In What about cholesterol we saw how important cholesterol is for so many essential bodily functions and in so many important ways, that there should never have been a shadow of a doubt in anyone’s mind that cholesterol is anything but essential and vital to our health and our life. And that, therefore, it is ridiculous to even have to say that cholesterol is good for us. However, it is more than completely absurd, non-sensical, and outright dangerous to claim that it is bad for us. Let me assume you are now well convinced of this.
There is something we didn’t go into that relates to the fact that we’ve been told—and continue to be told—that we should minimise our intake of dietary cholesterol. The crazy thing about that recommendation is that the amount needed by the body of this vital substance depends solely on the body’s needs for it. And thus, the normally functioning liver, supplied with adequate amounts of the essential building blocks, produces cholesterol in the amount that is necessary for proper bodily function—whatever that amount happens to be at a particular time. What this means is that in a healthy individual, the amount of cholesterol you eat should not really affect the amount of cholesterol in the blood, estimated by the concentration of the lipoproteins that transport it to and from tissues.
Even though this obvious consequence of considering the body’s physiological function should just be accepted as a plain fact, unfortunately, most people—including health professionals—don’t. We continue to believe that cholesterol is bad, and we continue to try to minimise dietary cholesterol in order to lower lipoprotein concentrations, completely ignoring the fact that cholesterol and lipoprotein production is an exceedingly refined and well regulated mechanism that responds directly to the body’s needs.
It is certainly possible that if dietary cholesterol intake decreases, the liver produces more, and if dietary cholesterol intake increases, then the liver produces less; to what extent certainly depends on the physiological circumstances, and specific needs for cholesterol depend on many factors, all related to the state of the body. But it is pretty well established that the body produces more or less the same amount of cholesterol regardless of the dietary cholesterol intake because it much prefers to use the kind of cholesterol the liver produces, which is free or un-esterified cholesterol, rather than having to de-esterify the dietary cholesterol that comes primarily as cholesterol ester. Therefore, much of the dietary cholesterol is used in bile and excreted through the intestines.
For a lot more details, you can check out Peter Attia’s essential points to remember on his series The straight dope on cholesterol, even if I don’t really agree with the points linking LDL with atherosclerosis, simply because lipoprotein concentration, particle number, size distribution and everything else are all secondary or even further removed consequences of other dietary and metabolic factors upstream. In fact, I believe we should not even have started measuring lipoprotein concentrations and cholesterol in the first place. What we should have always focused on are uric acid levels and tracers of inflammation. And on another note, Peter is categorical that dietary cholesterol is not absorbed and all excreted. However, a couple of review papers I read about lipid absorption state that about 50% of intestinal cholesterol is, in fact, absorbed. The truth is that it is almost certainly dependent on a whole slew of factors and that, as for all things, the body absorbs and excretes in accord with its needs.
A viral infection, for example, will generally lead to the increase of lipoprotein concentration because these are the molecules that can most effectively gobble up and destroy viruses. Dehydration leads to a scarcity of water at the cellular level. As a consequence, each cell’s survival relies on producing more cholesterol in order to more effectively seal in the precious water it depends on for life that appears to be so scarce. Hence, dehydration also leads to higher cholesterol. A diet high in sugar—simple and starchy carbohydrates—naturally leads to a much greater amount of damage to cells and tissues throughout the body, but especially to the blood vessels themselves, from the highly damaging presence of insulin, the result of glycation of proteins and fats by higher concentrations of circulating glucose, and several other related factors. To repair the damaged cells, cholesterol is needed, and thus, in this case also, lipoprotein concentrations rise accordingly.
Although the fact that the amount of dietary cholesterol does not affect blood lipoprotein concentrations much is not debated by people in-the-know about issues pertaining to cholesterol, I just wanted to see this for myself what would happen. So, I devised a simple self-experiment: compare the lipoprotein concentrations in my blood when following my low-card, high-fat, high-nutrient diet, to those after eating 6 eggs per day for 6 days in a row, where I basically just added to my diet more eggs, usually raw in smoothies. That’s a lot of eggs… But before I present the results, I think it’s important to go through a few numbers relevant to this discussion.
