The ABC’s of Health: “C” is for Cholesterol | Ron Elkayam

You have just gotten your results of your annual labs from the doctor and your total cholesterol is above 200! It says you have HIGH CHOLESTEROL! You’re going to have to start statins. You’re finished!

Wait, hold on. You are not finished, and I have some good news for you.

There are a lot of cholesterol myths, information that has been proven wrong about cholesterol, and unfortunately, it hasn’t filtered down to the masses. So, let’s learn about some of these myths.

Myth #1: “If you have high total cholesterol, you are at risk for heart disease, and need to get on cholesterol-lowering drugs.”

Fact: There are different types of cholesterol. There is “good cholesterol”, HDL, and “bad cholesterol”, LDL. In fact, it is a little more complicated than that, because there are different types of LDL cholesterol, one that is large and fluffy, and three that are small and dense. The large types are largely benign, so having high LDL may not necessarily be something to worry about.

Fortunately, you cannot be sure you are at risk for cardiovascular disease based on your total cholesterol. In fact, numerous (on living subject and post-mortem) studies on people with atherosclerosis show no correlation between high total cholesterol and heart disease.

Numerous studies, however, have shown when total cholesterol is too low, the risk of cardiac events increases. Low total cholesterol has also been found to correlate with dementia and depression.

Instead of looking at total cholesterol, use a different measure—your triglyceride to HDL ratio—to determine your risk for a cardiovascular event. Research has shown that this ratio should be around 1-2. When it is over 4, the risk of a stroke or a heart attack increases.

Myth #2. “To reduce your blood cholesterol, stop eating dietary cholesterol.”

Fact: Many studies have now shown that increased intake of dietary cholesterol has little effect on total blood cholesterol levels. The body is intelligent, and is able to regulate your cholesterol levels. In fact, in one study, subjects who increased their intake of eggs actually saw their HDL (“good cholesterol”) increase.

Most of the cholesterol in your blood is made in the liver, so the factors that lead to an increase in bad cholesterol is complicated, and not a function of how much dietary cholesterol you eat. This explains why, in 2015, the U.S. government changed its Dietary Guidelines for Americans to remove the restriction on dietary cholesterol, which was previously 300 mg/day.

This means that you can eat eggs again and not worry about your cholesterol. In fact, in one study, patients who ate more eggs experienced an increase in good HDL cholesterol.

Instead of worrying about cholesterol, focus on lowering triglycerides. You can do this by: decreasing intake of carbohydrates (let’s face it, Americans eat too many refined carbs, much more than they did a century ago), increasing exercise, and increasing intake of omega-3 (either by taking a supplement or eating more fish).

Myth #3. “If you have high cholesterol, it is important to lower fat intake, especially saturated fat.”

FACT: Numerous studies have shown that there is little relationship between consumption of saturated fat and cholesterol (one example would be Gaeini’s study in 2021). However, it has been shown that eating trans-fats and partially hydrogenated fats (like margarine and vegetable shortening) are bad for heart health, which is why these have been banned in the US.

Some have suggested that using PUFA’s or polyunsaturated fats (for instance, by increasing intake of canola or safflower oils) instead of saturated fat is healthier, but a study by the Mayo Clinic shows that there is no benefit of making this substitution.

Unfortunately, most PUFA’s contain high levels of omega-6, which increases the ratio of omega-6’s to omega-3’s in the body, leading to inflammation, which can cause cardiovascular disease, diabetes, obesity, and many other health issues.

Instead of eating “low-fat”, try lowering your intake of carbohydrates. Excess carbohydrates in the body are stored as fat and converted into triglycerides. As mentioned above, a high level of triglycerides can contribute to heart disease.

If you are eating healthy fats, there is no reason to worry about fat-intake. Healthy fats can be found in coconut oil, extra-virgin olive oil, and butter.

Myth #4: “I’ll just take a statin, which is a safe drug, to lower my cholesterol.”

Fact: While statins can be helpful in middle-aged men who have experienced an adverse cardiovascular event, they are not proven to be helpful to other populations. In fact, statins, like all pharmaceutical drugs, have been found to have side-effects. Side effects of statins include: memory loss, diabetes, muscle pain, insomnia, and many others. Because statins deplete the body of coenzyme Q10, if you are taking a statin, it is important to supplement with 100 mg of coenzyme Q10 twice a day.

As I’ve mentioned before, diet is key. Focus on eating whole (not processed) foods. As we get older, our endocrine system changes (hormone levels change), stress and chronic inflammation take their toll, and so we need to eat an anti-inflammatory diet. Decreasing carbs and eating healthy fats can go a long way to help decrease inflammation and ensure that our hearts stay healthy.

As I’ve recommended before The Perfect Health Diet by Paul and Shou-Ching Jaminet is a great place to start if you are looking for ways to change your diet.

Next Steps

Now that I’ve shared with you the common myths associated with cholesterol, its time for you to feel empowered and take some action.

If your doctor is recommending statins, ask if you could start by changing your diet. Most physicians will welcome this suggestion and be very supportive.

If your doctor did not recommend statins but you have been disheartened about your “high cholesterol”, then hopefully this article has helped you change that feeling into one of hope.

Good luck!



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