New model could explain old cholesterol mystery

I am close with someone who has chronic high cholesterol, in addition to a 6-pack abs. She exercises 5x&#x2F;week and eats .5kg of animal products&#x2F;week at most, usually white meat. She just visited her heart Dr and was told that her cholesterol is too high and that she needs to cut out animal products entirely as a next step.<p>I am thinking...is this really the modern answer to someone&#x27;s high cholesterol if they consistently exercise, are nearly underweight, and rarely eat animal products to begin with? It doesn&#x27;t add up to me.<p>It&#x27;s amazing how little we still know about heart disease - the #1 killer in the US. As someone who will inevitably inherit chronic high-cholesterol as well, I&#x27;m excited to read and share this ongoing research. Thank you for posting this.

So much nutrition research is all correlation and no causation. Statements like this, which over-infer, kill me:<p>&quot;There is little doubt that people with high cholesterol have an increased risk of disease.&quot;<p>It&#x27;s just as valid to say that people with heart disease are more likely to have high cholesterol. When all you have is correlation, there is a heart disease group, and a high cholesterol group, and all you shown with correlation is that there is a third overlapping group of people with both. With only correlation, you don&#x27;t know how&#x2F;why, or even if, members of one group transform into the other. Which is partly the underpinning of the article.<p>It&#x27;s possible that high cholesterol is a result of underlying heart disease (which the article says is possible), rather than a cause. But what shocks me is that people, even researchers, seem surprised to realize such possibilities.

PROBLEM #1: High saturated fat diet correlated to high serum cholesterol<p>ANSWER #1: Serum cholesterol is transferred back-and-forth between the blood and cell membranes to maintain a constant cell rigidity; normal behavior<p>PROBLEM #2: High serum cholesterol correlated to cardiovascular disease<p>ANSWER #2: Chronic inflammation associated with metabolic disorders upsets the various regulatory systems<p>I find the second answer unsatisfactory. Any chronic condition that damages arteries leads to plaque and this, in my opinion, accounts for all the other associations. The arterial wall damage can be due to excess blood sugar, oxidation, or pathogens (SARS-CoV-2?). The damage causes an inflammatory response and extra serum cholesterol is needed to repair the damage (forms the plaque). The chronic plaque formation reduces the arterial cross-section and reduces elasticity which both increase blood pressure.<p>The underlying cause is arterial wall damage. This can be measured non-intrusively using the Ankle-Brachial Pressure Index:<p><a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Ankle–brachial_pressure_index" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Ankle–brachial_pressure_index</a>

The idea that it is inflammation, not cholesterol, that is causing heart disease, is not new. See here: <a href="https:&#x2F;&#x2F;www.bloomberg.com&#x2F;news&#x2F;articles&#x2F;2008-04-15&#x2F;heart-disease-not-about-cholesterol-businessweek-business-news-stock-market-and-financial-advice" rel="nofollow">https:&#x2F;&#x2F;www.bloomberg.com&#x2F;news&#x2F;articles&#x2F;2008-04-15&#x2F;heart-dis...</a><p>Also see collection of links at bottom of this article: <a href="https:&#x2F;&#x2F;medium.com&#x2F;@petilon&#x2F;cholesterol-and-statins-e7d9d8eea983" rel="nofollow">https:&#x2F;&#x2F;medium.com&#x2F;@petilon&#x2F;cholesterol-and-statins-e7d9d8ee...</a><p>Cholesterol reduction is big business. Pfizer’s Lipitor alone raked in $125 billion between 1996 to 2012. This amount of money can be very corrupting. It’s almost impossible to find experts who are not influenced by money from industry.

I find this article quite fascinating. It provides a bit of a glimpse into how science can work, and how difficult it is to gain valid knowledge on some topics. It&#x27;s also a reminder that &quot;science&quot; isn&#x27;t just a simple process that you follow to find the truth. Sometimes people ask the wrong question, or draw the wrong conclusion from experiments. It seems that research related to nutrition and health has a fair amount of this.<p>It reminds me of my own experience earlier this week where I needed to call a certain service. The API has 2 parameters. I thought that one was required and one was optional. But whenever I called the service with 1 parameter, it failed. Eventually I thought &quot;maybe both parameters are required&quot; and called the service with 2 parameters, and it worked. So I concluded &quot;both parameters are required&quot;. But later I discovered that the service was just flaky and it was a coincidence that it started working just at the moment when I added the second parameter. After that experience it&#x27;s difficult to know what to trust, when everything could be due to randomness and unreliability.

