We have got cholesterol completely wrong

Here are six things that we need to know about cholesterol:

i)    It is virtually impossible to explain how vital cholesterol is to the human body. If you had no cholesterol in your body you would be dead. No cells, no bone structure, no muscles, no hormones, no sex, no reproductive system, no digestion, no brain function, no memory, no nerve endings, no movement, no human life – nothing without cholesterol. It is utterly vital and we die instantly without it.

ii)    Cholesterol is so vital to the body that our bodies make it. The body cannot risk leaving it to chance that we would get it externally from food or some other external factor – that’s how critical it is.

iii) There is no such thing as good cholesterol and bad cholesterol. Cholesterol is cholesterol. The chemical formula for cholesterol is C27H46O. There is no good version or bad version of this formula.HDL is not even cholesterol, let alone good. LDL is not even cholesterol, let alone bad. HDL stands for High Density Lipoprotein. LDL stands for Low Density Lipoprotein. (There are three other lipoproteins, by the way, chylomicrons, VLDL and IDL).

Fat and cholesterol are not water soluble so they need to be carried around the body in something to do their vital work. The carriers of such substances are called lipoproteins. We can think of lipoproteins as tiny ‘taxi cabs’ travelling round the blood stream acting as transporters. So, lipoproteins are carriers of cholesterol – oh – and triglyceride and phospholipids and protein. All lipoproteins carry all of these substances – just in different proportions. LDL would more accurately be called the carrier of fresh cholesterol and HDL would more accurately be called the carrier of recycled cholesterol.

iv)    The standard blood cholesterol test does not measure LDL  – it estimates it. The fasting blood cholesterol test can only measure total cholesterol and HDL. There are two other unknowns in a four variable equation – LDL and VLDL. The estimation is refined further using the Friedewald equation (named after William Friedewald, who developed it).

Total cholesterol = LDL + HDL + Triglycerides/5 (Ref 1) (More detail here.)

As any mathematician will tell you, one equation, with four variables, only two of which can be measured, is a fat lot of good. We need at least one more equation or known variable, to avoid circular references. This also means that:
–    All other things being equal, LDL will rise if a) total cholesterol rises and/or b) if HDL falls and/or if c) triglycerides fall.
–    All other things being equal, LDL will fall if a) total cholesterol falls and/or b) if HDL rises and/or if c) triglycerides rise.

No wonder an inverse association is observed between LDL and HDL – it is by definition. More surprising is that a fall in triglycerides, which would be welcomed by doctors, would be accompanied by an automatic increase in LDL, all other things being equal, which would not be welcomed by doctors. And you thought that this was scientific.

v)    Statins stop the body from producing the cholesterol that it is designed to produce. They literally stop one of our fundamental body processes from being able to function. The intelligent view on statins is that in the very limited arena where they appear to have some ‘benefit’ (men over 50 who have already had a heart attack), they ‘work’ by having anti-inflammatory properties and that the fact that they lower cholesterol (by stopping the body from being able to produce this vital substance) is a very unfortunate side effect. (Drug companies should work on developing something that has the anti-inflammatory benefit without this huge and damaging side effect – it’s called aspirin).

One in 500 people have familial hypercholesterolemia and may have a problem clearing cholesterol in their body (rather like type 1 diabetics who can’t return their blood glucose levels to normal). For anyone else to be actively trying to lower their vital and life affirming cholesterol levels is deeply troubling.

vi)    “Cholesterol in food has no impact on cholesterol in the blood and we’ve known that all along.” Ancel Keys.

Ancel Keys, the same man who did the brilliant Minnesota starvation experiment, spent the 1950’s trying to show that cholesterol in food was associated with cholesterol in the blood. He concluded unequivocally that there was not even an association, let alone a causation. He never deviated from this view.

Cholesterol is only found in animal foods (it is a vital substance for every living creature). Hence the only foods that Keys could add to human diets, to test the impact of cholesterol, were animal foods. Given that he concluded that eating animal foods had no impact on blood cholesterol levels, it follows that animal foods per se have no impact on blood cholesterol levels (not that high cholesterol is a problem – quite the contrary – but that’s another story).

There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products etc for any cholesterol that they may contain, or for any other reason.

The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.

