High Cholesterol (Dislypidemia) is one of the most prevalent chronic disease conditions of modern day. It is also one of the most misdiagnosed, misunderstood and mistreated health conditions in healthcare—with many claims that “high cholesterol causes heart disease.” Please read on to learn about the 5 High Cholesterol Myths.
The fact: It does not.
5 High Cholesterol Myths
As you will soon learn, the conventional diagnosis and treatment of high cholesterol may not be 100% accurate—especially when you understand these 5 High Cholesterol Myths.
- Myth #1: High Cholesterol is a Risk Factor for a Heart Attack
- Myth #2: LDL Cholesterol is Bad & HDL Cholesterol is Good
- Myth #3: High Cholesterol is Genetic (If Your Parents Had It, You’ll Probably Get It
- Myth #4: Statins Save Lives
- Myth #5: Avoid Dietary Cholesterol & Saturated Fat to Lower Cholesterol
Before we dive into these myths, let’s first define what “high cholesterol” means in the first place and what conventional treatment looks like in mainstream medicine.
WHAT IS CHOLESTEROL
Cholesterol is a fat-like sterol (steroid fat and alcohol combo) that is produced by the liver.
Cholesterol helps your body make other essential molecules such as hormones, human tissues, cell membranes, Vitamin D, and bile acids to help you digest your food. Cholesterol is also crucial for neurological (brain) function and helps you think clearly (i.e. no brain fog).
Without cholesterol, you would not exist. Your body needs cholesterol to function properly, think clearly and balance out your metabolic processes.
WHAT DOES IT MEAN IF I HAVE “HIGH CHOLESTEROL?”
Nearly 1 in 3 Americans has “high cholesterol” (1).
Many have no idea they have it since symptoms are typically silent or intertwined with other correlating conditions, such as metabolic dysfunction, thyroid imbalances, weight resistance, high blood pressure, skin problems and other signs of inflammation.
In short, “high cholesterol” typically means: “inflammation.”
The body desires balance.
Just like too much of anything can send your body out of balance (i.e. too much estrogen=PMS, too much Vitamin D=Vitamin D toxicity; too much thyroid hormone=hypothyroidism), too much cholesterol should be your “warning sign” that there is inflammation in your body somewhere.
Since your liver is your body’s natural detoxifier and “anti-inflammatory” organ, if your liver is unable to control and regulate the amount of cholesterol it produces, this often results in “out of whack” high cholesterol markers on blood work.
The main takeaway: Your body is inflamed…somewhere.
HIGH CHOLESTEROL DIAGNOSIS
Blood testing is the best way to test for high cholesterol, since many of the symptoms of high cholesterol typically go under the radar or are “masked” by other correlated inflammatory conditions (such as metabolic dysfunction, thyroid problems, insulin resistance, low energy, etc.).
According to standard lab testing, “High Cholesterol” markers meet the following criteria:
- Total Cholesterol
- Ideal: Below 200 mg/dL
- Borderline High: Above 200 mg/dL
- High: Above 240 mg/dL
- Total Cholesterol
- LDL (low density lipoprotein):
- Ideal: Below 100 mg/dL (for high risk patients), Below 130 mg/dL (for non-risk patients)
- Borderline High: 130-160 mg/dL
- High: Above 160-190 mg/dL
- LDL (low density lipoprotein):
- HDL (high density lipoprotein):
- Ideal: Above 50-60 mg/dL
- High Risk: Below 40 mg/dL (men); Below 50 mg/dL (women)
- High: Above 240 mg/dL
- HDL (high density lipoprotein):
- Ideal: Below 150 mg/dL
- Borderline High: Above 150 mg/dL
- High: Above mg/dL
In medicine, a diagnosis of true or “pure” hypercholesterolemia (high cholesterol) equals:
- High total cholesterol
- High LDL levels
- Normal triglycerides
- Normal HDL levels
Pure high cholesterol is typically related to genetics and/or long term inflammation.
Dyslipidemia, on the other hand, (i.e. “pseudo high cholesterol”) typically presents as:
- High triglycerides
- Low HDL
- Normal or high total cholesterol
- Normal or high LDL cholesterol
It is even possible to have normal and even low total cholesterol and high LDL particle number
Dyslipidemia (“pseudo high cholesterol”) is most commonly caused by metabolic dysfunction and inflammation in the body (i.e. other underlying conditions, like gut infection and hormone imbalances).
