(Mercola)—I’ve long been fascinated by cholesterol’s role in our health, and research published over the last few years challenges what we’ve been told for decades. For example, a groundbreaking study of over 23,000 people reveals surprising, never-before considered findings about the impact of race and genetics on cholesterol and its links to heart disease.

Is Lower Cholesterol Really a Good Thing?

You’ve been told that high cholesterol is bad and low cholesterol is good. But what if I told you that low cholesterol could actually harm your heart health? This might sound counterintuitive, but recent research has uncovered some surprising truths about cholesterol’s role in our bodies.

Cholesterol is a crucial component of cell membranes and a precursor to many important hormones.¹ It’s not just a harmful substance to be eliminated, but a vital part of our biology. In fact, cholesterol plays a key role in brain function, hormone production, and even vitamin D synthesis.

For decades, the medical community has focused on lowering cholesterol levels to prevent heart disease. This approach was based on studies like the Framingham Heart Study, which linked high cholesterol to increased cardiovascular risk. As a result, millions of people have been prescribed statins and told to follow low-fat diets.

However, new research is challenging this simplistic view. The REGARDS (REasons for Geographic and Racial Differences in Stroke) study² published in the Journal of the American College of Cardiology examined data from 23,901 participants over a median follow-up of 10.7 years.

The researchers found that the relationship between HDL cholesterol and heart disease risk actually varied depending on race. Low levels of high-density lipoprotein (HDL) cholesterol — often called “good” cholesterol — were only associated with increased risk of coronary heart disease in White adults. Even more surprisingly, high levels of HDL cholesterol didn’t seem to protect against heart disease in either White or Black adults.

This revelation challenges decades of medical advice that has emphasized raising HDL cholesterol levels as a way to improve heart health. It also highlights the importance of considering racial differences in health research and treatment recommendations.

Another intriguing discovery is the “cholesterol paradox” observed in various health conditions.³ In some cases, individuals with low cholesterol levels actually had worse health outcomes than those with higher levels — a finding that flies in the face of long-held beliefs about cholesterol and health. As noted in one 2023 scientific review:

“On average, patients with a total cholesterol level of 232 mg/dl had a 25% higher survival rate than those with a total cholesterol level of 193 mg/dl who were suffering from heart failure. A total cholesterol level under 200 mg/dl is generally preferred.”⁴

These unexpected results raise important questions about how we assess cardiovascular risk and whether current treatment guidelines are appropriate for all populations. Clearly, the relationship between cholesterol and health isn’t nearly as straightforward as we once thought.

Complex Interplay of Factors Influence Cholesterol’s Effects

Aside from race, individual genetics also play a big part in how our bodies handle cholesterol. Some people naturally make more cholesterol, while others make less. This is why two people eating the same diet can have very different cholesterol levels.⁵

Inflammation and oxidative stress in our bodies can also impact how cholesterol affects our health. When there’s a lot of inflammation, cholesterol can act differently and cause problems that would not occur in someone that did not have the same level of inflammation. This is one reason why overall health is so important when thinking about cholesterol.⁶

This complex web of interactions makes it hard to predict exactly how cholesterol will affect each person’s health.⁷ Here’s a short list of factors that influence cholesterol’s effects:

1. Cellular energy production
2. Genetic factors
3. Inflammation and oxidative stress
4. Interaction with other metabolic processes

Understanding these relationships helps explain why low cholesterol isn’t always good and high cholesterol isn’t always bad.

Shifting Paradigms in Cholesterol Management

The revelations about cholesterol’s complex role in health are causing waves across the medical community and beyond. Importantly, these findings are prompting a reevaluation of cholesterol treatment guidelines that have been in place for decades.⁸

Healthcare providers are increasingly moving towards a more personalized approach to cholesterol management. Instead of relying solely on total cholesterol numbers, doctors are considering a wider range of factors including race, genetics, and overall health status when assessing cardiovascular risk.⁹

The pharmaceutical industry may need to adapt to new understandings of cholesterol’s role in health. As research reveals the complex relationship between cholesterol levels and heart disease risk across different populations, drug development and marketing strategies really ought to shift to reflect more personalized approaches to cardiovascular health management.¹⁰ Whether that will actually happen remains to be seen.

Public health messaging about cholesterol is also undergoing a transformation. The old mantra of “lower is always better” is being replaced with more nuanced advice. Dietary recommendations are shifting away from blanket low-fat guidelines to focus on overall diet quality and individual metabolic health.¹¹

These changes are empowering patients to take a more active role in their health management. With a better understanding of cholesterol’s complexities, you can make more informed decisions about your diet, lifestyle, and medical treatments.