Eggs: An average organic egg of 50 g supplies 70 calories, and contains 5 g of fat (all in the yolk), 6 g of protein (all in the egg white), less than 0.5 g of carbohydrates and 215 mg of cholesterol. This means that 6 eggs supply a total of 1300 mg of cholesterol. For me, 6 eggs per day is 3 times my usual consumption of 2 eggs per day on average—a 300% increase.
Blood volume: The blood in our body accounts for about 7% of its mass (Ref). For a weight of 100 kg, there is 7 kg of blood (about 7 litres); if you weight 50 kg, then there is 3.5 kg of blood or about 3.5 litres. And therefore, for a 57-58 kg person like me, this makes almost exactly 4 kg, and thus about 4 litres or 40 decilitres.
Lipoproteins: Cholesterol is not water-soluble, and thus has to be transported by lipoproteins. Different lipoproteins carry a different amount of cholesterol. The bulk of it, however, is found in LDL and HDL molecules. The percentage of cholesterol by weight in LDL is about 40%, and in HDL it is between 20 and 35% (Ref). To keep our calculation simple, we’ll take this to mean that LDL is half cholesterol by weight, and HDL is one quarter cholesterol.
Here are the results of the blood tests from December 16 and 22, 2011, both taken in the late afternoon after nearly 24 hours of fasting (I do this every week, so it was nothing unusual). And please don’t worry about the boldface: it appears automatically if the numbers are not in the “recommended” range, which for cholesterol is below 200 and for glucose 65-110 mg/dL. And don’t worry about the spelling: it’s spanish because I live in Spain.
Now, looking at the results, can you guess which one is which: which is the result of the blood test before one week of 6 eggs per day, and which one is after?
The answer is that the first table is from the blood test done on Dec 16, and the second table is from the blood test done on Dec 22:
After one week of eating 6 eggs per day, the LDL decreased from 110 to 95 mg/dL, the HDL increased from 106 to 112 mg/dL, the “total cholesterol” decreased from 224 to 213, and the triglycerides decreased from 41 to 29 mg/dL.
About the lipoprotein concentrations, you may recall from this graph I linked to in my first post on cholesterol, and in which was compiled all the available data found by its author, that included mortality rates and what is referred to as “total cholesterol” (but is in fact total lipoproteins), the ideal range for which is labelled “Colesterol total” in the above test results is 200-240 mg/dL, and the minimum all-cause mortality is found for concentrations of 220 mg/dL. That’s right where my numbers happen to be.
As for the glucose, well, you already know I try to keep it as low as possible, and by the way, I had no signs of hypoglycemia when my blood glucose was 60 mg/dL. In fact, I never do, even during three-day fasts, cycling to and from work, and doing resistance training at lunchtime. This demonstrates that the state of hypoglycemia can not be defined by a fixed threshold of glucose concentration below which we are considered to be in that state, but rather is based upon the individual’s metabolic function. This should be obvious since some people feel the consequence of hypoglycemia quite regularly and at glucose levels that would be exceptionally high for others, who on the contrary never feel them, simply because their metabolism has been trained to use fats for the body’s energy needs efficiently, and in fact, almost exclusively—to function in ketosis—as is my case. I plan to revisit this topic in greater detail in the future. But for now, let’s come back to the blood test results.
Firstly, we see that the sum of LDL and HDL compared to the “total cholesterol” is 216 vs. 224 (Dec 16) and 207 vs. 213 (Dec 22). This tells us that the VLDL (very low density lipoproteins) and CM (chylomicrons) together account for 8 mg/dL on Dec 16, and 6 mg/dL on Dec 22. They are, and we’ll not discuss these lipoproteins any further in this post.
Secondly, we note that the small difference in the very low concentrations of triglycerides (three fatty acids attached to a glycerol backbone), considered to be “normal” up to 150 mg/dL, mirrors the small difference in the lipoproteins that carry most of the triglycerides: the CM (90% triglycerides) and VLDL (62% triglycerides). Low triglyceride levels with low glucose and insulin levels equate to efficient metabolic use of fats.
