Cholesterol: Friend or Foe?

In today’s world, a significant fear has been created around cholesterol, leading most people to perceive it as an enemy. However, cholesterol is an important nutrient and vital for life. Cholesterol is a type of fat found in all animal cells including humans and plays a vital role in the body. It is essential for various metabolic processes, including the production of hormones, bile, and vitamin D.

Our liver produces cholesterol, but most cells in the body also contribute to its production. It is transported through the blood by lipoproteins, often referred to as couriers. While the body needs only a small amount of cholesterol in the bloodstream, it serves several critical functions, such as:

• Masking and protecting injuries to blood vessels, which are caused by sugar, trans fats and ultra-processed foods.
• Building and maintaining the structure of cell membranes.
• Producing hormones like estrogen, testosterone, and adrenal hormones.
• Supporting efficient metabolism, including the production of vitamin D.
• Producing bile acids, which aid in digesting fats and absorbing essential nutrients.
• Cholesterol deactivates bacteria, controls infections, and protects against damage. It reduces the risk of AIDS and Alzheimer’s diseases and aids recovery from illness.
• Making our brain! The brain claims almost 23%  of total cholesterol in our body.

The liver produces sufficient amounts to support the body’s processes, making cholesterol a non-essential nutrient in the diet. When we consume inflammatory foods, cholesterotl levels rise. Conversely, when we eat foods rich in cholesterol, the body produces less to maintain balance.

Cholesterol levels vary at different times of the day and change with the seasons, adapting to the body’s needs. Levels tend to be higher in winter and lower in summer. Stress can cause cholesterol levels to rise, while meditation helps bring them down. Levels also increase after infections or surgeries.

Rapid Weight Loss Can Increase LDL Cholesterol

When we lose weight, our bodies burn fat that has accumulated over many years. The composition of this fat reflects one’s past dietary habits. The outer layer of fat cells is made of cholesterol, and when these cells shrink, they release not only triglycerides but also some cholesterol. Triglycerides are burned to release energy, but cholesterol is not. Instead, it travels to the liver, where it is converted into bile and sent to the gallbladder.

As a result, it is not uncommon for individuals to experience an increase in LDL cholesterol during rapid weight loss. This is something reported by many members of my health groups who have lost a significant amount of weight quickly. However, there is no need to be alarmed, as this increase is temporary. Once weight stabilizes, LDL cholesterol levels typically decrease, reflecting the benefits of an improved diet and lifestyle.

How Cholesterol Moves Around the Body: Cholesterol travels through the bloodstream via two key transport systems:

Low-Density Lipoprotein (LDL) Cholesterol, often referred to as “bad” cholesterol, carries most of the cholesterol delivered to cells.

High-Density Lipoprotein (HDL) Cholesterol known as “good” cholesterol, helps remove excess cholesterol from cells, including those in the arteries, promoting heart health.

Change in Dietary Guidelines:

Before 2015, the Dietary Guidelines for Americans recommended limiting cholesterol intake to no more than 300 milligrams per day. However, in 2015, the Dietary Guidelines Advisory Committee (DGAC) removed this recommendation, stating that existing evidence showed no significant link between dietary cholesterol and serum cholesterol levels. This position aligned with the findings of the AHA/ACC report. As a result, cholesterol was no longer considered a nutrient of concern for overconsumption.

However, further investigation revealed that many of the studies supporting this change were funded by the egg industry. Critics argue that the decision was made hastily to benefit the egg and meat industries. Evidence shows that dietary cholesterol does increase serum cholesterol levels, however there isn’t enough evidence to support that high cholesterol levels are the cause of cardiac and other problems that we assign to it. Cholesterol levels are more of a marker of ill health rather than cause of it. Here are two examples that illustrate the point I am trying to make.

(1) The Martian Scientist Analogy

Imagine you are a Martian scientist assigned to observe California. You notice that California experiences frequent wildfires during the fall season when timber is dry. You also observe that wherever there is a wildfire, a large number of humans wearing red hats (firefighters) are present. As a Martian, unaware of their role, you might mistakenly conclude that reducing the number of red-hat-wearing firefighters would solve the wildfire problem. We know this conclusion would be a grave mistake.

Similarly, in the human body, when we consume inflammatory foods, the endothelial lining of blood vessels becomes inflamed. Cholesterol in the blood comes to the rescue, forming a protective layer through a process called atherosclerosis. Interestingly, inflammatory foods often bring their own supply of cholesterol to assist in this process. For example, all animal-based foods contain dietary cholesterol.

(2) The Band-Aid Analogy

Imagine two young mothers with two-year-old boys. The first mother’s child is physically active, always running around and jumping, and frequently gets hurt. On average, he needs about seven band-aids a day. To prepare, his mother carries ten band-aids in her purse. The second mother’s child is quieter and more mentally inquisitive, spending his time pondering questions like why apples fall down instead of rising. He rarely gets hurt, so his mother carries only one band-aid in her purse. Now, if someone concludes that the first child gets hurt more often because his mother carries more band-aids and decides to take them away as a preventive measure, would that solve the problem? Obviously not.

These examples illustrate what is happening in the medical field. Cholesterol has been unfairly vilified. It is a marker of poor health, not its cause. Addressing the root causes of inflammation and poor health—diet and lifestyle —is the key to solving the cholesterol puzzle, not targeting cholesterol itself.

History of Statins

There is a rare genetic disease called Familial Hypercholesterolemia. It was discovered in the 1930s and affects less than 0.5% of the population. A drug was eventually developed and approved to treat it, but sales remained low, generating under $40 million annually. The manufacturers, seeking a broader market, rebranded the drug as a solution for heart health issues, including heart attacks and strokes, which were already on the rise. They lobbied extensively, and in 1987 successfully pushed for high cholesterol (levels over 199) to be classified as a disease. Once this reclassification occurred, the sales of statin drugs skyrocketed, making statins the first class of drugs to exceed $100 billion in worldwide sales.

This is a textbook example of the politics of health. On one hand, the FDA revised its 2015 dietary guidelines, stating that cholesterol is “not a nutrient of concern.” On the other hand, the definition of hypercholesterolemia—cholesterol levels above 199—remains intact, perpetuating the recommendation to lower cholesterol with statin drugs. Medicare willingly covers these drugs, creating a scenario where both interests are served. This situation exemplifies the saying: “Having your cake and eating it too.”