Cholesterol Confusion Cleared Up

One of the first questions people ask me when they hear about low carb healthy fat nutrition is “what is all that fat going to do to my cholesterol?”  Cholesterol and fats have been villainized for so long that BigPharma probably laughs at how easy it was to brainwash us all.  We have been told that LDL is “bad” cholesterol and HDL is “good” cholesterol, but neither concept is accurate at all.  The original reason that cholesterol was blamed for building plaques in blood vessels of the heart is related to findings during early autopsies.  When the clogged blood vessels were dissected and studied, there were LDL particles identified and blamed without adequate understanding of LDL function or purpose.  Since these “discoveries” BigPharma set out to build a plan to stop LDL from further intrusion into health.  The problem is that we did not know the exact purpose of LDL at that time; LDL and HDL are REALLY transporters of fatty acids.  They act in similar fashion as insulin does for glucose; insulin is the “truck” that moves glucose OUT of the bloodstream and INTO the cell for use/storage.  LDL and HDL are “trucks” that move fatty acids, like triglycerides, to/from the blood vessels/liver/brain/organs for use/storage.  LDL particles were found in those blood vessel plaques because they were part of the HEALING of the body; we are just now beginning to realize that the LDL particles were responding to an inflammatory process; they were NOT the CAUSE of the inflammatory process.  Thus, elevated LDL most often indicates high inflammation.  Mainstream medicine recommends an LDL level less than 100 mg/dL, but some recent studies are linking lower LDL to poorer outcomes, especially in people over 65 years of age. Years ago, it was acceptable and normal to see LDL levels around 200 mg/dL without alarm. 

HDL has long been known to be cardio-protective; somehow, HDL did not garner the “bad” reputation of LDL, but rather was identified as helpful to blood vessels and heart health. The “healthy” oils recommended over the past 50 years have actually contributed to LOWER HDL levels, and higher LDL levels.  Optimal HDL level is above 50 mg/dL, but most Americans typically run in the 30s or lower.  Many people on a low carb healthy fat eating plan will significantly raise HDL, but then become quite alarmed because it also pushes TOTAL cholesterol up.  There’s no real need for major concern, since the elevation is in the cardio-protective transporter, NOT in inflammatory cholesterol.

So what is the “inflammatory cholesterol?

The most worrisome component of the lipid panel is the triglyceride level.  Triglycerides have been recognized by several cardiovascular experts as the most dangerous piece of the cholesterol panel.  Triglyceride molecules are seen as inflammatory and sticky because they are related to high carbohydrate intake. Think about all the carbs typically consumed, and how the body manages those carbs/sugars. When we overconsume carbohydrates, it can take the liver up to 4 days to process them all; many of them are shipped to the liver for glycogen storage, but overload then triggers triglyceride production. Remember that LDL is the transporter of these triglycerides, so what happens when more and more triglycerides need to be transported?  The body responds by producing even MORE LDL, raising Total Cholesterol even more. The most dangerous situation is the combination of elevated triglycerides AND elevated LDL; the body is at significant risk of heart attack, stroke, and coronary artery disease when BOTH of these components climb to more than double the normal levels.  Keeping triglyceride levels under 150 mg/dL is considered “normal”, but ideally, less than 100 mg/dL is a more healthy goal.

In addition to understanding the relationship of triglycerides and LDL, there are a couple of other relationships that can prove helpful in understanding overall cardiac risk.  One of them is typically calculated and printed on your lipid panel report; it is the TC/HDL ratio.  Comparing total cholesterol to HDL provides us with a ratio that describes potential risk of heart disease.  For example: if your total cholesterol (TC) is 208 mg/dL and the HDL is 38 mg/dL, we set this up as a ratio/fraction, dividing 208/38 = 5.47, indicating a significant risk of heart disease, heart attack, or stroke.  The optimal ratio result is less than 1; a ratio result of >3 is recognized as a high risk, while 2-3 demonstrates a moderate risk. This calculation is typically the one that mainstream medical prescribers use when discussing health risks to patients.  The other calculation, the triglyceride/HDL ratio, has been developed and appears to show the most accurate comparison because it is comparing the highest risk (trigs) to the highest benefit (HDL).  So, for example, trigs of 245 mg/dL and HDL of 38 mg/dL would look like this: 245/38 = 6.4; any ratio greater than 4 is considered high risk of heart disease, while a ratio less than 2 is the goal.  Another example: trigs of 132 mg/dL and HDL of 64 – both of which are in the desired range – calculate to 132/64 = 2.  Thus, the lower the inflammatory triglycerides and the higher the cardio-protective HDL demonstrate a lower risk to heart health. 

But what if you have familial hypercholesterolemia?  Well, let’s take a moment to think about how this is usually diagnosed.  For the most part, mainstream medical providers typically will point the blame for elevated LDL or triglycerides on genetics without understanding that elevated cholesterol is created as part of normal liver function.  The most accurate method for determining genetic causes of elevated cholesterol is to have genetic testing done; a defect on chromosome 19 is what generally causes significantly elevated LDL.  However, low carb experts and more current research show no direct correlation between LDL and cardiac risk. 

