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
Are you concerned about cholesterol? Share below!
Discussion (49 Comments)
My doc has been trying to get me on statins for years, which I refuse to take. The side effects scare me to death! The women in my mom’s family have always had higher than average cholesterol, and not one of them has died of heart disease. Her aunt recently passed away of non-cardiac issues at the age of 94, and her cholesterol was well over 200. Even when fit, mine is in the 190-200 range, and it is usually more like 210. I noticed regulating my thyroid and avoiding grains and sugars helps the most.
I have ‘high cholesterol’ and my Gp’s concern is not about heart disease, but stroke. Have you seen anything about cholesterol in relation to strokes?
Love your articles – thanks!
In both cases, cholesterol is the “band aid” being sent to fight inflammation. I’d absolutely work with your doctor, but it would seem to be important to address inflammation as well.
My aunt has high cholesterol and it shows a yellow bump just under her eye. Is there a way to get rid of that yellow bump?
The narrowing of arteries works the same way in heart disease and stroke. In stroke, the carotid arteries are of the most concern. Like coronary arteries, they can narrow over time due to build up and they may be almost closed before there are symptoms. If one closes 100%, the result is a stroke. If a brain artery or carotid artery is blocked by a clot or other emboli, that results in a stroke.
Unlike heart attack, stroke can be caused by a bleed. Weak spots are caused by atherosclerosis or may be present from birth. The weakened areas bulge then leak or rupture. The higher the blood pressure, the more force on the weakened area, the more severe the stroke.
Unfortunately, aside from my past work experience as a nurse, I have seen the results of this with my own father who had a massive stroke 3 years ago. He went from an extremely active 73 year old (who most people assumed was at least 10 years younger) to a little old man in the blink of an eye. His carotid arteries were over 95% occluded with no symptoms prior to the stroke. One of his brothers had a stroke in his early 40’s. Neither of them were overweight, smokers, or regular drinkers. Genetics plays a huge role.
Although he, thankfully, is wholly alert and oriented he is paralyzed on one side and his speech is limited to the point he is mostly non verbal. It takes a lot of effort to make for him to communicate. That same year, one of my closest friends had a stroke and had a wonderful recovery other than some slight weakness on one side. No one would ever guess that she survived a stroke. The cause of her stroke is unknown. She had a few days of not feeling well in the weeks prior and the doctors theorize that she may have had atrial fibrillation during that time. (Cardiac output down, you don’t feel great because of lower oxygenation, and conditions right for forming a clot. Atrial fibrillation can be constant or come and go). Again that year, the mother of one of my son’s friends had a stroke following surgery caused by a clot. She is doing well now, but it took more than a year for her to seem like the woman she was prior to the stroke. Every time I run into her, she looks better and better. She was in her 40’s at the time of stroke.
Stroke can occur at any age, even in utero.
Unlike heart attacks, stroke can also be caused by a bleed in the brain. Because the skull is enclosed, the inter-cranial pressure is increased, causing damage. The higher the blood pressure, the worse it is. The symptoms are exactly the same in either case but the cause and treatment is different. The most important thing is to get to a hospital and FAST. A scan must be done to determine the cause. If it is a clot, drugs can be given in the first hour if the stroke is witnessed to dissolve the clot and prognosis is good. If it is a bleed, that same treatment would worsen the bleed and cause death.
There may be warning signs prior to a stroke that mimic a stroke (TIA/transient ischemic attack). In those cases, there is no actual loss of brain cells but they are a red flag. Proper treatment can prevent or lessen the impact of a future stroke.
With both stroke and heart attack, keeping blood pressure controlled is important. While people on a diet such as the paleo diet or a vegan diet may need to add salt, most of us need to decrease the amount of salt in our diet. Again, it is not all or nothing, it is the right amount.
Like Katie says, newer information suggests that inflammation plays a much bigger role in both heart attack and stroke than previous thought. Refined sugar and processed foods can cause inflammation. Gum disease is another common source of inflammation.
It is best to discuss risk factors with your doctor. I am also bugging mine to order a carotid sonogram to see how my carotid arteries are doing. I would much rather know that mine are becoming blocked when they are 40 or 50% closed than to find out farther down the road like my Dad did.
I hope this helped.
Jackie, I just wanted to say thank you for all the information you have shared. In-depth practical information from someone familiar with heart attack and stroke is really helpful. I’ve got a strong family history of both – even sudden death, which is so hard for family to deal with, to say the least.
So sorry about what happened to your dad.
I had a CIMT done by Vasolabs, if they’re in your area you may be able to get it done without the doctor ordering it.
