Some things never cease to amaze me. I particularly love how certain health myths continue to persist, despite a total lack of science to support them. One of my favourite myths is that "HIGH CHOLESTEROL WILL KILL YOU!" Of course, high cholesterol CAN be problematic, but typically isn't. Let's take a look at why.

Cholesterol is a soft, fat-like, waxy substance produced by the body or consumed in the diet.

 

Your body uses cholesterol:

  • to build and maintain cell membranes
  • to produce bile salts, critical for fat metabolism
  • for the formation of vitamin D
  • for the production of all of our sex hormones (estrogen, testosterone, progesterone,  etc)
  • as an integral part of your brain

Quite the impressive list! As anyone with a 5th grade education could attest, these functions seem to be fairly critical to life, so clearly cholesterol can't be all bad. Yet cholesterol still carries a bad reputation; what gives?

The hubbub surrounding cholesterol stems from its role in atherosclerosis, the thickening and narrowing of arteries. As arteries narrow over time, not only is the heart stressed from having to work harder to deliver blood, but arterial narrowing can promote blood clots or vessel ruptures, both of which can be fatal. Clearly, preventing cholesterol from building-up in our arteries is a matter of life or death.

Ever since the the 1950's, anti-cholesterol campaigns have sought to "educate" the public about the dangers of elevated cholesterol; campaigns that continue in various forms even today. These campaigns present a clear message: elevated cholesterol = increased risk for heart attack. Not only are people being told elevated cholesterol is a health concern,  but they are being taught that cholesterol is either "good" (HDL cholesterol) or "bad" (LDL cholesterol), with the emphasis being on reducing LDL cholesterol at all costs.

*As a quick aside, HDL (high density lipoprotein) and LDL (low density lipoprotein) are actually protein carriers for cholesterol, and not in-and-of-themselves cholesterol at all. Cholesterol, being a lipid (i.e. a fat) cannot travel through the water medium that is the blood and must be "carried" to various sites bound to a protein. So the "good" and "bad" designation actually applies more to the protein carrier, than to the cholesterol itself, which is relatively inert.*

As part of this cholesterol education campaign, cardiac health organizations such as the American Heart Association and the Heart and Stroke Foundation in Canada recommend limiting the consumption of saturated fats and restricting cholesterol intake to no more than 300 mg of cholesterol a day, which amounts to the cholesterol content of 1 1/2 whole eggs.

Given the purported dangers of too much cholesterol, this sounds like a prudent step to take. But does limiting dietary cholesterol result in a meaningful reduction in the amount of cholesterol in your body? Not really. Even a relatively small individual produces about a gram (1000 mg) of cholesterol every day. Your body's production increases if you reduce the cholesterol content of your diet, whereas production decreases if you consume more than 300 mg of cholesterol from your diet. Your body is smart that way. It's going to maintain a level of cholesterol that's pretty darn constant unless you force feed yourself grams of cholesterol each day. Therefore, unless you habitually indulge in 96 oz. steak eating competitions or have the genetic disorder for familial hypercholesterolemia (which occurs in at most 1 in 500 people), dietary cholesterol intake appears to have little to no impact on blood cholesterol levels.

Seeing as that reducing one's consumption of dietary cholesterol is a relatively futile approach to controlling cholesterol levels, conventional medicine has increasingly turned to the use of prescription medication to combat the "scourge" of high cholesterol. In fact, the class of cholesterol lowering drugs known as statins have rapidly become the best selling prescription drugs in history, prescribed to over 13 million Americans and an additional 12 million users worldwide. God Bless America!

Touted for their ability to reduce the risk of heart attack by 36%, it's easy to see why statins have become so popular. I'd love to decrease my chances of getting a heart attack by over a third! Except that this 36% reduction in risk contains a couple of caveats.

  1. It's a 36% reduction in patients with multiple risk factors for heart disease
  2. The study that investigated the benefit of statin use vs. placebo use found that over a  3-year time frame, 3% of placebo users suffered heart attacks whereas 2% of statin users did the same.

As highlighted in a brilliant article by Business Week:  Do Cholesterol Drugs Do Any Good?, this 36% reduction in risk actually means you would need 100 people religiously taking statins for a period of several years before seeing a benefit in a single individual. This of course assumes you are giving statins to high-risk individuals with multiple risk factors. When statins are being prescribed to individuals of lower risk, the number of users needing to take the drugs might number in the the thousands before even one will benefit (data accessed from Business Week: The Number Needed to Treat).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is going on?!? Although statins do a phenomenal job of decreasing LDL levels (remember, that is supposed to be your "bad" cholesterol), they don't appear to do much in terms of decreasing your risk for cardiovascular disease. In fact, statins primarily benefit people who've already had a heart attack, and don't appear to prevent people from having a heart attack in the first place.

