How to Lower My Cholesterol: A Beginner’s Guide to Cholesterol

Lego heart

For the past few decades, cholesterol has been portrayed as the Mini-Me of food.

While dietary fat, AKA Dr. Evil, has no doubt been stigmatized as the truly evil madman that is ruining our health, Mini-Me (AKA “cholesterol”) has been branded as the evil sidekick, almost as equally responsible for destroying our bodies.

We’ve been told for decades to avoid foods with cholesterol, because they are what’s clogging our arteries. No egg yokes, only egg whites!

We’ve been told that if we want to be healthy, we need to minimize cholesterol consumption. No butter, just margarine!

We’ve been told to switch to grains and minimize meat consumption. Meat has cholesterol, and cholesterol is bad! Meat will kill you!

If you’re anything like me, you have probably heard all of this stuff about cholesterol your whole life, and you just accepted it as truth. After all, 99% of doctors renounce cholesterol and put people on cholesterol reducing medication as quickly as possible when their cholesterol rises. Likewise, everything you’ve ever heard on the radio or in magazines tells you to avoid cholesterol just like you should be avoiding unhealthy fats!

But if Mini-me can join the good guys in Austin Powers: Goldmember, can cholesterol turn from the dark side and actually be something beneficial?

Right now, you probably have a few questions:

  • What the HELL is cholesterol?
  • What do I do I do if have HIGH cholesterol?
  • Do I need to be on medication for high cholesterol?

Don’t worry, my dear rebel friend, just like we’ve crushed topics like The Paleo Diet, Intermittent Fasting, Sleep, Water, and Supplements, we’re gonna cut through the crap and give you the real deal on Cholesterol.

Note: I am not a doctor nor registered dietitian, just a nerd who sometimes wears pants and lives for research and digging into the truth. Discuss all dietary changes with your doctor – heck, bring this article and have a discussion with them!

WTF Is Cholesterol?

heart hole

I’m gonna guess your first question is “Steve, WTF is Cholesterol?” to which I would reply, “Don’t swear, my gramma reads this site (hi Gramma!).”

Cholesterol is an organic lipid (fat) that exists in all animals and is created in order to perform basic bodily functions. Cholesterol naturally occurs and is produced within us, and plays an incredibly important role in keeping us alive. It’s present in EVERY single cell in our body.

As pointed out in this Harvard article: Cholesterol performs three main functions:

  • It helps make the outer coating of cells.
  • It makes up the bile acids that work to digest food in the intestine.
  • It allows the body to make Vitamin D and hormones (like estrogen in women and testosterone in men).

Those sound like three important processes to me!

Now, in order to make sure our bodies have enough cholesterol to carry out all of these functions, our livers create a LOT of the stuff daily.

That’s right: cholesterol plays such an important role that our bodies produce up to 1000+ mg of it per day.

So, if our bodies are producing a lot of cholesterol, what happens to the cholesterol we eat? Does that just get added to the big total (and thus “more cholesterol = bad”)?

Not exactly. Read these few sentences from a PubMed abstract:

Dietary cholesterol content does not significantly influence plasma cholesterol values, which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis.”

Long story short: Dietary cholesterol (cholesterol in your food) is poorly absorbed by our body and rapidly excreted, which means the amount of cholesterol you consume has VERY little to do with the levels of cholesterol in our blood stream!

On top of that, our livers actually regulate cholesterol levels by creating more or less of it based on how much of it is in our blood stream.

Now, before I get into why cholesterol is seen as the scapegoat for clogging our arteries, I want to quickly talk about the different KINDS of cholesterol.

Good vs Bad Cholesterol?

Donut burgers

There are three different types of lipoproteins associated with Cholesterol – though you probably only see two of them when you go in for your doctor check up.

It’s these three molecules that throw another layer of confusion into the “lower cholesterol is better” mix. We’ll soon discover that this is not true, even the very idea that there is good and bad cholesterol isn’t black and white either.

Let’s meet our contestants!

#1) High Density Lipoproteins (HDL): These are light, billowy transporters that take cholesterol out of our blood stream and deliver it to our livers. Our livers then dispose of this cholesterol as bile. Most doctors are in agreement that having MORE HDL is a good thing.

#2) Low Density Lipoproteins (LDL): These are also transporters, but they play the opposite role – they deliver the cholesterol from the liver to our cells. Doctors have decided that this number should be low (this has been branded the “bad” cholesterol), though it’s more complex than that.

#3) Very Low Density Lipoproteins (VLDL): There has been recent discovery of an even lower density lipoprotein compared to the regular LDL. Doctors have come to the conclusion that reducing the amount of this in our blood is where we should focus our efforts.

