The Cholesterol Myth

This post is by Craig, Maria’s husband.  I am a science geek but like to research and put things in easy to understand format.  In this post (and the next one) I will break down the whole issues of “The Cholesterol Myth”.  There is a hypothesis that says eating food high in cholesterol and saturated fat causes high cholesterol in your blood which causes coronary artery disease (CAD). It’s called the Lipid Hypothesis. This is what the majority of Doctors and Cardiologists believe. So lets break it down piece by piece and expose the myths that lie in every leg of the Lipid Hypothesis.

What is Cholesterol

First, lets talk about Cholesterol and what it’s purpose is in our bodies. Cholesterol is our bodies main repair mechanism. It comes into action whenever there is inflammation to repair that inflammation. Saying you need to lower cholesterol is killing the messenger. It’s like killing half the firefighters that come to put out a fire. It won’t help put out the fire or what caused the fire, it will make it harder.

There are two main forms of cholesterol. Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL). In the Lipid Hypothesis it is generally thought that HDL is the good cholesterol and LDL is the bad cholesterol. The general theory is that if your total cholesterol is above 200, you are in danger and need to go on a statin drug to lower your cholesterol (more on that later). But the total cholesterol is HDL+LDL. So too much of a good thing (HDL) can lead to a bad thing (too high total cholesterol)? This is the first of many contradictions of the Lipid Hypothesis. If you start digging into the science, it get even more confusing.  Recent studies have shown that there is Bad Bad cholesterol (small dense LDL), Good Bad cholesterol (large fluffy LDL) and intermediate LDL (which can be good or bad depending on when they occur). Then there is Good Good cholesterol (HDLs 1 &2) and Bad Good cholesterol (HDL 3). Now the Total Cholesterol number looks even more convoluted.

Saturated fats and cholesterol make the membranes of the cells firm—without them the cells would become flabby and fluid. Cholesterol and saturated fat act as the conduits enabling all of the cells in our body to communicate. Cholesterol and stiff saturated fatty acids form “lipid rafts”, which make little parking spots for every protein in the membrane and enabling it to perform its functions. Without cholesterol and saturated fats, our cells would not be able to communicate with each other or to transport various molecules into and out of the cell. As a result, our bodies would not be able to function the way they do. The human brain is particularly rich in cholesterol: around 25 percent of all body cholesterol is accounted for by the brain. Every cell and every structure in the brain and the rest of our nervous system needs cholesterol, not only to build itself but also to accomplish its many functions. (source)

One of the most abundant materials in the brain and our entire nervous system is a fatty substance called myelin.  Myelin coats every nerve cell like the coating on electric wires.  It provides nourishment and protection for our brain and nervous system.  People who lose this protective coating develop a condition called multiple sclerosis (MS).  Myelin is composed of over 20% cholesterol.

Many of the hormones in our body are made from cholesterol (testosterone, progesterone, pregnenolone, androsterone, estrone, estradiol, corticosterone, aldosterone and others). In our stressful modern lives we consume a lot of these hormones which can lead to Adrenal Fatigue.  In addition  every sex hormone in our bodies is made form cholesterol.  So without it, we wouldn’t be able to have children.

Our livers make bile out of cholesterol, so even digestion and our ability to absorb fats and fat-soluble vitamins is dependent on cholesterol. Cholesterol also plays a vital role in our immune health.  And most importantly (back to our original point), the liver sends cholesterol to the site of an injury or inflammation.  This is one of cholesterol’s most vital roles. Cholesterol and fats are essential in removing toxins and healing. This is why blood cholesterol levels go high after a surgical procedure.  The liver is sending out lots of LDL cholesterol to clean and heal the cuts and damage from the surgery. LDL also goes up when dealing with an infection, bacteria or viral attack.

Blood cholesterol levels of between 200 and 240 mg/dl are actually quite normal. In older women, serum cholesterol levels greatly above these numbers are also quite normal, and in fact, they have been shown to be associated with longevity. In this study, it is shown that the higher the number, the less mortality by all causes, heart disease, cancer, etc. So as you can see cholesterol and saturated fat are vital to our bodies and our health. We wouldn’t be able to live without them.

Myth 1: Eating Cholesterol and Saturated Fat leads to High Cholesterol

This is actually pretty easy to dispel.  The longest-running study and perhaps most significant study on heart disease is the Framingham Heart Study (followed 15,000 participants over 3 generations).  It has shown that dietary intake of cholesterol has absolutely no correlation to heart disease.  This chart shows the results and as you can see there are nearly identical rates of heart disease among men and women regardless of their cholesterol intake (above or below average).

