Is High Cholesterol the Problem?
My incredibly fit Man Bicep Mom has high cholesterol. Her doctor put her on a statin.
I have super high cholesterol. My doctor tried to put me on a statin at the age of 23. I refused. And I will keep refusing.
I don’t think cholesterol is the cause of the problem – inflammation is. I think red meat is great to eat. AND saturated fat? NO PROBLEM!
Of course, my doctor and even the Man Bicep Mom think that I’m crazy for thinking this, but I’m not. I think I’m avoiding the real problem – inflammation from carbs and vegetable oil.
Let’s look over a few facts and then I want you to decide…Am I crazy?
Where/when did this connection between cholesterol and heart disease begin?
- This connection was proposed in the 1850s by German pathologist Rudolf Virchow and it was called the lipid hypothesis. It proposed a connection between plasma cholesterol levels and the development of coronary heart disease. So saturated fat and cholesterol in the blood became known as major factors in causing cardiovascular disease.
- This lipid hypothesis began to receive greater attention in the middle of the 20th century when cardiovascular disease became a major cause of death in the Western world.
- In 1951, Duff and McMillian created the modern form of the lipid hypothesis.
- In 1953, Ancel Keys, one of the most well-known early modern proponents of the fact that saturated fats and cholesterol in the blood cause heart disease, wrote the book “Eat Well and Stay Well,” which helped the issue gain popular awareness.
- One of the major players in bringing cholesterol to the public’s awareness was Time magazine. Its piece on cholesterol in the March 26, 1984 issue was a devastating piece on both dietary cholesterol and dietary fat. Both – the article explained – were a main driving force behind the development of heart disease.
BUT is this lipid hypothesis correct?
- The lipid hypothesis was created based on OBSERVATIONAL data. BUT observational studies can’t necessarily show that correlation equals causation.
- There’s never been a single study that proves saturated fat causes heart disease.
- Dietary cholesterol has actually been proven to be pretty benign.
- The Framingham heart study showed NO CORRELATION between high cholesterol and heart disease. Below is an excerpt from the study.
In undertaking the diet study at Framingham the primary interest was, of course, in the relation of diet to the development of coronary heart disease (CHD). It was felt, however, that any such relationship would be an indirect one, diet influencing serum cholesterol level and serum cholesterol level influencing the risk of CHD. However, no relationship could be discerned within the study cohort between food intake and serum cholesterol level.
In the period between the taking of the diet interviews and the end of the 16-year follow-up, 47 cases of de novo CHD developed in the Diet Study group. The means for all the diet variables measured were practically the same for these cases as for the original cohort at risk. There is, in short, no suggestion of any relation between diet and the subsequent development of CHD in the study group…
With one exception there was no discernible association between reported diet intake and serum cholesterol level in the Framingham Diet Study Group. The one exception was a weak negative association between caloric intake and serum cholesterol level in men. [As to] coronary heart disease–was it related prospectively to diet.
No relationship was found! AND they tried VERY HARD to find one! The data showed NO correlation between diet and serum cholesterol and between diet and the incidence of coronary heart disease!
- Virtually every cell in the body has the ability to make cholesterol because cholesterol is so important to survival.
- As heart-disease rates were skyrocketing in the mid-1900s, consumption of animal fat was going down, not up. Consumption of vegetable oils, however, was going up dramatically.
- Half of all heart-attack victims have normal or low cholesterol. Autopsies performed on heart-attack victims routinely reveal plaque-filled arteries in people whose cholesterol was low.
- Asian Indians – half of whom are vegetarians – have one of the highest rates of heart disease in the entire world.
- From Good Calories, Bad Calories about the study that Time magazine used to PROVE how bad cholesterol is for you (actually what Gary Taubes shows us is that researchers MISUSED inconclusive data to PROVE what they WANTED):
In January 1984, the results of the trial (N.H.L.B.I. study) were published in The Journal of the American Medical Association. Cholesterol levels dropped by an average of 4 percent in the control group – those men taking a placebo. The levels dropped by 13 percent in the men taking cholestryramine. In the control group, 158 men suffered non-fatal heart attacks during the study and 38 men died from heart attacks. In the treatment group, 130 men suffered non-fatal heart attacks and only 30 died from them. All in all, 71 men had died in the control group and 68 in the treatment group. In other words, cholestryramine had improved by less than .2 percent the chance that any one of the men who took it would live through the next decade. To call these results “conclusive,” as the University of Chicago biostatistician Paul Meier remarked, would constitute “a substantial misuse of the term.” Nonetheless, these results were taken as sufficient by Rifkind, Steinberg and their colleagues [those who had been searching for ‘proof’ for decades that cholesterol causes heart disease] so they could state unconditionally that [Ancel] Keys had been right and that lowering cholesterol would save lives.
