The Great Cholesterol Myth

The widespread belief that cholesterol is the culprit behind heart disease is one of the biggest health myths of the last 70+ years. For decades, we have been told that consuming saturated fat and cholesterol raises cholesterol levels in the blood, which in turn causes heart disease. However, the theory behind this called the “Diet-Heart Hypothesis,” has never actually been proven. Despite the complete lack of evidence, the media, health organizations, and pharmaceutical companies continue to promote this hypothesis as fact, fueled by bias, vested interests, and institutional momentum.

Population studies are often cited to support the idea that high-fat, high-cholesterol diets cause heart disease and reduce lifespans, but the facts suggest otherwise. The Diet-Heart Hypothesis started from a series of population studies by Ancel Keys in the 1950s. His 1952 chart, “Fat Calories vs. Deaths from Degenerative Heart Disease,” shows a nice and tidy upward curve connecting increased fat consumption and deaths per 1,000 from heart disease. But as many critical observers have pointed out, there are two big problems with this graph and the theory it attempts to prove.

  1. The same curve could be plotted to show a correlation between deaths per 1,000 and per capita car ownership, cigarette sales, protein consumption, and sugar consumption—essentially everything that came along with increases in wealth in the mid-20th Any one of these factors (or some combination of them) could be the cause of the increased rates of heart disease we’ve seen over the past 100 years. But we can’t be sure because Keys’ study can only tease out correlative relationships.
  2. Keys created the graph by cherry-picking countries with data that fit his hypothesis. If one were to include a more significant number of data points, like Jacob Yerushalmy (the founder of the Biostatistics Department at the University of California, Berkeley) did in 1957 with 22 countries, a clean upward line can no longer be drawn, and the correlation between dietary fat and heart disease evaporates. But even if a correlation had remained after adding in more countries, we have to remember that, at best, epidemiological (i.e., observational) studies like these can only show a possible correlation between saturated fat, cholesterol, and heart disease. By definition, such studies cannot prove causation, and as every scientist knows, correlation IS NOT causation.

Dr. Keys was wrong, and we’re still drinking the Kool-Aid 74 years later! In the years following Ancel Keys’s work, much research was conducted to test the “Diet-Heart Hypothesis.” So, what do the studies really say that have purported to prove a link between cholesterol and heart disease?

  • The Framingham Heart Study. In 1948, Harvard University began a decades-long community-wide prospective study of the diets and habits of Framingham, Massachusetts. The study involved 6,000 people who were divided into two groups. One group was given a low-cholesterol and low-saturated fat diet, while the other group was put on a high-cholesterol and high-saturated fat diet. Although the study is often used to support the Diet-Heart Hypothesis, an honest review of the research shows the opposite conclusion. In fact, 40 years into the investigation, the director reported that the more saturated fat, cholesterol, and calories someone ate, the lower their serum cholesterol. The authors concluded that “No association between percent of calories from fat and serum cholesterol level was shown.” “There is, in short, no suggestion of any relation between diet and the subsequent development of coronary heart disease in the study group.” It’s worth noting that this fact is often overlooked and not reported.
  • Western Electric Study. The study authors concluded, “The risk of death from CHD was not significantly associated with the amount of saturated fatty acids in the diet.”
  • The Multiple Risk Factor Intervention Trial (MRFIT). Following the eating habits of 12,000 American men, the MRFIT trial tracked the effect of reduced saturated fat, cholesterol, and smoking on mortality rates. Contrary to what was reported in the media, the study showed that people who ate less animal fat and cholesterol had more serum cholesterol. We cannot survive without cholesterol, so the body will produce more when we eat less. It should be pointed out that although the study showed a marginal decrease in total coronary heart disease (which could very well be due solely to the benefits of quitting smoking), there was an overall increase in deaths from all causes, including cancer, brain hemorrhage, suicide, and violent death.
  • The Women’s Health Initiative (WHI): 49,000 women were put on a low-fat diet in what would be the largest, longest trial ever conducted on the connection between fat consumption and disease. The results? Women did not lose weight as expected and saw no significant change in their risk for heart disease or cancer.
  • Whitehall Study. This study followed 18,000 male civil servants in Britain over ten years, instructing half to reduce the amount of saturated fat and cholesterol in their diets, consume more unsaturated fats (e.g., margarine and vegetable oils), and quit smoking. After just one year, study participants eating a diet low in saturated fat but high in unsaturated fat had 100% more deaths than those in the control group who not only ate more saturated fat but even continued to smoke!
  • Nurse’s Health Study. This enormous study followed 80,082 nurses over 14 years. After removing the effect of trans fats, this study concluded that “Total fat intake was not significantly related to the risk of coronary heart disease.”
  • Meta-Analysis of Prospective Cohort Studies (2010). “No Significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD.”

