Rethinking Cholesterol and Heart Health

Rethinking Cholesterol

It’s hard to overstate the impact of cardiovascular disease:  It’s the #1 Cause of death in the U.S. and around the globe.

A person dies every 84 seconds and it kills more cancers than all cancers combined.  An estimated 1 million Americans have a heart attack each year.   And the annual costs in the U.S. exceed $300 billion.

Unfortunately, cardiovascular disease is one of the most misunderstood conditions in medicine.

Despite following decades long advice from the American Heart Association to cut back on dietary fat and the increasing usage of cholesterol-lowering drugs, more and more people are victims of heart attacks, stroke and other cardiovascular diseases.

However, the good news is that more experts are waking up to the overwhelming scientific evidence that throws out the “Diet Heart Hypothesis”, which holds that eating cholesterol and saturated fat raises cholesterol in the blood and is the primary cause of heart disease.   New research and forward thinking practitioners are looking beyond cholesterol for solutions.  The answer they say is not as simple as lowering cholesterol levels, but rather to address what is driving abnormal or unbalanced cholesterol numbers.

So if the answer to assessing and treating cardiovascular disease is not as simple as a low cholesterol level, what is really driving this epidemic and how should we be looking at our cholesterol to see how much we’re at risk?

The root causes of heart disease are multi-factorial and largely boil down to the food choices we make, how we handle stress and our exposure to environmental toxins.

These factors can drive systemic inflammation in the body, which is ultimately the process that damages the arteries in the heart leading to the formation of plaque and setting the stage for heart attacks or strokes.   It can be these underlying issues themselves that drive changes in the body’s production of cholesterol.

The fact is your liver produces the vast majority of your body’s cholesterol and only a small percentage actually comes from the food we eat.   Cholesterol production is actually a self-regulating mechanism in the body.  In other words, elevated cholesterol is a response to something else happening in the body.  It’s a symptom or perhaps a risk factor – but definitely not a cause when it comes to heart disease.

Cholesterol levels can change due to a host of factors:  in response to physiological stress (when the body is in fight or flight mode and produces cortisol it needs more cholesterol), changes in physical activity, changes in body fat, changes in hormone levels, or due to infection.   Tragically, when we artificially manipulate cholesterol levels with drugs, instead of preventing heart disease, we mask important underlying health conditions and compromise other important functions in the body.

Bottom line, cholesterol is a poor marker for heart disease.   Research supports that people who have low blood cholesterol have the same rates of heart disease as people who have high blood cholesterol.  In fact, studies have shown that 80% of the times, people who have heart attacks have the same exact cholesterol as people who have never had a heart attack.

What about LDL Cholesterol the so-called bad cholesterol?

It turns out that a typical lipid panel which measures the overall levels of high density lipo proteins (HDL) and low density lipoproteins (LDL) in the blood might also miss the mark when it comes to assessing risk for cardiovascular disease.   Many progressive minded practitioners are now using more sophisticated tests that show the precise number and detailed characteristics of LDL and HDL particles.  These tests, which are becoming more readily available, allow doctors to screen for patients with “normal” cholesterol numbers who might still be at significant risk as well as patients with “high” numbers who might be fine.

For instance, low LDL numbers can be misleading, if it is made up of tiny dense particles that are vulnerable to oxidation.   These tiny particles can more readily squeeze between the cracks in the lining of the blood vessels, causing plaque, which causes inflammation and can in turn trigger the cycle that leads to a heart attack.   Similarly, high LDL numbers may not signal high risk at all if the tests show that the particles are big and fluffy and therefore harmless.

So if small dense particles of LDL cholesterol are what increases heart disease risk, how can we prevent or reverse their formation?  We need to address the underlying causes of oxidation, which include: air pollution, insulin resistance (eating too many refined carbs and sugars), consumption of highly refined oils (i.e. corn, soybean, sunflower, safflower found in many processed packaged foods), exposure to toxins like lead, mercury as well as infections like hepatitis.

The Death of the “Diet-Heart Hypothesis”

As more and more medical practitioners accept that eating cholesterol and saturated fat does not raise serum cholesterol, the case for low-fat and fat-free diets is finally coming to an end.  In 2013, the American Heart Association and the American College of Cardiology reversed 50 years of warnings that we need to be concerned about dietary cholesterol.

Multiple studies in recent years support that it’s refined carbs and sugars –not saturated fat that drives abnormal cholesterol and heart disease because they contribute to insulin resistance and systemic inflammation.  In fact, saturated fats can have a beneficial effect on heart health, especially when part of a whole foods, low glycemic, high fiber diet rich in anti-inflammatory omega 3 fats (nuts, seeds, avocados and wild caught fish).   So thankfully, we can finally stop fearing the saturated fats in organic eggs, full fat yogurt and grass fed beef and butter.

The Truth About Statins

Despite the fact that low LDL cholesterol has not been shown to lower risk for cardiovascular disease, statin drugs are the #1 prescribed drug in the U.S with 1 in 4 Americans over the age of 45 taking them.    There is considerable debate on both their effectiveness and their safety.  Many studies conclude that statins seem to be most beneficial in patients who already have had a cardiovascular event, have a chronic disease or for those who have a genetic defect called familial hypercholesterolemia, which makes them resistant to traditional measures of normalizing cholesterol.

The controversy about statins really stems from their tendency to be overprescribed for patients that don’t really need them and the lack of disclosure on their long term side effects, which range from increased risk for diabetes, muscle weakness, nerve pain, cognitive mental decline and cancer.

The unintended consequence of statin use on both the part of the physician and the patient is the lack of focus on food and lifestyle as the primary protection against cardiovascular disease.

Bottom-line, if your doctor is concerned about your cholesterol, you can make the following key changes to optimize your lipids, reduce inflammation and live a heart healthy lifestyle:

  1. Eat Whole Foods – Eliminate processed packaged foods that often contain pro-inflammatory fats, artificial sweeteners and preservatives.
  2. Eat Anti-Oxidant Rich Foods – Berries, apples, citrus fruits and dark leafy green veggies.
  3. Eat a Low Glycemic Diet – Eliminate refined sugars and carbohydrates and eat a high fiber diet rich in cruciferous non-starchy vegetables and high quality proteins including beans, lentils, grass fed beef and pastured eggs.
  4. Eat More Healthy Fat – Enjoy more anti-inflammatory fats like avocado, nuts, seeds, olive oil, coconut oil and wild caught fish.
  5. Focus on Stress Management  – Find ways to reduce tension and chronic stress in your daily life with deep breathing exercises, mindfulness meditation, yoga or walks in nature.
  6. Incorporate Exercise  – Research shows that interval strength training and not just cardio exercises offer protective benefits for the heart.

Salmon Burgers with Avocado Dressing


  • 1 14 oz. can of wild caught salmon, well drained
  • Juice of ½ lemon
  • 1 tablespoon red onion, finely chopped
  • 1 teaspoon garlic, minced
  • 1 tablespoon dill, finely chopped
  • 2 scallions, thinly sliced
  • 2 teaspoons dijon mustard
  • 2 eggs, beaten
  • ¼ cup almond flour
  • ¼ teaspoon sea salt
  • ¼ teaspoon ground black pepper
  • coconut oil, for pan frying
Avocado Dressing
  • 1 medium ripe avocado
  • 1 small garlic clove, minced
  • 1 tablespoon cilantro, chopped
  • Juice of ½ lime
  • Salt and Pepper to taste
  • Water (as needed) to desired consistency
Salmon Burgers with Avocado Dressing Yield: 6 - 8 Patties Print
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