The Cholesterol myth: the truth of a controversial topic

Table of Contents

Breaking the Truth about the Cholesterol Myth: Debunking Long-Held Beliefs about Dietary Intake and Heart Health.

The Cholesterol Myth

The cholesterol myth is the idea that high cholesterol is the cause of heart disease, a predictor of heart attack, or that lowering cholesterol with statin drugs will prolong life. This is based on the millions of marketing dollars spent perpetuating this myth by pharmaceutical companies intent on supporting the $31-billion-a-year cholesterol-lowering drug industry.

There have been a lot of discussions lately about the cholesterol myth. Most experts say that a healthy lifestyle includes eating foods high in cholesterol, which most people do not want to hear. Yet studies show that many Americans are overeating it. So how much cholesterol is right for you?

Cholesterol plays a crucial role in our bodies, but levels can be confusing. There are so many cholesterol types and what’s considered “normal” differs from person to person, depending on factors like age and gender.

If you’ve been diagnosed with high cholesterol, chances are you’re not alone. More than one-third of Americans have it, and its prevalence is rising. 

Is the cholesterol myth a false belief?

Is the cholesterol myth a false belief?

It’s funny how baseless beliefs take root in us… and there is no more ingrained belief about our health than the cholesterol myth.

Do not be surprised. In health, there are many false beliefs. “You have to sleep 8 hours (when we know that it would be better to respect the sleep cycles and sleep 6, 7.5 or 9h article).” “You have to eat carbohydrates for energy when our main source of energy is fat.” Above all others, cholesterol must be lowered like this to the raw without nuances.

Patients come to my office without illness symptoms but are very alarmed because they have found high cholesterol in routine analysis.

But is it normal that cholesterol has become the absolute and universal bad of the movie?

This abundant but bad press is not accidental but is based on the belief that lowering cholesterol reduces the risk of a cardiovascular incident.

Since this is the leading cause of death in the western world, it is normal for it to be of this importance.

But as we will see in this article, the association between cholesterol -> cardiovascular disease is not exact.

Some confusion about cholesterol and its role in heart disease is caused by imprecise terminology.

We’ll first review how cholesterol relates to health and disease and cover some basic terminology. You will learn lipoproteins and the fundamentals of the cholesterol-cardiovascular risk association, and we will conclude with some final recommendations.

What is cholesterol?

The Cholesterol myth - Cholesterol is not technically a fat; instead, it is classified as a sterol, a combination of a steroid (fat) and alcohol

Cholesterol is not technically fat; instead, it is classified as a sterol, a combination of a steroid (fat) and alcohol.

Cholesterol is a substance of vital importance for your body:

  • It is an essential compound in the membrane of your cells.
  • The place in the body with the most cholesterol stored in the brain.
  • It is the raw material to synthesize hormones such as estrogens, and testosterone and manufacture vitamin D.
  • In our body, we have between 1.1 and 1.7 grams of cholesterol. It is assumed that a maximum of 25% comes from our diet, and the remaining 75% is produced endogenously by our liver.

The point is that the body tightly regulates the amount of cholesterol in the blood by controlling internal production, so when dietary fat intake decreases, the body produces more. When the intake of cholesterol in the diet increases, the body has less.

So if cholesterol is so important, why is it a scary subject?

Cholesterol and lipoproteins

Cholesterol and lipoproteins

It is crucial to understand that when they talk to you about cholesterol in the blood, they are not exact.

Cholesterol is not soluble in water, and blood is primarily water. Therefore cholesterol must be transported by unique proteins called lipoproteins.

Lipoproteins are classified according to their density. This density is given by the percentage of protein and fat of each lipoprotein. The higher the fat rate, the lower the thickness, and the larger the size, as shown in this graph.

The two best-known lipoproteins are:

  • LDL: Low-density lipoproteins
  • HDL: High-density lipoproteins

What do the LDL and HDL do that you always see in your blood tests?

LDL: Low-density lipoproteins HDL: High-density lipoproteins

LDL (Low-Density Lipoprotein) transports cholesterol to cells with LDL receptors, distributing them throughout the body. And HDL (High-Density Lipoprotein) is responsible for collecting excess cholesterol from the cells to take it to the liver and convert it into bile acids.

Maybe with so much terminology, you start to get confused, so let’s better use an analogy to clarify.

Imagine that your bloodstream is like a highway.

Lipoproteins are like the trucks that carry cholesterol and fats around your body, and cholesterol and fats are like the boxes they have.

Scientists believed that the number of boxes in the truck (that is, the cholesterol concentration in the LDL particle) is the determining factor in developing heart disease. However, more recent studies suggest that what matters most is the number of trucks on the road (i.e., LDL particles).

It seems that cholesterol itself is less important than its transporter.