Now, we’ve already talked about the fact that cholesterol is a VERY IMPORTANT part of how our body works – we need it to survive.  As you see above, not all cholesterol is created equal.

Most of it is actually really good and important!

if we need cholesterol, why do doctors hate it?

tyrion

The history of hatred for cholesterol is long and messy…like Game of Thrones

Ultimately, the medical community, in their quest to minimize heart disease, desperately needed a scapegoat to blame it on, not unlike the people of King’s Landing.

Let’s just say: Cholesterol = Tyrion.

You see, the end goal for doctors has been to reduce deaths from heart disease. 

Less heart disease = longer lives, happier people.

Years ago, doctors discovered cholesterol was part of the stuff that clogged people’s arteries, so they made the natural assumption that cholesterol was the cause, and thus, food with cholesterol in it (AKA animal products) should be avoided.

As Marks Daily Apple explains:

Tests in the fifties initially showed an association between early death by heart disease and fat deposits and lesions along artery walls. Because cholesterol was found to be present in those deposits (of course it would!) and because researchers had previously associated familial hypercholesterolaemia (hereditary high blood cholesterol) with heart disease, they concluded that cholesterol must be the culprit.

So, cholesterol: bad! Case closed…right?

Unfortunately…there are some mummies that would respectfully disagree with those doctors.

Let’s go back in the day…to the days of Tutankhamun and Cleopatra. It turns out, ancient Egyptians were plagued by a lot of the same issues that we suffer today in modern society: hardened arteries and heart disease!

Comically enough, articles like this make the accusation that the only way the Egyptians could have ended up with high cholesterol and clogged arteries HAD to be due to a “fatty diet.”

So, how did almost half of all the Egyptian mummies in this study end up with clogged arteries? Were they drinking raw eggs like Rocky, eating Big Macs, and downing ‘unhealthy’ t-bone steaks??

Nope.

It turns out that Egyptians primarily ate a vegetarian diet, with a strong emphasis on grains! Ruh roh! So much for that cholesterol hypothesis, though most doctors are still in…deNILE (terrible Egyptian puns +1).

Okay, so we’re starting to see that cholesterol is more complex than initially imagined.  

these aren’t the culprits you’re looking for

Darth

You might be wondering WHY you’ve been told your whole life that you need to avoid eating food with cholesterol.

As mentioned previously, they were thought to be responsible for clogging your arteries and giving you a heart attack. That previous article we mentioned from Mark’s Daily Apple refutes this hypothesis:

What happens is that in response to an inflammatory situation, the body uses cholesterol as a “band-aid” to temporarily cover any lesions in the arterial wall.

In the event the inflammation is resolved, the band-aid goes away and repair takes place. No harm, no foul. Unfortunately, in most cases, the inflammation proceeds, the cholesterol plaque is eventually acted on by macrophages and is oxidized to a point at which it takes up more space in the artery, slows arterial flow and eventually can break loose to form a clot.

This is like blaming the cops because the presence of police is “correlated” with crime. No no, they’re the good guys!

As we learned more about cholesterol, the thinking began to change. When we learned about HDL, LDL, and VLDL (that not all cholesterol was created equal), we ran more complicated tests and stopped assuming that a big total cholesterol number was bad.

Now, in the last ten years, additional research has questioned whether or not there is any link between dietary cholesterol and heart disease.

Going through ALLLLLL of the results from hundreds of previous studies, the following was concluded:

“Epidemiological data do not support a link between dietary cholesterol and cardiovascular disease.”

Now, if it was just cholesterol getting a bum rap (which is different from a “bum wrap”…don’t do a google image search), that’s one thing. However, around the same time, Cholesterol’s more infamous older brother, saturated fat, got pulled into the mud too.

We’ve been told since the 70s that saturated fat should be avoided – that we should eat less than 20 grams of the stuff per day.   

Before we get into the specifics, have you heard of the French Paradox? It’s the “confusing” observation that the French eat diets high in saturated fats, and yet have lower instances of Coronary Heart Disease (CHD) than most other developed nations (who eat much less saturated fat). 

What’s really going on here with fat and cholesterol?  

tell me about saturated fat steve!

Jamon

Cholesterol and saturated fat tend to be villainized together, like Vader and the Emperor Jar Jar and Annakin.  

Oftentimes animal products are high in both, and is thus the foundation of the “meat is bad for you” argument.

It’s no surprise that saturated fat has a history of being misunderstood.  Back in the 1940’s, a researcher from the University of Minnesota, Ancel Keys, studied the diets of countries around the world and compared them to their mortality rates.  His data (some of which was cherry-picked), showed a correlation between eating more fat and higher mortality rates.

