23 Responses to “Replacing, not lowering, cholesterol would be more accurate”

Would you like to make a comment?

Then please do so openly and politely and no hiding behind some pseudonym. As for spam, well that's just another word for junk and it will end up in the bin, where it belongs.

Read below or add a comment...

  1. avatar SteveC says:

    Hi Zoe,

    Please could I have your opinion?

    I have recently had bloods tested and was advised I need to start statins. Having already read ‘The Great Cholesterol Myth’ and following your website I have refused.

    My overall Cholesterol was 7.9 (supposedly sky high)

    My HDL were within the normal range
    My Triglycerides were within the normal range

    However my LDL was 6.07 which is high giving me a ratio of 5.8

    I am aged 40 in good health and weigh 162 Lbs. I do have hypothyroidism but have no history of heart problems.

    Despite everything I have read about the dangers of statins, I am still unsure as I have not found any data on anyone that has the same values as me.

    Many thanks,


    • avatar Zoë Harcombe says:

      Hi Steve
      I recently posted this blog to answer cholesterol queries. I think you can stop at point 1 – is 7.9 high? Er – no!


      Best wishes – Zoe
      p.s. I highly recommend Dr Malcolm Kendrick’s The Great Cholesterol Con on all the HDL/LDL/ratio nonsense. It goes something like this…
      Cholesterol causes heart disease.
      No it doesn’t.
      Well LDL causes heart disease …
      No it doesn’t.
      …and HDL prevents it.
      No it doesn’t.
      So it’s the ratio of HDL to LDL.
      No it isn’t.
      So there are big fluffy LDLs and small dense ones.
      Oh when will you just shut up and admit you were wrong!?

  2. avatar andrea burgener says:

    Hi Zoe – thanks for all the fascinating info. I’m trying to convince a friend on statins that he should take no notice of his so-called ‘too high’ cholesterol level, and leave the statins. Am I right in thinking that measuring a broad cholesterol level is at any rate of no use? To know anything about his cardio-vascular health, should his doctor rather be telling him his triglyceride level, HDL level, and LDL level? And if yes, what would the ‘correct’/healthiest levels be??? Thanks so much, regards Andrea

  3. avatar D Kirsh says:

    Thank you for pointing out this under discussed finding. I checked a bit further on the studies about low cholesterol. In a useful review Low Serum Cholesterol Hazardous to Health? by Elaine N. Meilahn, MD, it is noted that in the Honolulu Heart Study, “Results showed the expected association of elevated cholesterol with coronary disease. ” But there was a rise in non coronary deaths. This latter finding she says “provide(s) evidence that the association previously reported between low cholesterol and noncoronary mortality probably reflected the cholesterol-lowering metabolic consequences of long-term subclinical disease rather than a hazard associated with low cholesterol per se.” She follows this up.
    “This conclusion [that something else causes lowered cholesterol and that thing also causes mortality] is consistent with results of a recent meta-analysis10 of cause-specific mortality (including unpublished data on noncardiovascular causes of death) from 10 large cohort studies and 2 international studies that concluded that reduced serum cholesterol is not related to excess mortality among cohorts of employed individuals, whereas population-based studies did show a relationship. The investigators proposed that the discrepancy in results was probably due to a higher frequency of risk factors associated with low cholesterol, eg, alcohol abuse and ill health, in population-based study samples compared with employed cohorts.”

    Clearly more research must be done. But it might be nice to note the possibility that in population studies lowering cholesterol may be more an indication that something else is wrong.

    • avatar Zoë Harcombe says:

      Hi DK – I quote Meilahn in a section on cholesterol and mortality in my obesity book along with other findings on cholesterol and mortality (extract below).

      There’s a fab book by David Evans called “Low cholesterol leads to an early death” with evidence from 101 papers on this topic.

      You may also like this post on the global correlation between (high) cholesterol and (low) mortality http://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-there-is-a-relationship-but-its-not-what-you-think/

      Best wishes – Zoe

      “The Honolulu Study (ref 1) was a 20 year study of cholesterol levels and mortality in 3,572 Japanese American men. The study concluded that “Only the group with low cholesterol concentration at both examinations had a significant association with mortality”. The authors went on “We have been unable to explain our results”. (I.e. we were expecting lower cholesterol to equal lower mortality, not the other way round). All credit to the team for their honest reporting of these unexpected results and their final statement in the abstract: “These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4•65 mmol/L) in elderly people.”