We have known for many decades that it is <i>oxidized</i> blood cholesterol that correlates with heart disease. Fred Kummerow showed this back in the &#x27;50s, 60+ years ago. But you can&#x27;t get a blood test for oxidized cholesterol.<p>Fred Kummerow spent his whole working life getting trans fats out of the US food pipeline. He proved trans fat was poison in 1957, and finally in 2009, under compulsion of a lawsuit, the FDA declared it toxic. Then, they issued no regulations restricting their use until forced by another lawsuit, in 2014. Then, they gave vendors <i>3 more years</i> to put poison in stuff being sold as if it were food. In 2018 it was supposed to be illegal to sell trans fats as food, but a number of companies still do, under waivers.<p>He died in 2017, at age 102. He spent the final two years of his life working on Parkinson&#x27;s, which had taken his wife, since trans fats had (he thought) finally been outlawed. He was a great hero of experimentally-grounded health science.<p><a href="https:&#x2F;&#x2F;www.drmirkin.com&#x2F;histories-and-mysteries&#x2F;fred-kummerow-hero-of-the-trans-fat-battle.html" rel="nofollow">https:&#x2F;&#x2F;www.drmirkin.com&#x2F;histories-and-mysteries&#x2F;fred-kummer...</a><p>India and Brazil are still struggling to get it outlawed. The big corporations have resisted because selling poison as if it were food remains profitable.<p>We are still confused about fats. But a takeaway should be that nobody has ever found any evidence of harm from eating saturated fat, or benefit from eating unsaturated fat, despite decades trying.

This guy has been arguing for years that it is sugar (fructose actually) that increases the &quot;bad&quot; LDL in your blood stream <a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=dBnniua6-oM" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=dBnniua6-oM</a>

Cholesterol is is not the problem. HDL and LDL differences not withstanding.<p>Cholesterol is used by the body to patch damaged arterial walls which can cause clogging if the there is excessive damage to the arteries.<p>The problem is high sugar levels in the blood by eating high sugar content foods and high glycemic index foods like highly processed carbohydrates which turn to sugar quickly raising blood suggar levels.<p>High sugar levels cause damage to the arterial walls and bodies response is to patch the damage.<p><a href="https:&#x2F;&#x2F;www.adwdiabetes.com&#x2F;articles&#x2F;repeated-sugar-spikes-damage-arteries" rel="nofollow">https:&#x2F;&#x2F;www.adwdiabetes.com&#x2F;articles&#x2F;repeated-sugar-spikes-d...</a><p>Other issues interfere with the ability of lipids entering the wall properly in the repair process and cause the atherosclerosis exaserbated by ldl presence also caused by high sugar levels amongst others<p><a href="https:&#x2F;&#x2F;pubmed.ncbi.nlm.nih.f" rel="nofollow">https:&#x2F;&#x2F;pubmed.ncbi.nlm.nih.f</a> gov&#x2F;1222702&#x2F;<p>Unfortunately all these issues get conflated together to produce misunderstanding and alot of misunderstanding

<p><pre><code> A: saturated fats B: LDL cholesterol C: heart disease </code></pre> studies show saturated fats increase LDL cholesterol<p><pre><code> A =&gt; B </code></pre> People who get heart disease are more likely to have high LDL cholesterol<p><pre><code> C =&gt; B </code></pre> &gt; Researchers have thus drawn a logical conclusion: a lot of saturated fat in the diet produces more cholesterol, which in turn increases the risk of heart disease.<p><pre><code> A =&gt; B &#x2F;\ B =&gt; C </code></pre> &gt; But this has been surprisingly difficult to prove.<p>You don&#x27;t say?

I have an auto-immune disease. The medication prescribed has the side effect of making my &quot;bad&quot; LDL cholesterol skyrocket. I tried everything from diet, to exercise to bring it back down but nothing worked. I&#x27;m now on a Statin medication which solved the issue but I&#x27;m not thrilled about yet another medication.<p>Before my disease I ate like an average American (sugar, meat, dairy etc.) and my LDL cholesterol was high. I was diagnosed, changed my diet and my LDL dropped to healthy levels. Later I started a new medication (JAK inhibitor) and it jumped back up, but my diet did not change.<p>I read this article twice and have no idea how it applies to my situation.

