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Cholesterol: The Big Bad Wolf or Just Misunderstood

By admin | In Nutrition | on September 2, 2011

The T-shirts say it all...

One of the blogs I follow written by Chris Kresser posted a great article about cholesterol and why we shouldn’t use those numbers as a end all be all measure of our health.   He listed 5 reasons not to worry about cholesterol.  The article was so good that I couldn’t bear to give you a cliff note version of it.  Even if you’re young and cholesterol isn’t on your radar, take the time to read this article.  You may have family members who are being misinformed and taking unnecessary (and sometimes harmful medication).

Point #1: Eating saturated fat doesn’t raise cholesterol levels in the blood

There’s no convincing evidence that eating saturated fat raises blood cholesterol. Stephan Guyenet spanked that old yarn to the curb in this recent blog post.  In short, of all of the studies examining the relationship between saturated fat intake and serum cholesterol, only one found a clear relationship between the two and even that association was weak. The rest found no association at all.

Point #2: Eating cholesterol doesn’t (usually) raise cholesterol levels in the blood

Nor is there evidence that eating cholesterol in the diet raises cholesterol levels in your blood. A recent review of the scientific literature published in Current Opinion in Clinical Nutrition and Metabolic Care clearly indicates that egg consumption has no discernible impact on blood cholesterol levels in 70% of the population. In the other 30% of the population (termed “hyperresponders”), eggs do increase both circulating LDL and HDL cholesterol.

An increase of HDL is a good thing. And as it turns out, so is a boost of the type of LDL that eating saturated fat and cholesterol increases. We now know there are two different types of LDL: small, dense LDL, and large, buoyant LDL. Small, dense LDL is a significant risk factor for heart disease because it’s more likely to oxidize and cause inflammation. Large, buoyant LDL is not a risk factor for heart disease. And guess what? Eating eggs not only increases the benign large, buoyant LDL, but it also decreases the harmful small, dense LDL by 20%. I’ve written more about this here and here, and you can also watch some videos on this topic here.

Point #3: Even if eating saturated fat and cholesterol did raise cholesterol levels in your blood, it wouldn’t matter because “high cholesterol” isn’t a strong risk factor for heart disease.

This is the one that really spins people out. Even if they follow me on the first two points, their eyes tend to glaze over when I mention this one. As Mark Twain used to say:

The history of our race, and each individual’s experience, are sown thick with evidence that a truth is not hard to kill and that a lie told well is immortal.

Nowhere is that more true than with the lie that high cholesterol causes heart disease. It’s so deeply ingrained in our collective consciousness that it’s become an almost unassailable article of faith. That’s why people are so surprised to learn that there’s very little evidence to support the idea.

This point is the current bottleneck in my “3-minute” explanation, because it takes a while to explain why it’s not true. I’ve written about it extensively herehere and here. For the purposes of this brief article, we’ll have to leave it at this: both total and LDL cholesterol – which are the numbers your doctor, the media and everyone else seems to be concerned with – are only weakly associated with heart disease.

If “high cholesterol” were the cause of heart disease, you’d expect it to be a risk factor in:

  1. All populations around the world.
  2. In both men and women.
  3. In people of all ages.

And you’d also expect that lowering cholesterol should prevent heart disease.

Makes sense, right?

Unfortunately for the lipophobes, the cholesterol hypothesis fails on all fronts.

  1. High cholesterol is not a risk factor in all populations. The French have among the highest cholesterol levels in the world, and among the lowest rates of heart disease of any industrialized nation. The Austrians and other European nations are similar.
  2. Women on average have 300% lower rates of heart disease than men, despite higher average cholesterol levels.
  3. The rate of heart disease in 65 year-old men is 10 times that of 45-year old men. Yet high cholesterol is not a risk factor in men over 65. (In fact, men over 65 with low cholesterol (<150 mg/dL) are twice as likely to die from heart disease as those with normal or even “high” cholesterol.)

Finally, more than 40 trials have been performed to see if lowering cholesterol prevents heart disease. In some trials more people got heart disease, in others fewer. But when all the results were taken together, just as many people died in the treatment groups (those who took cholesterol-lowering drugs) as the control groups (those who did not).

Point #4: If you want to worry about your cholesterol numbers, forget about total cholesterol and LDL and pay attention to the ratio of triglycerides to HDL.

