0024 – Cholesterol: good or bad? Part II
Updated: Feb 21, 2020
In my previous blog, I talked about the different types of dietary and body fats, mentioned the research proving that saturated fats and cholesterol do not cause cardiovascular diseases but are, on the contrary, essential for our health. Read part I first, if you haven't already.
In this part II, I will tell you which dietary fats are healthy or toxic, how you can optimise your cholesterol levels to reduce the risk of developing cardiovascular diseases and whether saturated fats should be avoided in certain cases. I will also talk about the Statin drugs that are widely prescribed to those with high cholesterol.
Dietary fats: healthy or toxic?
Not all dietary fats are created equal. Fats that are found in wholesome produces are generally healthy, whereas fats that have been heavily processed are typically not.
The healthiest dietary fats are probably mono-unsaturated fats and omega-3's, followed by saturated fats and cholesterol, and then omega-6's (in moderation). Man-made hydrogenated fats and trans-fats are toxic and shall be avoided entirely.
Mono-unsaturated fats ("MUFA")
MUFA-rich foods include avocados, olives and their oils, as well as certain nuts (macadamias, pecans, almonds, cashews, pistachios...) and seeds (pumpkin, sunflower...).
They are anti-inflammatory and have many health benefits: they improve our blood lipid profile, can protect us from cardiovascular diseases, help prevent depression, improve body composition, insulin sensitivity and blood sugar balance, strengthen our immune system and can even reduce cancer risk.
Omega-3's are poly-unsaturated fats found in fatty fish (salmon, sardines, mackerel...), in walnuts and some seeds (chia seeds). They are anti-inflammatory, strengthen our immune function and can lower the risk of neuro-degenerative diseases, of certain cancers and rheumatoid arthritis, for instance. They are also essential for brain, skin and eye health.
Saturated fats and cholesterol
They are found in fatty meat, egg yolks, butter, cheese, full fat dairy products, coconut, coconut oil, cocoa, shellfish... I have listed the benefits of these fats in part I.
This is where it becomes more complicated as these fats are pro-inflammatory. A bit of inflammation is harmless or even good but too much is not. These poly-unsaturated fats are healthy when they are balanced with O3 (in a ratio between 4:1 and 1:1). Sunflower seeds, wheat germ, sesame seeds and walnuts are all healthy sources of O6.
Unfortunately, most of us consume way much higher O6 than O3, due to processed foods that contain vegetable seed oils, corn and soybeans. O6 are easily oxidised by light, heat or oxygen, can wreak havoc in our body and lead to chronic inflammation, the cause of many modern diseases. You can find more details here.
Hydrogenated fats and trans-fats
These man-made fats are toxic and should be avoided completely. They are easily oxidised, promote systemic inflammation, can interfere with hormone signalling, compromise our immune function, damage our nervous, cardiovascular and endocrine systems, and even our brain.
They are found in highly processed vegetable oils (canola, corn, soybean, cottonseed, safflower...), in margarine, shortening and in most processed and fried foods, snacks, sauces and frozen meals. See my blog Stay away from vegetable oils.
In summary, eat plenty of avocados, olives, coconut, full fat dairy products, fatty meat and fish, eggs, nuts and seeds - if possible from local, organic and/or regenerative agriculture - but stay away from vegetable seed oils, margarine and fried foods. Check the labels carefully before buying processed foods. Not only this will improve your cholesterol profile but also your health in general.
How good are your cholesterol ratios?
If you have had your blood tested and don't like maths, this handy calculation tool will tell you where you stand. Cholesterol ratios are better at predicting the risk of cardiovascular diseases than stand-alone cholesterol levels. In particular, your total cholesterol and/or LDL levels cannot tell much about your health. For instance, heart attacks can occur in individuals with low LDL but a high proportion of small, dense LDL.
(Triglycerides = TG, Total Cholesterol = TC)
TG / HDL <1 is optimal ; <2 is good
TC / HDL < 3.5 is optimal ; <4.4 (women) or <5 (men) is good
LDL / HDL <2 is optimal ; <3.1 is good
Apo-B / Apo-A1 < 0.6 (women) or <0.7 (men)
A total cholesterol below 180 mg/dL (4.6 mmol/L) triples the chances of suffering from a stroke and 180 mg/dL or more is needed for a healthy brain function.
Apo levels are not measured in standard tests but can help assess the risk of cardiovascular diseases. There is only one Apo-B or Apo-A1 per LDL particle (small or large, respectively) and it is used as a surrogate for LDL particle number and size. Alternatively, nuclear magnetic resonance can also be used.