And thirdly, we find that for 4 litres of blood, if we assume simple rounded figures of 100 mg/dL of LDL and 100 mg/dL of HDL, the total amount of cholesterol being carried around in the bloodstream is about 3000 mg: 40 dL*(50%*100 mg/dL + 25%*100 mg/dL). This is just 3 grams in the entire blood supply for a body weight of 58 kg! And an additional 1300 mg of cholesterol per day—almost half of the cholesterol in the bloodstream—from eating 6 eggs, and this for 6 consecutive days that supplied a total of 7800 mg of cholesterol, did not affect the lipoprotein concentration.
This leads us back to the hypothesis presented in the first paragraphs: the amount of cholesterol you eat should not really affect the amount of cholesterol in the blood. And although a quick experiment on a single person is far from being definitive proof of anything, this one clearly indicates, at least for me, that increasing intake of dietary cholesterol by an amount that is close to half of the total cholesterol circulating in the bloodstream, and doing this each day for 6 days in a row, does not raise lipoprotein concentrations (in this case, they went down slightly) when comparing the values measured at the same time in the late afternoon after a 24 hour fast once at the start of the week and 7 days later.
Furthermore, based on the sensible assumption that cholesterol synthesis by the liver is a response to the body’s needs, but also ability to manufacture it, if absorption of intestinal cholesterol is not nil but varies depending on the body’s needs, then supplying more dietary cholesterol may help ease the requirements on the liver for manufacturing the quantities needed. Therefore, this “help” to the liver can only be viewed as favourable considering the extreme importance of this organ for good health. It could also be that most or even all the additional dietary cholesterol was simply excreted in the stools. But in any case, it is absolutely certain that eating this huge amount of cholesterol every day did not affect lipoprotein concentrations in the blood after the period of fasting.
What I would like to do is to evaluate dietary cholesterol absorption on me, a 40-year old man in excellent health, by adopting an extreme diet of eating only eggs and water (this will remove the influence of other foods and nutrients and therefore reduce significantly the number of variables that can influence cholesterol synthesis and absorption), and take minimal blood samples at regular time intervals such as every hour or every couple of hours. By evaluating the changes in cholesterol transporters we would be able to estimate how much is absorbed because we know that lipids from the intestines are transported to the blood mostly by CM and VLDL, whereas HDL and LDL are mostly responsible for transport to and from the liver.
In any case, as we have seen here, but also as I mentioned in my opening sentences that we have known for a rather long time, dietary cholesterol does not influence blood cholesterol much. So please, when you hear someone say that we should avoid eating too much cholesterol because they have “high cholesterol”, you don’t need to say anything if you don’t want to, but remember at least this: cholesterol is so important and so good for us, that the liver and cells themselves will always do everything to supply the all the cholesterol that is needed, whatever that is at a particular time, and no matter how little or how much we get from our food. And maybe it is even the case that eating more cholesterol actually helps the liver and cells meet the body’s continuous demands throughout the day and night of this vital substance.
healthfully 
Interesting and very nice to read you performed an experiment on yourself; strengthens the case. Have you ever discussed this with other experts who are on the ‘other’ side?
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Truth be told, the fact that dietary cholesterol does not really affect blood cholesterol concentrations is quite well known in the lipid research community, and has been for quite some time. It’s just that the word hasn’t gotten out. At the same time, although I have read reports from several different trials that all found there was no such relationship, I wanted to see it first hand, for myself, on myself. Furthermore, I’m also pretty sure that anyone who is relatively healthy—meaning that they are not visibly ill or sickly—will find the same result I found if they repeated this small experiment of 6 eggs per day for 6 days.
The reasons why I write “pretty sure” and “relatively healthy”, is because the latter is awfully difficult to assess subjectively—most people think they are healthy until they get ill, and that there are a lot of factors that determine how the metabolism responds to something—the human body is really very complex. From what I’ve seen and hear, people in general think they are pretty healthy, wether they are overweight (a little or a lot) or pre-diabetic, wether they exercise or not, wether they smoke or not, wether they get a cold or flu 5 times a year or every month. All of this is very strange to me, and from my perspective, almost everyone is sickly and at the onset of developing any one of the major killers of our age: the diseases of civilisation. But they obviously don’t think so.