In general I’m not a fan of people worrying about their lipid panel numbers at all. Like Dr. Kurt Harris, I think this compulsive testing and re-testing of lipids that has become common in the Paleo community not only isn’t necessary, but may even be harmful. There’s still a lot we don’t know about how these numbers change on a day-to-day basis. What’s more, it’s not always easy to distinguish between cause and effect. Researchers made the mistake of assuming high cholesterol was the cause of heart disease, when in reality it’s much more likely that high cholesterol is a consequence of it.

But for crying out loud, if you’re going to get your lipds tested at least pay attention to the right numbers. And the most important number on a conventional lipid panel is the relationship between triglycerides and HDL. (Divide triglyercids by HDL to get it.) If that number is less than 2, this suggests you have mostly large, buoyant LDL – which is not a risk factor for heart disease. If that number is higher than 3, it suggests you have mostly small, dense LDL – which most certainly is a risk factor for heart disease.

Point #5: Eat good food and don’t worry about the numbers.

But in the end, even that ratio doesn’t matter so much. Why? Because the treatment is always the same! If your TG:HDL ratio is high (bad), what should you do? Eat a high-fat (saturated, of course) diet. This will reduce your triglycerides and small, dense LDL, and increase your HDL. Triple win. And if your TG:HDL ratio is low (good), what should you do? The exact same thing: eat a high-fat diet.

Conversely, replacing saturated fat with carbs, as we’ve been told to do for 50 years to protect ourselves from heart disease, actually contributes to it in three ways: it increases triglycerides and small, dense LDL, and decreases HDL.

Finally, I often get emails from people who’ve switched to a high-fat / Paleo-type diet expressing concern that their LDL and total cholesterol levels have gone up. My response usually has three parts: 1) don’t worry about it, because high total and LDL cholesterol do not cause heart disease; 2) the increase is usually temporary, and may be the result of the body curing itself of fatty liver (a good thing!); 3) don’t worry about it. Doesn’t hurt to remind them.

Chris Kresser’s blog has a host of great information.  He’s also the author of the Healthy Baby Code, a great source for anyone pregnant or looking to get pregnant.  For those of you who are interested in a really really comprehensive breakdown of the truth behind cholesterol, check out this podcast Chris Kresser hosts with Chris Masterjohn, who just received his PhD in Nutritional Sciences with a concentration in Biochemical and Molecular Nutrition.

Note: The gym will be open only at 9am and 10am for class on Labor Day.

WOD 9.2.11

In 10 Minutes:
Find your max shoulder to overhead weight

Rest 5 Minutes.

Run 400m for time.

Rest 2 Minutes.

Tabata-ish Wall Ball Shots
6 Rounds
30 seconds work
15 seconds rest

Take your max shoulder to OH weight, subtract your run time (in sec), and add your total WB shots for your final score.

(example Athlete A jerks 200#, runs a 90sec lap, and gets 120 WB shots will get a score of 230)

8 Comments to "Cholesterol: The Big Bad Wolf or Just Misunderstood"

  • paul says:

    September 2, 2011 at 7:45 AM -

    Thanks, Ruth. I welcome and will follow-up on the sources and references included in your post. This discussion highlights for me how we are responsible for making our own decisions about our health. It can be daunting to find and understand information that enables one to reject generally accepted practices.

  • becky says:

    September 2, 2011 at 8:59 AM -


    This information is quite timely for me because I got my lipid panel results on wednesday. Can’t wait to do the math, esp after my Dr. said to stop eating egg yolks. right away I relived my 30-minute lecture on eggs by Marcuspedia.

    1. ruth says:

      September 2, 2011 at 9:23 AM -

      It’s unfortunate that this info isn’t more mainstream. I really believe the doctors are well intentioned but the information made available to them was based on studies with serious flaws. (see Marcuspedia’s post on Ancel Keys)

  • Xuan says:

    September 2, 2011 at 1:24 PM -

    Anna I think you should be concerned…Napoli looks to be enjoying that stretch from Nick a little bit too much.

  • Brian says:

    September 2, 2011 at 2:55 PM -

    I was expecting them to photoshop those cartoon hearts around us

  • Tom says:

    September 2, 2011 at 3:25 PM -

    That photo leaves me speechless. The t-shirts, the facial expressions, the demonic Count Dracula laugh coming from Marcus.

    Re. today’s WOD, can I borrow either Nick or Holley’s scientific calculator to figure the numbers out correctly. If neither of them will be around, I wonder if Marcus will lend me his sliderule.

  • Holley says:

    September 2, 2011 at 3:36 PM -

    @Tom – LOL!

    1. ruth says:

      September 2, 2011 at 3:47 PM -

      @Tom, what’s wrong with my abacus?

      (was it wrong that I had to spellcheck abacus?)

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