Image Source: cavegirleats.com

How many people avoid egg-yolks and opt for egg-white omelets instead? And how many Pin articles that teach them how to replace cholesterol-rich butter with fat-free substitutes like apple-sauce in recipes? A LOT of people, that’s how many. I know until a few years ago I used to eat low-fat yogurt and avoided butter. Because these foods contain cholesterol and cholesterol is EEEEEVIL. You’ve all heard the drill – we need to keep our cholesterol levels down at all costs because otherwise we will instantly die of a heart-attack.

So OBVIOUSLY that means stop EATING cholesterol – because (in the same way that fat makes us fat and green vegetables turn us green*) eating cholesterol will raise our cholesterol. Right?! NOPE.
*not really

Eating dietary cholesterol does not have a significant effect on increasing our levels of cholesterol. And, in case you don’t believe me, there are plenty of studies to show this:
http://www.jacn.org/content/23/suppl_6/596S.long

http://www.jacn.org/content/19/suppl_5/540S.long

http://www.huffingtonpost.com/david-katz-md/eggs-health_b_1818209.html

http://pubs.rsc.org/en/Content/ArticleLanding/2010/FO/c0fo00088d

But, even if it did, cholesterol is NOT A BAD THING!

Somehow, over the years, we’ve all become accustomed to thinking that cholesterol is a bit like one of these guys. Something we need to suppress and lower at all costs. “You have GOT to get your cholesterol levels down” yell doctors, while scribbling down a prescription for some statins, and “oh my, I can’t possibly eat that full-fat cream, it will raise my cholesterol” murmur our grandparents, with a fearful look in their eyes.

This is how I feel sometimes:

not_having_it

All around me everyone is blindly clapping their hands in support for all this crap not-very-true information, whilst I stand here feeling like I’m the only person (or one of 3) who actually sees through it.

I’m gonna type this very slowly so that you don’t miss it:

Cholesterol is a good thing. Yes. Let me repeat that – CHOLESTEROL IS A GOOD THING!

It is absolutely essential to our physical, psychological and cognitive health and well-being. Every cell in our body requires cholesterol to survive, and it is critical, in particular for the development and function of the brain.

So what exactly is cholesterol?

It is a fat-soluble molecule called a sterol, which is an essential structural component of cell membranes, required to establish proper membrane permeability and fluidity. It is responsible for insulating neurons, building and maintaining cellular membranes, metabolizing fat soluble vitamins, producing bile and is a precursor for the biosynthesis of many hormones, including our sex hormones. Pretty essential stuff really. No cholesterol, no body.

200px-Cholesterol-3d

Since it is essential for us to live, our cells are able to synthesize it from simpler molecules starting in the liver, which produces some 1000-1400 milligrams daily. And yet the daily dietary recommendation for the intake of cholesterol is only 300mg. This is barely a drop in the ocean compared with what our bodies make, and doesn’t seem to take into account the fact that the body is pretty smart – we have a feedback system in place that regulates the production depending on our dietary intake. ie. When we eat more we make less and vice versa.

Where do HDL, LDL and Triglycerides come into the picture?

We’ve all seen those terms under our cholesterol profile if we’ve ever had a comprehensive blood-test. But what do they mean?
We’ll start with the popular guy HDL (or High Density Lipoprotein). This is what people often refer to as “good cholesterol”, even though it is actually just a lipoprotein whose job it is to transport cholesterol from the rest of the body back to the liver, where it is excreted as bile. Basically it gets rid of excess cholesterol when the body is done with it – a bit like a clean-up truck. HDL is very well liked, because of this important job and so, when your HDL levels are high, you will generally be applauded with a high-five by your doctor.

Then there’s its less popular cousin LDL (or Low Density Lipoproteins), which has been much maligned for its role in the transportation of so-called “bad cholesterol” throughout the body. In fact, both HDL and LDL transport the exact same cholesterol – it is the lipoproteins themselves that are different. And for all its bad rap, LDL is also necessary to the body. It is LDL’s job to transport cholesterol from the liver (where it is produced) to tissues in the body where it is needed. This could be to repair damaged cells, to aid in the construction of new neurons, as a precursor for hormone production etc. In other words, it is a very important job.

Imagine that cholesterol is a little like a band-aid. It is required in situations where there is inflammation – for example a lesion in an arterial wall. It will be used to temporarily cover the lesion (similar to a band-aid) until the inflammation is resolved. Unfortunately, in many cases, this inflammation is not resolved, and the cholesterol remains in place. If the LDL particles are stuck here too long, they are eventually acted on by macrophages and exposed to free radicals etc, in the surrounding tissue, which lead them to becoming oxidized, and thus expanding to contribute to, what we refer to as “arterial plaque”. This is what eventually can cause arteries to become clogged. Cholesterol was never the bad guy here – it was actually trying to help. This would be like blaming a band-aid for the cut on your finger (thank you Mark Sisson for that analogy). Ludicrous right?

The actual problem here is inflammation in the body and stress. Inflammation leads the body to produce more LDL particles, which are then at risk for this process of oxidation. Inflammation, as we know, is triggered by many different factors, such as: nutrient deficiencies, excessive refined carbohydrates (such as grains and sugar), smoking, excessive Omega 6 fatty acid intake (eg. from vegetable oils), and psychological stress.

So, what’s the issue with producing more LDL particles?

Consider arteries as highways and LDL particles as cars (with cholesterol as passengers in these cars). The blood in the arteries, which contains these LDL particles, is in constant contact with the endothelium (artery lining). Now imagine if the numbers of these particles is extremely high – there is then obviously a greater chance of some of these particles crashing into the endothelium. It is not the cholesterol inside the particles, but rather the particles themselves which can contribute to damage. Again, though, if there is no existing inflammation, it is likely that there will be no damage.

