Why Cholesterol Is Not Bad

In 1984, Time magazine published the famous cover with bacon and eggs frowning.  The image accompanied the launch of a war on cholesterol that has led to children being placed on statin drugs.  Turns out, it was all based on bad science.  In this post we will find out why cholesterol is not bad and what the real cause of heart disease has been all along.

In February of 2015, the USDA Scientific Report of the 2015 Dietary Guidelines Committee reversed the cholesterol recommendation.  Here’s the latest official guideline:

The reversal is still only a step in the right direction, but it has tremendous implications.  Time put it this way in their 2014 updated cover:

Cholesterol is cholesterol

Cholesterol is vital to the human body.  It is so important, that our bodies regulate it carefully to make sure we have enough.

About 75% of cholesterol is produced in the liver (about 1,000-1,500 mg per day), but every cell in the body contains cholesterol and most cells produce it.  Only around 25% of cholesterol comes from diet.

According to cholesterol specialist Dr. Peter Attia, MD, “Eating cholesterol has very little impact on the cholesterol levels in your body. This is a fact, not my opinion. Anyone who tells you different is, at best, ignorant of this topic. At worst, they are deliberate charlatans.”

Some of the most nutritious foods like egg yolks and liver are the richest in cholesterol.

Cholesterol is a soft, waxy substance that plays some important roles:

• building cell membranes
• interacting with proteins inside cells
• helping regulate protein pathways required for cell signaling
• producing hormones like serotonin that effects mood as well as all the steroid hormones, progesterone, estrogen, testosterone, cortisone and a host of other vital hormones
• producing bile acids – Bile acid helps your body regulate fat, cholesterol, and glucose metabolism. It’s also required for you to absorb fat soluble vitamins.
• producing vitamin D
• contributes to the formation of memories and is crucial for neurological function

Your brain makes up only 2% of body weight but contains 25% of the body’s cholesterol.

You’ve heard of “good cholesterol” and “bad cholesterol”, but those are really very misleading labels.  There’s actually only one kind of cholesterol.  Cholesterol is just cholesterol.

Cholesterol is not a fat, but is fat soluble and, therefore, doesn’t mix well with our watery blood.  It must be transported through the body on other particles.  These travel containers for cholesterol are called lipoproteins.  When you hear about good or bad “cholesterol”, it is really lipoproteins that are being referred to.

Eating cholesterol has very little impact on the cholesterol levels in your body. Click To Tweet

Lipoproteins transport cholesterol

Lipoproteins initially form in the intestines, where they gather and bind fat, cholesterol, and other nutrients. After they load up they move into the bloodstream to deliver those nutrients to various tissues.

Lipoproteins carry a number of molecules, such as phospholipids, fat-soluble vitamins and triglycerides (which are fats).  Lipoproteins are basically a core full of fat and cholesterol, along with a lipid membrane that contains proteins called apolipoproteins.

Chris Masterjohn, PhD, is one of the foremost authorities on lipoproteins.  He describes their composition this way:

“If we think of the lipoprotein as a bus, the “core” is the passenger section, and the fats, cholesterol esters, and vitamins are the passengers.

The phospholipid membrane is the outside of the bus.  Phospholipids contain fat-soluble fatty acids that face inwards toward the fatty core and water-soluble phosphate groups that face outwards toward the blood.  We could therefore think of the phosphate groups as the tires, since they allow contact with and movement through the blood, just like the tires of a bus allow contact with and movement on the road.

The apoprotein is like the driver.  It interacts with specific receptors on the surface of cells, so it determines where the lipoprotein goes, where it decides to park, and where it lets the passengers out.”

There are many types of lipoproteins, but the two most popular are called LDL (Low Density Lipoprotein) and HDL (High Density Lipoprotein).  Some others are chylomicrons, VLDL, IDL, and Lp(a).

The popular lipoproteins: HDL and LDL

High Density Lipoprotein (HDL) – is often labelled as “good cholesterol” even though cholesterol is merely one passenger.  HDL is a lipoprotein; a transport “bus” for many molecules, including cholesterol.

HDL is typically considered “good” because it is able to extract cholesterol from cells.

Chris Masterjohn says, “HDL particles can extract free cholesterol from cell membranes and attach it to fatty acids, producing cholesterol esters.  They generally pass this off to LDL and other apoB-containing proteins in exchange for fats, also called triglycerides, and fat-soluble vitamins such as vitamin E.  The result is that, over time, HDL tends to be rich in fats and vitamin E, while the other lipoproteins, especially LDL, are rich in cholesterol.” 

