The Big Fat Lie about Cholesterol

Cholesterol has a long, unhappy reputation as a bad, unhealthy substance in our diets. The basic theory is that if you eat foods with high dietary cholesterol, you’ll end up with a lot of cholesterol floating around in your blood, which clogs your arteries and increases your risk of heart attack and stroke. Even though the cholesterol theory sounds logical, it’s oversimplified, incomplete and misleading. The time has come to re-examine some of the well-intended premises that seemed so compelling 50 years ago but which are now outdated.

It’s because of dietary cholesterol, for example, that many people routinely pass on eating a real egg and opt for an egg substitute, a manufactured food mostly made out of egg-whites, but also containing a thickener and other controversial substances. Egg substitute products have no fat and no cholesterol, whereas a real egg has a little over 5 grams of fat (about 45 calories) and 200 milligrams of cholesterol. Since the “official” recommended daily limit for dietary cholesterol is still set at 300 milligrams per day or less, real eggs continue to be undesirable for many people. Part of the cholesterol marketing party line we’re asked to believe is that a processed, packaged food is a better, healthier choice than a real, whole food just because it has less fat or no cholesterol.

And yes, the food you eat has a modest influence on cholesterol production, but there’s a catch. 70% of the cholesterol floating around in the blood is made in the liver, and every cell in the body makes cholesterol, too. When you eat foods that contain a lot of cholesterol, your body makes less of it. Conversely, when you eat foods that don’t have a lot of cholesterol, your body makes more of it. All-in-all, cholesterol production is fairly constant. A diet that restricts foods that contain cholesterol has a small “helping” effect rather than a “driving” effect on the amount of cholesterol in the blood. This, obviously, is why so many people resort to taking drugs to manage their blood cholesterol levels. The biggest influences on high cholesterol levels are lack of physical activity, obesity, not eating enough unsaturated fat, and eating too much sugar and highly processed carbs. Gender, genetics and age also play a role.

Cholesterol is absolutely essential for good health, good skin and good sex. Technically, cholesterol isn’t a fat. It’s a lipid, which is a fat-like substance that makes your cell membranes rigid but porous. These two qualities are important for transporting nutrients and hormones into the cell while keeping toxins and wastes out. Cholesterol also enables the production of sex hormones, cortisone, vitamin D, and it’s the regulator of calcium and phosphorus.

These days, everyone’s familiar with HDL and LDL, two types of carrier molecules that bind with cholesterol and move it throughout the body. HDL, the healthy carrier, is like a gelatinous sponge that picks up toxins and transports them of the body. You want more HDL because it gets rid of the environmental and chemical poisons that make us sick. (As an aside, real whole eggs increase HDL.) LDL, the lousy carrier, is the kind of cholesterol that transports cholesterol to cells and that sticks to artery linings. The important thing to know about LDL, the one thing that few others will tell you, is that LDL only sticks to artery linings at a late stage of atherosclerosis, after damage to the artery has already occurred. Artery damage is initially caused by pollutants like cigarette smoke, excess alcohol, hydrogenated trans fats, overcooked protein, sugar, and excessive reliance on pain killers like aspirin and ibuprofen.

Early scientific studies that contributed to the cholesterol theory only examined animal fat consumption, which is where dietary cholesterol is found. They completely ignored other dietary factors, particularly the intake of sugar and highly refined carbohydrates. When a substance isn’t studied, it doesn’t count because it never comes up on the radar screen, so to speak. Fortunately, this situation is now in the process of being corrected, and the latest and greatest scientific news about heart health risks is beginning to point a finger at excess sugar. Note that the term “sugar” is used generically as a short-cut word to mean all highly processed or sweetening foods including fructose, honey, molasses, syrups of any kind, cane juice, white flour, white pasta, etc.

Excess sugar consumption leads to excess sugar in the blood. It’s as simple as that. The continual overload of excess glucose stresses every metabolic process, and kicks the production of insulin into overdrive to keep glucose levels in a normal range. The more sugar in your blood, the more your body produces insulin to get it out. And where does it go? Insulin converts the excess glucose to blood fat, commonly called triglycerides, and to LDL cholesterol so that it can be transported and put into storage, a/k/a fat. The glucose-converted-to-fat and cholesterol gets deposited anywhere there’s space in your body, predominantly in your fat cells, but can also spill over into your arteries, your brain and your organs. Oh, by the way, when your fat cells get filled up, insulin makes new ones.

High levels of triglycerides are harmful to health because they cause a thickening of artery walls, another major contributor to heart attack and stroke. The secret of low triglycerides (150 milligrams or less) is to eat omega 3 type fats, restrict consumption of highly processed foods and to avoid anything made with sugar or hydrogenated trans fats. Exercise helps, too.

Consider these two recent studies:

Study #1: The May 2010 Tufts Health & Nutrition Letter summarized the results of a meta-analysis of 21 studies which were combined into one jumbo study of 347,747 people. The results were compelling because it said there was NO LINK, none, nada, between the saturated fats you eat, heart disease and blood cholesterol. In short, it "failed to find a significant association between saturated fat intake and risk of coronary heart disease (CHD), stroke or cardiovascular disease."Tufts is one of the most highly regarded sources of nutritional information in the United States and typically presents readers with a very conservative message. Here's the most important part of the study. The researchers theorized that the primary reason "reducing saturated fat intake may not have the expected results is that people tend to replace fat with carbohydrates, especially processed carbs." Isn't that amazing?

"It's important to look at the big picture," says Ronald M. Krauss, MD, of the Children's Hospital Oakland Research Institute. "An overall eating pattern that emphasizes whole grains rather than refined carbs such as white flour, along with foods high in polyunsaturated fats, such as fish, seeds, nuts and vegetable oils, is of more value for reducing coronary heart disease risk than simply aiming to further reduce saturated fat." Dr. Krauss goes on to say that there's little evidence that a very low saturated fat intake of 9% or less is associated with a reduction in CVD risk. Predictably, the article does some CYA by talking about how complex and difficult it is to isolate and analyze food intake, and of course, they continue to recommend that saturated fats be displaced by unsaturated fat. "An easy way to do this is to give preference to fats from vegetable, rather than animal, sources."

Study #2: Reported in the June 2010 Tufts Health & Nutrition Letter, this study discusses the results of an Italian research project with 47,749 adults (15,171 men and 32,578 women). Using dietary questionnaires, the researchers were able to calculate the participants overall carbohydrate intake and the average GI of the carbohydrates. Eight years later, 465 participants developed heart disease. It was discovered that women who consumed foods with a high GI (which suggests lots of highly refined, sugary foods or drinks) were 2.24 times more likely to develop heart disease than those who didn’t.

At long last, the American Heart Association issued guidelines for sugar consumption. These guidelines refer to the sugar added to foods by food manufacturers, not to sugars that occur naturally in foods. Keep in mind that all fruits, veggies and most dairy products have some naturally occurring sugars. Naturally-occurring sugars are not the problem. The problem is all the sugars that are in just about everything that comes in a package. Women should limit sugar consumption to 25 grams or about 6 teaspoons per day, and men should limit sugar consumption to 37.5 grams or about 9 teaspoons a day.

Excess sugar consumption puts you at risk for high LDL cholesterol, high triglycerides, high levels of insulin production, and high risk for every major health problem you want to avoid. As Bill Clinton might say, “It’s the sugar, stupid!”