Over the past 30 years I’ve talked a lot about cholesterol. I’ve written a report on it, I’ve compiled questions to ask your doctor about blood cholesterol readings and medications to lower cholesterol and I write about it in my book Lab To Table. Now I find myself writing about it again because I keep hearing people say that they went on the ketogenic diet, their cholesterol went up and their doctor told them they would need to reduce it by going on statins and that the diet was dangerous.
I also recently heard these exact words from a highly-educated science mind in pharmacology and cannot believe that this narrative is perpetuating unchecked in the medical fraternity. It’s time to educate in order to understand.
First of all, if you are on the Healthy Keto Way (HKW), don’t worry – it’s not dangerous. If you’ve read the HKW book you know that it is a survival diet that the human race phases in and out of as food is scarce and then plentiful respectively. It is not dangerous when you understand the mechanism behind how it works and if you understand cholesterol and its true association to heart disease and blood cholesterol readings. The HKW is about moving in and out of using ketones as energy, unless you have a medical reason to stay in ketosis.
Cholesterol in the Body
I was listening to a recent podcast (2020) with Ivor Cummins and Dr Malcolm Kendrick on cholesterol and heart disease (https://thefatemperor.com/ep40-dr-malcolm-kendrick-the-true-causes-of-heart-disease-are-not-what-you-think/). It is from the Fat Emperor Podcast – Decoding the Science – Transforming Your Health.
When I was writing my first book Changing Habits Changing Lives back in the 1990’s, I found a wonderful quote from Dr Malcolm Kendrick and it has stayed in my book since that time. He said: “The cholesterol hypothesis can be likened to a cathedral built on a bog. Rather than admit they made a horrible mistake and let it sink, the builders decided to try and keep the cathedral afloat at all costs. Each time a crack appeared; a new buttress was built. Then further buttresses were built to support the original buttresses”.
Dr Kendrick has become an expert in heart health and it’s worth listening to him talk about the latest research in prevention of heart disease.
Cholesterol is, to me, a super fat. Your liver produces and regulates the cholesterol levels needed as building blocks for cells and hormones. Here are some facts about cholesterol:
- Making up more than 50% of the cell membranes, cholesterol maintains membrane permeability and protects the core of the cell while still allowing the cell to be fluid.
- Cholesterol is the precursor for vitamin D. When converting sunlight into vitamin D, cholesterol in the tissues acts as the catalyst for this important process. Vitamin D in turn is crucial for mineral metabolism and targets over 2000 human genes. Vitamin D Deficiency is linked to some cancers, heart disease and autoimmune diseases. Since the COVID19 pandemic it has become glaringly obvious in observation studies with concurring blood tests that the blood status of low vitamin D has a direct correlation with mortality of COVID19.
- The liver converts cholesterol into bile acids so that the body can absorb fats and fat-soluble vitamins (A, D, E & K).
- Cholesterol maintains proper gender-specific hormone levels.
- It is important for the production of the hormone cortisol (the stress hormone).
- Studies on cholesterol are beginning to unveil its role in metabolising calcium, boosting the immune system, cancer prevention and mental health and cognition.
- The Myelin sheath that protects nerve cells contains cholesterol as does the brain – this helps with cognition and function of the brain.
So you can see that cholesterol is a vital nutrient that is important for physical and mental health.
Readings for Cholesterol
When a cholesterol reading is taken, the total cholesterol is worked out as well as triglycerides and high-density lipo proteins (HDL) and low-density lipo proteins (LDL). LDL’s are called bad and HDL’s are called good. The first time I heard this I was puzzled as I couldn’t figure out why anything the body makes for regular function could possibly be bad. Let me explain.
The job of LDL’s among other things is to take cholesterol from the liver where it is made, into the tissues where it can manufacture the products that we need like hormones, brain parts, and vitamin D.
The job of HDL’s among other things is to take cholesterol from the tissues to the liver to be stored. So, when the body has no need for the cholesterol to manufacture any goods, it sends it into storage. In my way of thinking, HDL’s and LDL’s are both necessary wonderful products that create a cholesterol homeostasis. Neither are bad and neither are good, they are just normal functions working on a regular basis for the normal healthy body function.
Both HDL’s and LDL’s are like passenger taxis picking up and dropping off passengers/substances for the biochemistry and health of the body. I hope that is now cleared up. While we are on cholesterol readings, if you have what is deemed a high triglyceride level, then a change in diet away from refined carbohydrates and alcohol will correct the situation.
The body does not need to eat cholesterol, it is quite capable of making cholesterol from other products that you consume. So dietary cholesterol has very little to do with blood cholesterol. It is a nice benefit when you eat it, but not essential.
