Veganism versus carnivore diet, calorie counting versus intuitive eating, weight lifting versus cardio, keto versus low fat the list goes on. Unfortunately, the field of nutrition is one full of controversy. Dietitians and other nutrition experts are often divided over almost everything when it comes to what eating a healthy diet means. Cholesterol is no exception. Rather than tell you what to believe about cholesterol, I’ll present both sides and let you decide.
But first… what is cholesterol?
The first thing to know about cholesterol is that your body makes this type of fat on its own. That is to say, you do not need to eat dietary cholesterol in order to have bodily cholesterol. Nor does eating dietary cholesterol cause high body cholesterol. Egg lovers: feel free to celebrate.
Our bodies depend on cholesterol to make hormones, produce vitamin D, and assist the liver in making bile (the substance that helps us digest fat). Cholesterol also serves as the cell membrane around every single one of our trillions of cells. Because all of these functions are vital to life, one of the criteria for being considered a mammal is the ability to synthesize cholesterol.
Different types
LDL: Low Density Lipoprotein
The AHA (American Heart Association) refers to this type of cholesterol as bad cholesterol. These lipoproteins are the delivery vehicles in your body that distribute fat and cholesterol to all the organs that need it. This is the type of cholesterol the AHA recommends to be <100 mg/dL. Functional medicine recommends testing the number and size of the specific LDL particles to determine if there is significant risk to the patient.
HDL: High Density Lipoprotein
The AHA refers to this type of cholesterol as good cholesterol. These lipoproteins are known to calm down inflammation in the body as well as prevent blood clots. This is the type of cholesterol the AHA recommends to be >40 mg/dL. Functional medicine standards are >60 mg/dL.
Triglycerides
Think of these guys as little fat bubbles of potential energy floating in your blood. When we eat, some of our excess calories are stored in the form of triglycerides to draw on for quick energy between meals. The AHA recommends them to be <150 mg/dL. Functional medicine recommends a level of <70 mg/dL optimally, with 100-150 mg/dL indicating insulin resistance, and >150 mg/dL a very concerning level.
Causes and complications of high cholesterol
High cholesterol is most commonly caused by smoking, stress, high alcohol intake, lack of physical activity, aging, and diet. Over time, high cholesterol can accumulate in arteries leading to atherosclerosis (hardening of the arteries). Atherosclerosis, if left untreated, can spread to the coronary arteries, resulting in a condition known as Coronary Artery Disease (CAD). CAD is more commonly referred to as heart disease, and it is the leading cause of death in the United States.
The current cholesterol controversy: conventional vs functional
Conventional viewpoint
Conventional medicine believes high cholesterol is extremely problematic for our bodies due to concerns over heart disease. Therefore, when labs exceed a total cholesterol of 200 mg/dL, the recommended treatment is often a statin in conjunction with lifestyle modifications. Statins prevent your liver from creating cholesterol. While effective at lowering LDL and total cholesterol, statins can also increase your risk for Type II Diabetes. They are typically taken indefinitely, as your cholesterol numbers will increase again off the drug. In terms of dietary adjustments, conventional practitioners recommend a diet low in saturated fat. Saturated fat is found in red meat as well as dark meat poultry, cheese, and full-fat dairy products. They recommend replacing saturated fats with polyunsaturated fats, such as subbing vegetable oil for butter.
Functional viewpoint
Functional practitioners believe that cholesterol is good for bodies and naturally increases as we age. They believe that the number 200 as the maximum for total cholesterol is arbitrary and not rooted in science. They do not see an association between high LDLs and heart attacks, attributing heart attack risk more to oxidized LDL (i.e. LDL particles altered via smoking, stress, vegetable oil consumption). Functional practitioners would be more concerned with the type of fat a person is eating rather than the lab results. They recommend a diet rich in unrefined, natural oils with no refined oils like canola, corn, and sunflower oils for example. These practitioners are concerned that statins negatively affect brain health, cause muscle damage, and increase risk of diabetes development. Should someone want to lower their cholesterol, they would recommend the use of fish oil or red rice yeast extract.
Still not sure which side of the cholesterol controversy you fall on? Check out the articles below for more information.
If you are interested in exploring the conventional viewpoint of cholesterol further, check out this article:
https://www.heart.org/en/health-topics/cholesterol/about-cholesterol
If you are interested in exploring the functional viewpoint of cholesterol further, check out these articles:
https://drhyman.com/blogs/content/7-ways-to-optimize-cholesterol