Advanced lipid testing methods that provide more detailed information about cholesterol particle size and number are becoming increasingly important. These tests offer insights beyond standard lipid panels, allowing for more accurate cardiovascular risk assessment and targeted interventions.¹²

As our understanding of cholesterol continues to evolve, it’s clear that its impact extends far beyond individual health. It’s reshaping medical practice, influencing public health policy, and even affecting economic sectors.

To better understand the real-world implications of these findings, let’s look at some specific examples and case studies that illustrate the complexity of cholesterol management in different scenarios.

Real-World Scenarios Illustrate Complexity of Cholesterol Management

Consider the case of John, a 55-year-old White male with low HDL cholesterol levels. Traditional medical wisdom would have flagged him as high-risk for heart disease, and indeed, the REGARDS study^{13,14,15,16,17} confirmed that that low HDL cholesterol is associated with increased risk in White adults. So, for someone like John, a White male, the traditional wisdom about low HDL cholesterol increasing heart disease risk holds true.

In contrast, Maria, a 60-year-old Black woman with high HDL cholesterol, might have been considered at low risk for heart disease based on outdated guidelines. However, the new research suggests that high HDL levels aren’t necessarily protective for Black adults, prompting a reevaluation of Maria’s overall cardiovascular health beyond just her cholesterol numbers.

Another intriguing example is seen in highly trained, keto-adapted athletes. These individuals often display what appears to be paradoxically high cholesterol levels, yet they maintain excellent cardiovascular health.¹⁸ This phenomenon highlights the complex interplay between diet, physical activity, and cholesterol metabolism.

These scenarios underscore the need for a more nuanced and individualized approach to cholesterol management. They demonstrate that relying solely on standard cholesterol numbers can lead to misclassification of risk and inappropriate treatment decisions.

Given these complex scenarios, what can be done to optimize cholesterol management and improve health outcomes? The answer lies in a more holistic and personalized approach to health assessment and treatment.

Advanced Strategies for Optimizing Cholesterol Health

The takeaway is that improving cholesterol health goes beyond simply lowering your total cholesterol levels. A comprehensive approach that considers individual factors and overall metabolic health is key. Here are some strategies to promote optimal cholesterol balance. By embracing a more holistic strategy, you and your healthcare provider can work together to reduce your cardiovascular health risks.

• Personalized risk assessment — Healthcare providers should look beyond standard cholesterol numbers and consider factors like race, age, genetics, and lifestyle when evaluating cardiovascular risk.¹⁹
• Advanced lipid testing — This provides a more detailed picture of cholesterol levels than standard tests. These tests break down different types of LDL and HDL particles, giving you a clearer understanding of your individual heart disease risk.²⁰ Importantly, this detailed information helps identify individuals at risk even when their standard lipid panel appears normal.²¹
• Diet — Instead of focusing solely on lowering fat intake, focus on the quality of fats consumed. Incorporating foods rich in omega-3s, and saturated fats such as butter and coconut oil, will help you maintain a healthy cholesterol level while supporting your overall heart health.
• Exercise — Regular physical activity, especially a combination of aerobic exercise and strength training, helps improve lipid profiles and overall metabolic health.²²
• Targeted supplementation — For some individuals, targeted supplementation might be beneficial. For example, nutrients like omega-3s, niacin, and plant sterols have shown promise in supporting healthy cholesterol levels.²³

Sources and References

• ^{1, 3, 4, 5, 6, 7, 10, 11, 12, 14, 18, 21, 22, 23} Int. J. Res. Ayurveda Pharm. 14(2), 2023
• ^{2, 8, 9, 13, 19, 20} Journal of the American College of Cardiology Volume 80, Issue 22, November 29, 2022, Pages 2104-2115
• ¹⁵ NBC News, November 22, 2022
• ¹⁶ Healio, November 21, 2022
• ¹⁷ Medical News Today, November 22, 2022

(Mercola)—The more I study science, and particularly medicine, the more I come to see how often fundamental facts end up being changed so that a profitable industry can be created. Recently I showed how this happened with blood pressure, as rather than causing arterial damage, high blood pressure is a response to arterial damage that ensures damaged arteries can still bring blood to the tissues and, in turn, rather than helping patients, aggressively lowering blood pressure can be quite harmful.

In this article, I will look at the other half of the coin, the Great Cholesterol Scam — something that harms so many Americans it was recently discussed by Comedian Jimmy Dore.

First, they scammed you on skin cancer when the sun is good for you.

Now, they're scamming you again on cholesterol to sell you a lifetime medication.