Low Density Lipoprotein (LDL) – is commonly referred to as “bad cholesterol”, but actually, it is also a transporting lipoprotein that carries cholesterol.

According to Chris, LDL gets the oversimplified misleading name because, “LDL that does not get taken up into cells tends to oxidize.  The polyunsaturated fatty acids (PUFA) in its membrane get damaged by free radicals, and then they proceed to damage the protein in the surface, and finally the fatty acids and cholesterol in the core. Once LDL oxidizes, it can invade the arterial wall in areas that experience disturbed blood flow, like the points were arteries curve or branch.  These areas, especially in people who do not exercise enough, are permeable to large molecules.  Oxidized lipids cause them to attract white blood cells and initiate an inflammatory cascade that produces arterial plaque.”

Dr. Ron Rosedale, MD, is widely considered to be the leading anti-aging doctor in the United States.  He says, “LDL particles come in many sizes and large LDL particles are not a problem. Only the so-called small dense LDL particles can potentially be a problem, because they can squeeze through the lining of the arteries and if they oxidize, otherwise known as turning rancid, they can cause damage and inflammation. Thus, you might say that there is ‘good LDL’ and ‘bad LDL.’ Also, some HDL particles are better than others. Knowing just your total cholesterol tells you very little. Even knowing your LDL and HDL levels will not tell you very much.“

Cardiologist, Dr. William Davis concurs: “Total cholesterol is, in my view, an outdated and total useless value, except for occasional use in epidemiological observations within large populations, but not for application to specific individuals.”

In another blog post, Dr. Davis notes that “LDL cholesterol is calculated, not measured. The Friedewald calculation, developed in the early 1960s to provide an easy but crude means of estimating the quantity of cholesterol in the low-density lipoprotein fraction of the blood appled several basic assumptions: 1) that everyone consumes an average diet of average macronutrient composition, and 2) that the triglyceride content of all lipoproteins remained constant from person to person (which is not true, but wildly variable, and 3) that all LDL particles are the same size (also not true, as LDL particles vary in size within a wide range of diameters).”

The real danger is when lipids oxidize.  Small dense LDL transporter particles oxidize the most readily. The buildup of plaque in and on the artery walls (arteriosclerosis) is not a cholesterol disease after all. In simplified terms, it is really an oxidized lipoprotein disease.

Arteriosclerosis is not a cholesterol disease. It is an oxidized lipoprotein disease. Click To Tweet

Cholesterol is not the cause of heart disease

Cholesterol was one of the first molecules identified when scientists began to study heart disease.  It was present when LDL particles would breach the wall of an artery to set off inflammation. Because cholesterol was always noticed at the scene of the crime, it was initially thought that cholesterol was the cause; like saying since there are fire trucks at the scene of a fire, fire trucks must cause fires.

Numerous studies have debunked the idea of cholesterol being a risk factor in heart disease. In 2012, researchers at the Norwegian University of Science and Technology examined the health and lifestyle habits of more than 52,000 adults ages 20 to 74, concluding that women with “high cholesterol” (greater than 270 mg/dl) had a 28 percent lower mortality risk than women with “low cholesterol” (less than 183 mg/dl).

Researchers also found that, if you’re a woman, your risk for heart disease, cardiac arrest, and stroke are HIGHER with lower cholesterol levels.

Oxidized lipoproteins cause inflammation

Inflammation is another buzzword that tends to be thought of as a cause, but it’s really a natural process.  Inflammation is the body’s response to a perceived threat.  However, it can also allow healing.  Here’s what the steps of inflammation look like when you get a cut:

• Blood vessels constrict to stop the bleeding.
• The blood becomes thicker so it can clot
• The immune system sends cells and chemicals to fight off infection
• Cells multiply to repair the damage and a protective scar may form over the area

Inflammation is linked to many diseases because it is the body’s initial response to a threat.  Let’s look at the role of cholesterol and inflammation in heart disease:

• Oxidized LDL particles penetrate and damage the wall of an artery.
• In response to the damage, blood vessels constrict and blood thickens. Inflammation begins.  Inflammation from diet and lifestyle can also be a pre-existing condition that make artery walls more susceptible to penetration by Oxidized LDL particles.
• The liver is notified to make more cholesterol and release it into the bloodstream to help produce new healthy cells.  New cells cannot form without cholesterol.  This is a deliberate process.
• A scar begins to form, only a scar on an artery is called “plaque”.
• If the process is repeated often, plaque builds up and blood pressure increases.  A state of chronic inflammation is created.
• HDL particles, which contain a good deal of the antioxidant vitamin E, can reduce the oxidation of particles in their place, thus lessening the inflammation and protecting the artery from plaque formation.  HDL protects and repairs LDL and fats from oxidative damage.

