The Great Cholesterol Debate

Sunday Jun 25 | BY |
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Do Beef, Eggs, and Chicken
Belong in Your Diet?

And Why Cholesterol Still Matters


Warning
: The Following Information Could Save Your Life!

This "tsunami ball" could save your life! (Like many other things you'll probably never need.

This “tsunami ball” could save your life! (Like many other things you’ll probably never need.

It’s pretty rare that I start an article with such an attention-grabbing statement. After all, the words “save your life” are overused.

We’ve recently seen viral videos on how a sharp hammer could save your life (if your car ends up in a river and you can’t open the window), or how  “tsunami balls” could save thousands of lives.

It’s a fact that we tend to worry more about things that are very unlikely to harm us than what is most likely to kill us.

For example, you may be worried about violent crime, traffic accidents, terrorism or brain cancer. But in reality, your chances of dying from any of those things are relatively small.

On the other hand, we don’t worry too much about the things that are most likely to kill us.

And this killer is… heart disease.

  • Still the leading cause of death in the United States. To put things in perspective, one in every four death is due to heart disease, or about 600,000 people in the USA every year.
  • In Canada, heart disease is the second killer, right after cancer.
  • In Europe, the statistics are even more shocking. More than half of deaths are due to heart disease.

Ok, so heart disease is a big deal. But why am I bringing this up?

Am I going to scare you off eating eggs, beef, chicken and dairy and again claim the disproven nonsense that high cholesterol causes heart disease?

Yes.

That’s exactly what I’m going to do, but without the nonsense part. And the reason is…

  • There’s too much misinformation at the moment on the Internet on this topic, and thousands of people are going to die as a result.
  • This subject is dear to me.

On this last point, I lost my father when I was only 35 (he was 63) to heart disease.

My dad, just like most people, never took this terrible disease seriously, until it took his life.

His lifestyle was not the best, so many of my readers, I suspect, might be thinking, “This can’t happen to me because I lead such a healthy life.”

I don’t have the stats on the most common causes of death in the vegan, paleo, or “natural health” world, but from the anecdotal evidence I get, they are roughly the same as those of the population as a whole. Numerous famous vegans and health authors have died of heart disease — and if you don’t pay attention to this important topic and act upon it, there’s a good chance you’ll die of heart disease too.

Why? Because it’s SO common disease in Western societies.

And from my guess, you live in Western society, and therefore are exposed to the same risks as everyone else. You grew up on the same diet, and in spite of your best efforts to change your lifestyle, your risk of dying of heart disease is rather high — compared to the almost non-existent risked you would have faced if you had lived in a more traditional society.

You might be questioning my scare tactics that I’m using to start off this article, but my motivations are:

  • I want you to pay attention
  • Choosing to act on the wrong kind of information can lead to your early death
  • I like you, and I’d prefer if you stayed alive to read my articles

Got it? So let’s begin!

Cholesterol and Heart Disease

Every time I write an article warning people against eating beef, eggs, and other high-cholesterol foods, I get angry and passionate readers write back with more or less the same information that they’ve read somewhere online and are spitting back.

Here are some replies I received on my last article about eggs.

“You are totally misinformed about “eggs.” There is no “scientific” research condemning cholesterol in eggs. Our brains need cholesterol to function & without it; we can’t regrow our brain cells. Eggs have many nutrients especially in yolks required by our bodies.”

“Eggs are an ideal food, but they need to be organic, truly free range, and not over cooked. There really just aren’t enough studies for you to say that eating eggs will raise cholesterol if you are already eating a healthy diet and practicing healthy living. The body, especially your brain, needs cholesterol, it is the precursor to many hormones, it is a needed nutrient.”

“We need Cholesterol! It is NOT a true indicator of Cardiovascular Dis-ease. The true indicator is homocysteine one of my friends has “Perfect” Cholesterol which the “Practicing Western medicine doctors” monitors giving Him FALSE hope of health when He has a heart attack.”

A common thread in those replies is the necessity of consuming cholesterol in food because “our brain needs cholesterol.” We’ll see how that’s false in a moment.

More importantly, these replies show who these people have been reading on the Internet. Mainly anti-vegetarian bloggers who have created a sort of conspiracy theory around cholesterol and heart disease.

The main statements made by these anti-vegetarian authors are:

  1. “High cholesterol is not the primary cause of heart disease.”
  2. Diets high in saturated fats and cholesterol don’t cause heart disease
  3. Saturated fats don’t raise cholesterol
  4. Eating animal foods doesn’t increase cholesterol levels or risk of heart disease.

Every one of those statements is false. Choosing to believe them is something you’ll do at your risk and in spite of all the evidence available.

Naturally, it’s important that we explain this information first. Otherwise, here’s what’s likely to happen:

  • If you think that high cholesterol is not the primary cause of heart disease, you’ll probably dismiss blood tests that show high levels of cholesterol, and continue with your existing diet and lifestyle
  • On the other hand, if you accept the premise that high LDL cholesterol is the primary cause of heart disease, you’ll likely take those blood results more seriously and act accordingly. At least, you’ll have been informed.
  • If you believe that a diet high in saturated fats and cholesterol cannot be a cause of heart disease, you’ll likely give yourself a free license to eat lots of saturated fats and cholesterol
  • On the other hand, if you accept the premise that diets high in saturated fats and cholesterol can be a major risk factor for heart disease, you’re more likely to act differently, eat different foods, and do the best you can to avoid beef, eggs, chicken and high-fat dairy.

What Is Heart Disease?

First, let’s define heart disease, so we don’t get lost in our search for the truth. From now on, I’ll often refer to heart disease as cardiovascular disease or CVD.

CVD is not one disease but a set of conditions involving the heart or blood vessels. Many diseases are included under this umbrella: angina, heart attack (myocardial infarction), strokes, and many others.

The primary pathology leading to heart disease is atherosclerosis. Preventing atherosclerosis is what you want!

Atherosclerosis is primarily a thickening of our arteries from an accumulation of white blood cells. We call this “fatty streaks.”

This stuff contains cholesterol, dead cells, white blood cells, and a bunch of other nasties.

We can understand atherosclerosis as an inflammatory and a scarring process.

A few crucial considerations:

  • Atherosclerosis is completely asymptomatic. It can go on for decades without you noticing it or affecting your blood flow.
  • The most common path to a heart attack is not necessarily the progressive narrowing of the arteries, but rather the sudden rupture of plaque, which leads to a sort of “clot” — rapidly slowing or stopping blood flow
  • If you were born in a Western country and exposed to a “Western” diet, you most likely have a good degree of atherosclerosis — even if you’ve lived a good portion of your adult life on the healthiest diet possible.
  • This led Dr. Greger to say (and I’m paraphrasing): The question is not “how are you going to prevent heart disease” but rather “what are you going to do about the heart disease you already have”?

The last point is important.

I have heart disease; you have heart disease. We all have heart disease.

Why? Because everyone exposed to the Western lifestyle develops atherosclerosis from the earliest age.

It’s not something that only happens to people who eat burgers every day or smoke two packs of cigarettes. It happens to everybody. It’s just a question of time before it kills us, and the only reason why it doesn’t kill everybody is that some people end up dying of other diseases before their heart disease kills them.

Therefore, our goal is not to prevent heart disease.

Our goal is to avoid the worsening of our existing heart disease so we may die of another cause of death (ideally a natural one at a proper age!). We may even reverse some of the atherosclerosis we already have.

The good news is that if we don’t worsen our existing heart disease, we’ll most likely be okay without ever feeling any symptoms of it.

The Proof That High Cholesterol Is the Main Factor in Heart Disease

CVD is a complicated disease that involves a lot of factors and includes an inflammatory process.

But the important thing to remember is that elevated LDL levels are the most important factor of all.

Without high LDL, it’s almost impossible to develop CVD even if one engages in lots of risky behaviors like smoking and being sedentary. As long as LDL levels are low (under 70-80 mg/dl)), atherosclerosis will not occur.

The Proof

There are several pieces of evidence we can look at to support our statement that high LDL levels are the primary cause of CVD.