You are so welcome. I wish I was more up to date (I have been home raising kids for many years). I also have a lot of heart disease and stroke in my family. I will check into the company you mentioned. Sudden death is often caused by an arrhythmia but unless someone is hooked up to a heart monitor at the time, it is impossible to know which one. Some do run in families and can be treated if you know which one it is. An electrophysiologist can do tests to induce and diagnosis these type of conditions. If you have this type of family history and have symptoms of feeling light-headed, feel dizzy, or have palpitations, it might be a good idea to look into this. Electrophysiologists are cardiologists with a specialty in the electrical conduction of the heart. They generally practice in larger hospitals but not every large hospital has one. Depending on the type of problem detected, medication, ablation of cardiac cells to destroy irritable cells, pacemaker or defibrillator may be recommended to prevent the potentially lethal arrhythmia. The testing is long and can be difficult so this is only done when there are indications that this may be a problem. If there is reason, it is well worth the time and trouble.
My father is doing well despite his disabilities and we enjoy every day we have with him. He had high cholesterol levels for years, it runs in our family. Other than the high cholesterol, he was very active and didn’t smoke. His diet could have been better but it wasn’t awful either (no fast foods, not too much processed meat). He had just come back from a hunting trip where he spent several hours a day tromping around the woods. Thank God he didn’t have his stroke there! He was completely non-verbal at first and couldn’t have called for help and was an hour from the closest hospital. Time is of the essence when a stroke happens. He was at the hospital once my mom found him within 2O minutes and transferred across town soon thereafter and seen by a top neurologist. Unfortunately, he wasn’t a candidate for intervention immediately after his stroke.
While I like this article, high cholesterol is a problem and a danger for at least some of us but that doesn’t mean the levels need to be as low as previously thought. In fact, this thinking was reversed many years ago that moderation with whole eggs and butter in small amounts should be fine for most people. Unfortunately, a lot of us don’t fall into the “most people” category.
Outside of work when waitressing my way through nursing school I knew some regular customers who had cholesterol levels in the 400’s. This was a group of sisters in their 40’s who had been monitored for years. All of them had a heart attack or angina before age 50. None of them were overweight. One of them had a kid who at age 12 (if I remember correctly) had cholesterol levels in the 800’s! No, not overweight, either! I don’t know what ended up happening with him but he was treated with an experimental therapy every two weeks at a children’s hospital at the time. Hopefully, he is alive and well and in his 30’s these days. While this is an extreme example, too high is obviously a problem, the proper range is debateable. It make sense that we need some cholesterol to maintain good health and that level may be different for those of us with a genetic disposition for certain diseases.
When it comes to articles like these, I consider myself to be an open-minded skeptic. I am open to new information but I am well aware that one size does not fit all and that the information is constantly changing. I was raised in a Wellness-Mama-type household and many of the ideas thought to be healthy and natural in the 70’s and 80’s have been disproven or found to be less effective than believed or even harmful. Some things are great and I still do them. I am always on the lookout for new information. However, being raised in a household with a negative view of western medicine while I am also skeptical of the medical community at times, there is more good than bad in general.
The best thing to do is to find a doctor or nurse practitioner who is open minded and willing to listen to your concerns. Communication is so important. Now, it is easy to look up information online but that hasn’t always been the case. When I come across a medical condition that I am unfamiliar with, I use WebMD or the Mayo clinic website for good basic explanations and then go from there.
The information on cardiovascular health is constantly changing. I went on maternity leave for 8 weeks once and came back and a whole bunch of stuff was completely different. It bothers me when things are referred to as a myth in medicine. We all learned the scientific process in school and that is how these recommendations evolve but they do not always prove out over time. Another thing to keep in mind is that relationships in a study are not always cause and effect. Sometimes, there is another reason for lab results and the high or low levels are a result of the disease process, not a cause. People used to believe that flies came from rotten meat. It made sense at the time. Here’s some bad meat and now there are maggots. Flies come from rotten meat! So simple! Germ theory was considered quack science in the beginning but feeling bumps on your head to diagnose was accepted in its time. Method, size of study, and peer review are all important when deciding whether to accept or reject a health recommendation. Whatever we know today will change tomorrow as new information from new studies is gathered.
Thank you Jackie. I’m so glad your father is doing well. Getting quick treatment is so important. And knowing the signs of stroke/heart attack is just critical. I believe it may have saved the life of one of my family members if the person there when it happened had realized what was going on.
My cardiologist thinks I’m ok right now. The sudden deaths in my family were ascribed to a heart attack with 90% blockage, and to a stroke, respectively. But as you say, neither one was hooked up to a monitor at the time. And one of them was many decades ago, so the method of assessing may not have been terrribly accurate.
The super high cholesterol levels you mention have been common in my family, and most of us are skinny. Was the boy having the procedure that’s similar to dialysis? I have always wondered how people deal with that.
I look on the bright side, we have heterozygous rather than the homozygous form. So we’re not having poor little kids with cholesterol in the 1000s and possibly having heart attacks at age 5. That has to heartbreaking.
No kidding that the information on cardiovascular health is constantly changing. Since I started paying attention at about age 10, there have been huge changes. Being able to look up information online is a blessing, I’m no longer limited to just the books available at my library. Being able to find multiple studies in just minutes at Pub Med still amazes sometimes. And I absolutely agree that sometimes the lab values are a result of the disease process, rather than the cause.