 

Ref 1: EH Mangiapane, AM Salter, Diet, Lipoproteins and Coronary Heart Disease: A Biochemical Perspective, Nottingham University Press, (1999). (See reference 159 The Obesity Epidemic)

16 comments on “We have got cholesterol completely wrong
  1. avatar john says:

    This is my Lipid result Total HDL LDL Triglyceride
    5/1 5.5 1.4 3.5 1.2
    28/8 7.2 1.9 5.0 1.7
    The previous result on the January this year was when I had returned from 12 weeks overseas trip I had gained about 6kg on that result the the GP wanted me to double cholestrol tablets on those result I decided that I would change my diet by eliminating all processed and go to the gym,and stop taking my medication as well I also ride a bicycle. I am 67yrs old .Anyway my question what am I doing wrong cause I would have thought it would have helped with lowering these figures

  2. avatar Pam Slade says:

    I’ve been very interested by the info on this website. Im thinking of stopping my statins, which I’ve taken since my Lateral Medullary Syndrome stroke 5 years ago, back then I was 72 yrs old, 5’7″and weighed around 10.5stone. I am now 77, a bit shorter, and weigh 8stone 12lbs. and losing. I’ve been told by a dietician at my surgery to start eating all those rich foods and dairy that I’ve been denying myself for 5yrs. My BMI is apparently fine. Oh and I take aspirin.
    Wouldn’t it make more sense to is discontinue statins and aspirin but continue with healthy balanced Diet?

    • avatar Zoë Harcombe says:

      Hi Pam
      That needs to be your decision – this is where I’ve captured links to the key things I’ve written about cholesterol and statins. http://www.zoeharcombe.com/2015/03/worried-about-cholesterol-andor-statins/

      One very important thing to point out – which your doctor should have done and I’m appalled that they haven’t – is that most statins have warnings in the patient leaflets for over 70s. That’s as close as the drug cos get to saying don’t take them over 70! Here’s an example leaflet – you can check your own. https://www.medicines.org.uk/emc/medicine/2498
      The evidence for living longer with HIGHER cholesterol is vast.

      The jury is out on aspirin. There has been research in the past saying that is helps the heart. There is evidence that it can damage the stomach lining. This can be mild or serious. Recent suggestions have also emerged about aspirin helping cancer and I recently met one of the pioneer researchers in this area – Prof Peter Elwood. It’s a judgement call on aspirin therefore and a good doc should be able to present you with the pros and cons – with absolute risk numbers (not relative) to help you make an informed decision. If your doc doesn’t know about statins and patient leaflets, I doubt this has happened!

      Hope this helps
      Best wishes – Zoe

  3. avatar Anna says:

    Dear Zoe,

    I was relieved to come across your website and I have read most of your comments on cholesterol. I recently had my cholesterol tested and my overall result was 7. My GP said given my family history of heart disease (my sister died aged 44 from a heart attack, my father aged 68 – both were heavy smokers, my mother had a stroke in her 80s and is in a nursing home, my uncle is on medication for high bp) she said I had a 12% chance of heart/stroke attack. This seems really high to me – and terrifies me! She recommended either medication, or a re-test in 6 months after trying a low cholesterol diet. I opted for the latter – but realise I do eat healthily anyway so there is very little I can change. My bp is apparently perfect and I appear in good health. I eat wisely and certainly tick all the right boxes on the pamphlet of how to avoid saturated fats. I have never smoked.

    With my family history should I be worried? I don’t want to take statins unnecessarily based on this one result. Should I be looking at something other than cholesterol as an indicator that I may have a problem in the future? Is it possible to see what state my arteries are in? Could my cholesterol level of 7 be my norm, and I should stop worrying?

    Any advice would be very welcome,

    Anna

    • avatar Zoë Harcombe says:

      Hi /Anna
      I can’t give advice on your personal health. I can say that 7 is a completely normal reading (see 1 below) and I personally wouldn’t worry about this (but then I wouldn’t have a cholesterol test in the first place – about as useful as knowing how many hairs there are on my head!)

      This post may help – it’s gathered together the key things I’ve written about cholesterol and points to other things to read.
      http://www.zoeharcombe.com/2015/03/worried-about-cholesterol-andor-statins/

      1) 7 is not high. The first link in that post takes you here: http://www.zoeharcombe.com/2014/06/diabetes-cholesterol-bp-normal-is-no-longer-normal/
      You are part of the scam (in my view) to redefine normal so that more people can be medicated.

      2) You don’t say how old you are – even the patient leaflet cautions against anyone over 70 going near statins (I’m not saying you’re anywhere near that, but does you doc know this?) Is doc saying I want you on these for x years and then you must stop or does doc know as little about statins and cholesterol as most I’ve met/heard about.

