Does Cholesterol Really Cause Heart Disease?


When our book, The Great Cholesterol Myth, reached best-seller status, people approached us at conferences, in airports, and at numerous events understandably asking us this question: “What exactly is ‘the great cholesterol myth’?”

Definitely a fair question, so here’s the short answer: The great cholesterol myth is the persistent idea that cholesterol is an important—if not the most important—measure of risk for heart disease; that we should be spending billions of dollars educating people on how to lower it; and that the drugs given to lower it are by and large safe and effective in multiple populations.

About 695,000 people die of heart disease in the United States every year–that’s 1 in every 5 deaths.

The truth is that numerous doctors and other experts continually perpetuate that myth. After all, what’s the No. 1 reason you’ve been told to keep your saturated fat intake as low as possible? Because saturated fat has been associated with higher cholesterol levels.

So—and stay with us for a minute now—if cholesterol is not the major risk for heart disease, and if the relationship between saturated fats and cholesterol is far more complex than we’ve been taught, and if the effect of saturated fats on cholesterol, when measured accurately, was actually positive, then the dietary recommendations of the past 30 years crumble like a house of cards.

Evidence clearly shows that all of the above are true. Cholesterol is not a major risk factor for heart disease, certainly not the most important, and certainly not the one that deserves a three-decade (and counting) pharmaceutical war against it while the real culprits in heart disease get comparatively little attention.

Consider a tsunami. Water is involved in tsunamis—you can’t have a tsunami without it—but water doesn’t cause tsunamis. Trying to prevent tsunamis by draining the ocean is a fool’s errand, yet that’s exactly the kind of approach we’ve been taking when it comes to cholesterol and heart disease. Rather than focusing on the conditions under which cholesterol becomes a problem (oxidation and inflammation), we’ve focused all our attention on the molecule itself. As Stephen Sinatra, MD, is fond of saying, “Cholesterol is found at the scene of the crime—but it is not the perpetrator.”

Which leads us to the obvious question: If cholesterol doesn’t cause heart disease, then what does?

Four Risk Factors for Heart Disease

It’s a great question, and the answers are multifactorial and complex—and we are very far from having all the answers. But we have a lot of them. Surely there’s some genetic component, not to mention dietary, environmental, hormonal, and lifestyle factors. That said, we believe that four of the major promoters of heart disease are:

  • Inflammation
  • Oxidative damage
  • Stress
  • Dietary sugar

We also believe that these four factors are far more important than overall cholesterol levels, and that there is a great deal we can do about each one of them.

For instance, you can lower stress, cut out sugar, and eat an anti-inflammatory diet. You can address the balance of omega-6 to omega-3 in your diet—we consume about 16 times more omega-6 than we do omega-3, a pattern that is associated with the production of inflammatory chemicals in the body (prostaglandins/ eicosanoids) and the suppression of important anti-inflammatory chemicals. We can eat more spices and antioxidant-rich foods. We can eat more fat and protein from grass-fed beef, wild salmon, and pasture-raised chicken and pork (and shun their factory-farmed counterparts). We can exercise. We can get some sun. And we can have healthy and nourishing relationships.

Are We Anti-Statin Drugs?

Now, when we say these things, people often accuse us of being anti-pharmaceutical or anti-drugs—or at least anti-statin drugs. What we really oppose is statin overuse, and there’s a ton of that happening. We oppose using statins in populations in which they have not been tested, in which they have shown little benefit (healthy middle-aged men, women, the elderly), and in which they could reasonably be expected to do harm (children).

Drug companies need us to believe that fighting cholesterol is essential to our own personal “homeland security.” Why not? Reports show that cholesterol-lowering statin drugs bring manufacturers about 30 billion dollars a year in revenue. That success is fueled by the myth that statin drugs save large numbers of lives. Little wonder that drug companies fund countless studies, which researchers then write up to highlight a small benefit while burying some real liabilities.

Statin drugs have shown a modest—emphasis on modest—benefit in the population of middle-aged men who’ve already had a heart attack or who have existing cardiovascular disease. This group is called a secondary prevention cohort because we’re trying to prevent a second heart attack. Statins have not shown consistent benefit for primary prevention—for people who have not had a heart attack and are generally healthy. Yet statins are being given out like candy in this very population.

Furthermore, we, like many of our colleagues, believe that whatever modest benefits statin drugs have do not result from lowered cholesterol but from lowered inflammation—plus, statins thin the blood.

So what’s the big deal, you might ask? If they do just those two things, isn’t that enough of a reason to just put ‘em in the water supply?

Well, no, actually. Because they also do a lot of nasty things. Side effects range from the mild to the serious and include loss of sex drive, memory impairment, muscle pain, joint pain, and loss of energy. And although those side effects might happen only 20 percent of the time, why take the chance when there’s so little likelihood of benefiting in the first place?

The coup de grace is that you can do the two good things that statins do—lower inflammation and thin the blood—with far more gentle substances. Fish oil, curcumin, resveratrol, gamma-tocopherol (vitamin E), and garlic are all gentle but effective blood thinners. You can lower inflammation quite well with omega-3s, especially with EPA and DHA. You’ll see basically no side effects, unless, of course, you count improved blood pressure and triglycerides, reduction of joint pain, improvement of mood, and healthier skin and nails as side effects.

Look—neither of us believes there is a conspiracy to keep the truth about cholesterol hidden from the public.

But we do find wisdom in the words of Upton Sinclair: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

Jonny Bowden, PhD, CNS

Jonny Bowden, PhD, CNS, (aka “The Nutrition Myth Buster”) is a nationally known expert on weight loss, nutrition and health, and the best-selling author of 15 books on health. Learn more about Dr. Jonny by visiting his website

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