WARNING!
This is an older article that may not reflect Dr. Mercola’s current view on this topic. Use our search engine to find Dr. Mercola’s latest position on any health topic.
By Dr. Mercola
In a survey conducted by the U.S. Centers for Disease Control and Prevention (CDC), the vast majority of Americans (76 percent) said they had had their cholesterol level checked at least once in the previous five years.1
Despite the commonality of the cholesterol test, many are seriously misled about what the results of the test mean. Many people aren't even receiving a useful cholesterol test at all.
A total cholesterol test, for instance, tells you practically nothing about your health. What you really need to know is how much high-density lipoprotein (HDL) and low-density lipoprotein (LDL) you have and, beyond that, the size of the LDL particles.
If you're confused, it's not your fault. Cholesterol has been a highly publicized scapegoat for causing heart disease for decades, and many have diligently cut all cholesterol-rich foods (which are often also nutrient-rich foods) from their diets as a result.
Others have opted to take cholesterol-lowering statin drugs at the behest of their physicians. More than 1 in 4 Americans over 45 take them, despite their lengthy list of side effects and dubious effectiveness. But the real question is this: do you really need to be worried about cholesterol?
Is it the villain that's it's portrayed to be, silently clogging up your arteries and putting you at a dangerously high risk of heart attack, one cholesterol-laden egg yolk at a time? The answer is, for most people, no. So let's put some of the most widely circulated cholesterol myths to bed once and for all.
Top Cholesterol Myths: Busted!
Myth: Cholesterol Is Bad
Cholesterol is not inherently bad. If it were, your liver wouldn't produce it (unbeknownst to many, your liver makes about three-quarters or more of your body's cholesterol—that's how important it is).
Many of the healthiest foods happen to be rich in cholesterol (and saturated fats), yet cholesterol has been demonized since the early 1950s following the popularization of Ancel Keys' flawed research.
In reality, cholesterol has many health benefits. It plays a key role in regulating protein pathways involved in cell signaling and may also regulate other cellular processes,2 for instance.
It's already known that cholesterol plays a critical role within your cell membranes, but research suggests cholesterol also interacts with proteins inside your cells, adding even more importance. Your body is composed of trillions of cells that need to interact with each other.
Cholesterol is one of the molecules that allow for these interactions to take place. For example, cholesterol is the precursor to bile acids, so without sufficient amounts of cholesterol, your digestive system can be adversely affected.
It also plays an essential role in your brain, which contains about 25 percent of the cholesterol in your body. It is critical for synapse formation, i.e. the connections between your neurons, which allow you to think, learn new things, and form memories.
Myth: High Cholesterol Is Caused by What You Eat
This is simply untrue. The biggest factor in cholesterol is not diet but genetics or heredity. Your liver is designed to remove excess cholesterol from your body, but genetics play a large part in your liver's ability to regulate cholesterol to a healthy level.
Take, for instance, people with genetic familial hypercholesterolemia. This is a condition characterized by abnormally high cholesterol, which tends to be resistant to lowering with lifestyle strategies like diet and exercise.
Further, eating nutritious cholesterol-rich foods is not something you should feel guilty about; they're good for you and will not drive up your cholesterol levels as you may have been told. It's estimated that only 20 percent of your blood cholesterol levels come from your diet.
One survey of South Carolina adults found no correlation of blood cholesterol levels with so-called "bad" dietary habits, such as consumption of red meat, animal fats, butter, eggs, whole milk, bacon, sausage and cheese.3
If you're still worried about the cholesterol in your diet, take a look at the newly released 2015 U.S. Dietary Guidelines. As recently as 2010, U.S. dietary guidelines described cholesterol-rich foods as "foods and food components to reduce."4
They advised people to eat less than 300 milligrams (mg) per day, despite mounting evidence that dietary cholesterol has very little to do with cholesterol levels in your body.
The latest guidelines have finally removed this misguided suggestion, and they even added egg yolks to the list of suggested sources of protein.
The long-overdue change came at the advice of the Dietary Guidelines Advisory Committee (DGAC), which acknowledged what the science shows, which is that "cholesterol is not considered a nutrient of concern for overconsumption."5
Myth: Everyone's Cholesterol Level Should Be the Same
What is a healthy cholesterol level? That depends. Despite what your doctor may tell you, there's no rule that says everyone's total cholesterol should be less than 200 milligrams per deciliter (mg/dL) and your LDL less than 100 mg/dL.
Further, this will tell you very little about your heart disease risk. If your doctor tells you your cholesterol is too high based on the standard lipid profile, getting a more complete picture is important—especially if you have a family history of heart disease or other risk factors.
For starters, you can ask for a NMR LipoProfile, which looks at particle sizes of LDL cholesterol.
Large LDL particles are not harmful. Only small dense LDL particles can potentially be a problem, as they can squeeze through the lining of your arteries. If they oxidize, they can cause damage and inflammation.
Some groups, such as the National Lipid Association (NLA), are now starting to shift the focus toward LDL particle number instead of total and LDL cholesterol, in order to better assess your heart disease risk. But it still has not hit mainstream.
In addition, the following tests can give you a far better assessment of your heart disease risk than your total cholesterol alone:
• HDL/Cholesterol ratio: HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your total cholesterol. That percentage should ideally be above 24 percent.
• Triglyceride/HDL ratios: You can also do the same thing with your triglycerides and HDL ratio. That percentage should be below 2.
• Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar.
The insulin released from eating too many carbs promotes fat accumulation and makes it more difficult for your body to shed excess weight. Excess fat, particularly around your belly, is one of the major contributors to heart disease
• Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increased higher risk of having coronary heart disease than people with a level below 79 mg/dl.
• Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml.
