82 Responses to “Cholesterol & heart disease – there is a relationship, but it’s not what you think”


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  1. avatar Sandra says:

    Unfortunately data is for mortality rates and doesn’t account for intervention rates that are greatly variable in success rates in different countries I’d imagine. Are there databases dealing with incidence of disease as opposed to mortality?

  2. avatar Michael Lovin says:

    As a FORMER Angina patient I rejected the doctors advice to take SSRI (anxiety) to lower my blood pressure and a STATIN for high HDL… I only opted for an Asprin (which I now have replaced with Cayanne Pepper) and the “Nitro” pills as a emergency pain vasodialator.
    I stopped most processed food (chemicals) and started high fiber, and inflammation lowering foods, such as garlic, lemon, spinach, beans, etc…..and I still eat meat and fats… the removal of the chemicals and this altered diet (to me Spicy Chili con Carne with beans is a superfood) I have been symptom free and not used a Nitro pill for 8 months, I played basketball yesterday, and last year I could not even walk up a flight of stairs.. NEVER TAKE STATINS or SSRI DRUGS !

  3. avatar Stephen Blackbourn says:

    2) “But that’s total cholesterol – the key thing is the ratio of good to bad cholesterol.”

    Probably true, but doesn’t the low carb/high fat approach change these ratios in a positive way? i.e. High HDL/low Trigs.?

  4. avatar Rory McGill says:

    Brilliant, Zoe – good old cognitive dissonance – may take a while for the penny to drop but drop it will

  5. avatar David says:

    I love science…especially when the “facts” are manipulated to sell us all something. Global warming is a myth and I truly believe that this Cholesterol scam is also a myth. It just makes so much sense that if the body makes cholesterol, it must need it and in the quantity that it needs it. I also love the fact that for me, it is always better to exercise and eat a comfortable amount of food, get enough rest and not add to my problems. I quit all forms of smoking, cigs and cigars…I don’t inhale either…lol I had a heart attack within a year of quitting smoking. My cholesterol was just fine on a very low carb diet as was my blood pressure. Unfortunately, I allowed myself to get out-of-shape and gained a whole lot of weight. I listened to my Cardiologist and lost weight by reducing calories…on-going. I just had my Cholesterol checked and the overall number came down 5% and the LDL/HDL/Tri are all off of the dr’s chart…He wants a Statin…I don’t. The problem is this…until I started to get regular checks on Cholesterol, I never had it checked and now, I have nothing in my past to reference the numbers for my “normal”…I suggest a cholesterol check up from birth to old age to use as a guide…That way, each person can guage their normal and respond according to it and not to a Pharm company….

  6. avatar Catharine says:

    I believe the US Framingham study linked cholesterol with CHD, but careful reading of the study shows no association after age 50. Good discussion in Overdosed America by John Abramson.

  7. avatar ally says:

    i have lost 6.5 stones over last 2 year by trying to follow the zoe diet and still need to drop 2 more stone ,iv never felt better in my live.i do 7miles walk once or twice a week.plus zumbra twice aweek.which i didnt do anything before. i do get checks by my doctor and is very happy with
    me so far.

  8. avatar Murray says:

    Great piece of work. One note though on dietary saturated fat raising cholesterol. Yes, the cholesterol in LDL is related to consumption of carbohydrates, but I have read from several sources the assertion that some saturated fats down regulate the uptake of LDL particles by the liver, with the indirect effect of raising LDL levels by causing more LDL particles to circulate in the bloodstream longer. Assuming oxidation of LDL as atherogenic, then this would increase the amount of oxy-LDL in the bloodstream. Presumably other aspects of more saturated fat offsets this, given the lack of correlation of saturated fat to actual CVD. Nonetheless, it may be misrepresentative to say that attracted fats do not affect levels of LDL.

