Key Takeaways:

Your body produces cholesterol and it is vital for healthy cells and hormones

• More cholesterol in the blood can increase risk for damage done to the endothelium (blood vessel wall), but it’s not the ONLY factor
• Excess inflammation/oxidation and not enough antioxidants in the body promote cholesterol oxidation and hardening of the blood vessel wall
• Factors like high blood sugar and oxidized fats from things like processed seed oils can promote inflammation and oxidation in the body
• It’s not only about the amount of cholesterol in your blood, but also about how you keep it from clogging your arteries with an antioxidant-rich diet full of anti-inflammatory fats
• There are many other factors involved in heart disease risk, and overall diet and lifestyle are so much more important than cholesterol intake

Cholesterol as it relates to coronary artery disease, the most common heart disease in the US, is one of the biggest misconceptions out there. 

• Myth 1: You need to reduce foods high in cholesterol to reduce your blood cholesterol
• Myth 2: Saturated fats are to blame
• Myth 3: Vegetable oils are “heart healthy”
• Myth 4: High cholesterol is what determines risk of heart disease

Allow me to explain: 

MYTH 1: YOU NEED TO REDUCE FOODS HIGH IN CHOLESTEROL TO REDUCE YOUR BLOOD CHOLESTEROL

Believe it or not, very little cholesterol from food becomes cholesterol in your blood. Your body actually synthesizes its own cholesterol to make cell membranes, many hormones including vitamin D, bile salts, to fight inflammation, etc. In other words, cholesterol is ESSENTIAL for the body.

Cholesterol is produced at a greater rate in the body when there is energy excess. This means intaking more energy than your body needs on a consistent basis. And while it’s true that more cholesterol in the blood can increase risk for damage done to the endothelium (blood vessel wall), it’s not the ONLY factor.

Nothing can really be looked at in isolation, can it? If you’re consistently intaking more energy than you need, chances are it’s not because you’re eating way too many greens, fruit, and legumes. It’s more likely from processed, energy-dense, nutrient-poor foods.

MYTH 2 & 3: SATURATED FATS ARE TO BLAME & VEGETABLES OILS ARE HEART HEALTHY BECAUSE THEY ARE LOW IN SATURATED FAT

This becomes an issue particularly due to the resulting excess inflammation/oxidation and not enough antioxidants in the body. So what does this have to do with heart disease risk? I was shocked when I learned this:

When blood sugar is too high for too long due to excess carbohydrate intake, or you consume poor-quality fats (hello highly unstable vegetable oils) that oxidize in the body, this does damage to your blood vessels. This means that the guidelines for swapping butter for margarine has lead us immensely astray. Once this oxidative damage is done, cholesterol is actually sent to the site of injury to REPAIR the damage done. If there aren’t enough antioxidants in the body to prevent the cholesterol from oxidizing, it may become oxidized and “stick” to the blood vessel wall, becoming the plaque build up that contributes to atherosclerosis and increases our risk of a cardiac event.

This is a massive missing piece when it comes to the previous logic of statins that merely block cholesterol synthesis (and you can now see why that’s a bad thing for other reasons!) rather than keeping it healthy.  As for saturated fats that got demonized along the way, recent studies have shown that while saturated fat from red meat and butter may increase heart disease risk, other saturated fat sources like fish and fermented dairy can lower heart disease risk. You also have to think about the diet that accompanies these things too – red meat and butter may be your typical “home cooking” diet built on meat, potatoes, and very little fruits and vegetables. On the other hand, fermented dairy and fish may be in the context of a Mediterranean diet, one of the most research-backed eating philosophies for preventing chronic disease. This would also make sense given the other healthy fats in fish and abundance of health-promoting probiotics in yogurt. Again, nothing can be looked at in isolation. You must learn to think critically.

Myth 4: CHOLESTEROL DETERMINES HEART DISEASE RISK

Cholesterol is only a small piece of the full picture of heart health. It’s important to explore advanced testing in determining true risk, and some doctors are using tests such as Cardiac IQ or Boston Heart Labs to take a closer look. Additionally, there are genetic reasons for higher cholesterol, and you’ll often see people with a lipid panel that’s out of whack but a calcium score of zero and advanced markers that give a better picture of overall risk come back int the clear. Some markers that we look for are:

• Blood pressure under 140/80
• HBA1C 5.6 or lower
• Fasting glucose below 99 umol/L
• Fasting insulin less than 7 U/ml
• Cholesterol less than 200 mg/dL
• HDL over 40 mg/DL
• Trigylcerides less than 150 mg/dL
• Lipoprotein (a) less than 30 mg/dL
• ApoB pattern cholesterol less than 100 mg/dL
• Fibrinogen less than 300 mg/dL
• NT-proBNP less than 125 pg/mL
• hs-CRP less than 2.0 mg/L
• MPO less than 350 mg/g
• Homocysteine less than 10 umol/L
• TMAO less than 6.2 uM
• Calcium score as close to 0 as possible

Bottom Line:

So much more than fat and cholesterol intake, risk factors for heart disease that may need more attention include:

• High blood pressure 
• High cholesterol with increased calcification
• Tobacco or vape use
• Type 2 diabetes
• Lack of physical activity
• Excess body weight
• Poor diet
• Misuse of prescription or recreational drugs
• Preeclampsia or toxemia
• Gestational diabetes
• Chronic inflammatory or autoimmune conditions
• Chronic kidney disease
• Hypothyroidism
• High homocysteine
• Family history of heart disease
• Overuse of alcohol
• Menopause (resulting from hormonal changes)

So from my perspective, it’s not only about the amount of cholesterol in your blood, but also about how you keep it from clogging your arteries with an antioxidant-rich diet full of anti-inflammatory fats. Cutting back on fats WILL NOT cut it if you are looking to reduce heart disease risk. This is why the principles above all work together towards the bigger picture of reducing inflammation, increasing nutrient intake, and keeping your blood vessels healthy.

Have you heard cholesterol explained this way before??