I write this thinking about Nelson Mandela. The link is weak, but he too was a force for good, who got caught up in the crosswinds of bad actors and oppression. Cholesterol has been enemy number one for 50 odd years, imprisoned for crimes it did not commit. But, there had to be a fall guy…
This high-level article offers the everyday person the basics on Cholesterol function and purpose within the human body, the common blood lipoproteins measured and caught up in the heart disease fight, and offering a perspective on both good and bad cholesterol and lipid profiles.
We all need to be brought up to speed on this hot topic. With correct information, we can make material differences in our health, and those around us.
Prefer Deep-Dive Podcasts? - click through to hear the 2019 Cholesterol Masterclass with Dave Feldman.
Cholesterol, the villain
Cholesterol has been vilified for as long as the lipid hypothesis started doing the rounds in medical institutions some 50-60 years ago. Ancel Keys and others were convinced that heart disease was caused by high cholesterol and that a low saturated-fat ‘mediterranean diet’ seemed to lower LDL – the ‘bad cholesterol’.
In Sickness and in wealth
We’ve been following the guidelines of low fat diets (specifically low saturated fat), and replacing those animal fats with high carb and sugary foods, as well as seed oils replacing animal fats.
Our disease risk has sky rocketed. From epidemic rises in obesity, diabetes, heart disease, metabolic syndrome and a plethora of autoimmune conditions.
The Statin industry, that is focussed on reducing LDL via pharmacological drugs, is a $20bn+ industry as of 2016 data, yet there is negligible clinical evidence that reducing LDL by itself reduces heart disease risk and atherosclerosis. Hmmm…
Have we imprisoned the wrong guy?
Given the disease trends, combined with data that confirms clear western societal adherence to the last half century’s worth of dietary guidelines, and the pharma industries making obscene amounts of money…
…could it be that we’ve got it wrong about Cholesterol?
Well, the common sentiment across leading lipid experts, researchers, clinicians, cardiologists and functional medicine practitioners is that we have absolutely got it wrong. We’ve banged up the wrong guy!
Some questions to ask yourself
- Why can something that the body produces, and is essential for human function, be the thing that is killing us?
- If high Cholesterol and LDL in our blood cause arterial plaque in our hearts, why does this plaque not build up elsewhere throughout our vascular system?
- Why do observed older healthy populations express high LDL without risk of CVD, nor any heart events?
- Why is low LDL Cholesterol associated with violence, impulsivity, brain strokes, depression, anxiety and other cognitive impairments?
OK, so what is Cholesterol?
Cholesterol is essential for all animal life. It is biosynthesised by all animal cells and is an essential structural component of animal cell membranes, as well as being the precursor for vitamin D, bile acid and steroid hormones such as cortisol, progesterone, oestrogen and testosterone.
Moreover, approximately 25% of our bodies Cholesterol is found in the brain, where it supports membrane function, acts as an antioxidant, and acts as the raw material for steroid hormones that interact with the brain. A recent NIH study showed that in the elderly, those with the highest cholesterol had the best memory function, and low cholesterol is associated with depression and cognitive impairment.
Cholesterol is a waxy white-yellow fat, where the liver and intestines make up over 80% of the levels we need to stay healthy. Only 20% of cholesterol measured in our blood comes from the food that we eat.
If we eat more cholesterol-rich foods, our liver will reduce its own production to maintain balance and increase efficiency. In actual fact, ingested cholesterol has little (if any) effect on blood concentrations after 7-10 hours of eating.
As an example, a human male weighing 150lbs normally produces 1 gram of cholesterol per day, and has about 35g within his body – most of which is within cell membranes.
Talk to me about Lipoproteins
As you’ve read, Cholesterol is a building block molecule. It’s usually packaged up with Triglycerides, a fatty acid that acts as an efficient and highly effective fat-based energy source for our muscles and tissues. But both are hydrophobic, meaning they don’t mix nor travel well with water.
As such, to move effectively through our bloodstream, our liver and intestines package up Cholesterol, Triglycerides and fat soluble vitamins (A, D, E & K) into Lipoproteins. Effectively a protein vessel that holds a cargo of lipids – fats.
You would have almost certainly heard of LDL and HDL when people refer to Cholesterol. These are types of lipoproteins that carry Cholesterol. They are not themselves cholesterol – just the carriers. Here’s a brief run down of the main lipoproteins:
- Chylomicrons – produced from the gut with a short ~one hour lifespan to enable quick uptake of the triglycerides from our food. Then absorbed by the liver.
- VLDL (very low density lipoprotein) – Produced by the liver. The main outbound vessel loaded with Triglycerides, and some Cholesterol and vitamins. Insulin alerts cell receptors to take in glucose and fatty acids from the blood. Glucose is taken first, and based on energy needs, VLDL will dock and alight its Triglycerides.