The bottom line: Pure high cholesterol is most often caused by genetics and family history. Dyslipidemia is caused by inflammation and lifestyle (especially metabolic dysfunction).
CONVENTIONAL TREATMENT OF HIGH CHOLESTEROL
If it is determined you have high cholesterol the first line of defense for treatment is “lifestyle changes,” such as a “healthy diet” and exercise. Patients are typically told to:
Conventional Medicine: High Cholesterol Lifestyle Modifications
- Avoid red meat and high cholesterol foods (like eggs, bacon and butter)
- Avoid saturated fat
- Take it easy on the salt
- Move more
- Eat heart healthy whole grains, fruits and vegetables—potentially even consider a vegan or vegetarian diet
- Eat less overall
However, if you’ve made these important lifestyle changes and your cholesterol levels STILL remain high (as they often do because several of these advice tips, like “avoiding fat,” are actually myths), your doctor may also recommend medication—namely statin drugs, like Pravachol®, Zocor® and Lipitor.®
Approximately 1 in 4 Americans over age 40 are on a statin drug to “lower” total cholesterol (2).
Common Medications Prescribed for High Cholesterol
Other common medications sometimes prescribed for “high cholesterol” include: Bile-acid-binding resins, Cholesterol absorption inhibitors, Injectable medications, Fibrates, and Niacin (for “high triglycerides”).
Unfortunately, while there are many exaggerated claims and a lot of hype about the benefits of statins and these other drugs, there are also many studies showing little to no benefits at all—particularly for preventing heart disease (3, 4, 5).
Even worse, recent studies actually reveal people have increased risk for heart attacks and cardiovascular disease when they quit statins altogether (6). The Mayo Clinic also highlights several known risks and side effects including: liver damage, muscle pains, gastrointestinal problems, insulin resistance (blood sugar imbalances), memory loss and neurological impairment (7).
While statins can be beneficial for some people in certain circumstances, they may not be beneficial for all—especially when you better understand the myths and truths about high cholesterol and treatment in the first place.
So what should YOU do about “high cholesterol?”
Check out these 5 Myths About High Cholesterol You’ve Believed to understand what really matters, what does not, and how to naturally support your high cholesterol markers to be the healthiest version of yourself.
5 High Cholesterol Myths That Will Blow Your Mind
Myth #1: High Cholesterol is a Risk Factor for a Heart Attack
We have all been led to believe that cholesterol is bad and that lowering it is good—especially for preventing heart disease.
But what does that evidence really show?
75% of people who have heart attacks have normal cholesterol (8, 9).
Plain and simple: the cholesterol-heart disease link is weak.
When considering the real “side effects” of “high cholesterol” it’s important to look at what is driving the “high cholesterol” in the first place (inflammation).
High cholesterol markers are a sign of inflammation somewhere in the body.
Certainly, heart disease may be a result of inflammation in the body, but more common side effects of high cholesterol (inflammation) include: metabolic dysfunction, insulin resistance, blood sugar problems, thyroid problems, fatigue, gut problems, hormone imbalances and an inflammatory lifestyle (smoking, high alcohol consumption, toxic burden, etc.). Often times when we address those other sources of inflammation first, cholesterol markers naturally resolve.
Myth #2: LDL Cholesterol is Bad & HDL Cholesterol is Good
When people talk about cholesterol, they often use the terms LDL and HDL.
Both are lipoproteins (compounds made of fat and protein) that are responsible for carrying cholesterol throughout the body in the blood.
- LDL is low-density lipoprotein, often called “bad” cholesterol.
- HDL is high-density lipoprotein, or “good” cholesterol.
LDL is called the “bad” cholesterol because it’s believed that too much of it can lead to hardening of the arteries. The American Heart Association states that LDL leads to plaque accumulation on the walls of your arteries, narrowing blood vessels and leading to blood clots.
HDL, on the other hand, is called the “good cholesterol” because it is thought to keep your cardiovascular system healthy. The American Heart Association states it aids in the removal of LDL from the arteries and carries the bad cholesterol back to the liver, where LDL is then broken down and eliminated from the body.
However, while the LDL-HDL theory SOUNDS good, NEITHER of these markers are as important as two cholesterol markers that are NOT tested on average cholesterol panels: lipoprotein (a) or “Lp(a)” and LDL-P.
Your Lp(a) or lipoprotein numbers shows the measure of the TOTAL AMOUNT of lipoprotein particles (i.e. LDL and HDL) in your body.