  • Traditional societies where cholesterol levels are less than 150 mg/dl (total cholesterol) don’t experience any atherosclerosis and almost no CVD.
  • On the other hand, as cholesterol levels increase in other societies, the prevalence of CVD increases.
  • Total cholesterol is associated with CVD, but LDL cholesterol is the strongest positive correlation.
  • Placebo-controlled, double-blind studies in humans have shown that individuals with CVD with lowered LDL experienced fewer fatal or symptomatic events, compared to control groups.
  • Wild primates maintain low LDL cholesterol levels and don’t suffer from heart disease.
  • It is possible to cause heart disease in herbivorous mammals by feeding them large quantities of saturated fats and cholesterol.
  • It is NOT possible to induce atherosclerosis in carnivorous species by feeding them any amount of saturated fat or cholesterol.
  • “In contrast to feeding cholesterol and/or saturated fat, it is not possible to produce atherosclerotic plaques in herbivores by raising the blood pressure chronically, by blowing cigarette smoke in their faces for their entire lifetimes, or by somehow raising the blood glucose levels without simultaneously feeding them an atherogenic diet.” William C. Roberts.3

Here’s from the summary by William C. Roberts, current editor of both the American Journal of Cardiology and the Baylor University Medical Center Proceedings.

robert.001

 

Cholesterol.014

Consider this:

“Among the many genetic and environmental risk factors that have been identified by epidemiological studies, elevated levels of serum cholesterol are probably unique in being sufficient to drive the development of atherosclerosis in humans and experimental animals, even in the absence of other known risk factors. In humans, the majority of serum cholesterol is carried by LDL particles.” 2

But… My Cholesterol Is Healthy!

One of the most common misconceptions I get about the link between cholesterol and heart disease is people thinking that their cholesterol is healthy when in fact it is simply in the “normal” zone.

A “no-worry” cholesterol is an LDL level below 70 mg/DL or total cholesterol below 150 mg/DL. If you can get your cholesterol that low while eating all the eggs you want, be my guest!

But all the people who have written to me that they eat plenty of eggs and have “healthy” cholesterol are still in the danger zone.

Here’s from a fascinating study co-authored by Loren Cordain, Ph.D. and author of the Paleo Diet!

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Cholesterol.018

Cholesterol.019

Can Your Cholesterol Be Too Low?

Some people, when they follow a low-fat vegan diet or a raw vegan diet, come back with surprising blood test results, with cholesterol levels so low that their doctor is puzzled and even worried. They’ve just never seen any patient with levels that low.

With total cholesterol levels way below 150 mg/dl (for example 120 mg/dl), some people start believing that their cholesterol levels might be too low.

Many paleo authors claim that low cholesterol leads to depression and other health problems.

Hunter-gatherers, long-lived agricultural societies, most mammals, and even human infants have very low cholesterol levels.

chart

Here’s again from the study I quoted earlier:

Cholesterol.021

Let’s consider the following:

  • Other mammals without heart disease have LDL less than 80 mg/dl.
  • Hunter-gatherers have low cholesterol, with a total cholesterol of about 70 to 140 mg/dl (35-70 mg of LDL).
  • Wild primates have total cholesterol levels below 120 mg/dl
  • LDL level in newborn humans is around 30 mg/dl
  • Infants have total cholesterol levels of 50-90 mg. 10
  • What we need is in the range of 25-60 mg/dl for LDL, and total cholesterol of 110 to 150 mg. 6
  • Official Recommendations (Mayo Clinic) for LDL Cholesterol: Below 70 mg for people at very high risk of heart disease.

How Much Cholesterol Do We Need?

Optimal for LDL seem to be 50 to 70 mg/dl. Lower is better and physiologically normal.

Your total cholesterol can be very low compared to Western standards, and yet this can only be a good thing unless the cause of your low cholesterol is not your healthy diet and lifestyle but rather a pathological condition that happens to cause a drop in cholesterol levels as well.

But, Isn’t Cholesterol Essential to Life?

One of the arguments of many Paleo bloggers and dissidents is that “cholesterol levels is essential to life,” therefore: “you don’t want it to be too low.”

Yes, cholesterol is essential to life. That’s why our body produces it… just like every mammal does, including herbivorous ones!

The problem is that our diet and lifestyle increases our cholesterol levels past a breaking point, where too much cholesterol becomes a problem.

If you lower cholesterol via natural methods, we can say that: the lower is better — because you’ll be relying on your body’s ability to produce the cholesterol it needs.

It’s also possible to suffer from a disease condition that also causes our cholesterol levels to be low not as a result of a healthy diet.

For example, malaria (parasites) lowers cholesterol. Some diseases cause cholesterol to be lower. So, that’s why people have lower cholesterol at the end of their lives.

Sometimes, this is why low cholesterol levels are associated with certain diseases. The low cholesterol is a consequence of the condition, not likely a cause!

“Cholesterol is an essential component of the cell membrane and an obligate precursor for bile acid, steroid hormone, and vitamin D synthesis. (…) Although individuals with serious chronic illnesses, such as cancer, often develop depressed LDL levels as a result of malnutrition, epidemiological studies show that people with naturally low LDL levels are associated with improved longevity.” 15

What Causes High Cholesterol

Hopefully, I’ve convinced you that elevated LDL cholesterol levels are the most important risk factor for CVD.

The question is naturally: what causes elevated LDL cholesterol levels?

Here, there’s confusion. We know that several factors can affect our cholesterol levels

  • Our diet
  • Exercise or lack of exercise
  • Drinking unfiltered coffee
  • Being overweight

Let’s focus specifically on nutrition to try to answer the following questions:

  • Does dietary cholesterol raise LDL cholesterol level?
  • Does fat intake, and particularly saturated fat, increase cholesterol levels?
  • What is the most important dietary reason for high cholesterol is Western populations?

Does Dietary Cholesterol Increase Blood Cholesterol?

There is a lot of substantial controversy regarding dietary cholesterol — what is food in animal foods such as eggs, beef, chicken and fish. We know for sure that an elevated blood cholesterol causes heart disease, but what accounts for high cholesterol?

In the book “Cholesterol and Beyond,” which is one of the most compelling scientific book ever compiled on the research on heart disease — the conclusion is that dietary cholesterol may affect plasma cholesterol.

The evidence is not so clear because many studies contradict each other and come to different results.

Different animals react differently when fed dietary cholesterol. When rabbits are fed cholesterol, some of it is absorbed, and the rest is not excreted because rabbits cannot increase bile acids. Therefore their cholesterol goes through the roof.

Humans cannot absorb much dietary cholesterol, and when we ingest some cholesterol we produce less, so that’s why their blood cholesterol does not increase as much as that of rabbits.

Many studies done in the 1960s and 1970s on humans show that increases up to 600 mg. of cholesterol a day produce an increase in blood cholesterol. After that, the increase stops. Some people respond more than others, and in many individuals adding dietary cholesterol to the diet does not produce a rise in blood cholesterol.

One Key Finding

New research revealed that cholesterol has a greater effect if we add it to someone on a low-cholesterol diet.

If your cholesterol intake is zero, adding 500 mg/day (about two eggs) would raise your cholesterol by an average of 10 mg/dl.

But if your diet already contains 500 mg/day, then adding another 500 mg will only raise cholesterol levels by 1.50 mg/dl, according to the research.

Here’s another study showing what happens to the blood cholesterol of people on a low-cholesterol diet when we feed them a ton of eggs.

Cholesterol.050

If you read my articles you probably have a pretty healthy diet, so the question is whether they include an egg or two or some meat would be harmful. If you start with zero cholesterol in your diet, this inclusion can cause a significant increase. 10 mg/dl may not sound like much, but it is quite remarkable considering this is just the “average” from the research (you may experience a much higher rise) and that each 10 point increase or decrease in LDL cholesterol significantly affects your risk of heart disease.

These findings also mean that for someone eating two eggs a day or one egg and some meat or fish, NOT eating those foods would mean a drop in cholesterol level JUST from the cholesterol content alone. But cholesterol is not everything…

The Link Between Saturated Fat and Heart Disease

So the link between dietary cholesterol and blood cholesterol is not overwhelming but can be significant if you are sensitive and you start with a low cholesterol intake or are considering removing all cholesterol from your diet.

One scientific point where there is much less debate is how saturated fat increases blood cholesterol.