The coronary arteries are essentially hollow tubes, and the endothelium (lining) of the artery is very thin – just one cell deep. Blood, which carries lipoproteins such as LDL, is in constant contact with the endothelial lining.

If the LDL particles penetrate the endothelium, they can accumulate and generate an atheroma plaque. Later on, if it detaches, it can cause an arterial occlusion and, therefore, a heart attack.

How does the LDL particle react?

what are lipoproteins?

The LDL particle leaves the blood. It enters the endothelium and the artery wall. This is that it is a gradient-based process. Going back to our resemblance, the more trucks there are on the road at the same time, the more likely some of them will crash into the fragile lining of the artery. So the determining factor is not the number of cholesterol boxes that the trucks transport but the number of trucks.

Indeed, LDL cholesterol levels and the number of LDL particles are often consistent. Usually, when one is high, the other is high and vice versa. This is probably why there is a correlation between cholesterol. LDL and heart disease in observational studies.

Check out the best cholesterol supplements on the market.

Elevated LDL cholesterol has served as a surrogate marker for high LDL particle numbers. But the fact of the matter is that the amount of LDL cholesterol and the number of particles can also be jarring.

It is possible to have normal or even low cholesterol but a high number of LDL particles.

If this person is only measured for cholesterol and not particle number, they will be falsely led to believe they have a low risk of heart disease.

Worse still, patients most likely to exhibit this pattern are among the highest-risk patients: those with metabolic syndrome or full-blown type 2 diabetes.

Metabolic Syndrome

Metabolic Syndrome

The more components of the metabolic syndrome present, such as abdominal obesity, hypertension, insulin resistance, high triglycerides, and low HDL, the more likely the number of LDL particles is elevated. 

According to studies and statistical evidence, patients with high LDL cholesterol (LDL-C) and low LDL (LDL-P) particles do not have an increased risk of heart disease. Studies show that patients with low LDL-C and high LDL-P levels have an even lower risk.

However, they will often be treated with statins or other cholesterol-lowering drugs since the doctor only tests for LDL-C. This is controversial for several reasons.

  • First, statins are not harmless.
  • Second, low cholesterol can increase death risk, especially in women and the elderly and,
  • Third, you generate an unnecessary alarm in the patient that he will live like a sick person when he is healthy.

Another important aspect is that LDL particles carry cholesterol and contain triglycerides, fat-soluble vitamins, and antioxidants. You can think of LDL as a transportation service that delivers essential nutrients to the body’s cells and tissues.

As you might expect, there is a limit to the amount of “stuff” each LDL particle can carry. Each LDL particle has a certain amount of cholesterol molecules and a certain amount of triglycerides.

As the number of triglycerides increases, the amount of cholesterol it can carry decreases. The liver will have to produce more LDL particles to carry a certain amount of cholesterol throughout the body. This person will have a higher number of LDL particles and a higher risk of suffering, therefore, a cardiovascular event.

And do you know which foods generate the most triglycerides?

The most common factor for high triglyceride levels is a diet high in carbohydrates and poor-quality fats (what we know as pastries and fast foods).

Nevertheless, what is still recommended is a low-fat diet (almost without distinction).

For decades Americans have been encouraged to consume less than 10% of their daily calories from saturated fat.

Despite this, heart disease continues to rage, and as we all know, it has not made people thinner either.

Faced with a controversial issue, it is interesting to analyze how the recommendation to lower cholesterol appears.

It must be considered that the greatest cause of death in the world is related to cardiovascular events, as shown in the graphs of the World Health Organization.

This, of course, is not something new. We have long struggled with coronary heart disease. That is why it is crucial to find the cause that generates them to reduce the population’s mortality.

And the answer was found half a century ago with a study of 22 countries called the “Study of the 7 countries”. In this study, an ascending curve could be observed. It indicates a direct correlation between saturated fat intake and the increased risk of death from coronary heart disease.

However, this finding is not entirely accurate. Under the conclusions of this study, the reduction in the intake of saturated fat was recommended by the American Heart Association.

Considering that a single variable is the cause of coronary heart disease is the wrong result of oversimplifying health.

However, the way cholesterol works and how our body processes, stores, and uses fat (all of them) is complex.

What is known today?

Cholesterol test

In 2018 The British Medical Journal published a review of several studies in which a correlation was sought between the presence of LDL (what we know as bad cholesterol) and mortality from coronary heart disease. This review concluded that adults with a higher LDL-C presence were less likely to suffer from heart disease. Contrary to what has been thought for decades, a low amount of LDL-C seems more related to a high risk of coronary diseases.

8 years earlier, the American Journal of Clinical Nutrition also reviewed 21 studies. After analyzing more than a quarter of a million participants, no relationship could be found between saturated fat consumption and coronary heart disease.

