The Cholesterol Confusion

The Cholesterol Confusion

Half- truths are injurious to your health!

If someone told you “smoking is beneficial for health”, at the most it may amuse you, but you would easily discard it as false. No half- truth about it.

However, when in the garb of a truthful statement, misleading falsehood is propagated, that too in what  now-a-days is turning out to be the fastest mode of communication-the social media-it has the propensity to cause harm of great magnitude.

Such a message has been in circulation recently, captioned:

 “Cholesterol is finally officially removed from Naughty List”.

Yes, the 300gm per day limit on dietary cholesterol is relaxed. But this is nothing new or extra-ordinary, because dietary cholesterol- that is raw cholesterol in diet like egg yolk, has low propensity to raise blood cholesterol in the quantity consumed (each egg yolk has 186 mg of cholesterol). However, what raises blood cholesterol most is saturated fats and trans fats.

The danger from the circulating message is the lumping together of foods containing ONLY cholesterol, like eggs and seafood, including shrimp and lobster with foods containing BOTH cholesterol and saturated fats & trans fats,  like dairy products, meat, and some processed foods.

Both are not the same. The 2015-2020 US guidelines have NOT recommended butter, full-fat dairy products, and meat as safe, as wrongly mentioned in the circulating message.

The US guidelines can be seen from: http://health.gov/news/dietary-guidelines-digital-press-kit/2016/01/top-10-things-you-need-to-know/

The relevant sections reproduced verbatim, say the following:

5.       Healthy eating patterns limit added sugars. Less than 10% of your daily calories should come from added sugars. ChooseMyPlate.gov provides more information about added sugars, which are sugars and syrups that are added to foods or beverages when they are processed or prepared. This does not include naturally occurring sugars such as those consumed as part of milk and fruits.

6.       Healthy eating patterns limit saturated and trans fats. Less than 10% of your daily calories should come from saturated fats. Foods that are high in saturated fat include butter, whole milk, meats that are not labeled as lean, and tropical oils such as coconut and palm oil. Saturated fats should be replaced with unsaturated fats, such as canola or olive oil

So please do not mix up foods containing cholesterol ONLY,  with foods containing BOTH cholesterol and saturated fats & trans fats.

While the former can be had in moderate amounts, the recommendation for saturated fats is not more than 10% of total calories, and trans fats - as low as possible. And yes, sugar should be restricted.

The second half- truth reads :  “Cholesterol doesn't cause heart disease”.

Yes, cholesterol in the blood is important for many body functions. Yes, the majority of the cholesterol  is produced by your liver. Yes, many (not majority of) people who have heart attacks have normal cholesterol levels. And yes, cholesterol doesn’t CAUSE heart disease the way the TB germ produces TB or the polio virus causes polio.  

In fact, we still don’t what is THE cause of heart disease. But we do know the following :

1.       That atherosclerosis is a disease of multiple causality. That there are various factors (we call ‘risk factors’) which singly or in combination increase your chances of having atherosclerotic coronary artery disease (CAD).

2.       That cholesterol is one of the most important of these risk factors and studies on millions of people world wide show that CAD is a continuous function of cholesterol levels even within the range we once considered "normal."

3.       Other risk factors are high blood pressure, diabetes, smoking  abdominal obesity, diet, physical inactivity, ageing, male gender (at least in the young), occurrence of coronary disease in family members etc.

4.       Different set of risk factors operate in different people. In some patients, high cholesterol alone may indeed be the dominant cause; for example people with genetically very high cholesterol levels; in others, hypertension is the dominant cause, for example in the Japanese; in still others, cigarette smoking may be the dominant cause.  But in most people multiple factors act synergistically to cause CAD.

5.       That more than a century of laboratory and human findings show that some abnormality in lipids (fats circulating in the blood like LDL and HDL cholesterol, triglycerides etc) is highly associated with atherogenesis. Although LDL cholesterol (LDLC) level is the commonest and most easily measured abnormality linked to atherosclerosis, in many patients LDLC may be normal and other abnormalities in the blood may be the reason for the disease -such as low HDL cholesterol, high  triglycerides, high Non HDLC,  LDL particle number or size, HDLC particle number or size, apoB concentration, , Lp(a), hsCRP, homocystein  etc.. That is why, although LDLC is our primary target, we also look at complete lipid profile and other chemicals in blood.

6.       That whatever the cause, the final pathway for atherosclerosis is inflammation of the inner lining of arteries (making it sticky) due to above mentioned factors and entry of cholesterol containing lipoproteins into this lining creating atherosclerosis.

7.       And finally, that  whatever the cause, studies on millions of patients worldwide since decades have shown that reducing blood cholesterol-whether by diet and exercise or by drugs or by both- causes a substantial reduction in heart disease occurrence. Diet, exercise , healthy life style and drugs like statins, not only reduce cholesterol levels in the blood but also cause the fatty deposits in arteries to stabilize and even regress, which can REVERSE CORONARY DISEASE, as seen in many studies and our own experience in clinical practice.

So the cholesterol story is not a ‘scam’, but the unfolding of one of the most important discoveries of the last century.