High Cholesterol: Are Carbs The Culprit?
WHAT'S AHEAD: a less-known underlying factor to our cholesterol concerns & why “high cholesterol” isn’t as simple as avoiding high-cholesterol foods or as concerning as we’re told.We’re often instructed to avoid foods like egg yolks, butter, and animal meat to lower our LDL and reduce plaque in our arteries — but what if high cholesterol foods aren’t what causes high cholesterol? What if the type of carbohydrates we eat has a stronger connection to plaque formation than any other food group to date?
WHAT IS CHOLESTEROL & WHY WE NEED ITCholesterol is just a specific type of fat molecule. Since it’s a fat molecule, it’s not soluble in water (it can’t just float around in our water-based bloodstream to get where it needs to go). So instead, our body shuttles cholesterol around in little vehicles that are water-soluble called lipoproteins.¹ ² ³ We’ve got multiple types of lipoproteins: maybe you’ve seen ‘em on bloodwork your doctor has ordered (VLDL, LDL, HDL, etc) which is a measurement of cholesterol you have inside that type of lipoprotein.
LDL (low-density lipoprotein) = delivers triglycerides & cholesterol to our cells.
HDL (high-density lipoprotein) = collects the used LDL and returns it to the liver to be excreted as waste.
Total cholesterol = all cholesterol in all lipoproteins
And others like VDL, IDL (precursors to LDL), or chylomicrons that we won’t get into.
These little taxis are crucial because they’re what allow cholesterol to get into our cells! Why is that important? Because our body need cholesterol.
forms cell membranes (protects us from toxins, lets nutrients in, kicks waste out)¹ ² ³
creates bile to help us digest fats & fat-soluble vitamins (Vitamins A, D, E, and K2)⁴ ⁵
precursor for estrogen, progesterone, testosterone, cortisol, aldosterone)⁶ ⁷ ⁸ ⁹
WHERE THE PROBLEM STARTSLDL is what’s widely accepted as “the bad cholesterol” for a combination of 3 reasons:
The poor epidemiological study called the Framingham Study which correlated (didn’t prove) high LDL with an higher rate of heart disease
The common “response-to-retention” theory which assumes the more LDL in our bloodstream, the greater risk of plaque forming.¹²
When you combine these things together, you get doctors who generally assume high LDL = plaque (and if plaque = heart disease, then LDL = heart disease).
But there are zero conclusive studies that prove high LDL in circulation = more LDL used to form plaque! Actually, there are just as many epidemiological studies that show no correlation between LDL and heart disease as well as interventional studies proving LDL itself is not harmful, high LDL is protective and “high cholesterol” ain’t a curse!
Studies of people on LDL-lowering statins or inhibitors show their cardiovascular disease progressed despite low LDL levels.¹³
LDL has been shown to bind to endotoxins released by bacteria in the body & also prevents bacteria from proliferating causing much lower mortality rates and inflammation in mice.¹⁴ ¹⁵ ¹⁶
A study of 347 adults over the age of 65 found a significantly lower risk of dying in those with elevated total cholesterol/LDL levels.¹⁷
A study of 105 adults over the age of 80 found the highest total cholesterol/LDL had less than half the mortality rate of those with lower levels.¹⁸
Not only that, but high HDL plays a healthy role working hand-in-hand with LDL!
HDL recycles extra cholesterol back to the liver where it’s excreted as waste.¹⁹
Studies show low HDL levels in those with insulin resistance, meaning: people with higher levels of HDL are less likely to develop insulin resistance.²⁰ ²¹ ²² ²³ ²⁴ ²⁵
If you split that Framingham Study (see above) into groups based on their HDL levels (like Paul Saladino did so freakin’ incredibly in his book, The Carnivore Code) you can see a huge correlation between high HDL, high LDL, and a lower rate of cardiovascular disease!