This other Harvard study shows that people with a lower proportion of triglycerides and HDL (the “good cholesterol”) have a 16 times less risk of having heart attacks.

They found that almost 75% of all patients admitted for heart attacks had utterly normal cholesterol levels at UCLA within what is considered “healthy markers.”

American Medical Association

An article bomb was published in the journal of the American Medical Association. It reveals the text written by a group of San Francisco professors from the discovery of internal documents of the food industry from the sixties. The Sugar Research Foundation (SRF, now Sugar Association) paid three Harvard nutritionists around $ 50,000 today to publish research that gave a good place to sugar and pointed to saturated fat as the leading cause of heart disease.

If this research was so important, publication in the ‘New England Journal of Medicine’ was very influential in the following decades’ nutritional recommendations.

“The SRF sponsored its first research project on heart disease in 1965, in a review of studies that highlighted fat and cholesterol as the nutritional causes of these ailments and downplayed the evidence that sugar consumption was also a risk factor”, says the investigation. Unlike what happens today, in which all investigations must show their fundings and make explicit the conflicts of interest, the study did not recognize the role of the SRF.

So what to do with cholesterol?

Based on modern science and all the new research, it is essential to follow new cholesterol recommendations.

Heart disease is a complex and multifactorial process. 

The risk of having a heart attack depends on many factors, such as genetics, diet, lifestyle, and environment. 

The purpose of this article is not to suggest that cholesterol is not a risk factor. It is to point out that other risk factors should be considered. Evidence indicates that LDL-P is a better predictor of heart disease than LDL or total cholesterol. It appears to be one of the best indicators available to us right now.

Don’t be afraid of cholesterol. 

Don't be afraid of cholesterol.

Is the cholesterol myth a reality? We have always consumed cholesterol and probably much more than what has been classically recommended during our history. Therefore, it is not surprising that cholesterol is the protagonist of many of our vital functions. So reducing its consumption can be dangerous.

Know where fats come from. 

For decades there has been a fear of fat, and light, fat-free, and high-sugar products have increased. But as I have already explained in this article, the higher fat we store is due to the high consumption of refined sugars than the fat we consume. He also considers that these refined sugars cause metabolic syndrome, a reasonably reliable predictor of coronary heart disease.

Eat food and not products. 

How many times have I mentioned this to you in this blog? Food naturally offers you carbohydrates, proteins, and fats in just the right amount without abusing macronutrients. The products are designed to increase your consumption. They are filling you with low-quality macro and micronutrients and many additives that are not good for your health.

Put eggs in the food. 

In a healthy diet, eggs are great allies

Surely you have ever heard someone tell you that you should not eat the yolk of an egg because it has cholesterol. Now you know that it is no problem. In general, in a healthy diet, eggs are great allies. That is because of their ease of cooking and the fact they are easily accessible protein and high-quality fat. Besides, eggs’ consumption is associated with an increase in large LDL and HDL lipoproteins compared to small ones. The larger your LDL and HDL molecules, the lower the risk of coronary heart disease.

Not all fats are the same. 

Remember that, in general, saturated fats are neutral for the heart, as we have seen in this article. Monounsaturated and polyunsaturated omega 3 could be beneficial, and we know that trans fats are harmful to health. Trans fats (TFAs) are unsaturated fatty acids made when liquid oil is turned into solid fat in a factory. This is a hydrogenation process and is found in many products.

Measure your body fat. 

Consider the sources of your fats and verify that your body fat percentage does not increase. My recommendation would always be to measure your body mass index. To do so, you can use this button:

Move on. 

Coronary heart disease is not only related to cholesterol. A sedentary lifestyle is also associated with always improving your lipid profile and your cardiovascular system.

Conclusions about the cholesterol myth

Conclusions about the cholesterol myth

The cholesterol myth is a term that refers to the false belief that consuming foods high in saturated fat and cholesterol will increase blood cholesterol levels. Although saturated fatty acids and dietary cholesterol are not essential nutrients, there is no scientific evidence linking dietary saturated fat or dietary cholesterol with an increased risk of heart disease.

In this article, we have learned the confusing origin of fatphobia, and we have delved into what we can consider as a risk factor for coronary heart disease.

We have also had a new impact on the understanding that the clinical approach should not be the same as the scientific one. While the scientific methodology seeks to isolate variables in its studies to find significance (impact of a factor on your health), the clinical approach must contemplate the maximum possible variables affecting you.

Heart disease is a complex and multifactorial process. How likely we are to have a heart attack depends on many factors, including genetics, diet, lifestyle, and living environment.

Finally, we insist in this world of massive information loaded with interests, the contrasting of data is becoming increasingly relevant.



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