- Time Magazine also used Fred Shragai as an example of a man who now had to live without fear of a heart attack because he had switched to a low-fat diet and his cholesterol was down to 195. Of course, what the article doesn’t tell you is that Fred died of a heart attack two months later. Sounds like the low-fat diet and lower cholesterol really helped him…
- Same for Eisenhower…his cholesterol was only 164 when he suffered his first heart attack. AND what about Tim Russert? His cholesterol was only 105 (AND HE WAS TAKING A STATIN) when he died of a heart attack at 58.
- If you look at the anthropological evidence, the health of early humans took a turn for the worse when agriculture came along. Read the linked article by Michael R. Eades for more proof.
- Making fat and cholesterol the problem helps make companies money! Marking low-fat products as heart healthy makes the American Heart Association money! SO why wouldn’t they keep supporting a theory that makes them a profit? If it came out that animal fats were good for you, “heart healthy” veggie oils wouldn’t be making companies as much money!
- And Ancel Keys…he sounds like a vegetarian to me…which means of course he supports this theory! If fat is bad, people will abstain from fatty meats eat, in his opinion, eat more fresh fruits and vegetables! I thought this was also an interesting comparison between him and Jack Lalanne.
- Did I mention that making cholesterol and fat the problem makes people money? I mean statins make pharmaceutical companies MONEY! So of course they hope everyone believes the lipid hypothesis!
AH! Ok…that is all I have energy to rant about for now.
Here is one last article to look at if there isn’t enough proof here to convince you (and if this article doesn’t do it, take a look at the one in my post the other day that talks about how eating like a Caveman is good for you! OR just buy this book if you aren’t convinced – The Great Cholesterol Con.
And here is a good quote that I found during my research to leave you with…The Lipid Hypothesis (fat and cholesterol are the problem) is all one big lie that’s been repeated so often that we believe it!
If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State. – Goebbel
Posted on November 16, 2011, in Conventional Wisdom - How I hate you, Diet, Man Biceps and tagged Cholesterol, cholesterol con, Lipid Hypothesis, Primal, Statin. Bookmark the permalink. 10 Comments.
I may be biased, being a student of Nutritional Epidemiology, a field based primarily on observational data, but I think some of your conclusions are incorrect. So I’d like to add my two cents….
In terms of methods:
– When making a simple plot of y vs. x (your basic run of the mill correlation), correlation does not imply causation. No question.
– When you measure factors that are likely to confound a given relationship (i.e., create an association between your predictor of interest (say, serum cholesterol) and outcome (say, CHD) that is not due to the predictor causing the outcome), you can statistically “remove” the effect of those confounding variables. If you measure all the relevant confounders (and measure them well without much error) and design a study to limit other potential sources of bias, you can assess a true causal relationship between a predictor and outcome. (True, you can not 100% guarantee that the relationship is causal, but you can be pretty confident in many cases).
– You can think of statistical adjustment (using the methods used in most epidemiological papers you read anyway) as stratifying people based on levels of potential confounders (e.g., if you think age is the real explanation for a relationship, look for a relationship between your predictor of interest and exposure only within people of a given age group).
– Studies of the effects of smoking have all been observational. Would you argue that smoking does not cause lung cancer, heart disease, etc. etc.?
– RCTs are not the answer to all questions. They, too, have methodological flaws (not to mention being infeasible and unethical for answering many public health questions).
– Also, I’d put MUCH more weight in epi studies enrolling thousands of individuals rather than anecdotal evidence based on a handful of cases. With cases like this, you have no idea if it’s representative of a true relationship and you also don’t have many key pieces of information.
– I do agree it is easy to fall into a rut of believing something just because it’s been repeated often. Ultimately you have to believe the data!