In any case, blood cholesterol levels and ratios should be considered together with other markers (waist circumference, blood pressure, HbA1c, Hs-CRP, CAC score...) and risk factors (smoking, stress, sleep...) to assess one's health and risk of cardiovascular diseases.
How does the cholesterol turn "bad" and how to improve your ratios?
The primary causes of cardiovascular diseases are inflammation and stress, which can result from many unhealthy habits.
A poor diet
The well-named "SAD" (Standard American Diet), also prevailing in Europe, Australia and many other countries is one of the leading causes of cardiovascular diseases. This is due to processed foods packed with excess carbohydrates (refined "carbs" and sugar in particular), oxidised vegetable oils and other harmful man-made preservatives, additives, colouring, flavours... I have renamed it the Carb-Rich And Processed diet...
In other words, dietary fats can increase total cholesterol but it is the processed foods that turn it "bad", together with the other catalysts listed below. These poor diets have been associated with a higher risk of obesity, diabetes, cardiovascular diseases and other health conditions. They worsen our blood lipid profile and their pro-inflammatory effects accelerate the formation of artery-clogging plaque.
As mentioned in part I, the journalist Nina Teicholz' observed that the past 60 years of this low-fat / high-carb regime has amounted to a global experiment with disastrous consequences for our health. Did you know that the annual consumption of sugar per capita has increased from about 1.8 kg (4 lbs) to 54 kg (120 lbs) in the past 200 years? This is scary!
One of the best strategies for improving your cholesterol is to adopt a nutrition that replaces inflammatory processed foods by fresh wholesome foods, organic if possible. That means buying meat, fish, fruits and veggies, full fat dairy products, nuts and seeds, herbs and spices... from the fresh produce section of your market and skip anything that has been transformed by a food or drink manufacturer.
In particular, it is key to avoid foods that contain processed vegetable oils, added sugar, food additives and preservatives, artificial flavours, GMO, pesticides and other toxic residues. Reduce excess carbs (sugar and starches, including cereals, bread or anything containing flour) and prefer colourful vegetables and low-carb fruits (such as berries). Swap sodas and sugary juices for green tea, coffee, lemon or mint-infused water.
Smoking is a leading cause of high (bad) cholesterol and contribute to cardiovascular diseases. It accelerates plaque build-up on the walls of the arteries and can lead to the formation of blood clots and inflammation.
High chronic stress levels
If you have read my article How full is your stress bucket, you know that, in response to stress, our body releases cortisol and adrenaline, as part of a “fight or flight” mechanism, which in turn stimulates the release triglycerides and fatty acids and make us crave more sugary foods, which can contribute to worsen our blood lipid profile.
High blood pressure
High blood pressure affects about a quarter of the population and is also the major cause of stroke and a leading cause of dementia. Hypertension narrows the blood vessels, which worsens the artery-clogging plaque issue mentioned before and also disrupts the regulation of blood supply to the brain.
Insufficient physical activity
Being sedentary is also associated with worse cholesterol profile. Spending hours behind a computer during the day and bingeing on Netflix in the evening is not only bad for our waistline and our mood but also negatively affects our cholesterol and other catalysts for cardiovascular diseases (high blood pressure, diabetes, inflammation...).
Exercise regularly but do not over-train. Try to be active every day and find sports or activities that you enjoy (walking, playing outside with your kids, gardening, dancing...). It will also help you feel more relaxed and energised, stronger and leaner. There are so many reasons why moving is good for you.
Yes, even sleep can impact our blood cholesterol. See my 10 tips to improve your sleep. In short, get some sunlight during the day, dim the lights and start relaxing a few hours before going to bed and adopt a consistent bed routine to get about 8 hours of quality sleep per night, in a cool dark room.
Many other factors have been associated with "bad" blood cholesterol levels: insulin resistance, type 2 diabetes, inflammation (from infections, food sensitivities, toxins, over-training...), nutrient deficiencies, hypothyroidism, sunlight deficiency... The more healthy habits you can adopt, the more beneficial synergistic effects you will enjoy.
Who should avoid saturated fats?
The impact that saturated fat and cholesterol intakes can have on blood cholesterol vary depending on the diet (when combined with excess refined carb and sugar in particular) and other risk factors (smoking, stress, sleep...) but also on genetic predispositions.
If you smoke, are very stressed, sedentary and eat a lot of processed foods, consuming a lot of fats is not a good idea. That said, rather than cutting eggs and bacon, consider adopting healthier habits first: reduce excess sugar and processed foods/drinks, quit smoking and move more.