You can quickly see that the notion of cholesterol “clogging your arteries” is a silly myth.

Blaming cholesterol for heart disease is like blaming firetrucks for fires. Click To Tweet

By the way, there’s a blood test for chronic inflammation.  According to Dr. Joseph Mercola:

“The test usually used to determine if you have chronic inflammation is a C-reactive protein (CRP) blood test. CRP level is used as a marker of inflammation in your arteries. Generally speaking:

• A CRP level under 1 milligrams per liter of blood means you have a low risk for cardiovascular disease
• 1 to 3 milligrams means your risk is intermediate
• More than 3 milligrams is high risk”

The true causes of heart disease

Dr. Ron Rosedale points out:“If excessive damage is occurring such that it is necessary to distribute extra cholesterol through the bloodstream, it would not seem very wise to merely lower the cholesterol and forget about why it is there in the first place. It would seem much smarter to reduce the extra need for the cholesterol — the excessive damage that is occurring, the reason for the chronic inflammation.”

The causes of heart disease are:

• Eating hydrogenated vegetable oils – According to Chris Masterjohn: “Atherosclerosis (plaque buildup in artery walls) is largely driven by the degeneration of lipids which infiltrate the blood vessel and thereby cause inflammation. Inflammation from other sources may accelerate the process or further the degeneration of the atherosclerotic plaques once they are formed, but the initiating factor for fatty plaques appears to be the degeneration of lipids — especially the degeneration of polyunsaturated fatty acids (PUFA).” Oxidized LDL’s are much more likely when you eat a lot of polyunsaturated fats, or PUFAs.  PUFAs are very fragile. They’re extra susceptible to oxidation by free radicals, and having too many of them can trigger a cascade of inflammation and disease. PUFA’s are found in hydrogenated vegetable oils like soybean, corn, canola and cottonseed.
• Excess Fructose (not from fruit) and HFCS – Dr. Joseph Mercola explains: “A high-sugar diet raises your risk for heart disease by promoting metabolic syndrome—a cluster of health conditions that includes high blood pressure, insulin and leptin resistance, high triglycerides, liver dysfunction, and visceral fat accumulation.”
• Eating grains – In addition to promoting insulin and leptin resistance, Dr. Davis points out: “Grain consumption, thanks to the process of de novo lipogenesis, increases blood levels of triglycerides and VLDL particles. VLDL particles interact with LDL particles, enriching LDL particle triglyceride content and reducing cholesterol content. This leads to a process of LDL particle “remodeling” that creates small LDL particles–glycation-prone, oxidazable, adherent to inflammatory blood cells, and persistent in the bloodstream for 7 days, rather than the 24 hours of more benign large LDL particles. Grains thereby trigger the process creating small LDL particles; fats trigger the process that does not.” “Given the unusual persistence time of small (7 days) vs large (1 day) LDL particles, grain consumption is FAR worse than fat consumption.”
• Foods cooked at high temperatures – Per a National Academy of Sciences Study, “When foods are cooked at high temperatures, advanced glycation end products (AGEs) are produced. These compounds, which stimulate cells to produce proteins that cause inflammation, can be toxic to the body.  After six weeks, people who consumed the high AGE diet had increased levels of tumor necrosis factor-alpha (TNF-alpha) and the inflammatory protein C-reactive protein (CRP), both indicators of increased inflammation. These two levels decreased in those who consumed the low AGE diet.”
• Smoking – According to the NHLBI, “the chemicals in tobacco smoke harm your heart and blood vessels in many ways. For example, they:
  • Thicken your blood and make it harder for your blood to carry oxygen.
  • Increase your blood pressure and heart rate, making your heart work harder than normal.
  • Lower your HDL cholesterol (sometimes called “good” cholesterol) and raise your LDL cholesterol (sometimes called “bad” cholesterol). Smoking also increases your triglyceride level. Triglycerides are a type of fat found in the blood.
  • Disturb normal heart rhythms.
  • Damage blood vessel walls, making them stiff and less elastic (stretchy). This damage narrows the blood vessels and adds to the damage caused by unhealthy cholesterol levels.
  • Contribute to inflammation, which may trigger plaque buildup in your arteries.”
• Drinking excessive amounts of alcohol – According to the NIAAA, excessive drinking can result in:
  • Cardiomyopathy – Stretching and drooping of heart muscle
  • Arrhythmias – Irregular heart beat
  • Stroke
  • High blood pressure
• A sedentary lifestyle – One of the primary benefits of exercise is that it helps normalize and maintain healthy insulin and leptin levels. Exercise also boosts HDL, increases your growth hormone production, helps curb your appetite, and improves your mood and sleep.
• Emotional stress – German researchers found that as your stress level rises, so do your levels of disease-promoting white blood cells. Co-author Dr. Matthias Nahrendorf explains: “High levels of white blood cells may lead to progression of atherosclerosis, plaque rupture and myocardial infarction. The latter implies that a part of the heart muscle, which pumps the blood with every beat, dies off.  This may cause heart failure, either right away if the infarct is large, or later on through maladaptive processes. The heart tries to compensate for the loss of contractile muscle tissue but over time this compensation leads to a larger heart, which is weaker.”