      3) One of the other links takes you here: http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-lower-cholesterol-and-kill-you-one-cell-at-a-time/
      Does doc know the consequences of blocking the mevalonate pathway? Do you?!

      With your family history your doc should be saying Don’t smoke! And I guess you don’t.

      I hope the reading is of interest
      Best wishes – Zoe

      • avatar Anna says:

        Dear Zoe,

        Thank you for your quick and reassuring response. I am 63 – and a fairly active grandmother! I had a routine eye test and the optician noticed a small bleed at the back of my eye. She was not worried – said it was very small, like a little bruise and might just clear up. But given my family history wanted to have it double checked. She recommended a blood test. So the blood test I had covered diabetes (for which I came out as clear) and I presume the cholesterol test was thrown in too. I did not know this was being tested too. I am being referred to an ophthalmologist.

        My GP didnt say anything further about statins since I said I wanted to try improving my diet first. There are areas I can take more care with – I love cheese – so I can cut down how much I eat.

        I will look at those links you gave me.

        Thank you,

        Anna

  4. avatar Leslie Garsten says:

    What about fibrate drugs? My triglycerides are always high. 441 in Sept.then I went to India, lost 20 pounds in 5 weeks, very little fruit and dairy, felt great. Gained 15 pounds back since March, more dairy and fruit, more food intake.Triglycerides went up to 900. Got scared and started taking gemfibrozil 600 mg 2x day. Just had blood test this morning after 2 weeks medication. What should my approach be? Can you recommend an inexpensive self test for this?

    • avatar Zoë Harcombe says:

      Hi Leslie
      I’m sorry but I can’t give advice – I’m not a doctor and docs wouldn’t give advice on drugs without assessing you and medical history. You’ve seen the impact of carbs first hand. Carbs are a key (if not the key) determinant of VLDL/triglycerides, as this shows:

      Elizabeth Parks study in 2001 entitled “Effect of dietary carbohydrate on triglyceride metabolism in humans” concluded: “When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise. This phenomenon, known as carbohydrate-induced hypertriglyceridemia, is paradoxical because the increase in dietary carbohydrate usually comes at the expense of dietary fat. Thus, when the content of the carbohydrate in the diet is increased, fat in the diet is reduced, but the content of fat (triglycerides) in the blood rises.” (Elizabeth J. Parks, “Effect of dietary carbohydrate on triglyceride metabolism in humans”, The Journal of Nutrition, (2001).)

      This has the key stuff I’ve written on cholesterol/statins in one place with links elsewhere: http://www.zoeharcombe.com/2015/03/worried-about-cholesterol-andor-statins/

      I don’t know anything about cholesterol tests because it’s not something I care about. 900 is high by any measure, however – I would be trying to get docs to help work out why you have these levels – not just try to artificially lower them without understanding the cause.

      Best wishes – Zoe

  5. avatar Tae Kim says:

    Are we really suffering from high cholesterol?

    I’ve read “Fat and Cholesterol are Good for You” by Ulfe Ravnskov and “Cholesterol Clarity” by Jimmy Moore, and have completely changed my views on cholesterol.

    I do admit that this is a very sensitive topic, because health is interestingly enough, a very ‘subjective’ matter. We do try to be objective through studies and researches, but it’s no secret that the human body is still largely unknown, and of course, studies being flawed and controlled by big pharmaceutical companies do not help.

    I think taking statins for the rest of our lives in order to control our cholesterol levels is just an act of negligence. There’s a clear line between preventing potential cardiovascular diseases and being just paranoid.

    Would it be really wise to artificially lower our cholesterol levels with drugs which has been proven to cause a myriad of other health complications? Or should we be focusing our efforts to naturally lower the “inflammation” within our bodies, not cholesterol itself?

    Some doctors are saying that the condition of “high cholesterol” is a disease invented by man.

    Many questions, many doubts, but one thing I do believe and know is that there is no bad cholesterol, our efforts should be more focused on how to lower inflammation levels which is the real culprit behind diseases associated with high cholesterol.

  6. avatar Joseph says:

    Dear Ms Harcombe

    You said “There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products … or for any other reason.”

    But what about over accumulation of iron in the body by eating too much meat? Also, antibiotics and hormones being pumped into animals these days?

    Further clarification will be great. Thank you for the wonderful work you are doing!

