What do we really know about cholesterol? The lower the better, doctors have told us since the 1960s, when the “cholesterol hypothesis” became widely accepted as fact, and millions reluctantly gave up bacon and eggs for cereal with skim milk. If we reduced our intake of cholesterol, less of it would build up, we were told. Despite shaky science, Americans were quick to accept the thinking that high cholesterol foods were the chief villain in the disease of atherosclerosis—the process whereby fatty deposits build up in arteries, hardening and narrowing them, eventually starving the heart of blood. Finally, cholesterol is getting a closer look.
Gatekeeper to Cells, Precursor to Hormones
Found in all animals (including humans), cholesterol is a waxy substance that is essential to creating and maintaining healthy cell membranes. While most cholesterol is produced in the liver, it is so crucial for cellular health that virtually all cells in the body produce it. The brain contains the highest percentage of cholesterol, as nerve cells require cholesterol to form connections between synapses. Research indicates that cholesterol may also act as an antioxidant, protecting cells from damage.
Because blood is water-based, and cholesterol is insoluble, it must be carried through the bloodstream inside water-soluble particles called lipoproteins, chiefly high-density lipoprotein (HDL) and low-density lipoprotein (LDL). LDL largely transports cholesterol from the liver to our tissues, while HDL ferries “used” cholesterol back to the liver, where nearly all is recycled. This “recycled” HDL cholesterol actually forms the basis for many important hormones, including the estrogen hormones, testosterone, and progesterone, as well as cortisol. It is also needed for the production of bile acids, which the body uses to digest food and to make vitamin D.
Dr. Sergey Dzugan maintains that deficiencies of the hormones produced by the body from cholesterol are the reason for elevated cholesterol levels because the body is gearing up and struggling to produce more of those deficient hormones. He has demonstrated repeatedly that cholesterol levels will indeed drop if the hormones are supplemented to normal levels. He believes that the correlation between high cholesterol levels and heart disease only exists because the deficient hormones are needed for cardiac health.
Despite medicine’s obsession with lowering dietary cholesterol, about 65% of the cholesterol in our bloodstream is produced by the body itself, with just 35% ingested from our food. This is why dieting often fails to lower cholesterol levels. The body can compensate for lower dietary intake of cholesterol by simply making more of it.
History of the “Bad Cholesterol” Hypothesis
If cholesterol is so essential for basic cellular functions, how did we come to demonize it? By 1950, nearly one out of every three men in the United States developed some form of heart disease before reaching the age of 60. Pathologists searching for the cause discovered that blood vessels of heart disease victims were often clogged with plaque and debris. Because cholesterol was at the mushy center of this plaque, it was thought to be the cause of the disease.
In The Myth of Cholesterol, Dr. Paul Dugliss explains that the evidence that drove this hypothesis surfaced in the 1950s in the form of population studies that showed:
- Heart disease was more prevalent in some, but not all, countries where cholesterol levels were typically high
- Individuals with a genetic mutation that causes very high cholesterol levels (over 300 mg/dL) were four to five times more likely to have heart disease than those with cholesterol levels around 180 mg/dL
- Cholesterol drugs lowered the risk of heart attacks
The most influential figure in the spread of such population-based evidence was researcher Ancel Keys. In 1953, he published a paper showing that four to five times as many Americans die of heart disease as Italians. He blamed this statistic on the high saturated fat content of the typical American diet. Keys compared heart disease and nutritional data from six countries, even though this data was available from 22 nations. Using only his selected nations, Keys was able to show a clear relationship between high saturated fat intake and death from coronary events. Other researchers, in his day and later, pointed out that examining the data from all 22 nations roundly disproved this theory.
To answer his critics, Keys responded with the Seven Countries study, published in 1958, which followed a group of men in seven countries (again hand-picked by Keys) over a number of years to trace the links between cholesterol, fat, and heart disease. When comparing heart disease rates between these countries (such as rates for Finns versus Japanese), he found that saturated fat intake was indeed the best predictor of heart disease risk. This result was widely publicized and Keys’ prescriptions for a low-fat diet were incorporated into the 1961 dietary guidelines from the influential American Heart Association (AHA).
Around the same time, results from perhaps the most famous of the population studies—the ongoing Framingham Heart Study—began to appear. The initial results supported one of their primary hypotheses: that elevated cholesterol levels contribute to an increased risk of cardiovascular disease. However, some practitioners question whether the Framingham study really did “prove” that link.
For example, in both the 1977 report and 1987 follow-up, the results indicate an association between high cholesterol levels and increased death due to heart disease among just one group—people under age 50—who comprise only five percent of all deaths related to heart disease. Not only did high cholesterol levels fail to raise heart disease risk for those over age 50, but the 1987 data also showed that participants who had reduced their cholesterol levels over the past decade actually had higher mortality rates from cardiovascular problems and other causes.
One notable distinction from the 1977 report has endured. The Framingham Heart Study gave the world a new standard of measuring cholesterol levels: total cholesterol readings would now be broken into “good” versus “bad” cholesterol.
“Good,” “Bad,” or “No Big Deal”?
By the late 1970s, new laboratory techniques allowed for the measurement of cholesterol carried within LDL to be compared to the amount of cholesterol found within HDL. In 1977, the Framingham researchers found that people with high levels of LDL tended to have more artery disease, while those with high levels of HDL typically had less artery disease. The AHA then revised its recommendations to encourage the lowering of “bad” LDL while raising “good” HDL levels. Many clinicians now focus on getting patients to reduce LDL levels, even if they have no other risk factors for heart disease.
Cholesterol results should always be interpreted by a practitioner who is familiar with your overall health picture. In some cases, a high LDL level can be balanced with a high HDL level. Also, elevated total cholesterol or LDL could be a sign of defense against inflammation, infection, or cancer. In addition, HDL cholesterol levels can vary by as much as 40% within an individual. Dr. Dugliss offers a number of additional points to consider, including:
- Illness, drugs, seasonal variation, and the position (sitting or lying down) in which the blood is taken can all affect the outcome
- Levels must be drawn after 12-14 hours of fasting
- Levels will be elevated in people with hypothyroidism
- Synthetic derivatives of sex hormones and adrenal hormones can elevate cholesterol levels
- Diuretic drugs can also increase cholesterol levels
If your test results prompt your healthcare practitioner to encourage you to reduce your cholesterol levels, there are other medical conditions you may also want to explore:
- Dr. Broda Barnes notes that hypothyroidism often accompanies high cholesterol levels as we age, so he recommends testing for a thyroid deficiency before taking other steps to lower cholesterol. His experience has shown that correcting this deficiency often leads to a reduction of cholesterol concentration in the blood.
- According to Dr. Jens Möller, high cholesterol levels are not a cause of cardiovascular disease, but rather a symptom of poor circulation. Patients given testosterone experienced significantly lower cholesterol levels, which he attributed to improved circulation.
In fact, for many people, lowering cholesterol may not be the most important factor in reducing heart disease risk. As the AHA points out, age is the best predictor of risk: 82% of those who die from heart disease are over age 65. Gender, family history, smoking, hypertension, obesity, lack of exercise, and diabetes are other significant risk factors. It also bears noting that a “risk factor” is not a “cause” of a disease, just something typically associated with it.
In 2003, a study published in both Circulation and the Journal of the American Medical Association reported on the risk factors for heart attack, as determined by an analysis of three large studies that followed patients for more than 20 years: the Chicago Heart Association Detection Project, the Multiple Risk Factor Intervention Trial, and the Framingham Heart Study. The authors discovered that for people under age 60, the best predictors for heart attack were smoking and hypertension. High cholesterol was among the least predictive factors.