It is unclear whether those suffering from cardiovascular issues should limit their consumption of saturated fats to avoid the disease progression. Consider cutting any excess sugar and refined carbs first, monitor your cholesterol and discuss with your qualified health practitioner.
About 10 to 15% of the population has what is called the "APOe4" variant. It is the ancestral form of the APOe gene that enhances the inflammatory response in highly infectious environments. It used to be an advantage for our hunter-gatherer ancestors. However, in today's sanitised world, this APOe4 allele may lead to an increased risk of high cholesterol, inflammation, cardiovascular issues, Alzheimer's and other diseases. If you have done your genetic testing and have this allele, swapping saturated fats for mono-unsaturated fats could be a good option.
Last, the "lean mass hyper-responders" are lean people whose LDL can double after adopting a very low carb / high fat diet (keto or carnivore for instance). Between 5 and 25% of those adopting a high fat diet fall into this category. However, their inflammatory markers and triglycerides remain low and their HDL high. Whether or not these hyper-responders should limit their saturated fat intake depends on other risk factors (smoking, high stress, poor sleep, other health conditions...). Their typical markers are: body fat <20% (men) or <23% (women); LDL >200 mg/dL (5.2 mmol/L); HDL > 80 mg/dL (2.1 mmol/L); and triglycerides < 70mg/dL (0.8 mmol/L).
Other genetic variances can lead to LDL levels much higher than normal with high saturated fat diets, which can increase the risk of developing cardiovascular diseases. More than half of patients with a coronary artery disease before the age of 60 have a familial blood cholesterol disorder. So, if very high levels of cholesterol (in the absence of other obvious reasons) run in your family, you might be better reducing your fat intake. Typical markers of such genetic predispositions include total cholesterol >300 mg/dL, triglycerides >500 mg/dL and/or xanthoma (a skin condition).
In any case, if eating saturated fats worsen your cholesterol profile or if you have other risk factors, consider eating less eggs, bacon, coconut, butter, cheese, cream and fatty meats, and more avocados, olives, fatty fish, nuts and seeds, whilst also addressing your other risk factors. And stay away from processed vegetable and seed oils!
Should you take Statins if you have high cholesterol?
Statins are widely prescribed to lower cholesterol and the risk of cardiovascular diseases. However, several studies (but not all) have shown that taking Statins has little to no benefit. Some studies report that between 104 and 154 patients need to take Statins for 5 years for 1 to benefit. Other studies show no benefit at all. Besides, Statins can have side effects including muscle pain or damage (for 10-33% of patients), diabetes (0.1-2%), strokes... This is a highly controversial subject and different pieces of research have observed different outcomes. So before taking any cholesterol-lowering medication, make sure you understand the possible risks and benefits, based on your personal circumstances.
Many proponents of this medication mention a 50% reduction in heart attacks and a 30% reduction in strokes, without disclosing that it is a relative risk reduction. In fact, the absolute risk reduction is less than 1%. Even for those already suffering from cardiovascular issues, it is estimated that 83 people need to take the drug for 5 years to prevent 1 death.
Statins suppress the production of all cholesterol, including the good one that is critical for good health (hormone and neurotransmitter production, nutrient absorption, brain function, protection against pathogens and toxins..., see part I). Lower cholesterol levels is strongly associated with higher death rates. So why would you want to reduce your levels, in the absence of other high risk factors?
Instead of prescribing Statins as the first option to reduce the cholesterol levels of millions of patients, the risk of developing cardiovascular diseases should be assessed based multiple biometrics and risk factors including full blood lipid profile, blood glucose and insulin, inflammation markers, blood pressure, but also stress levels, smoking, family history, physical activity levels, diet and sleep quality. Those with a high risk profile who could benefit from taking Statins should also work on adopting healthier habits to address the underlying causes of their health issues. Unfortunately, the Statin market amounts to about USD 19bn per year and there are lots of financial interests at stake.
In the absence of excess carbohydrate intake and other risk factors, dietary saturated fats and cholesterol are a healthy, efficient and long-lasting source of energy for the body that can keep you fuller for longer. It is the addictive high-carb processed food that contributes to the exponential growth of obesity, diabetes and cardiovascular diseases and in the constant struggle of millions of dieters to maintain a healthy weight.
This article is for educational purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, cure, heal or prevent any disease or medical condition. See full Disclaimer here. I encourage you to do your own research and to discuss with a qualified healthcare practitioner the options that could work the best for your specific circumstances.
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