Current Research for High Cholesterol
Current research overwhelmingly reveals that your Total lipoprotein levels—specifically the LDL particle number (LDL-P)—are more strongly associated with heart disease, “clogged arteries” and whether or not you’re genetically at risk for such conditions instead of the standard HDL and LDL levels. (10, 11, 12, 13, 14, 15).
In short: If you have MORE total lipoprotein particles (HDL and LDL) in your body, the HIGHER risk you are for unhealthy cholesterol levels actually being a “big deal.”
Higher lipoprotein particles (particularly LDL-p) in conjunction with abnormal LDL or HDL levels means you ACTUALLY DO have higher amount of cholesterol in your body, or a medical diagnosis of “high cholesterol.”
However, if you have a LOW AMOUNT or NORMAL AMOUNT of total lipoprotein particles in your body and your standard cholesterol markers come back “high” on bloodwork, they ACTUALLY may NOT be as clinically significant or “high” as doctors may lead you to believe.
UNDERSTANDING HOW LIPOPROTEINS, LDL & HDL WORK
Consider this analogy: Your bloodstream is a highway.
The lipoproteins are the cars that carry the cholesterol and fats around the body.
The cholesterol and fats are the passengers in the car.
For decades, we’ve been hyperfocused on the number of passengers in the cars (i.e. especially LDL cholesterol), without paying attention to how many lipoproteins you actually have in your body in the first place.
If you have ALOT of cars on the road, during rush hour traffic (LOTS of lipoproteins), then you are at a higher risk for crashes, break-downs and stalled vehicles (i.e. “problems” associated with high cholesterol and inflammation).
If you have FEWER cars on the road (fewer lipoproteins), you have less risk for “crashing” and breaking down.
How do I check my lipoprotein (a)?!
Unfortunately, most doctors and lab tests do NOT check for lipoprotein(a) markers on traditional blood panels.
Ask your doc at your next routine visit if he or she can check both the LDL-P and Lp(a)-P markers. .
True Health Diagnostics https://truehealthdiag.com also offers a panel that many functional medicine doctors will use, which contains both LDL-P and Lp(a)-P, and Direct Labs offers the Lp(a) blood marker that patients can order directly: https://www.directlabs.com/TestDetail.aspx?testid=288
Once you get results back, normal values for Lp(a) are less than 30 mg/dL, and normal values for LDL-P are less than 1000 mg/dL.
Myth #3: High Cholesterol is Genetic (If Your Parents Had It, You’ll Probably Get It
Genes load the gun, but environment (always) pulls the trigger.
In fact, genes hold only about 5-10% weight in our health as a whole.
The other 90%? Lifestyle and inflammation related—including diet, movement, stress, environmental toxicity, sleep, hormone balance, underlying pathologies (gut infection, thyroid, metabolic dysfunction) and all around health behaviors.
Unfortunately, only 6% of Americans engages in all 5 of the “top” health behaviors according to the CDC (16), including:
- Not smoking
- Sleeping 7-9 hours each night
- Moderate or no alcohol consumption
- Keeping physically active
- Maintaining a healthy weight
In short: What COULD your health be (and cholesterol markers) if you addressed and focused on your lifestyle first?
Since “high cholesterol” is a sign of inflammation in the body, it is ALSO crucial to address the other “underlying” factors that play a role in inflammation, including metabolic dysfunction, blood sugar imbalances, liver congestion, gut infection and bacterial overgrowth, leaky gut, thyroid imbalances. Often times as these other markers are addressed holistically, standard “high cholesterol” markers improve.
Lastly, in addition to addressing your lifestyle and underlying pathologies, ask your doctor to consider these two markers to determine if you have genetic high cholesterol or not:
- lipoprotein (a) particle number —specifically LDL-P
- apoB protein
High Cholesterol Interpretation
Familial hypercholesterolemia (FH) involves a mutation of a gene that codes for the LDL receptor or the apolipoprotein B (apoB protein), and LDL-P (as discussed in Myth #2) are strongly influenced by genetics. If you have higher LDL-P (above 1000 mg/dL), chances are your higher cholesterol IS more associated with your genetics.
Here’s how to interpret your lipoprotein (a) results if the number comes back “high:“
- High LDL-P Results + Genetic History: If your LDL-P lipoprotein test comes back and says you have HIGH LDL-P and HIGH cholesterol markers and you have a family history of high cholesterol, then your “high cholesterol” is most likely due to genetic factors, and this is when medications may be warranted after addressing lifestyle factors and underlying pathologies first.