- LDL (low density lipoprotein) – As VLDL loses it triglycerides, it gets remodelled to IDL and then LDL. LDL will have mostly Cholesterol left, which will be taken by cells that need replenishment. Then it’s back to the liver for re-uptake.
- HDL (high density lipoprotein) – HDL acts as a donor and transferor of LDL contents and proteins. It supports the remodelling process of VLDL to LDL. High HDL is a sign of strong metabolic health.
The special role of LDL
Based on the cargo on board the low density lipoproteins (VLDL and LDL), you can see that they are an important transporter of energy and nutrients within our bloodstream.
Well, the role of LDL within the body is becoming better understood, as the dogma of ‘LDL is bad’ is starting to lift within the scientific community. Released of what seems to be faulty logic, lipid experts are observing some powerful roles of LDL.
By way of analogy, it seems that LDL is like the ambulance, being called on by our immune system whenever there is inflammation, damage or pathogens present in our bloodstream and vascular system. They are observed to have many immune supporting roles.
For example, LDL seems to bind to pathogens in the blood, in turn taking one for the team such that our cells don’t absorb them. LDL particles also seem to absorb harmful LPS’s that enter into our blood from a leaky gut, as well as absorbing pathogen probes that prevent pathogen replication.
We also find that triglycerides and cholesterol increase during infection, suggesting that they are elevated to fight infections and to fuel cells that have become temporarily insulin resistant. Hence the reason our appetites typically shrink when we are ill, because our cells are being fuelled by stored triglycerides.
Moreover, LDL is always present in arterial plaques, as observed by cardiologists. For a long time, it’s been assumed that the presence of LDL at the ‘crime scene’ of atheloscrlerosis incriminates LDL as the bad actor. That they caused the plaque and therefore must be reduced with statins and low fat diets.
However, given LDL’s immune supporting, nourishing and protective capacities, leading experts are now strongly asserting that LDL is present at the crime scene in the capacity of the ambulance, not the criminal. They are there to try and repair the endothelial damage of our arteries injured by other means, but have been caught up in the calcification and inflammation.
LDL is present at the crime scene in the capacity of the ambulance, not the criminal. They are there to try and repair the endothelial damage
And by ‘other means’, experts are hypothesising that arterial walls are getting damaged by turbulence and amplified glycation – caused by a diet chronically high in carbohydrates that in turn causes metabolic syndrome, insulin resistance * and hyperinsulinenimia (often all present in diabetes and pre-diabetes).
* Insulin Resistance is being challenged as a concept. Instead of this notion that cells are no longer responding to normal levels of of insulin, there is the Overflow Hypothesis, where the chronic elevation of glucose means that the liver and cells are too full with glucose to allow more to enter. The former would be treated with Insulin injections, whereas the latter would prescribe low carb and fasting protocols to reduce the hyperglycaemia (excess of glucose).
So what should my blood results look like?
Ok, so we’ve covered the basics of cholesterol, Lipoproteins and triglycerides. We’ve also covered off the special role of LDL. All aspects measured within a cholesterol blood test.
As you can see, it seems a little strange that Cholesterol and LDL have been demonised for so long. Yes, they are at the crime scene in arterial plaques, but were we too hasty to point the finger at them and desperately go against nature by attempting to eliminate them our bodies?
I believe we were. Many many others have reached the same conclusion, based on the professional analysis and experience. Dr. Nadir Ali, Dave Feldman, Ivor Cummins, Dr. Paul Saladino, Dr. Ted Naiman, Jason Fung and 100’s (probably 1,000’s) more leading professionals are challenging the healthcare institution and media to reflect.
So, based on everything we currently know, are we able to leverage blood Cholesterol markers for assessing health and disease risk?
There seems to be some utility, but things can and absolutely will change. We can relatively confidently describe a healthy profile and an unhealthy profile, assuming more is known about the individual.
An UNHEALTHY Cholesterol Profile
- Total Cholesterol – This metric seems largely irrelevant these days, as the below measurements are more detailed.
- HIGH Triglycerides – Triglycerides are not bad, but high levels in your blood indicate low cell utilisation, and likely too great a dependance on glucose
- LOW HDL – HDL is a marker of a strong and robust metabolic state. If it’s low, things are not operating smoothly
- HIGH Inflammation – If your HS-CRP reading is high, then there is always reason for concern. What is triggering the inflammation?
- HIGH LDL – With all of the above known, if you have high LDL, there is a problem metabolically.