In terms of nutrition:
– TOTAL cholesterol is not a great predictor of heart disease. LDL is generally considered “bad” and HDL “good” (overly simplified, but most will agree with this). If your total cholesterol is high but this is driven by high HDL, then awesome! If, however, it’s driven by high LDL, that’s not good. LDL help promote building of atherosclerotic plaques and narrowing of your arteries.
– It’s true that dietary cholesterol has little to no correlation with serum cholesterol. Your serum cholesterol is much more dependent on family history and physical activity and other dietary factors.
– That being said, SERUM cholesterol DOES predict atherosclerosis in large, population-based studies. I’d put at least some weight in that.
– From what I’ve read, I do think saturated fat is often unjustly vilified. If it’s so bad, then how come we “eat” saturated fat when we break down our fat stores for energy?
– I also agree that oxidation and inflammation are the biggest issues. Even if you have atherosclerotic plaques (which pretty much everyone does to some extent, even young and healthy people), as long as they are stable you’re good to go. When they rupture, which inflammation can help make happen, you’re in for some serious trouble.
– I think a major problem in nutritional epi is the frequent inability to distinguish subtle differences across foods. Because you’re limited in your ability to assess diet, you often have to lump together, for example, all types of red meat, when in reality, the quality of meat (e.g., grass vs. grain fed) may have drastically different impacts on your disease risk.
– However, limitations like this should not lead you to disregard an entire field. For outcomes that have long latencies, like cancer, you cannot rely on self-experimentation to find out for yourself what is healthy vs. unhealthy. You need to rely on some kind of study, which undoubtedly has some degree of error/bias. But is hopefully good enough to give you the right answer.
And just in general, while you can speculate on the motivations of physicians and drug companies all you like, I don’t quite understand when people propose all these conspiracy theories about scientists. Most are funded by federal grants and do not benefit from finding a dietary factor to be helpful vs. harmful. Also, for the people for whom diet and exercise don’t sufficiently help reduce their risk factors (or for those who refuse to make lifestyle changes), statins can be very helpful. I’m not saying they’d be right for you (I’m willing to bet your risk of CVD is waaaay lower than most people), but don’t suggest that statins are not right for anyone.
Thanks for sharing your opinion. I can see that you definitely “disagree” with my thoughts even though I don’t think you can rightly say my conclusions are incorrect.
Everyone is entitled to have their opinions and voice them. And I definitely agree with your comment that “You need to rely on some kind of study, which undoubtedly has some degree of error/bias. But is hopefully good enough to give you the right answer.” Each of us has to pick some study to follow and then base our nutritional choices on it. I’ve done just that and my decision is counter to what most of society has done. There are lots of studies out there that prove my point and I’ve chosen to follow those.
Also, in regards to your comments about observational studies…all of the variables WEREN’T controlled in all of the studies I found proving cholesterol to be bad. If you look at them closely, you will find that in those studies the “high fat” group was also eating a “high carb” diet as well. Also, you don’t know that vegetable oils weren’t also part of their diets (which I do believe to be a cause of inflammation). So you can’t really say that it was the fat causing the issue…You could say the “American Diet” is to blame…but not fat. Feel free to send me a couple of studies where the “high fat” group wasn’t also eating vegetable oils and carbs and then maybe I’ll reconsider my stance.
Also, while statins do aim to lower LDL they also lower total cholesterol INCLUDING HDL. That doesn’t sound good to me… (Plus doctors now tell you to get your numbers down while years ago it was about ratio…if you had a good ratio of HDL to LDL). ALSO, the only BAD cholesterol is the little dense LDL particles.. There are also bigger LDL which aren’t dangerous BUT that count in your overall LDL number. Why don’t doctors test for the very small LDL particles? Why do they only pay attention to the overall LDL number when only some of those particles may be dangerous?
And one final point just to keep this brief because I could argue this topic all day…I’m not saying there is a conspiracy or that doctors and drug companies don’t want to make us healthy…I’m just saying that they are also businesses. I mean if a study showed results that helped you make money, wouldn’t you take advantage of it? I would! I mean if a study came out tomorrow saying that nutritionists are so necessary that you need to book a session with one today, wouldn’t you post that all over!?! 🙂 I would if I were you! And would you really pay attention to how that data was collected and if it really PROVED that point? Potentially not….
M, this is all just food for thought. I think we honestly have a far way to go to finding out what is TRULY healthy. Right now all we can do is gamble on something.
