(Disclaimer: I’m not a doctor, and these are simply my opinions, and are not a substitute for medical advice)
Just last week I went to my primary care doc for my annual physical. It’s been a few years since I had any labs drawn and I was quite curious to find out what the results would show.
I wasn’t really concerned about anything in particular, because I live a relatively healthy lifestyle. Sure I have the occasional ice cream binge, and every once in a while I will crush a Chipotle burrito, but for the most part I eat an array of good food.
However, this post isn’t about “duh” foods like fruits and veggies, because it’s a non starter that anyone looking to improve their health should consume lots of them. This post is about meat, eggs, and cheese, or at least the component parts of them, fat and cholesterol.
Fat and cholesterol are two of the most demonized nutrients around, and have been for going on 3 decades now. The low fat craze and the subsequent demonization of cholesterol really go hand in hand. Anybody that has ever made any sort of health improvements has at one time come across the idea that abnormally high blood cholesterol carries with it an increased risk of heart disease.
Much of the literature surrounding the lipid hypothesis may in fact point to an association of cholesterol and heart disease, but I’m not here to talk about research studies. I’d like to highlight that associations do not mean there is a cause and effect relationship and that is an important distinction to make. When two things are associated it simply means that where one thing is found (high cholesterol) there just so happens to be another thing found with it regularly (heart disease). Understanding why that is important is at the heart of how the lipid hypothesis unravels. There are also other concerns with respect to how nutrition research is performed that leave much to be desired as well.
These two factors and how they apply to the lipid hypothesis is what we’ll explore today. The first is that the lipid hypothesis is accepted as fact, when in reality it is not. If something is to be accepted as fact then it must hold true all the time no matter what, and the lipid hypothesis does not.
The basis of the lipid hypothesis is, eating animal fat increases cholesterol, this cholesterol then clogs your arteries, and therefore puts you at increased risk of heart disease. If this was an indisputable fact then anyone who eats a lot of foods high in cholesterol like animal fat etc should have elevated blood cholesterol and basically be at deaths door. Sadly this is not often the case. To use myself as an example I’ve eaten roughly 500 lbs of red meat, an equal amount of cheese, and somewhere in the neighborhood of 8,000 eggs(cooked in butter no less) over the past decade.
My total cholesterol from my recent doctors visit was a whopping 152, LDL of 53, HDL of 91, and triglycerides of 39 (pretty stellar results thank you very much:). Something doesn’t add up? That means from the eggs alone I’ve consumed 1.5 million milligrams of cholesterol in the past 10 years. I contend that if the cholesterol we consume were to truly have an effect on our blood cholesterol numbers don’t you think mine, after 1.5 million milligrams, would show just the slightest bit of elevation? Yet it doesn’t.
Now some may say “well you’ve got great genetics”, but honestly genetics probably have less to do with our health than we might give them credit. I’m not saying there aren’t certain genetic factors that effect of our health, but I do believe it’s overstated. Sadly I think when you get the “it’s your genetics card” from your doctor it’s a nicer way of him/her saying I have no fucking idea what else I can do. Now I know my n=1 example cannot refute an entire body of evidence and is far from scientifically valid, but the fact that one example stands in opposition to the lipid hypothesis means it cannot be a fact.
Aside from my own example, if you ask many of the other fitness professionals in the industry I’d bet you would find they too consume far more cholesterol than is recommended, with little to no effect on their blood cholesterol and health. If an example from a lifelong health nut like myself doesn’t convince you then let me introduce to you John Smith (John Smith isn’t an actual person but a fictitious conglomeration of the thousands of people I’ve worked with).
You see John Smith is a 48 year old male, who was diagnosed with high cholesterol in his late 30’s and has been on a statin ever since. He’s completely cut out his red meat, egg, and other high fat food consumption since then and even exercises regularly. Now if the cholesterol we consume from the foods we eat is the culprit, it would logically make sense that when said foods are removed John’s cholesterol would go down. This again is not often the case. John’s cholesterol over the years remains the basically the same, he continues to take the statin, exercise, and be miserable because the poor guy can’t eat a steak occasionally and still his cholesterol won’t go down.
So if you eat all the wrong foods (me) with no effect or you avoid all the wrong foods (John), and neither can conclusively be shown to have the expected result, I’m not real sure why the lipid hypothesis is still spewed out like gospel? The answer is that if you tell a lie often enough people will begin to believe you, and that is how the lipid hypothesis became “fact”.
The second part of the problem is that much of the research in nutrition is done via dietary recall. This means the test subjects get a form and the authors of the study say write down what you ate over the last month. While I’m sure it’s a bit more in depth that’s what it boils down to. Now I’m not sure about you but I can hardly remember what I 2 days ago, let alone one month ago, and the kicker is humans are notoriously awful at dietary recall.
So to say the information gathered for many of the studies is less than perfect is in my eyes an understatement. Even with the existing association of heart disease and cholesterol it is really nothing more than that, an association because there is no way to control for the number of other factors that explain why a person gets heart disease. There simply are too many variables present and it is short sighted to say that one factor, cholesterol, is the cause of heart disease when there are so many other factors that are overlooked.
At the end of the day I’m no doctor and I’m in no way saying that the book on cholesterol is closed and that people can eat whatever they want willy nilly. I am saying that there is more to the story than just the idea that eating fatty foods will increase your cholesterol then your heart explodes. Likewise I’m not attempting to call out doctors or any of that, I’m simply saying when our so called truths don’t hold up that we be humble enough to accept that we don’t know everything and continue to look for new answers and broaden our knowledge.