Thus, the great “fat raises cholesterol levels and thus increases risk of heart disease” campaign began, and Team Anti-Fat took a commanding early lead.  

I’m going to guess you’ve probably heard this “avoid saturated fats if don’t want to die” about a million times, so I won’t hit you over the head with it.  Just remember it started with Dr. Keys and has been championed ever since.

Now, as we all know at Nerd Fitness, just because two things are correlated doesn’t mean that one causes the other.

Businessweek humorously points this out with an infographic that asks “Is Facebook driving the Greek financial crisis?”  Correlation does not prove causation!

But that’s not even the point…because after further analysis it turns out Dr. Key’s data didn’t actually show a correlation between fat and mortality (thanks for the heavy lifting, Denise)!

How our body handles saturated fat is much more complex than we thought.  In fact, believe it or not…recent studies have concluded that “saturated fat does not cause heart disease.”  Whoa.

If you’re more of a visual person, here’s a gathering of data on various countries relating coronary heart disease deaths and total energy from saturated fats:

saturated fat and heart disease

Now remember, correlation STILL doesn’t prove causation!  But, two can play at this game, Dr. Keys!  Kidding aside, this gives us a chance to carefully scrutinize conventional wisdom and take an objective look at our diets!  

The problem here is that old habits and old beliefs die hard (as Derek Halpern points out in his latest post).  Thus many doctors are still very quick to prescribe low-fat, “heart healthy whole grain,” reduced meat diets, all in the name of “reducing cholesterol and preventing heart disease!” 

So, what are you supposed to do if you happen to be in this situation?

What does this all mean for me?

storm trooper heart

Okay, at this point I might have your world flipped turned upside down.

You might be wondering:

  • What does this all mean?
  • What should I eat if cholesterol and saturated fat aren’t evil?
  • If I have high cholesterol, should I start taking cholesterol reducing statins?

Hopefully at this point you’ve come to the conclusion that the number your doctors tells you relating to your cholesterol isn’t the end-all be-all solution.

Just lowering your cholesterol isn’t necessarily going to keep you alive longer, as studies like this, this, this, and this, have shown that cholesterol levels is not a reliable risk factor for heart disease and mortality.

Our thoughts: cholesterol isn’t the root of the problem, but simply one possible risk factor of many that should be considered as we age. Only worrying about cholesterol is like only checking and fixing your oil levels every time your car breaks down, when your mechanic should really be checking out everything under the hood.

So, if cholesterol isn’t related as closely to heart disease as we thought, what IS?

According to the folks in the health and fitness industry that I truly respect, trust, and admire, it really comes down to two things: lifestyle and dietary choices. Mark’s Daily Apple attributes a poor diet, high in carbohydrates and starches and sugar, which can lead to inflammation and oxidation (which is the root cause of plaque buildup in our arteries).

Along with that, Chris Kesser does a fantastic job of breaking down the cholesterol vs heart disease debate and is worth a mention.  He quotes Frederick Stare, a long-time American Heart Association member and (former) proponent of the lipid hypothesis:

“The cholesterol factor is of minor importance as a risk factor in CVD. Of far more importance are smoking, hypertension, obesity, diabetes, insufficient physical activity, and stress.”

Here’s the bottom line: cholesterol and saturated fat are very complex subjects. Just taking a pill instead of fixing lifestyle or diet could be a shortcut not worth taking. Our humble, nerdy advice: Before you are put on cholesterol-reducing medication by your doctor, we encourage you to do your own research, and have an educated conversation with him or her; raise some of these points and ask if lifestyle change is an option.

If you have already been put on statin medication or are considering it, take a look at the point that Dr. Mark Hyman makes (along with sources to back up each): going on statins might not solve your health problems, especially if that problem is just “high cholesterol.”

In our humble nerdy opinion here at Nerd Fitness, dietary or lifestyle changes should be the first door checked for all potential solutions before biologically-altering medication is taken.

NOTE: If you are already on cholesterol reducing medication, we encourage you to be extra diligent with your dietary and lifestyle choices (again, our advice being to eat more whole foods, less process crap. Generally, follow a more paleo-like diet) and work with your doctor over time to see if you can reduce your need for that medication.

Built to last

veggies

One of the rules of the Nerd Fitness Rebellion  is to question everything.

Please do not take the words of Nerd Fitness as gospel.  Don’t slap your doctor in the face when he talks to you about cholesterol and tells you about statins. Rather, allow yourself to question the conventional wisdom that has guided your choices up to this point.