This aside, LDL comes in different forms

Not all LDL is created equal, and therefore not all types of LDL are potentially damaging. There are large bouyant LDL particles, for example, which move easily through the arteries, causing little damage (imagine these to be like beach balls gently bumping into the walls but leaving it intact), and then there are smaller denser LDL particles, which are more like bullets – they can easily penetrate the delicate arterial walls upon contact. These small dense LDL particles are also far more susceptible to oxidation, forming oxidized particles (oxLDL). It is this oxidized LDL that has been shown to be associated with the risk of a heart attack, as described earlier. So, once again, it is important to distinguish here between, not just the number of LDL particles, but the numbers of small dense LDL, as opposed to large buoyant LDL particles, since it is THESE particles that have been associated with heart disease.

Unfortunately, the distinction between cholesterol and cholesterol PARTICLES is rarely clarified when you get a cholesterol profile done. The levels of these are often concordant, but it is the particles, and not the cholesterol itself, that are the issue. It is possible to have low or normal total cholesterol numbers, but a high number of LDL particles, in which case the patient is falsely led to believe they are at low risk.
Conversely, a patient with high LDL cholesterol, but low LDL particle numbers is not at risk for heart disease at all – in fact studies suggest that they are at even lower risk than people with low cholesterol and low particle counts. Unfortunately these patients will often be mistakenly treated with statins, which can be extremely harmful.
The takeaway here is to get the HDL and LDL particle numbers tested and not just cholesterol levels. And within the LDL category, to assess the number of small dense LDL particles, since these are the dangerous ones.

So what about Triglycerides? These actually have no relationship with cholesterol, but rather, are the form fat takes when it is transported to the tissues in the body in the blood stream. High levels of these are often a marker for problems in the body such as insulin resistance (which leads to diabetes), and inflammation (which can lead to heart disease, as described above). High levels of triglycerides are also often seen with low levels of HDL (the good guys).

So, back to HDL and LDL – to sum it up:

If small dense LDL is low, buoyant LDL is high, and HDL is high, then the patient is likely to be healthy and not at risk for heart disease.

However, if small dense LDL is high, buoyant LDL is low, and HDL is low and triglycerides are high, and the patient is experiencing systemic inflammation, then they are likely at risk for heart disease.

Unfortunately statins are aimed at reducing overall LDL cholesterol, and do not take into account the differences in the types of LDL particles. A large study published in the American Heart Journal in 2009 found that the level of LDL cholesterol is actually lower in people with heart disease, not higher.

Low LDL High Heart Disease

So, to reiterate again – LDL is not “bad”. Elevated levels of small, dense LDL particles may be a risk factor, but overall LDL levels are not enough to make any sort of conclusive diagnosis.

The real issues here are INFLAMMATION and STRESS. Without these, there would be no heart disease.

And how does all of this related to food?

As I stated above – dietary cholesterol DOES NOT increase small, dense LDL. CARBOHYDRATES increase both these particles and triglycerides. Saturated fat and dietary cholesterol actually REDUCE small, dense LDL. This study shows that reducing saturated fat and increasing carbohydrate intake leads to high levels of small LDL, lower buoyant LDL, and lower HDL, which is a very BAD thing.

Unfortunately, this is the exact opposite to what we have been told over the years. Most doctors tell us to avoid saturated fat and increase carbohydrate intake, which is a recipe for disaster in terms of our cholesterol profile, and this is why heart disease is such an epidemic in the world today.

If you remember nothing else, here’s what I’d like you to take away:

  • Not all LDL is equal. Only small, dense LDL particles have been associated with heart disease. Large buoyant LDL particles are benign or may even protect against heart disease
  • If you want to reduce your risks of heart disease, you need to reduce inflammation and stress. It would also make sense to reduce your small dense LDL particles and increase HDL particles
  • Contrary to popular belief, a low-fat, high carbohydrate diet INCREASES small dense LDL and reduces HDL – and therefore INCREASES risk of heart disease under conditions of inflammation and stress
  • Conversely, increasing saturated fat and reducing carbohydrate intake REDUCES small, dense LDL, decreases triglycerides and increases HDL, thus reducing risk of heart disease
  • Eating cholesterol is not only harmless, it is beneficial. In fact, one of the best ways to lower small, dense LDL is to eat eggs every day. Yes, you read that correctly. University of Connecticut researchers found that people who ate three whole eggs a day for 12 weeks dropped their small-LDL levels by an average of 18%.
  • Cholesterol itself is NOT the real risk factor here at all. As I have stated repeatedly – the main culprits are inflammation and stress. Aside from lifestyle factors such as not getting enough sleep, a stressful job etc, these are triggered by foods like grains, sugar, industrial seed oils, and other processed artificial “foods”.
  • Want to avoid heart disease?

    Eat a non-inflammatory diet, make sure you get enough sleep, learn how to manage stress, and quit worrying about your cholesterol levels!

    I eat eggs, bacon, sausages, red meat, full-fat raw cream and I cook using lots of butter, lard, tallow and coconut oil all the time. I actually lost weight eating this way and my cholesterol levels are beyond perfect.

    So, go make yourself some eggs fried in butter, and eat them with a side of bacon whilst you watch this:

    Further reading:

    http://chriskresser.com/the-most-important-thing-you-probably-dont-know-about-cholesterol

    http://www.statinnation.net/journal/

    http://www.marksdailyapple.com/cholesterol/#axzz2Ui1rMpgH

    http://chriskresser.com/why-you-should-eat-more-not-less-cholesterol

    http://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy