Cholesterol and Heart Disease

The common advice often heard from doctors, helpful government agencies, women's magazines and the back of your cereal box is that cholesterol causes heart disease. "Artery clogging fats" are the evil to be avoided and that everyone should monitor their blood lipids, ever vigilant against "bad" LDL. All of this comes from two outdated, disproven hypotheses: the diet-heart hypothesis and the lipid hypothesis. Both are both predicated on similar grounds: the fat in your blood causes plaque and heart disease.

Fortunately science, researchers and many cardiologists have moved on. Unfortunately most everyone else is still getting their information from the 1970's... Below is a rundown of how I understand the relationship between cholesterol, LDL and heart disease. The short version: LDL isn't "bad", eating fat doesn't raise your cholesterol and eating saturated fat is actually good for you.

Recent large scale studies have shown that for women, the higher your cholesterol is, the less likely you are to die from all causes of death, including heart disease. For men, moderately high cholesterol was also associated with a lower risk of death. Check out my blog post for more detail.

What is cholesterol, LDL, etc?

I found it difficult to really digest and understand the information about cholesterol, LDL and HDL until I learned what they really were. So often the media, blogs, etc will throw around these terms without clearly defining them. Check out Bio 101: HDL and LDL for a quick overview.

How is LDL involved with Heart Disease?

How does diet affect LDL?


So my biggest question is this: Since a LCHF (low carb high fat) diet is associated with mostly pattern A LDL, does that mean that your risk of heart disease is lessened? It's not entirely clear.

One potential reason that high carbohydrate diets are associate with pattern B LDL is that it affects LDL receptors, causing LDL to live longer. Which is not good because lesser LDL receptor activity » longer LDL lifetime » increased oxidation » increased in heart disease risk.

Another idea is that these diets change the composition of your VLDL to begin with such that they quickly convert from VLDL directly to pattern B LDL, but doesn't increase the LDL lifespan. In which case maybe the difference is irrelevant and even the new more accurate lipid tests like the NMR and VAP tests (which measure LDL size) don't give you any better information than you had before, simply looking at your HDL and triglyceride ratios.

I don't have an answer though I learn towards the first theory. Here's what I takeaway from all this:

  1. Eating saturated fats is better for my health and polyunsaturated or processed fats (e.g. vegetable, canola, seed and nut oils) should be limited.
  2. Eating a variety of whole foods, especially organ meats, will increase my anti-oxidant intake.
  3. I want my blood lipids results to look this this:
    • High HDL because it is resistant to oxidation.
    • Pattern A LDL because is less likely to have been oxidized.
    • Low triglycerides because that is an indicator that I am not badly insulin resistant.
    • LDL in a safe range because when it's extremely low/high it may be an indicator that something else is wrong.

Most of the information here is my understanding and regurgitation of an interview with Chris Masterjohn. After listening to the interview, I read a bit more on his website but most of it came from the first part of his interview with Chris Kresser, aka The Healthy Skeptic.

  1. High Cholesterol and Heart Disease - Myth or Truth? - Chris Masterjohn
  2. The Central Role of Thyroid Hormone in Governing LDL Receptor Activity and the Risk of Heart Disease - Chris Masterjohn
  3. The Healthy Skeptic Podcast #11 Interview with Chis Masterjohn on Cholesterol and Heart Disease (Part 1)
  4. The Healthy Skeptic Podcast #16 Interview with Chis Masterjohn on Cholesterol and Heart Disease (Part 2)

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