Outdated scientific beliefs:
Leeches cure ear infections. Doctors don't need to wash hands between patients. Dietary cholesterol is bad for you—and having high cholesterol is bad news, too.
Safe to say the first two beliefs have been thoroughly debunked. But many conventional doctors and a lot of the general public still believe in the last one. But when we take a closer look at the cholesterol story, the myth starts to fall apart.
Is Cholesterol Actually Bad? Breaking Down the Big Bad Wolf of Bloodwork
Cholesterol is a type of fat naturally found in your body. There are a few different kinds, including small low-density lipoprotein (LDL), larger high-density lipoprotein, and triglycerides. Just like not all calories are created equal, not all cholesterol molecules are either. That is, LDL is "lousy" and can get stuck in your arteries. HDL is "good" and helps shuttle cholesterol around your body, preventing your arteries from clogging up (a condition known as atherosclerosis).
Unfortunately, many 20th century assumptions made about dietary cholesterol consumption, blood cholesterol, and heart disease risk were just that—assumptions (there were also a handful of animal studies and observational data peppered in). People believed that if you ate food with cholesterol and saturated fats (like eggs, dairy, and fatty meats) then you would increase the amount of cholesterol in your blood and, ispo facto, increase your risk for heart disease.
But ever since the diet-heart hypothesis got its foothold in the minds of American public, new experimental data has been hitting peer-reviewed journals and calling all that into question. Simply put, dietary cholesterol and saturated fat—found in things like dairy, coconut, and butter—just aren't the dietary evils once believed to be (of course, I advise most people to stay away from dairy, but not for reasons related to its fat content).
For instance, eating cholesterol does not appear to affect cholesterol levels in your blood. Plus, evidence shows that while consuming saturated fats can raise your lousy LDL levels, it can also raise healthy HDL levels, too (especially saturated fats found in coconuts). PLUS, saturated fats have even been shown to change small LDL particles into bigger ones, emulating the larger and safer HDL particle size. And a 2010 meta-analysis published the American Journal of Clinical Nutrition assessed data from 21 studies and found that "there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD."
If we MUST have a fat bogeyman, make it trans fats—this engineered Frankenfood (e.g., hydrogenated vegetable oil) does appear to increase the risk of heart disease and its associated heartaches, including heart attacks, atherosclerosis, and stroke.
So mainstream media, please stop demonizing grass-fed butter, ghee, and coconuts (which are also loaded with antioxidants). These fats are an important part of a healthy balanced diet!
6 Things Driving High Cholesterol
So if your morning eggs and bulletproof coffee aren't the main things driving high cholesterol levels, what are? Here are six main ones to keep in mind:
- Metabolic dysfunction. Metabolic syndrome is a cluster of conditions which increase a person's risk for heart disease, diabetes, and/or stroke. Among the conditions are elevated triglycerides and low levels of healthy HDL cholesterol. Chronic stress, obesity, and other factors are believed to contribute to metabolic dysfunction. It's also possible that
- Chronic infections. Latent viral or bacterial infections can overtax the immune system (and are also indicators of a weakened immune system in general). These contribute to widespread and harmful inflammation. More and more researchers and doctors are confirming the evidence which says inflammation rather than cholesterol per se is the main factor behind chronic illness—especially heart disease.
- A messed up gut. Research, including a 2018 study published in Nutrition, Metabolism, and Cardiovascular Diseases, has shown that increased gut permeability (diminished gut barrier function) is associated with both increased inflammation and higher levels of LDL cholesterol.
- Poor thyroid function. It doesn't even necessarily have to be clinical hypothyroidism, either—suboptimal function is enough to affect your body's ability to properly breakdown and remove LDL cholesterol from your blood.
- Exposure to environmental toxins. Research shows that exposure to certain chemicals (including ones used in common food packaging) is positively associated with higher cholesterol levels.
- Genes. Sorry—some of us are just genetically predisposed to having higher than normal cholesterol...but this doesn't necessarily spell doom and gloom. Maximizing lifestyle via nutrition and exercise is still effective for optimizing blood lipid levels in people with a family history, and it's even MORE essential for people with the inherited gene mutations driving cholesterol levels up.
As you can see, a lot of these are within our control. By improving main lifestyle factors—how well we sleep, how well we exercise, how well we manage stress, and how well we stay away from refined sugar, gluten and other substances known to disrupt our digestive, metabolic, and immune health—we can help keep our cholesterol levels in check.
But let's not forget one last important point: "high" cholesterol isn't even necessarily bad.
A Better Way to Assess Your Lipid Panel
I 10/10 recommend getting your blood work done with your physician—or better yet a functional medicine doctor who's privy to the latest research in nutrition and holistic wellness. Collecting both subjective data (how well you feel/look) and objective data (what your "numbers" are, including body fat percentage, lean body mass, and lipid panel) helps you better understand your unique health and how you can improve it.
But simply looking at your total cholesterol isn't enough to give you the whole picture. Don't let your doctor be intellectually lazy and get away with telling you your cholesterol is "bad" simply because the total amount is over 200 mg/dL. Be sure to ask for the following data points:
- HDL: the good stuff, heart healthy. Aim for 60 mg/dL or higher.
- LDL: the bad stuff. Aim for less than 100 mg/dL.
- Total cholesterol to HDL level: this ratio helps you see how much of your good HDL cholesterol is contributing to your total cholesterol. The lower the ratio the better.
- Non-HDL cholesterol level: subtract your HDL level from your total. It shows you how much "bad" cholesterol you have. Optimal is less than 130 mg/dL.
- Triglycerides: these cholesterol particles increase with greater levels of inflammation, so the lower the better. Shoot for less than 150 mg/dL.
By the way, if you're wondering why a lot of conventional docs just aren't looking at blood lipid profiles in this way, it's largely because many doctors simply aren't aware of the latest research on what cholesterol levels are actually telling us. Few fields outside of healthcare see innovation happening at a faster rate, which means that by the time many doctors get into clinical practice, the information they learned from their medical textbooks is often outdated. And if they aren't keeping up with the latest research (which takes a modest investment in time and energy), then they simply won't be able to practice the type of evidenced-based medicine that due diligence demands.
For what it's worth, I also recommend testing for additional biomarkers including Vitamin D, C-reactive protein (a marker of inflammation), fasting glucose (how much sugar is in your blood), A1C (the average amount of sugar in your blood over the past 2 to 3 months), and thyroid-stimulating hormone, or TSH (which assess how well your thyroid gland is working). But getting a solid lipid profile done—and knowing how to evaluate it correctly with your healthcare provider—is a great start.