“Doc, what’s my cholesterol, all of it, the LDL, HDL, ratio, the whole thing?”
This is a common question; inquiring people want to know! I have had people on hospice at the end of their lives who want to know. I’ve had people bluntly tell me that they want to know so that they can talk about it at dinner. Many others think their cholesterol is of tremendous import, the barometer of whether they’ll live or die, get a heart attack or stroke, or be healthy for the next year. It really is a number that has become almost Devine in its character.
But what does it really mean?
A new Study in the Journal of the American Medical Association (JAMA Internal Medicine) has revealed a finding that counters the mis-placed axiom that cholesterol is a risk factor for heart disease and strokes and that lowering cholesterol will help prevent disease and extend life. Put simply, it doesn’t. This finding confirms what every doctor should have known for the past 50 years when the fabric of the cholesterol myth was sewn into the hearts and minds of Americans. Cholesterol is not a risk factor for significant disease, it doesn’t matter how you slice it up or how high or low it is, your likelihood of having a stroke or heart attack has nothing to do with this absurd measurement.
Then why do so many doctors measure it and tell you that you must take medicines to “fix” it?
As our video explains, the seeds of the myth were planted in the mid 1900’s by Ansel Keys, whose Seven Country Study demonstrated conclusively that in the 7 countries he studied there was a link between cholesterol and heart disease. This was breaking news! It showed up on the front page of Time Magazine, in all the big newspapers, on TV, soaring out of the mouths of doctors and patients. We must measure and lower cholesterol, that’s the ticket to good health! So simple and so scientific. And that triggered more bought-off studies by highly placed academic doctors, more fear mongering about fats, more and more medicines to lower big bad cholesterol, and a dive into our nation’s low-fat obsession.
But there was one problem. Keys’ study was manipulated to achieve the results he wanted, subsequent published studies were tainted by the stench of corporate meddling, and the anti-fat craze took off with the blessing of the academic medical community but with about as much legitimacy an earlier one devised by industry and supported by doctors that smoking leads to good health.
How did Keys do it? He studied 22 countries, and 15 of them showed the opposite conclusion of what he sought to demonstrate by failing to reveal any link between cholesterol and illness. So, like all good academic researchers financed by a corporation and on a mission to find a singular truth, Keys tossed out the results of the 15 “bad” countries and only focused on the seven that helped his case, although even in those seven nations when we correct for other variables—smoking, obesity, family history—cholesterol still doesn’t correlate to cardiovascular disease.
But reality never trumps a media-corporate-academic alliance, and soon enough America was leaping into a low-fat muck, eating more sugar and white flour, sucking down the toxic medical creation of trans-fats (margarine) which burns the body into an inflammatory fire, and not eating any of the good fats that keep our gut bacteria happy. Cholesterol numbers dropped, especially with the advent of expensive pills to lower that holy number, and in a performative act played out in every doctor’s office across the country, patents adapted the gospel that measuring and “fixing” cholesterol is the best way to make sure everything is ok in the body.
During the past 30 fat-free years, diabetes cases skyrocketed, heart attacks and strokes increased, and longevity started to stabilize and then decline. Fixing cholesterol was making people sicker. Several new studies showed an inverse relationship between cholesterol and longevity among people over 75—the higher one’s cholesterol, the longer one lives—and the fact that people showing up to the hospital with heart attacks and strokes didn’t have any worse cholesterol profiles than people not coming down with vascular disease. But those were buried in the press, and despite the dramatic increase in the very diseases our low-cholesterol focus was supposed to eliminate, everyone continued to be obsessed with measuring and fixing this vexing number. What was going on?
Turns out, as cohort studies like the Baltimore Women’s Longitudinal Aging Study concluded, the extraction of fats from our diet deprives us of healthy fat, causes us to eat more sugar and trans-fat, and lowering cholesterol doesn't translate into a smaller disease burden or longer life, just the opposite in fact.
We need to eat fat. We need to eat cholesterol. Many of us have higher cholesterols in our bodies than others, but that doesn’t mean we’re more likely to have heart attacks and strokes, nor does the ratio or the various components of cholesterol shed any light on our health. What this new study shows, and what clinical reality had proven, is that measuring and fixing cholesterol is an exercise in absurdity. We are fixing a number but doing nothing to help the person whose number is fixed. We are in fact deceiving them and making them sicker.
Most cholesterol medicines, like the expensive Zetia and Repatha, sell for tens of billions of dollars, drop cholesterol but don’t lower the incidence of fatal heart attacks. Statins (Lipitor, Crestor) do improve outcome in some circumstances, but only in people under the ago of 80, and only in people with vascular disease or high risk of developing vascular disease. In fact, statins work as well in people with low cholesterol as in people with high cholesterol if they have inflammation and are young.
Then why are we still measuring cholesterol when it is a meaningless indicator of health? Why are we using potentially toxic medicines to “fix” cholesterol when they don’t help us live longer or avoid bad outcomes? Why are we telling people to be on a low-fat diet when such diets are dangerous?
Medial dogma is difficult to exorcise from the minds of those who have been fed a huge dish of the low-fat myth and still believe it. Doctors continue to fuel the flames of this myth by using calculators (programmed by drug companies) that purport to assess the risk of having a heart attack based on their cholesterol measurements, calculators not accurate in the slightest but precise enough to convince a patient whose mind already believes that Cholesterol and Satan are close cousins. It’s time we stop paying attention to this useless number. It’s time, especially when we are older, to eat fat, to not care what our cholesterol is, and to take care of ourselves rather than expecting a pill that fixes a number to do anything for us. It won’t. Cholesterol isn’t important and its treatment is often dangerous.
Focusing on cholesterol takes our minds and bodies off what really counts: good health habits at any age.