It’s not conspiracy theory to question anything anyone does. Yes, this includes your government funded studies.
“Most are funded by federal grants and do not benefit from finding a dietary factor to be helpful vs. harmful”
I feel like you’re pulling the wool over your own eyes. How do you figure the USDA, who promotes 6-11 servings of grains a day does not benefit from finding a dietary factor to be harmful or helpful??? They would greatly benefit from a study proving their little food pyramid is correct. (even though the health of our country has gone to shit since they started making their recommendations)
Why would a non-profit like the American Heart Association benefit from finding a dietary factor to be harmful or helpful? Let’s see, maybe because they make millions of dollars each year selling their “heart healthy” logo to cereal companies. A local farmer who pasture raises his cows wouldn’t get one of these and even if he could, he probably doesn’t have the money to pay for it.
I agree inflammation is a much bigger problem than serum cholesterol. Statins reduce C-reactive protein (inflammation) which is probably why they have any benefit at all in reducing heart disease. Of course they say they can’t determine if it’s the reduction of cholesterol or CRP that reduces the risk…even though people with low cholesterol and high CRP were tested.
I’d like to see some of these “large population based studies” you speak of. Can you provide links?
Love the comment! Thanks for posting those two studies!
It sounds like they haven’t controlled very many variables in their studies if they can’t tell if it is inflammation or cholesterol which is the problem..or maybe they don’t want to be able to tell since that would destroy the basis of our current diet industry!
I love a good healthy debate!
First of all, I’d like to say that I am definitely NOT endorsing a low fat diet. My current diet is ~40-45% fat (probably 65% of which is due to peanut and almond butter alone! I may be addicted.) which is way beyond “conventional” recommendations. I’ve been trying to reduce carb/grain intake and up healthy proteins/fats like fish as well as up my vegetable intake. I don’t eat a ton of red meat, primarily due to preference not health reasons. I do avoid processed meats, not because of fat or cholesterol but because of all the other stuff that gets added in during processing. I’d much rather bake with butter than with vegetable oil. I don’t use the USDA’s guidelines for advice because their advice is mostly crap. My understanding is that the USDA’s main job is promotion of US agriculture, NOT health, so it makes sense why they are so big on promoting grains and dairy, even when “grains” can be french fries and corn chips. Please, though, do not lump the USDA with scientific papers from academic institutions. For the most part, the latter is unbiased (or must clearly declare their conflicts of interest), while the former is essentially unable to criticize any food that the US produces. That’s why it’s good that there are competing health recommendations based on science and which are hopefully free from politics and economics.
I’d also like to point out that I did say “LDL is generally considered “bad” and HDL “good” (overly simplified, but most will agree with this)”. You are correct that there are subtypes of LDL, many of which are currently being explored.
As to your question (“Why don’t doctors test for the very small LDL particles? Why do they only pay attention to the overall LDL number when only some of those particles may be dangerous?”)….
I’m guessing it’s largely cost. Recent studies have shown that, as you say, subtypes of LDL are the main enemy while your overal LDL might not be. Tests for these biomarkers, however, are often expensive or not widely available. Not all labs do all kinds of testing. And as the field of CVD epi with regards to lipids is still not settled, it would be difficult to promote widespread adoption of a new biomarker. It’s possible that 6 months down the line, an even better predictor of CVD risk is discovered, and unfortunately there is often a big delay between identification of a new relevant biomarker and adoption of testing for it. At this point, testing for just general LDL in a medical setting is a simpler/cheaper way to screen people for CHD risk. Are you finding most of the truly at-risk people? Hopefully. Are you also finding some people who aren’t really at elevated risk because they have the safer kinds of LDL? Of course. I think the same thing goes for dietary recommendations. There is still a lot unknown, and it’s easier to issue a blanket recommendation of “avoid anything that makes your blood cholesterol go up” while researchers find out more about the specific molecules involved and how lifestyle factors affect them. Another thing is that it’s not clear how to change these subtypes of cholesterol, whereas it’s easier to change total cholesterol. So if you told someone they had high levels of a potentially harmful form of LDL, what could they do? What behaviors could they change or what treatment could they receive? At least by testing HDL and LDL, you can tell people to exercise more (raise HDL) and improve their diet.
