“My doctor says my LDL cholesterol is really high and he’s concerned,” is this week’s house call question. “Now you’re saying that I should eat more fat, which should improve my cholesterol. I thought fat was the last thing I should be eating with high cholesterol.”
I know how confusing cholesterol and dietary fat has become. The media, many scientists, and even doctors still disseminate outdated research on nutrition.
The reality is, most of us have little understanding about our cholesterol levels in our blood and the whole topic is much more complicated than we thought.
Many people still believe that eating cholesterol and fat, especially saturated fat, causes heart attacks and that taking statin drugs provide a powerful way to reduce your risk of heart attacks. But is this really true?
One of the biggest refuse-to-die myths is that dietary and cholesterol levels are the enemy and a high-fat diet causes heart attacks.
Your doctor, the media, and traditional health professionals advise that you shouldn’t eat too much fat or cholesterol; yet, study after study shows no link between total fat, saturated fat, or dietary cholesterol and heart disease.
Total Fat and Saturated Fat Don’t Cause Heart Disease
One review of 72 studies comprising almost 600,000 people found no link between total or saturated fat and heart disease, but they did find that trans-fats were clearly harmful and omega 3 fats were beneficial.
What most doctors and drug company commercials don’t talk about are the studies that show that most people who have heart attacks actually have normal cholesterol levels. Because we have statins and other drugs that lower cholesterol, the belief is that these drugs are preventing the heart attacks. What we need to focus on, is what we can do to reduce our risk for heart attack.
One large study looked at 541 hospitals with 136,905 admissions for heart attacks. Altogether, researchers accounted for 59 percent of all heart attacks in America that year.
Interestingly, all of these patients who had heart attacks did not have high LDL or elevated total cholesterol. In fact, 75 percent of those people had “normal” LDL cholesterol, with 50 percent having optimal LDL levels. So much for the high LDL contributing to heart attacks.
Here’s where it gets interesting. Only 10 percent of the participants had levels of HDL (“good”) cholesterol over 60. This means that 90 percent of these patients who suffered a heart attack had HDL levels under 60. Low HDL is a big red flag for pre-diabetes, or what I call diabesity. And we now know that low HDL is the real driver of most heart attacks and heart disease.
Indeed, researchers in this study found most of these patients had metabolic syndrome, pre-diabetes or diabesity.
I have seen this over and over in my practice over several decades. Fat and dietary cholesterol are not the culprits. It’s sugar and refined carbs that contribute to diabesity, heart disease, and so many other problems.
The End of Low-Fat Diet Recommendations
The 2015 U.S. Dietary Guidelines Advisory Committee reviewed all the research over 40 years and told us to stop worrying about dietary cholesterol, arguing it is “not a nutrient of concern.” They also finally lifted any recommendations to restrict dietary fat after 35 years of a steady diet of low-fat recommendations! This was buried in the report but is huge news.
I recently interviewed one of the world’s leading cholesterol experts, Dr. Ronald Krauss. He told me in the 1980s, when low-fat recommendations were in their heyday, he performed a study taking people with normal cholesterol and feeding them a low-fat, high-carb diet, which experts considered healthy at the time.
Dr. Krauss was shocked at what happened. This supposedly healthy low-fat diet changed healthy cholesterol profiles into heart attack-prone profiles, with high triglycerides, low HDL, and small LDL particles. Researchers were shocked.
What we now know matters most is the type of fat you eat, not the amount. Trans-fats and refined vegetable oils promote abnormal cholesterol profiles; whereas, omega 3 oils from fish and monounsaturated fats found in nuts and olive oil can actually improve the type and quantity of your cholesterol.
Trans and damaged fats are unhealthy, but the biggest culprit of abnormal cholesterol levels is not fat at all. It is sugar in all its many forms.
The sugar you consume converts to abnormal blood cholesterol and belly fat. The biggest culprit of all is high-fructose corn syrup (HFCS) found in soda, juices, and in most processed foods. That’s what causes cholesterol issues in most people, not saturated or total fat.
When you ingest fructose in high amounts without the associated fiber found in whole fruit, it turns on the cholesterol-producing factory in your liver called lipogenesis which makes super dangerous small LDL particles, jacks up your triglycerides, and lowers the HDL (or good) cholesterol. So does sugar in any form, including flour and refined carbs.
The Dangers of Statin Medication Used to Lower Cholesterol
So, why are we all obsessed with total cholesterol and LDL cholesterol when we know they aren’t the primary culprits for heart attacks? Because a multi-billion dollar drug industry exists behind the number-one best-selling class of drugs on the market: Statins.