A diet high in antioxidants (vegetables and fruits) and low in carbohydrates will reduce factors of oxidation in the body.  I recommend The Wellness Repair Diet. For maximum benefit, combine the diet with intermittent fasting because fasting is known to reduce oxidative radicals and increase insulin sensitivity.  Skipping breakfast is good for heart health!

Heart disease is really caused by PUFAs, fructose, grains, sedentary lifestyle and stress. Click To Tweet

Healthy fat helps PREVENT heart disease

In 2013, a prominent London cardiologist by the name of Aseem Malhotra argued in the British Medical Journal that you should ignore advice to reduce your saturated fat intake, because it’s actually increasing your risk for obesity and heart disease.

Then in March 2014, a new meta-analysis published in the Annals of Internal Medicine, using data from nearly 80 studies and more than a half million people, found that those who consume higher amounts of saturated fat have no more heart disease than those who consume less.

They also did not find less heart disease among those eating higher amounts of unsaturated fat, including olive oil.

The latest studies indicate healthy fats (saturated and unsaturated fats from whole food, animal, and plant sources) should comprise anywhere from 50 to 85 percent of overall energy intake. Saturated fats provide a number of important health benefits, including:

• Helping to lower cholesterol levels.
• Provides building blocks for cell membranes, hormones, and hormone-like substances
• Conversion of carotene into vitamin A
• Optimal fuel for your brain
• Mineral absorption, such as calcium
• Provides satiety
• Carriers for important fat-soluble vitamins A, D, E, and K
• Acts as antiviral agent (caprylic acid)
• Modulates genetic regulation and helps prevent cancer (butyric acid)

The best indicators for heart disease risk

Dr. Mercola advises these are the best indicators for heart disease risk based on standard blood testing.  He ads that these same indicators have also been found to be fairly accurate in predicting dementia risk.

HDL/total cholesterol ratio: HDL percentage is a very important heart disease risk factor. Just divide your HDL level by your total cholesterol. This percentage should ideally be above 24 percent. Below 10 percent, it’s a significant indicator of heart disease risk.

Triglyceride/HDL ratios: Divide your triglyceride number by your HDL. This ratio should ideally be below 2.

NMR lipoprofile: Possibly the most powerful test for evaluating heart disease risk, this test determines your proportion of smaller, more damaging LDL particles. Small LDL particles get stuck easily, cause more inflammation, and are tied to insulin and leptin resistance. This test is not typically ordered, so you might need to request it from your physician or order it yourself through a third-party.

Fasting insulin: A normal fasting blood insulin level is below 5, but ideally, you’ll want it below 3. If your insulin level is higher than 5, the most effective way to optimize it is to reduce or eliminate all forms of dietary sugar, particularly fructose, and processed grains.

Fasting blood glucose: Studies have shown that people with a fasting blood glucose of 100-125 mg/dl had nearly three times the risk of coronary artery disease of people with a blood glucose below 79 mg/dl.

Waist-to-hip ratio: Visceral fat, the type of fat that collects around your internal organs, is a well-recognized risk factor for heart disease. The simplest way to evaluate your risk here is by simply measuring your waist-to-hip ratio. (For further instructions, please see the link to my previous article.)