I think it was a mistake to focus public health discussions around the finer details of work in progress research.<p>The ambiguities and unknowns have opened the door for fitness gurus and health product grifters to turn this into a sort of holy war. It’s sad to see how many people have been convinced they are “healthy” because they follow a couple out of context fragments of the overall health picture.<p>I know too many people who think they are doing everything right because they avoid gluten, or don’t eat dairy products, or minimize saturated fat. Yet they go on to consume excessive amounts of sugar, or drink copious amounts of alcohol, or eat 4000+ calories per day of their chosen healthy foods.

Correct me if I&#x27;m wrong, but wasn&#x27;t one of the founding &#x2F; influencial &quot;cholesterol is bad&quot; studies found to be bad science, and that ultimately it was the result of &quot;financing&quot; by Big Sugar? They were Harvard profs &#x2F; researchers I believe.<p>The point being, much of collective knowledge on this subject is based on misleading &#x2F; false assumptions. That is, you&#x27;re going to struggle to find results that align with conventional wisdom because that wisdom is flawed.

So the new model seems to be suggesting that high LDLs are not a cause for heart disease, but rather a symptom. Have other studies tying high LDLs to heart disease taken this into account, or did their main findings just show a correlation with high LDLs and heart disease?

This is why I have three things I never trust the experts in. - How to be healthy - How to educate - How to raise kids<p>It seems like every decade we find out everything we did last decade was bad and wrong but now we&#x27;ve finally for sure got it figured out, and this time we know we are right because we have fancier gadgets and more citations in our name.<p>From Frued to the Food Pyramid it seems that the experts always have just finally figured it out.

I just love how the author use a few paragraphs to explain the weakness of this model and why it need more research.<p>Most pop science articles just dont have it

I&#x27;m glad to see new approaches to this problem being discussed, because even after researching about lipids for quite awhile, I was unable to come to a full conclusion on them myself. There&#x27;s so many confounding variables, and attempting to control for all of them just isn&#x27;t really feasible in an RCT (not to mention most studies are correlational and nowhere near an RCT to begin with).<p>I think it&#x27;s likely the case that sometimes high LDL is good, and sometimes it is bad, and this may depend on many other factors related to yourself and your diet. But disentangling these cases is very difficult, and the food supply of nations has changed so much that we keep seeing very misleading correlations. These misleading correlations are why we sometimes hop onto bandwagons like &#x27;fat is bad for you&#x27;, &#x27;high salt is bad for you&#x27;, or &#x27;animal products&#x2F;red meat are bad for you&#x27;, and then after more research and RCTs, we realize that this is not the case (if the press would stop reporting correlations to everyone as important research that you need to act on right now, that would certainly be nice).<p>I&#x27;m looking forward to more progress here, but until then I don&#x27;t mind eating saturated fats myself, although I do avoid certain sources of them, such as in fried oils high in linoleic acid. I also don&#x27;t focus a ton on LDL precisely, but rather some other related measures (different types of cholesterol, low inflammation, and coronary calcium scans if possible)

It&#x27;ll be interesting to see how this theory stands up. It seems like they&#x27;re on the right path, tying together several things that seem to be problems.<p>The homeoviscous adaptation to dietary lipids (HADL) model explains controversies over saturated fat, cholesterol, and cardiovascular disease risk<p><a href="https:&#x2F;&#x2F;academic.oup.com&#x2F;ajcn&#x2F;article-abstract&#x2F;113&#x2F;2&#x2F;277&#x2F;6104795?redirectedFrom=fulltext" rel="nofollow">https:&#x2F;&#x2F;academic.oup.com&#x2F;ajcn&#x2F;article-abstract&#x2F;113&#x2F;2&#x2F;277&#x2F;610...</a><p>&quot;Corresponding with the model, we suggest alternative contributing factors to the association between elevated LDL cholesterol concentrations and ASCVD, involving dietary factors beyond SFAs, such as an increased endotoxin load from diet–gut microbiome interactions and subsequent chronic low-grade inflammation that interferes with fine-tuned signaling pathways.&quot;

Reminds me of this FoD vid: <a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=5Ua-WVg1SsA" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=5Ua-WVg1SsA</a>

&gt; saturated fat in the vast majority of people increases their LDL and that this in turn will increase their risk of cardiovascular disease<p>I still don&#x27;t understand this. I thought the cause and effect had never been proven, but only the correlation.<p>Like people who have heart disease often have high cholesterol.<p>But was it shown that if they lower their level of cholesterol they can revert their condition?<p>Or was it shown that it was the increase which led to heart disease?

