1920-1923 showed that the body eliminates more cholesterol than it takes in with the food, (29) so that cholesterol is not really a food. With a purely vegetarian and therefore practically cholesterol-free diet,the organism is able to produce all the cholesterol it needs. On the other hand cholesterol is continually eliminated as the organism is not able to break it down. If the diet contains high levels of cholesterol - high proportion of foods of animal origin - the body's own synthesis is reduced, though it never ceases completely. (28) The cholesterol balance thus varies depending on the diet. The following figures given in an article on cholesterol give an approximate idea of the situation. Daily dietary intake is 500 mg, but only 200mg are actually absorbed, since only 40-50% of food cholesterol are absorbed,compared to more than 95% of fats. 700-900 mg are produced in the body,and in accord with this about 1,000 mg = 1 g is eliminated as cholesterol or bile salt in a ratio of approx. 1:1 and as steroid hormone (about 50 mg). (28,20)

Cholesterol is thus the complete opposite of the fats as characterized above. The latter are needed as foods. They are taken up from the outside world and metabolized in the organism. With cholesterol, the opposite is the case. It is mainly produced in the organism itself and eliminated. In human metabolism, fats and cholesterol are polar opposites in one major aspect.

4.  Polarity of cholesterol and dietary fats

Fats have been described as substances human beings have used as foods taken from the natural world around them from early times. Vegetable fats have ripened in the light and in the heat of the sun; they have numerous qualities that relate to the particular plant and reflect the conditions under which the fat was produced in the plant. They go through a physiological combustion process in the human organism that destroys their substance qualities.

Cholesterol on the other hand is produced in the organism and does not immediately show itself. It needed to be discovered. Compared to the qualitative variety of fats which is reflected in the wide variety of fatty acids,cholesterol is a single substance (See also section 5). It does not go through combustion in the organism but is excreted into the outside world, into the light.

Fats and cholesterol also differ in their qualities as substances. Both are completely insoluble in water, but fats are saponifiable and may thus be converted to fatty acids and glycerin, whereas cholesterol is not saponifiable.The melting temperatures of fats have been considered above; cholesterol does not melt at temperatures in the range of life, as they do, but only at a high temperature, having a clearly defined melting point. The substances also differ in density. Fats are, of course, lighter than water - "fat floats on top" - whereas cholesterol has a density of 1.046 g/ml (Beilstein), which makes it heavier than water. Compared to the wide variety of fats that are produced in the light and show a wide range of qualities, cholesterol is thus a heavy, monotonous substance produced in the dark (Fig. 2)



Cholesterol became the subject of research as a substance that has dropped out of life. This determined its image for a long time, although it was noted that cholesterol was a necessary part of many organisms and was produced especially in the course of growth processes. In the above-mentioned feeding experiments cholesterol was added artificially, thus teaching us nothing about the substance in a healthy organism. People were blinded by the material substance, failing to see where the activity really lay, in this case in themselves. In a living context, the organism itself is active. Views on cholesterol are now turning in this direction, and people now concentrate less on influencing plasma cholesterol levels by the amount of cholesterol in the diet, which is only possible to a limited extent. Instead, attention focuses on the way the diet influences plasma cholesterol levels, quite apart from the cholesterol it contains, and the effects of people's behavior and life style. (18,10,6,21) Cholesterol is seen as a substance that is really passive in itself.

What are fats, and what is cholesterol to the human being?

When the human organism is given nourishment in form of fats, qualities from the outside world enter into the human being. These qualities are "burned" to destroy them. This generates heat and the potential for movement in the human being, i.e. he brings his will impulses into the world.It is thus immediately apparent that dietary fats relate to the human will pole. Compared to this, what is the significance of a substance the human being produces himself, and which he then makes into something alien and eliminates?

In Extending Practical Medicine, (36) Rudolf Steiner and Ita Wegman describe substances that are eliminated to the inside or the outside and provide the material basis for conscious human experience in contrast to substances taken into the body which are connected with unconscious processes. The examples given are uric acid for elimination and protein as a substance taken in. Does something like this also apply to cholesterol and dietary fats in the sphere of lipids?

