Last year, I was pleasantly surprised when I got my new primary care physician to admit the standard cholesterol test administered at annual checkups isn’t an accurate indicator of heart disease risk, and that said test doesn’t differentiate between the healthy and the dangerous varieties of LDL cholesterol (that’s right, not all LDL cholesterol is “bad”).
And yet, somehow this is the test most doctors (including my then-doctor) reference to decide whether they should recommend and prescribe statins.
Of course, doctors and lab tests should play a vital role in everyone’s integrative healthcare programming. However, when it comes to cholesterol, confusion and misinformation clearly abound.
In order to help you make informed decisions about your health, I’ve compiled a comprehensive list of ten surprising things you need to know about cholesterol (including heart disease risk, diet, and statins), beginning with a simple answer to the most fundamental question: What is cholesterol?
If you want to go deeper (and I hope you do!), you can reference all the rigorous research these ideas are based on in my bestselling book, Eat Like a Fatass, Look Like a Goddess: The Untold Story of Healthy Foods.
#1 What cholesterol is (and what it isn’t)
Technically, cholesterol isn’t a fat. It’s an alcohol (different from the cocktail-kind, of course).
What’s more, cholesterol doesn’t provide calories. It’s not a macronutrient like fat, protein, or carbohydrates, all of which provide the body calories (read: energy).
Cholesterol itself is not unhealthy. It’s how it’s packaged as lipoproteins (molecules of proteins and fats) that matters. What we tend to refer to as “cholesterol” are really these packages of lipoproteins.
There are many varieties of these lipoprotein packages (more than the media, or mainstream medical community discuss, or the latter regularly tests for) that affect the body in different ways, in different situations, for better or for worse. The cholesterol in all these lipoprotein packages is itself always the same.
HDL (commonly known as the “good” cholesterol) and LDL (commonly known as the “bad” cholesterol) are lipoproteins that transport cholesterol in the body; they are not themselves cholesterol.
#2 You need cholesterol
Believe it or not, your body needs cholesterol to be healthy. Cholesterol performs many essential body functions. It is involved in
- helping the body repair itself
- manufacture of cell membranes
- production of bile acids (which help digest fat)
- brain and nervous system function (think: mental clarity)
- regulating hormone production (think: balancing hormones for milder and more regular periods, increasing fertility and easing menopause)
- production of vitamin D (which controls over 2,000 chromosomes in the body)
- serotonin levels (read: mood).
#3 You can’t eat enough dietary cholesterol on a daily basis
Except for a small percentage of the population born with a genetic condition that causes overproduction of “bad” cholesterol, human beings can’t eat enough of the dietary cholesterol we need each day for proper biological function.
That’s right: for the majority of humans, there’s no need to limit dietary cholesterol intake.
In reality (the reality based on science, not hype), cholesterol in our bodies comes to us in small part via food (dietary cholesterol).
The rest of the cholesterol in our bodies comes to us in another way…
#4 Your body makes cholesterol when you don’t get enough in your diet
Because we can’t get all the cholesterol our bodies need to properly function on a daily basis, our bodies make cholesterol.
While all our cells can make cholesterol, our livers are the main source of cholesterol-production.
Our bodies make around 80 percent of the cholesterol we need to properly function, and to make up for what we don’t get from food. This percentage can vary, depending on what we do and don’t eat (more on this soon).
For now, know that our bodies are doing something right (yes, right) by making cholesterol. However, there are pluses and minuses to this process, rooted in things we do in our daily practices.
#5 “Bad” cholesterol and “good” cholesterol are oversimplified misinformed hype
There is more than one kind of cholesterol—more than we hear about from mainstream media and even our doctors.
We hear a lot about “good” cholesterol, commonly known as HDL (high-density lipoprotein), and “bad” cholesterol, commonly known as LDL (low-density lipoprotein). But things aren’t quite so black and white.
First, remember LDL and HDL aren’t even cholesterol. They’re lipoproteins that transport cholesterol.
Second, we actually need LDL (it’s responsible for repair of damaged tissues—a critical function of our glorious bodies!).
