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What Most Doctors Won't Tell You About Cholesterol
Posted by Dr. Ben Kim on Jul 28, 2015
Updated on July 14, 2011
During my university years, I used to frustrate my parents by throwing away egg yolks and eating only the whites. No worries, I thought, as my parents just didn't know enough to realize that I was reducing my risk of heart disease by avoiding cholesterol. Looking back, I'm sure that my parents were wondering how I could so easily toss away precious egg yolks that they were able afford only a few times a year when they lived in Korea.
Today, I am grateful to have a better understanding of the relationship between cholesterol and health. How about you? Are you afraid of having high cholesterol? Are you throwing away egg yolks because you think they're bad for your health? Are you taking cholesterol-lowering medication or considering starting on one?
If you answered yes to any of these questions, I encourage you to consider the work of Uffe Ravnskov, MD, PhD, author of The Cholesterol Myths : Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. I consider Dr. Ravnskov to be the world's leading expert on the relationship between cholesterol and human health.
Here are some facts from his book:
Cholesterol is not a deadly poison, but a substance that you need to be healthy. High cholesterol itself does not cause heart disease.
People who have low blood cholesterol have the same rates of heart disease as people who have high blood cholesterol.
The cholesterol found in your blood comes from two sources: cholesterol in food that you eat and cholesterol that your liver makes from other nutrients.
The amount of cholesterol that your liver produces varies according to how much cholesterol you eat. If you eat a lot of cholesterol, your liver produces less. If you don't eat much cholesterol, your liver produces more. This is why a low cholesterol diet does not typically decrease a person's blood cholesterol by more than a few percent.
Drugs that solely lower your cholesterol do not decrease your risk of dying from heart disease, nor do they increase your lifespan. These drugs pose dangers to your health and may decrease your lifespan.
The newer cholesterol-lowering drugs - called statins - do reduce your risk of heart disease, but through mechanisms that are not related to lower blood cholesterol. And alarmingly, statins like lipitor mevacor, zocor, pravachol, and lescol are known to stimulate cancer in rodents.
What about HDL and LDL?
Well, here are some facts about LDL and HDL that the vast majority of my patients are surprised to learn:
LDL and HDL are not types of cholesterol.
LDL and HDL are lipoproteins that transport cholesterol through your blood circulatory system.
LDL stands for Low Density Lipoprotein, and HDL stands for High Density Lipoprotein.
LDL is often mistakenly thought of as being bad cholesterol because it carries cholesterol to your arteries.
HDL is often mistakenly referred to as good cholesterol because it carries cholesterol away from your arteries (to your liver).
LDL and HDL carry the same cholesterol.
Here are the main points to take away from the facts presented above:
Cholesterol that naturally occurs in animal foods is not harmful to your health. But it can become harmful to your health if it is damaged by exposure to high levels of heat and/or harsh processing techniques.
If you regularly consume damaged cholesterol and foods that are rich in free radicals, you likely have significant quantities of damaged cholesterol floating through your circulatory system.
And if you regularly have damaged cholesterol floating around in your blood, then a high LDL level correlates with a higher-than-average risk of developing cardiovascular disease, and a high HDL level correlates with a lower-than-average risk of developing cardiovascular disease.
In other words, if you have significant amounts of damaged cholesterol in your blood circulation, you don’t want a lot of LDL to be available to carry this cholesterol to your arteries, where the damaged cholesterol can contribute to atherosclerosis, and you want a lot of HDL available to shuttle damaged cholesterol away from your arteries.
So while it’s true that a high HDL/total cholesterol ratio can reflect a lower risk of developing cardiovascular disease, what’s most important when it comes to cholesterol and your health is to avoid eating animal foods that have been cooked at high temperatures, since these foods are typically rich in damaged cholesterol.
Where Conventional Guidelines Come From
Sadly, conventional guidelines that promote lower cholesterol levels for a healthy heart are influenced in large part by pharmaceutical companies earning billions of dollars with their cholesterol-lowering drugs.
For example, in the summer of 2004, a panel of physicians lowered the “safe” level of LDL cholesterol from 130 to 100, and further recommended that people at high risk of developing cardiovascular disease aim to lower their LDL levels to 70.
This modification in medical standard of practice caused an estimated eight million Americans to become instant candidates for cholesterol-related drug therapy.
While this “news” was covered by major media outlets and news wires, only one newspaper, Newsday, reported that most of the physicians responsible for establishing the new recommendations had a conflict of interest. Almost all had received money – usually in the form of grants or honoraria – from at least ten drug companies. The National Cholesterol Educational Program, the source of the new medical treatment guidelines for cholesterol, failed to report these financial disclosures.
Guidelines for Healthy HDL, LDL, Total Cholesterol, and Triglyceride Levels
What follows are my personal guidelines on monitoring cholesterol, based on the research that I've done on this issue, and evaluating the blood test results and health of hundreds of people I have worked with over the past several years.
Ideally, it's best to have a blood cholesterol level of over 150 mg/dL (3.9 mmol/L). But if your blood cholesterol level is lower than this, so long as you are eating a nutrient-dense, plant-centered diet and not suffering from any health challenges, there is likely no cause for concern.
Low cholesterol over the long term may lead to depression, increased risk of stroke, and numerous problems related to hormonal imbalances. If you are not getting enough vitamin D from your diet, having low cholesterol may lead to vitamin D deficiency, as sunlight creates vitamin D in your body by acting on cholesterol found in your skin.
Ideally, your HDL/total cholesterol ratio should be above 25%. Generally, the higher this ratio, the better. If this ratio is 10-15 percent or lower, there increased risk of eventually experiencing a heart attack.
Ideally, it's best to have a triglyceride/HDL ratio of 2.0 or lower.
If your HDL/total cholesterol and triglyceride/HDL ratios are in the ranges listed above, and you are eating mainly undamaged cholesterol, having a total cholesterol of more than 200 mg/dL (5.2 mmol/L) most probably isn't a cause for worry. In fact, even people whose genetics cause them to have total cholesterol above 350 mg/dL (9.0 mmol/L) have been shown to have no elevated risk of heart disease as long as their ratios are fine and they stay away from eating damaged cholesterol.
Here's my take-home perspective on cholesterol and your health:
Rather than focus just on the numbers from your latest blood test, your health is best served by:
Ensuring regular intake of a wide variety of nutrient-dense plant foods (vegetables, legumes, fruits, whole grains, and small amounts of nuts and seeds).
Ensuring regular intake of healthy fats, such as those found in avocados, olives, coconuts, organic eggs, and perhaps some cold water fish on occasion.
Minimizing intake of animal foods that have been highly processed and/or exposed to high cooking temperatures.
Striving to live a balanced life that includes adequate rest, physical activity, exposure to fresh air and sunlight (without getting burned), meaningful relationships, and a sense of purpose.
Please note: Some organizations cite various studies that indicate that low-fat and low-cholesterol diets are healthier than diets that include generous amounts of healthy fats and undamaged cholesterol. The problem with these studies, as I see it, is that they don't make a distinction between damaged vs. undamaged fat and cholesterol. And this is an extremely important distinction; there's a huge difference between eating lightly cooked organic eggs vs. a well done steak several times a week for many years.
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