In Section 6, an attempt will be made to describe the physiology of cholesterol and examine this possibility of a connection with conscious awareness processes. Before that, however, a description will be given of cholesterol in the natural world outside man and as a starting material for substances with hormone-type actions.

5. Cholesterol in the natural world outside man and as the starting
material for substances with hormone-type actions

Cholesterol in plants and animals (41)

Cholesterol is found in the membranes of all eukaryotic (nucleated) cells, and not only in humans. But whereas in humans only a few per cent of other sterols occur associated with cholesterol, (28) a large number of these occur with cholesterol, with the cholesterol itself going more into the background. Thus one substance is replaced by many. Terrestrial vertebrates have almost only cholesterol, like humans, marine fish on the other hand up to a third of sterols other than cholesterol. Plants may also synthesize cholesterol and usually contain small amounts of it, but they mostly produce special phytosterols. In evolutional terms, sterol production is thus progressively simplified both as regards variety and method of synthesis.

Bacterial membranes hold a special position, being sterol free. (8) The anthropods, including the insects, are unable to synthesize new sterols themselves, though these are found in their membranes. They take in sterols with their food or from symbiotic micro-organisms and modify them. Sterols are thus essential food constituents for arthropods, just as fatty acids (e.g.linolic acid) are for us, with the organism able to modify but not produce them. Insects thus relate in the opposite way to cholesterol or to the sterols that take the place of cholesterol than humans do.

Conversion of cholesterol to substances with homone-like actions. As already mentioned, part of cholesterol is eliminated in form of bile salt,calciferol (vitamin D) or steroid hormones. About 0.5 g of bile salts and 50 mg of steroid hormones on average are produced daily and eliminated by the human organism. (38, 21,28) Bile salts emulsify cholesterol in the bile fluids and play an important role in breaking down dietary fats. This, then, is the point where the cholesterol and the fat aspects come together.

Calciferol production from cholesterol is remarkable if one considers the character of cholesterol as it has been presented so far. 7-dehydrocholesterol is converted to cholecalciferol under the influence of light in the skin. (19) Calling cholecalciferol vitamin D is therefore misleading. It is not an essential vitamin; light is essential. Deficiency of this can be corrected by giving cholecalciferol as "vitamin D". The substances needed above all to regulate bone development and hence the human form are produced from cholecalciferol in the liver and kidneys. Thus cholesterol, produced in the darkness of the organism, is under the influence of light converted to a substance with hormone-like action.

Steroid hormones are produced from cholesterol in certain organs of the adrenal cortex and gonads and have regulatory functions in growth and metabolic processes. The effect is always on the whole organism. The steroid hormones produced in the adrenal cortex or gonadal cells are distributed throughout the organism by the blood. These processes take hours at their shortest, more often days (reproductive cycle) and even longer in growth processes. On the other hand the arachidonic acid cascade results in active compounds such as prostaglandins being produced from essential fatty acids. Unlike the steroid hormones, these compounds, collectively called eicosanoids, act within very short time spans, seconds, and only locally. The mode and direction of their action depends on the site in which they occur and may even be the opposite for one and the same substance in another site.We note that substances with hormone-like actions are produced from both fatty acids and cholesterol. The steroid hormones produced from cholesterol act for relatively long periods and within the whole organism; the eicosanoids produced from fatty acids act locally and in the short term.

It is also worth looking at the sulfuric acid compound of cholesterol which is cholesterol sulfate, a substance found mainly in the epidermis. The two play a role in regulating comification and the desquamation of corneal cells. A most illustrative example is the horse's hoof. Its lipid part contains 27% of cholesterol and 20% of cholesterol sulfate. In this extreme case the character of cholesterol emerges as a substance that shows up where firmness, structure and external pressure are found. No up-to-date literature could be found on cholesterol sulfate in human cornified matter.