This entire narrative of cholesterol being the villain in heart disease was built on a lie.

What doctors fail to tell you is… pic.twitter.com/bhhkFBBDbb

— A Midwestern Doctor (@MidwesternDoc) September 11, 2024

Cholesterol and Heart Disease

Frequently, when an industry harms many people, it will create a scapegoat to get out of trouble. Once this happens, a variety of other sectors will jump on the bandwagon and create an unshakable societal dogma.

For example, the health of a population (or if they are being poisoned by environmental toxins) determines how easily an infectious disease can sweep through a population and who is susceptible to it, but reframing infectious diseases as a “deficiency of vaccines” it both takes the (costly) onus off the industries to clean up the society and simultaneously allows them to get rich promoting the pharmaceutical products that “manage” each epidemic and the even larger epidemic of chronic diseases caused by those vaccines (discussed in detail here).

Note: The major decline in infectious illness that is credited to vaccines actually was a result of improved public sanitation, and when the data is examined (e.g., for smallpox) those early vaccination campaigns made things worse not better.

In the 1960s and 1970s, a debate emerged over what caused heart disease. On one side, John Yudkin¹ effectively argued that the sugar being added to our food by the processed food industry was the chief culprit. On the other side, Ancel Keys² (who attacked Yudkin’s work) argued that it was due to saturated fat and cholesterol.

Note: Leaders in the field of natural medicine, like Dr. Mercola, have made a strong case this spike came from the mass adoption of seed oils (which thanks to our unprecedented political climate is at last being discussed on the mainstream news). Likewise, some believe the advent of water chlorination was responsible for this increase.³

Ancel Keys won, Yudkin’s work was largely dismissed, and Keys became nutritional dogma. A large part of Key’s victory was based on his study of seven countries (Italy, Greece, Former Yugoslavia, Netherlands, Finland, America, and Japan), which showed that as saturated fat consumption increased, heart disease increased in a linear fashion.

However, what many don’t know (as this study is still frequently cited) is that this result was simply a product of the countries Keys chose (e.g., if Finland, Israel, Netherlands, Germany, Switzerland, France, and Sweden had been chosen, the opposite would have been found).

Fortunately, it’s gradually become recognized that Keys did not accurately report his data. For example, recently an unpublished 56 month randomized study⁴ of 9,423 adults living in state mental hospitals or a nursing home (which made it possible to rigidly control their diets) was unearthed.

This study, which Keys was the lead investigator of, found that replacing half of one’s animal (saturated) fats with seed oil (e.g., corn oil) lowered their cholesterol, but for every 30 points it dropped, their risk of death increased by 22% (which roughly translates to each 1% drop in cholesterol raising the risk of death by 1%).

Note: The author who unearthed that study also discovered another (unpublished) study from the 1970s of 458 Australians, which found that⁵ replacing some of their saturated fat with seed oils increased their risk of dying by 17.6%.

Likewise, recently, one of the most prestigious medical journals in the world published⁶ internal sugar industry documents. They showed⁷ the sugar industry had used bribes to make scientists place the blame for heart disease on fat so Yudkin’s work would not threaten the sugar industry. In turn, it is now generally accepted that Yudkin was right, but nonetheless, our medical guidelines are still largely based on Key’s work.

However, despite a significant amount of data that now shows lowering cholesterol is not associated with a reduction in heart disease, the need to lower cholesterol is still a dogma within cardiology.^{8,9,10,11,12,13} For example, how many of you have heard of this 1986 study which was published in the Lancet¹⁴ which concluded:

“During 10 years of follow-up from December 1, 1986, to October 1, 1996, a total of 642 participants died. Each 1 mmol/L increase in total cholesterol corresponded to a 15% decrease in mortality (risk ratio 0 to 85 [95% Cl 0·79 to 0·91]).”

Statins Marketing

One of the consistent patterns I’ve observed within medicine is that once a drug is identified that can “beneficially” change a number, medical practice guidelines will gradually shift to prioritizing treating that number and before long, rationales will be created that require more and more of the population to be subject to that regimen. Consider for example the history of the (immensely harmful) blood pressure guidelines:

In the case of statins, prior to their discovery, it was difficult to reliably lower cholesterol, but once they hit the market, research rapidly emerged arguing for a greater and greater need to lower cholesterol, which in turn led to more and more people being placed on statins.

As you would expect, similar increases also occurred within the USA. For example, in 2008 to 2009, 12% of Americans over 40 reported taking a statin, whereas in 2018 to 2019, that had increased to 35% of Americans.¹⁵ Given how much these drugs are used, it then raises a simple question — how much benefit do they produce?