The reason the common belief that LDL’s are bad is because atherosclerosis plaque (narrowing of the arteries and the precursor to heart disease and stroke) has cholesterol within its fold. So the assumption was if we keep cholesterol out of the tissues then we will stop atherosclerosis. But the body is not that simple. By reducing LDL’s and raising HDL’s, we then take the precursors for products required for the body away from the tissues into storage. What I find quite disturbing at the moment is that we now have an epidemic of vitamin D deficiencies and thus vulnerability to viruses. Many people tell me after I explain this whole process to them that they are on cholesterol-lowering drugs and, since they have been on them, have had a vitamin D deficiency. Can no-one see the correlation?! And, by the way, vitamin D will not be the only substance being affected. Cortisol, the stress hormone, will also be reduced in production along with gender-specific hormones and other important products for the body and brain.
I just love the human body; in most situations it is born perfect and given the right resources (not junk food) and left alone to do what it does best, can be healthy. So many people do not understand this and believe that this magnificent body is flawed and that they need drugs to control all processes from blood pressure, blood sugar, blood cholesterol, brain chemistry and so on in order to be healthy. The scary thing is that many doctors tell their patients that they will need to be on these drugs for the rest of their lives. If any doctor has said this to you, I expect that you need to find another doctor whose aim is to get you healthy so you don’t need to be on body- and mind-altering drugs. I saw a quote the other day that revealed a good doctor works hard to get you off your medications. Times are changing.
Drugs have a black and white job, but the body is not black and white. When you affect one process, you affect 1000’s of other processes too. We are not a machine, we are an innate intelligence that has lived for 100’s of 1000’s of years on this planet, eating foods we evolved to eat without heart disease and without microscopic observation.
It is important that I add here that medicine is a wonderful art and we have advanced so much in what we have learnt from research and science. In fact if it were not for medicine, many of my family members would be in trouble. I have a cousin that was diagnosed with type 1 diabetes at age two, so he needs insulin. I also have nine family members with the bleeding disorder haemophilia, which means they need prophylactic factor 8 in order to live a normal life. Six did die from HIV, but that’s another story.
There are situations without a doubt where medicine has me in awe, but like all healing arts, they have their limitations, and it is time the institution of medicine and science realise they are not the panacea for everything.
Let’s go back to cholesterol being part of the atherosclerotic plaques. Yes, it is true, but is the cholesterol the chicken or the egg? Does cholesterol cause the plaque or does the cholesterol come after the plaque has started? More and more research shows that it is inflammation that causes the beginnings of a plaque and cholesterol goes to the point of inflammation as a policemen would go to a robbery or an ambulance to an accident. Imagine if you always showed up after the robbery or accident had occurred and the police and ambulance had arrived. After some time you might assume that the policeman/ambulance is the cause of the robbery/accident, but of course you would be wrong. So when cholesterol was being researched the scientist always arrived after the police/cholesterol came and therefore declared them to be the culprits to the robbery/plaque. It is an easy assumption to make but so very wrong.
Evidence is mounting as to the cause of atherosclerosis which does not include blood cholesterol. More and more professionals and heart specialist realise that inflammation of the blood vessels is what begins the plaque. Causes of this inflammation can be several including parasites, rogue foreign bodies including fungi, bacteria and viruses, chemicals that we consume, breathe in or put on our skin, poor integrity of the microbiome of the body, as well as foreign food particles, including the 1000’s of flavours, colours, additives, man-made fats, processed foods, refined vegetable oils, and synthetic biology and technology-driven foods we eat that the body has no idea what to do with.
I also believe the mechanism of vitamin supplementation (single dose vitamins or minerals made in a laboratory) may have some affect on the inflammation of blood vessels. When you listen to the podcast with Dr Malcom Kendricks and Ivor Cummins, they both acknowledge that it is not one thing that causes atherosclerosis and heart disease but an etiology of many factors.
The continuous bombardment to the body from the minute we get up until we go to bed is the problem, as the acute inflammation, which is good, turns into chronic inflammation. If on occasion some foreign food substance or virus enters our system then the body will mount up a defense and clean up the foreign substance with acute inflammation. But when we constantly bombard the body from the minute we get up until the minute we go to bed, then eventually the body protects itself by creating chronic inflammation which in turn leads to plaques on arterial walls, heart disease, autoimmunity, cancer and all the modern maladies we see in the population in 2021.
A good analogy to atherosclerosis is to imagine if you kept scratching your skin in exactly the same place day in and day out. Firstly, you will bleed, then a scab will form, but if the irritation keeps going, the scab will never fully heal and the skin will manufacture a scar that will get thicker and thicker until it has protected itself from the offending scratcher. Of course this is an oversimplification of the amazing process of the body, but it will give you an idea. The difference between the skin and the lining of the artery walls is that skin grows from under to the surface while the arterial wall does not have that luxury – it is just a few cells thick and can become damaged under pressure.
Dr Meyer Texon, a prominent New York pathologist and doctor, says: “Accusing fat and cholesterol of causing the injury that led to atherosclerosis is akin to accusing the white blood cells of causing infection, they are both there to help repair.”