6.  Physiology of cholesterol

Describing the human physiology of cholesterol we have to consider three aspects, depending on the direction our inquiry takes.

1. Inquiring into the genesis of cholesterol we are taken into the metabolic sphere, to the liver and intestine. Cholesterol is, of course, produced by all nucleate cells, but the liver and intestine produce an excess to serve other organs.

2. If on the other hand we ask where cholesterol occurs in greater concentration - as a substance, we have to think of the head region, the brain. A quarter of the total cholesterol in the body, which is about 140 mg, is found in the brain, where it represents up to 10% of the dry matter. (38)

3. From the point of view of health and sickness, attention focuses on blood plasma cholesterol levels, as the body is particularly sensitive to cholesterol - in this area, so that there is considerable potential for pathology.

The three aspects - cholesterol in the metabolic sphere, in the nervous
system and in the blood circulation - will be considered below.

1.   Metabolism

The question as to cholesterol synthesis initially takes us to the liver and intestine. Cholesterol is produced in all tissues in the organism, i.e. in all nucleate cells, so that this metabolic aspect may be found throughout the organism. The liver and intestine produce the largest amounts of cholesterol,however, passing it on to other organs via the blood. On the other hand the elimination of cholesterol via the bile and intestine also starts from the liver.Cholesterol - emulsified by phospholipids and bile salts produced from cholesterol - gets into the intestine in the bile and there encounters food substances, above all fats. Part of this cholesterol is eliminated through the intestine, another part is absorbed together with the dietary lipids and reaches the liver via the blood circulation; it is therefore involved in the biliary cycle.

We thus have three processes connected with cholesterol in the liver and intestinal tract - synthesis, elimination and biliary cycle. The metabolic processes relating to fats go in the opposite direction. Cholesterol synthesis has its opposite in fat degradation (Fatty adds and therefore fats may also be synthesized in the liver. With a balanced diet the amounts involved are negligible). What both have in common is that substance - cholesterol or fat - is moved and transformed.(In the sphere of the metabolic organs, bile acids and cholecalciferol are also produced in the liver and steroid hormones in the adrenal cortex and gonads, see section 5.)

2.  Brain and nerves

The question as to the site of major cholesterol synthesis and conversion took us to the metabolic sphere of intestine and liver. If we then ask where the highest concentrations of cholesterol may be found, we have to go to the brain (v. s.). If we consider that cholesterol goes through the biliary cycle several times a day, whilst its half life in the central nervous system is much longer, up to several years, we can appreciate the opposite nature of the situation in the latter. In the brain, cholesterol is found above all in the myelin sheaths, extreme forms of cell membranes with the emphasis on the insulating, separating function. Cell membranes in the metabolic sphere, in liver cells, for instance, have the emphasis on a mediating as well as a limiting function, permitting the catalysis of processes and exchange of substances.The functional difference correlates with the higher protein levels in liver cell membranes and higher lipid levels in myelin sheaths. (22) Myelin sheaths with their high lipids and cholesterol levels form an insulating layer around nerve cells; they are persistent structures with closed-off surfaces.

The lipids in all cell membranes in the human and mammalian organism are made up of cholesterol on the one hand and polar lipids that give mediation towards the watery element on the other (e.g. phospholipids orsphingolipids). These derive from triglycerides in so far as they are saponifiable and fatty acids are liberated in the process. The polar lipid and cholesterol composition results in the liquid-crystalline state of the membranes as anew quality that cannot be derived in a linear way from the properties of the individual components. Thus the melting point of the membrane is not a mean of the high melting point of cholesterol (147.5°C) and the low melting point of the lipids. Instead the liquid-crystalline state is a synthesis of the properties of liquid and solid bodies. A higher proportion of cholesterol gives the membrane greater solidity and impermeability, a property seen above allin myelin sheaths. Triglycerides are of no significance in the sphere of the brain and nerves,not as a substrate for energy metabolism nor as a structuring agent. Only the polar membrane lipids derived from them play a role (v. s.). Compared to the fat stored in fatty tissues, where the composition of fats reflects that of the diet to a remarkable degree, (34) the fatty acid composition of these polar membrane lipids is largely controlled by the organism. Brain lipids do, however, have particularly high essential fatty acid levels. Again cholesterol is the polar opposite. Cholesterol supply to the brain is independent and does not depend on plasma cholesterol, (24 )whereas cholesterol synthesis in the liver balances the organism's needs against the dietary supply in a flexible way (v.s.). We thus see a tendency in the brain for processes to be determined by the organism and not be open to the triglycerides, which are greatly influenced by the environment; here the character of the organism's own cholesterol production emerges clearly.