    Best Regard
    Joseph

    • avatar Zoë Harcombe says:

      Hi Joseph
      Many thanks for your kind words.

      I think generally we should worry far more about nutrient deficiency than having too much of a good thing. Rickets (vit D deficiency) is returning in UK children; there are far more cases of anemia than excess iron.

      On the excess iron – this post may help – http://www.zoeharcombe.com/2014/04/healthy-whole-grains-really/
      We would have to eat half a kilo of liver every single day to get the max recommended dose of 45mg of iron; or 2.5 kilos of eggs… In a normal (Real food) diet, we are still going to get nowhere near having too much iron.

      On the antibiotics/hormones, that’s why real foodies (like me) are also strong advocates of pasture grazing animals. Animals needs to eat real food too – or we don’t get the health benefit from our health.

      People who buy 3 chickens for £10, which have been unnaturally fed and fattened and have never seen the light of day, would be better off buying some of the cheapest (and healthiest) cuts from the butcher: liver; ox heart; rolled spare rib of pork etc. Not good for the poor chickens or humans!

      Hope this helps
      Best wishes – Zoe

  7. avatar Philip Evans says:

    Thank you, Zoe, for this enlightening article. I recently had my first Medicare physical after which my doctor told me my hdl cholesterol(his wording) was a bit high. He ordered a prescription for me which I am hesitant to pick up because I am not symptomatic, eat whatever I want, and have a normal body weight. I have started doing my research and came upon your article. I have made my decision NOT to take the medication. I am not relying on this one article that you wrote, not because it is not the best, most concise and logical essay on the subject – it is. It is because of the volume of supporting literature of your facts. I am not one to deny science based medicine, as it is still the only method through which mankind ever gets it right. Fortunately, it is science that also shows us when and where have gotten it wrong!

  8. avatar Kingsley says:

    Hi

    I found your read very contrary. And possibly useful.
    On 18 April I got my cholesterol results (see table below for results) and then set out an eating plan of no red meat, significant reduction of trans and saturated fats. Only use olive oil and little of suflower seed oil. No cheese. No eggs. Exercise 2x per week. I am 44. I weighed 90.5kg now I weigh 89 kg.

    10 June I got follow up test results. An as you can see below the results are rather paltry.

    According to your approach is my cholesterol too high? What is your recommendation ?

    My total cholesterol is:

    Total. LDL. HDL. TRI
    18april. 7.4. 5.5. 0.8. 2.3
    10june. 7.3. 5.5. 0.8. 1.9

  9. avatar Virginia Bunker says:

    Dear Ms Harcombe

    So refreshing to find a knowledgeable person who doesn’t think that cholesterol is bad. I’ve known for years (courtesy of Adelle Davis) that the body made its own cholesterol, and more than one can consume, so, as you say, I couldn’t believe our bodies want to kill us.

    Unfortunately, my husband believes his doctor, who believes wholeheartedly in all drugs. (Oddly enough, he’s a very honest caring guy, and a good doctor in many ways.) A couple of days ago, Dr. Sanjay Gupta said ***publicly on CNN*** that people who had no history of heart disease should not take statins because of the side effects, which I also knew. My husband has never had a heart incident, nor has any member of his immediate family. He’s been on statins for 10 years and suffers from many side effects which his MD manages to attribute to anything else. Any suggestions from you about which of your essays I could suggest to the doctor to read that might make him think a little more logically?

    Thank you,

    Virginia

    • avatar Zoë Harcombe says:

      Hi Virginia
      There is so much that doc could/should read:
      – The Great Cholesterol Con – Dr Malcolm Kendrick
      – Ignore the Awkward – Dr Uffe Ravnskov
      Here are a couple of my blogs, as requested
      http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-lower-cholesterol-and-kill-you-one-cell-at-a-time/
      http://www.zoeharcombe.com/2015/03/worried-about-cholesterol-andor-statins/

      However – in my experience – docs wedded to the belief that cholesterol is bad and statins are good rarely change from this view and no amount of literature, articles etc will make them change their mind. It will just annoy doc that his wisdom is being questioned. The person who needs to read all of this stuff is your husband. He’s the one who is suffering the side effects He’s the one whose quality of life is being spoiled. See if you can get him to read any of this. Most men would ditch the tablets as soon as they saw “loss of libido” as a side effect. Has hubby read the patient leaflet?!

      Good luck!
      Best wishes – Zoe

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