Now about the “other” side, it is true that there has been and still exists a debate about wether cholesterol is a risk and cause of heart disease or not. But for me it is very simple: Human physiology is the in same, statistically, for every single human being. The heart, the brain, the lungs, the stomach, intestines, liver, pancreas and all the other organs and systems work in the same way and need the same things on order to function well in every person, and to a great extent, in every animal. Yes, there are inherent differences, for example, some people have larger hearts than the norm (Miguel Indurain, five-time winner of the Tour the France), and some people naturally produce less lactic acid than others (Lance Armstrong, seven-time winner of the Tour de France), but these are statistical in nature. The primary cause of the enormous differences in the way peoples’ bodies respond to different things are metabolic differences: differences in how well their body is functioning metabolically. This is why something pretty close to a one-size-fits-all recipe for diet such as Ron Rosedale’s, for example, works so well on so many thousands of different people of various ages and backgrounds, with seemingly different health conditions and symptoms, to bring them all back to health, and to a stage where their bodies and organs appear to function normally, and for everyone more or less the same way. Is that surprising to you? No matter how special or different we might think we are, the fact remains that physiologically, we are all pretty much the same.
Finally, the fact that there is a debate about cholesterol does not mean this debate is justified; it is not. The reason why it is not, is because we know precisely how arterial plaques form, we know precisely how cholesterol is synthesised, how it’s transported, what it’s used for and so much more, and we know that cholesterol is not in any way a cause of the inflammation that leads to the formation of arterial plaques, but that instead it is an essential player in the body’s healing response to this inflammation. The problem is not that we—collectively as the human race—don’t know this; the problem is that most people, including medical scientists and especially practitioners, do not know this. But there’s nothing mystical about it. It is physiology-based, and it’s just a matter of reading, learning and thinking about it to understand what’s true and what’s not.
This was the long answer. The short answer is: no, I have never discussed this with “experts”.
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6 days is hardly conclusive, try six months and rewrite your article…
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Of course, you are perfectly right: an experiment, on a single person, for only 6 days, can not be conclusive. Mind you, there are published “scientific” studies that are even shorter and even less conclusive; but this is another matter. So, although I agree that it is not conclusive, at the very least, the result of this small self-experiment is indicative that the effect on lipoprotein levels of having these 6 eggs per day for 6 consecutive days is small.
As an aside, have you ever tried to eat at least 6 eggs per day, every day for several days in a row? Some people eat this much or more of months or years on end, but for me, it wasn’t easy. I love eggs, but I was just not hungry at all, and thus had to make the effort to keep up my 6-egg intake. I suppose I could reduce other foods and concentrate more on having only eggs … an idea for another self-experiment, maybe later. But the next self-experiment I want to do relates to water intake and retention as a function of salt intake.
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Hi Guillaume, I came across this article from a heart surgeon in the USA, take a look:
WORLD RENOWNED HEART SURGEON SPEAKS OUT ON WHAT REALLY CAUSES HEART DISEASE
We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong. As a heart surgeon with 25 years experience and having performed over 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific fact.
I trained for many years with other prominent physicians labeled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.
The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.
It Is Not Working!
These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.
The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.
Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.
Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.
Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.
Inflammation is not complicated — it is quite simply your body’s natural defense to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process, a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.
What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully.
The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.
Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine.
What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.
Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. You kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.
Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation.
While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.
How does eating a simple sweet roll create a cascade of inflammation to make you sick?
Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.
When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.
What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.
While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator — inflammation in their arteries.
Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6’s are essential -they are part of every cell membrane controlling what goes in and out of the cell – they must be in the correct balance with omega-3’s.
If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation.
Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.
To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.
There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.
There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.
One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.
Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labeled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.
The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.
What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.
Dr. Dwight Lundell is the past Chief of Staff and Chief of Surgery at Banner Heart Hospital , Mesa , AZ. His private practice, Cardiac Care Center was in Mesa, AZ. Recently Dr. Lundell left surgery to focus on the nutritional treatment of heart disease. He is the founder of Healthy Humans Foundation that promotes human health with a focus on helping large corporations promote wellness.
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Thanks Kevin. How are things? Any changes in your diet? Any consequences?
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