The profile above is often indicative to Metabolic Syndrome – high blood pressure, high blood sugar, excess body fat around waist, and abnormal cholesterol and triglyceride levels. From here, expect Diabetes type 2 and other conditions to follow suit, unless diet is corrected.
You often see this profile with those who chronically overeat with diets high in processed food, refined carbs, sugars and seed oils, and insufficient nutrition from whole-foods.
A HEALTHY Cholesterol Profile
**following a LOW-CARB REAL FOOD diet**
- Total Cholesterol – As above, irrelevant
- LOW Triglycerides – When fat-adapted, you will be using and trafficking more triglycerides as your primary fuel source. Higher and more effective utilisation results in lower blood serum levels
- HIGH HDL – HDL is a marker of a strong and robust metabolic state. Generally, the higher the better
- LOW Inflammation – This style diet typically has a low inflammation profile, which is good. HS-CRP should be low. Other lifestyle factors can contribute to high inflammation
- HIGER(er) LDL – When using fatty acids as your primary fuel source, it means you will rely more heavily on VLDL to transport triglycerides to your cells. This in turn increases LDL. When combined with the above, this is normal and healthy
This profile is considered metabolically flexible and healthy. Perhaps because this is the most consistent with our evolutionary biological preference as Homo sapiens. You are fuelling primarily off of fat, which brings both a stable energy, plus all the essential nourishment that fat and fat soluble vitamins provide.
This profile typically includes a higher more healthy percentage of protein. Fat is used for energy and cell nourishment. Protein is the building block for cell creation and repair. Carbs are non-essentially nutritionally, but do provide a rapid delivery of energy.
**Low Carb = By low carb, we’re talking about a diet where carbs are the minority, not the majority. Most standard modern diet choices are high in carbs – representing 60-70% (or more) of calories. A diet where only 5-15% of calories come from carbs would be a fair way to describe low carb. With low carbs, fats naturally increase, as you need to predominately be fuelled by one or the other. A typical macro split would be something like 60% Fat, 25% Protein and 15% Carbs.
Other Healthy Profiles
Whilst the above seems consistent logically and evolutionarily, as well as highly correlated with people in good subjective and objective health status and lower chronic disease incidence, there are other permutations within your Cholesterol profile that are considered healthy too.
We won’t try and cover them here, but Dave Feldman has a neat beta version tool on Cholesterol Code where you can plug in your values, age and eating style and it measures your profile based on well regarded models.
By way of example, here are my stats and health risk scores based on my Low Carb real food diet that has animal-based nutrition as the central and dominant pillar:
Do what ACTUALLY makes you feel healthier
Hopefully this Cholesterol 101 piece gives you a different and refreshing perspective on Cholesterol. You needn’t worry about eating whole cholesterol-rich foods. These typically are some of the most nourishing foods for our bodies, and should be embraced, not avoided.
Cholesterol is a critically important molecule in the body. And yes, whilst there is an unhealthy lipid profile, it’s less about cholesterol and more about metabolic dysfunction through a poorly constructed diet high in inflammatory foods and refined carbs.
With this knowledge, it may make you sceptical. Sceptical of the information shared, or of the traditional guidance you’ve been told for decades. That’s a good thing. You should be sceptical – we’ve got so much wrong in the past, and are living with those consequences as a result today.
Be sceptical. Do your own research. But above all else, what matters most is how you feel and perform.
Nutritional and biochemical science is a new phenomenon in the grand scheme of Homo sapiens existence. Prior to all this data, science, measurement and guidance, we had to rely on our body and our feelings to determine if we were in good health or not. Just like every other species on the planet…
We’ve become deaf to what the human body can tell us about our health. Instead of relying on ‘fact’ to define if you are healthy or not, how about you start relying on the deep and infinitely capable intuition?
It requires you to start listening to your body again. It requires you to tune down the noise from media and ‘experts’. Don’t live a certain way with poor subjective wellbeing. If you are not feeling great, it’s not working. Doesn’t matter what the experts say…
Resources from mentioned Specialists:
- 2019 Cholesterol Masterclass with Dave Feldman – Should you be worried? – AdapNation Podcast
- Dr. Nadir Ali discussing LDL, Cholesterol, Heart Disease Risk and Low Carb Diets – Fundamental Health Podcast
- Dr. Nadir Ali describing why LDL Cholesterol goes up on a low carb diet – Low Carb Down Under Talk
- Cholesterol Code website, by Dave Feldman
- The Fat Emperor Podcast, by Ivor Cummins
Follow this and other topic areas in our longer-form Articles series as they unfold, as well as the AdapNation Food Diary for healthy meal inspiration and AdapNation’s #HyperWorkouts for free training plans. Comment if you have questions or ideas.