      “Framingham similarly concluded that “There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels).” (Ref 2) Kendrick does a clever calculation on this quotation and translates this into – a reduction in cholesterol from 5 to 4 mmol/L would increase your risk of dying by 400%.

      “Elaine Meilahn reported in Circulation (2005) “In 1990, an NIH (National Institutes of Health) conference concluded from a meta-analysis of 19 studies that men and, to a lesser extent, women with a total serum cholesterol level below 4.2 mmol/L exhibited about a 10% to 20% excess total mortality compared with those with a cholesterol level between 4.2 and 5.2 mmol/L. Specifically, excess causes of death included cancer (primarily lung and hematopoietic), respiratory and digestive disease, violent death (suicide and trauma), and hemorrhagic stroke.” (Ref 3)

      1 Schatz, Masaki, Yano, Chen, Rodriguez and Curb, “Cholesterol and all-cause mortality in elderly people from the Honolulu heart programme”, The Lancet, (August 2001).
      2 Anderson, Castelli and Levy, “Cholesterol and Mortality: 30 years of follow-up from the Framingham Study”, Journal of the American Medical Association (JAMA), (1987).
      3 Elaine Meilahn, “Low serum cholesterol: Hazardous to health?” Circulation, (2005).

  4. avatar George Henderson says:

    @zor, an estimate of how many calories are in a pound of fat tissue is useful, in theory at least, for an endurance athlete who wants to know how long their energy reserves might be expected to last.
    It is completely useless for predicting weight gained by eating or weight loss by exercise.
    The conversion of carbohydrate to fat, for example, is so inefficient that most carb calories are expended in the conversion, 20% or less are saved as fat, and it is the insulin response to carbohydrate added to the energy contribution from carbohydrate and dietary fat together that determines fat storage – in the case that it does in fact happen.
    Under such circumstances, no estimate is useful.

  5. avatar Mark C says:


    I am completely blown away by your statements. Especially in light of the fact that I have been told by my doctor that I need to lower my cholesterol levels and I am at the point where they want to put me on medications. Your contrarian data as well as the numerous studies you offered will be reviewed before I make any decision to go on medication to lower my numbers. I will also request that my doctor review some of the studies you cited and answer the question, why didn’t higher cholesterol numbers translate into more CVD.

    Thanks for providing some additional insights that are eye opening.

  6. avatar Mark John says:

    I have thought about taking time off and then retesting; again, just out of curiosity but that would be “very difficult” for me to do. Training becomes almost an addiction even though I “hate” the pain of the sessions but then like the feeling afterwards. I have previously thought about seeing Dr Kendrick (I am close enough-ish) and think I may just do that. Thank you!

    In terms of watching the footy for a month, do you really expect England to last that long?! ;)

    Thanks also for publishing my posts – I half didn’t expect you to.

    • avatar Zoë Harcombe says:

      Hi again Mark. Ha ha! There are teams other than England playing! Wrong shaped ball for me anyway ;-)

      If you can get a copy of today’s (Saturday’s) Times – there’s an interesting bit in an interesting article. I’ve cut and pasted the interesting bit: http://www.thetimes.co.uk/tto/health/diet-fitness/article4111188.ece

      Dr Carl Lavie says: “But just as fat is not always bad, exercise is not always good. There have been many studies that show that the benefits of running can come to a screeching halt later in life. If you draw the blood of a person who has just run 26.2 miles in a marathon, about a third of them will have released the same enzyme that’s released in heart failure. If you do scans of their heart, about a third of them have dilation of the heart, particularly the right side of the heart. These abnormalities go away within days or weeks but it shows that this extreme level of exercise has some toxicity.

      “So if somebody does a marathon and never does it again, even if they get the abnormality they’ll recover in a few days, but people who do this over and over again are risking chronic damage.”

      About that footy!
      Best wishes – Zoe
      p.s. worth a session with Malcolm just for the entertainment value – so funny :-)

  7. avatar Mark John says:

    Hi Zoe

    Thanks for your reply to my post below.

    (I almost didn’t actually expect a reply because I’m aware that everyone shies away from making any form of diagnosis on the internet. I’m not after a diagnosis per se, but just a general discussion surrounding my “high” cholesterol levels which would probably drive most GPs for the statination pad…!

