Why Cholesterol Matters… and Why it Doesn’t

When you saw the title of this article, did you do a double take? I wouldn’t blame you a bit.

For over a decade I’ve been calling “naked emperor” (a nicer way to say “B…s…t”) on the cholesterol establishment, an industry worth well over 31 billion dollars a year (but who’s counting) the sole purpose of which seems to be perpetuating the myth that cholesterol causes heart disease, while at the same time promoting the message that statin drugs should be in the water supply.

(I exaggerate, but not by much.)

In 2012, cardiologist Stephen Sinatra and I published a book (The Great Cholesterol Myth) in which we argued that cholesterol was a poor predictor of heart disease, was certainly not the cause of heart disease, and that trying to lower your risk for heart disease by lowering your cholesterol was like trying to lower your risk for obesity by taking the lettuce off your Big Mac. (I actually said that on the Dr. Oz show and I still smile when I think of it!)

So what in the world do I mean when I now say, “cholesterol matters”?

Glad you asked.

The other day I was getting ready to appear on the morning show on WHN in Chicago. The segment was on healthy oils and fats, and I was setting up my prop table with samples of good oils and bad oils. On the table was a bottle of crummy generic vegetable oil—which I brought along as an example of what not to cook with. The label on this junk food oil proudly proclaimed “NO CHOLESTEROL”.

One of the crew stopped by my table, picked up the bottle, and snorted. “No cholesterol, huh?” he said. “Must taste like crap”.

OK, where do we begin?

Cholesterol matters, not as a blood test, but as a cultural meme. We are so deeply, profoundly entrenched in the myth that cholesterol is “bad”, that my poor clueless crew member assumed that anything that didn’t have this “bad” thing in it must be some kind of horrible tasting “health food”. (Cholesterol, by the way, is tasteless.) We cling to the notion that lowering the Satanic Molecule will make us healthy, lowering our risk for cardiovascular disease and early death.

None of it is true.

The point here isn’t to reargue why it isn’t true. Trust me on this for now—it’s not.

But huge masses of people continue to believe it is, and that’s why it matters. Those same people also believe that saturated fat is bad and dangerous. Why? Altogether now, class: Because saturated fat raises cholesterol. Which, as we all know, causes heart disease.

See where I’m going with this?

Continuing to believe that saturated fat causes heart disease, cholesterol clogs your arteries, and statin drugs are the 21st century’s version of penicillin—costs all of us. The belief in the dangers of cholesterol allow doctors to continue to practice medicine as a paint-by-numbers affair, allows them to continue treating numbers rather than patients, blood tests rather than diseases, and symptoms rather than causes.

Your cholesterol is 240? Get out the script pad. Never mind the fact that statin drugs have only been shown to be beneficial (and modestly so at that) in middle aged men with previous heart disease. Never mind that there’s not a single research study showing a single woman’s life has ever been extended by statin drugs. Never mind that research shows that higher cholesterol is protective in older people. Never mind that we’re measuring cholesterol with old-fashioned, out-of-date tests. Never mind that several major studies published in august, conservative journals like the Annals of Internal Medicine and the American Journal of Clinical Nutrition  have exonerated saturated fat of any involvement in heart disease.

And never mind that the side-effect profile of statin drugs includes memory loss, muscle pain, fatigue, and loss of libido. (Is it really a coincidence that we have an epidemic of “erectile dysfunction” in middle-aged men precisely when millions of those same men are on statin drugs? Maybe it is. But it doesn’t pass the smell test.)

So cholesterol matters. To many people.

And therein lies the problem.

I believe we’ve been on the wrong track in our attempts to extend life by lowering this critical, vital molecule.

I believe that the dietary recommendations of the last forty years have been built on a house of cards that crumbled when saturated fat was found “not guilty”.

And I believe that the true promoters of heart disease—and practically every other degenerative disease you don’t want to get—are inflammation, stress, and oxidation. By obsessively focusing on cholesterol, we’ve taken our collective eyes off the things that really matter when it comes to health.

I also believe that sugar—not fat—has always been the culprit in the modern diet.

Now getting that message out there—in a sea of well-funded, establishment attempts by virtually every major health organization and pharmaceutical company—has not been easy

But we’ve been doing it.

More and more doctors are getting on board, more and more books are being written detailing how we got on the wrong path, and more and more research is emerging to support the position that we’ve been wildly, bone-headedly wrong about fat and cholesterol. And that research is getting harder and harder to ignore or explain away.

But cholesterol still matters because so many people think it does.

Which means people like me—and Dr. Sinatra, Dr. William Davis, Dr. David Perlmutter, Drs. Michael and Mary Dan Eades, Dr. Uffe Ravnskov, Dr. Chris Masterjohn, Chris Kresser, many of our friends in the Paleo movement, and so many others to numerous to mention—have our work cut out for us.

Let the games begin!