The cholesterol theory doesn&#x27;t hold water.<p>The claim is that cholesterol is so sticky that is clogs up the largest arteries of the body, is almost laughable.<p>If cholesterol is as truly sticky as claimed then it should be clogging up the tiny capillary vessels in the lungs, but it doesn&#x27;t do that.<p>Linus Pauling discovered the basis for heart disease, but his theory has been &#x27;discredited&#x27; by scientists who have bought and paid for by big pharma.

&gt; When we eat more polyunsaturated fat, the cells incorporate more polyunsaturated fat into the cell membrane, making it more fluid.<p>That seems like an absolutely wild idea to me. So the cell just grabs whatever lipids arrive from the diet and turns them into phospholipids and puts them in the membrane? I know nothing about this process, but my biochemist&#x27;s intuition tells me to be skeptical. Is there research on this?

I can&#x27;t help but think that there is active effort to halt our understanding of nutrition. I mean, if we still can&#x27;t say at least that saturated fat is causally related to heart disease, then this whole field is in a very bad place. My hypothesis though, is that this finding has already been established but people keep coming back to this subject to try to adjust it to their lifestyle choices.

It&#x27;s an interesting hypothesis. But it seems contradicted by Mendelian randomization studies, which find that LDL cholesterol levels to be causally associated with heart disease.<p><a href="https:&#x2F;&#x2F;pubmed.ncbi.nlm.nih.gov&#x2F;26780009&#x2F;" rel="nofollow">https:&#x2F;&#x2F;pubmed.ncbi.nlm.nih.gov&#x2F;26780009&#x2F;</a>

Not sure how &quot;new&quot; this model is, it&#x27;s just not well-known in the mainstream. Dr. Rhona Patrick has been explaining this very clearly for years. Go watch any of her podcasts with Joe Rogan.

This is parallel to the question of vitamin D and COVID. There&#x27;s a strong correlation between vitamin D deficiency and COVID mortality, yet taking vitamin D doesn&#x27;t help. Conjecturally, it&#x27;s the genetic cause of vitamin D deficiency that increases COVID mortality.<p>I had been taking Clemastine and vitamin D. I asked a former student now a doctor at the center of the COVID response whether these would interfere with my vaccine. She said to stop Clemastine on the off chance that one study was on to something, but there was no reason to take or stop taking vitamin D.

High cholesterol and hypertension here. Anyone want to give me a tl&#x27;dr?<p>The obvious and constant advice to date is: drink less alcohol, exercise more and eat less saturated fat.<p>Tackling all three at once is quite a challenge so it would be lovely if someone threw me a bone here. ;-)

The idea that animal products are unhealthy seems to be misguided.<p>It seems more likely that the supposedly &quot;heart healthy&quot; seed oils are causing heart disease.<p>The Carnivore Code has some very good insights (at least in my opinion) [1]<p>And this talk on how seed oils are destroying our health is also pretty interesting: <a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=7kGnfXXIKZM" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=7kGnfXXIKZM</a><p>[1] <a href="https:&#x2F;&#x2F;www.amazon.com&#x2F;Carnivore-Code-Unlocking-Returning-Ancestral&#x2F;dp&#x2F;1734640707" rel="nofollow">https:&#x2F;&#x2F;www.amazon.com&#x2F;Carnivore-Code-Unlocking-Returning-An...</a>

NICE no longer specifies target cholesterol levels for people with diabetes. Your doctors will use a calculator, called QRISK2, to work out your risk of heart disease using a number of factors such as age, BMI, gender, blood pressure levels, cholesterol levels and which type of diabetes you have.<p>If you want a general guide of how healthy your cholesterol levels are, find out your total cholesterol-to-HDL ratio<p>To find this, take your total cholesterol figure and divide it by your HDL figure. A result of less than four is healthy<p><a href="https:&#x2F;&#x2F;www.diabetes.co.uk&#x2F;Diabetes-and-cholesterol.html" rel="nofollow">https:&#x2F;&#x2F;www.diabetes.co.uk&#x2F;Diabetes-and-cholesterol.html</a>

Good article, thanks for sharing