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March 11, 2013

The Great Cholesterol Myth Of Today

cholesterol mythThis is a must see video on the topic of cholesterol. We have dummied down the management of heart disease to that of lowering cholesterol. Cholesterol is simply one of several risk factors and far from the most important or most useful. It’s been known for a long time that half the patients who suffer heart attacks have normal cholesterol, and half of those with elevated cholesterol do not get heart disease. So obviously there’s more to the story – The Great Cholesterol Myth as Dr. Johnny Bowden calls it.

Cholesterol Myth #1: Cholesterol isn’t needed.

Cholesterol is necessary for normal function. Cholesterol makes up part of the cell membrane in all the cells of our body. The cell membrane allows nutrients into the cell and waste products to leave the cell. It also houses hormone receptors. Twenty-five percent of the cholesterol in the body is found in the most important organ of the body – the brain. Cholesterol is the skeleton structure from which we make our sex hormones enabling the continued propagation of the human species. It’s also the skeleton structure for vitamin D.

Cholesterol is so essential that the body will make it even if you don’t consume it in the diet.

Cholesterol Myth #2: Lowering cholesterol significantly reduces heart disease.

It depends on your definition of significantly. Statin drugs are great at lowering cholesterol, but no so great at preventing heart attacks or deaths. Statin drugs have high numbers to treat (NNT). This means that a lot of people need to take the drug in order to prevent one heart attack or one cardiovascular death. The lower your risk for heart disease the higher the number to treat becomes.

These high numbers to treat suggest that there is much more to heart disease than cholesterol. See How The FDA Determines Drug EffectivenessThere is no good evidence that statin drugs lower heart disease in women of any age, or in men above 69.

Cholesterol Myth #3: There is good cholesterol and bad cholesterol.

This is in incorrect. In order to be transported through the blood cholesterol is carried by a lipoprotein which come in different sizes and densities.

We hear of “good ” cholesterol and “bad” cholesterol. But, the cholesterol molecule is the same in both HDL and LDL cholesterol. What differs is the lipoprotein carrier. So it’s the lipoprotein carrier that is “good” or “bad”.

We traditionally think of HDL cholesterol as the “good” stuff and LDL cholesterol as the “bad” stuff. In reality there are 5 types of HDLs and 5 types of LDLs. There are good and bad HDL lipoproteins, and good and bad LDL lipoproteins. The traditional lipid or cholesterol panel is outdated (but that’s what insurance companies cover) only measures the HDLs and LDLs without determining the subtypes of each.

For cholesterol to have damaging effects on the cardiovascular system two processes have to happen. There has to be oxidation of cholesterol and there has to be damage to the endothelium or inner lining of blood vessels. Cholesterol is needed to repair cell wall damage since it makes up a part of the cell membrane. If there is no damage there is no need for cholesterol and thus no risk that it will build up in the walls of the blood vessels.

Thus, cholesterol is an innocent bystander in the body’s attempt to repair damaged endothelium. When we see firemen at a fire we do not conclude that they started the fire, but that’s what we assume with cholesterol and damaged endothelium. Just like firemen are there to fix the problem, cholesterol is there to repair the endothelium.

Cholesterol Myth #4: Cholesterol is a good predictor of heart disease and its severity.

As mentioned in the opening paragraph cholesterol is not a good predictor of heart disease. HDL, though, appears to be a better predictor of severity of heart disease than is LDL based on a study that showed that age, HDL, and free testosterone were better predictors of coronary artery blockage in men than the traditional heart disease risk factors.

Cholesterol Myth #5: The science linking fat and cholesterol to heart disease is solid.

The science linking fat and cholesterol to heart disease has never been very strong. The fat hypothesis was proposed by Ancel Keys and was based largely on a study he performed called the Six Countries Study. He later did a Seven Countries Study. In these studies he showed that fat consumption is associated with heart disease. His assumption was that fat intake, especially saturated fat, increases blood cholesterol and that increases heart disease.

Keys simply took what the national diet was for each country and looked at heart disease rates. There’s no way to know if the individuals who developed heart disease actually ate their country’s national diet – so that’s a problem with the study. Also, he actually studied 22 countries, but reported the 6 and 7 countries that showed a nice relationship between fat intake and heart disease. In other words, he cherry-picked his data to prove his point.

In fact, if you were to take the 22 countries that Keys studied and selected a different seven countries than he chose, you could show the complete opposite – that higher intakes of fat are associated with lower rates of heart disease.

In addition, he did not consider sugar intake to see if it might be a better predictor in populations he studied. Countries that consumed more fat also consumed more sugar, but Keys did not consider the possibility of sugar being a factor.

The American Heart Association (AHA) originally rejected the fat hypothesis. It was not until Ancel Keys and a Keys’ supporter became representatives on the AHA committee some four years later that the fat hypothesis became accepted with Keys finding himself on the cover of Time Magazine.

Cholesterol: An Alternative Opinion

Cholesterol is an issue for some, and those with existing heart disease should take aggressive steps to lower their cholesterol (preferably with diet and exercise first). But, in my opinion the perceived need to treat cholesterol across the board is a pharmaceutical industry driven problem. If you avoid the American or Western diet cholesterol is less of an issue.

Inflammation and oxidation are at the root of heart disease. For more in depth reading on this topic I suggest the following books,  Good Calories, Bad Calories, Why We Get Fat, Fat Chanceor The Great Cholesterol Myth.

See related articles.

Have Low Energy? It Might Be Your Statin Drug

Cholesterol Supplements For Those Concerned About Cholesterol

Libido Busters: 5 Drug Classes That Lower Sex Drive






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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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