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.
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.
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
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