I wish you the best. These hereditary problems can be really concerning. You never want to watch your whole family going through it, and see it transferring down the generations.
Excellent article but might I suggest that everyone do additional research. There is a theory out there that seems to make sense to me. It involves table salt. Table salt, from what I understand, contains glass and sand, both of which can cut the inside of our veins. In reaction, the body uses/speeds cholesterol to these injuries in order to prevent us from bleeding to death and that, in turn, causes cholesterol build up. If you cannot eliminate salt, I understand that Himalayan Pink Salt is the purest on earth and the best alternative.
I have been reading the blog of Dr. Malcolm Kendrick, a Scottish cardiologist, for a couple of years now and he’s fantastic. He talks about how cholesterol and high blood pressure and many other things have gotten a bad rap over the last few decades and why it’s no wonder people are so confused. He also is one of the few people who is finally saying things like “skinny does NOT equal healthy”. Too many people live under the assumption that if they are skinny they MUST be better off. Wrong. Of course, being obese is not healthy either, but what he does say is that as we age we are better off with a little meat on our bones than vice versa.
He’s also got a great sense of humor in his writing, so check him out. Lots to learn from this very educated man. Usually the reader comments are interesting to read, as well.
Wellness Mama you rock big time, thanks for this post
This is an extremely useful article as it attempts to unfold the myths of cholesterol. As mentioned in the article, for almost five decades it is assumed that cholesterol is bad. The differentiation between good cholesterol and bad cholesterol is disappearing and people just assume that cholesterol is by itself bad for heart health. A must read for all those concerned about the heart health.
I have always had very low cholesterol as well. The first time I ever got it checked, in my late teens, it was 79. 79 total!! I am now 40 and have been trying everything I can to raise it for over 20 years. The highest I have ever gotten it is 125. Currently I’m at 120. I have always eaten full fat foods. I raise chickens and average 3 eggs/day. I eat grass fed butter on everything and use lots of coconut oil in my cooking. I eat lots of meat and drink raw whole milk. You can read a billion articles on high cholesterol and how to lower it, but there is hardly any info on how to raise it.
I do not agree on the part that diet does not really affect cholesterol.
If I watch what I eat my cholesterol levels are good. If I eat a lot of full fat diary, cheese, butter and
less beans, apples, oats, nuts my cholesterol level hits the roof! I test my levels every 3 months
and for my bloodlevels proof that diet does matter….
Chris Materjohn stated that in his opinion around 80% of people are not sensitive to dietary cholesterol and fat so you could be in the 20%. Of course that does not mean that if your levels go up you are in some sort of danger. I tend to agree with masterjohn, I ate liver twice in one week along with eggs for breakfast every day and my levels spiked from 2.9 mmol LDL to 4.0 mmol. I think the better lipid levels to check are Lp(a) and find out if your LDL is large or small. Also check your Homocysteine level
Thank you Olia for your great knowledge and information!
I have never checked my Lp(a) and homocysteine. I will ask my doctor next time when I want to do a checkup
Last time my levels were
That time I watched my food moderately. I ate butter, eggs and cheese 2/3 times a week
I think the point here is a re-thinking of what “good” numbers are, not that diet doesn’t influence our cholesterol levels. Those numbers you get when you eat butter, cheese, and eggs may be the good ones.
maybe, but I guess it is really difficult to know what are ”good” numbers..
when i eat full fat dairy, cheese, eggs and butter regularly my levels are more or less 300 mg/dL.
and my dutch gp is not happy to say the least..
I appreciate you spreading the knowledge that cholesterol is necessary for health, and addressing common misconceptions.
I just hope that people don’t think they can consume as much as they want without regard for family history or their personal lipid levels. I’m taking the time to write this because some people have told me cholesterol doesn’t matter, and I shouldn’t even pay attention to it in my diet. Follow that advice could cause suffering for some of us.
Many folks have hereditary conditions which cause very high total and LDL cholesterol. Even though most of us have large “fluffy” LDL particles, that doesn’t mean we’re totally off the hook. A large amount of LDL particles can cause damage (even though they aren’t the small dense type). I believe you can read more about that at Chris Kresser or Chris Masterjohn’s sites.
And there are others who may have a genetic tendency to hyper-respond to dietary cholesterol.
Just to clarify, I am not really talking about total cholesterol levels in the 200s, I’m referring more to the 300- 400 and higher levels that often come with conditions like hypercholesterolemia. There is a higher risk of heart attack with this condition even in otherwise healthy people. The one bright side I like to pay attention to is that it usually comes along with normal triglycerides.
My doctor has been trying for years to get me on cholesterol meds, I keep refusing. I would rather keep my brain cells and the high LDL instead of fast-tracking the aging process to get it lower. I have read many articles like this, and considering the reputation of the drug companies to make money, I will continue to refuse.