There is a fundamental assumption that dietary cholesterol is the cause of heart disease. Millions of Kenyans have abandoned red meat and eggs in the belief that such actions are protective.
Have we paused to interrogate this position? Do we wonder why these ancient foods are being blamed for a modern disease? Is optimal heart health really defined by a ‘normal’ cholesterol level?
Heart Health – The Villain
When it comes to heart disease, the villain seems to have been identified – Cholesterol. It has now become a ritual to have one’s cholesterol level checked on a regular basis. Thanks to a perfect storm of bad science, compromised researchers and relentless advertising, your cholesterol level has now become the ‘perfect’ surrogate marker of your future heart health.
Your cholesterol level is widely considered a barometer for your heart health.
This excessive focus on cholesterol numbers as the holy grail of heart health is observed worldwide. We’ve been told that ‘fat is bad’ and that ‘fat makes you fat’. It makes sense; it’s an easy sell. We’ve been advised, for over 50 years, to fear natural saturated fat and cholesterol – despite scientists knowing for many decades, that the cholesterol in our food does not affect the cholesterol in our blood.
Your liver is central to the regulation of cholesterol levels in your body. The higher your dietary cholesterol, the less cholesterol your liver produces.
We know that cholesterol is an utterly essential nutrient. We also know that the amount of cholesterol we have in our blood depends on how much is needed, not how much we consume. This explains why raised cholesterol levels are common in periods of prolonged stress, in response to a long-standing infection, if you are injured, pregnant or recovering from an operation.
Dietary cholesterol has recently been declared safe. It is no longer a nutrient of concern. However, we cannot easily get over our fear of fat because we’ve avoided it for so many decades. We find ourselves in a position where the presence or absence of evidence, to a large extent, makes no difference to a deeply ingrained way of thinking.
In mainstream nutrition, the cholesterol-heart disease belief remains steadfast. Your cholesterol level is widely considered a barometer for your heart health.
It is never wise to be completely convinced of anything told by another without question, reservation or reason.
So, before we continue to apply or promulgate a blanket ban on dietary cholesterol, let’s observe what’s happening in specific countries.
The French have the highest consumption of animal fat in Europe and higher than average cholesterol levels, yet the lowest rate of heart disease. Ditto for Switzerland. On the other hand, Russia has over 10 times the French death rate from heart disease, despite having substantially lower cholesterol levels than France.
The French Paradox
Researchers have observed that animal fat (mainly saturated fat) does indeed raise cholesterol levels. However, they also discovered that those who ate animal fat had a low risk of heart disease. In an attempt to understand this observation, I wish to raise three points.
First. If saturated fat raises cholesterol levels, which is allegedly the cause of heart disease, why are we observing very low rates of heart disease in those populations that eat the most saturated fat?
Second. The studies investigating cholesterol observed what happened to those who ate animal foods. Neither cholesterol nor saturated fat was consumed and tested in isolation. Cholesterol is only found in animal foods. No link was found between cholesterol and heart disease. Those animal foods also contain saturated fat. So why do we still vilify saturated fat? Why whitelist one and not the other?
Third. The relationship between death and blood cholesterol has now been investigated repeatedly in many different countries. The totality of the best available evidence confirms that the higher the LDL (‘bad’) Cholesterol, the lower the risk of dying. Most of these studies reached statistical significance, meaning that this finding was very unlikely to be due to chance.
How does one square these observations with the cholesterol-lowering fever that has become an international obsession and a trillion-dollar industry?
We must remember that we’re in the business of improving health outcomes and not surrogate endpoints. There is no logic in lowering cholesterol simply to achieve a low cholesterol level. Cholesterol-lowering cannot and should not be an end in itself. The objective must be to reduce poor health outcomes, such a disability or death from heart disease.
The cholesterol saga continues….
This article was published in print and online in The Star Kenya on 20th January 2020.