    I’ve read “The Great Cholesterol Con” by Dr Kendrick and follow his blog as well as yours so was not overly concerned about my levels even though they’re “high”. My cholesterol test was actually a year ago. A more recent one was actually just over 10 with the ratios about the same as a year ago. I decided to do the tests privately just out of curiosity having followed a LCHF diet for about a year after reading Volek and Phinney’s “The Art and Science of Low Carbohydrate Living” and their training book as well. I train very, very intensely at national competition level. My interval training is mostly done to my absolute limits and my heart rate exceeds my theoretical max for most of my sessions. Following my switch to LCHF I gained a podium place at a recent national event. I won’t give the actual discipline but it’s one of the most intense cardiovascular events there is. Incidentally, I lost about 30lbs on the LCHF diet (I didn’t consider myself overweight but still shed about 4″ from my waist!) and have regained about 7lbs but that being mostly muscle I think / hope! I’m stronger than I ever have been.

    My exercise sessions have recently begun to worry me though. I bought a blood ketone meter based on the recommendations of Volek and Phinney and then bought a blood glucose meter. The ketone level is fine (I often struggle to get into ketosis, probably because of eating too much protein) but the glucose level post exercise worries me but I’m not sure what is “normal” for my circumstances. Everything on the internet brings up discussions about diabetes.

    Prior to a 5km or interval session my blood glucose is usually between 4.2 – 4.5. All good. Immediately after the session it can be between 9.5 – 10.5. It usually drops to around 5.5 – 6 within the hour. Is this response normal or am I pre-diabetic? I appreciate my liver is pumping out glucose to feed my muscles and it doesn’t know when the session will finish but should it be going as high as 10.5? Could my stressing my body through my training be causing my high cholesterol due to my body subsequently rebuilding itself?

    My HbA1c was 5.3 and a recent blood homocysteine test was 4.9%.

    I’d go to see my GP but after seeing my cholesterol levels I know exactly what he’d do and I don’t even want the discussion with him or being reported as being “awkward”!

    I know from reading your blog and especially Dr Kendrick’s that you’d say “cholesterol is just a number”, but even with all that I’ve read you can’t help but worry… Apologies! ;)

    • avatar Zoë Harcombe says:

      Hi Mark – very interesting! My first thought it that what your body is trying to tell you is: what’s going on?! You know that what you’re doing isn’t natural but it’s what you do/your passion I guess, so there will be consequences. The key sentence for me was “Could stressing my body through my training be causing my high cholesterol due to my body subsequently rebuilding itself?” I would say so! Something needs to repair any damage that you’re doing with this very, very intense activity.

      I can’t help beyond agreeing with your thought I’m afraid. When you do something abnormal all bets are off on what normal body responses should/could be. Dr Malc does private appointments – it could be worth exploring this as an option if you’re close enough? http://drmalcolmkendrick.org/

      Don’t suppose you could sit on the sofa and watch the footy for a month?! ;-)
      Best wishes – Zoe

  8. avatar Andrew says:

    Tom – the phrase “perhaps due to diseases predisposing to death” is speculation, not science. Reading between the lines, it sounds like “the results were not what we expected or hoped for, so we’re going to make something up to explain them away”.

    Incidentally, I can’t see how Zoe’s blog is particularly beneficial to her bank balance. If making money was her motivation she would be writing “The Gogi Berry and Chia Diet”, or “Zoe’s Fat-Free Drop-a-Dress Size-in-Two-Weeks Diet” (500 calories a day). That’s what makes money.

  9. avatar Tom says:

    Zoe-I have to take you up on some more of your selective reporting of data. I looked up the JAMA 1987 study (abstract below). You conveniently fail to mention that “Under age 50 years, cholesterol levels are directly related with 30-year overall and CVD mortality; overall death increases 5% and CVD death 9% for each 10 mg/dL.” Or the conclusion that “After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling—perhaps due to diseases predisposing to death.” i.e cholesterol level fall when people get sick from other causes leading to the finding that people with low cholesterol are more likely to die.

    Come on Zoe try upping your game rather than your bank balance.

    Under age 50 years, cholesterol levels are directly related with 30-year overall and CVD mortality; overall death increases 5% and CVD death 9% for each 10 mg/dL. After age 50 years there is no increased overall mortality with either high or low serum cholesterol levels. There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels). Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling—perhaps due to diseases predisposing to death.