The elevated TC/HDL risk is often the reason mainstream medical providers recommend statin medications, even in the ABSENCE of elevated LDL sometimes.  Other reasons that statins are recommended include elevated LDL and elevated TC; in addition, certain diagnoses will cause providers to recommend or prescribe statin drugs.  Diabetes and atherosclerosis will generally automatically create a statin prescription.  While statin drugs have some effective uses, they are not the cure-all that BigPharma has led us to believe.  In some circles, it is estimated that more than 15 people have to suffer side effects for 1 person to have any benefit from a statin.  Statins actually appear to lower the actual risk of a heart attack by 1%.  Yes, you read that correctly – ONLY 1% .   Dr.  Eric Berg has presented information about 300 adverse effects of statins that include Parkinson’s, Alzheimer’s, muscle/nerve/liver damage, heart damage, cancer and even diabetes.  One of the most troublesome actions of statin drugs is depletion of the enzyme CoQ10; CoQ10 is recognized as essential – meaning we must consume it to live.  CoenzymeQ10 is a fat-soluble nutrient found in the mitochondria of the cell.  CoQ10 is required for the production of energy, cell membrane stabilization, antioxidant actions, and is effective at stabilizing cardiac muscle electrolyte balance, reducing stress on the heart.  Reputable and

well-read cardiologists often recommend adding a CoQ10 supplement when they prescribe statins, but not all prescribers are aware or take the time to explain it. 

In 2017, the Australian Longitudinal Study on Women’s Health indicated that women over 76 years of age had a 17-49% risk for developing NEW-onset diabetes while taking a statin drug.  This study also correlated higher statin doses with higher risks of diabetes development. The original article appeared in Drugs & Aging, March, 2017, Volume 34, Issue 3, if you’d like to read the details of this study. 

While statins continue to be the number 1 most commonly prescribed drug in America, they are also the most feared by many patients because of the risks of side effects.  BigPharma continues to advocate the use of statins to lower cardiac risks, but the data isn’t really supporting their dogmatic stance. Emerging evidence suggests that cholesterol is not the true health hazard, but rather INSULIN resistance is the highest predictor of heart disease, and elevated triglycerides is recognized as evidence of insulin resistance.   

So, then.  What do we do with all these lipid panels and cholesterol tests our providers insist we have done? The Patient’s Bill of Rights grants each of us the right to choose/refuse any test or treatment because we should be PARTNERS in our own health care; many providers do not agree with this idea, and will try to persuade, coerce, and even BULLY patients into doing what they say.  This behavior is not appropriate or professional.  Dr.  William Davis has even authored a blog article regarding the bullying by medical professionals. We do NOT have to accept such treatment; it’s not acceptable for our spouse/partner to treat us this way.  It is certainly not acceptable for licensed and educated professionals to treat us less than human beings with feelings either.

Who actually benefits from taking a statin? 

There are a few patients that MAY benefit from a statin; some people who might find statins useful include those with previous heart attacks or strokes, including those with certain stents placed.  These patients have already suffered damage from significant atherosclerosis and are likely to have higher inflammation than those without this kind of medical history; and we do have studies that suggest statins to decrease inflammation.  In addition, smokers may also benefit from statins because of their associated high inflammation as well. 

Other tips to consider:

In a study published in JAMA in 2007, 121% of study participants showed an increase in liver enzymes while taking a statin; these patients were at low risk for cardiovascular disease – basically healthy people, and the drug raised their liver enzymes.  More recent guidelines have recommend that providers NOT alter statin dose based solely on elevated liver enzymes; why?  I truly don’t understand this recommendation; if a medication I prescribe causes an unhealthy side effect, the usual response is to stop that medication and list it as an allergy in the medical record. But because BigPharma’s bottom line may be at risk, I guess our health must be at risk too. (Do you hear my sarcasm?)

Cholesterol serves as the foundation for our hormones; our insulin, reproductive hormones, and many other hormones depend on adequate Vitamin D and cholesterol in our bloodstream. Without adequate cholesterol and Vitamin D, our hormones will not be efficient or sufficient to perform the assigned tasks within our bodies.  It’s no wonder so many men today, suffer with low testosterone; we get NO sunlight and what we DO get is not nearly sufficient, and everyone has been prescribed a statin.  With lower and lower cholesterol levels, testosterone cannot be produced in sufficient quantities, resulting in fatigue and other imbalances and symptoms. So far, all my low-T patients have normalized their testosterone levels by optimizing their Vitamin D levels.

What can be used to help lower cholesterol? Well, as we have already discussed, there’s no significant need to “lower cholesterol” in the majority of people.  Statins lower LDL, and LDL is not a health hazard, EXCEPT IN THE PRESENCE OF significantly ELEVATED triglycerides.  Lowering triglycerides is the priority.  Lowering triglycerides is most effectively done by lowering carb intake; because triglyceride levels can be impacted rather quickly, it’s not unusual for them to drop in about 2 months or so. However, LDL and HDL can take closer to a year or more to stabilize. Niacin has been prescribed for elevated triglycerides, but often causes such flushing that many people opt to avoid it.  Fish oil is another option, and is often recommended by cardiologists at a dose around 2000 mg total per day.  Keep in mind that fish oil in higher doses can have a “blood-thinning” effect and so patients taking anti-coagulants should use fish oil with great caution.

Cholesterol remains a hot topic among low carbers as well as mainstream medicine; it likely will remain a topic of conversation for years to come. Stay current on the research; keep cutting processed foods and carbs so the body can continue to heal.


The information provided in this article and on the Joyful Heart Health Care and KetoNurses blog should be taken as basic & general information, and NOT as medical advice.  All information presented by Joyful Heart & KetoNurses should be carefully evaluated and discussed with YOUR health care professional.

NOTICE: This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal health care professional. All viewers of this content are advised to consult their own qualified health professionals regarding specific health questions. Neither KetoNurses or the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their medical providers before beginning any nutrition, supplement or lifestyle program.


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