For the past few decades, cholesterol has been portrayed as the Mini-Me of food.

While dietary fat, AKA Dr. Evil, has no doubt been stigmatized as the truly evil madman that is ruining our health, Mini-Me (AKA “cholesterol”) has been branded as the evil sidekick, almost as equally responsible for destroying our bodies.

We’ve been told for decades to avoid foods with cholesterol, because they are what’s clogging our arteries. No egg yokes, only egg whites!

We’ve been told that if we want to be healthy, we need to minimize cholesterol consumption. No butter, just margarine!

We’ve been told to switch to grains and minimize meat consumption. Meat has cholesterol, and cholesterol is bad! Meat will kill you!

If you’re anything like me, you have probably heard all of this stuff about cholesterol your whole life, and you just accepted it as truth. After all, 99% of doctors renounce cholesterol and put people on cholesterol reducing medication as quickly as possible when their cholesterol rises. Likewise, everything you’ve ever heard on the radio or in magazines tells you to avoid cholesterol just like you should be avoiding unhealthy fats!

But if Mini-me can join the good guys in Austin Powers: Goldmember, can cholesterol turn from the dark side and actually be something beneficial?

Right now, you probably have a few questions:

What the HELL is cholesterol?

What do I do I do if have HIGH cholesterol?

Do I need to be on medication for high cholesterol?

Don’t worry, my dear rebel friend, just like we’ve crushed topics like The Paleo Diet, Intermittent Fasting, Sleep, Water, and Supplements, we’re gonna cut through the crap and give you the real deal on Cholesterol.

Note: I am not a doctor nor registered dietitian, just a nerd who sometimes wears pants and lives for research and digging into the truth. Discuss all dietary changes with your doctor – heck, bring this article and have a discussion with them!

WTF Is Cholesterol?

I’m gonna guess your first question is “Steve, WTF is Cholesterol?” to which I would reply, “Don’t swear, my gramma reads this site (hi Gramma!).”

Cholesterol is an organic lipid (fat) that exists in all animals and is created in order to perform basic bodily functions. Cholesterol naturally occurs and is produced within us, and plays an incredibly important role in keeping us alive. It’s present in EVERY single cell in our body.

As pointed out in this Harvard article: Cholesterol performs three main functions:

It helps make the outer coating of cells.

It makes up the bile acids that work to digest food in the intestine.

It allows the body to make Vitamin D and hormones (like estrogen in women and testosterone in men).

Those sound like three important processes to me!

Now, in order to make sure our bodies have enough cholesterol to carry out all of these functions, our livers create a LOT of the stuff daily.

That’s right: cholesterol plays such an important role that our bodies produce up to 1000+ mg of it per day.

So, if our bodies are producing a lot of cholesterol, what happens to the cholesterol we eat? Does that just get added to the big total (and thus “more cholesterol = bad”)?

Not exactly. Read these few sentences from a PubMed abstract:

“Dietary cholesterol content does not significantly influence plasma cholesterol values, which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis.”

Long story short: Dietary cholesterol (cholesterol in your food) is poorly absorbed by our body and rapidly excreted, which means the amount of cholesterol you consume has VERY little to do with the levels of cholesterol in our blood stream!

On top of that, our livers actually regulate cholesterol levels by creating more or less of it based on how much of it is in our blood stream.

Now, before I get into why cholesterol is seen as the scapegoat for clogging our arteries, I want to quickly talk about the different KINDS of cholesterol.

Good vs Bad Cholesterol?

There are three different types of lipoproteins associated with Cholesterol – though you probably only see two of them when you go in for your doctor check up.

It’s these three molecules that throw another layer of confusion into the “lower cholesterol is better” mix. We’ll soon discover that this is not true, even the very idea that there is good and bad cholesterol isn’t black and white either.

Let’s meet our contestants!

#1) High Density Lipoproteins (HDL): These are light, billowy transporters that take cholesterol out of our blood stream and deliver it to our livers. Our livers then dispose of this cholesterol as bile. Most doctors are in agreement that having MORE HDL is a good thing.

#2) Low Density Lipoproteins (LDL): These are also transporters, but they play the opposite role – they deliver the cholesterol from the liver to our cells. Doctors have decided that this number should be low (this has been branded the “bad” cholesterol), though it’s more complex than that.

#3) Very Low Density Lipoproteins (VLDL): There has been recent discovery of an even lower density lipoprotein compared to the regular LDL. Doctors have come to the conclusion that reducing the amount of this in our blood is where we should focus our efforts.

Now, we’ve already talked about the fact that cholesterol is a VERY IMPORTANT part of how our body works – we need it to survive. As you see above, not all cholesterol is created equal.

Most of it is actually really good and important!

if we need cholesterol, why do doctors hate it?

The history of hatred for cholesterol is long and messy…like Game of Thrones.

Ultimately, the medical community, in their quest to minimize heart disease, desperately needed a scapegoat to blame it on, not unlike the people of King’s Landing.

Let’s just say: Cholesterol = Tyrion.