  10. avatar Mike Wroe says:

    Zoe, I would be interested to read your comments on the genetic condition Familial Hypercholesterolaemia (FH).I am one of the 1 in 500 who have it but refuse to take statins.

    I have retained a print off of a blog from the pen of the wonderful Dr Kendrick which refers to an unpublished study in the Netherlands in which University students whose fathers had proven CHD before the age of 55 years were recruited. Age an sex matched controls were recruited from the same populations for each case. Results:

    2 of 1089 students with family history of CHD had FH
    4 of 1727 controls had FH.

    Thus the prevalence of FH in both groups was not significantly different at approximately 1 in 500. Dr Kendrick’s conclusion was “The evidence that heterozygote FH is, of itself, a cause of atherosclerosis is unsatisfactory”. Does the genetic test tell us anything about anyone?

    • avatar Zoë Harcombe says:

      Hi Mike – Uffe Ravnskov dedicates Chapter 3 of Ignore the Awkward to FH and he is doing a paper on the condition at the moment. The last email I saw from him on this (yesterday) was requesting more full papers from friends and it said “I find more and more studies showing no association between LDL and CVD/atherosclerosis in these people.” Watch this space!

      My personal view on FH is that it is merely a marker. The genetic defect manifests itself in LDL cell receptors being impaired from taking LDL lipoproteins from the blood stream and hence the LDL in the blood is high. The real harm is the fact that the cell didn’t get the contents of the LDL that it needed. The particularly high LDL in the blood just tells us there’s a problem.

      Hope this helps for now
      Best wishes – Zoe

  11. avatar zor says:

    you idiot zoe, in regards to your 3500 caloreis does not equal 1 lb… its an estimation you genius!!! you wasted your and our time with stupid calculations to show its 100 calories up or down get a life!

  12. avatar Mark Johnson says:

    So, should I be worried?

    Total Cholesterol: 9.1mmol/L
    HDL : 2.27mmol/L
    LDL : 6.4mmol/L
    Triglyceride : 0.91mmol/L

    I follow a LCHF diet.

    • avatar Zoë Harcombe says:

      Hi Mark – I think that cholesterol can be useful as a marker – never as a cause of anything.

      This is higher than the actual (non statinated) average, which is c. 7 mmol/l. But then some people have cholesterol levels of 3 so some people ‘need’ to have cholesterol levels of 9 for 7 to be the average! It’s still on the normal distribution curve so the level in itself wouldn’t worry me. What’s interesting is what it might say as a marker. Where is this for you personally? If this is your first ever test then see what the next one says (because it’s inaccurate by up to 20% on tests anyway). If it’s higher than normal is that because you’ve not been in the sun? Are you injured? Have you had an op? Are you stressed? The cholesterol test can tell you something – especially as a comparator with other readings for you personally. Against some made up number of 5, produced by a committee with pharma interests, it’s irrelevant.

      Hope this helps
      Best wishes – Zoe

  13. avatar Kathy Hall says:

    Zoe, I’ve noticed that most prostate supplements contain Beta-Sitosterol. I presume we should stay away from these supplements??

    • avatar Zoë Harcombe says:

      Hi Kathy
      I kept it simple talking about sterols generally. Here’s a reference that may help – the short answer is – I would!
      Best wishes – Zoe

      Phytosterols are cholesterol-like molecules found in all plant foods, with the highest concentrations occurring in vegetable oils. They are absorbed only in trace amounts, but inhibit the absorption of intestinal cholesterol (Ostlund, 2002). The most commonly occurring phytosterols in the human diet are βeta-sitosterol, campesterol and stigmasterol, which account for approximately 65%, 30% and 3% of diet contents respectively (Weihrauch and Gardner, 1978).

  14. avatar Ed Terry says:

    Another fascinating article that provides a mechanistic explanation for the effect of phytosterols on longevity is Ratnayke, WMN (2000) Influence of Sources of Dietary Oils on the Life Span of Stroke-Prone Spontaneously Hypertensive Rats. Lipids, Vol. 35, no.4

If you'd like to leave a comment, please do so openly and politely and no hiding behind some pseudonym. As for spam, well that's just another word for junk and it will end up in the bin, where it belongs.

8 − = 3