Educate yourself before blindly following somebody else’s lead – even ours! Question everything.

We’re huge fans of turning ourselves into superheroes, curing ourselves with dietary and lifestyle choices, and not relying upon unsustainable solutions. If we become reliant upon medication, cleanses, and quick fixes, we’re not addressing the root problem of our unhealthiness [or kryptonite], and could be causing other bodily issues when we introduce artificial solutions.

When it comes to cholesterol, saturated fat, clogged arteries, and heart disease, it’s a complicated beast. All we ask is that you do your research when you are advised to start pumping yourself full of pills, especially if you’re told the goal of those pills is to reduce your cholesterol in the name of “reducing risk of heart disease.”

You’re reading Nerd Fitness, which means you are a pretty smart person – let’s level up how we attack health issues, let’s stop taking conventional wisdom as written-in-stone solutions, and let’s take control of our lives.

I’d love to hear from you:

  • What sort of questions do you still have about cholesterol and fat?
  • Do you have any stories to share about improving your health through dietary/lifestyle changes?
  • Have you run into any challenges you’ve had with taking cholesterol medication?

I realize this is a very controversial topic and flies in the face of a lot of what’s accepted as truth, but I’m excited to have this discussion with you.  If you’re confused about something, please let us know and we can continually update the article.

Let’s hear it!

-Steve

###

photo source: Pedro Vezini: Darth, Nathan Proudlove: lego heart, Eskimo Justice: TyrionStadt Braut: Veggies, Mykal Roventine, JD Hancock: Storm Trooper, Renee Suen: Jamon, Clay Caviness: Donut Bacon Burger

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124 thoughts on “How to Lower My Cholesterol: A Beginner’s Guide to Cholesterol

  1. So, just because he doesn’t have high cholesterol – he can’t talk about it? Get off your high horse Julie.

    He is citing scientific studies, MULTIPLE scientific studies that had the conclusions he explained. AGAIN, he didn’t say this is gospel, he is just talking about information discovered through research and through scientific studies.

    I bet you didn’t even read the studies, and I doubt you ever gave Paleo a real go.

    Just shut your face.

  2. Well now this had been on my mind recently. Every older man in my family is on cholesterol pills as high cholesterol apparently ‘runs in the family’ I’ll be reading every article here and linking this article to everyone else so they can start asking the questions too. I had actually been a bit worried about getting a health checkup incase I was told I had to start taking pill’s which I really don’t want.

  3. There is a very interesting chapter on cholesterol in Barry Grove’s book “Trick and Treat: why healthy eating is makng us Ill”, where he explains the close relationship between government’s nutritional recommendations in the 70s and the pharmaceutical lobbies who wanted to sell cholesterol-lowering medication. It gives an interesting insight as to how and why this common demonization of cholesterol has come to be.

  4. Well… your argument is wrong. Sorry. I’ve actually ALREADY researched this and seen most of these studies. I’m glad you seem to know what I’ve done over the years and tried in order to aid in my cholesterol numbers. When you are told at age 29 that you have high cholesterol and believe in evidence based medicine, you tend to do these things on your own.

  5. Seriously trying to get to about 80% of “Primal” eating – according to Mark’s Daily Apple. Occasional pizza and beer with buddies (1x / week or so) to keep me sane and I’m comfortable with where I’m at. Along with some references in here, MDA actually promotes a high-fat diet when compared to “traditional” recommended diets. I suggest at least checking it out for yourselves.