As it turns out, this is a remarkably difficult question to answer as the published studies use a variety of confusing metrics to obfuscate their data (which means that the published statin trials almost certainly inflate the benefits of statin therapy), and more importantly, virtually all of the data on statin therapy is kept by a “private” (industry-funded)¹⁶ research collaboration¹⁷ that consistently publishes glowing reviews of statins (and attacks anyone who claims otherwise)¹⁸ but simultaneously refuses to release their data to outside researchers,¹⁹ which has led to those researchers attempting to get this missing data from the drug regulators.²⁰

Note: As discussed in Dr. Malhotra’s interview below, this collaboration (which militantly insists less than 1% of statin users experience side effects) also created a test one could utilize to determine if one was genetically at risk for a statin injury — and in their marketing for the test said 29% of all statin users were likely to experience side effects (which they then removed once health activists publicized this hypocrisy).

Nonetheless, when independent researchers looked at the published trials (which almost certainly inflated the benefit of statin therapy) they found²¹ that taking a statin daily for approximately 5 years resulted in you living, on average, 3 to 4 days longer. Sadder still, large trials have found²² this minuscule “benefit” is only seen in men. In short, most of the benefit from statins is from creative ways to rearrange data and causes of death, not any actual benefit.

Note: This is very similar to Pfizer’s COVID vaccine trial²³ which professed to be “95% effective” against COVID-19, but in reality only created a 0.8% reduction in minor symptoms of COVID (e.g., a sore throat) and a 0.037% reduction in severe symptoms of COVID (with “severe” never being defined by Pfizer).

This in turn meant that you needed to vaccinate 119 people to prevent a minor (inconsequential) case of COVID-19, and 2711 to prevent a “severe” case of COVID-19.

Worse still, a whistleblowers later revealed that these figures were greatly inflated as individuals in the (unblinded) vaccine group who developed COVID-19 like symptoms weren’t tested for COVID-19 and their vaccine injuries were never reported. Sadly, in most cases (e.g., the statin trials) we don’t have access to whistleblowers who can inform us of how unsafe and ineffective these drugs actually are.

In circumstances like these where an unsafe and ineffective but highly lucrative drug must be sold, the next step is typically to pay everyone off to promote it. For example:²⁴

“The National Cholesterol Education Programme (NCEP) has been tasked by the National Institutes of Health to develop guidelines [everyone uses] for treating cholesterol levels. Excluding the chair (who was by law prohibited from having financial conflicts of interest), the other 8 members on average were on the payroll of 6 statin manufacturers.²⁵

In 2004, NCEP reviewed 5 large statin trials and recommended: ‘Aggressive LDL lowering for high-risk patients [primary prevention] with lifestyle changes and statins.’”

In 2005 a Canadian division of the Cochrane Collaboration [who were not paid off] reviewed 5 large statin trials (3 were the same as NCEP’s, while the other 2 had also reached a positive conclusion for statin therapy). That independent assessment instead concluded:²⁶ “Statins have not been shown to provide an overall health benefit in primary prevention trials.”

Note: The primary reason no cure for COVID-19 was ever found was that the guideline panel for COVID-19 treatments was handpicked by Fauci²⁷ and comprised of academics taking money from Remdesivir’s manufacturers. Not surprisingly, the panel always voted against recommending any of the non-patentable treatments for COVID-19, regardless of how much evidence there was for them.

Likewise, the American College of Cardiology made a calculator²⁸ to determine your risk of developing a heart attack or stroke in the next ten years based on your age, blood pressure, cholesterol level, and smoking status. In turn, I’ve lost track of how many doctors I saw proudly punch their patient’s numbers into it and then inform them that they were at high risk of a stroke or heart attack and urgently needed to start a statin.

Given that almost everyone ended up being “high risk” I was not surprised to learn that in 2016, Kaiser completed an extensive study²⁹ which determined that this calculator overestimated the rate of these events by 600%. Sadly, that has not at all deterred the use of this calculator (e.g., medical students are still tested on it for their board examinations).

Note: One of the most unfair things about statins is that the health care system decided they are “essential” for your health, so doctors who don’t push them are financially penalized, and likewise patients who don’t take them are as well (e.g., through life insurance premiums).³⁰

So, despite the overwhelming evidence against their use, many physicians believe so deeply in the “profound” benefits of statins that they do things like periodically advocating for statins to be added to the drinking water supply.³¹

In tandem, a cancel culture (reminiscent of what we saw with the COVID vaccines) has been created where anyone who challenges the use of Statins is immediately labeled as a “statin denier” accused of being a mass murderer and effectively canceled. Recently, a statin and COVID vaccine dissident, British Cardiologist Aseem Malhotra discussed the dirty parallels between these two industries on Joe Rogan:

In addition to doctors being forced to follow these guidelines, patients often are too. Doctors often retaliate against patients who do not take statins (similar to how unvaccinated patients were reprehensibly denied essential medical care during COVID-19).