  9. avatar Murray says:

    *saturated fats! not “attracted” fats. (Curse autocorrect)

  10. avatar Sigrid de Castella says:

    Thanks for doing this research and proving what I suspected. I lost 70kg (over 150lbs) following my own diet … I never avoided animal fats .. rather included the right amount of animal protein (including lots of eggs) with mostly fresh vegetables, a few complex grains, nuts and a little fruit. My total cholestrol was never high, even when I weighed over 143kg it sat around 3.8, but on my ‘diet’ it dropped to 2.0. I just don’t get the meds thing. The body has a way of working iteself out if you put the right stuff into it … and yes that means no sugar or highly processed foods. It’s done this for thousands of years and will continue to do so, only if we let it.

  11. avatar Mie says:

    “Why are we lowering cholesterol when lower cholesterol is associated with more deaths from heart disease and all causes for men and women?”

    Because low cholesterol is a marker for a variety of health problems/diseases/etc. such as cancer, frailty syndrome etc. etc. Lowering elevated LDL via diet, exercise, medication etc. etc. doesn’t increase CVD or all cause mortality.

    That wasn’t so hard, now was it?

  12. avatar Alex K says:

    Hi Zoe, thank you for this very interesting article.

    I know you specialise in the obesity side of nutrition, but what are your thoughts for athletes, that actually require higher levels of energy and find carbohydrates as a useful source? Due to the nature of high GI foods, athletes tend to turn to these during physical activity, in order to replenish glycogen stores faster and also provide the body with readily available energy in the bloodstream. It’s actually quite hard to expect athletes to not have a high carbohydrate diet. Obviously athletes would be considered as healthy individuals and are less prone to diseases but surely based on what you mention in this article, the “fast releasing” carbohydrates may still cause damage to vessel walls and in turn increase LDL levels.



  13. avatar Zoë says:

    Hi Alex
    I could debate this one!

    One thought is that it depends on the exercise being done. There may well be an argument for unnatural activity (marathons, iron man stuff, long cycle rides etc) needing unnatural fuel (carb loading). Normal activity (walking, working as a labourer, gardening etc) should not need any carb loading.

    Having said this – I can also see an argument that not even unnatural activity requires carb loading and there is certainly an argument that the better tuned an athlete is to burning fat, the more competitive advantage they can acquire.

    You’re right that I’m more interested in the obesity side, but I have worked with a couple of professional athletes and a few ‘amateur’ athletes (if doing even one leg of the tour de France is amateur!) to help them with weight and performance. Carb loading doesn’t help weight so an athlete needing optimal power to weight ratio can benefit from dropping carb intake to reduce weight. This needs to be achieved with no loss in performance and it can be done – but my sample sizes are very small.

    I would point you in other directions for more evidence:
    - http://www.mensjournal.com/health-fitness/nutrition/paleos-latest-converts-20130618
    - http://thelowcarbdiabetic.blogspot.co.uk/2013/12/australian-cricket-team-thrash-england.html
    - http://www.marksdailyapple.com/a-metabolic-paradigm-shift-fat-carbs-human-body-metabolism/
    Check out Djokovic going gluten free and many more professional athletes are not carb loading for optimal performance.

    Thinking about it – the body will always use glucose if available – in the blood stream and then stored glycogen. The max energy we can store as glucose/glycogen is c. 2,000 cals in the extreme – many people far less than this. I’m 110lb and less than 20% body fat, but that still means I’ve got c. 20lb of fat to live off. The 3,500 calorie theory is not accurate, so it’s not as simple as saying I have 70,000 calories available (and I don’t want fat around organs lost) but you can see how training your body to burn fat would be a far better idea than training it to burn carbs!

    Research low carb athletes – there’s a whole world out there of people munching butter and not fake energy drinks, bars and gels – and they’re doing very nicely.
    I’ll stick to gardening and walking the dog!
    Very best wishes – Zoe

  14. avatar Micke says:

    Hi. One of the Swedish gold medalist at the latest Olympics in Sochi is a LCHF – Low Carb High Fat athlete. Only different he have seen is that he lost some more fat on his body. No different in energy. Björn Ferry is his name.

