How the Cholesterol Skeptics Can Harm You

by Paul Rogers on August 26, 2008

Cholesterol and saturated fat in the diet

Pic courtesy jslander

Do a search for ‘cholesterol and heart disease’ in Google and you will see that many of the results in the first few pages are from sites that dispute the current medical view that cholesterol is a major factor in causing heart disease.

Some of the advocates of this position are well known ‘alternative’, or at least fringe movements that have a particular dietary barrow to push. Many belong to the low-carb brigade, indigenous diets advocacy, Paleo nutritionists, and sadly, some bodybuilders and weight trainers and men’s health advocates. And, of course, it should be said that many reputable people within these movements do not accept the ‘cholesterol myth’ line.

Cholesterol is a factor in heart disease and these people are dangerously wrong. They rely on dumbing down a complex scientific issue to impress a gullible audience. I could write a long review of this issue, fully supported by references, but I won’t waste my time, or yours. Here are a few crucial points to consider.

It’s the Cholesterol, Stupid!

  1. In the condition familial hypercholesterolemia (FH), individuals have naturally very high cholesterol levels as a result of a genetic abnormality. If undiagnosed, or without treatment, such people can die of heart attacks in childhood or in early adulthood depending on the severity of the condition. Brown and Goldstein won the Nobel Prize for their work on cholesterol, HF, and how cholesterol causes cardiovascular disease. The science of HF alone, should be enough to send the cholesterol skeptics packing — but still they persist.
  2. Although I am no promoter of pharmaceutical company interests per se, there is little doubt that statin medications improve heart disease conditions and fatal outcomes in people with high cholesterol by a combination of lowering LDL cholesterol and probably raising HDL cholesterol. The evidence is just too overwhelming. In fact, in recent years, the cholesterol skeptics have subtly shifted their attacks from “cholesterol does not cause heart disease” to, “saturated fat does not cause heart disease”, which is a softer target for them considering the complexities of different chain length saturated fats and the interactions of mixed diets.
  3. The skeptics like to juggle the medical literature to try to show that there is no valid evidence linking high cholesterol to heart disease. However, it’s not in dispute that heart disease is dramatically low in healthy populations with total cholesterol levels under 150 mg/dL or 3.9 mmol/L. Cardiovascular disease rises with increasing total cholesterol, and especially LDL cholesterol, in most populations.
  4. Even so, some populations in some countries seem to defy this trend, and these are the people the skeptics concentrate on when delivering their message. The thing to remember is that heart disease is multifactorial — that is, cholesterol may only be one factor among several, even though it is a major factor. Some populations will, through genetics or lifestyle, defy the atherogenic effects of higher cholesterol to some extent. This seems to be the case with the ‘French paradox’, in which French populations have much lower heart disease than other country groups with similar cholesterol levels. That does not mean that cholesterol is not a major factor in heart disease for most populations.

Overall, considering the established science of familial hypercholesterolemia, and the evidence from statin drug trials, including regression of plaque with cholesterol lowering, the evidence is so overwhelming for a dominant role of blood cholesterol in heart disease, and the influence of poor nutrition in raising blood cholesterol, that one can only assume the cholesterol skeptics have another agenda. I don’t know what it is, but it doesn’t take too much thought to come up with a list of industrial food interests that might benefit from this hogwash. Believe them at your peril.

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