Employers sometimes require cholesterol numbers to meet a certain threshold for employment (although they never did anything on the scale of the COVID-19 vaccine mandates placed on workers around America). Similarly, life insurance policies often penalize those with “unsafe” cholesterol numbers.

Statin Injuries

My primary issue with the statins is not the fact we waste billions each year on a useless therapy (approximately 25 billion per year in America alone).³² Rather, it’s the fact that they have a very high rate of injury. For example, the existing studies find between a 5% to 30% rate of injuries,³³ and Dr. Malhotra, having gone through all the existing evidence estimates that 20% of statin users are injured by them.

Likewise, statins are well known for having a high percentage of patients discontinue the drugs due to their side effects (e.g., one large study³⁴ found 44.7% of older adults discontinue the drugs within a year of starting them, while another large study of adults of all ages found 47% discontinued within a year).³⁵

Statins in turn, are linked to a large number of complications³⁶ that have been well-characterized (e.g., mechanistically) and described throughout the medical literature.^{37,38,39,40,41,42} One group of side effects are those perceived by the patient (which often make them want to stop using the medications). These include:

• A high incidence of muscle pain^{43,44,45,46,47,48,49}
• Fatigue^50,51 especially with exertion and exercise⁵²
• Muscle inflammation (whose cause remains “unknown”)^53,54
• Autoimmune muscle damage^55,56,57,58
• Psychiatric and neurologic issues such as depression, confusion, aggression, and memory loss^{59,60,61,62,63,64,65,66,67}
• Severe irritability⁶⁸
• Sleep issues⁶⁹
• Musculoskeletal disorders and injuries^70,71
• Sudden (sensorineural) hearing loss⁷²
• Gastrointestinal distress⁷³

The other group are those not overtly noticed by the patient. These include:

• Type-2 diabetes,^{74,75,76,77,78} particularly in women^79,80,81
• Cancer^82,83,84,85
• Liver dysfunction and failure^86,87
• Cataracts^88,89
• ALS-like conditions and other central motor disorders (e.g., Parkinson’s disease and cerebellar ataxia)^{90,91,92,93,94}
• Lupus-like syndrome⁹⁵
• Susceptibility to herpes zoster (shingles)^96,97,98
• Interstitial cystitis⁹⁹
• Polymyalgia rheumatica¹⁰⁰
• Kidney injury^101,102
• Renal failure¹⁰³

From the start, I noticed statin patients often reported numbness, muscle pain, or cognitive issues after starting these drugs, which resolved once they stopped. When this was brought up with their doctors, the response was often hostile, with doctors insisting statins couldn’t be the cause, citing their own experience or claiming the patient needed to continue the medication to avoid a heart attack.

In turn, as the years went by, I saw increasingly elaborate excuses being created to protect the statins from an ever-increasing awareness of their dangers. A common one was the “nocebo effect” — the idea that negative expectations caused the reported symptoms. For example, I lost count of how many doctors I knew who cited this 2016 study¹⁰⁴ when patients stated they had been injured.

The nocebo effect is the opposite of the placebo effect. While the placebo effect occurs when a person experiences positive outcomes from a treatment because they believe it will help, the nocebo effect happens when negative outcomes arise simply because a person expects harm from a treatment, even if the treatment itself is harmless or ineffective.

This theory was used to dismiss patients’ experiences despite the fact that many were unaware of possible side effects until they occurred and then looked them up.

If you take this story and replace “statin” with COVID-19 vaccines, you will see it is essentially what everyone has experienced over the last four years (e.g., I lost count of how many times vaccine myocarditis was diagnosed as “anxiety”).

Note: Two adverse event reporting systems exist for adverse reactions to pharmaceuticals, MedWatch¹⁰⁵ and FAERS.¹⁰⁶ Like VAERS, they suffer from severe underreporting (it is estimated only 1% to 10% of adverse events are reported to them), but none the less, thousands of (ignored) reports can be found there of the common injuries which result from statins.¹⁰⁷

Conclusion

Most pharmaceutical medications work by blocking the function of an enzyme within the body, which while an effective way to change physiology, is often incredibly detrimental as each enzyme within the body is there for a reason. Statins do just that (and at the time were a revolutionary approach since decades of research had not yielded a consistent way to lower cholesterol). Unfortunately, the enzyme they chose doesn’t just lower cholesterol.