If It’s Wrong, Why Has The “Diet-Heart Hypothesis” Persisted?

 So, if the studies have not conclusively shown that consuming saturated fat or cholesterol causes heart disease, why do so many doctors, scientists, and institutions continue to recommend low-fat, low-cholesterol diets and prescribe statins (cholesterol lowering drugs)? I believe the following two quotes sum this up perfectly:

  • “Masses of valid scientific evidence should have destroyed the diet-heart idea by now. Yet, like the ancient Greek Hydra, a mythological monster that grew new heads whenever its old ones were chopped off, the cholesterol Hydra continues its life as if nothing had happened… Scientists who support the diet-heart idea and are honest must be ignorant, either because they have failed to understand what they have read or else, by unquestioningly following the authorities, they have failed to check the accuracy of the studies written by those authorities. But some scientists must surely have realized that the diet-heart idea is impossible and yet, for various reasons, have chosen to keep the idea alive.”

-Dr. Uffe Ravnskov, MD, PhD, author of The Cholesterol Myths

  • “Practicing physicians get most of their information from the drug companies. Compared to their peers a half-century ago, most doctors don’t have the time or skills to critically evaluate reports, very few know anything about research, nor did the generation that taught them.”

-Dr. Paul Rosch

Cholesterol Is Essential For Human Life

Many people, including some doctors and researchers, commonly believe that atherosclerosis is a simple accumulation of fat and cholesterol inside the arteries, like what happens when you pour bacon grease down the sink. However, this is only partially accurate. Atherosclerotic plaques are mainly composed of fibrous tissue (about 68%) that the body uses to cover lesions in the artery wall caused by chronic inflammation. This is actually a positive response from the body as it quickly mends the damage to the blood vessels. Such injury would be rapidly repaired in a healthy individual without chronic and uncontrolled inflammation. However, when inflammation persists, as in people who consume diets high in refined carbohydrates, sugar, and trans fats, the injuries never heal, and the plaques continue to grow. In this sense, blaming cholesterol for heart disease is like blaming firefighters for the fire they are responding to. Or put another way, the typical approach to preventing heart disease is analogous to trying to reduce crime by removing police officers from the area.

Dr. Natasha Campbell-McBride, MD, explains this accurately:

“When we have a high blood cholesterol level, it means that the body is dealing with some damage. The last thing we should do is interfere with this process! When the damage is dealt with, the blood cholesterol will naturally decrease. If we have an ongoing disease in the body that constantly inflicts damage, then the blood cholesterol will be permanently high. So, when a doctor finds high cholesterol in a patient, what this doctor should do is to look for the reason. The doctor should ask, ‘What is damaging the body, so the liver has to produce all that cholesterol to deal with the damage?’ Unfortunately, instead of that, our doctors are trained to attack the cholesterol.”

Not only is cholesterol not the cause of atherosclerosis, but it is also protective against this and many other degenerative diseases. Moreover, the organic molecule is a critical component of nearly every body function and tissue. Cholesterol is:

  • Found in every cellular membrane. Without cholesterol, your cells would lack the simultaneous stiffness and flexibility necessary to function correctly.
  • Found in high concentrations in the brain. Cholesterol is required for the proper function of serotonin receptors, which helps explain why low levels of cholesterol lead to depression, suicidal tendencies, and violent behavior.
  • Found in high concentrations in breast milk. Cholesterol is critical for human growth and development, so it should come as no surprise that a mother’s breast milk is extremely high in the substance (and even includes a particular enzyme that helps babies better absorb it).
  • A major component of bile. Without cholesterol, your liver could not create bile salts. Without sufficient bile, you would not be able to break down and absorb fats, leading to fatty acid deficiencies (marked by musculoskeletal issues, endocrine issues, cardiovascular issues, immune issues, allergies, skin problems, and depression).
  • Necessary for a healthy gut lining. Cholesterol helps keep the intestinal wall strong and flexible. A cholesterol deficiency can increase intestinal permeability (“leaky gut”), allowing undigested proteins and pathogens into the bloodstream.
  • A precursor to sex and stress hormones. Without cholesterol, you cannot make testosterone, estrogen, progesterone, cortisol, etc., meaning you would not be able to respond to stress, have a sex drive or reproduce.
  • A precursor to protective corticosteroids. Cholesterol is required to make corticosteroids, hormones that help prevent cancer and heart disease.

So, What Does Cause Heart Disease?

