Cholesterol has gotten a bad reputation in the past six decades or so, and most people have the idea that it is bad in all forms. Sure, there is one kind of “good cholesterol” but in general, numbers should be low… right?
Recently, certain government organizations have reversed their position on cholesterol, at least somewhat, claiming that it is no longer “a nutrient of concern,” and that it *may* not be dangerous when obtained form whole-food sources and non-processed foods. This is something that many doctors and health researchers have already known for decades, but I’m glad to see an official reversal from regulatory organizations (although I personally wouldn’t rely on nutrition advice from government organizations without doing some independent research!).
Unfortunately, for decades, we’ve been told that it “causes” heart disease and that it is important to avoid sources like butter and eggs. An entire industry of low-fat dairy and yolk-less “eggs” was established and many people dutifully avoided these “bad” foods.
Now, it turns out that eggs and butter haven’t been the enemy all along… here’s why:
What is Cholesterol?
Cholesterol is an organic molecule that is essential for all animal life. Classified as a sterol, it is found in the cell membrane of animal tissues and is a necessary precursor for steroid hormones and bile salts in the body. Physically, its texture is often compared to soft candle wax.
Cholesterol can be found in certain foods, but it is also created by the body daily. In fact, the body creates more on a daily basis than a person consumes through diet, synthesizing over 1,000 mg of cholesterol total while obtaining only an average of about 300mg from food. (1)
This is part of the reason that dietary amounts doesn’t necessarily correlate to total cholesterol in the body and why avoiding dietary sources wouldn’t necessarily be effective, even if cholesterol was problematic for health. Only about 1/4 of the cholesterol used by the body on a daily basis comes from diet, with the majority being created in the body. In fact, when dietary consumption decreases, the body will create more to compensate.
Cholesterol and Heart Disease
This is where things get interesting. As I already mentioned, this lipid is necessary for the body and is found in the cell membranes of all animal tissue. In short, without it, we would die. In fact, the lower a person’s levels, the higher their risk of death and high cholesterol levels have more recently been correlated to longevity.
As with all aspects of life, it is important to note that correlation does not equal causation, but ironically, this is where the myth of the danger of cholesterol originated.
The Framingham Heart Study that began in 1948 and followed over 5,000 people for 50 years. One of the early results of this study was the observation of a correlation between high cholesterol and heart disease. It is important to note that this result was strictly observational and that when we consider the actual data, those with heart disease only had an 11% increase in serum levels. Additionally, the data only held up until the subjects were 50 years old. After age 50, the study found no correlation between heart disease and high cholesterol. (2)
So, either something about turning 50 magically increases a person’s ability to avoid heart disease or there is more to the story…
Consider These Points
- 75% of people who suffer from a heart attack have normal levels. (3)
- Low serum cholesterol has been correlated with higher mortality. (4)
- High levels correlate with longevity. (5)
- Cholesterol has never been clinically demonstrated to cause a single heart attack.
- In women, serum levels have an inverse relationship with mortality from all causes. (6)
- For every 1 mg/dl drop in cholesterol per year, there was a 14% increase in the rise of overall mortality. (7)
- Many countries with higher average cholesterol have lower rates of heart disease.
- Low levels are a risk factor for several types of cancer (8) (Note: consider the implications of statin drugs to lower cholesterol on cancer risk in light of this research).
- 1/4 of the body’s cholesterol is in the brain and studies have demonstrated higher rates of dementia in people with low cholesterol. Research also found a correlation between higher LDL and better memory in elderly patients. (9)
Even the “dangerous” LDL type doesn’t hold up to scrutiny as a culprit for heart disease. A study conducted in 2015 attempted to clarify the relationship between heart attack and serum levels and after following 724 patients who suffered a heart attack. The authors found that those with lower LDL-cholesterol and triglyceride levels had a significantly elevated mortality risk when compared to patients with higher LDL and triglyceride levels. Another study in 2018 found the same patttern. (10)
Lower LDL and lower triglycerides were associated with HIGHER mortality rate. This makes sense if you consider that triglycerides (fats) are an important source of energy from the body and that cholesterol is needed in the cell membranes of all animal cells and is used in making necessary hormones.
Heart Disease: More to the Story
Now, this isn’t to say that heart disease isn’t a big problem… it certainly is! It is also a much more complex problem than just a simple number like cholesterol levels, and the last four decades have demonstrated that attempting to fight heart disease by addressing cholesterol levels is ineffective.