Sadly, however, since that was the only way to make statin’s “work,” the research community has largely ignored the consequences of eliminating all the other essential biomolecules that originate from mevalonate. For example, many of the characteristic side effects of statins can be addressed by simply supplementing with Coenzyme Q10 (an essential nutrient for the mitochondria, heart and muscles) — in fact Merck even patented a Statin-CoQ10 preparation.¹⁰⁸

However, acknowledging that would be akin to admitting statins are not “safe and effective” and it hence has never been done (a situation analogous to the fact many disabling childhood vaccine injuries could avoided if the vaccines were spaced out, yet those who proposed doing so are instead simply attacked for “not following the CDC’s schedule”).

Worse still, the massive market for “lowering cholesterol” has suppressed all research into the actual causes of heart disease and as a result, despite spending 25 billion a year on statins,¹⁰⁹ heart remains the top cause of death in America. This is an immense tragedy as the actual causes and treatments of heart disease have been known for decades, but still remain Forgotten Sides of Medicine.

Author’s note: This is an abridged version of a longer article about the great cholesterol scam which goes into greater detail on the dangers of statins, the actual causes of heart disease, and the natural ways to safely heal the arterial system and prevent heart disease. That article and its additional references can be read here.

A Note from Dr. Mercola About the Author

A Midwestern Doctor (AMD) is a board-certified physician from the Midwest and a longtime reader of Mercola.com. I appreciate their exceptional insight on a wide range of topics and I’m grateful to share them. I also respect AMD’s desire to remain anonymous since AMD is still on the front lines treating patients. To find more of AMD’s work, be sure to check out The Forgotten Side of Medicine on Substack.

See all references

(Mercola)—You’ve likely heard that high cholesterol is bad for your health, however cholesterol is found in nearly every cell of your body and is vital for optimal functioning. If you have too little, your risk of health problems increases, including all-cause mortality.

Research published in Frontiers in Endocrinology found a revealing link between low total cholesterol (TC) levels and increased mortality risk in those aged 85 and above.¹ This research challenges the conventional dogma that lower cholesterol is always better, especially for older adults.

The study, which analyzed data from the Chinese Longitudinal Healthy Longevity Survey, found that individuals with TC levels below 3.40 mmol/L (131 mg/dL) had a significantly higher risk of all-cause mortality compared to those with higher levels.² In fact, the mortality risk increased by 12% for every 1 mmol/L reduction in TC.³ These findings suggest that maintaining higher cholesterol levels may benefit longevity in your later years.

Why Low Cholesterol Is Harmful in Late Life

Cholesterol, often misunderstood as merely harmful, plays several crucial roles in maintaining bodily functions. This waxy substance serves as a fundamental building block for cell membranes, providing structural integrity and fluidity. It acts as a precursor for various essential hormones and is vital in the production of vitamin D when your skin is exposed to sunlight, contributing to bone health and immune function.

In your digestive system, cholesterol aids in the formation of bile acids, which are necessary for the absorption of fats and fat-soluble vitamins. Further, cholesterol is integral to myelin sheath formation, enhancing nerve signal transmission throughout your body. A balanced amount of cholesterol is indispensable for optimal health and plays a protective role as you age.

As for why low cholesterol increases risk of all-cause mortality in older adults, low TC levels may compromise cell function and increase your vulnerability to infections and other health problems. Additionally, cholesterol helps regulate inflammatory markers in your body. With lower TC levels, you might experience enhanced inflammation, which is associated with numerous age-related diseases.

The study found the protective effect of higher cholesterol is independent of nutritional status or chronic health conditions, suggesting a direct biological link between TC levels and longevity in advanced age. The researchers explained:⁴

“Although the biological pathways that link TC to mortality are poorly understood, several mechanisms may explain this inverse association. For example, blood lipids, which are an important component of cell membranes, may affect cell electrophysiology by modulating the distribution and function of some ion channels.

Low TC levels may contribute to the pathogenesis of some common diseases in older people, such as atrial fibrillation. Another potential mechanism is that TC may regulate inflammatory markers such as C-reactive protein and attenuate the biological response to inflammation. Therefore, individuals with low TC levels may be more vulnerable to physiological disorders because of enhanced inflammation.”

