What’s up with cholesterol?

Does cholesterol cause heart attacks?

That is the million, no, billion dollar question. And it seems that there are many different opinions floating around. There are doctors, scientists, pharmaceutical companies, health gurus, government agencies and even your Uber driver trying to convince you on the effects that cholesterol has on your health. It’s time to challenge the widely accepted notion that cholesterol is the main culprit behind heart attacks. Contrary to popular belief, cholesterol is not the enemy lurking in your arteries, waiting to strike. In this article I will explain why I believe that cholesterol does not need to be feared.

 

Cholesterol: A Complex Compound

Before we delve into the reasons why cholesterol is not the enemy, let’s first understand what cholesterol is and its vital role in the body. Cholesterol is a waxy substance found in every cell, and it plays a crucial role in several bodily functions, including:

1. Cell membrane structure: Cholesterol forms an essential part of cell membranes, providing stability and fluidity.

2. Hormone production: Cholesterol acts as a building block for the synthesis of important hormones, such as estrogen, testosterone, and cortisol.

3. Vitamin D synthesis: Cholesterol serves as a precursor for the production of vitamin D, which is crucial for bone health and various physiological processes.

4. Bile acid production: Cholesterol is involved in the synthesis of bile acids, which aid in the digestion and absorption of dietary fats.

5. Cholesterol repairs damage in our cardiovascular system.

In short,  Cholesterol is important for our survival. It has so many important functions that keep us in a healthy state. Cholesterol affects the membranes around each one of our cells and keeps our metabolism running at optimal levels.

 

Often Cholesterol is not elevated in people suffering heart attacks

When I had my sudden cardiac arrest, my blood levels were completely normal. My total cholesterol was not elevated and my HDL and LDL levels were in an optimal range. So what gives? Should my body not have indicated crazy high levels of blood cholesterol? Add to that the fact that more than 50 percent of people suffering from a heart attack have normal levels of cholesterol… Hmmm, well, cholesterol is probably one of the most complex and misunderstood subjects of the last few decades.

Over the last fifty years we’ve been told over and over and over again that elevated cholesterol causes heart attacks. High levels of LDL have been portrayed as the dark knight of human health. Will it cause heart attacks? Maybe, with the help of some other factors such as diabetes or insulin resistance, unstable plaque, inflammation, smoking, high blood pressure, lack of physical activity and oxidative stress to name a few.

Recent research shows that ingestion of dietary cholesterol (such as eggs, cheese, shellfish and red meat) will not harm your health.

 

Debunking the Cholesterol Myth

1. Understanding the Role of LDL and HDL

Contrary to popular belief, not all cholesterol is created equal. Low-density lipoprotein (LDL) cholesterol is often dubbed the “bad” cholesterol because elevated levels of LDL are associated with an increased risk of heart disease. However, LDL is not the sole villain.

High-density lipoprotein (HDL) cholesterol, on the other hand, is known as the “good” cholesterol. HDL helps remove excess cholesterol from the bloodstream and transports it back to the liver for processing and elimination. Research suggests that having higher levels of HDL can actually have a protective effect against heart disease.

2. The Inflammation Connection

Inflammation plays a pivotal role in the development of heart disease. When our arteries become inflamed, it triggers a series of events that can lead to the formation of plaque. This plaque buildup narrows the arteries and restricts blood flow, potentially leading to a heart attack or stroke.

Studies have shown that inflammation, not cholesterol itself, is the primary driver of atherosclerosis (the narrowing of arteries due to plaque buildup). Cholesterol, particularly LDL, may be involved in the process, but it is not the root cause.

3. Challenging the Cholesterol-Heart Attack Link

Despite the longstanding belief that high cholesterol directly causes heart attacks, recent research has challenged this association. Numerous studies have found that up to 75% of people who experience a heart attack have normal or low LDL cholesterol levels.

This discrepancy raises questions about the simplistic notion that cholesterol is solely responsible for heart attacks. It is crucial to recognize other factors, such as inflammation, oxidative stress, high blood pressure, smoking, and diabetes, as significant contributors to cardiovascular disease.

 

The Benefits of Cholesterol

It’s time to shed light on the positive aspects of cholesterol and its role in maintaining our health. Cholesterol:

1. Promotes brain health: The brain relies on cholesterol for optimal function. Adequate cholesterol levels are essential for neurotransmitter synthesis, learning, and memory.

2. Supports hormone balance: Cholesterol serves as the building block for steroid hormones, including testosterone and estrogen, which play critical roles in reproductive health, mood regulation, and overall well-being.

3. Enhances vitamin absorption: Cholesterol aids in the absorption of fat-soluble vitamins, such as vitamin A, D, E, and K, which are essential for various physiological processes.

 

Should you be concerned?

So, should we be concerned about LDL (the bad ones) and HDL (the good ones). Mainstream medicine has preached that LDL may cause a ‘fatty buildup’ in your arteries, constricting them, causing heart trouble. While HDL, like a knight in shining armor, carries extra cholesterol back to the liver. Again, it is important to note that cholesterol is vital to our health.