The first studies on the topic showed a link between total fat intake and blood cholesterol. Then they noticed that it was the saturated fat content of the diet that raised blood cholesterol. Replacing saturated with unsaturated fat lowered cholesterol levels.

Here’s a summary of the research on the topic:

  • A high fat intake is linked to high blood cholesterol
  • Serum cholesterol goes up with butter intake, and down with sunflower seed oil. Olive oil raises cholesterol a bit due to its saturated fat content.
  • Studies done on populations living on a low-cholesterol diet, such as the Javanese in the Dutch East Indies between 1916-1922, showed that a diet rich in saturated fat and cholesterol raised their cholesterol dramatically. In this example, from 128 to 168 mg/dl in just three months.
  • Not all saturated fatty acids have the same effect. Myristic acid is the most potent cholesterol-elevator. Stearic acid has little or no effect on blood cholesterol. (Studies later showed that stearic acid could be converted to oleic acid in the body). The biggest sources of myristic acids? Palm oil, coconut oil, and butter fat.
  • When researchers Brown and Goldstein discovers the receptors for LDL cholesterol in cells (which gave them the Nobel Prize in Medicine, 1985), we understood how saturated fats raise cholesterol levels. They suppress LDL-receptor activity, and less LDL-cholesterol is taken up by the cells. So they increase the “pool” of cholesterol by affecting how the receptors work. Unsaturated fats have the opposite effects.

Want More Proof?

I don’t know how much proof I’d need to give you to convince you that eating saturated fats raises cholesterol levels. You could start by reading “Cholesterol and Beyond” by A. Stewart Trusdell, a non-vegan book with no affiliation with any vegetarian associations (it does not even recommend a vegan diet specifically), which is a complete review of the research done on cholesterol between 1900 and 2000.

But if that’s not enough, you could find proof in the pudding. The paleo pudding…

Why do so many paleo followers complain of high cholesterol? Take a look at some of the articles on the topic you’ll find online:

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Cholesterol.034

One article by Mark Sisson, leading Paleo advocate, stood out for me in its idiocy and lunacy. Mark starts by agreeing that for many followers of the diet, LDL cholesterol skyrockets. He obviously understands that this is a problem. Otherwise, he wouldn’t dedicate an article on what to do about it.

Cholesterol.037

But next, his suggestions are ridiculous. According to him, lack of exercise might be to blame. “Take a walk,” he says! He also suggests “lifting heavy things.” The level of denial is high.

Cholesterol.038

How Paleo Bloggers Get the Research So Wrong

This article is getting pretty long, and I could not possibly review ALL of the studies that show no correlation between saturated fats and high cholesterol. But I will cover one to show you the flaws in these studies.

We start with a blogger that I enjoy reading and highly respect, Stephan Guyenet, who’s a biochemist and neurobiologist who writes about obesity and nutrition.

He may have changed his mind since, but in 2011 he wrote a comprehensive article questioning the link between saturated fats and blood cholesterol.

Cholesterol.041

He starts off by quoting a 1963 study that showed no link between animal fat intake and blood cholesterol.
However, when I looked at the study, it told a different story.

Cholesterol.043

The researchers said that “animal protein shows low positive correlations with cholesterol level.” That means they see some correlation. Next, they say that carbohydrates have the opposite effects.

Cholesterol.044
They then recognize the flaws in their study.

Cholesterol.045

Cholesterol.046

And finally they talk about our beloved “threshold,” the same problem we ran into with dietary cholesterol. When someone is already on a high-fat diet, adding MORE fat to the diet does not change blood cholesterol much!

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Finally, results matter. All the research shows that if you include almost no cholesterol in your diet, and eat whole plant foods with a minimal amount of saturated fats (no coconut oil), you’ll have the lowest LDL cholesterol possible, which will lower your risk of heart disease significantly.

If you eat lots of saturated fat and cholesterol, you will raise your blood cholesterol significantly, thereby increasing your risk of heart disease.

If someone can prove the opposite, then please show me the results! Most likely they will be exceptions rather than the rule.

And by “prove the opposite” I mean:

  • An LDL cholesterol below 70 mg/dl
  • Total cholesterol under 150 mg/dl

Recently, Gary Taubes, an author who loves saturated fat and cholesterol, posted his blood test results to prove to the world that his diet is healthy. This is from a man who starts the day with sausages.

Cholesterol.053

Buried in the date, you’ll find the “numbers that kill.”

Gary Taube’s cholesterol levels are:

  • 116 mg/dl of LDL
  • 204 mg/dl of total cholesterol

Cholesterol.054

That puts him in the high-risk category for heart disease, and we can safely say that atherosclerosis is building up in his arteries with every bite of sausage that he takes in the morning.

I rest my case.

Summary

In summary, what I said in this article is very simple, but nonetheless critical to understand:

  • Blood cholesterol does matter, and in fact are the most important risk factor for heart disease. LDL cholesterol is the number to watch.
  • Dietary cholesterol does increase blood cholesterol in many individuals
  • Saturated fat and animal protein, in general, does raise blood cholesterol
  • There are many things you can do to lower your risk of heart disease, but one of them is to keep your animal food consumption to a minimum (by that I mean to do the best you can to avoid it altogether).

Questions You’ll Probably Ask

What about HDL cholesterol?

Yes, I mostly focused on the “bad” cholesterol (LDL) because that’s the number that matters.

HDL is the high-density lipoprotein that may be protective for heart disease risk based on the research. Although HDL may be protective, the goal is still to lower your LDL to desirable levels, even though that may mean that your HDL goes down a bit too.

What About Particle Size?

One reader commented on a previous article I wrote on the topic:

The LDL particle size and number are the important things, not merely just LDL.

Some people say that large, fluffy LDL particles are not as bad as small and dense LDL particles. But even those large particles matter! Large LDL raise heart disease risk by 44% versus 63% for the small SDL particles.

No matter how you look at it, LDL cholesterol causes atherosclerosis. The debate around large vs. small sized LDL particles is like the debate some people have on the best way to commit suicide without pain.

The French Paradox

Another question from a reader:

Also, what about the French people in France, who eat more saturated fat and cholesterol but have less heart disease?

This one is so annoying but true. The French Paradox was not due to red wine or any other component in French people’s diet. It was due to statistical error and the fact that as much as 20% of heart disease deaths went under-reported in death certificates, put by local doctors as “other causes.” It turns out that French people die of heart disease as much as you’d expect, considering their diet high in animal fats.

Heart Disease is Caused by Sugar!

Up until 1984 scientists were working out the theory that sugar could cause heart disease. John Yudkin, professor of nutrition at London University in the 1960s, pointed out that with increased sugar consumption, heart disease also went up.

Yudkin tested his theory with animal experiments, feeding a high-sugar diet to rats. It increased triglycerides, but less consistently cholesterol. The dairy, egg and meat industries promoted Yudkin’s idea. His sugar theory was popularized in a number of books he published at the time. But these ideas were later discredited by the scientific community.

Here’s from Cholesterol and Beyond, referring to how the sugar hypothesis was rebutted:

By the 1980s these sets of evidence included: 

  • Sucrose does not ordinarily raise plasma cholesterol.
  • It does not raise plasma triglycerides if energy balance is maintained.
  • There is no plausible mechanism from animal experiments whereby sucrose could lead to CHD
  • Experimentally induced atheroma in primates regresses on very low fat, high sucrose diets.
  • Several countries with high sugar intakes had low rates of CHD, e.g., Cuba, Venezuela, Costa Rica.
  • Sugar intake has not been found an independent risk factor in prospective studies.
  • No prevention trial of CHD with sugar restriction has been completed, started, planned or even contemplated. 

Please post your comments, questions, or send your hate mail below!