  6. I find interesting that the “confusing” French paradox, where French people eat lots of fats and have less heart disease, means fats are really ok, yet “heart healthy grains” are put in quotations in this article and are blamed for coronary disease by most of the commenters here and the Paleo enthusiasts. Don’t French people also eat a lot of breads and pastries, with grains and sugars? This could be an incorrect stereotype as I’ve never been there, but I did learn French from a French person and a bit about their lifestyle in those classes. I think portion control probably has more to do with it. Also I think doctors are well aware of the limitations of cholesterol-reducing medications in lowering cholesterol numbers compared to a change to wholefoods and an active lifestyle, but have to implement a plan that the majority of society are more likely to stick to in order to improve their health (assuming cholesterol is a culprit, I have not yet developed a solid opinion on the matter). The readers of this blog may find it obvious that they should be recommending a healthier lifestyle instead, but a huge proportion of society hasn’t made the decision to commit to a big lifestyle change compared to the people who have sought out this site.
    Just to clarify, I’m not saying I think grains and sugars are good for you or that doctors are always right. I don’t think ANYONE can know the correct information yet as there are significant limitations to science and our understanding of biology. And you can find experts who will say whatever you were hoping to find if you look hard enough as we are all human and will be influenced by a number of different factors including personal experiences and beliefs, emotions, apathy, company sponsorship, etc. We haven’t built any robot doctors yet that will only spew the facts from double-blinded controlled clinical trials in large populations.
    Another thing is, just because you can, does it mean that you should? I’m a vegetarian (also low grain and very little sugar), not necessarily because I think it’s what will make me healthiest and strongest, but because I believe there’s something a little more important than that. I’m willing to scrounge harder to make a good filling meal with quality proteins because any time there are animals in a system designed for profit (ie meat production) their welfare will suffer. I have seen this firsthand. I could also tell you that the transition to vegetarianism immediately let me drop 7kg of fat and keep it off, my vitamin b12 levels actually IMPROVED (I believe this is because my intestines are now healthier), and I’m less likely to stop at Hungry Jack’s or get an unhealthy freezer meal. But the most important thing to me is not how my body feels, but how my soul feels. I know this is getting off topic but I’ve been getting so many emails lately of how to cook with bacon and chicken, and don’t worry if you can’t afford free range eggs so long as you can eat healthier, and people replying with how they do better with their workouts if they eat meat etc, that I just get sad that it seems like personal health is the only consideration on some people’s minds.

  7. Well, “healthy” is a loaded and complex term. High (or low) cholesterol alone does not make a food healthy or unhealthy. In the case you mentioned, its most likely because general perception is “White meat”=good, “Red meat”=bad.

  8. Thanks for the great article, Steve. In late 2012, Before discovering NerdFitness.com, my doctor told me I had elevated cholesterol. My LDL was 156, the borderline of needing medication. He said that before recommending medication, I should try some diet and lifestyle changes and if those didn’t work, we would discuss medication. I DID NOT WANT TO GO ON MEDICATION. I started exercising on my own – and then I discovered this site (April 2013) and your post on walking – so I started walking. Then I read the post about the beginner bodyweight workout – and I started that. Then I started running with Couch to 5K, and then 5K to 10K. I put off my follow up visit for a while to let the exercise and the eating changes I had started work a little more. When I returned to the doctor in October of last year I lost about 30 pounds and had reduced my LDL to 146 (still in the elevated category but no longer in the borderline category). My doctor was impressed with my progress and I told him about the site and what it has done for me. Thanks again, Steve! You helped save my life!

  9. Hi nielmalan, thanks for the comment. One of the points we try to make is that previously there were only correlations found, and correlation does not equal causation. “High cholesterol causes heart disease” is a controversial statement, to be sure. In any event, we provided a number of links to studies and articles which argue that there is in fact no or minimal correlation.

  10. I feel like I need to add a quick reminder to everyone that food is a
    complex mixture of thousands upon thousands of compounds that can be
    synergistic with each other, or antagonistic with each other, in regards
    to their effect on health. When you combine that with the fact that
    everyone’s genetic make up is unique, it becomes impossible to pin-point
    exactly one food, one chemical or even one gene that is responsibly for
    any outcome. Sometimes we just need to step away from the reductionist
    approach to nutrition and see what works for each person on an
    individual basis, and remember that what works for you may not work for
    someone else.

  11. Great article! I also appreciate the discussions happening here. One thing I’d love to see NF address more is how these concepts may differ with women. There was a really great Ted Talk on the inclusion of women in scientific research http://www.ted.com/talks/paula_johnson_his_and_hers_healthcare. Would the results differ on the chart you posted on saturated fat correlations if it weren’t just male participants? Just a suggestion 🙂

  12. The only point made here, even though just simply glazed over and definitely not the focus, that I think may be questionable is that a “poor diet is high in carbohydrates.” This is only true if you are inactive. If you are an active individual, carbs are great. If, however, you tend to spend much of your time on your booty, you may want to ease up on the carbs.

  13. Bravo Allyson, I might say we could expand this to overall health! Contributing Factors such as rest/sleep habits, stress, and physical activity level must be considered as well.
    I hope everyone reading this keeps in mind that Steve is talking about reframing and challenging conventional wisdom when it comes to cholesterol in your diet and its lack of correlation with serum cholesterol. I am sure that many people benefit from statins because elevated BLOOD cholesterol levels are still considered a risk-factor. We all need to do what works for us as individuals, as has been said many times before.

