Stop worrying about cholesterol

My doctor is concerned about my cholesterol on keto. 

Once a day at least, a message like this comes into the coaching window of the Senza app. It’s a puzzling trend because for more than 15 years, research has shown that what we were told about the links between cholesterol, saturated fat, and heart disease is dead wrong:

• The Weston A. Price Foundation knew in 2008 that cholesterol is one of the most important substances in the body. 

• Investigative journalist Nina Teicholz published The Big Fat Surprise in 2014, exposing the story of Ancel Keys and his deeply flawed diet-heart hypothesis.

• Dietary cholesterol has not been a nutrient of concern, according to the U.S. government, since 2015. 

Since our own launch in 2017, the Senza team has sent nearly a million messages to our keto community members sharing updated information about cholesterol, saturated fat, and heart disease.

Why then, in 2022, do so many people still worry about eating egg yolks, butter, and red meat? 

Myths about cholesterol and saturated fat seem to be exceptionally stubborn. Even for people who muster the courage to try a low-carb approach to nutrition, it’s hard to undo half a century of bad advice. For this issue of Fix the Food, we wanted to revisit key points in the story of cholesterol and introduce you to some of the experts you’ll want to follow to get a better grasp of the truth.

Cholesterol is vital to your well-being.

Cholesterol maintains the structure of cell membranes, supports the production of vitamin D, and assists with critical hormone balance. Fun fact: Very little, if any, cholesterol in the body comes from the food we eat. (Most people do not digest dietary cholesterol well.) The liver makes most of the cholesterol our bodies need.

Dietary cholesterol does not cause heart disease.

Neither does saturated fat. And replacing animal-based fats with industrially produced vegetable oils does not prevent heart disease. This article from the Kresser Institute rounded up the evidence in 2017, and many more studies have arrived at the same conclusion since then. 

There is no such thing as good cholesterol and bad cholesterol.

Did you know, the cholesterol carried by High Density Lipoprotein (HDL) is the same as that carried by Low Density Lipoprotein (LDL)? Peter Attia explains this fact in a May 2022 video, Intro to Lipids and Lipoproteins. 

The problem is sugar, not fat.

Over-consuming refined carbs, as well as elevated levels of stress and other factors, causes systemic inflammation that drives the need for cholesterol to intervene and repair damaged tissue in the arteries. Always-on inflammation puts us at greater risk of developing insulin resistance and obesity, which are now recognized as contributors to heart disease. As this 2018 study concluded, the key to reducing the incidence of cardiovascular disease is to control inflammation through diet, exercise, and lifestyle choices.

“Heart Healthy” labels are meaningless.

The American Heart Association’s criteria for putting the Heart Check Mark on a packaged food label are incredibly outdated:

• Total Fat: Less than 6.5 g

• Saturated Fat: 1 g or less and 15% or less calories from saturated fat

• Trans Fat: Less than 0.5 g (also per label serving*). Products containing partially hydrogenated oils are not eligible for certification.

• Cholesterol: 20 mg or less

• Sodium: One of four sodium limits applies depending on the particular food category.

• Beneficial Nutrients (naturally occurring): 10% or more of the Daily Value of 1 of 6 nutrients (vitamin A, vitamin C, iron, calcium, protein or dietary fiber)

Although it’s regulated at some level by the FDA, “heart-healthy” is essentially a marketing campaign funded by sellers of Big Food, who want you to keep eating products made of cheap, processed grains. So next time you are wondering whether to buy a processed food, flip the package over and look at what it contains, not what it claims.

Statins have not reduced death rates from heart disease.

Cholesterol-lowering drugs have been over-prescribed. According to Dr. Aseem Malhotra, statins have a marginal effect at best, and for many patients, they come with serious side effects. Perhaps most dangerously of all, they give an illusion of protection from bad eating habits. There’s more to come on this topic in a future issue of Fix the Food.

Misguided advice about cholesterol and saturated fat has taken a toll on human health.

When people remove satiating animal-based fats from their diet, they fill the void with ultra-processed carbs and industrial seed oils, which introduces a cascade of health problems. From Type 2 Diabetes to brain disorders and an unprecedented mental health crisis, society continues to pay a high price for the ill-conceived diet-heart hypothesis.

Heart disease is a big and expensive problem in the developed world, but it is largely preventable through lifestyle changes. Experts like Peter Attia, Aseem Malhotra, Dave Feldman (Cholesterol Code), Paul Saladino (CarnivoreMD), Ivor Cummins (The Fat Emperor), and Bret Scher (Low Carb Cardiologist) have been sounding the alarm for years. Read and watch their content, and start getting CAC scans, so you can be better informed the next time someone questions your way of eating.

And if your doctor is using simplistic terms like good and bad cholesterol, pushing statins, or advising “everything in moderation,” it’s probably time to find someone who has a deeper understanding of the latest nutrition science. 

Learn more about the science of cholesterol, saturated fat, and heart disease:

• Basics of Cholesterol on a Low Carb Diet is a video series with Dave Feldman.

• What causes heart disease? is an informative “Ask Me Anything' podcast episode with Peter Attia.

• A Statin Free Life, by Aseem Malhotra, makes the case for lifestyle changes over drugs.

• Bret Scher clarifies the confusion around high-density lipoprotein in this blog post.

• Ben Bikman, author of Why We Get Sick, explains that LDL plays a number of important roles in the body