Heart disease affects millions of people each year and costs billions of dollars. I’m certainly not suggesting in the least that we shouldn’t be actively searching for answers and solutions to heart disease, but that by concentrating so much on one substance that isn’t even correlated to higher heart disease rates, we may be missing more important factors!
Since there is evidence (as mentioned above) that high levels may not be a big factor in the heart disease equation, shouldn’t we be more focused on reducing rates of heart disease itself rather than just lowering cholesterol levels?
There are other theories about the origins of heart disease and emerging research points to factors like inflammation, leptin resistance, insulin levels and fructose consumption.
Exonerating Cholesterol?
Thankfully, the tables seem to be turning and news about the importance of cholesterol seems to be more common. Even Time Magazine, a publication that helped spread early reports from the Framingham Heart Study and published a 1984 article touting the dangers of cholesterol, seems to be wising up to the new research. The magazine ran a cover in 2014 with the title “Eat Butter” and recently reported that:
In the latest review of studies that investigated the link between dietary fat and causes of death, researchers say the guidelines got it all wrong. In fact, recommendations to reduce the amount of fat we eat every day should never have been made.
A study out of Finland shed further light on the equation:
The Finnish study, in The American Journal of Clinical Nutrition, followed 1,032 initially healthy men ages 42 to 60. About a third were carriers of ApoE4, a gene variant known to increase the risk for heart disease (and Alzheimer’s). The researchers assessed their diets with questionnaires and followed them for an average of 21 years, during which 230 men developed coronary artery disease.
After controlling for age, education, smoking, B.M.I., diabetes, hypertension and other characteristics, the researchers found no association between cardiovascular disease and total cholesterol or egg consumption in either carriers or noncarriers of ApoE4.
The researchers also examined carotid artery thickness, a measure of atherosclerosis. They found no association between cholesterol consumption and artery thickness, either. (11)
In short, evidence doesn’t seem to support focusing largely on cholesterol as the culprit in heart disease, and there are a variety of other factors that may be much more important.
The Benefits of Cholesterol
It turns out that not only is it not as harmful as once believed, it has a variety of benefits to the body. Even writing that cholesterol is beneficial may seem crazy in light of the dietary dogma of the last half century, but its importance is well-supported by research!
In fact, cholesterol has the following benefits in the body:
- It is vital for the formation and maintenance of cell walls
- It is used by nerve cells as insulation
- The liver uses it to make bile, which is needed for digestion of fats
- It is a precursor to Vitamin D and in the presence of sunlight, the body converts cholesterol to Vitamin D
- It is needed for creation of vital hormones, including sex hormones
- It helps support the immune system by improving t-cell signaling and may fight inflammation
- It is necessary for the absorption of fats and fat-soluble vitamins (A,D, E and K)
- It is a precursor for making the steroid hormones cortisol and aldosterone which are necessary for regulation of circadian rhythms, weight, mental health and more
- It is used in the uptake of serotonin in the brain
- It may serve as an antioxidant in the body
- As it is used in the maintenance of cell walls, including the cells in the digestive system, there is evidence that cholesterol is necessary for gut integrity and avoiding leaky gut
- The body sends cholesterol from the liver to places of inflammation and tissue damage to help repair it
Additionally, cholesterol-rich foods are the main dietary source of the b-vitamin choline, which is vital for the brain, liver and nervous system. Choline is vital during pregnancy and for proper development in children (and only 10% of the population meets the RDA for choline!)
The Bottom Line on Cholesterol
Dietary cholesterol does not significantly affect blood levels and is no longer considered a “nutrient of concern” when it comes to heart disease.
Cholesterol levels do not statistically correlate to heart disease and those with low levels have a higher risk of death from all causes while high levels are linked to longevity. Men under age 50 do have a *slightly* increased risk of heart disease with levels over 300, but levels just under 300 removed this risk and maintaining levels at 200 or lower did not offer any more statistical benefit. Also, since 90+% of heart disease occurs in those over age 60, the big push to lower cholesterol levels (and the corresponding rise in cancer risk) may do much more harm than good.
Low cholesterol is also correlated with mental problems like dementia and several types of cancers so the idea of taking drugs specifically to lower serum levels warrants further scrutiny, especially in segments of the population (like children, women, and men over age 50) when there is no correlation to heart disease to begin with!