REFERENCES
1 SOURCE: (Arteriosclerosis, Thrombosis and Vascular Biology. 1987:7:612-619 – “Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake”)
2, 3 SOURCE: (Cell, Vol. 104, 503-516, February 23, 2001 Christopher K. Glass and Joseph L. Witztum Specialized Center of Research on Molecular Medicine and Atherosclerosis Other source: book called “Nutritional and Metabolic Bases of Cardiovascular Disease”)
4 Source: (Familial hyperalaphalipoproteinamia J Lab Clin Med, 1976, Dc,88(6)-941-57)
5 Source: (The Johns Hopkins Textbook of Dyslipidemia) – Peter O. Kwiterovich, Jr., MD)
6, 7 Source: (“A Receptor-Mediated Pathway for Cholesterol Homeostasis” – Nobel Lecture, 9 December, 1985 by Michael S. Brown and Joseph L Goldstein)
8, 9 SOURCE: (“Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia” – Circulation, 2008; 118:672-677)
10 SOURCE: (Serum Cholesterol Concentration in New-Born African and European Infants and Their Mothers) – American Journal of Clinical Nutrition, Vl 4, No. 8, 1962)
11-16 SOURCE: (James H O’Keefe, MD*; Loren Cordain, PhD†; William H Harris, PhD*; Richard M Moe, MD, PhD*; Robert Vogel, MD‡ J Am Coll Cardiol. 2004;43(11):2142-2146. doi:10.1016/j.jacc.2004.03.046 http://content.onlinejacc.org/article.aspx?articleid=1135650)
17 SOURCE: (“Role of cholesterol in parasitic infections” – Lipids in health and disease 2005,4:10)

Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.

Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.

52 COMMENTS ON THIS POST

Comments are closed for this post.

  1. Frederic you wrote a good article- one that re-states the important and overwhelming message that diet is the absolute most significant cause of CVD.

    I have never met a Paleo fan that could refute any of it. That is …when actually put to the test. Like you say, they like to spit back single studies from their favorite blogger but never seem to have the time to do proper research nor do they understand the difference between single studies and meta data or randomized trials. It is pointless to argue with them since they act like Pontious Pilate- they ask questions and make statements but never stick around for the actual detailed and backed-up answers. It is as if they do not want to learn.

    My cholesterol numbers are very low due to my raw vegan diet. Even when I was just eating vegan 20 years ago they dropped significantly. I have clients who have done the same – with more reduction and in less time than their friends who take drugs to “lower cholesterol”.

    I even have one client that has a son with a total cholesterol of 87. In fact their family doctor actually used a sample of his blood to show medical students “what the best quality human blood should look like under the microscope”. I don’t have the figure here but the LDL was extremely low of course. Ronald, my client’s son had been on a very simple raw vegan diet. He was also as strong as an ox- he could easily lift his entire body on one hand, and balance it for as long as he wanted without any prior training whatsoever. Of course after nine years raw vegan he also had not suffered a single illness great or small.

    It is a shame that there still exist people in our modern society who, not only shun the truth about diet, but actually have an uncaring attitude about their health, as if medicine can even make a dent, and somehow “save” them if all else fails.

    The only way to go beyond even the best studies in the world is to do it yourself and prove it to yourself for sure. We live in an ever growing age of information HUGE overload! The truth shows up a lot faster when you just do it yourself. AS Einstein said, “Science explains nature”. Nature is the source. Science is good but after the fact.

    • Liam Vogel says:

      Great comment, Chris! You hit lots of nails on the head! Since yours is the first comment posted (and I read the article very soon after it was published), I find it very refreshing to see an intelligent comment after Frederic’s post. The last article of his I read on this topic, the comments started off with 5 or 6 “meat-heads” trying to convince Frederic he didn’t know what he was talking about. I was feeling bad for Frederic, but not so today! To your health!
      Liam Vogel

  2. Hi, old friend … and thanks for this great article! I’m wondering if I missed something. You said above, “A common thread in those replies is the necessity of consuming cholesterol in food because “our brain needs cholesterol.” We’ll see how that’s false in a moment.” But after that sentence, the word “brain” does not appear in this piece. I haven’t had time to read this carefully yet in full but was scanning specifically for a refutation to this assertion, which a friend recently brought up. Did you possibly forget to come back to that topic? If so, I’m hoping you can find time to add it!

    L A U R I E M A S T E R S
    Freelance Editor | Precision Revision
    “I turn what you wrote into what you meant!”

    • Hi Laurie! I talked about how our body and that of animals produce all the cholesterol it needs. I think that answers the comment “our brain needs cholesterol.” The answer is: yes, but we produce enough for that!

  3. Greg says:

    The following highly scientific articles and studies disprove the info you’ve provided above. I’ve posted some of the highlights from the articles.

    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-ii
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-iii
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-iv
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-v
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-vi

    How cholesterol from the food we eat affects us:

    Only free or unesterified cholesterol (UC) can be absorbed through gut enterocytes. In other words, cholesterol esters (CE) cannot be absorbed because of the bulky side chains they carry.

    Much (> 50%) of the cholesterol we ingest from food is esterified (CE), hence we don’t actually absorb much, if any, exogenous cholesterol (i.e., cholesterol in food). CE can be de-esterified by pancreatic lipases and esterolases – enzymes that break off the side branches and render CE back to UC — so some ingested CE can be converted to UC.

    Furthermore, most of the unesterified cholesterol (UC) in our gut (on the order of about 85%) is actually of endogenous origin (meaning it was synthesized in bodily cells and returned to the liver), which ends up in the gut via biliary secretion and ultimately gets re-absorbed by the gut enterocyte. The liver is only able to efflux (send out via bile into the gut) UC, but not CE, from hepatocytes (liver cells) to the biliary system. Liver CE cannot be excreted into bile. So, if the liver is going to excrete CE into bile and ultimately the gut, it needs to de-esterify it using enzymes called cholesterol esterolases which can convert liver CE to UC.

    Also realize that the number one way for the liver to rid itself of cholesterol is to convert the cholesterol into a bile acid, efflux that to the bile (via a transporter called ABCB11) and excrete the bile acids in the stool (typically most bile acids are reabsorbed at the ileum).

    Most of the cholesterol we eat is not absorbed and is excreted by our gut (i.e., leaves our body in stool). The reason is it not only has to be de-esterified, but it competes for absorption with the vastly larger amounts of UC supplied by the biliary route.

    The only “bad” outcome is when cholesterol ends up inside of the wall of an artery, most famously the inside of a coronary artery or a carotid artery, AND leads to an inflammatory cascade which results in the obstruction of that artery (make sure you check out the pictures in the links, above). When one measures cholesterol in the blood – we really do not know the final destination of those cholesterol molecules!

    1. With respect to laboratory medicine, two markers that have a high correlation with a given outcome are concordant – they equally predict the same outcome. However, when the two tests do not correlate with each other they are said to be discordant.
    2. LDL-P (or apoB) is the best predictor of adverse cardiac events, which has been documented repeatedly in every major cardiovascular risk study.
    3. LDL-C is only a good predictor of adverse cardiac events when it is concordant with LDL-P; otherwise it is a poor predictor of risk.
    4. There is no way of determining which individual patient may have discordant LDL-C and LDL-P without measuring both markers.
    5. Discordance between LDL-C and LDL-P is even greater in populations with metabolic syndrome, including patients with diabetes. Given the ubiquity of these conditions in the U.S. population, and the special risk such patients carry for cardiovascular disease, it is difficult to justify use of LDL-C, HDL-C, and TG alone for risk stratification in all but the most select patients.
    6. This raises the question: if indeed LDL-P is always as good and in most cases better than LDL-C at predicting cardiovascular risk, why do we continue to measure (or calculate) LDL-C at all?

    https://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/

    The second tenet of the cholesterol-heart disease hypothesis, the notion that high cholesterol levels in the blood cause heart disease, is referred to as the “lipid hypothesis” in the scientific community. Though it still accepted as gospel truth by the general public and many medical professionals, most researchers now believe the primary causes of heart disease are inflammation and oxidative stress. Unfortunately, the rest of us haven’t gotten the memo, so to speak, that cholesterol isn’t the cause of heart disease.

    It would take several articles to explain this in complete detail, but I’d like to give at least a brief summary here.

    If cholesterol caused heart disease, it should be a risk factor in 1) all ages, 2) both sexes and 3) all populations around the world (barring any protective factor, of course). Also, if cholesterol caused heart disease we would expect that lowering cholesterol would reduce heart disease. But none of these assumptions turn out to be true.