Third, there are actually different kinds of LDL. And HDL too.
All varieties of LDL and HDL are named for the higher or lower density of proteins in relation to the cholesterol transporting those proteins.
One kind of LDL is actually “bad”: the smaller, denser variety is potentially dangerous if we have too much of it. Certain foods trigger your body to make this kind of LDL.
However, there is also another bigger, “fluffier” kind of LDL that’s “good.” Certain foods trigger your body to make this kind of LDL.
#6 The real root of arterial plaque and heightened heart disease risk isn’t what you think
Now we know we need cholesterol, but can’t get enough of it from food on a daily basis, so our bodies must resort to making it. We also know there are different kinds of lipoproteins, some very healthy, some dangerous at higher levels.
Unfortunately, certain foods prompt the body to make more unhealthy LDL packages (the small dense variety) that are linked to disease when overabundant. These trigger-foods are
- sugars and excess starchy carbohydrates
- synthetic trans fats
- polyunsaturated fatty acids (PUFA)—particularly omega-6 PUFA, an inflammatory fatty acid largely found in plant oils and commercially-raised animal foods (in contrast, grass-fed pasture-raised animal foods contain ideal levels of this fatty acid).
Contrary to popular belief, saturated fat doesn’t make the list because it isn’t a trigger for unhealthy lipoprotein formation.
The membrane of LDL particles contains PUFA, which are highly unstable and therefore prone to oxidation (contrast to saturated fat, which is highly stable). While oxidation can serve a helpful function in some cases, it’s also a key process that heightens disease risk, especially when it comes to LDL.
LDL resides in the liver where it has plenty of antioxidants to stabilize PUFA. However, LDL regularly travels outside the liver (it carries most of the cholesterol found in the blood).
HDL collects cholesterol from tissues, including the arteries, then returns it to the liver. When the liver and diet are healthy, the liver is able to move unneeded cholesterol from the body.
One problem: things like too much sugar, starch, and environmental toxins can decrease liver function, impeding this important process.
Another problem: once LDL is sent out of the liver, it only has a limited antioxidant-supply to prevent PUFA in its membrane from oxidizing. If the LDL is away from the liver too long, trouble starts.
LDL will stay away from the liver too long when various stressors (i.e. smoking, infection, eating excess starchy carbohydrates, sugar, or pro-inflammatory omega-6-polyunsaturated-rich foods) cause inflammation that damages artery walls, and LDL is sent in to repair them (the way you might use putty to repair a leaky pipe).
At first, this repair is helpful. But if artery walls are repeatedly inflamed and damaged, over time the PUFA in the LDL starts to oxidize. Arterial plaque builds up, and narrows artery passageways. If plaque breaks off and blocks blood flow, this can trigger acute events that impact coronary arteries (think: heart attacks).
Case in point: arterial plaque and heightened heart disease risk are not the result of eating saturated fat.
#7 National Guidelines’ definition of “high” cholesterol is misinformed hype
The standard numbers for “normal” total cholesterol levels have decreased over the decades to the point that half the population can now be diagnosed as having “high cholesterol.”
According to The National Heart, Lung, and Blood Institute (NHLBI), a total cholesterol level less than 200 is desirable, 200-239 borderline-high, and 240+ high. These numbers were set in 1984. Before that, the desirable cut-off was 240.
Prior to 2004, 130 mg was the suggested “healthy” level for LDL. However, in 2004, the National Cholesterol Education Program further changed its recommendations, advising those at risk for heart disease to lower LDL cholesterol to the extremely low levels of less than 100 mg, and for those at high risk a meager 70 mg. Here’s the rub: it’s almost impossible to reach such low levels without taking multiple cholesterol-lowering drugs.
Not surprisingly, the NHLBI “experts” who set the healthy cut-off at 200 all have verifiable financial ties to the pharmaceutical companies that manufacture cholesterol-lowering drugs, like Lipitor, which pulls in profits of billions of dollars of profits every year, and funds $10-million-per-day TV-commercial campaigns. Big Pharma has the will and the means to exert indomitable influence.