The Framingham study also found the same to be true about saturated fat intake:

“In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. The opposite of what… Keys et al would predict”

Even Ancel Keys, the father of the Lipid Hypothesis said in 1997:

“There’s no connection whatsoever between the cholesterol in food and cholesterol in the blood. And we’ve known that all along.”

Gary Taubes wrote a great piece on why this became the “law of the land” and the politics behind it (source).

Myth 2: High Cholesterol causes Coronary Artery Disease (CAD)

So this is where we are killing the messenger.  Yes, high cholesterol is present, but it is not causing the problem, it is there to fix the problem (inflammation, more on that in our next post).   There are numerous studies that dispel this myth.  First, there is no correlation by country.  Here is a video that shows how countries with the highest cholesterol levels (like Switzerland) have low heart disease rates and people like the Australian Aboriginals who have one of the highest rates of heart disease also have one of the lowest blood cholesterol levels.

Another example is the Conference on Low Blood Cholesterol which reviewed 11 major studies including  125,000 women and determined that there was absolutely no relationship between total cholesterol levels and mortality rate from cardiovascular or any other causes (source).

There are also more than 40 trials (source) performed to determine whether lowering cholesterol levels can prevent heart disease.  In some trials the rates went up, others they went down.  But on average, when all taken together, just as many people died in the groups taking cholesterol lower drugs as those with no treatment.

Lastly and possibly most alarming is that there is evidence that points to lower cholesterol leading to higher death rates. Again form the Framingham Heart Study:

“There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years.”

So as cholesterol levels fell, death rates went up.  The Honolulu Heart Program study had 8,000 participants and in their 2001 publication:

“Long-term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier the patients start to have lower cholesterol concentrations, the greater the risk of death.”

I will end this section by quoting Malcolm Kendrick from 2005 on a different study: “The great ship Cholesterol-Lowering has ripped its guts out on the harsh rocks of evidence, but still it does not sink”

Statin Drugs

So as you can see above, lowering your cholesterol levels may actually increase your chance of dying. So with all this modern science and data showing that the Lipid Hypothesis is wrong in every way, why do doctors still believe in it and prescribe cholesterol lower drugs (statins)?  Well I think it is important to point out that doctors on average receive 23.9 hours of nutritional education in medical school! (source) That’s right, with 4 years of pre-med, 4 years of medical school and 4 years of residency, the average doctors spend less than 24 hours getting nutritional education. This is a major problem in general but especially in this case because one of the primary factors in CAD is nutrition.  More on this in my next post.

I also think it is important to mention that statin drug pharmaceutical sales are over $35 Billion worldwide in 2011 (source). This is an industry force that isn’t going away without a major fight. Not only that, but they are trying to expand their customer base.  Yes, the American Academy of Pediatrics recommended giving kids as young as 8 years old statins!!  (source)

Statin drugs should never be taken by women, as preventative or for post heart attack (source by Dr. Stephen Sinatra – audio).  Epidemiologist David Jacobs of the University of Minnesota, Twin Cities, brought together researchers from 19 studies around the world.  He reported to National Heart, Lung, and Blood Institute (NHLBI), which in 1990 hosted a conference to discuss the issue. When investigators tracked all deaths, instead of just heart disease deaths, the cholesterol curves were U-shaped for men and flat for women. In other words, men with cholesterol levels above 240 mg/dl tended to die prematurely from heart disease. But below 160 mg/dl, the men tended to die prematurely from cancer, respiratory and digestive diseases, and trauma. As for women, if anything, the higher their cholesterol, the longer they lived (source).

On top of all of this, the side effects of statins are numerous and serious. Statins are marvelous cholesterol killers because they intercept about 20 different biochemical pathways; one of those pathways is for CoQ10 and CoQ10 is one of the most important nutrients to protect your immune system. CoQ10 is also very good for heart health.  Isn’t it ironic that this drug that is supposed to protect you from heart attacks severely damages one of your bodies biggest mechanisms for maintaining a healthy heart (CoQ10)?  I won’t go into all the side effects (erectile dysfunction, muscle cramps, heart failure, cancer, loss of memory or lowered thinking ability, muscle pain or fatigue, neuropathy, etc) as there are many other sources for that information.

So what issues with cholesterol can be of concern?  There are four main causes of cholesterol problems, Stress, Smoking, Physical Inactivity, and Poor Nutrition.  In our next post (located Here) we will talk about what really causes coronary artery disease and what we can do about it.

Cholesterol On the Ketogenic Diet

Are you interested in eating the ketogenic diet but are concerned about your cholesterol? Did your doctor warn you about cholesterol going up if you eat too many eggs? What is the true cause of heart disease and what does high cholesterol mean?

In this YouTube video Craig discusses all things cholesterol related.