    The rate of heart disease in 65-year old men is ten times that of 45-year old men. Yet a recent study in the Journal of American Medical Association indicated that high LDL cholesterol is not a risk factor for from coronary heart disease (CHD) mortality or total mortality (death from any cause). It is extremely unlikely that a risk factor for a disease would stop being a risk factor at a time when that disease kills the greatest number of people. That is akin to suggesting that smoking causes lung cancer in young men, but somehow stops doing so in older men!

    Another consistent thorn in the side of supporters of the “lipid hypothesis” is that women suffer 300% less heart disease than men, in spite of having higher average cholesterol levels. At the recent Conference on Low Blood Cholesterol, which reviewed 11 major studies including 125,000 women, it was determined that there was absolutely no relationship between total cholesterol levels and mortality from cardiovascular or any other causes.

    Nor is cholesterol a risk factor in all populations around the world. In fact, some of the populations with the highest levels of blood cholesterol have among the lowest rates of heart disease, and vice versa.

    Finally, more than 40 trials have been performed to determine whether lowering cholesterol levels can prevent heart disease. In some trials heart disease rates went down, in others they went up. But when the results of all of the trials were taken together, just as many people died in the treatment groups (who had their cholesterol levels lowered by drugs) as in the control groups (who had no treatment).

    Again, the Framingham Study which followed 15,000 participants over three generations:

    “There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years.”

    In other words, as cholesterol fell death rates went up.

    The Honolulu Heart Program study, with 8,000 participants, published in 2001:

    “Long-term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier the patients start to have lower cholesterol concentrations, the greater the risk of death.”

    And finally, the huge Japanese Lipid Intervention Trial with over 47,000 participants:

    “The highest death rate observed was among those with lowest cholesterol (under 160mg/dl); lowest death rate observed was with those whose cholesterol was between 200-259mg/dl”

    In other words, those with the lowest cholesterol had the highest death rate, and those with cholesterol levels that would today be called “dangerous” had the lowest death rate.

    • Greg, the last quote you provided seems to come from a book called “Fat is your friend.” I’d be interested to find the actual study and the page where the quote you provided comes from. Otherwise I can’t comment.

      The same goes for the quote you provided on the Honolulu Heart Program. It seems to also come from the book “Fat in Your Friend,” and not from the study itself. The “Honolulu Heart Study” seems to show the opposite of what you’re claiming. “Age, systolic blood pressure, serum cholesterol, serum glucose, cigarette smoking and alcohol consumption were highly significant risk factors”
      About the Framingham study: Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling–perhaps due to diseases predisposing to death. https://www.ncbi.nlm.nih.gov/pubmed/3560398
      The study authors themselves admitted that the association between low cholesterol and mortality was due to confounding factors, something I addressed in my article.

    • DM says:

      Great post Greg! thank you for the information. I totally agree with you and believe this article is pretty misleading and not based on real understanding of cholesterol or on up to date science and research.

      Frederic, I appreciate you and thank you for broaching this tough highly disputed topic. But your response to greg was woefully inadequate and you did not answer any of the main points which are based on sound logic, science, research, and statistics, and what most of the top CVD experts in the alternative health field now support and believe and teach. Please address these points and the difference in results of research because many of them are in stark contrast to your article. Did you even read the 6 articles cited by Greg? IT is in fact the case that most research (outside of the big pharma) shows that the higher the cholesterol the less risk of mortality as brought up by greg in a number of study’s he referenced. You should address this.

      I want to point out a couple of additional points:

      1. This article would be hailed by big pharma, they would love it they would totally agree with it. That should be your first clue that something might be wrong with your beliefs. In fact this article is almost a plug for statins, arguably the most fraudulent drug of all time and a major cause of type 2 diabetes. Your article is also in stark contrast to what many of the top nutritionist believe and teach now, including Dr. Mark Hyman, whose copius research in his new book, “Eat Fat, Get Thin”, completely contradicts your cited research on both cholesterol and fat. Please address this fact. It seems you are cherry picking your research rather than looking at it as a whole. Dr. Hyman literally reviewed every published research study on fat and cholesterol (ever) and came to very different conclusions than you.

      2. You do not make a distinction between oxidized and unoxidized cholesterol. As a result, your villification of LDL is wrong. It is not based on science. The only type of cholesterol that is a threat is OXIDIZED cholesterol, specifically small particle LDL, which very easily oxidizes. Large fluffy LDL is a very low threat and not a concern because it so rarely oxidizes. I dont know where you got your numbers, but they seem incorrect based on my research. There is copious evidence cited by Dr. Mark Hyman in the his book, “Eat fat, get thin”, that shows large LDL is not much of a concern at all because it does not readily oxidize, totally disagreeing with your numbers. I trust his documented research much more than your spouted numbers. It is in fact OXIDIZED cholesterol that can cause damage. Not unoxidized. Unoxidized cholesterol brings healing to tissues, not damage. You do this in general with your villification of animal foods and oils. You do not distinguish source and preparation and neither do your studies that you cite. You also lump all people together and do not take into account different physiologies (metabolic typing) that thrive much better with at least some animal foods in the diet. See the work of Dr. Nicholous Gonzales for information on metabolic typing and why some people thrive better than others on animal foods. For example, do any of the studies you cite on eggs consider the source and how they are cooked? There is a tremendous difference between raw organic egg yolks from healthy free range chickens (a nutritional powerhouse) and cooked egg yolks (from any source). Cooking egg yolks oxidizes the cholesterol, denatures the protein, and damages many of the nutrients like B12 and Choline. Duh, of course this is not healthy. And none of which is true for raw egg yolks. There is a massive difference between organic raw virgin olive oil and rancid toxic oxidized olive oil. There is a huge difference between grass fed organic ghee (or butter, but ghee is better) and highly toxic non grass fed butter. For example, there are studies that show regular non organic butter can have 20 times the pesticides as non organic produce. Again, duh, thats going to be toxic and unhealthy – but not because of the fat. My question to you: does it bother you that you generalize so much?? This is the same problem with the famous (or infamous) China Study, which is rubbish because it cherry picks the research and massively over generalizes, which I believe you are doing with your vendetta against animal protein and oils. I believe you are dong exactly what Ansel Keys did, cherry picking the data. His misinformation drove CVD medicine for decades and even today when we realize his research was totally invalid, his ideas are still clung to by people like you and the doctors you cite. Be aware: this aligns very well with big pharma and the lies and misinformation they spread about cholesterol, CVD, and statins.

      3. For you to try to exonerate sugar as not culpable in CVD is utter nonsense. This is how suger can contribute to CHD/CVD that was NOT mentioned: excess sugar will cause gut flora imbalance and subsequent major inflammation. The more out of balance your gut becomes, the more inflammatory your gut becomes. And you yourself mention over and over that inflammation is driving heart disease. Sugar by itself is highly inflammatory and much of it is drenched in glyphosate!! A double whammy to the gut flora. It is so inflammatory that if insulin does not take it out of our blood it will kill us. It is completely ridiculous to try to exonerate sugar from contributing to practically any degenerative disease including CVD. Excess sugar will contribute to ALL degenerative diseases, period! It is a biological fact that any amount of sugar will cause some damage. We may repair it, but sugar in the blood causes minor damage to major damage over time always. Glycation and inflammation are only two of the many problems. See Dr. Ron Rosedale’s book or lectures to undersand the damage done by sugar. Sugar may not necessarily be a direct cause but it cannot be exonerated out of contribution to CVD as you try to do. It is amazing to me that you vilify all fat and try to exonerate sugar. WOW! To me that is very ignorant and biased and flies in the face of many studies performed over the past several decades. It also flies in the face of basic physiology and science. Again, see Dr. Ron Rosedale or Dr. Mark Hyman’s book to understand the huge differences fat and sugar have on human metabolism.

      4. I disagree with you on reversing CVD. CVD is virtually 100% reversible with high dose vitamin C (and a few other nutrients: L-lysine, L-proline, Vitamin D & E, Sulfur, magnesium, Ubiquinol, k2, copper, B complex, Rutin, Omega 3s, etc.). Vitamin C will heal the arterial lining. This was proven by Dr. Linus Pauling decades ago. See http://www.vitamincfoundation.org/unified.htm. There is a good article recently in the Well Being Journal on this topic. Of course diet is incredibly important as well for preventing and healing CVD. Detoxification is incredibly important. Exercise, hydration, etc, etc. If you are not damaged too badly, you can absolutely reverse it and heal your cardiovascular system and prevent further damage by strenthening your tissues with high dose vitamin C.