Cholesterol is tied in with opposing functional complexes in the neurosensory and metabolic spheres. The two spheres interpenetrate in space, with cholesterol synthesis taking place throughout the organism and cholesterol a membrane constituent in all tissues. Liver and intestine are nevertheless major sites for cholesterol synthesis; cholesterol elimination is via the bile only, and the role cholesterol plays in the membranes is at its highest level in the myelin sheaths with their high lipid levels.

3.Circulation

The dynamics in the metabolic sphere and the static state of matter in the neural sphere are balanced out in the blood circulation. The movement of lipids in the blood mediates between the two. Lipophilic, i.e. water-insoluble substances are kept in the liquid, watery state in the blood by lipoproteins. How are these processes, where changes of a high order are continually occurring, approached in experimental research?

The first observations were made on dogs in 1622. Their lymph vessels contain a milky white fluid after feeding. (3) Blood samples taken after a fatty meal are also milky and turbid. This points to the presence of lipoproteins as vehicles for lipophilic substances in the blood. They appear as spherical or drop-shaped structures under the microscope, certainly comparable to fat droplets in milk, but should not be thought of as static but in continuous motion and transformation.

A first experimental differentiation of lipoprotein according to density gives the generally used terms VLDL (very low density lipoprotein), LDL(low density lipoprotein, and HDL (high density lipoprotein). These tell us nothing of their physiological significance. Chemical analysis of the selipoproteins according to fat, cholesterol and protein content shows that VLDL have the highest fat content (which correlates with their low density,fat being light), LDL the highest cholesterol and HDL the highest protein content (see Table 1).



What is their physiological role? Lipoproteins with high fat content have nutrient function, supplying organs - except for the brain - with triglycerides. Considering the site of synthesis, distinction must be made between VLDL that are largely produced in the liver and "chylomicrons" which are produced in the intestinal wall. Dietary fats digested in the intestine and absorbed into the intestinal wall are incorporated in the organism as chylomicrons. This is the reason for the milky, turbid lymph. The chemical composition of chylomicrons shows that they are nutrients by nature. The fat composition is the same as in the food, and compared to VLDL, chylomicrons contain retinol (vitamin A, as its essential nutrient element) and compared to the dietary cholesterol level less of the non-nutrient cholesterol (see Table1). Chylomicrons convey the lipids taken in from outside via the intestine into the organism; VLDL convey lipids produced or transformed by the liver within the organism.

In the organs, triglycerides are released from the lipoproteins whilst still within the blood capillaries. Cholesterol-rich residues remain. If one considers that the fats of lipoproteins also go through a physiological form of combustion, the high-cholesterol residues may also be called "ashes" to give us a picture. The "ashes" of chylomicrons are taken up into the liver and digested;those of VLDL partly remain in the blood and are converted into high-cholesterol LDLs. These may be taken up both into the liver and into other cells in the organism, thus complementing tissue cholesterol metabolism. (LDLs are taken up entire into the cell (endocytosis) and digested within it. Triglycerideson the other hand are released from lipoproteins with high fat concentrations in the plasma and only then absorbed into the cells.)

