This speaks for itself.1 It is quite clear that the countries are listed in order of climbing cholesterol levels, but the rate of heart attack rises and falls fairly randomly. Also it is undeniably true that the Aborigines have the lowest cholesterol levels and highest rate of heart disease while the Swiss have the highest cholesterol levels and the lowest rate of heart disease2 34 .
So what is this demon substance cholesterol high levels of which have been inextricably linked us clutching our chests and croaking? Well, here is the definition as given in my copy of Collins internet-linked dictionary of medicine: Cholesterol an essential body ingredient [my bold] found in all human cells, mainly as part of the structure of the cell membranes, CORTISOL, corticosterone and ALDOSTERONE [their caps, not mine], the male and female sex hormones and the bile acids. It is synthesized in the liver and a large quantity of cholesterol passes down the bile duct into the intestine every day. Most of it is reabsorbed. A diet high in saturated fats encourages high blood cholesterol levels. Soluble dietary fibre and various drugs [hurrah – profits] can bind intestinal cholesterol and prevent its reabsorption. Cholesterol is carried to the tissues in tiny cholesterol carriers called low density lipoproteins (LDLs). Oxidation of these allows cholesterol to be deposited in the walls of arteries causing dangerous narrowing (ATHEROSCLEROSIS).
So there we have it – essential to human life. Google search ‘What is cholesterol’ and this sentence will be found endlessly. It is vital in the cell membranes for building the structure of their walls, and for allowing permeability; it is important in the production of both male and female sex hormones and in the production of the stress hormones, in bile conversion (so very important in digesting fat) and in the metabolism of the fat soluble vitamins A D E K, and finally it insulates the nerve fibres.5. Add to this the synapses in the brain -the connections between the nerve cells – are made almost entirely from cholesterol. This all sounds very important to me in order to be happy and healthy. Yet the Dept of Health recommends a level under 5 mmo/litre. Is this really desirable?
There is an very distressing genetic condition called Smith-Lemli-Opitz Syndrome (SLOS). With this condition, there is a defect in cholesterol synthesis that results in very low cholesterol levels:
In short this condition is characterised by quite dreadful effects on health: stillbirth, death from multiple organ failure, visual loss, congenital heart disease and autistic type behaviour.
At the other end of the spectrum there is FH – familial hypercholesterolaemia. With this condition the cholesterol levels are stratospherically high. Unlike SLOS, there are frequently no symptoms of FH and having FH does not mean you will automatically die young of a heart attack. Far from it, many go on to live to a ripe old age. Anybody reading this blog with this condition ought to buy Dr Kendrick’s book The great cholesterol con. 6
As the video says, there are no studies linking cholesterol to heart disease. However there are studies linking low cholesterol levels to a higher level of all cause mortality. One such is the study called Why Eve is not Adam7. The introduction contains the following sentence: The significance of low cholesterol as a predictor of health status has been reappraised. This interest began first with the evidence that iatrogenic [doctor causing the disease or disorder] lowering of the cholesterol level was associated with unexpected mortality from causes other than cardiovascular disease. Later on in the discussion we read In men a low cholesterol level is significantly predictive of risk [of death from any cause] at all ages, although<50 yrs is borderline significance. In women low cholesterol is even more markedly predictive <50 yrs, but no significance on mortality after 50. Further on can be read The relationship between low cholesterol levels and all-cause mortality is confirmed for both men and women ≤50yrs. This contradicts previous assessments that low cholesterol level is a proxy or marker for frailty occurring with age. So in all the hysteria endlessly surrounding high cholesterol levels and saturated fat causing us all to die from CVD (cardiovascular disease), it can be easy to forget that there are actually many other ways of dying, and, given a choice, I would rather a heart attack than dementia or cancer.
There are other studies coming to similar conclusions, studies comparing death rates from CVD amongst men and women8 – and in some countries the women die of CVD more than the men – irrespective of levels of cholesterol. Yet the medical profession is utterly wedded to the link between cholesterol and heart disease – as the above dictionary quote well represents. It started out saying it is an essential body ingredient but ends linking it to causing atherosclerosis. Surely something has to be wrong here. Atherosclerosis certainly exists but in the face of what is actually overwhelming evidence9 to link it inextricably to overall high cholesterol levels is illogical, captain. However this link does make a lot of money for drug companies selling cholesterol lowering drugs. Most peculiar.
Enough for now. A separate blog will deal with these wondrous things: HDL, LDL, VLDL and IDL, Lp(a)s and how cholesterol is transported around the body. It is also very important to find out about that other dreaded killer saturated fat. Excuse me while I just go to load up on some more butter.
- Of course, there is the French Paradox which supposedly shows France as having a low death rate from heart attack despite noshing piles of saturated fat – but a problem with this is that apparently French doctors don’t put cause of death down as heart attack when other countries would. [↩]
- This graph is taken from the World Health Organisation Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA project) [↩]
- Incidentally heart disease is more than just heart attacks. It covers all ills related to the heart and circulation. [↩]
- The Aborigines were not part of the MONICA study funded by the WHO. They have been added to this graph by Dr Kendrick to illustrate the point. [↩]
- This all found in Medical News Today [↩]
- Essentially what he says that this has been called a fatal condition linked to a great risk of developing heart disease – but that this is based on the fact that studies are based on those already diagnosed with a heart condition so we end up with over inflated results and that many with FH go on to live a very long life indeed. However he does say that FH can cause atherosclerosis but by a different mechanism than elevated LDL levels; a mechanism to do with blood clotting abilities. It is almost as if FH is the opposite in effect to Haemophilia. So instead of reducing cholesterol levels, ways should be found to reduce blot clotting when it has done its job of holding the wounded artery together. It is complicated – read the book. [↩]
- Ulmer H, Kelleher C, Diem G, Concin H. Why Eve is not Adam: prospective follow-up in 149,650 women and men of cholesterol and other risk factors related to cardiovascular and all-cause mortality. Journal of women’s Health. Vol 13 no 1 2004 [↩]
- I can’t resist it – results from part of the MONICA study comparing Russian women (RW) to British men BW): rate of smoking RW 10%, BM 27%; Average cholesterol levels: RW 5.4mmol/l, BM 6.0mmol/l; average systolic BP: RW 132, BM 134; saturated fat consumption RW 8.2% of calories, BM 13.6% of calories; death rate out of 1 million RW 267, BM 229 per year. So the Russian women smoked less, had lower cholesterol levels, lower blood pressure, ate less saturated fat, were women and yet more died of heart attacks than their British male counterparts. What on earth is going on with the high cholesterol hypothesis? [↩]
- which I can hardly go into endlessly in a short blog [↩]