Believing that having a low LDL is the best way to prevent heart disease, doctors often prescribe medications like statins to keep those levels low.
Yet these drugs can introduce a whole host of problems including muscle damage, memory issues, Parkinson’s-like symptoms, and muscle aches and pains. We now know that statins can increase risk of diabetes by about 50 percent.
They also prevent your muscles from working properly so when you exercise, you can’t get as fit. One 12-week study found that people who took statins showed a 13 percent reduction in fitness after a vigorous exercise program. The statins blocked the benefits of exercise.
Even more concerning is that statins don’t even work that well for preventing heart attacks, despite all the media hype and your doctor’s advice. You have to treat 50 people with statins to prevent 1 heart attack or treat 890 people to prevent 1 death. That means 889 people are taking statins with no benefit.
When the statins do work, it often has nothing to do with their effect on cholesterol. Some of the touted benefits of statins are that they lower inflammation and perform like antioxidants in the body.Overall, however, the drawbacks outweigh these and other potential benefits for most people. They may have a little more benefit for those who already have had a heart attack but not much for those who have never had one (which is when most statins are prescribed – before an incident has occurred).
7 Steps to Optimize Your Cholesterol
If your doctor is concerned about your cholesterol, you will want to use these seven strategies to optimize lipid levels and your overall health:
- Get the right cholesterol tests. You must check for particle size and particle number by asking your doctor to do a particle size test. Other cholesterol tests are outdated. A regular cholesterol test won’t reveal particle size. The tests to get are either an NMR Lipid Panel from LabCorp or the Cardio IQ Test from Quest Diagnostics. Insist on one of these tests. They are the only way to know what’s really going on with your cholesterol. You want to see results that show lots of safe, light, fluffy, big cholesterol particles. You do not want to see small, dense, artery-damaging cholesterol particles.
- Check for metabolic syndrome or diabesity. If you have small LDL and HDL particles or high triglycerides (over 100), you probably have metabolic syndrome. If your triglyceride-to-HDL ratio is over 2 you also likely have diabesity. Ask for a glucose-insulin challenge test or an insulin-response test. Most doctors don’t do this test for insulin; they only check glucose. It is performed by checking your glucose and insulin after fasting. Then you drink a 75-gram glucose drink and your insulin and blood sugar are measured again at 1- and 2-hour intervals. You should also ask your doctor to check your hemoglobin A1C, which is a measurement of your blood sugar control over the last six weeks. If it’s greater than 5.5 percent, you may have metabolic syndrome.
- Eat a healthy diet with healthy fats. The good fats in foods like avocado, coconut oil, extra-virgin olive oil, wild-caught fish, nuts, and seeds can improve the type and quantity of cholesterol in your body.
- Eat a low-glycemic load diet. Besides healthy fats, focus on a high-fiber, plant-based diet with lots of phytonutrients and omega 3 fats. That includes lots of non-starchy veggies. Consume plenty of good-quality protein found in beans, seeds, nuts, and high-quality, sustainably raised or grass-fed animal protein.
- Exercise regularly. Studies show consistent, regular exercise can optimize cholesterol levels. If you’re a newbie, even 30 minutes of walking will help. More advanced exercisers can incorporate weight training and high-intensity interval training.
- Focus on quality sleep. Optimizing blood sugar is just one of the numerous benefits of eight hours of sleep every night. Practice good sleep practices: Turn off the TV and Internet a few hours before bedtime. Many patients like to unwind with my UltraCalm CD. Get 19 of my top sleep tips here.
- Take the right supplements. You can find high-quality supplements to optimize cholesterol in my store. These include:
- A multi-vitamin
- Fish oil or EPA/DHA
- Vitamin D3
- Glucomannan or PGX (a super fiber)
- Red rice yeast
- Low-dose statins (only if you’ve had a heart attack, heart disease or if you have multiple other risk factors while carefully monitoring for muscle and liver damage)
I hope you can see how the story of cholesterol is not black and white. It’s certainly not the enemy. Follow these seven strategies outlined above and you will be able to optimize your cholesterol levels and achieve optimal health.
To learn more, sign up for my free Fat Summit: Separating Fat from Fiction, where I interview top scientists, doctors, researchers, and other health experts that show us how to lose weight, stay healthy, and reverse chronic disease. Trust me, you don’t want to miss this groundbreaking, cutting-edge summit.
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Wishing you health and happiness,
Mark Hyman, M.D.