At the end of the day, we are each responsible for our own health and with the emerging evidence that exonerates cholesterol as a culprit in heart disease, I hope that many of us will research and question the dogma that it is harmful or that lowering it can be beneficial.
Additional Reading
Book: The Cholesterol Myths (available to read online here)
Article: Leptin Reset from Dr. Jack Kruse
Article: Statin drugs shown to be largely ineffective for the majority of people who take them, but why does this fact seem to have passed researchers by? from Dr. Briffa
Article: The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy from Chris Kresser
Book: Cholesterol Clarity: What The HDL Is Wrong With My Numbers?
Book: Put Your Heart in Your Mouth: Natural Treatment for Atherosclerosis, Angina, Heart Attack, High Blood Pressure, Stroke, Arrhythmia, Peripheral Vascular Disease
Are you concerned about cholesterol? Share below!
Thanks mama, this is very helpful than more just blindly listening to doctors.
Again, your information is incorrect, people love to hear good news about their bad habits.
You are incorrect, according to Cardiologist, Dr Kim Williams speaking at the Debakey institute for cardiovascular education and training.
Dr Kim Williams is the Immediate Past President, American College of Cardiology
My husband has numbers slightly higher than the doctors recommended number so and his first reaction was to cut eggs and butter. I searched your site for info on it and am glad I did. But I’m not sure I can get him to listen to anything other than the mainstream medical info. Thanks for sharing. I love your blog!
How many milligrams of cholesterol should a many eat?
my doctor will NEVER be able to put me on cholesterol medicine! I’m middle age, total cholesterol is 291, my HDL is 78 which is higher than the highest number of the “good range,” and my ratios are all good. i absolutely believe our bodies need the cholesterol that it makes and it is there to protect us not hurt us. If you do your best to live a healthy lifestyle, include plenty of foods that are good for you, limit foods that aren’t, exercise, and keep your weight w/in a healthy range you are doing more for yourself than any cholesterol med claims to be able to do. Be informed.
My cholesterol levels have always been low.
Now they are very low, at 117, probably because I had to eliminate cheese, butter, and eggs from my diet (gallbladder problems and food intolerances). I still eat meat 3x a day and cook with coconut oil. So how do you raise your cholesterol in such a limited diet?
Thanks for an interesting article! I just had my cholesterol levels tested & am baffled by the results & all of the information out there. My triglyceride level is 254, doctor says it should be 150. My HDL is 29, doctor says it should be above 46. My LDL is 130, doctor says it should be 130 or below. Can someone explain what all of this means in an easy to understand way? I’ve been researching and quite honestly, panicking a bit. I’m 5’7 130 lbs. I eat a GF, organic diet, no red meat, very few refined sugars, etc. Here I thought I was doing well, but according to my doctor I’m at high risk for a stroke. Advice would be most welcomed!
Have you ever had any testing like 23 and me? I wonder if there could be a genetic factor or a mutation causing the higher numbers? Is there a naturopath in your area you could work with to find some answers for your specific case? One thing I know for me helps keep my numbers in good range is eating enough protein, taking Omega 3 and keeping fats and carbs separate at meals.
Your post and the thoughtful comments are my gold standard for good information! Thank you.
Thanks for reading, Helen!
Thank you so much for this post, I have been saying this for so long, and we need more articles like this out there to spread the message!!
i think the take away from this information is that your body needs (and makes its own) cholesterol for a reason, and that having a higher than the gold standard cholesterol number alone does not necessarily mean you are at risk for heart disease.
maybe an individual’s cholesterol number is very specific to their body. in light of the fact that there is no real evidence that high cholesterol levels alone have anything to do with heart disease, heart attack or stroke, i think it would be important for a doctor to be able to justify otherwise why it is necessary to take a statin in the first place. considering too, the medication doesn’t clean up the cholesterol you have eaten, cholesterol is reduced by stopping your body from making cholesterol. why would i want to stop my body from doing something it is supposed to do? doctors don’t know everything and big pharma is definitely making big $$ putting people on statins. my doctor also wants to put me on statins and i think not. my ratios are “good, good and ideal” and i do not have any other heart disease risks. it is critical to be informed and learn all you can about this subject. also use your common sense.
even in the case of hypercholesterolemia, if you have high cholesterol but don’t have any other real heart disease risks (high BP, smoking, overweight, poor diet, no exercise, known family history etc.) its possible high cholesterol levels represent your body’s way of healing itself, or doing something else that has nothing to do with heart disease.
plenty of vitamin c keeps the arteries healthy.