My main point was to not rule out observational studies. Of course everyone can and should ultimately make their own decisions and conclusions. Most people don’t have the interest or motivation to do their own research and need to have very overly simplified advice. Which is a shame. Another major frustration to me is that even the good advice of “eat real food” is hard to follow, since many things that seem like real food are arguably not (e.g., meat and dairy of crap quality and little nutritional value).
Ok first off, the article isn’t about observational studies OR about doctors and the medical industry and whether or not they are out for money or are ethical.
The article is about cholesterol and whether or not that really is the problem. It is also about questioning everything you read. Everyone out there is biased and trying to promote their opinion, whether it is back by science or not. My goal with this article was to promote my opinion and get people to see that there is another side to this whole cholesterol debate (and that it is actually well researched).
I see no debate in what you said above except that you don’t like that I questioned the legitimacy of an observational study (and by they way…the observational studies you mentioned about smoking…well they are now QUESTIONING whether or not second-hand smoke is truly harmful…) and that you don’t like that I made what you considered to be a statement about conspiracy in the medical field.
I was trying to get people to see every angle of the debate – to question from every angle just like I do. Also, as I said above, everyone has a bias. AND sometimes that bias creeps into scientific research…unintentionally, but it does.
And I just also want to point out that you said we aren’t doing research on something because of COST. So does that mean that people did the research they did on cholesterol because it was CHEAP or because SOMEONE IN AN INDUSTRY THAT COULD BENEFIT FROM IT WAS FINANCING IT?
Just food for thought.
Also, you may not want to be eating that many nuts. The reason to cut out carbs is because of the phytic acid in them, which inhibits the absorption of minerals. Nuts may actually even have more phytic acid than carbs…
Actually it’s very easy to test for test for pattern A and pattern B particles when measuring LDL. The Vertical Auto Profile (VAP) test does this and It’s about the same price as a regular cholesterol test and is covered by most insurance providers. It directly measures 15 types of cholesterol in the blood versus only 4. The fact that LDL is calculated is another reason cholesterol research can be thrown out the window in my opinion.
Our LDL is generally calculated with The Friedewald formula which is:
LDL + HDL + [Trigs/5] = Total Cholesterol.
This might be a pretty accurate profile of a low-carb, high fat eater.
Total: 250 (ideal 60)
LDL: ? (must be calculated) (ideal <100)
Trig: 40 (ideal <150)
So to calculate LDL…
250 – (70 + (40/5)) = LDL
250 – (70 + 8) = LDL
250 – 78 = LDL
172 = LDL
Oh my god! you're going to have a heart attack! TAKE STATINS IMMEDIATELY!
Actually better idea! Just start eating ice cream with sugar on top, this should raise your triglycerides and make you much healthier. Try to get your triglycerides up to 150, which will still be ideal.
250 – (70 + (150/5)) = LDL
250 – (70 +30) = LDL
250 – 100 = LDL
150 = LDL
Look at that! You shaved 22 points off your LDL! You've already become a healthier you! The problem is, if you have high triglycerides or low triglycerides, the formula loses isn't accuracy. This is formula that is almost always used to calculate LDL, even though 1/3 of Americans have high triglycerides and most low carbers have low triglycerides.
"So if you told someone they had high levels of a potentially harmful form of LDL, what could they do? What behaviors could they change or what treatment could they receive? At least by testing HDL and LDL, you can tell people to exercise more (raise HDL) and improve their diet."
Well if they potentially had harmful LDL? They should directly measure it instead of potentially prescribing them unnecessary drugs. They could tell them to exercise AND eat more animal fats which also raise HDL.
it would be difficult to promote widespread adoption of a new biomarker because we've been programmed to think arteryclogginsaturatedfats and cholesterol cause heart disease for the last 60 years. It's like trying to convince religious people there's no such thing as god. It's just not going to happen. It's a shame, but there's nothing wrong with questioning what currently isn't working
PS- The USDA funds scientific papers from academic institutions. And ,if the USDA's main job isn't to promote heath, why do they have an entire website dedicated to promoting "health"?
Genetics, genetics, genetics…please consider familial hypercholesterolemia….
Please don’t ignore “super high cholesterol”. It is not anywhere close to the norm for someone of your age and lifestyle.
Interesting! Came across this guy
Are there any randomized trials of statin therapy in FH that tell us for sure whether statins help or not?
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