For nearly a century, cholesterol has been popularly marketed as an indicator for poor health, poor dietary practices, and chronic disease. This predominantly arose from a theory brought on in the mid-1900s called the diet-heart hypothesis, which proposed that reducing serum cholesterol and saturated fat intake would reduce the risk for diseases of the heart. This has led to recommended serum cholesterol levels being markedly lower than in the past in order to prevent chronic disease, yet these diseases persist on an epidemic scale. As with all science, it is important to continuously question one’s own theories and never accept a scientific finding as gospel, but this is exactly what has happened with cholesterol. The role of cholesterol in the body, lipid patterns, and the correlation between dietary cholesterol and serum cholesterol are all still poorly understood, yet dietary and medical recommendations indicate otherwise. Below we will analyze the current hypothesis behind cholesterol in order to better understand possible alternatives to the diet-heart hypothesis, such as that high cholesterol levels may benefit human health.

The tragedy of science is the slaying of a beautiful hypothesis by an ugly fact 

-TH Huxley

The Role of Cholesterol in the Body

Cholesterol is found in every cell in our body. One of the primary functions of cholesterol is to maintain the integrity of cell membranes, essentially making our cells firm and enabling proteins to remain embedded in the membrane, which is vital to cellular functioning. Cholesterol also plays a vital role in synthesizing various substances including hormones, bile acids, and Vitamin D3. Certain parts of the body require more or less cholesterol, dependent on their role. The brain and other parts of the nervous system have the highest concentrations, making it vital to proper nervous system functioning.

Why has high cholesterol been linked to Coronary Heart Disease (CHD)?

There are three types of cholesterol, commonly known as high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). HDL is commonly referred to as the ‘good’ cholesterol,  LDL is the ‘bad’ cholesterol, while VLDL is rarely discussed.  Elevated levels of LDL and VLDL combined with low levels of HDL have been linked to diseases of the heart, with high VLDL being the predominant risk factor. The role of VLDL is to supply the body with triglycerides, a type of fat. Elevated triglyceride levels appears to be the most accurate predictor for chronic diseases such as heart disease, and triglyceride levels tend to be elevated due to increased sugar intake. Despite this, it is normal for only LDL, HDL, and total cholesterol to be taken into consideration when assessing an individuals risk for chronic disease. It is important to note that the relationship between LDL and HDL as well as the implications of elevated total serum cholesterol levels are not fully understood. There have been cases of healthy individuals with high cholesterol never experiencing chronic disease, while some with low cholesterol have a history of heart problems. Regardless, high serum cholesterol and high dietary cholesterol intake are continuously marketed to be a recipe for disaster in terms of heart health, while statins are the one-size-fits-all solution for anyone with cholesterol levels above the recommended guidelines.

Dietary Cholesterol and Serum Cholesterol

There are certain simplistic ideas that have woven their way into our nutritional culture. One very popular idea is that dietary fat equals body fat, and another is dietary cholesterol equals blood cholesterol. The correlation outlined above (high blood cholesterol levels being linked to atherosclerosis) is one of the primary reasons why the dietary guidelines include the limitation of dietary cholesterol. This concept, however, has never been consistently proven. In fact, blood cholesterol levels vary widely dependent on numerous factors including age, gender, body weight, and more. The recommendation that everyone should have similar levels of cholesterol is unrealistic and unscientific, to say the least. Furthermore, the body is able to produce it’s own cholesterol, and various studies have indicated that a diet low in cholesterol will just cause the body to produce more cholesterol, and vice versa.

CHD Trends (20th-21st Century)

The dietary guidelines are often praised for the lower rates of CHD since the mid-late 1900s; however, the measurement of CHD tends not to account for the type of CHD or the causation. CHD is not a single disease with a single cause, rather it can be one of various diseases with various causes. When asked what causes CHD, the most common answer is diet or the high intake of saturated fat/cholesterol in the diet. However, CHD rates in the early 1900s were likely due to infectious diseases, genetic, or autoimmune disorders which could not be adequately treated at the time. CHD rates today are predominantly cases of myocardial infarction (commonly known as a heart attack) which is caused by a lack of blood flow to one or more coronary arteries, caused by a blood clot or plaque. Myocardial infarction was incredibly rare until the 1950s, and the cause is probably more complex than we are led to believe.

