One of the most perplexing questions in the medical community is how such smart people got it so wrong when it comes to cholesterol and heart disease. There are two books that document what some people call the multibillion dollar “farce” in detail and in truth. There’s more money, politics, drama and ego documented in “The Big Fat Surprise” by Nina Teicholz and “Good Fats Bad Fats” by Gary Taubs to last any one interested in a good health saga a few months of good reading.
But for our purposes, we’ll do our best to hit the highlights needed to convince you, for the last time that fat is not bad.
A good place to start is Ancel Keys and the McCovern Commission. Ancel Keys was a biochemist in the 1950’s who did a lot of study on fat and cardiovascular disease. He submitted a paper that hypothesized high levels of saturated fat and cholesterol cause cardiovascular disease. It looked pretty straight forward that the countries that ate more fat had more heart disease, but it turns out he failed to use all the available data which shows a very different picture. In the end his study did not show any clear correlation between amount of fat consumed and heart disease when all the data was included. The scientific community was quite split on the work of Ancel Keys, but in the end a few key government officials and senators took hold of Ancel Key’s work and ran with it. McGovern convinced senators that they didn’t have the luxury of waiting for conclusive data like scientists do and something must be done. Therefore government policy and agencies like the American Heart Association were born out of half baked science and government policy driven primarily by, what some would say, Ancel Key’s personal relationships and money.
Now, the paradox here is that the main message that became so misconstrued is that fat makes you fat and gives you heart disease. This idea “fat makes you fat” sounds like it makes sense, but just because something is logical doesn’t make it true. Cardiovascular disease is so much more than cholesterol levels. It’s essentially a disease of inflammation. That is what wasn’t even part of the conversation for Ancel Key in the 1950’s and what is finally becoming clear as the masks have come off and saturated fat is no longer the villain. Populations like the Kitavans consumed very high levels of saturated fat and had very little cardiovascular disease. There are other ancestral populations that show the same. This was evident when the data from all 22 countries of Ancel Key’s study was analyzed versus the 6 countries he chose to include in his paper that showed the results he had hypothesized. How his message became mainstream and the basis of over 50 years of government policy is on many levels, unbelievable but likely part of the phenomenon of a “sticky” idea, the term that Malcom Gladwell coined to describe an idea that may or may not be true, but picks up steam and becomes something bigger than it is. At the time the ideas where being used as the foundation for government policy and nutrition education, the medical, nutrition, and scientific community were not in agreement that the fat/cholesterol hypothesis was indeed true.
Here’s what it looks like:
Like I mentioned in the opening lines, the details of how poor science shaped health and public policy is detailed in work by Gary Taubs, Nina Ticholz, Denise Minger, and Dr. Michael Eades, M.D., and it has taken so much energy by good scientists and quality nutrition and medical professionals to battle the cholesterol myth that there hasn’t been much room in the conversation for what should be part of a healthy diet, until now.
It is now becoming mainstream to eat real foods, full fat foods, and saturated fats like butter, coconut oil, high quality full fat dairy and yogurt. Low fat salad dressings, low fat cheese, and low fat recipes are on the decline and should be out of your kitchen and your eating. To decrease inflammation, support good heart health, and manage weight, lowering carbohydrates and sugar is the better way to go.
News flash! Cholesterol is absolutely necessary for survival. There is not any function in your body that doesn’t require cholesterol at some point. Our brain and nerves are made up of cholesterol. Your liver produces approximately 2,000 mg of cholesterol daily – on purpose.
Every cell in your body is surrounded by membranes made up of cholesterol. Without it, cells can’t function. The body also uses cholesterol to make stress and sex hormones. The way statins inhibit the body’s ability to make it’s own cholesterol is particularly problematic for maintaining good hormone levels, since sex hormones are dependent on cholesterol.
Additionally, the cholesterol from the food you eat is only a very small percentage of blood cholesterol levels. Some would even go as far as to day they are basically unrelated. There is evidence from scientists that says cholesterol from foods is low, the liver actually makes more cholesterol itself. Therefore, you cannot affect cholesterol numbers with any significance by eating less cholesterol.
There has been a lot of information for years surrounding “good” and “bad” cholesterol, but these concepts are actually oversimplified and misrepresent the role of cholesterol in the body.