- High LDL-P Results (BUT No Strong Genetic History): If your LDL-P lipoprotein test comes back “high,” “borderline high” or “normal,” but you don’t have any family history or minimal genetic ties to high cholesterol, then chances are, your “high cholesterol” is due greatly in part to inflammation and lifestyle factors and is more reversible. Work with a functional medicine practitioner, nutritionist or other skilled professional to address the OTHER underlying causes of inflammation first—with an emphasis on metabolic dysfunction (Other body systems to consider: thyroid health, insulin resistance, blood sugar, physical activity, diet, etc.)
Myth #4: Statins Save Lives
Statins are the “go to” drug of choice with 1 in 4 adults above age 40 on these “cholesterol lowering” medications nationwide.
In fact, it is perhaps not coincidence that, in 2004, when the statin Lipitor went viral in the pharmaceutical market , that same year the FDA changed the “healthy” lab ranges for high total cholesterol markers from 250 mg/dL or below, to 200 mg/dL or below; and “healthy” LDL ranges from 130 to 100 mg/dL or below—making more of a case for more Americans to need these life saving medications. (17) By 2005, Lipitor had generated a total profit of $12 billion alone in sales. For years, we’ve been told by the pharmaceutical industry that lowering cholesterol via statin drugs prevents heart disease, but can statins really cure or reverse coronary heart disease?
The answer is a clear “no.”
The risks of heart attacks and death have been seemingly reduced, but not eliminated, nor statistically “significant” —making researchers question whether or not statins for “high cholesterol” are really worthwhile. For example, in the widely pub-licized Scandinavian Simvastatin Survival Study, 4,444 participants took the statin drug (Zocor®) or a placebo (18, 19).
Heart attacks and death decreased from 28% in the placebo group to 19% in the statin group. In other words: for every 100 people who took a statin drug (Zocor®), 9 heart attacks were prevented…however 19 heart attacks still occurred.
The researchers concluded that the statin group had only a 30% less likely chance of getting a heart attack at best. Similar trials (3, 4, 5) have yielded similar unimpressive results for high-cholesterol patients in particular (especially considering that MOST heart attack patients do not have high cholesterol in the first place).
Certainly statins lower cholesterol markers on paper, but the side effects may far outweigh the benefits as well.
The bottom line: We must step back for a moment and recognize that statin therapy for high cholesterol is just one piece of a bigger picture. Heart disease has many other risk factors, and there are many other ways to reduce risk and identify people at risk.
Using statins to “lower cholesterol” may not be beneficial unless the individually is clearly genetically at risk for heart disease and all other lifestyle and inflammatory causes of heart disease and high cholesterol have been addressed first.
Myth #5: Avoid Dietary Cholesterol to Lower Cholesterol & Prevent Heart Disease
For 50 years we’ve been told by our doctors and Cheerio’s commercials that intake of dietary cholesterol is a key contributor to heart disease and high cholesterol. We now know that is NOT the case.
In fact, Ancel Keys, the founder of this diet-heart hypothesis himself rebuked his initial claim in 1991 (20) , stating:
Dietary cholesterol has an important effect on the cholesterol level in the blood of chickens and rabbits, but many controlled experiments have shown that dietary cholesterol has a limited effect in humans. Adding cholesterol to a cholesterol-free diet raises the blood level in humans, but when added to an unrestricted diet, it has a minimal effect.
Studies overwhelmingly show that about 75% of the population’s cholesterol levels are not affected at all by their dietary intake at all (21). And while the other 25% do experience an increase in LDL, but they also experience an increase in HDL. In short: there’s NO net change in their LDL-to-HDL ratio, and because of that, researchers conclude there’s really no clinical significance to any increase the 25 percent experiences when they eat cholesterol-rich foods (like eggs or butter).
The research is so clear now that as of 2016, the USDA dietary guidelines finally removed its restrictions on intake of dietary cholesterol and saturated fat, no longer suggesting to limit the intake of dietary cholesterol.
The bottom line: We’ve now established that eating cholesterol and saturated fat does not increase cholesterol levels in the blood for most people.