The study identified an optimal range for TC levels in those aged 85 years and over. Participants with TC levels between 3.40 and 4.39 mmol/L (131 to 170 mg/dL) and those with levels at or above 4.39 mmol/L (170 mg/dL) had significantly lower mortality risks compared to those with levels below 3.40 mmol/L.⁵

“Our findings contribute to the growing body of evidence challenging the ‘lower is better’ paradigm for cholesterol levels in older adults,” the researchers noted, proposing that the optimal TC range for older adults might lie between 3.40 and 5.18 mmol/L (131 to 200 mg/dL).⁶

Low Cholesterol Linked to Increased Diabetes Risk

Another important study of 3.26 million Chinese adults aged 65 and older also revealed the importance of properly optimizing your cholesterol. It found low cholesterol levels are associated with a higher risk of diabetes.⁷

The researchers observed a J-shaped relationship between total cholesterol and diabetes risk. This means that both very low and very high cholesterol levels were associated with increased diabetes risk, with the lowest risk occurring at moderate levels. Specifically, TC levels below 4.04 mmol/L (156 mg/dL) were linked to higher diabetes odds. This “cholesterol paradox” could further explain why low cholesterol contributes to increased mortality in late life.

The findings even held true for low-density lipoprotein (LDL) cholesterol, often labeled as the “bad” cholesterol. The study found a similar J-shaped relationship between LDL cholesterol levels and diabetes risk. LDL cholesterol levels below 2.33 mmol/L (90 mg/dL) were associated with higher diabetes odds. For every 1 mmol/L increase in LDL cholesterol below this threshold, there was a 12% decrease in diabetes risk.⁸

This again challenges the “lower is better” approach to LDL management, especially for older adults. The protective effect of moderately higher LDL cholesterol levels could be another piece of the puzzle in understanding increased late-life mortality associated with low cholesterol — your body needs a certain level of LDL cholesterol for optimal health throughout life, including in your later years.

The Protective Role of Cholesterol in Brain Health

Maintaining adequate cholesterol levels is also crucial for your brain health, especially as you age. Cholesterol plays a vital role in the production and maintenance of cell membranes in your brain and is essential for the formation of lipid rafts, specialized regions in cell membranes that are crucial for synaptic function and plasticity.⁹

These processes are fundamental for learning and memory. When your cholesterol levels are too low, it can disrupt these lipid rafts, potentially affecting your memory consolidation and cognitive function. Additionally, cholesterol is necessary for myelin production, the protective sheath around nerve fibers that enables efficient signal transmission in your brain.

Low cholesterol levels might interfere with the repair and regeneration of myelin, leading to impaired information processing and potentially contributing to cognitive decline. Further, research indicates that women have a higher lifetime risk of developing Alzheimer’s disease compared to men, and cholesterol levels may play a role in this difference.

The study focused specifically on post-menopausal women, finding that those with total cholesterol levels below 153 mg/dL had a significantly higher risk of developing dementia.¹⁰ Even women with cholesterol levels above 201 mg/dL had a reduced risk of developing dementia compared to those with the lowest levels.¹¹

This suggests that maintaining adequate cholesterol levels may be particularly important for cognitive health in post-menopausal women. The researchers explained several reasons why low cholesterol may increase dementia risk in this population:¹²

“In neurons, lipid rafts are … believed to be involved in synaptic function and plasticity, which are essential for learning and memory processes. Low cholesterol caused by drugs or toxins may disrupt lipid rafts, subsequently affecting memory consolidation and cognitive function and finally resulting in dementia.

In addition to lipid raft disruption, demyelination caused by low cholesterol levels might also be another important factor that interferes with the regeneration of myeline; therefore, signal (information) transformation and consolidation become disrupted.

Several factors including hyperglycemia, hypertension, toxins, infections, and many other factors that induce free radicals, oxidation, and the inflammation of myeline results in the aging process or the destruction of myelin. In this situation, a higher cholesterol level might be a rate-limited process for repairment and remyelination.

Without intact functional lipid rafts and myeline, information in the brain for conduction, consolidation, or plasticity is not possible.”

Link Between Low Cholesterol and Blood Cancer Risk Unveiled

Recent research from the UK Biobank study has also uncovered an unexpected relationship between low cholesterol levels and an increased risk of plasma cell neoplasms, including multiple myeloma.¹³

This large-scale study followed 502,507 participants for up to 14 years, revealing that individuals with lower levels of total cholesterol, LDL, high-density lipoprotein (HDL) and apolipoproteins had a higher likelihood of developing these blood cancers.¹⁴ While the exact mechanisms are not fully understood, this research points to the complex role of cholesterol in cellular health and immune function.

