The Cholesterol Myth
Most people will cringe at the idea of eating 10 eggs. This is not because of how eggs’ taste, but because of the amount of cholesterol, an egg has. Our society is incredibly afraid of cholesterol. After all, “it causes heart disease and it can kill you”.
However, if we pick up a physiology book, we will learn that cholesterol is essential for our health. This type of lipid is necessary for the proper formation of all cell membranes;, production of steroid hormones (estrogen, testosterone, cortisol, progesterone, and aldosterone);, preparation of bile acids;, synthesis of vitamin D;, and may even play an important role in your immune function and protection against cancer. Cholesterol is also vital for our brain health (since 25 percent of the body’s total cholesterol content can be found there).
So, is cholesterol good or bad? Where should we stand?
Let’s start by understanding what cholesterol is. Cholesterol is a sterol (, a type of lipid) that, as we just saw, is a necessary raw material for many compounds and processes in the body. Nevertheless, most people use the word cholesterol to refer to low-density lipoprotein (aka: LDL) cholesterol, high-density lipoprotein (aka: HDL) cholesterol, and even to a type of fat called triglyceride.
The bad rep comes from the fact that with heart disease, (in particular atherosclerosis), cholesterol is deposited in the walls of the arteries;, consequently, causing a decrease in blood flow and even blockages. This idea was further supported by some epidemiological studies around total cholesterol (and LDL in particular) consumption. And the correlation with increased prevalence of atherosclerosis and heart disease.
The thought process is,“If cholesterol is creating atherosclerosis, we should not consume it”.
However, things are not as linear as we have been told. So much so, that even if we stopped consuming foods that contain cholesterol, our bodies will still produce it. Our bodies absolutely need it. In fact, dietary cholesterol (cholesterol we consume) only accounts for around 25 to 40 percent of our daily turnover; whereas production in the body accounts for 60 to 75 percent.
If we look at some higher-quality research, we can see that half of the heart disease patients have within-range cholesterol levels. Additionally, according to a 2009 study, nearly 75 percent of heart attack patients who were hospitalized also had cholesterol levels that would not put them in the high-risk category.
Ironically, research supports that low cholesterol is actually associated with a higher risk of mortality from heart disease, stroke, and cancer.
What’s causing heart disease?
If eating cholesterol-rich foods is not causing atherosclerosis, what is? In truth, there is no single culprit. It’s a combination of different factors.
Let’s start by talking about carbs, in particular sugar. When we eat an excess of carbs (easily achieved by consuming sugar), our body channels the excess sugar (glucose) to our liver to be converted into fat (triglycerides in particular). LDL cholesterol (often called ‘bad cholesterol’) is then recruited to transport these triglycerides to various places in the body for storage. When everything is working well, an acceptable amount of triglycerides are produced in the liver; and later distributed and stored with the help of LDL cholesterol. Problems arise when we over-consume carbs and sugars. In this state, we produce an excessive amount of triglycerides. As a result, we then need to produce more LDL cholesterol to transport them. This excess of “traffic” on the road leads to a higher number of accidents. In other words, LDL cholesterol can “crash” into your artery walls and cause an accumulation of cholesterol plaque.
What’s important to notice is that cholesterol was not the culprit. LDL was just doing its job. The increase in LDL and “vascular accidents” comes from the metabolic consequences of overconsumption of carbs and sugars.
Besides carbs and sugar, we also have to consider processed polyunsaturated fats (aka: PUFA) mostly found in vegetable oils. When we consume vegetable oils, these oxidized fats need to be transported by LDL to be stored. As LDL carries the oxidized PUFA, the oxidation spreads into the LDL molecule.
Once LDL becomes “oxidized LDL,” our immune system identifies the threat and sends macrophages (aka: immune cells) to “eat” the mutant LDL. The big-bellied macrophages (aka: foam cells) accumulate, and, once again, become the beginning of the atherosclerotic plaque.
Finally, we cannot forget the insulin resistance issue. An issue also triggered by the excessive consumption of sugar and oxidized oils. Several studies have shown that in cases of insulin resistance, both the LDL particles and the arterial walls become “stickier”. This stickiness compromises the interaction between LDL and the arterial wall; and increases the risk of plaque formation.
These are just some of the possible causes of atherosclerosis. The important thing here is to understand that there are different factors causing heart diseases. But dietary cholesterol is not one of them.
Beware of Statins
Statins are a cholesterol-lowering drug. Their adoption by doctors had the goal of lowering the supposedly dangerous cholesterol and reducing cardiovascular disease. As we already saw, this logic is flawed. Considering that statins are one of the most widely prescribed classes of drugs in the world, we should definitely be aware of their negative consequences.
For starters, we now know that aiming to lower the much-needed cholesterol is not a good idea. Additionally, statins have been shown to create major micronutrient deficiencies of copper, selenium, zinc, and vitamin E. Additionally, while research is still unclear, there are studies showing likely connections between statin intake and higher risk of nerve and muscle damage, liver disease, diabetes, birth defects, endocrine dysfunction, and even cancer.
We should not be afraid of cholesterol. Instead, our attention should shift toward removing sugars and vegetable oils from our diet. While not shared yet by mainstream media, these are some of the main contributors to cardiovascular disease. So, don’t be afraid of adding some healthy fats to your diet. Especially the eggs we discussed at the beginning of this article.
We should also focus on better markers. Instead of only looking at LDL, it’s probably wiser to look at the ratio of Triglycerides and HDL as cardiologists used to do back in the day. There are also other diagnostic tests like the CAC (aka: coronary artery calcium) score that provide a better representation of your heart health.
Contact us and talk to one of our team members. We are here to help you in this process.
If you want to learn more about how to optimize your cardiovascular health, please check this week’s video lecture. Click the button below to watch it.
Marcos de Andrade MD, MBA Biohax