There are ‘subdivisions’ of LDL that many doctors don’t pay enough attention to: LDL-A are the big fluffy particles that are considered harmless. LDL-B are small dense particles that can cause inflammation. Then there’s Lipoprotein (a) or Lp(a) which are very small, dense particles that can clot the blood when they build up in the body and become inflamed.

Every cell in our body needs cholesterol to survive. Our liver makes most of it, approximately 80%, the rest comes from our diet. If you restrict cholesterol intake, your liver will simply step up production and produce more of it…and vice versa. In other words eating a diet high in cholesterol will not automatically increase your overall blood cholesterol.

Exceptions are a genetic condition of hyper responders. But in those people, even though cholesterol levels were elevated after ingesting more, they did not experience an increase of heart disease. Yet another condition is people suffering from Familial Hypercholesterolemia, an inherited condition of super high levels of blood cholesterol.

There are a myriad of studies that claim the dangers of cholesterol. But now there are also many high quality studies have shown that dietary cholesterol has very little or no impact on an increase of heart disease. In fact it’s been found that a high level of LDL is not a very good predictor for future cardiovascular disease. In order for atherosclerosis to occur there must be damage to the lining of the artery. So who is to say that LDL noticed the damage and rushed to help the injured part? In other words, LDL found in arterial plaque may  simply be an innocent bystander, a good Samaritan rushing to help fix the damage to the artery? Even though the great majority of the medical community believes LDL causes heart disease (because that’s what was taught in medical school) , it has never been proven conclusively.

 

Cholesterol does become lethal if it is oxidized

No doubt. Your immune system may see the oxidized cholesterol as a threat and fight it off causing inflammation inside of the arterial wall. How does it become oxidized? The main culprits are smoking and vaping, eating the wrong fats (Polyunsaturated such as vegetable oils), and processed foods (fried and fast food, baked goods etc). Besides your diet, it is also the breakdown of the mighty pillars of health  (mental attitude, exercise, stress, sleep and diet) that influence your lifestyle, causing oxidative stress.

 

Insulin resistant people have to be even more cautious

Pre-diabetic (insulin resistant) and diabetic people have compromised arteries (approximately 40% of Americans are insulin resistant). These people may have a higher incident of heart attack regardless of LDL levels.

If you are a healthy person who doesn’t have insulin resistance, an elevated cholesterol level may not be much to worry about. In fact rather than looking at total cholesterol or total LDL levels, one should be watching certain lipid ratios. The ratio of triglycerides to HDL levels are an important indicator. A ratio of 2:1 is considered normal but a high ratio of triglycerides to a low number of HDL may point to trouble. 

There are better indicators than measuring LDLs to predict risk of cardiovascular disease. One is an increased level of high-sensitivity C-reactive protein (hs-CRP) which can be measured with a simple blood test. Increased levels indicate more inflammation. In my opinion the very best test is a Coronary Calcium Scan which will expose the amount of calcified plaque build-up in your arteries (which will give an accurate indication if you are in danger of having cardiovascular issues).  Also, measuring troponin (a protein) levels in your blood may help predicting future heart disease. 

So should I eat cholesterol rich food? Well, please keep in mind that not all cholesterol rich foods are created equal. Some are incredibly nutritious such as eggs, full fat yoghurt, cheese, shellfish and organ meats. Others are downright detrimental to your health such as fried foods, processed meats and fast food including most desserts.

 

Here is a short list of food that is high in cholesterol and is good for you:

Eggs, the whole egg! May even increase your HDLs

Cheese

Shellfish

Free range cattle (and its organs)

Full fat yoghurt and kefir

Oily fish such as sardines and mackerels

Avocados, olives

 

Here is a short but loaded list of food high in cholesterol to be avoided:

Desserts, such as donuts, muffins, cookies cakes, ice cream…you get the drift

Fried foods, French fries, fried chicken, ALL deep fried foods!!!

Fast food and processed meats, boy the list is long, but think food such as hot dogs, fries, sausages, bacon microwave popcorn etc

 

In a nutshell

Cholesterol is not the enemy it has been portrayed to be. It is a complex compound with essential functions in our bodies. While high levels of LDL cholesterol may contribute to heart disease, it is crucial to recognize the bigger picture. Inflammation and other risk factors play a significant role in the development of heart attacks and strokes.

To deepen your understanding of cholesterol and its intricate role in health, I recommend reading “The Great Cholesterol Myth” by Jonny Bowden and Stephen Sinatra. This insightful book challenges common misconceptions and provides evidence-based information about cholesterol and heart health.

Let’s remember that cholesterol is essential for cellular function and that the “good” vs “bad” cholesterol narrative is oversimplified. Instead of focusing solely on cholesterol numbers, I advocate for a holistic approach to heart health, including a whole-food diet, stress management, regular movement, and proper gut health maintenance. By reframing our perception of cholesterol and embracing a holistic approach to heart health—one that considers inflammation, lifestyle choices, and overall well-being, we can debunk the myth and promote a more accurate understanding of cholesterol’s role in our bodies.

Listen to your body. Let your common sense prevail.