- CDC. 2015. Cholesterol Fact Sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm
- CDC. 2014. Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012. https://www.cdc.gov/nchs/data/databriefs/db177.htm; Adedinsewo, D., Taka, N., Agasthi, P., Sachdeva, R., Rust, G., & Onwuanyi, A. (2016). Prevalence and Factors Associated with Statin Use among a Nationally Representative Sample of US Adults – National Health and Nutrition Examination Survey, 2011–2012. Clinical Cardiology, 39(9), 491–496. http://doi.org/10.1002/clc.22577
- Pollack, A. 2015. Eli Lilly Abandons Heart Disease Drug in Final Stage of Trials. New York Times. https://www.nytimes.com/2015/10/13/business/eli-lilly-abandons-heart-disease-drug-in-final-stages-of-trials.html
- Golomb, B. A., & Evans, M. A. (2008). Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism. American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions, 8(6), 373–418.
- John Munkhaugen, Elise Sverre, Jan E Otterstad, Kari Peersen, Erik Gjertsen, Joep Perk, Lars Gullestad, Torbjørn Moum, Toril Dammen, Einar Husebye. Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients. European Journal of Preventive Cardiology, 2017; 204748731769313 DOI: 10.1177/2047487317693134
- Zhang H, Plutzky J, Shubina M, Turchin A. Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. Ann Intern Med. 2017;167:221–227. doi: 10.7326/M16-0838
- Mayo Clinic. 2016. Statin Side Effects. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
- American Heart Association. 2009. Heart Disease and Stroke Statistics—2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. http://circ.ahajournals.org/content/circulationaha/119/3/e21.full.pdf.
- Champeau, R. 2009. Most heart attack patients’ cholesterol levels did not indicate cardiac risk. UCLA Newsroom. http://newsroom.ucla.edu/releases/majority-of-hospitalized-heart-75668
- Sniderman AD. Differential response of cholesterol and particle measures of atherogenic lipoproteins to LDL-lowering therapy: implications for clinical practice. J Clin Lipidol. 2008; 2(1):36-42. https://www.lipidjournal.com/article/S1933-2874(08)00004-4/fulltext
- Cromwell WC, Otvos JD, Keyes MJ. LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study—Implications for LDL management. J Clin Lipidol. 2007; 1(6):583–592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/pdf/nihms36287.pdf
- Otvos JD, Mora S, Shalaurova I, et al. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. J Clin Lipidol. 2011; 5(2):105–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070150/pdf/nihms-274658.pdf
- Degoma EM, Davis MD, Dunbar RL, et al. Discordance between non-HDL-cholesterol and LDL-particle measurements: Results from the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2013; 229(2):517-523. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066302/pdf/nihms-462449.pdf
- Toth PT, Grabner M, Punekar RS, et al. Cardiovascular risk in patients achieving low-density lipoprotein cholesterol (LDL-C) and particle (LDL-P) targets. Atherosclerosis. 2014; 235:585-591. https://www.atherosclerosis-journal.com/article/S0021-9150(14)01164-2/pdf
- Kronenberg F, Utermann G. Lipoprotein(a): resurrected by genetics. J Intern Med. 2013; 273(1);6–30. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2796.2012.02592.x
- Yong Liu, MD, MS; Janet B. Croft, PhD; Anne G. Wheaton, PhD; Dafna Kanny, PhD; Timothy J. Cunningham, ScD; Hua Lu, MS; Stephen Onufrak, PhD; Ann M. Malarcher, PhD; Kurt J. Greenlund, PhD; Wayne H. Giles, MD, MS. 2016. Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States, 2013. CDC. https://www.cdc.gov/pcd/issues/2016/16_0054.htm
- Kolata, G. 2004. Experts Set Lower Low for Levels of Cholesterol. New York Times. https://www.nytimes.com/2004/07/13/us/experts-set-lower-low-for-levels-of-cholesterol.html
- Scandinavian Simvastatin Survival Study Group. 1994. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(94)90566-5/abstract
- Ballantyne, C. 2009. Clinical Lipidology. https://www.sciencedirect.com/science/book/9781416054696
- Kern, F. 1991. Normal Plasma Cholesterol in an 88-Year-Old Man Who Eats 25 Eggs a Day. The New England Journal of Medicine. 324:896-899. DOI: 10.1056/NEJM199103283241306 https://www.nejm.org/doi/full/10.1056/NEJM199103283241306?query=recirc_curatedRelated_article
- Gaziano, JM. Djousse, L. 2009. Dietary cholesterol and coronary artery disease: a systematic review. Curr Atheroscler Rep: 11(6):418-22. https://www.ncbi.nlm.nih.gov/pubmed/19852882