This has to be one of the most misunderstood yet highly-profitable molecules in the human body.
Let’s go through a few cholesterol myths.
Myth #1: Cholesterol is dangerous / toxic.
You might be surprised to discover that cholesterol is actually needed for the production of:
- Cell structures and membranes (so any growth or repair)
- Vitamin D when your skin is exposed to the sun
- Hormones like oestrogen, testosterone, progesterone, cortisol and aldosterone
- Bile for the breakdown and absorption of dietary fats and fat soluble vitamins
- Brain synapses (neurotransmitters)
- Myelin sheath surrounding nerves
Cholesterol is so important that the liver actually makes it for us.
In fact, the liver makes the majority of our body’s cholesterol whereas most of the cholesterol that comes from our diet is not able to be absorbed.
Even if you ate a zero cholesterol diet you would still make cholesterol (and can actually have high cholesterol levels).
Cholesterol is so important that we’re able to produce cholesterol from fats, proteins and carbohydrates – any macronutrient can be converted into cholesterol.
So now we know cholesterol is important – right?!
Myth #2: High Cholesterol is bad and should be lowered by any means possible.
We’ve been taught that cholesterol increases our risk of heart disease but is that really true?
It’s important to have a basic understanding of cholesterol before going about trying to reduce it.
To start with, we need to know what ‘it’ is.
From experience with my clients, it seems there has always been this preconceived image of cholesterol as this gunky stuff that sits inside of our arteries clogging them up.
Whilst cholesterol is a part of the process of plaque development in an arterial wall which can lead to a cardiovascular event (e.g. heart attack), cholesterol is not the cause.
Cholesterol is actually a soft waxy substance produced by most cells and particularly by the liver.
Wherever there is inflammation in the body, cholesterol is transported to the scene to help repair the damage—because remember, we need cholesterol to build healthy new cells.
So when an artery wall has been damaged, cholesterol is sent there to help heal that damage.
Now for most people, their introduction to cholesterol is via a number on a doctor’s report.
So let’s take a look at what that means.
When your blood cholesterol is tested you will likely get a result back for total cholesterol, HDL, LDL and TG (triglycerides – fats).
The L stands for lipoprotein, HD is high density and LD is low density.
The lipoprotein particle is the vehicle carrying the cholesterol.
So what we see on our test results is a measure of how much cholesterol is being carried by the different lipoproteins.
HDL particles collect cholesterol from around the body and transport it to the liver to be removed if we don’t need it.
That’s why it is typically thought of as “good cholesterol” and higher HDL levels are considered a good sign.
LDL particles carry extra cholesterol made in the liver out to the rest of the cells in the body.
And that’s why LDL has always been thought of as ‘bad’ cholesterol.
Cholesterol is just cholesterol, it’s the vehicle it’s being carried by, and therefore the direction that it’s moving in that differs.
Firstly, total cholesterol is not a very good predictor of cardiovascular disease risk.
Now without going into too much detail (you can read Dr Peter Attia’s 10 part series on cholesterol here), the way a plaque begins in an artery is a lipoprotein busts through the artery wall and causes an inflammatory reaction (because it isn’t supposed to be there).
LDL particles are more likely to do this.
Remember though that Low Density Lipoprotein particles are the vehicles carrying cholesterol – it is not the cholesterol itself doing the initial damage here.
The problem is we aren’t routinely testing for the number of LDL particles we have – the ones that start the damage in our arteries – only the amount of cholesterol they are carrying is tested which doesn’t necessarily tell us what our risk is.
Dr Attia explains it as a numbers game – the more LDL particles you have – the more likely one is going to punch through an artery wall and trigger inflammation.
So when looking at your blood test results and considering whether that high cholesterol number demonstrates a high risk, appreciate that there are other important factors to consider, such as:
- The number of LDL particles you have (there is a test for this – lipid nuclear magnetic resonance – or NMR)
- How old you are (more time equals more opportunity for arterial wall damage to occur)
- The health of your endothelium or artery wall lining (inflammation plays a big part here)
- Combining HDL and TG into a ratio (TG/HDL-C) is probably the single best predictor of cardiac risk you can derive from a standard cholesterol test (the lower the ratio, the lower your chances of having an “adverse cardiac event”)
The problem is most doctors aren’t testing LDL particle number, considering inflammation or even explaining the possible causes of high cholesterol to patients, they are simply prescribing cholesterol lowering drugs like statins.
It is beyond the scope of this blog to go deeper into the testing of cholesterol but just know that your risk of cardiovascular disease is not directly linear to your total cholesterol, your LDL cholesterol concentration or HDL cholesterol concentration (traditional lipid values).
This statistic from the U.S. highlights that fact even more:
50% of people with heart disease have normal traditional lipid values.
Let that sink in for a second…
This might sound scary, but if you’ve been stressing and losing sleep about your cholesterol numbers lately, this might actually help take the pressure off a little!