  14. I’ve learned recently that anything can cause inflammation. Not just high carbs and sugar. Nightshades do a terrible number on me. So I imagine something about the Paleo lifestyle may have caused inflammation for Julie. I don’t know, I’m not her. This article is certainly food for thought and I’ve heard this before, not just from NF. If anything, I think it encourages people to think and take their health concerns into their own hands. I’ve been given so much wrong information from doctors or told they just don’t know what’s wrong I can’t take their word as the be all end all. If you’re comfortable with the doctor’s advice, continue following it. If not, seek out alternatives and do your research.

  15. Nerd Fitness, interesting article, but really breezy with the facts. First of all, the studies that were done only comment on the actual presence of atherosclerosis – not anything else. No specific findings about diet or lifestyle or mortality. The basics are that, on average, 1/3 of the mummies scanned showed signs of the condition therefore they conclude that modern lifestyle is not necessarily causative. Data suggests that the condition worsens with age, so 1/3 of these dead people having it is actually a bit better than older people now.

    As for diet, Egyptians (and the other populations) were most certainly NOT vegetarians. Of course they probably ate a lot more than modern Americans LOL.

    Discovery.com (http://news.discovery.com/history/ancient-egypt/mummy-scans-clogged-arteries-130311.htm)
    “According to the study, the ancient populations’ diets had been varied — including everything from shellfish and fish, game, domesticated cattle, sheep, pigs and ducks to a wide variety of berries, farmed maize, beans and potato — even beer and wine in the case of the Egyptians.
    None of the groups were known to be vegetarian, and physical activity was probably high.”

    The actual article about the studies
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960598-X/fulltext

  16. good read…..lots of ammo for next “statin recommend” been on high fat diet plan for 3 years and already see significant results…. heading towards Paleo NOW so hope to see more

  17. You’re welcome! I can hear Yoda saying… “Sugar is the root of all evil”

  18. Great article Steve – thanks. I’d been very worried about my cholesterol when I started my paleo/primal life back in August. For years (ever since I started getting my cholesterol checked) I was told it was high, but my ratios were good so no worries. I only recently came to understand what that meant. My doctor and I are very pleased with my numbers. Since going paleo, my HDL went up 20 pts. and my LDL dropped 22 pts. and my triglycerides stayed about the same at 53. Yes my total is still high at 276, but I have no other risk factors for heart disease. The body is a complex machine, and I think we all need to experiment with diet and lifestyle changes before resorting to medication.

  19. Thank you for posting this article on Cholesterol. My number is on the high end and my good cholesterol is really high. I don’t worry about it. While there are a number of drugs out there to assist those who need help to control certain genetic matters, I have always been a fan of making sure that your lifestyle is in check first and consider your last resort as drugs or surgery. I’m constantly on my parents about exercise and not just diet. I’m going to foward this article to them to read. I enjoy your posts and your adventures. Keep up the good work of putting our and your health first.
    Cheers – Mary La

  20. No, I did not make any controversial statement. The correlations are well known, and the cellular mechanism for the disease are well understood. The mechanism explains the correlation.

    For a detailed review of the history of the unraveling cholesterol/heart disease connection, a job the required decades of hard work by some very intelligent people, read the five-part review by Daniel Steinberg:

    Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part I
    http://www.jlr.org/content/45/9/1583.full.pdf+html

    Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part II: the early evidence linking hypercholesterolemia to coronary disease in humans
    http://www.jlr.org/content/46/2/179.full.pdf+html

    Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy, part III: mechanistically defining the role of hyperlipidemia.
    http://www.jlr.org/content/46/10/2037.full.pdf+html

    Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy, part IV: The 1984 Coronary Primary Prevention Trial ends it—almost
    http://www.jlr.org/content/47/1/1.full.pdf+html

    Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy, part V: The discovery of the statins and the end of the controversy
    http://www.jlr.org/content/47/7/1339.full.pdf+html

  21. Having re-read the post, I find it a jumble of inaccurate interpretations and dodgy references.

    Some of my thoughts:

    1. It is probably true that dietary cholesterol don’t contribute to blood cholesterol levels, it being synthesized and regulated by the body. BUT, it has been shown again and again that a diet high in saturated fat (which is not cholesterol but an entirely different beast) induces a higher level of blood cholesterol.

    2. The earlier recommendation that carbohydrates should make up a large portion of the diet has been scrapped.

    3. If you have high cholesterol/LDL, and the doctor recommends a statin, take it. If you can adjust your lifestyle enough to go off it later, good for you.

    4. There is at least one sensible sentence in this post:
    “Only worrying about cholesterol is like only checking and fixing your oil levels every time your car breaks down, when your mechanic should really be checking out everything under the hood.”