Is CHD caused by macro- or micronutrient deficiencies?

The guidance for CHD prevention is to limit overall fat intake (particularly saturated fat), consequently reducing dietary cholesterol intake. The limitation of a single macronutrient group is another simplistic—yet very common—antidote for nutrition-linked diseases. Shifting the focus to micronutrients would likely aid in preventing CHD and other chronic diseases, because a strong balance of micronutrients would inevitably lead to macronutrient ratios being optimized.

There are various micronutrients that may protect the heart from CHD. Nutrition and Physical Degeneration by Dr. Weston A Price found that the increased consumption of the bioavailable form vitamin A and vitamin D led to reduced rates of CHD. Additional researchers throughout the 20th century found that vitamin E, C, B6, B9, and B12 as well as certain minerals can lead to decreased risk of CHD. The ignorance of the role of micronutrients in CHD prevention could be intentional for multiple reasons. The first is the bioavailable form of these nutrients are commonly only found in animal foods, which have been popularly demonized since the mid-1900s. Furthermore, the promotion of the bioavailable form of these nutrients would disrupt the financial gain of the agricultural and food industry. Refined grains and vegetable oils are cheap to manufacture and provide massive profits, and unfortunately financial incentives tend to outweigh the moral obligation to public health. The second reason is that various drugs used to treat CHD actually impair the absorption of some of these nutrients, indicating there is a pharmaceutical financial incentive at play.

Replacing foods low in bioavailable nutrients with foods that are high in bioavailable nutrients could be the most important step to take in order to reduce the likelihood of having CHD. Focusing solely on the reduction of cholesterol and saturated fat will always lead to a diet low in these very powerful nutrients, while sugar and vegetable oils take their place.

Low Cholesterol: Undiscussed implications?

Cholesterol’s role in regulating hormonal and nervous system function is indicative of the strong role this substance may play in human mental health. Low serum cholesterol’s link to poor mental health has surfaced within recent decades likely due to the drastic changes in serum cholesterol recommendations over the past 40 years. The current dietary guideline for cholesterol shows that a reading of 200 mg/dL or more is considered high. The median ranges for statin therapy were 240-259 mg/dL in 1990, 300-319 mg/dL in 1986, and 340-359 mg/dL in 1983. It is probable that encouraging the public to significantly reduce their cholesterol levels in a relatively short period of time has led to increased adverse psychological symptoms today. These symptoms include behavioral disorders such as depression, aggression, suicidal ideation, as well as chronic diseases such as Alzheimer’s and Parkinson’s disease.

Conclusion

It is a common mindset that the human body is not a well-oiled machine and requires medicalized assistance to keep us healthy. As a society at large, we do not trust our bodies and we assume that pharmaceutical interventions are a necessary part of life. In reality, our bodies are doing everything in their power to work in our favor, if only we provided them with the right environment. Controversial scientific topics, commonly found in the field of nutrition, have kept us from understanding what that environment looks like, and it will continue to do so as science is constantly evolving. There are certain elements of the human body and nutrition that we can grasp in order to get as close as possible to that environment, and that includes cholesterol. The idea that the public is being encouraged to reduce cholesterol levels to avoid diseases of the body, while this reduction has been directly correlated with increased diseases of the mind, is a failure of the medical industry and a failure in communication between the medical professionals practicing and those researching. The factors outlined above need to be taken into consideration in order for medical professionals to best help their patients, although this is not very likely in the near future due to the heavy promotion of statins amongst the medical community. As individuals, we all have a choice to research alternatives and make the best decisions for ourselves with the information we collect. I hope the above information provided you with a glimpse into the unknowns that still exist, and the motivation to take that information and use it to make the best possible decision for yourself.

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