You see, the end goal for doctors has been to reduce deaths from heart disease.

Less heart disease = longer lives, happier people.

Years ago, doctors discovered cholesterol was part of the stuff that clogged people’s arteries, so they made the natural assumption that cholesterol was the cause, and thus, food with cholesterol in it (AKA animal products) should be avoided.

As Marks Daily Apple explains:

Tests in the fifties initially showed an association between early death by heart disease and fat deposits and lesions along artery walls. Because cholesterol was found to be present in those deposits (of course it would!) and because researchers had previously associated familial hypercholesterolaemia (hereditary high blood cholesterol) with heart disease, they concluded that cholesterol must be the culprit.

So, cholesterol: bad! Case closed…right?

Unfortunately…there are some mummies that would respectfully disagree with those doctors.

Let’s go back in the day…to the days of Tutankhamun and Cleopatra. It turns out, ancient Egyptians were plagued by a lot of the same issues that we suffer today in modern society: hardened arteries and heart disease!

Comically enough, articles like this make the accusation that the only way the Egyptians could have ended up with high cholesterol and clogged arteries HAD to be due to a “fatty diet.”

So, how did almost half of all the Egyptian mummies in this study end up with clogged arteries? Were they drinking raw eggs like Rocky, eating Big Macs, and downing ‘unhealthy’ t-bone steaks??

Nope.

It turns out that Egyptians primarily ate a vegetarian diet, with a strong emphasis on grains! Ruh roh! So much for that cholesterol hypothesis, though most doctors are still in…deNILE (terrible Egyptian puns +1).

Okay, so we’re starting to see that cholesterol is more complex than initially imagined.

these aren’t the culprits you’re looking for

You might be wondering WHY you’ve been told your whole life that you need to avoid eating food with cholesterol.

As mentioned previously, they were thought to be responsible for clogging your arteries and giving you a heart attack. That previous article we mentioned from Mark’s Daily Apple refutes this hypothesis:

What happens is that in response to an inflammatory situation, the body uses cholesterol as a “band-aid” to temporarily cover any lesions in the arterial wall.

In the event the inflammation is resolved, the band-aid goes away and repair takes place. No harm, no foul. Unfortunately, in most cases, the inflammation proceeds, the cholesterol plaque is eventually acted on by macrophages and is oxidized to a point at which it takes up more space in the artery, slows arterial flow and eventually can break loose to form a clot.

This is like blaming the cops because the presence of police is “correlated” with crime. No no, they’re the good guys!

As we learned more about cholesterol, the thinking began to change. When we learned about HDL, LDL, and VLDL (that not all cholesterol was created equal), we ran more complicated tests and stopped assuming that a big total cholesterol number was bad.

Now, in the last ten years, additional research has questioned whether or not there is any link between dietary cholesterol and heart disease.

Going through ALLLLLL of the results from hundreds of previous studies, the following was concluded:

“Epidemiological data do not support a link between dietary cholesterol and cardiovascular disease.”

Now, if it was just cholesterol getting a bum rap (which is different from a “bum wrap”…don’t do a google image search), that’s one thing. However, around the same time, Cholesterol’s more infamous older brother, saturated fat, got pulled into the mud too.

We’ve been told since the 70s that saturated fat should be avoided – that we should eat less than 20 grams of the stuff per day.

Before we get into the specifics, have you heard of the French Paradox? It’s the “confusing” observation that the French eat diets high in saturated fats, and yet have lower instances of Coronary Heart Disease (CHD) than most other developed nations (who eat much less saturated fat).

What’s really going on here with fat and cholesterol?

tell me about saturated fat steve!

Cholesterol and saturated fat tend to be villainized together, like Vader and the Emperor Jar Jar and Annakin.

Oftentimes animal products are high in both, and is thus the foundation of the “meat is bad for you” argument.

It’s no surprise that saturated fat has a history of being misunderstood. Back in the 1940’s, a researcher from the University of Minnesota, Ancel Keys, studied the diets of countries around the world and compared them to their mortality rates. His data (some of which was cherry-picked), showed a correlation between eating more fat and higher mortality rates.

Thus, the great “fat raises cholesterol levels and thus increases risk of heart disease” campaign began, and Team Anti-Fat took a commanding early lead.

I’m going to guess you’ve probably heard this “avoid saturated fats if don’t want to die” about a million times, so I won’t hit you over the head with it. Just remember it started with Dr. Keys and has been championed ever since.

Now, as we all know at Nerd Fitness, just because two things are correlated doesn’t mean that one causes the other.

Businessweek humorously points this out with an infographic that asks “Is Facebook driving the Greek financial crisis?” Correlation does not prove causation!

But that’s not even the point…because after further analysis it turns out Dr. Key’s data didn’t actually show a correlation between fat and mortality (thanks for the heavy lifting, Denise)!

How our body handles saturated fat is much more complex than we thought. In fact, believe it or not…recent studies have concluded that “saturated fat does not cause heart disease.” Whoa.