  22. Speaking as someone who was diagnosed with high cholesterol at the age of 17 (and weighing about 120lbs at 5’7 at the time) I have seen countless doctors. I was put on a basically no fat diet for 3 months, with zero effect on my cholesterol levels. At about 27 years old, I was put on statins, which I continue to take. One thing I notice as I see different doctors is that the general feeling seems to be moving much more towards what Steve is spelling out here. When I was first diagnosed, I was told that my TOTAL cholesterol was at a dangerous level. As medical knowledge evolved, the doctors started focusing much more on my splits. As I have worked on improving my diet, my cholesterol has gone UP, but this is a GOOD THING. My genetic predisposition is to have a slightly elevated amount of LDL. My poor diet also led me to have lower HDL. As my diet has improved, my HDL has gone up my more than my LDL has decreased, meaning a higher total but a healthier ratio. So while your cholesterol may have “skyrocketed” by going paleo, that may not have been a good thing (for the record, I do not eat paleo). The important thing – as Steve mentioned several times in his post – is to have an informed discussion with your doctor.

  23. Hi nielmalan, thanks for the links. This series seems thorough and I will definitely add it to my list.

    I will say that at first glance, this appears to simply track the initial history of this issue as doctors came to a consensus on cholesterol. It doesn’t seem to addresses anything after that – specifically a lot of the more modern objections that are made to push back against this initial consensus – what a lot of the links in this article are doing.

    That said, I haven’t read it yet, and seems to be an interesting read in any case. Thanks!

  24. Love this comment. Carbs (from grains and starches, especially) get a really bad rap these days, with Paleo proponents often pointing to the rise of agriculture as key point in the decline of our health. My opinion (and it’s just that – opinion) is that the rise of refined flours and such was actually hugely beneficial to those who “worked the land” for a living, as it gave a very practical source of energy for them to expend while working. This real problem came when we all moved to desk jobs, but kept eating like we were farmers…

  25. great work. You seem to know your stuff about cholesterol! Can’t wait to read more from you

  26. Hi, I’m french and I don’t think that we eat a lot of saturated fat. We do like cheese (everyday for me, but not for everyone) but nothing else … At least nothing more than anywhere I guess (for exemple we do not eat bacon in the morning, but sugar product like cereal or bread).

    When I see what people eat in the USA, we certainely don’t eat a lot of saturated fat.
    I don’t think that the french paradoxe is real, we eat healthy most of the time.
    We even have commercials that tell us to eat healthy and do some exercices ^^

  27. I really like the presentation of this article. I was funny, but very educational. In America we try to fix all of our health problems with a pill (well, at least in my family – don’t want to offend anyone), but
    also in America, we tend to live very unhealthy lifestyles – the obesity epidemic just to name one!! In addition, I think (and this is just my humble opinion) that much of the data that tells us that cholesterol is bad is handpicked by pharmaceutical companies – yep, another one of those …. Think about it though, how much money do they make by telling us we are sick?
    What the info in this article tells me is to take responsibility for my own health. I have genetic, high cholesterol with no heart disease in my family. I also lead an incredibly high stress life. The stress is definitely going to get me before the cholesterol.
    Take away: I need to start being responsible for my own health. Not only that, how much better do we feel when we are eating right and exercising. No pill can make you feel that good.

  28. I find it interesting that the article linked about mummies’ cholesterol being linked with high fat ends with “Analysis of digestive remains suggested the Egyptians enjoyed a wide
    diet that included fish, a little meat, beer, bread and sugar-rich
    fruits, such as dates.” (And I couldn’t find anything in the article suggesting that “the only way the Egyptians could have ended up with high cholesterol and clogged arteries HAD to be due to a ‘fatty diet.'” The closest I found was “This[build-up in their legs of plaque] can be caused by a rich diet high in fat, or it can be genetic,” which doesn’t seem a strong conclusion to me.) Then you go on to say they were vegetarians. I’m interested by the results of the study in the article you linked suggesting this and confused by the lack of fish. I think I may have to go looking this one up a little more thoroughly.

  29. Not sure it anyone mentioned this, but new guidelines actually recommend statins for a variety of cardiac risk factors – not hyperlipidemia only. Also, we don’t treat to a lipid goal anymore. New data, new recommendations! (See 2013 aha recs)

  30. Follow the money. I highly recommend the new book “The Big Fat Surprise” by Nina Teicholz which traces the power, politics and personalities behind dietary guidelines. One of the personalities discussed is Harvard’s Walter Willett. Any one commenting here about “having researched the topic” may discover why he/she may want to try again.

  31. I absolutely LOVED this article! I work in social media marketing and some of my company’s clients are medical research facilities, so I spend a good amount of time reading medical blogs. This is by far the funniest and best-written I have seen so far. Love the kind, informative and digestible (pun intended!) tone.

