Why Cholesterol Got a Bad Rap

If cholesterol provides so many health benefits, how did it get such a bad rap?

It was a mixture of bad science and politics as usual.

Back in the 1950s, Ancel Keys, the scientist who created the K-ration for WWII soldiers, noticed that well-fed American business executives had high rates of heart disease, while malnourished individuals living in post-war Europe had lower rates of it. Keys hypothesized that the American diet — which was filled with high fat, high cholesterol foods — was responsible, and he concocted a study to prove it.

His famous “Seven Countries” study was one of the first longitudinal studies to test the effect of diet on health. Keys examined saturated fat and cholesterol consumption in seven countries (hence the name) and found a seemingly perfect relationship between rates of heart disease and rates of cholesterol and saturated fat consumption. His data showed exactly what he had predicted it would.

Right away, other researchers questioned the validity of the study. A British doctor named John Yudkin was particularly skeptical. Yudkin had done similar research and found several countries that had above average intake of saturated fat consumption but low rates of heart disease. Yudkin, along with other scientists, basically accused Keys of cherry-picking the countries in his study in order to prove his conclusion. They argued that it wasn’t cholesterol and fat that caused heart disease, but rather increased sugar consumption that was the true culprit.

But because of Keys’ role in developing nutrition standards for soldiers during WWII, he had tremendous political clout with congressmen, agency bureaucrats, and the media. Encouraged by the results of his study, Keys began to lobby heavily for the U.S. government to recommend low fat, low cholesterol diets. In 1977, Senator George McGovern, the chairman of the Senate Select Committee on Nutrition and Human Needs, published dietary guidelines based on Keys’ research that would radically change how Americans ate. The guidelines called for a diet low in fat and cholesterol and high in carbohydrates from vegetables and grains. The USDA issued guidelines recommending only 300 mg of dietary cholesterol a day. Which isn’t very much. Just two whole eggs contain 374 mg of cholesterol.

The result was a boom in food products marketed as “Low Fat” and “Heart Healthy.” Low-fat Snackwell cookies, cholesterol-free margarine, and non-fat potato chips lined the shelves of grocery stores. Americans replaced natural foods that had been common fare for centuries with these lab-produced, factory-made products. They stopped eating eggs and butter, switched from whole to skim milk, and gave up on bacon.

What’s more, pharmaceutical companies jumped on this bandwagon and created cholesterol-lowering drugs called statins. Statins work by blocking a substance your body needs to create cholesterol. Doctors began prescribing these drugs by the boatloads to any patient who walked in with higher than normal cholesterol levels.

But a funny thing happened.

Despite the fact that more Americans were eating low-fat and cholesterol-free foods, heart disease rates and obesity continued to climb. What gives?

Well, come to find out Yudkin and his colleagues were right. It wasn’t cholesterol and fat that caused people to gain weight and get heart disease; it was sugar and processed carbs. And guess what food manufacturers often replaced the missing fat with in their “heart healthy foods”? Sugar and processed carbs, of course. And that cholesterol-free margarine? It was made from hydrogenated vegetable oil that created trans fat, a type of fat that actually is linked to heart disease and stroke.

Those supposedly heart-healthy diet guidelines from the 70s were wreaking havoc on the circulatory systems of tens of millions of Americans.

And all those statin prescriptions? They worked wonderfully at lowering cholesterol…but probably a little too wonderfully. Many patients began complaining about symptoms like memory loss, depression, increased infections, erectile dysfunction, and lowered testosterone levels. Researchers discovered that in many patients, statins lowered cholesterol levels so much that the body wasn’t getting enough of the cholesterol it needed for healthy functioning.

Thankfully, in the past few years, we’ve regained some sanity when it comes to fat and cholesterol. Recent research has confirmed what scientists 60 years ago knew. It’s not dietary cholesterol and saturated fat that causes heart disease, it’s sugar combined with other lifestyle factors — like stress and being sedentary — that promote inflammation.

Consequently, government agencies and health organizations are backtracking on their stringent dietary cholesterol limits. In fact, earlier this year, the Dietary Guidelines Advisory Committee issued a draft document stating that dietary cholesterol plays little or no role in heart disease and that most folks probably shouldn’t worry about how much cholesterol they’re eating. While the panel doesn’t issue official guidelines, agencies responsible for food guidelines usually adhere very closely to them.

When it comes to statin prescriptions, many doctors are now using much more discretion. Instead of prescribing them to anyone with above average cholesterol levels, doctors now only do so for high-risk heart disease patients. Who’s a high-risk patient? Basically, those who already have existing heart disease.

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