  15. avatar Zoë says:

    Hi Micke – many thanks for this. We like to keep examples like this for amateur athletes who are trying to move away from carb loading
    Best wishes – Zoe

  16. avatar Micke says:

    Same to you Zoë. Listening to your Youtube-films and wondering how to give a punch to the old wrong establishment of healt and a kick some where at the rear. Feel free to use my e-mail.

  17. avatar Nick Ofield says:

    Thank you for an informative article. I have copied it and will present to my GP.

    I have just been diagnosed with high cholesterol, and been put medication to lower it. I have also been told to change my eating habits etc. My cholesterol level is 8.6, and based on my age of 67 the GP told me I had a 30% greater chance of a stroke or heart attack in the next ten years. This information was all on my local GP’s computer, which appears to have a program that churns out an answer once the results of the blood test are put in. I can only surmise that this is a standard ‘program’ for GPs, provided by the NHS. Therefore ‘high cholesterol is bad’ is set in stone.

    I have to assume that I have a 30% higher chance chance than someone with low cholesterol levels? I asked if this meant that if I got my cholesterol level to zero, would I live another ten years? He didn’t think this was very clever.

    I quote from your article “Back to – this is serious. Why are we lowering cholesterol when lower cholesterol is associated with more deaths from heart disease and all causes for men and women?”

    This is ‘confirmed’ whenever someone receiving treatment for high cholesterol dies of a stroke or heart attack. Obviously, the damage was done by the cholesterol in the blood BEFORE the treatment started. Those who have never been tested (or treated) all died from other causes

  18. avatar Zoë Harcombe says:

    Hi Nick – I laughed out loud at your question – brilliant! A couple of docs have looked at that computer game they’re playing with.
    Here’s Dr Malcolm Kendrick: http://drmalcolmkendrick.org/2013/11/18/you-need-a-statin-now-what-was-the-question/
    And Dr John Briffa’s: http://www.drbriffa.com/2014/03/07/how-good-is-the-tool-doctors-use-to-predict-who-should-be-treated-with-statins/
    Everything on these sites is brilliant – this you may enjoy too:

    You should also check your patient leaflet – the ones I’ve looked at for statins say not for those over 70 so you can ask doc why he is putting you on them for at this age anyway?! Or does he think he’s saving your life for 3 years despite the evidence for 192 countries?!

    There’s also this – even more serious: http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-lower-cholesterol-and-kill-you-one-cell-at-a-time/

    Keep reading and suggest your doc does the same :-)
    Very best wishes – Zoe

  19. avatar Tatiana C. says:

    Zoe, thank you so much for this info. It makes sense a lot. What I am trying to understand is since high level of cholesterol is a symptom of metabolic disorder why people could have normal cholesterol levels and get their arteries clogged.
    Thank you.

  20. avatar Zoë Harcombe says:

    Hi Tatiana – keep challenging! Who says high cholesterol is a symptom of metabolic disorder/risk factor? The same people who think cholesterol is bad and statins are good. Cholesterol is not bad in my world (or that of many other people). I do think that it is a marker. It can tell us about vitamin D levels (cholesterol is high when vitamin D is low because cholesterol turns into vitamin D with sunshine exposure). Higher cholesterol can mean the time of the year, it can mean a woman is pregnant, it can mean the person is injured/stressed/post an operation – any other factor which would lead the body to make more cholesterol. It can tell us many things but I don’t think it’s bad per se.

    Try looking at a couple of the “myths & facts” down the right hand side – the fat, arteries and cholesterol ones especially. Damage to arterial walls (sugar, smoking, stress etc) causes lipids (including cholesterol) to be sent to the scene of the damage to repair that damage. One of the myths & facts explains how build up occurs and arteries can get clogged. Cholesterol is just trying to help!