      5. The levels of cholesterol that you are advocating for have been shown to cause nerve damage in older people leading to parkinsons: http://www.wellnessresources.com/health/articles/low_ldl_cholesterol_associated_with_parkinsons_risk/. In my opinion the levels you are suggesting are way to low and will result in brain damage over time.

      I do not mean this comment to be “hate” mail and hope you do not take it that way. I think there are many unanswered questions regarding this topic that you should answer, especially the contrast in research studies that do not agree with your conclusions.

      Regards.

      • Bob says:

        Who ever you are you know your stuff but if someone has a passionate belief and tries to gain support for it they tend to pick and choose what supports that idea but he does have some good points. I prefer science that uncovers biochemical mechanisms as this information is more reliable for eg how an engine works mechanically rather than which model of car someone is trying to sell. Everything else outside of describing how something works is too often subject to wrong focus, self promotion, money and bias. I also prefer to look at real life to see if something really works or not and what the goal is. If you say eating this way makes you live longer then lets examine those communities that live the longest and see what they are eating. Did any historical group do this and are they still around today? If eating this way does not make you live longer or better(quality of life) and only shifts the risk factor to some other area than I would re-think the strictness of this concept and what is being achieved.

        • Good point Bob. All of this information only makes sense when you look at it also in the context that you’ve mentioned. Who are the cultures that live without heart disease and what do they eat? Anyone interested in finding out will discover that the answer will match the scientific data.

      • Neil says:

        Try not to be too brainwashed because this is how their science works – to brainwash people like yourself.
        Go to any hospital in the western world and find an adult on the death bed at 60 dieing from eating too many plants and not enough animal products. Let me know when you find this person.

    • Neil says:

      Nice work but a waste of time my friend. I don’t even need to read the links. I concur with a comment made by BOB further down. The real science is in breaking it down to the real facts of real life- look at REAL PEOPLE who live the longest and healthiest lives. They don’t have habits that you support as some kind of evidence towards a healthy long disease free and disability free life by over consuming animal products. So where are these people? I have still yet to meet one and we see people every week at our health retreat. All i ever see are mainly sick overweight people who have over-consumed meat, eggs, dairy,butter, icecream, milk etc. NO, it is not the sugar – sugar/ glucose is used as a quick energy source but the body stores animal products. What hangs out over their belt and hip lines is not excess broad beans or broccoli!

      It’s hilarious the lengths that people go to to justify their animal food cravings. Lets also understand something else here – i can’t say that i have ever found one of these individuals ( authors, so called experts etc) who have an avid interest in human longevity, but rather just trying to dispel the myth that eating animal products is ‘not’ unhealthy.

      Please point me towards the area of any hospital in the world to find a section of people who eat a diet of plants. Vegans and vegetarians are not filling hospitals, perhaps this is the first logic and basic science to learn about.

      At least WHO came out recently to support the inherent risks associated with meat, but of course, this gets squashed by the meat lovers association of the world.

      ALL the REAL science with REAL PEOPLE points towards a plant based diet to support disease free and disability free longevity – at least 90 -95% calories from plants. Simple.

  4. Nancy says:

    Thanks Frederic for your information. It was very interesting. You are right, there is so much information that it is hard to know what is real! Thank you for your suggestions .
    warmly, Nancy

  5. suzanne says:

    Thanks for your research. Simple ? and I probably already know your answer. Eating whole fat grass fed plain yogurt is going to raise my LDL?

  6. Thank you so much for this article. I have surprised myself by becoming a vegan, because of the weight of research indicating that it is the healthiest diet. But I worried about my choline. You didn’t mention choline, but I assume I needn’t worry about it. Please tell me if I am wrong.

    However, I have been enjoying coconut oil, and I will be restricting that, thanks to your article.

    I am very grateful for your article. It would be a shame for me to enjoy my coconut oil, not realizing that it is sabotaging my low saturated fat diet. I had imagined that it, being a medium chain triglyceride, would have a lesser effect on serum cholesterol that other saturated fats. Thanks for setting me straight.

    • Hi Barbara. I personally avoid coconut oil but I eat whole coconut products. In the whole package it’s healthy. As for choline there’s no need to worry about it. It’s found in many plant foods. Enjoy!

    • Andi says:

      Barbara, in one of Dr. Greger’s videos on eggs and cholesterol, he briefly says that people used to think that we need the choline from eggs, but that choline from eggs was then found to be harmful.

      • crosswind says:

        I can believe it—especially for people who are born as “Over-methylators” and sluggish detox pathways and MTHFR genes and CBS, COMT, MAO. We can’t handle more Methyl donors in the body. We already have excess. I have developed a sensitivity to TMAO and choline. My holsitic MD said some people are sensitive to L-carnitine and Choline pills. Many of her patients get a fishy body odor from it. It goes away after stopping the supplement and food. I cannot take anything METHYL or food high in Methyl donors (No methyl B12, No carnitine, No choline, No eggs, No fish, No beef etc or other foods high in methyl). I develop a body odor. Maybe this is from specific bad bacteria i have acquired that make TMAO. Not sure. Great article by Dr. Mensah on Under-methylation vs Over-methylation. http://www.mensahmedical.com/methylation-disorders/

  7. Hubert says:

    Hi Fred,

    There are two basic assumptions in your article that cause all the conclusions to have to be reconsidered.

    1. You (and almost all other researchers) do not differentiate between raw and heated animal foods. Heated animal foods are very different (much more toxic) form the raw ones as they are eaten by all animals except man.
    All studies your quote do not take this into account and can therefore not be used as proof of anything.
    2. Cholesterol is not a cause of anything. It is a repair mechanism. The fire brigade so to say. So saying that it’s the cause is reversing cause and effect. The body repairs damage, done by heated animal foods, with cholesterol. That’s why we find it at the ‘hot spots’, it patches up holes and neutralizes irritants and the process is called ‘inflammation’. (funny how the comparison with the fire brigade matches).

    Conclusion: it might very well be that consuming raw eggs (like people used to do ‘as medicine’) and raw fish (like the Japanese do with sashimi) and raw meat (who dares?) is perfectly fine. There are many people in Europe who do just that (instincto’s) and they are super healthy. But they are considered weirdo’s (as vegetarians/vegans were once).

  8. DMM RAO says:

    MyTC 254,HDL61,LDL149,TRIGLY 87,VLDL17.4. what type of food is suitable to me. I Spend 300 Cal daily on treadmill and do strength training .Is medication necessary? Please advise

  9. Dee says:

    I would first like to say I am not an expert in this field, but food and my health are important to me so I read and try to keep myself informed. In my research I’ve never found that anything is really ever so simple as, don’t eat this but do this and you’ll liver longer & healthier. I think I understand the good & bad cholesterol but aren’t there other things to take into consideration? You didn’t mention anything about calcium, D3, K2, or Magnesium that also appear to play a major role in heart disease. Is just stopping the intake of all animal products really the only answer, or is there a balance to be found?

    • Andi says:

      Proper nutrition is probably important in addition to stopping the animal products. It is possible to get all nutrition from plants, except maybe you need a B-12 supplement as you get older.
      Avoiding animal products but just eating vegan pizza would probably not extend your lifespan.

  10. Robert says:

    Thank you for all the data and quotes from well identified sources. I learned valuable information about the
    varied viewpoints on cause and affect for fat, cholesterol, and cardiovascular disease.

  11. why is it that drs lundell and sinatra have published books saying the polar opposite of your premise? they both say that cvd is caused by inflammation ,not cholesterol

    • Good question. CVD is caused by inflammation, but this inflammation comes from cholesterol lodging itself in the endothelium lining of our arteries. I repeat my point, which I didn’t invent but comes from top cardiologists (not just plant-based): without high cholesterol heart disease is virtually impossible.