Compared to the rest of the organism, cholesterol exists largely - about 76% - as a fatty acid ester combined with essential linolic acid in the blood. (28) Here, in the middle, rhythmic sphere of human physiology, the two sides which we have been considering as polar opposites in this paper - essential fatty acid taken in with the food and cholesterol - combine in a kind of neutralized storage form of cholesterol. (Only a small proportion of cholesterol in cells is fatty acid ester, and in that case mainly esterified with oleic acid; in the brain it exists only as non-esterified cholesterol.) Binding of fatty acid to cholesterol is possible because cholesterol has an "alcohol function". This reveals a side of cholesterol that is not immediately obvious. Though practically water-insoluble, it has an affinity to the watery element. It therefore crystallizes with water of crystallization and is used as an emulsifier in ointments. The olending relates to this aspect, whilst the term cholesterin, which was chosen by Chevreui, puts the emphasis on the waxy appearance (as in paraffin, stearin).

Protein-rich lipoproteins (HDL) play a major role in cholesterol esterification in the blood plasma, for they contain the enzyme which catalyzes the esterification (LCAT = lecithin-cholesteryl-acyl-transferase). (16)

These high-protein lipoproteins are not uniform but changing. Even the appearance under the microscope of lipoproteins newly produced by the liver or the interstitium differs from that of others. They do not yet have the spherical form shown by the others but are said to be discoidal. (16)

They change in the plasma, assuming the spherical form, growing larger,with a lower specific weight, and have higher lipid and above all cholesterol levels. They take up cholesterol from the organs and combine it with linolic acid, thus withdrawing it from the organism, for this esterified cholesterol is above all eliminated via the liver and bile, with the lipoproteins taken up into the liver and digested. Cholesterol esterification in the blood plasma is thus an important stage in "reverse cholesterol transport", i.e. its transport back to the liver for elimination. (16)

Distinction is therefore made today between LDL and HDL cholesterol,and high HDL cholesterol levels are rated positive, unlike high LDL cholesterol levels.

Lipoproteins with their nutrient function support metabolic and limb activity; the eliminatory function, "reverse cholesterol transport", relieves the organism of cholesterol. Pathological changes threaten if the right balance is not maintained.

The cholesterol discussion shows that the potential for disease is particularly great in the circulation. In the region of the brain and nerves, the composition of the membranes, cholesterol levels, etc. are largely subject to laws and not greatly variable. As a rule they cannot be changed to any major extent by nutrition (except in cases of extreme malnutrition) nor by behavior, moods or stress situations. This is different in the metabolic sphere. Digestive functions,the secretion of digestive juices, production and composition of bile depend to a considerable degree on psychological factors, though the deviations are tolerable to a relatively high degree. Thus intestinal cholesterol absorption differs markedly between individuals. (21) In the sphere of the circulation, the influence of the psyche on physiological processes is again considerable, but the limits are narrower and too great a deviation may lead to disease. A common example is a high plasma triglyceride level, usually in conjunction with a high LDL cholesterol level. In that case nutrient processes are too powerful compared to activity in limbs and metabolism, and there is a danger that processes which can only be healthily dominant in the head region become too powerful here, resulting in lipid and cell substance deposition (atheroslerotic plaques). Suggested preventive measures in that case are physical movement and a diet rich in ballast and fats with high oleic acid content (olive oil).(6) This will increase metabolic and limb activity.

Little well-founded knowledge is available today on the significance of the reverse situation, i.e. a low cholesterol plasma level. Correlation between this and with neoplasia, (26) hemorrhagic cerebral accident (30) and increased death rate involving violence is controversial. (1,11,33) Extremely low plasma cholesterol levels are seen in patients with advanced AIDS and in cases where the immune system is reduced to an extreme degree (personal communication). In that case the low cholesterol level reflects a weakness in the powers to maintain oneself against the outside world, with the organism flooded by that outside world.

We have characterized three functional spheres in the human organism that interpenetrate in space but may be clearly differentiated by their functions. In so far as food uptake is dominant in the intestine, the food must be broken down, mixed up, made chaotic. At the other pole we have the neuro-sensory sphere which is connected with the development of conscious awareness and powers of memory. For this, we need stable structures in the brain where substances come to rest. This only applies to substances that give structure, the brain itself having a very high energy metabolism, of course.The opposite pole to the homogenizing, chaos-creating, form-dissolving processes in the intestine is the structure at rest and the generation of surfaces in the brain. The circulation holds a middle position. There we have the spherical droplet form of lipoproteins continually changing and in motion in a highly ordered fashion.