Iron level: Excess iron can exert very potent oxidative stress, so if you have excess iron in your blood, you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your serum ferritin level and make sure it is below 80 ng/ml. The simplest ways to eliminate excess iron are blood donation and therapeutic phlebotomy.

Does it make sense to take a statin drug to lower cholesterol?

The quick answer is no, because it doesn’t address the cause of Arteriosclerosis, which is oxidized LDL’s and inflammation.

The 2004 National Cholesterol Education Program guidelines recommend that people who don’t have heart disease should take statins to prevent heart disease. It is important to note, however, that 8 of the 9 panel experts making the recommendation had ties in the pharmaceutical industry.

Dr. Mercola says, “If you are concerned about your cholesterol levels, taking a drug should be your absolute last resort. And when I say last resort, I’m saying the odds are very high, greater than 100 to 1, that you don’t need drugs to lower your cholesterol. To put it another way, among the more than 20,000 patients who have come to my clinic, only four or five of them truly needed these drugs, as they had genetic challenges of familial hypercholesterolemia that required it.”

No one has ever had a statin deficiency.  But statin drugs deplete the body of Coenzyme Q10 (CoQ10), which is beneficial to heart health and muscle function. Because doctors rarely inform people of this risk and advise them to take a CoQ10 supplement, this depletion leads to fatigue, muscle weakness, soreness, and eventually heart failure.

Muscle pain and weakness is the most common side effect of statin drugs.  Statins activate the atrogin-1 gene, which plays a vital role in muscle atrophy.

Statin drugs have also been linked to:

• Kidney damage
• An increased risk of nerve damage that causes pain in the hands and feet and trouble walking
• Dizziness
• Cognitive impairment, including memory loss
• A potential increased risk of cancer
• Decreased function of the immune system
• Depression
• Liver problems, including a potential increase in liver enzymes (so people taking statins must be regularly monitored for normal liver function)
• An increased risk of Lou Gehrig’s disease.
• Mitochondrial damage
• Type 2 diabetes
• Sexual dysfunction

Other cholesterol-lowering drugs besides statins also have side effects, most notably muscle pain and weakness.

Odds are greater than 100 to 1 that you don’t need a statin drug. - Dr. Mercola Click To Tweet

The symptoms of cholesterol deficiency

• Cognitive impairment, including memory loss
• Vitamin D deficiency
• depression and suicidal thoughts
• an increased capacity for violence and aggression
• An increased risk of cancer and Parkinson’s disease

According to Dr. Mercola, cholesterol is too low when much under 150.  He says an optimum would be more like 200.

Takeaways

• The USDA Scientific Report of the 2015 Dietary Guidelines Committee says, “…available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report. Cholesterol is not a nutrient of concern for overconsumption.”  Enjoy those egg yokes!
• Blocked arteries are not caused by cholesterol, but they are caused by oxidized lipoproteins and inflammation.  Lowering cholesterol doesn’t correct the source of the problem. A diet high in antioxidants (vegetables and fruits) and low in carbohydrates will reduce factors of oxidation and inflammation.  Heart health is already built into The Wellness Repair Diet.
• The most effective test for evaluating the risk of heart disease is called the “NMR lipoprofile”.
• Out of 20,000 patients, only four or five actually needed a statin drug and that was required to treat familial hypercholesterolemia. None of the MDs, PhDs or researchers reviewed for this post felt statin drugs should be anything but a last resort for very rare conditions.
• Be wary of recommendations and studies from experts with financial ties to pharmaceutical companies.

If you know someone who is taking a statin drug, please share this article with them.  Not only could you save them a lot of money, but you may help them attain better health.

What dietary changes do you plan to make now that you know dietary cholesterol from a healthy diet is safe and necessary?  Leave a comment below and let me know.

Also, if you found this helpful and don’t want to miss any future posts on nutrition and wellness, please subscribe to my email mailing list.  I typically email once a week to let you know when new posts are published and what the topic is.

Thanks for reading!
Jeff

 

Additional Resources:

Dr. Peter Attia: “The Straight Dope on Cholesterol”: Parts I, II, III, IV, V, VI, VII, VIII, IX.

Chris Kresser:  The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy

Chris Kresser: RHR: Chris Masterjohn on Cholesterol and Heart Disease – Part 1, Part 2, Part 3

ABC News Nightline

Dr. Mercola Interviews Chris Kresser

Dr Peter Attia, MD – The Straight Dope on Cholesterol and Diet

Dr. Mercola Interviews Dr. Chris Masterjohn

Dr. Mark Hyman