Gary Taubes’s groundbreaking 2001 Science article, “The Soft Science of Dietary Fat” offers a revealing glimpse into how the standard of “healthy” and “unhealthy” cholesterol levels were lowered to current numbers at the weekend-long “Cholesterol Consensus Conference” back in 1984—despite the complete lack of scientific evidence to demonstrate need for further reduction.
Taubes highlights how, in 1990, NHLBI conference experts flagrantly ignored presentations from scientists behind nineteen different research teams around the world that demonstrated higher cholesterol offered women undeniable protective benefits against different causes of death (heart disease, cancer, respiratory and digestive diseases, and trauma): “the higher their cholesterol, the longer they lived.”
#8 Cholesterol and your diet work together in different ways than you’ve been told
We’ve learned we can’t get enough cholesterol from food every day for our bodies to function properly. It’s actually pointless, counterproductive, and unhealthy to avoid cholesterol-containing foods.
However, we have to be skillful about how the foods we eat (whether they contain cholesterol or not) trigger our bodies to produce cholesterol—both healthy and unhealthy varieties.
As biochemist Dr. Mary Enig wrote in her seminal book, Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol: “When there is some cholesterol in the diet, our own synthesis declines, and when there is no cholesterol in our diets (as would be the case with strict vegetarians [vegans who eat no animal foods]), the body’s cholesterol synthesis is very active.”
Similar to many things in nature and nutrition, cholesterol isn’t so much about quantity as it is about proportions. The key is the ratio of LDL to HDL.
- Not Good = Something you eat causes your small, dense LDL levels to go up
- Good = Something you eat causes your HDL levels to go up
- Good = Something you eat causes your bigger, “fluffier” LDL levels to go up
- Good = Something you eat causes your LDL and HDL levels to both go up in proportion to one another.
Take eggs, for example. According to cholesterol-expert Chris Masterjohn (who holds a PhD in Nutritional Sciences), in over two-thirds of the population, eggs don’t affect cholesterol, or only very little. In the remaining less than one-third of the population, eating eggs will increase LDL and HDL in proportion to one another, and will also make small, dense LDL (the dangerous kind) bigger (“fluffier”) and safer.
You know what they say, an egg a day keeps the doctor away…
(I’ll follow up this article with a breakdown of dietary and lifestyle practices that promote healthy cholesterol levels.)
#9 Your best indicators of heart disease risk
Obviously, the standard cholesterol test and total cholesterol levels are not an accurate indicator of heart disease risk.
Some more progressive experts (think: Dr. Mercola) advocate that certain ratios from standard cholesterol tests are better indicators of heart disease risk (i.e. an HDL to total cholesterol ratio of >25%; a triglyceride to HDL ratio of <2).
However, the only ironclad way to know if you have lots of the healthy, big, fluffy varieties, or the dangerous small dense varieties, is to request your doctor order the VAP+ Lipid Panel (VAP stands for Vertical Auto Profile).
If your doctor ever tells you your cholesterol is “high” or “bad” (and likely tells you to go on statins), request a VAP test first. The VAP distinguishes between the healthy fluffy kinds of lipoproteins, and the dangerous small dense kinds. You and your doctor will be equipped to make an optimally-informed decision with the help of this test.
Other markers of heightened disease risk are vLDL (very low-density lipoprotein), triglycerides, various inflammatory markers, and fasting insulin levels.
#10 Statins don’t lower heart disease risk
We’ve learned total cholesterol is not a cause of heart disease, and diet plays an integral role in maintaining healthy levels of the different types of lipoproteins (LDL and HDL).
This means lowering cholesterol with statins isn’t necessary to lower heart disease risk.
Statins also lower levels of the vital substance known as coenzyme Q-10, making statins not only unnecessary, but potentially unhealthy (especially as we age because our bodies’ natural production of the substance decreases with age).
If you’re fired up to learn more about all the provocative rigorously-evidence-based ideas presented in this article, pick up my bestselling book, Eat Like a Fatass, Look Like a Goddess: The Untold Story of Healthy Foods.