    I also admire that you encourage your readers to evaluate their health and what they can do to naturally make their cholesterol levels better. Although the whole “don’t punch your doctor in the face when offered statins” is equally great advice. If you’re are interested, my fiance recently wrote an article for Achieve Clinical Research (one of our clients) that highlights a new non-statin therapy. It can be found at http://www.achieveclinical.com/news/non-statin-therapy-shows-promise/ and is definitely worth a read. I hope everyone in this enthusiastic discussion is having a wonderful weekend!

  32. My mom had a heart attack in the last year and her doctor put her on statins and a low-fat/low-cholesterol diet. It’s seems like nothing I say can persuade her that those two choices might not be in her best interest and might be doing more harm than good. Sorry, I just kinda had to vent for a second. =/

  33. Another article that makes me think Steve must be in the pocket of Big Beef. This site is called Nerd Fitness, not Nerd Nutrition.

  34. I have an alternate experience with cholesterol. My whole life (even as a child) my cholesterol was “elevated.” As far back as I can remember, my total was around 190-210. Heart disease runs in both sides of my family, so my doc was always diligent watching it. A few years ago, my total suddenly dropped to the 160s. My doctor openly admitted she wasn’t sure why, but she praised my good work and said to keep it up.

    At the time, I didn’t mention I was suddenly having some autoimmune symptoms because I really wanted to bask in the glory of my improved numbers (no one had ever said my blood work was good before!). A few months later, I read an article that said a sudden drop in choloesterol can signal other problems in the body (specifically mentioning cancer or autoimmue disease).

    So, in my case, suddenly lower cholesterol was correlated with a drop in my health (or inversely, I would say, when my levels were higher, I was much, much healthier). Whether one caused the other, I’ll never know. But after having “borderline high” numbers my entire life and being mostly healthy, then suddenly dropping ~50 points, and my health taking a dive as well, I feel like it was an indicator of a problem. There may not have been a way to prevent it, but I feel like my doctor should have used that to start a (non-panic-inducing) conversation.

  35. I had my health screening for work a couple of months ago and everything was good but my ‘good’ cholesterol was too low. I’m overweight (working on it) but i don’t eat meat often and when i do it’s healthy cuts. The nurse for the insurance said to stop smoking, exercise at least thirty min a day, cut back on alcohol, etc. Everything suggested, i already do. I even eat oatmeal with flax every morning for breakfast. Any other tips / tricks?

  36. I think your point about curing it being a lifestyle choice rather than simply some medicine is completely right. I’ve been eating healthy food and recording (via myfitnesspal) what I eat for a couple of years and I wince at what I used to eat (and I wasn’t even that bad!)

    I’m really not sure what the root cause is, because I certainly knew I should be eating better I just wasn’t so I don’t think we can blanket blame education. Is it convenience? I often perceived healthy food to be much more expensive which I don’t think is entirely accurate.

  37. Nutrition should be a part of peoples fitness. You can’t outrun a bad diet, as they say.

  38. It’s a good book but, I think you’re beating a dead horse with this one. Don’t frustrate yourself with the ones who don’t feel the need to change. It would be like me telling you to be a vegetarian.

  39. Talk to your doctor but do your research. Read studies on the subject and print them, form good questions to ask your doctor, bring your printed material with you. Prepare yourself so that you can have a useful conversation with your doctor. It will be some leg work but, your health is worth it.

  40. This is why I appreciate local farmers and pasture raised animals. They will die in the end but, they will be happy on the way and I’ve experienced their happiness. Nothing is as fun as watching cows run out to the fresh grass after a long snowy winter.

  41. Doctors would love it if patients would commit to lifestyle changes but 99% of people just don’t follow through and end up needing meds. Of course it would be preferable if people took ownership of their own health needs.

  42. The real mistake here is people relying on doctors too much. They are killing us! Take responsibility for your health and do your own research: don’t just listen to your doctor. (I’m an RN, by the way)

  43. Information that challenges what we have been taught to believe is difficult to digest. Just when we think we’ve got it all figured out, someone comes along and says something contrary and it sounds ludicrous! I research this kind of stuff daily, though, so what Steve has written is actually very well known to many. It is very well documented in the literature and many, many doctors have written on the subject. It’s good to question, to do your own research, etc. but please, don’t dismiss excellent information just on the basis that it doesn’t conform to what you’ve always thought. Read heart surgeon, Dwight Lundell and others like him. He will tell you why the prevailing advise is wrong 🙂 God bless!

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