Diet Heart Hypothesis – Part 2

Part 2

Cholesterol as an Enemy of Heart…

Cholesterol is an organic molecule that is essential for the normal function of our cells and our body is capable of making all the cholesterol it needs. We all have heard of LDL (“bad”) and HDL (“good”) cholesterol and how supposedly high LDL is related to the high risk of CVD. So how did the scientist came to this conclusion?

Let’s look at the studies that tried to support the idea of cholesterol causing cardiovascular disease.

In 1986 the Journal of American Medical Association (JAMA) has published a study that became a standard and is used as a reference to this day. “Relationship between serum cholesterol and risk of premature death from coronary heart disease” by Stamler et al. In this study, scientists came to conclusion that “ 1% higher serum cholesterol level was associated with an almost 2% higher CHD risk”.

But let’s look at the actual numbers in the study and see if this conclusion makes sense.

People with the lowest LDL cholesterol:

99.7% – didn’t die from CHD

0.3% – died from the CHD

People with the highest LDL cholesterol:

98.7% – didn’t die from CHD

1.3% – died from the CHD

So how did the scientist came up with a risk factor for high cholesterol, you ask? If you take the extremes and divide 1.3% / 0.3% you will get 4.13 which translates into 400% risk factor or increase in deaths. Math magic isn’t it?! 

It’s worth remembering an important point: correlation doesn’t equal causation. 1% rate of deaths across the entire range of cholesterol amount is a way too small to be considered a “cause” for any type of disease.

There several other studies, including the ones from the large pharmaceutical companies (the ones that produce statin drugs) that also manipulated data in such fashion. But we also have a few that have some evidence showing LOW levels of cholesterol AND LDL can be linked to the increased risk of CVD.

  1. Familial Hypercholesterolemia: a genetic and metabolic study” by Harlan et al, published in 1966: “no evidence that familiar hypercholesterolemia appreciably shortens the life and affected individuals. On the contrary, they show that high levels of serum cholesterol are clearly compatible with survival into the seventh and eighth decades”.

  1. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study” (20 year long study) by Schatz et al., published in 2001: “Our data accord with precious finding of increased mortality in elderly people with low serum cholesterol, and show that long-term persistence of low cholesterol concentration actually increases risk of death”

  2. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review”, meta-analysis by Ravnskov et al, published in 2016: “ Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis.

As you can see, the actual studies give quite opposite answers to what we normally hear these days.

The reasons behind cardiovascular diseases are quite versatile and cholesterol DOES play a role but not in the way you probably used to think.

Here are some facts:

  • There are 5 types of LDL and HDL molecules

  • Not all LDL is bad and not all HDL is good

  • LDL-a are “fluffy”, large molecules that are harmless and serve their purpose

  • LDL-b molecules, are very small and “hard’, golf-like molecules that are dangerous for our health

  • Some HDL types do not reduce inflammation that’s why some people with high HDL still develop heart disease

  • At least 50% of people with high total cholesterol have healthy hearts

  • Cholesterol alone is not a reason for heart disease.

Useful to know: Next time you do your cholesterol check instead of simply checking total cholesterol, do the particle test. That’s the only way to know what is actually happening with your cholesterol. Low total cholesterol but a high amount of LDL-b particles are BAD news. On the other hand, over the top high total cholesterol with a high count of LDL-a particles are GREAT news.

Unlike in the criminal justice system, where you are innocent until you are proven guilty; in science, the hypothesis is considered wrong until proven right.

This post is my attempt to bring your attention and to encourage you to think cryptically of anything you hear on the media, literature and even your doctors. As my 7th-grade physics teacher said: “don’t believe everything people say just because they say they know better. Analyze before you come to your own conclusion”.

This post is inspired by the work of many influential people, including Dr. David Diamond, Uffe Ravnskov, Nina Teicholz, Dr. Thomas Seyfreid, and many others. I highly recommend reviewing their lectures and books for a more in-depth understanding of the topic of nutrition.