There are many factors that need to be taken into account when assessing heart disease risk; taking only cholesterol blood markers as the risk factors is proving not to be so accurate. There are many great thinkers from researchers to medical doctors and biochemical engineers that have methodically thought through the process of being in ketosis and high cholesterol levels and have theories on this matter. The reason these are theories is that the science has not been done on the small amount of people that go on a ketogenic diet and have an increase in cholesterol levels, especially LDL’s. For most people who go on the ketogenic diet, their blood cholesterol falls, as do many of their inflammatory markers.
There are three theories that have been proposed regarding a rise in cholesterol:
- In the process of making ketones, acetyl-CoA is required, which is a precursor to cholesterol, therefore having more acetyl-CoA in the blood could mean an increase in cholesterol synthesis and LDL’s.
- Higher saturated fat intake increases cholesterol absorption and the low insulin state, due to lack of carbohydrates, decreases LDL receptor activity. Therefore, less receptor activity will reduce the amount of LDL particles being pulled out of circulation; this in theory could increase circulating LDL.
- More energy demands and lower body fat and glycogen stores triggers the liver to increase LDL so that fat can be transported to the cells to be used as fuel.
This of course is a simplification of all the theories, but until we have scientific fact, the science community is divided on the issue of whether the ketogenic diet is good for the heart.
If you want to learn more, I recommend the following article: https://www.dietdoctor.com/low-carb/cholesterol-basics#strategies-heart-health
For most people, they know they feel better and they have more energy and it seems enough for them to stay in an ebb and flow state of ketosis as we have always done in the history of man’s eating.
When the science isn’t clear I always go back to my two main guiding principles: Firstly, how we ate and what we historically consumed through the history of humans and, secondly, my guiding philosophy of vitalism – looking at all aspects of food and health not just focusing on a number in our bloods and reducing it with a medication.
In other words, if I find someone eating a junk food SAD (Standard Australian Diet) with a poor lifestyle and their cholesterol and inflammatory markers are high, then I’m going to be looking at suggesting drastic diet and lifestyle changes. Even if their blood cholesterol is low, I’m going to suggest the same thing. But if I find someone who has higher than standard cholesterol levels, with low inflammatory markers and they have an incredibly healthy lifestyle, then the high cholesterol reading may mean something else, like infection, stress, an increased requirement for hormones and/or an increase in energy needs.
To look at one thing and believe it is the whole equation can be like looking at an elephant’s trunk and believing it is a hose rather than a sophisticated part of the elephant’s anatomy required for foraging, eating, drinking water and dust bathing, nurturing, smelling, defending, protecting and breathing.
The HKW is based on real food that includes individuality of carbohydrate tolerance. We do not use ketone supplements, nor do I recommend them. (You can read about them here). Tolerance to carbohydrates changes as health improves and there is less insulin resistance. When the program is done correctly, then a state of wellbeing both mentally and physically begins to take shape; this is our guide that we are on the right step to finding more energy and vitality and to live a life filled with more joy and health.
Questions to ask your doctor if your blood test is high for cholesterol, or your LDL or HDL markers are not what they want:
Is high cholesterol proven to be a bad indicator of total health?
Do our cholesterol levels change from day-to-day, week-to-week? And if so would I be out of the ‘danger zone’ if you took a reading in a week or a month?
Is there really such a thing as good and bad cholesterol, or is it a homeostatic mechanism in the body?
Do you live longer using statin drugs or does it just lower your cholesterol?
Is cholesterol really an indicator of cardiovascular disease? What percentage of people with heart disease have low cholesterol?
Does the body need higher cholesterol levels in times of stress?
Does the cholesterol we eat make any difference to blood cholesterol? If so how much?
How much cholesterol will the body make if I eat no cholesterol?
Is there another reason why cholesterol might be high?
Is the body really that black and white: high cholesterol – heart disease, low cholesterol – no heart disease?
If my brain and nervous system is largely protected by cholesterol then why is cholesterol bad?
If I take statin drugs will I have a vitamin D deficiency – after all we need cholesterol to make vitamin D?
Are there side effects to statin drugs? If so what is the complete list?
Can you guarantee that if I don’t take the medications that I will die tomorrow of a heart attack or are you just scaring me?
Ask your doctor whether they would take the medications?
Would diet help?
Would a traditional diet make a significant difference?
Would taking wheat out of the diet as well as sugar cause a reduction in triglyceride and cholesterol readings?
Do I need my thyroid tested, could that have something to do with why my cholesterol is high? (Undiagnosed and untreated hypothyroidism can increase cholesterol in the blood)
Could it be an iron and copper deficiency that is causing my cholesterol to be high?
Or could it be my ferritin levels that would be a better indicator?
Should you take my calcium score, would that be a better indicator?
Perhaps it is the lack of antioxidants in my diet that may be causing my LDL to oxidise, therefore staying in my blood longer and increasing my levels?
What is the particle size of my LDL’s and have you tested for the many different LDL’s in my blood stream or just calculated LDL results from HDL and cholesterol count?
Should I try a diet high in antioxidants and real foods before I use the medication?