If you’re more of a visual person, here’s a gathering of data on various countries relating coronary heart disease deaths and total energy from saturated fats:

Now remember, correlation STILL doesn’t prove causation! But, two can play at this game, Dr. Keys! Kidding aside, this gives us a chance to carefully scrutinize conventional wisdom and take an objective look at our diets!

The problem here is that old habits and old beliefs die hard (as Derek Halpern points out in his latest post). Thus many doctors are still very quick to prescribe low-fat, “heart healthy whole grain,” reduced meat diets, all in the name of “reducing cholesterol and preventing heart disease!”

So, what are you supposed to do if you happen to be in this situation?

What does this all mean for me?

Okay, at this point I might have your world flipped turned upside down.

You might be wondering:

What does this all mean?

What should I eat if cholesterol and saturated fat aren’t evil?

If I have high cholesterol, should I start taking cholesterol reducing statins?

Hopefully at this point you’ve come to the conclusion that the number your doctors tells you relating to your cholesterol isn’t the end-all be-all solution.

Just lowering your cholesterol isn’t necessarily going to keep you alive longer, as studies like this, this, this, and this, have shown that cholesterol levels is not a reliable risk factor for heart disease and mortality.

Our thoughts: cholesterol isn’t the root of the problem, but simply one possible risk factor of many that should be considered as we age. Only worrying about cholesterol is like only checking and fixing your oil levels every time your car breaks down, when your mechanic should really be checking out everything under the hood.

So, if cholesterol isn’t related as closely to heart disease as we thought, what IS?

According to the folks in the health and fitness industry that I truly respect, trust, and admire, it really comes down to two things: lifestyle and dietary choices. Mark’s Daily Apple attributes a poor diet, high in carbohydrates and starches and sugar, which can lead to inflammation and oxidation (which is the root cause of plaque buildup in our arteries).

Along with that, Chris Kesser does a fantastic job of breaking down the cholesterol vs heart disease debate and is worth a mention. He quotes Frederick Stare, a long-time American Heart Association member and (former) proponent of the lipid hypothesis:

“The cholesterol factor is of minor importance as a risk factor in CVD. Of far more importance are smoking, hypertension, obesity, diabetes, insufficient physical activity, and stress.”

Here’s the bottom line: cholesterol and saturated fat are very complex subjects. Just taking a pill instead of fixing lifestyle or diet could be a shortcut not worth taking. Our humble, nerdy advice: Before you are put on cholesterol-reducing medication by your doctor, we encourage you to do your own research, and have an educated conversation with him or her; raise some of these points and ask if lifestyle change is an option.

If you have already been put on statin medication or are considering it, take a look at the point that Dr. Mark Hyman makes (along with sources to back up each): going on statins might not solve your health problems, especially if that problem is just “high cholesterol.”

In our humble nerdy opinion here at Nerd Fitness, dietary or lifestyle changes should be the first door checked for all potential solutions before biologically-altering medication is taken.

NOTE: If you are already on cholesterol reducing medication, we encourage you to be extra diligent with your dietary and lifestyle choices (again, our advice being to eat more whole foods, less process crap. Generally, follow a more paleo-like diet) and work with your doctor over time to see if you can reduce your need for that medication.

Built to last

One of the rules of the Nerd Fitness Rebellion is to question everything.

Please do not take the words of Nerd Fitness as gospel. Don’t slap your doctor in the face when he talks to you about cholesterol and tells you about statins. Rather, allow yourself to question the conventional wisdom that has guided your choices up to this point.

Educate yourself before blindly following somebody else’s lead – even ours! Question everything.

We’re huge fans of turning ourselves into superheroes, curing ourselves with dietary and lifestyle choices, and not relying upon unsustainable solutions. If we become reliant upon medication, cleanses, and quick fixes, we’re not addressing the root problem of our unhealthiness [or kryptonite], and could be causing other bodily issues when we introduce artificial solutions.

When it comes to cholesterol, saturated fat, clogged arteries, and heart disease, it’s a complicated beast. All we ask is that you do your research when you are advised to start pumping yourself full of pills, especially if you’re told the goal of those pills is to reduce your cholesterol in the name of “reducing risk of heart disease.”

You’re reading Nerd Fitness, which means you are a pretty smart person – let’s level up how we attack health issues, let’s stop taking conventional wisdom as written-in-stone solutions, and let’s take control of our lives.

I’d love to hear from you:

What sort of questions do you still have about cholesterol and fat?

Do you have any stories to share about improving your health through dietary/lifestyle changes?

Have you run into any challenges you’ve had with taking cholesterol medication?

I realize this is a very controversial topic and flies in the face of a lot of what’s accepted as truth, but I’m excited to have this discussion with you. If you’re confused about something, please let us know and we can continually update the article.

Let’s hear it!

-Steve

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photo source: Pedro Vezini: Darth, Nathan Proudlove: lego heart, Eskimo Justice: Tyrion, Stadt Braut: Veggies, Mykal Roventine, JD Hancock: Storm Trooper, Renee Suen: Jamon, Clay Caviness: Donut Bacon Burger