Cholesterol leads to heart disease. Or does it? We’ve been taught that cholesterol gets deposited as plaque in the arterial wall, causing atherosclerosis. We are told we need to maintain a low cholesterol diet to protect our heart. But what if cholesterol wasn’t the enemy? What if high-cholesterol food like eggs and red meat weren’t as bad for you as some doctors lead you to believe? What if cholesterol is vital for life? Here’s an in-depth look at cholesterol, and what is the real cause of heart disease.
Dr. Peter Attia — The Straight Dope On Cholesterol And Diet
If you haven’t heard of Dr. Peter Attia, you need to spend some time listening to this brilliant man. Dr. Attia has been vocal over the last few years about the real reasons we get fat, and why we are so unhealthy. Here is a great talk he gave in 2013 about how all cholesterol is good for us. The best way to learn is to listen to an expert in the field, like Attia. You can find his main points below:
Any talk on cholesterol has to start with atherosclerosis. What causes atherosclerosis? Maybe low HDL, or high LDL, or obesity, or high blood pressure, or smoking? While these may all contribute to atherosclerosis, it is important to keep the actual definition in mind.
“The sine qua non of atherosclerosis is the presence of a sterol in the artery wall — nothing more, nothing less.”
If you do not have a sterol in the artery wall that gets engulfed by the artery wall macrophage, you do not have atherosclerosis.
What gets the sterols in there?
First it is important to realize that cholesterol isn’t the only sterol. Cholesterol is the sterol from the animal kingdom, but phytosterols are the sterols found in plants.
What about good and bad cholesterol?
“No cholesterol = no life”
Dr. Attia says this is a very misleading term. All cholesterol is good. Cholesterol is essential for life, not important, essential. The production of needed hormones is not possible without cholesterol, and if we didn’t have cholesterol, cells wouldn’t be able to move. No cholesterol = no life.
There is exogenous cholesterol, the cholesterol we eat, and endogenous cholesterol, the cholesterol our cells produce. Every cell in the body can produce enough cholesterol to sustain its function, with two big exceptions, the adrenal cortex, and the gonad.
The liver not only produces 20% of your cholesterol, but it is also where cholesterol goes to get turned into bile salts, which then get sent to the gut. The gut then becomes the ultimate regulator. It regulates how much of the cholesterol we eat/produce gets reabsorbed into the body. 15% is from what we eat, and 85% is recycled cholesterol that we made. We are not in taking so much cholesterol that the body shouldn’t be able to regulate it. If your cholesterol is too high it’s an indicator that there is something keeping your regulator from working correctly.
An interesting thing to note is that at one point people were taking tons of phytosterols to flood receptors so cholesterol wouldn’t get absorbed. These people ended up with higher rates of coronary heart disease.
When cholesterol isn’t attached to anything it is called free cholesterol, but most of the cholesterol we eat has big, bulky side chains. These are called cholesteryl ester. Cholesteryl ester, free cholesterol, triglycerides, and phospholipids make up the cargo carried by lipoprotein, which works like a boat to carry the cargo.
All of the cargo is hydrophobic, meaning it repels water. This means they have to go into a “boat” to get through the body. Cargo goes nowhere without boats, so unless the boat carries the cargo to the artery wall, you don’t have atherosclerosis.
Atherosclerosis is not a lipid-mediated disease (it is not a cholesterol based disease).
Atherosclerosis is a lipoprotein-mediated disease.
There is a common belief that bigger LDL is less dangerous than small LDL particles. However, studies show it is the number of particles, not the size of the particles that make them dangerous. The more particles, the greater risk of heart disease. Yet, many studies are showing people with heart disease to have low LDL, so what is causing the heart disease?
The trouble comes when you have too many triglycerides. If you have too many triglycerides the “boats” won’t be able to carry the cholesterol, and your body will make too many boats (apoB lipoproteins) to compensate.
Studies show the lowest triglyceride levels were in people eating all fats and low levels of carbohydrates. Sugar, especially fructose and high fructose corn syrup, showed to raise triglycerides dramatically, worsening your lipoprotein.
Dr. Attia gives this summary:
- Cholesterol is vital for life.
- The cholesterol we eat has little to do with the cholesterol in the body.
- Problems occur when cholesterol (or other sterols) end up in the artery wall macrophages.
- The only way this happens is if sterols are carried there by an apoB lipoprotein.
- A particle is a particle is a particle… the higher the LDL-P (not LDL-C), the higher the risk — independent of size.
- You need fewer “boats” if your boats can carry more of their intended “cargo.”
“Cholesterol is vital for life.”
So what can you do if you have high cholesterol and/or high triglycerides? The first thing you should do is listen to your doctor, but also talk to your doctor. If they give you medication to lower it, take it as prescribed. Don’t be afraid to talk to your doctor about what foods to eat, and talking about if a low-carb diet is right for you. Additional things you can do are cutting junk food out of your diet, and start eating right. Cut the simple sugars out of your diet. Cut the high-carb junk out of your diet, and eat natural whole foods. Even if you don’t go low-carb, cutting processed foods out of your diet is a huge first step, and you’ll notice incredible healthy changes when you do.
It is important to note that not everyone who goes on a low carb diet will see major reductions in triglyceride and LDL-P levels. The diet has shown to almost universally improve health, but it isn’t a guaranteed cure for high triglycerides. There can be other factors involved.
Cholesterol is a complicated subject. It does the body a lot of good, but can also cause it harm. However, it is important to note the trouble isn’t the cholesterol’s fault, but is a result of a poor transportation system. Remember that the body needs cholesterol to live. The amount of cholesterol you eat is minimal in comparison to what the body creates. Cutting back on the amount of exogenous cholesterol isn’t going to solve high cholesterol levels. High cholesterol levels aren’t caused by excessive cholesterol intake, but are a result of poor regulation. Until you fix the mode of transportation, your body won’t be able to properly regulate cholesterol. If you want your body to work properly, you need to feed it properly. That means eating clean, healthy, whole food.