 Multiple factors can cause inflammation and damage to the endothelium, the layer of cells that form the inside wall of every blood vessel in your body:

  • Metabolic syndrome (chronically high levels of glucose, insulin, and triglycerides in the blood) caused by eating a diet high in sugar and refined carbohydrates.
  • Trans fats, hydrogenated oils, and processed seed oils like canola, soy, corn, etc. (which have wrongly been touted as “heart healthy”).
  • Toxic chemicals from industrial pollution, pesticides, chlorine, fluoride, cigarette smoke, personal care products, domestic cleaning products, and detergents (laundry and dishwasher).
  • Infectious microbes like Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus, Herpes zoster virus, Bacteroides gingivalis, etc.
  • Gut dysbiosis (microbial imbalances in the digestive tract) and intestinal permeability (a.k.a. “leaky gut” damages the gut lining that allows undigested proteins, pathogens, etc., into the bloodstream).
  • Deficiencies in vitamins, minerals, amino acids, and essential fatty acids. Deficiency in vitamins B6, B12, and folate can cause high levels of homocysteine, which damages the endothelium. Vitamin D, for example, is required by every cell in the body and is essential for repairing injuries (such as to the lining of blood vessels). Yet, vitamin deficiencies from a lack of sun exposure are widespread.
  • Modern lifestyles that are high in stress, high in processed foods, low in relaxation, and low in movement. While all of these factors are important to consider, extra attention should be given to the chronic overconsumption of sugar and refined carbohydrates. Not only does this lead to chronic inflammation, it also creates several adverse effects on the body that contribute to disease:
  • The formation of AGEs (Advanced Glycation End Products), sticky compounds formed when glucose attaches to proteins. Fructose consumption drives this reaction seven times faster. AGEs adhere to the endothelium, contributing to atherosclerosis, and clog up capillaries in the eyes (which can lead to blindness), the kidneys (which can lead to renal failure), the brain (which can lead to Alzheimer’s disease), and in the penis (which can lead to erectile dysfunction).
  • A chronic magnesium deficiency. Magnesium is a crucial mineral that plays a vital role in several essential bodily functions, including the proper functioning of the heart and arterial muscles. Inadequate intake of magnesium can lead to severe, life-threatening issues such as high blood pressure, arrhythmias, atherosclerosis, congestive heart failure, heart muscle disease, heart attack, and sudden cardiac death. It is estimated that more than three-quarters of Americans suffer from chronic magnesium deficiencies, which could be attributed to excess consumption of sugar. The body uses 28 molecules of magnesium to metabolize every molecule of glucose.

From a nutritional approach, the key to preventing heart disease is reducing inflammation and arterial damage in the cardiovascular system.  The Standard American Diet (SAD) of nutrient deficient, ultra-processed, refined carbohydrates, sugars, chemical toxins, industrial seed oils, and trans fatty acids is a direct causative factor in the development of atherosclerosis. Additionally, exposure to environmental pollutants and tobacco smoke, combined with lack of exercise, a high stress lifestyle, and a lack of antioxidant nutrients in the diet, all contribute to oxidative damage inside the vascular system. I have always taught the food drives both illness and wellness; it’s the poison and the antidote. Every bite you take is a powerful opportunity to create health or promote disease. It’s time for us to return the diet of our ancestors: real food in its whole form, fresh, minimally processed,  chemical free, and nutrient dense.

 

Michael Chase, MS, NTP
Nutrition Science and Dietetics

 

 

SHEKELLE RB ET AL. DIET, SERUM CHOLESTEROL, AND DEATH FROM CORONARY DISEASE: THE WESTERN ELECTRIC STUDY. N ENGL J MED. 1981 JAN 8; 304(2):65–70.

 

SIRI-TARINO PW ET AL. META-ANALYSIS OF PROSPECTIVE COHORT STUDIES EVALUATING THE ASSOCIATION OF SATURATED FAT WITH CARDIOVASCULAR DISEASE. AM J CLIN NUTR. 2010 MAR; 91(3):535–46

 

HU FB ET AL. DIETARY FAT INTAKE AND THE RISK OF CORONARY HEART DISEASE IN WOMEN. N ENGL J MED. 1997 NOV 20; 337(21):1491–9.

 

Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014 Mar 15;383(9921):999-1008. doi: 10.1016/S0140-6736(13)61752-3. Epub 2013 Sep 29. PMID: 24084292; PMCID: PMC4159698.

DISCLAIMER: The information provided in this post is for educational purposes only, and should not be construed as personal medical advice or instruction. No action should be taken based solely on the contents of this information. Individuals should consult appropriate health professionals on any matter relating to their health and well-being. The statements made in this informational document have not been evaluated by the Food and Drug Administration. Any product discussed is not intended to diagnose, treat, cure or prevent any disease.

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