  12. Lara says:

    Thank you Frederic, for your thoughtful article. Higher LDL levels do indeed correlate with an increased risk for CVD. Correlation is not cause, and statins may not be the solution. Many researchers hypothesize that a lesion in the vessel wall due to inflammation is the initial insult, cholesterol being the ‘patch’ which becomes problematic if the cause of the inflammation is not addressed. It is also worth noting that we are a variable lot. Some people are genetically configured to make more cholesterol, and their levels will be high regardless of diet. While I appreciate your perspective that considering overall cholesterol levels, and especially the LDLs is important, I would hope that consideration would not eclipse the larger perspective which would include those of our biochemical individuality and the role other factors might play in predisposing us to CVD.

  13. Where can you read your optimal weekly food intake?

  14. Maya says:

    Hi Frederic,

    thanks for the great work in your article.

    Just a note: I was on a healthfair in Phoenix, AZ in 1996 (I was then 44) and the made free colesterol tests… so I did one… came back 2 hrs later to get my results.. the made a big anouncement at the hall and said that I had the lowest colesterol that they have measured so far… 96 and the LDL was 54…
    I was surprised, as I did eat eggs that morning… normally I eat eggs only on very rate occations, and none since I have been living on mostly uncooked fruits and veggies/greens with very little nuts and some seeds.

    I just turned 64 now and feel and look great… you where one of my inspiration when I first starded this lifestyle in 2005…

    Thank you for all you do to educate the rest of us thatvarevseeking the truth…

    Blessings and Love to you and yours..

    Maya…

  15. Sheila E says:

    Not all of us go around with complete disregard of taking responsibility for our health that have high cholesterol.

    I am a female, almost 70, in very good health except for high cholesterol. People are completely shocked at my age, since I don’t look it.

    My CRP is .8. I have high cholesterol varying between 217 – 235. My HDL is in the normal range, yet at the highest level. My BP averages 110/63. I take some supplements, including probiotics, for health and eat my 6-12 veggies without fruit daily. I am not diabetic. I do eat turkey, fish and eggs weekly. I do drink my own bone broth that has been strained and defatted. I haven’t eaten processed food in years. I make everything from scratch.

    I exercise daily plus do weight training. I teach a Tai Chi fitness program. I have been doing so for years. I fast 2 – 3 times per month for a day. I would like to lose 10 pounds, but no matter what I do, I cannot move the scale.

    I didn’t get high cholesterol until after menopause. Prior to that my cholesterol was always 150- 160. Everyone in my family seems to have high cholesterol, yet our diets and lifestyles are completely different.

    I do not take any medications, except I do have low thyroid. That, also, began after a hysterectomy in my 50’s. At one time I tried red yeast rice and it brought the cholesterol down, but I was sensitive to it and got pain all over my body.

    So what am I supposed to do to get my cholesterol in the right range? I feel I am doing everything I can, which poses the question can it not be a genetic predisposition of over production? Can a lack of balanced hormones in my body be part of the cause?

    Because of food sensitivities being completely vegetarian makes me feel I have no energy, sluggish, and I gain weight. I am gluten free, dairy free, soy free, and eat primarily organic, plus I eat very few grains because they don’t make me feel well. Must I focus continually on eating or not eating to control my cholesterol?

    What kind of diet am I to be on that is the big question?? I have been raw for 90 days, my cholesterol number still high and I never lost a pound. I have been vegetarian and gained 15 pounds and felt like crap. I have tried Paleo I feel something is missing. I have tried WW and never lost a pound and found the program ladened with processed food and artificial that and that.

    So what is the answer? I haven’t found it yet.

    • Hi Sheila. Your blood pressure is very good and that in itself is the most important risk factor for overall health outcomes. I don’t know what you should do for cholesterol, but best would be to connect with a M.D. that is specialized in plant-based nutrition. For example Dr. Klaper at the True North Health Center will give Skype consultations (or in person, of course). I personally would get rid of the animal products and OILS. Perhaps the vegetarian diet you tried was simply not healthy enough to make a difference. You could eat fruits, vegetables, nuts, seeds and add as you need root vegetables (potatoes, etc.), well-cooked beans and avocados. Making sure to supplement with absorbable B12.

    • Don’t bother replying to this troll post. This is some pathological liar who goes around to all the vegan sites writing this fake story. The sooner this troll dies of CVD the better.

  16. Alan says:

    It is homocysteine levels that you need to pay attention to. Statin drugs do more harm than good!!
    A good friend of mine had “Western Medicine” perfect Cholesterol levels and had a Heart attack.
    That is when He found out the hard way about homocysteine.. It is the REAL marker for cardio vascular Dis-Ease..

  17. Ann says:

    I can give my experience with high cholesterol. My total and LDL were high. At that time I was ingesting no meat ab eating basically lowfat vegetarian but very high in carbs like breads and pasta. Also, was eating baked goods with high amounts of added sugar. I was eating organic just for reference not that that matters. So, I removed most bread products and rarely if ever have pasta anymore., I also control my sugar intake to a bare minimum. Both my cholesterol and LDL dropped to a safe level. I actually got off my NO bread and pasta diet and started eating those again against better judgement. And, there went my cholesterol up again. I do intake some butter, yogurt, and eggs. No other dairy. But, I don’t eat coconut oil and I occasionally do have low fat meat choices. I use olive oil. But, for me I believe the high carbs like bread products and pasta is what raised my cholesterol. I cannot follow or believe any studies on either end of these controversial beliefs. I go by my own personal experience and feel most of these studies are flawed in my opinion. There some rights and wrongs with all of them. I do agree on exercise and lifting weights, which is healthy for the body overall.

  18. ROBERT JOKEL says:

    great article! thank you Frederic.
    I was surprised to read that sugar was not linked with high cholesterol.
    It my experience with many clients it is definitely linked with most people.
    I also agree with you that eating fats from dairy and meat will affect cholesterol in most people.
    Some people with metabolisms that are fast oxidizers and /or parasympathetic dominant may not react the same as you might expect. That I why I agree with you when you say to check the blood test results.
    You also might want to check your terminology. Proteins are not fats and might be better not to call proteins cholesterol? Even though some of your articles do.
    Now all that being said … I hope you and your audience knows that how we live … how alive we are … how we express our creativity … a deep sense of meaning … being loving and receiving love … having supportive and loving friends … etc etc etc … has much to do with our total health as well as our heart health.

    There was a village that had very little heart disease in PA even though they had the same “poor diet” as those people with significant heart disease. And they ruled out genetics also. It was their relationships that kept their hearts healthy.

    https://wholebeinginstitute.com/relationships-are-the-ultimate-currency/

    Now with cancer as well. Even what was considered terminal cancer.

    Lawrence LeShan, Ph.D., author of cancer as a turning point, helped numerous people heal from terminal cancer by helping them to “find themselves” more and what they wanted out of life and then to go get it. These were people challenged by catastrophic illness and they healed via focusing on the human spirit and strengthening that. It is interesting to note that while these people were in the hospital they had a horrible diet including white bread. Still over 55% of the people challenged by “terminal” cancers were alive at least ten years later.

    There is so much fear is so many people around what to eat to avoid illness.

    I have found in my experience the people I have worked with that were considered incurable did much better focusing on living than focusing on not being ill.

    Bernie Siegel, MD
    also writes about this in his many books and are worth checking out.

    Also Dean Ornish, MD showed you could consistently reverse coronary artery narrowing dramatically with a holistic program that included diet, yoga, counseling, and exercise … and worth looking into.

    ok thank you for providing this forum.

    I look forward to your next article! Rob

    • Hi Robert! Regarding sugar, it can increase triglycerides and that itself is a risk factor for heart disease. The idea being that refined sugar is not the main cause of heart disease. This was an article on the importance of cholesterol (or low cholesterol). I’m preparing another one for heart disease itself in the near future. Thanks for your other points.

  19. You stated that we have not had time to evolve to eating animals—so then why do we have teeth that have evolved for eating as both a vegan AND a carnivore?

    • I don’t really consider the human canines carnivorous appendage. Gorillas have very long canines compared to ours (chimpanzees too) and they are near herbivores. But we CAN digest meat and maybe in small amounts it’s not that harmful. Even if that’s the case we’re certainly not carnivores in my opinion.

  20. Neil says:

    another great article, great effort Fred.