Wow, that's depressing. Haven't we always been told that the link between cholesterol levels in the blood and atheroscleroris/heart disease is an undeniable fact? Unfortunately, the reality appears to be a resounding: NO!

Much of the population data and a majority of the better designed intervention studies show that the link between blood cholesterol and heart disease is highly variable and often uncorrelated. In fact, the typical blood cholesterol-heart disease data that emerges looks something like this:

 

 

Interesting. Now we start to see why cholesterol lowering interventions like forced dietary reductions of cholesterol or statin use yield such underewhelming results in terms of disease prevention. But if total cholesterol levels and LDL cholesterol levels are weak predictors of heart disease, what really is the issue?

One of the factors complicating the issue of LDL cholesterol is that there are actually numerous LDL subfractions. Generally, the larger, "fluffier" subfractions present little cardiovascular risk, whereas the small, dense subfractions seem to correlate with an increased risk for cardiovascular disease. Simply testing for total LDL cholesterol content doesn't really tell you much about someone's risk, which helps explain why the fanatical obsession with reducing LDL levels has been met with failure. Unfortunately, too many doctors don't appreciate this subtlety about the LDL molecule and will rarely order a blood test sensitive enough to detect LDL particle size, thus continuing to misdiagnose people who aren't at risk.

Incidentally, while on the topic of LDL particle size, remember how I mentioned earlier that cardiac associations recommend limiting intake of both dietary cholesterol and saturated fats? Whereas dietary cholesterol had no impact on blood cholesterol, consuming saturated fat clearly does. So did the cardiac associations get half of the recommendation correct?

Nope! Yet another misinterpretation by conventional science. A number of research studies, which I'll highlight in a future article, have shown that consuming saturated fats tends to increase both HDL (our "good" cholesterol) and the large, fluffy LDL particles in the blood. Everyone seems to agree that increasing HDL is a good thing, and since large particle LDL doesn't seem to present any significant cardiovascular risk, it would appear there is little basis for avoiding saturated fats for most people. Kind of makes you wonder if returning to a diet with more natural sources of dietary cholesterol and saturated fats might actually be cardio-protective!

 

Breakfast of Champions

Conversely, what appears to be detrimental to blood chemistry is a diet high in carbohydrates. High carbohydrate diets (particularly those high in sugars and refined starches) increase the amount of small, dense subfractions of LDL as well as triglycerides, both of which correlate with an increased incidence of cardiovascular disease. Therefore despite the mainstream diet advice of the past 30 years, it appears most of us would be far better off ditching the breads and breakfast cereals in favour of eggs and steak. Consider it a gift to your heart.

Just remember that cholesterol is a natural compound that is primarily responsible for repairing and rebuilding cell membranes. Cholesterol on its own has zero affinity for attaching itself to arterial walls; why would it? Cholesterol only gets deposited on arterial walls in response to inflammation. Therefore, instead of obsessing about LDL cholesterol levels, the focus should be on avoiding triglyceride-forming foods and minimizing things that promote inflammation. Do this and your health will take a quantum leap forward!

 

 

 

Here as just a few lifestyle modifications that can help reduce inflammation and improve blood chemistry:

  1. Smoking cessation
  2. Decreased consumption of simple sugars
  3. Decreased consumption of refined grains
  4. Avoidance of most vegetable oils (exceptions: olive and coconut oils)
  5. Limited consumption of processed meat products (i.e. bacon, sausage, lunch meats)
  6. Limited consumption of caffeine
  7. Increased consumption of anti-oxidant rich vegetables and fruit
  8. Increased consumption of omega 3 fats, particularly from marine sources
  9. Daily exercise

This is far from an exhaustive list; however, even incorporating a few of these lifestyle changes can help turn cholesterol worries into a thing of the past.

Remember that when it comes to your physique and your health advice that is simply, "good enough", isn't!

 

As always, I welcome any feedback, discussion or debate!

Graeme is a high-performance nutrition consultant and university lecturer based out of London, Ontario. Graeme offers both in-person and distance coaching for physique competitors, elite athletes and those individuals looking for aggressive, yet sustainable fat loss. To learn more about his services, use the "Contact Me" tab in the main menu bar.
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