I listened to a teleseminar by clinical nutritionist, Johnny Bowden. He stated that you should divide your triglyceride level by your HDL level. If the resulting ratio is 1 or a negative/fractional value, this is fantastic but rare (mine is .73). If the ratio is 2 or less, this is darn good too as this too is probably a sign you are not particle B LDL ( the small and dense particle). If the ratio is high, such as over 5, there is a 16x greater chance of heart disease. This is also the standard for insulin resistance, i.e. the ratio is ranging around 4 you need to take action. I have been getting the lecture on my cholesterol levels for years from my primary care doctors. I also see a functional medical doctor for 3 years who is also a MD. The latter told me my high cholesterol levels are protective. I do have low free T3 thyroid issues and the thyroid and cholesterol levels are related. Usually your conventional medical doctors don’t explore the thyroid connection.
This is a complicated issue. There is an electrical conduction system in the heart and the plumbing system/vessels of the heart. A problem with either can cause death. Genetics (how you process fat), lifestyle, diet, diabetes, and more all factor in to individual risk of heart disease. To make it even more complicated, when there is a blockage in the cardiac or carotid arteries, it can be cause by a blood clot or other embolism (particle traveling in the blood stream) an overall hardening of the artery, or a fatty lump with a hardened outer layer that can suddenly rupture. A disruption in the conduction of the heart can cause sudden death (ventricular arrythmia) or can lead to clot formation (atrial fibrillation is an example of this). This type of patient may or may not have elevated cholesterol levels. I am guessing that most, if not all, bypass patients do have elevated levels of cholesterol. However, we often don’t know if “Uncle Fred” died because he had a ventricular arrythmia or because one of his coronary arteries became 100 percent blocked and the damage was too great to survive. Also, to make things even more confusing, the damage from a physical blockage can lead to a fatal arrythmia. We just say that he died from a heart attack. Fatal arrythmias can also be caused by electrolyte problems, especially low or high potassium. Renal patients have trouble eliminating potassium and have high levels, for example but certain medications, like some diuretics, lead to low potassium. Too low or too high is a problem.
Medicine is always evolving. As time goes by, more is learned and recommendations change. Keep in mind that doctors must adhere to accepted “standards of care.” As research goes on, these standards change but for malpractice reasons physicians must be careful about prescribing the unproven.
It is worth noting that for someone who doesn’t have the best diet, increasing the amounts of fruits and vegetables, eliminating things like fast food, and adding aerobic exercise will lower total cholesterol even if the amount of fat overall doesn’t change much. Since all these things are beneficial, I don’t think the lower cholesterol that results is a negative. If the only thing that someone does is take a statin drug without lifestyle and diet changes, the number may be lower but the benefits might not be as great as someone with a higher level but a healthier lifestyle. .
The best thing to do is to discuss what is right for you, with your family history and current risk factors, with your doctor or cardiologist.
As with most things, cholesterol levels are part of a larger picture. And, as with most things, it is not a question of high is good or bad and low is good or bad but rather what the right amount is given other risk factors.
Around age 50, our endocrine system experiences changes. This is especially true of women as we enter menopause. These changes also effect the risk of heart disease. As we age, women seem to catch up to men in regards to heart disease.
Someone can have overall hardening of the arteries and have NO symptoms until one or all the the three major branches have closed by more than 90 percent. This is pretty late in the game to find out you have heart disease. Or, the symptoms can be very vague, especially in women. It is important to realize that most studies used white males until the last 20 or 30 years. Women’s symptoms can be very different than men’s. Women may have fatigue or shortness of breath, even only nausea or heartburn. If the damage is small to the heart, she may not even seek treatment and find out only later on an EKG that there was an actual heart attack (death of cardiac tissue) at some point in her past.
In closing, I do believe the right type of fat is essential for good health. As to where your cholesterol levels should be, I would say that depends on the situation. Discuss it with your doctor and look closely at your family history.
No matter what we know about heart disease now, more is always being discovered and recommendations will change and will probably continue to change for many decades. I know that things have changed since I have worked in a hospital’s cardiac unit. They changed during the 3 or 4 years I worked in one and that was a long time ago. Because information and recommendations change doesn’t mean a doctor was wrong or close-minded. Look for a physician who keeps learning and educate yourself as much as possible.