    Very best wishes – Zoe

  21. avatar peter says:

    Hi Zoe. Like many others I have found your articles interesting, informative and well documented. I especially like the fact that you are taking the trouble to answer many of the posts and hope that mine also would be included.
    My story. Male age 66 extremely fit and active weight 140LLBS waist 33” chest 42” non smoker. Many years ago during days of heavy physical work and also exercise sessions I developed atrial fibrillation, (slight problem with my electrics). After many tests I was told to take beta blockers. I evaded taking them for many years by simply monitoring my heart rate and rhythms, cutting out salt and sticking to a good diet. Eventually though, through having arrhythmias I had to take them and now only take the smallest dose once a day (even though I am prescribed 2 a day) with no further problems and, I can work out with no discomfort (Obviously monitoring heart rate carefully). About 2+ years ago I started getting dizzy spells when I overdid work or exercises and ended up taking more tests only to find that I had 2 partially blocked arteries. All stringent tests/scans found no other problems.
    Cutting a very long story as short as I can, I was told by my GP to start taking statins. Over past years I have always considered my diet to be excellent. I have always been involved and interested in good health and nutrition and due to this I had a little knowledge of what statins are and why I should not take them. (Previous tests have proved my HDL, LDL and triglyceride levels to be good) I asked my doctor why she was prescribing statins and she told me in a quite nonchalant manner that I needed to reduce my cholesterol? Being the type of person that I am I insisted on speaking to a specialist on the matter, an appointment was made. The meeting with the specialist went exactly the same way as with the doctor and with the same nonchalant manner. I asked the specialist whether there were any alternatives and he categorically stated NO. I then booked in an appointment for a cholesterol check.
    Results as follows. (Fasting sample) 28th May 2013.
    Total cholesterol/HDL ratios should be interpreted in relation to other coronary risk factors (including BP, diabetes, smoking, age, gender, triglycerides and personal and family history) please refer to Joint British Societies coronary risk prediction charts which are represented in the BNF.
    Serum cholesterol 4.3mmol/L… serum HDL cholesterol level 1.2mmol/L… Total cholesterol HDL ratio 3.6… Serum triglycerides 0.9mmol/L…
    Calculated LDL cholesterol level 2.7mmol/L. calculated using the friedwald formula
    I recently had another blood test 3 April 2014. Showing a slight increase in all levels. Why I have the increase, I don’t know? I do eat a lot more fish now (tinned salmon)
    Serum cholesterol 5.6… Serum HDL 1.6…Total cholesterol 3.5… Total triglycerides 1.0mmol/L. Calculated LDL 3.55 One concern was that my bilirubin level had increased from20umol/L to 35umol/L and this will be tested again in 3 weeks.
    I have never had much faith in your average doctor I believe that most of them are just pill pushers and simply look forward to their pay packet at the end of the week. Most I’ve met are overweight individuals that know nothing about nutrition. And very little about the human body.
    I have a question. I am hoping that, by eating the right foods and exercising to the extent that I am pushing my blood faster and with more pressure around my system I will eventually clear away some of the blockage in the arteries? Does this make any sense Many thanks Pete.

  22. avatar Zoë Harcombe says:

    Hi Pete – so sorry I missed this one – been a busy week! You seem in absolutely tip top health – great waist/chest measurements and non smoking is always the single best avoidable thing.

    Both of your cholesterol readings were low. Cholesterol is particularly protective in older people and old people – you fall into older ;-) Mortality studies for older/old people indicate that low cholesterol is the last thing you want. The graphs in this post clearly show it’s not just for this section of the population, but for everyone, that low cholesterol is not good.

    Why was your reading higher the second time? There’s a 20% margin of error in the test – even before all the guessing that you’re aware of using Friedwald. This level of inaccuracy is known but rarely shared with patients. We had some nice weather early last year – you could have had some vitamin D? I doubt you’ve had much so far this year. Did you fast before the April 2014 test? Not that any of this is relevant – both readings are low and well within known margins for error.