As it turns out, HDL and LDL are not technically cholesterol at all. They are high density lipoproteins (HDL) and low density lipoproteins (LDL). Fat and cholesterol have to be carried by something, and those carriers are the lipoproteins. It’s like a taxi cab traveling in the blood transporting the various components to where they need to go. Cholesterol and fats are like the passengers in the taxi. It used to be believed that the number of the passengers in the taxi (concentration of cholesterol in the LDL particle) were what caused the development of heart disease. But what has since been found is that the number of cars on the road is really what matters.
Arteries are basically a hollow tube, and the lining of the tube (endothelial lining) is pretty thin. So when the “road” becomes jam–packed with taxis (our LDL particles), some crash into the wall, damaging the tissue and allowing the cholesterol to get into the artery wall – beyond the endothelial tissue. So the buildup of plaque in the artery is caused by damage to the lining of the artery, not simply an overabundance of fat.
Why does this matter? Well, your total HDL and LDL cholesterol numbers, which most practitioners look at, are telling you how many passengers are in the taxi (lipoprotein), not how many taxis are on the road. An LDL particle number tells us how many taxis are on the road and can be a better indicator of cardiovascular risk. Sometimes the particle number and total number do correlate, but other times they do not. That means without measuring LDL particle number, you run this risk of having a normal or even low cholesterol but a high number of LDL particles (or, too many taxis on the road). This would falsely lead someone to believe they had low cardiovascular risk. This is why there are people who have normal cholesterol levels who still die of heart attacks. They look great on paper, but the true risk identifiers are not being used.
Conversely, you could have a high total LDL, but low particle number. If the particle number wasn’t measured, you’d think you were at higher risk than you really are!
A Norwegian study of over 52,000 people showed women with total cholesterol levels below 195 mg/dL had a higher risk of death than this with a cholesterol higher than 195 mg/dL. Low cholesterol is also associated with increased risk of other diseases, namely mental health and brain disorders. This makes sense when you think of how much of brain tissue is fat and cholesterol. The brain lives on fat, so continuing to lower and lower your numbers may not be the best idea.
When it comes to cholesterol and heart disease, many people think that we can control heart disease by decreasing cholesterol, but heart disease is a complex process with multiple factors involved. Other causes of heart disease include:
- metabolic syndrome
- poor thyroid function or thyroid disorders
- leaky gut
Lowering levels with statin drugs don’t address the root cause of inflammation causing the cholesterol numbers to increase. Lowering your cholesterol with a statin drug simply makes you looks better on paper as the disease progresses in the background. Statins are known to have a benefit of decreasing inflammation, but they also have huge damaging side effects by stopping the body’s own production of cholesterol. This actually causes stress and inflammation in other ways as the body becomes starved of necessary raw materials for basic cell function.
Dr. David Newman in 2010 did research on statins in men with pre-existing heart disease, on a statin for 5 years. This is what he found:
- 96% saw no benefit at all
- 1.2% (1 in 83) had their lifespan extended
- 2.6% (1 in 39) were prevented from having a repeat heart attack
- 0.8% (1 in 125) were helped by preventing a stroke
- 0.6% (1 in 167) were harmed by developing diabetes
- 10% (1 in 10) were harmed by muscle damage
So, the conclusion here is that 83 people would have to be treated to extend one life with every 10 of those having muscle damage. That’s not to mention the number of people who lived with muscle pain while taking the drug, but continued on it anyway. Other research indicates statins do not extend the life of men or women over 80 and the highest death rates in people over 80 are associated with the lowest cholesterol levels. When Dr. Newman studied the effects of stains on those who no pre-existing heart disease for 5 years, 98% saw no benefit at all.
This isn’t to say that statins may not have a role in the treatment of men under 80 with pre-existing heart disease. There is evidence they have saved lives, but they are not the magic bullet or blanket prevention for everyone although they are often treated that way.
So, what’s the take home message here? Cholesterol is necessary for not only daily life, but optimal functioning. Lowering and lowering and lowering the cholesterol does not prevent heart disease and can cause unwanted side effects. Statins aren’t the magic bullet they are often billed for, as a person can look perfect on paper with huge disease risk factors lingering behind what appear to be great cholesterol numbers.
So, what do you do? Work with a functional medicine practitioner who is not going to put you on a statin, tell you to exercise and give you pats on the back for lower and lower cholesterol numbers.
Work with a functional medicine practitioner who is looking at your real risk, not your perceived risk based on a generic cholesterol panel that doesn’t consider things like LDL particle number.
Lastly, address lifestyle issues that cause inflammation which will be addressed in subsequent parts of this series. Contact LifeWorks Integrative Health for all of your integrative health care needs, and visit our functional medicine clinic in Overland Park to speak with an expert.