Meaning: there’s obviously more at play in plaque formation than just high levels of LDL & we have to look at more than just the amount of LDL to understand how atherosclerosis (plaque) happens or if it’s as “bad” as we’re told.
the real problem witplaque really forms
The “Sticky” Situation
What we do know for now (the science never ends) is normally, LDL passes through our arteries to deliver the nutrients it’s carrying, makes it way back out, and plaque begins forming when LDL gets “stuck” as it’s passing through¹ ² ³ ⁴ ⁵ — problem is, we have millionssss of LDL particles floatin’ around our bloodstream: so if every LDL particle was getting stuck, we’d be dead.⁶ ⁷ ⁸ ⁹
Q: so then what turns LDL into a problem? What makes some LDL particles get stuck and others don’t? What causes certain LDL particles to pass through our artery wall and deliver nutrients, but never make it back to our bloodstream because it starts forming plaque?
A: metabolic dysfunction in my humble opinion and in agreement with many healthcare professionals before me.
Why? Because metabolic dysfunction (ie. hyperglycemia, insulin resistance, diabetes, alzheimers, inflammation) is what damages the biological process and cellular structures that normally allow LDL to pass in and out of our arteries with no problems! Instead, the damages from metabolic dysfunction make LDL particles and our arteries “sticky” like a velcro-and-tennis-ball kind of match-made-in-heaven with an extreme affinity for eachother (strongly predisposing us to plaque formation)!¹⁰ ¹¹ ¹² ¹³ ¹⁴
Meaning: is LDL truly a problem? Or is it the environment we create in our body that damages the way LDL and our arterial walls interact makin’ them more susceptible to plaque formation.
DoDgin’ the dysfunction
Simple Carbs Are The Culprit
If we’re trying to get to the root of plaque or prevent the metabolic dysfunction that creates that “sticky” situation, then it makes more sense to minimize the simple carbohydrates that are contributing most to the metabolic dysfunction (without the pressure of doin’ it perfectly, ofcourse).
The reason I’m singling out simple carbohydrates is because they’re in the “simplest” form of sugar: when we eat them, our pancreas immediately releases insulin (to tell our cells it’s go-time and instruct our cells to absorb that sugar for energy).¹ ² But if we’re constantly consuming simple carbs and triggerin’ our body to release a bunch of insulin all day everyday — overtime, our cells get tired of insulin knockin’ on their door and eventually our cells don’t give a shit what insulin has to say: they ignore insulin (insulin-resistance).³ ⁴ ⁵ And unless our sugar-backup-tanks (glycogen) need to be refilled, that sugar from our food just sits in our bloodstream (high blood sugar) eventually getting stored in fat tissue causing a handful of (inflammatory) problems including hormone imbalances, increased appetite, restlessness, hard time waking up, headaches, weight gain, blurred vision, tumor growth, etc.⁶ ⁷ ⁸ ⁹ ¹⁰ Basically: simple carbs create the exact environment, metabolic dysfunction, and “sticky” situation that not only makes LDL more likely to turn into plaque but lowers HDL levels too (remember low HDL is not beneficial):
A cross-sectional study of of 6,000 adults were grouped by intake of simple sugars and showed a statistically significant correlation between higher amounts of added sugars and low HDL levels (remember: low HDL is not beneficial).¹¹
574 adults were observed over 4 years and higher carbohydrate intake correlated with lower levels of both HDL and LDL.¹²
In a meta-analysis of 300+ studies to review the efficacy of drugs used to manage Type 2 Diabetes, insulin-resistance was discussed as a risk factor of cardiovascular disease.¹³
And think about this: 88% of the American population has metabolic dysfunction to some degree¹⁴ rising from 25.3% (1988-94) to 34.2% (2007-10)¹⁵ — and what are diabetics with low LDL at greater risk for? Heart disease!¹⁶ ¹⁷
These are examples of significant correlations that the food industry, doctors, and medical researchers should be payin’ attention to and lookin’ further into — especially before sending shockwaves through the media.
what about the cholesterol we eat?
