Does Cholesterol Cause Heart Disease?
Here’s the truth. Cholesterol is not synonymous with heart disease. It is not a poison or a foreign substance like a virus. On the contrary, it is needed by the body:
- As building blocks for cell membranes in all our cells
- As raw material for steroid hormones (cortisol, progesterone, estrogen, and testosterone), bile acids, and vitamin D
- As a major component of the brain that helps in learning and memory
An adult on a low-cholesterol diet typically synthesizes about 800 mg of cholesterol per day, mostly in the liver. This number can bump up to as high as 3000 mg per day.
Are these facts contradicting the “cholesterol” alarm bells in your brain? We have heard time and again that cholesterol is evil – a taboo for a healthy heart and something that must be suppressed at all costs. The version we all heard is this:
Any damaging agent – an infectious organism, a toxic chemical (like nicotine), or a free radical – can injure the walls of our arteries. Cholesterol in the blood gravitates toward the site of injury where it fills in lesions and tears, accumulates, and hardens over time to form plaque.2 If the plaque ruptures, blood clots and blocks the free flow of blood in the arteries. Any arterial blockage can cause organ failure and potentially death.
However, now understanding how natural and necessary cholesterol is for our body, we can’t help but question: Is cholesterol really all that bad? Does it really cause cardiac disease?
Claim 1: Yes – High Cholesterol Causes Inflammation
Has Misinformation Misled Us?
All the brouhaha linking dietary fat and heart disease stems from Ancel Keys’ Seven Countries Study done decades ago. The conclusion was based only on 7 of the total 22 countries in the study, eliminating data from countries that opposed the theory that high fat intake equals a high rate of heart disease.
This popular school of thought suggests that high cholesterol triggers tissue-damaging inflammation and, hence, cardiac disease. Because of high dietary intake of cholesterol and/or unhealthy fats, blood cholesterol levels rise. Immune cells engulf cholesterol and are activated. While this is definitely an advantage when it comes to fighting off an infection, it worsens diseases that are associated with chronic inflammation, such as atherosclerosis and obesity.
Claim 2: No – Inflammation Causes High Cholesterol
Cholesterol and LDL production in the liver is increased due to inflammation. This is why cholesterol levels are seen to increase after any inflammation-stimulating activity like a tooth extraction or a surgery.
This less popular cholesterol hypothesis, common among naturopaths, proposes that inflammation is the real culprit and cholesterol is just an indicator of inflammation. It proposes that cholesterol helps keep inflammation under control.
In response to tissue injury, our immune system gets activated and sends inflammatory molecules to ward off infections at the site of injury. While the immune system intends to do only good, free radicals are often produced in the process – the true culprits of diseases like cardiovascular disease. The liver then steps in and increases the production of cholesterol to cement the site of injury and prevent further damage by free radicals, while also providing raw material for new cells needed for the repair. Cholesterol is sometimes successful, and other times it is not. Free radicals may counterattack and oxidize cholesterol, causing it to become denser and pellet-like. When pellet-like cholesterol settles in the the walls of arteries, it can cause arterial blockage.
Claim 3: It Depends On Type – Some Types Of LDL Are Bad, While Others Are Not
A cholesterol particle test measures each type of LDL giving a more accurate diagnosis of cardiac disease risks compared to a lipoprotein profile.
Recent findings claim that there are two different types of LDL and not all LDL is bad. One type is large, fluffy, and harmless, while the other is small, pellet-like, sticky, and harmful.7 Only the latter is believed to be indicative of any risk of cardiac disease.
Tips On How To Lower Cholesterol Naturally
Avoid anything that is refined, processed, white (bread, bagels, buns, pasta, rice, tortillas), or artificially sweetened.
Extensive research on cholesterol is still under way, and concrete claims still need to be made. Prevention of cardiac disease being the prime goal for us to lower our cholesterol levels, we can safely say lowering cholesterol, LDL, and inflammation will offer us significant protection. Diet and physical activity is the way to go.
1. Steer Clear Of Packaged, Long Shelf Life Foods
The need for longer-lasting foods emerged not too long ago. To meet this need, man created a new variety of fats that, unfortunately, also happened to be self-detrimental. These fats called trans fats or hydrogenated fats are nothing but vegetable oils that have been solidified to make them more reusable and long-lasting. While they serve their purpose, they also increase cholesterol levels. Trans fats can also be found naturally in animal fats – dairy products and some meats.
Despite the FDA banning artificial trans fats or partially hydrogenated oils in processed foods and removing their “generally recognized as safe” label, they have continued to linger in the fast food industry.
Foods to avoid: Foods fried in hydrogenated shortening (french fries and chicken), packaged baked goods (crackers, cookies, doughnuts, cakes), hard margarine, and even unsuspecting dietary supplements.
Tip: Check food labels for “hydrogenated,” “trans,” or “shortening” and avoid them. Suspect foods that are packaged or processed and can last for months. When eating out, check with the restaurant if they are using trans fats for cooking.
2. Keep Away From Sugar
A common low-fat diet mistake is substituting fat for sugar. It is equivalent to choosing the worse of two evils. Sugar increases inflammation in the body, including the arteries. Directly or through elevated cholesterol levels, inflammation can lead to atherosclerosis, making sugar a risk factor for heart disease. High sugar content also translates to more calories, something that is best avoided for optimal health.
Foods to avoid: Not just table sugar, but anything that has “syrup” or “ose” in its ingredients list. Sugar-rich foods include sodas, energy drinks, bread, pasta sauce, and salad dressings.
Caution: Patients with insulin resistance, obesity, and metabolic syndrome need to be particularly careful about their sugar intake.