The function of cholesterol may be seen most clearly in the neurosensory system, in the brain's myelin sheaths with their high lipid and hence cholesterol content, persistence, with the brain always creating its own cholesterols and triglycerides of no significance. In the middle sphere of the circulation there can be no persistence; the processes that are dominant in the head have to be overcome here, with cholesterol brought to elimination in the intestine.There it meets the nutrient stream, especially dietary fats (Fig. 3).




7. Connection between processes relating to substance and those relating

to the psyche

Cholesterol research is simply vast. In so far as it is not merely descriptive,defining substance properties, molecular structures, occurrence in the organism and biosynthesis, it has initially concentrated on the connection between plasma cholesterol levels and cardiovascular disease as well as the factors that influence plasma cholesterol levels. The focus has been on cholesterol in relation to pathological changes. Relatively little is known,however, about the actual significance of cholesterol in the organism. Apart from the role it plays as a precursor in steroid hormone, cholecalciferol and bile acid synthesis, research has for a long time concentrated mainly on physical membrane properties in relation to their cholesterol levels. To date,the influence of membrane cholesterol on a number of biochemical parameters has been investigated. (25,4) From the above we may deduce cholesterol to have a function which is the opposite of that of lipophilic anesthetics. (4) With the latter one sees increased fluidity/ with cholesterol increased solidity and impenetrability of membranes. This is in accord with the image we have evolved from total cholesterol metabolism of a substance that shows its character in the neurosensory sphere. A connection exists between the substance character of lipids in particular in the central nervous system and the potential for conscious awareness. In the past, the power of anesthetics was estimated by determining their solubility in olive oil. Today more detailed insight into the connection is the subject of intense research. (40,1)

The phenomenon of human conscious awareness cannot be explained from substance processes like these, nor the human will in terms of energy released in the combustion of fats. Physiological processes do, however, go hand in hand with every act of will, and the creation and condensation of matter in some form is the precondition for human waking consciousness.The way the balance between solidification and dissolution is found in the circulation ultimately depends on how the human being relates to the world in his inner experience, thus reflecting his feelings.

A similar quality of gesture was described by Rudolf Steiner in his lectures on occult physiology in 1911. (35) He spoke of processes originating in the blood that accompany thinking, feeling and acts of will with crystallization, flocculation and warmth processes, and of processes in the development of the human body where bone development, gelatin and physiological combustion provide the physical basis for human thinking, feeling and doing.

As we have seen, cholesterol has significance in all spheres of the human organism. Considering the characteristic role it plays in the physiology one sees it to be the polar opposite to fats in every sphere. It is possible to establish, even at substance level, that the synthesis and function of cholesterol is above all under the influence of forces dominant in the neurosensory sphere.

A signature may also be seen at the social level if one considers the scientific and cultural role of cholesterol. With pathological changes it drops out of the organism as a whole, becomes a single substance, and is then easily detectable using color reactions. Here it makes us aware of it as substance,becoming the object of egotism and anxieties. The changing views on cholesterol reflect a turning away from focusing mainly on the substance.Gradual realization that the organism is responsible for the control of matter,under the influence of soul and spirit, is putting an end to fixation on matter,with growing awareness of personal responsibility for the way one lives one's life. A stage in the evolution of conscious awareness thus crystallizes out from the cultural history of cholesterol.

The idea to take up this theme arose within the Anthroposophical Pharmaceutics Group, and the work would not have been possible without the many opportunities for discussion at the Carl Gustav Cams Institute. For this I am most grateful.

Martin Errenst, MD

Carl Gustav Cams Institut

Am Eichhof

D-75223 Niefem-Oeschelbronn, Germany

References:

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