The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body.
Myth: Children Cannot Have High Cholesterol
It's possible for children to have high cholesterol levels, which is typically due to a liver problem that makes the liver unable to remove excess cholesterol from the body. Lifestyle changes, including exercise, limiting sugar intake and eating real (not processed) foods, will often help to restore healthy levels.
Myth: Margarine Is Better Than Butter for Cholesterol
Butter, especially raw organic butter from grass-fed cows, is a wealth of nutrition and nourishing fats. Research points to the fact that butter may have both short-term and long-term benefits for your health. A Swedish study found that fat levels in your blood are lower after eating a meal rich in butter than after eating one rich in olive oil, canola oil, or flaxseed oil.6
Further, replacing saturated animal fats with omega-6 polyunsaturated vegetable fats (i.e., margarine) is linked to an increased risk of death among patients with heart disease, according to a 2013 BMJ study.7 Swapping margarine for healthy butter is the opposite of what your body needs for heart health, and here's why. Saturated fats have been shown to raise HDL cholesterol—a benefit—and may also increase LDL.
The latter isn't necessarily bad either, as research has confirmed that eating saturated fats raises levels of large, fluffy LDL particles—the type that do not contribute to heart disease. Further, eating saturated fat may even change the small, dense LDL in your body into the healthier large, fluffy LDL!8,9
On the other hand, margarine has historically contained synthetic trans fat, the worst type of man-made fat that increases small, dense LDL—and your risk of chronic disease.
Cholesterol Drug Shows No Benefit for Heart Health
In October 2015, drug maker Eli Lilly stopped a trial for a cholesterol-lowering drug called evacetrapib. Many believed the drug, which could not only lower LDL cholesterol but also raise HDL, would be the next blockbuster cholesterol treatment.
But it wasn't until April 2016, when the results of the study were presented at the American College of Cardiology's annual meeting, that health professionals learned just how dismal the study results were. The drug had virtually no impact on heart health. As The New York Times reported:10
"Participants taking the drug saw their LDL levels fall to an average of 55 milligrams per deciliter from 84. Their HDL levels rose to an average of 104 milligram per deciliter from 46. Yet 256 participants had heart attacks, compared with 255 patients in the group who were taking a placebo.
Ninety-two patients taking the drug had a stroke, compared with 95 in the placebo group. And 434 people taking the drug died from cardiovascular disease, such as a heart attack or a stroke, compared with 444 participants who were taking a placebo."
Dr. Steven Nissen of the Cleveland Clinic told The New York Times, "These kinds of studies are wake-up calls." Indeed, it's not the first time a cholesterol-lowering drug has been found to be worthless, or worse, when it comes to heart health.
Statins May Make Heart Health Worse
There is evidence showing that statins may make your heart health worse and only appear effective due to statistical deception. One report published in the Expert Review of Clinical Pharmacology concluded that statin advocates used a statistical tool called relative risk reduction (RRR) to amplify statins' trivial beneficial effects.11
If you look at absolute risk, statin drugs benefit just 1 percent of the population. This means that out of 100 people treated with the drugs, one person will have one less heart attack. This doesn't sound so impressive, so statin supporters use a different statistic called relative risk. Just by making this statistical slight of hand, statins suddenly become beneficial for 30-50 percent of the population.
As STATS at George Mason University explained, "An important feature of relative risk is that it tells you nothing about the actual risk."12 Further, statins deplete your body of coenzyme Q10 (CoQ10), which is used for energy production by every cell in your body, and is therefore vital for good health, high-energy levels, longevity, and general quality of life.
CoQ10's reduced form, ubiquinol, is a critical component of cellular respiration and production of adenosine triphosphate (ATP). ATP is a coenzyme used as an energy carrier in every cell of your body. When you consider that your heart is the most energy-demanding organ in your body, you can surmise how potentially devastating it can be to deplete your body's main source of cellular energy.
So while one of statins' claims to fame is warding off heart disease, you're actually increasing your risk when you deplete your body of CoQ10. The depletion of CoQ10 caused by the drug is why statins can increase your risk of acute heart failure.
If you take a statin drug, you MUST take Coenzyme Q10 as a supplement. If you're over 40, I would strongly recommend taking ubiquinol (CoQ10's reduced form) instead of CoQ10, as it's far more effectively absorbed by your body.
How to Protect Your Heart Health
Are you looking for a non-drug way to boost your heart health? Here are some of my top recommendations:
- Reduce, with the plan of eliminating, grains and sugars in your diet. It is vitally important to eliminate gluten-containing grains and sugars, especially fructose.
- Consume a good portion of your food raw.
- Make sure you are getting plenty of high-quality, animal-based omega-3 fats, such as krill oil. Research suggests that as little as 500 mg of krill per day may improve your total cholesterol and triglycerides and will likely increase your HDL cholesterol.
- Replace harmful vegetable oils and synthetic trans fats with healthy fats, such as olive oil, butter, avocado, pastured eggs and coconut oil (remember olive oil should be used cold only, use coconut oil for cooking and baking).
- Include fermented foods in your daily diet. This will not only optimize your intestinal microflora, which will boost your overall immunity, it will also introduce beneficial bacteria into your mouth. Poor oral health is another powerful indicator of increased heart disease risk.
- Optimize your vitamin D levels, ideally through appropriate sun exposure as this will allow your body to also create vitamin D sulfate—another factor that may play a crucial role in preventing the formation of arterial plaque.
- Exercise regularly. Make sure you incorporate high-intensity interval exercises, which also optimize your human growth hormone (HGH) production.
- Avoid smoking or drinking alcohol excessively.
- Be sure to get plenty of high-quality, restorative sleep.
- Practice regular stress-management techniques.