Dietary Cholesterol
Alright so if simple carbs are what impact the way LDL interacts with our arteries — does that mean cholesterol-rich foods don’t matter? In my opinion, simple sugars and dietary cholesterol go hand-in-hand but dietary cholesterol is not as problematic as simple sugars and here’s why:
In addition to the cell membranes, hormones, etc… the cholesterol we eat is specifically needed to make bile (helps digestion)¹ ² ³ ⁴ but our liver actually makes a large portion of the cholesterol we need everyday and regulates it’s own production based off how much cholesterol we’re getting from our food (liver makes less when we eat cholesterol-rich foods, and liver makes more when we don’t eat enough)⁵ ⁶ ⁷ ⁸ ⁹ ¹⁰ which means dietary cholesterol is not the same as the cholesterol our liver makes, but we use them the same way (packin’ it up into little lipoproteins until there’s no more space and creating more lipoproteins to package up the rest) and if we increase our intake of cholesterol, we are increasing the number of LDL particles (LDL-P) in our blood which has been correlated with cardiovascular disease and metabolic dysfunction.¹¹ ¹² ¹³ ¹⁴ ¹⁵ ¹⁶
But if we increase the number of LDL particles (with dietary cholesterol) and we’ve created the “sticky” situation (with simple carbs) — we’re adding more LDL into a broken system, meaning: we’re making more LDL particles circulate through an environment that’s encouraging them to turn into plaque. Both simple carbs and dietary cholesterol are at play and part of the equation, but simple carbs are setting cholesterol up for failure and making high-cholesterol levels more problematic than truly are. And if we’re concerned or having problems with plaque (ie. high blood pressure, atherosclerosis, embolisms, etc), it’d be more effective to minimize simple carbs first so our body can benefit from cholesterol!
Worry-free cholesterol foods when enjoyed in combo with a “sticky-free” environment:
Eggs
Meat
Seafood
Butter
don’t give up carbs
Opt for Complex Carbs
Does the “sticky” situation mean we should avoid any and all carbohydrates? Nooo, way. Sure my job as a nutritionist is to help every client be more self-aware of their carb intake & find their body’s happy medium but we never, ever eliminate carbs completely. They’re an incredibly efficient, easy source of energy for our brain and muscles — and the goal is to build a body that burns carbs better.
What we can do is make educated decisions to understand what type of carb we’re eating — and the alternative to simple carbs (the “simplest” smallest form of sugar) are complex carbs (the longer molecules of sugars with added fiber). This means they take longer to be metabolized, require less insulin at once, and keep you full for longer. https://lowcarbcardiologist.com/low-carb-ldl-a-call-for-reason/ Ultimately, the type of simple sugars you decide to minimize involves a lot of personal preference, your own judgement, and your unique body’s biology (we offer Strategy Sessions to support you through it)!! But let’s recap a few:
final food for thought
Cholesterol Ain’t A Curse
It’s all about context. Minimizing dietary cholesterol matters, but minimizing simple carbs may make more sense for you if you’re lookin’ to get to the root and reduce your risk of plaque. If you ever have questions, need help, or wanna share your personal story — don’t hesitate to message me! But it’s about taking in the overall health of our body instead of just LDL levels. It’s less about lowering cholesterol to prevent plaque — and more about minimizing the chances our LDL & arteries become an abnormally dangerous duo. Once we realize that the measurements we’re told to worry about are actually an inaccurate predictor of plaque or heart disease, the stress of high cholesterol melts away.
And if the doctor you love, trust, and depend on is recommending less eggs, meat, or salt in order to lower your cholesterol — maybe you should consider bringing him/her the research that proves simple sugars have a stronger connection to high cholesterol than eggs or meat? He/she should be open to it, receptive of it, and willing to help you understand how dietary cholesterol works in your body (or refer you to a nutritionist in his network who can).
Rooting for you, Danika.
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EVERYDAY AMERICAN
Welcome! I’m Danika.
Middle-class, low-maintenance woman from the outskirts of town who didn’t keep trusting a broken, ass-backwards system to tell me the whole truth and what’s best for me. The internet can be so bittersweet sometimes, but I hope this space becomes a resource that inspires you to simplify the most important foods, make the most informed decisions & stress less about living perfectly! Craving a realistic, root-cause approach to real food? Maybe we’re your cup of tea.
