Why cholesterol is so darn confusing

Last month the British Medical Journal published a study on the relationship between LDL (aka ‘bad’) cholesterol and dying among very high-risk heart disease patients. It showed that (shock, horror) the higher the LDL, the lower the risk of dying.

The study reviewed data on over 23,000 people hospitalised for a heart attack or acute heart failure at the Mayo Clinic in the US between 1996 and 2015.

The results, of course, fly in the face of conventional wisdom on LDL and the need to lower it. Moreover, the researchers found that similar studies have shown the same trend.

So why is cholesterol so confusing? On one hand we’re constantly told that lower LDL is better, then this kind of research throws that into question.

One reason could be that although LDL has been positioned as the critical factor in heart disease, perhaps it’s not.

That’s not to say that it’s unimportant, but maybe it’s not the be-all-and-end-all.

The trouble is that so much has been invested in the LDL theory it can be next to impossible to suggest that there’s more to the story.

Someone who’s tried to do that is San Francisco-based research professor Ron Krauss. He’s been studying cholesterol for decades and has published hundreds of articles on it.

He argues that LDL is more complex than we’ve been led to believe. It’s comprised of particles, and the size and density of those particles is what determines whether it’s dangerous or not.

Some particles are large and buoyant while others are small and dense. The large buoyant ones aren’t risky but the small dense ones are.

And the small ones can circulate for a long time, giving them plenty of opportunity to wreak havoc in our arteries.

According to Professor Krauss small dense particles go hand-in-hand with excess belly fat, high blood pressure and high blood sugar.
He recommends reducing our carbohydrate intake and belly size to reduce our level of small particles. Saturated fat intake, he says, is more likely to affect the large (benign) particles.

Cholesterol is made even more complex by our genetics, because we don’t all respond the same way to dietary changes or treatment.

Despite that, the takeaway message from Professor Krauss is that when LDL creeps up, rather than automatically lowering it with medication, if you’re carrying too much around your middle, as a first option try losing weight and cutting down on the (refined or processed) carbs instead.

ABC radio’s Life Matters program addressed the issue of weight management last Tuesday morning (Jan 28). Some of the messages from that were around focusing on getting healthier vs losing weight, developing a good relationship with food, embracing the kind of body you have, and that regular physical activity is the highest predictor of success in this area. There were some useful conversations so have a listen if you’re interested.