(Plus stress and lack of sleep increase inflammation……)
Myth #3: High cholesterol reduces life expectancy.
This is where things get pretty interesting.
A review of studies found that after 60 years of age, high LDL cholesterol was actually inversely proportional to mortality i.e. as LDL cholesterol went down, deaths from all causes went up.7
Dr David Diamond, one of the authors of the study states that “There have been decades of research designed to deceive the public and physicians into believing that LDL causes heart disease, when in fact, it doesn’t.”
Dr Diamond Ph.D. is a professor in USF’s Departments of Psychology and Molecular Pharmacology & Physiology and states that “The research that has targeted LDL is terribly flawed.
Not only is there a lack of evidence of causal link between LDL and heart disease, the statistical approach statin advocates have used to demonstrate benefits has been deceptive.”8
Two studies in Norway and Italy also looked at mortality in elderly individuals and found that those with low total cholesterol had a lower survival rate than those with high cholesterol, regardless of their health status. 1
Like I said, interesting right?
Myth #4: We should limit the amount of cholesterol we eat for heart health.
Remember that most of the cholesterol in your blood is made by your liver. It’s actually not from the cholesterol you eat.
And when you eat a low cholesterol diet, your liver will still make more cholesterol to account for that.
The DGAC (U.S. Dietary Guidelines Advisory Committee) actually made some really significant changes to their advice a few years ago.
Dietary cholesterol was removed as a “nutrient of concern” due to the lack of scientific evidence demonstrating an appreciable relationship between dietary and blood cholesterol or clinical cardiovascular events in general populations.
Total fat now has no recommended consumption limit and the report states that “Reducing total fat does not lower cardiovascular disease risk. Dietary advice should put the emphasis on optimising types of dietary fat and not reducing total fat.”
These changes come after about 40 years of recommending reducing fat intake… 5
Ok so what is the truth about high cholesterol?
Well, as Dr Georgia Ede MD says :
“Chances are if you have “high cholesterol” you do not have a cholesterol problem…
You have a carbohydrate problem.”10
And once again, we’re back to diet (and carbs).
We’ll talk about how you can naturally improve your lipid profile and cardiovascular disease risk in the next blog.
Overall know that the science of cholesterol is complicated and not well understood by most health practitioners regardless of their licence to prescribe you drugs to lower it.
You may not need to be as afraid of cholesterol as you are and if you’re here reading about how to improve your diet and lifestyle, then chances are you’re already moving in the right direction.
—–
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Kelly Moriarty is an online health & nutrition coach and founder of The Green Body Plan.
After 5 years as a veterinarian Kelly was unhealthy, stressed out and generally dissatisfied.
She now helps professional women make the same changes she did to beat burn out, lose weight, recover their energy and take back control of their health naturally.
References:
- Scand J Prim Health Care. 2010 Jun;28(2):121-7. doi: 10.3109/02813432.2010.487371. Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up. Tuikkala P1, Hartikainen S, Korhonen MJ, Lavikainen P, Kettunen R, Sulkava R, Enlund H.
2. J Am Geriatr Soc. 2003 Jul;51(7):991-6. Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging. Brescianini S1, Maggi S, Farchi G, Mariotti S, Di Carlo A, Baldereschi M, Inzitari D; ILSA Group.
3. N Engl J Med. 2006 Nov 9;355(19):1991-2002. Low-carbohydrate-diet score and the risk of coronary heart disease in women. Halton TL1, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB
4. Arch Intern Med. 2009 Apr 13;169(7):659-69. doi: 10.1001/archinternmed.2009.38. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Mente A1, de Koning L, Shannon HS, Anand SS.
5. The 2015 US Dietary Guidelines – Ending the 35% Limit on Total Dietary FatDariush Mozaffarian, David S. LudwigJAMA. 2015 Jun 23-30; 313(24): 2421–2422. doi: 10.1001/jama.2015.5941PMCID: PMC6129189
6. Obes Rev. 2012 Nov;13(11):1048-66. doi: 10.1111/j.1467-789X.2012.01021.x. Epub 2012 Aug 21. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors.
Santos FL1, Esteves SS, da Costa Pereira A, Yancy WS Jr, Nunes JP.
7.Ravnskov U, Diamond DM, Hama R, et al.
BMJ Open. Published online June 12 2016
8. No connection between LDL cholesterol levels and heart disease, according to researchers by University of South Florida
https://medicalxpress.com/news/2018-10-ldl-cholesterol-heart-disease.html
9. Arch Intern Med. 2012 Jan 23;172(2):144-52. doi: 10.1001/archinternmed.2011.625. Epub 2012 Jan 9. Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative.
Culver AL1, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y.
10. “Cholesterol” Diagnosis Diet, Nutrition Science Meets Common Sense, Georgia Ede MD https://www.diagnosisdiet.com/food/cholesterol/#i18
kellyannmoriarty.com 