I Have High Cholesterol and I Don't Care

If you're a regular reader of this blog, you may know that I love to talk about cholesterol.  You know about my many blog posts on the falsity of the lipid hypothesis, the idea that high cholesterol causes heart disease.  It's been by far the most covered topic on my blog (1, 2, 3, 4, 5, 6, 7, 8, 9, 10).  It's always been a major topic of interest to me, because I feel so strongly that people are being misled when it comes to cholesterol.  It's my view that high cholesterol (recognized by most doctors as higher than 200 mg/dl) is completely overrated as a risk factor for heart disease, and that cholesterol-lowering drugs are unnecessary/useless/potentially harmful for 95% of the population.  Everyone is always so damn worried about their cholesterol, and they don't need to be.  So I'm "that guy".  I'm the guy who scoffs at doctors when they prescribe statin drugs for women with cholesterol levels of 210.  I'm the guy who shakes his head when an otherwise healthy person returns from the doctor's office upset about having high cholesterol.  And I'm DEFINITELY the guy who laughs when you start eating egg white omelets every morning to fix it.  That's just hilarious in so many ways.

What in holy hell...

Now it's one thing to challenge the mainstream ideas on blood lipids; anybody can read books and come up with a take on it.  But it's a totally different animal when you find out that YOU have high cholesterol... very high.

According to my first blood lipid panel, my cholesterol was 408 mg/dl.  Said my doctor, "People with cholesterol this high are the ones who have heart attacks in their 30s."  Suddenly I began to question my beliefs... What if conventional medicine has been right all along?  What if cholesterol really is a killer?  Will it kill me?  Am I eating too much fat?  Do I need to take Lipitor?  But most of all, am I really prepared to disregard all of the conventional wisdom on cholesterol and heart disease when it's my life at stake?  As you can see, it's a little more difficult to keep being "that guy" when I'm the one with high cholesterol; and not just high... super high.

Well, fortunately it's come down quite a bit since then; 287 mg/dl at most recent measurement.  Still a bit high compared to the average person, but high cholesterol runs in my family, so there's not a whole lot I can do outside of taking statins.  We all know that's not gonna happen.  And although high cholesterol runs in my family, heart disease does not.  Yes, do a double take.  Cholesterol and heart disease are not inextricably linked. Anyway, here's the breakdown of my three blood lipid tests...

I've highlighted the out of range labs in red, and the good ones in green.  As you can see, my total cholesterol and LDL came down significantly from the first test.  But there's more to a blood lipid profile, and by every other marker I'm at low risk.  Actually, every other measurement is immaculate.  HDL is very high, triglycerides are very low, total:HDL ratio is perfect, my LDL particles are large and buoyant, and my CRP (measure of inflammation) is almost zero. 


Why did my cholesterol come down 121 points?

First test
At the time of my first test, I had been eating very low-carb paleo; less than 100 carbs a day.  I was eating lots of vegetables and meat, especially fatty conventional meat from Stew Leonard's... I'll admit, not the best option.  I ate very little dairy and grains at that time.  Roughly 60% fat, 25% protein, 15% carbs.

Second test
My diet had not changed that significantly from the first to the second test, in which my total and LDL dropped dramatically.  I began to increase my carb intake a little, and I cut back on the conventional fatty meat for sure.  I ate more full-fat dairy and eggs, as well as some rice and potatoes.  The macronutrient ratios likely didn't differ much from that of the first test:  55% fat, 25% protein, 20% carbs.

Third test
I would say my diet has changed more from the second to the third test than from the first to the second.  I now eat significantly more gluten-free grains like rice and corn, as well as potatoes.  I still eat around 4 eggs each day and drink whole milk regularly.  But of course, meat, vegetables, and fruits are still a major part of my diet.  Oh, and grass-fed butter.  What would I ever do without you.  I would estimate my diet at about 40% fat, 25% protein, 35% carbs. 

So what accounts for the huge drop in total and LDL cholesterol?  Well, I think that first test was a bit of an aberration.  I don't have any data before that, but I would guess that it hasn't always been as high as 408.  My super-high cholesterol was a likely result of just starting a low-carb, high-fat diet.  It is well documented that high-fat diets can increase blood cholesterol in the short-term.  In the long-term though, cholesterol returns to normal levels.  I discussed this here.  This is exactly what happened in my second test, where the fat content of my diet had only minimally changed but my cholesterol dropped 100 points.  It's also possible that I just don't do well on a super-low-carb diet.  Who knows.

Could I lower my cholesterol further if I adopted a low-fat, plant-based diet?
Yes, I'm sure I could.  But why would I?  Cholesterol isn't the end-all-be-all when it comes to overall mortality... actually it pretty much sucks as a predictor of heart disease too.  Take this statistic for example... about 50% of those hospitalized with heart attacks have normal total cholesterol levels.  50%!! (proof)  Why don't we just base our heart disease risk on a coin flip!?  We need to take into account HDL, LDL particle size, triglycerides, and CRP... total cholesterol on its own is pretty useless.  And it's probably the grass-fed dairy/meat and egg yolks that are keeping my HDL high, so no vegetarian for me thanks. 


Bottom line... I've done some pretty extensive research on this topic ever since I got my cholesterol scare, and I've come to a few conclusions.  
1.  If my cholesterol stayed over 400 I'd be concerned... that would indeed be a problem and could be indicative of familial hypercholesterolemia.  Total cholesterol isn't a great predictor of heart disease, but when it's this high, there could be a real issue.  These people really can have heart attacks in their 30s, and they benefit tremendously from statins, as much as it pains me to say it.
2.  Having a total cholesterol around 287 may or may not be an issue; it depends on HDL, LDL, triglycerides, and other markers of health.  If I were a fat, diabetic, out-of-shape loaf with a 287, low HDL, and high triglycerides, then there would be something to worry about.  However, I'm in great shape, have fantastic HDL, triglycerides, and CRP, and have no blood sugar issues.  I'm not worried.
3.  Rather than waste my time and energy worrying about my cholesterol, I plan on getting periodic heart scans to find my calcium score, which is a direct measure of how much plaque I have built up in my arteries.  Why concern myself with shitty risk factors when I can measure my risk directly?

So I have high cholesterol and I don't care.  It's time to get out of the dark ages; we've got bigger things to worry about than total cholesterol.  Tell all your friends.