Tip: Instead of opting for low-fat foods with high sugar, opt for higher-fat variants with no trans fats.
3. Limit Intake Of Red Meat And Whole-Milk Dairy Products
About 85% of your blood cholesterol is produced by your liver and only 15% comes from food. This means whether or not you consume large amounts of cholesterol, the chances of it affecting your blood cholesterol levels are insignificant.
Saturated fats and dietary cholesterol are mostly of animal origin – meat (particularly red meat) and dairy. While there is evidence that too much saturated fat in the diet increases cholesterol, whether or not this causes an increased risk for heart disease is still debatable. The stand on dietary cholesterol seems to be more definite. Studies implicate that dietary cholesterol may increase LDL, but by simultaneously increasing HDL, it maintains the LDL:HDL ratio. Also there seems to be no link between dietary cholesterol and heart disease. Because cholesterol and saturated fats are both usually of animal origin, they are often are found in the same foods. By limiting the intake of one, the other automatically is kept in check as well.
Keeping in mind these discrepancies, it makes sense to eat saturated fats and dietary cholesterol but in small amounts and preferably every couple of weeks.
Foods to eat in small amounts:
- Saturated fats: Fatty cuts of meat, whole-milk dairy products (such as butter and high-fat cheeses), lard, and some tropical plant oils like coconut and palm oils. Leaner meats like poultry (with the skin) and pork loin generally have less saturated fat. Limit saturated fat intake to no more than 30g of saturated fat a day for men and 20g for women.
- Dietary cholesterol: Liver and other organ meats, egg yolks, shrimp, lobster, and whole-milk dairy products (including butter, cream, and cheese). Up to 4 egg yolks a week is fine, egg whites as many as you like.
4. Eat More Soluble Fiber
Though soluble fibers, derived from plants, don’t add any nutritional value to your diet, they help lower blood cholesterol. Soluble fibers dissolve into a gel-like substance and coat the intestinal walls, preventing absorption of fat and cholesterol into the bloodstream. They also promote the growth of probiotics in the gut and help in intestinal cleansing, added perks for your digestive system. Fiber-rich foods also keep you satiated for longer, reducing your appetite and your calorie intake.
Foods to eat: Whole-grain foods (barley, oatmeal, oatbran), fruits with the skin (berries, bananas, apples), leafy and cruciferous vegetables (broccoli, Brussels sprouts, carrots), legumes (dry beans and peas), and flax and chia seeds.
Caution: Increase your fiber intake gradually to allow your body to adjust. If you shock your body with an overdose of fiber, it may reciprocate with abdominal cramps or bloating.
5. Eat Unsaturated Fats
Know Your Fats In A Nutshell
Bad: Trans fat (packaged foods), solid at room temperature
In between: Saturated fat (meat and dairy), bad if consumed in excess, usually solid at room temperature
Good: Unsaturated fat (extra virgin olive oil, fatty fish, avocados, and plant-derived oils), liquid at room temperature
Monounsaturated and polyunsaturated fats help reduce blood cholesterol levels. Omega-3s, a type of polyunsaturated fat abundant in fatty fish, may help prevent inflammation in arteries and subsequent clotting of blood, reducing the risk of heart disease.
Foods to eat:
- Monounsaturated fats: Olive oil (about 77% monounsaturated fats), canola and soybean oils, peanut oil, avocados, flax seeds, and most nuts (walnuts).
- Polyunsaturated fats: Fatty fish (wild cut salmon, herring, trout, tuna, and mackerel), plant-based oils (safflower, olive, canola, grapeseed, sunflower, and peanut oils), tofu, soybeans, nuts (such as walnuts), and seeds (such as sunflower seeds).
Caution: Pregnant and breastfeeding women should avoid some types of fish, especially those high in mercury.
Tip: Eat two fish meals each week.
6. Include Plant Stanols And Sterols In Your Diet
Being structurally similar to cholesterol, plant stanols and sterols block out cholesterol absorption in the intestines, getting absorbed themselves and eliminating excess cholesterol from the body. This helps lower LDL levels without affecting HDL levels. If you are already at a high risk of heart disease or your cholesterol levels are high, only then including these compounds in your diet will prove beneficial. No such benefits are seen for other groups of the population.
Foods to eat: Colorful fruits and vegetables like yellow squashes, carrots, tomatoes, strawberries, plums, and blueberries, wheat germ, wheat bran, peanuts, vegetable oils (corn, sesame, canola, olive oil), almonds, and Brussels sprouts.
Caution: Plant stanols and sterols should be avoided by pregnant and breastfeeding women. As they also lower intestinal absorption of vitamins and beta-carotene, it is advisable to compensate by eating lots of fruits and vegetables, including at least one rich in beta-carotene (carrot, broccoli, apricot).
9. Quit Smoking
Chemicals in tobacco can irritate the walls of your arteries, promoting inflammation and plaque formation. To make matters worse, they also increase LDL cholesterol and lower HDL cholesterol – the perfect recipe for heart disease. Conquer your addiction and quit smoking. This will help you increase and normalize your HDL cholesterol levels. More HDL cholesterol means lesser availability of cholesterol in tissues, lowering the chances of clogged arteries. What’s more, this increase occurs rapidly after quitting, likely within three weeks.
Some Extra Advice
- Instead of using salt, sugar, or fat to make foods tastier, use spices (turmeric, basil, and rosemary) and herbs. While adding flavor, they also suppress inflammation.
- Get a lipoprotein profile blood test done after a 9-12 hour fast to know your cholesterol levels – total cholesterol, HDL, and LDL. Those aged 20 and above should get this test done at least once every 5 years.
- To reduce risks of atherosclerosis and heart diseases in general, limit sodium, alcohol, and caffeine intake.