Think You Know the “Cholesterol Story?” Think Again…

Ever since Nikolai Anitschkow fed rabbits a high cholesterol diet in 1913, medicine has been obsessed with this molecule and its relationship with heart disease.

First, a primer on what cholesterol does do in the body, since most seem to glaze over the fact that it’s actually there for a reason. Here are a few functions of the cholesterol molecule:

  1. It is an essential component of every cell membrane in your body.
  2. It is an essential component of the myelin sheath that helps nerves transmit impulses.
  3. It is the building block for our steroid hormones like cortisol, aldosterone, testosterone, progesterone and estrogen.
  4. In addition, the same pathway that makes cholesterol makes CoQ10, a critical molecule used by every cell in the body to make energy.

Other than this, cholesterol is an evil molecule that needs to be squashed out of our diets and lowered to almost zilch with high levels of statins drugs put into our water supply alongside hydrofluorosalicylic acid.

Maybe this dysfunctional view was created alongside the statins. It would not be the first time that mainstream medicine found something to treat with a drug they wanted to promote. But it seems like, much like hormone replacement therapy and the cigarette-smoking-is-good-for-you idea, the cholesterol hypothesis may be dying.

And good riddance to it when it happens. But it’s not quite time to write the obituary.

Never, ever, ever, EVER forget that cholesterol is the symptom, not the cure. Lowering it artificially with drugs will not produce the same outcome as lowering it with medications. It’s the equivalent of putting ice on the thermostat inside of a burning house. Sure—the temp is going to LOOK good, but you’ve really done nothing to change the outcome.

So what does my ranting have to do with this article? Researchers are beginning to tease apart just how worthless it is to look at just a single marker in the bloodstream and try to determine what your risk of disease is going to be.

Initially, the equation was simple total cholesterol > 200 = heart disease = statins.

Then, we matured, realized total cholesterol was relatively worthless and instead, focused on LDL (the “bad” cholesterol). Then, equation became LDL cholesterol > 130 = heart disease = statins.

Now, we may be maturing again. In this particular study, researchers looked at the “discordance” between estimating heart disease risk using purely LDL numbers versus using them along with other lipid markers. Here are the other lipid lab values that were checked:

  • Non–high-density lipoprotein cholesterol (NHDL-C)—calculated by subtracting HDL-C from total cholesterol (TC). It combines LDL-C, very low density lipoprotein cholesterol (VLDL-C), intermediate density lipoprotein (IDL-C) and lipoprotein (a) (LP(a)). Lower is better.
  • Apolipoprotein B (apoB)—a component of LDL proteins, lower is better.
  • LDL particle number (LDL-P)—a more accurate measure of LDL cholesterol.

They then looked for the number of participants that fit into one of two groups:

  1. Those with LDL of 121 mg/dL or higher but lower than average of the other markers.
  2. Those with LDL lower than 121 mg/dl but higher than average on the other markers.

This mismatch was found in 11.6% for NHDL-C, 18.9% for apoB and 24.3% for LDL-P.

Women who had the lower than average LDL-C numbers but above average numbers on the other markers, the risk of a heart attack was underestimated (NHDL-C 292%, apoB 248%, or LDL-P 232%).

On the flip side, in women with above average LDL-C levels but lower than average numbers on the other markers, the risk of a heart attack were overestimated (NHDL-C 60%, apoB 66%, or LDL-P 58%).

Overall heart disease risk remained underestimated or overestimated by anywhere from 20% to 50% for women with discordant levels. That’s a pretty wide range.

For a system of medicine that prides itself on its perceived accuracy and drug companies that spend billions of dollars to determine if we should use Drug X when the blood value is at 14 units instead of 15 units this is almost laughable.

I do have to conclude and proudly proclaim that lifestyle changes, as opposed to drugs, are going to have a positive effect regardless of what your risk of a heart attack is. Drugs to lower cholesterol, on the other hand, still remain pretty much a crap shoot.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.