    The blockage one is heading out of my area of interest. What I can share is the general blockage process – http://www.zoeharcombe.com/the-knowledge/fat-does-not-clog-up-our-arteries/ – something causes damage and build up over the ‘scab’ can occur. You don’t smoke. You would be unlikely to be in such good shape eating sugar. So stress? What kind of exercise do you do? Is it what I would call unnatural?! You could be stressing the body with extreme exercise, in which case more would make it worse, not better. I’d go and see an open minded doctor (Dr Malcolm Kendrick is seeing people privately now, such is the demand for someone who doesn’t statinate – check drmalcolmkendrick.org) and investigate options. It could be as simple as aspirin for the anti-inflammatory effect or calcium build up may be worth investigating. Either way – statins will make your chance of repair worse, not better. In 4 years time you’ll be able to wave the patient leaflet at the doctor and point out that over 70 years olds should not be on statins. Doc won’t know that!

    Good luck
    Very best wishes – Zoe

  23. avatar pete says:

    Hi again Zoe. Thanks for the reply. I don’t know where you find the time to answer all these posts but all credit to you for doing so.
    Thank you for putting me in the young section of old people. lol.
    The 20% margin is interesting. Yes I did fast on both of these tests 12 hrs as requested? The vitamin D is worth thinking about although I have always had plenty of tuna and skimmed milk powder and now eat a tin of wild salmon most days. Sunshine, I love it I’ve always worked outside and the shirt comes off with the first rays.
    The blockages, unfortunately are in the carotid artery in my head so there is no chance of stents (“according to the “specialist” £££?) Hence my interest in removing the plaque in a natural way??? I’ve done a lot of research into how and why the build up occurs. And I have read pretty much all of your links (thank you so much)
    Stress, Mmm possibly? Processed Sugar, definitely no! My no no’s are anything that involves flour, (bread, pizza’s, cakes etc) and almost anything that involves processing. Ham, spam, burgers etc
    McDonald’s UUGH! How any sane human being can put this muck into his or her body amazes me. I have taken on board your points regarding carb sugars and you may have ended up with another convert?
    Exercise I am no triathlete. This would certainly put me in A&E. I do a bit of weight training, golf, tai chi, chi gong, stretching etc. treadmill for aerobics keeping a max bpm of about 150, spiking occasionally to around 160.
    Aspirin. I was advised to take aspirin daily but it was giving me stomach problems so I starting eating lots of various fruits. Grapes, Dates, raisins, etc as snacks The idea was to increase my salicylate consumption and in doing so I would thin the blood naturally but due to getting headaches I have cut back on this practice, I believed that it was probably due to the salicylates? The headaches have now ceased. I am going to take half of one aspirin and see how it goes?
    According to all my tests and I have had many, my heart, arteries, veins, blood flow and lungs are all in excellent condition. If my cholesterol is low how can I raise it and what should I be aiming for? Could you imagine the headlines. WONDER PILL FOR RAISING CHOLESTEROL.
    Thanks once more Zoe, I am reading through many of your internet pages but it doesn’t get any less confusing, however keep up the good work. Pete.

  24. avatar Zoë Harcombe says:

    Hi again Pete – you are not the first person to wonder why there is nothing to raise cholesterol! It is that good. I believe that – left alone – the body will make what it needs. You could artificially try to raise it by raising triglcerides with carbs – but you know that’s not a good idea!

    Try this on stents: http://drmalcolmkendrick.org/2012/04/13/the-joy-of-coronary-arteries-the-body-aint-that-simple/

    You sound in terrific health and your food and exercise choices seem ideal. There is a whole area of research into calcification and arteries. Malcolm would know about that. Vitamin K is the natural blood clotting assistant so it may be that you want less green leafy veg rather than more fruit? Not sure how the fruit would have helped.

    Enjoy the reading!
    Very best wishes – Zoe

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