  21. Andi says:

    I was just watching Dr. Greger’s videos on cholesterol and went back to my blood test results from a few months ago and was distressed to realize that my cholesterol levels have increased from when I was younger. I used to have ldl around 70’s, total cholesterol around 120, and my hdl was too low, during a time when I was vegetarian, although I don’t exactly remember what I was eating. I’m still vegetarian, and 95% vegan. I eat a tablespoon of organic yogurt a day, occasionally eat a little cheese, and at the time of the blood test was probably eating an egg a week, because I got my own chickens for protein. (I was giving away a lot of eggs.) I would also have a bite or two of my husband’s meat about once a month at a restaurant. I think maybe the protein bars I am eating have trans fat??? Also confounding is post-50 hormonal changes, not enough exercise and significant weight gain. I’m going to have to figure out all the ways in which I can lower cholesterol. Obviously the low hdl is handicapping me, putting me at higher risk of heart disease.

    Thank you for your article. Almost had an argument with my chiropractor when he said eating cholesterol is good for your brain. I told him that if you have ldl levels over 70, you have more than enough cholesterol in your body to provide your brain whatever it needs. He decided to not to go further.

    • “Low” HDL is not a problem if LDL is also low. Dr. Esselstyn has talked about that, and not to worry about low HDL scores. It’s much more important to keep LDL low. And getting nutrition advice from chiropractors and other health professional can be risky business…

      • Andi says:

        Thanks. Not to worry, I try to do my own research on nutrition. Anyway, my total cholesterol has increased to 161 and LDL is 97, so I’m getting close to the danger zone. HDL is not helping.

  22. Jackie says:

    Does everyone know that 50% of people who have heart disease have normal cholesterol?

    • That’s only because “normal” values are too high. Cholesterol levels between 150 and 199 mg/dl are considered normal, but as you mentioned, a good proportion of people with heart disease have these numbers. The reality is that truly normal and healthy cholesterol levels are under 70 mg/dl of LDL or 150 mg/dl of total cholesterol.

  23. Jac Su says:

    Thank you! Finally someone who gets it right and summarizes it best. This is what I preach daily (and now will STOP using the coconut oil ). Thank you !

  24. Rosemary says:

    I was on a raw vegan diet and then moved to Paleo. It’s been a fantastic move. I get so annoyed though when people bad mouth meat, eggs etc. Your information is based on grain fed animals. We’re meant to eat animal products but we’re meant to eat naturally fed animal products (grass fed, hormone & antibiotic free). I would also like to note that there are many plant foods that one should never eat raw, because they have a negative impact on the thyroid and hormones, there are also many plant foods we shouldn’t eat at all. I haven’t felt better & I haven’t been healthier since leaving the raw food life for Paleo diet. I am now going to block all future emails from you.
    Cheers.

  25. John. says:

    Hi Frederic,

    It seems like I can’t win at having a diet that is healthy that helps to prevent CVD and also that is good for teeth.

    I have read the following one piece of information below from an article on the internet which I have included the source from where it came from:

    “Remember, if you’re going to beat tooth decay, you need to increase your fat-soluble vitamin intake and mineral intake. If I were creating an ideal diet to follow, it would look like this:

    – Rich in animal foods like bone broth, meat, fish and eggs.”

    https://draxe.com/naturally-reverse-cavities-heal-tooth-decay/

    You mention the following in your article:

    “There are many things you can do to lower your risk of heart disease, but one of them is to keep your animal food consumption to a minimum (by that I mean to do the best you can to avoid it altogether).”

    In the work of Weston Price he noted that he never found a single group of primitive racial stock which was building and maintaining excellent bodies by living entirely on plant foods. He never saw a pure vegan diet to help prevent dental decay and people who followed this diet got extensive tooth decay.

    Can you shed any light on what I am reading?

    Best regards,

    John.

  26. DM says:

    This is true. Weston A Price in fact sought to find a healthy culture that had a 100% plant based diet back when he did his world tour, but found NONE. ZERO. Every healthy culture of the healthiest cultures in the world at that time that he visited consumed some form of animal foods. Not only did these cultures have very healthy teeth but they had essentially zero CVD and cancer. Their teeth were often very straight as well because proper nutrition results in wider more accommodating jaws so that teeth are not over crowded. And in fact when he returned he incorporated some of what he saw these healthy cultures eating and fed these foods to children with dental problems and saw remarkable results. Part of what he fed these children was indeed animal foods, in particular bone broth and red meat.

    You certainly would think that if animal foods were a primary cause of CVD, these cultures would have had more CVD.

    Regards.

    • John. says:

      Thanks DM for your comments. It is helpful knowledge.

      I think you wouldn’t want to eat just animal foods, as I am sure there would have to be a limit and a balance.

      I would think the best diet would have to include vegetables, like nice green lettuce and other good vegetables, cabbage, carrots, etc.

  27. DM says:

    I want to point out that the premise of this article, that high cholesterol and animal foods and saturated fats (like coconut oil) is what causes CVD, agrees with the following:
    1. Big Pharma and their research and the use of statins
    2. The AHA
    3. The FDA and every governmental agency concerned about such things
    4. Most conventional doctors who know very little about nutrition and health and only understand and promote the use of drugs and who believe diet is mostly useless.

    Moreover, the premise of this article DIS-agrees with the following:
    1. Many top nutritionists, scientists, and medical doctors including: Dr. Mark Hyman (head of the cleveland clinic functional medicine department), Dr. David Perlmutter, Dr. Joseph Mercola, Dr. Peter Attia, Dr. Ron Rosedale, Dr. Chris Masterjohn, the late Dr. Nicholas Gonzales, Dr. Mary Enig, Jon Barron, Chris Kresser, David Wolf, Truth Caulkins, Daniel Vitalis, and many more. Many of these experts are calling the belief that cholesterol causes heart disease the “Cholesterol Myth of Heart Disease”. These are no slouches. These are brilliant well read scientists and doctors and clinicians and these folks are not out to brainwash anyone. They seek the truth. Many used to believe that cholesterol and animal foods and saturated fat caused CVD and no longer do because of newer more complete science and understanding and statistics and many many studies. Studies dating back decades in fact. Mary Enig’s research showed back in the 80s that saturated fat was not causing heart disease. These experts are now promoting high fat diets, low grain diets, low starchy vegetables. They promote careful consumption of animal foods that are clean and organic and humanely raised with proper nutrition (e.g. grass fed and free range ). Of course they promote high consumption of non starchy vegetables – but everyone agrees on vegetables.
    2. Many if not most published research including the largest study ever done – the framingham study. The claim that the anomalous data is no good is bogus in my opinion. Here I am referring to studies not sponsored by or influenced by big pharma.

    I Just wanted to point out the agreement of this article with the above entities (especially with Big Pharma, the most corrupt industry in history) makes its premise questionable. Moreover, the disagreement of this article with more and more nutritionists and diet savvy medical doctors and a LOT of published research makes it even more questionable.

    If high cholesterol truly is the main cause of CVD, then why hasn’t the almost ubiquitous use of statins helped? Heart disease has gotten worse and worse and is killing more and more people ever since Ancel Keys villified cholesterol and fat in his cherry picked and highly biased studies. Perhaps the epidemic of CVD is because the American Heart Associations obsession with cholesterol (perfectly in line with big pharma profits) has been wrong all along. The AHA’s promotion of refined vegetable oils in place of saturated fats and their promotion of eating lots of grains, starches, and sugar is almost certainly contributing to the CVD epidemic. It is most likely not cholesterol levels that are causing the epidemic, it is in fact the highly inflammatory dietary recommendations of the AHA, the FDA, and nearly all conventional doctors. It is in fact chronic inflammation, poor gut flora balance, and toxicity (dietary and environmental) that is damaging arterial tissues that is causing this epidemic, not high cholesterol.

    Here are two good articles on the “myth” that cholesterol is the main cause of CVD:

    https://jonbarron.org/heart-health/cholesterol-does-not-cause-heart-disease

    https://jonbarron.org/article/cholesterol-myth

    Frederic, I would like to hear your response to these articles (both by Jon Barron).

    Regards.

    • Hi DM,

      I will post a reply video or article to your comment, addressing the points made and the articles you asked me to review. However, it may take me a few weeks or up to two months to get to it… stay tuned.

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