In the context of blood cancers, cholesterol appears to have protective effects. Higher levels of HDL and its associated apolipoprotein A have been linked to reduced inflammation and improved immune cell function. These lipids can regulate cancer cell proliferation and modify the function of macrophages and other immune cells.¹⁵

Additionally, cholesterol is crucial for the homeostasis of your hematopoietic system, which produces blood cells. The study suggests that very low cholesterol levels might disrupt this delicate balance, potentially increasing the risk of malignant transformations in plasma cells.¹⁶

The study found that the relationship between cholesterol and plasma cell neoplasms was particularly pronounced in males and individuals over 60 years old. The use of cholesterol-lowering medications didn’t reduce the risk of these blood cancers, suggesting that artificially lowering cholesterol levels does not provide the same protective effects as naturally occurring higher levels.

Statin cholesterol-lowering medications are among the most-prescribed drugs in the U.S., but the number of people taking them may soon decline significantly. Based on previous guidelines, 45.4 million adults meet the criteria to take statin drugs, but if updated guidelines from the American Heart Association are adopted, this will drop to 28.3 million.¹⁷

Optimizing Cholesterol Levels for Overall Health

Maintaining optimal cholesterol levels involves more than just focusing on the numbers. Your gut health plays a significant role in this complex equation. Oxygen-intolerant bacteria, which thrive in an oxygen-free gut environment, are vital for converting plant fibers into beneficial fats. However, modern lifestyle factors can disrupt this delicate balance, potentially leading to a shift toward oxygen-tolerant bacteria that produce more potent endotoxins.

This shift can have far-reaching implications for your health. Endotoxemia, often resulting from this bacterial imbalance, is a significant underlying cause of septic shock — a condition that may be more prevalent than commonly recognized.

In fact, it could be a leading cause of death, surpassing even heart disease and cancer in some estimations. Many cases of heart disease or heart failure might actually be triggered by endotoxemia, underscoring the interconnectedness of your gut health and cardiovascular system.

To truly optimize your cholesterol levels and overall health, it’s essential to look beyond conventional metrics and instead consider the following tests for a more comprehensive understanding of your heart disease risk:

• Omega-3 index
• HDL/total cholesterol ratio
• Fasting insulin level
• Fasting blood sugar level
• Triglyceride/HDL ratio
• Iron level

This personalized approach, combined with strategies to improve mitochondrial function and maintain a healthy gut ecosystem, offers a more holistic path to cardiovascular health. By addressing these underlying factors, you can naturally optimize your cholesterol levels while supporting your overall well-being.

• ^{1, 2, 3, 5} Front. Endocrinol, 12 June 2024
• ^4, 6 Front. Endocrinol, 12 June 2024, Discussion
• ^7, 8 Lipids Health Dis. 2024; 23: 167
• ^9, 10, 11 Nutrients. 2023 Oct; 15(20): 4481
• ¹² Nutrients. 2023 Oct; 15(20): 4481, Discussion
• ^13, 14 Cancer Med. 2023 Nov; 12(22): 20964–20975
• ^15, 16 Cancer Med. 2023 Nov; 12(22): 20964–20975, Discussion
• ¹⁷ JAMA Internal Medicine June 10, 2024

Editor’s Note: This article is a reprint. It was originally published October 10, 2018 but the science stands and it is arguably even more relevant today.

(Mercola)—Cholesterol is a waxy substance found in nearly every cell of your body, vital for optimal functioning. For instance, your body uses cholesterol in the construction of cell membranes and in regulating protein pathways required for cell signaling. Without sufficient amounts of cholesterol in your body you may experience a negative impact on your brain health, hormone levels and heart disease risk.

Your body also uses cholesterol to manufacture vitamin D after exposure to the sun. Most of the cholesterol in your body is manufactured in your liver using nutrients extracted from your food. Animals use cholesterol in much the same way, which means meat from beef, pork or chicken have similar levels.¹

The rate your body absorbs dietary cholesterol ranges between 20 and 60%, depending on individual factors.² Unfortunately, while critical to your health, saturated fats and cholesterol have been wrongly vilified as the culprits of heart disease for more than six decades.

The first scientific evidence linking trans fats to heart disease and exonerating saturated fats was published in 1957 by the late biochemist Fred Kummerow.³ Unfortunately, his research was overshadowed by Ancel Keys’ Seven Countries Study,⁴ which linked saturated fat to heart disease.

Later, reanalysis of Keys’ study revealed the data was cherry picked to produce this link, but by then the saturated fat myth was already firmly entrenched. In the past several decades, other studies have debunked the saturated fat myth.

Most recently, a scientific review⁵ identified significant flaws in three industry-funded studies, and presented substantial evidence that total cholesterol and low-density lipoprotein (LDL) cholesterol levels are not an indication of heart disease risk.

Yet Another Study Busts the Cholesterol Myth

Guidelines published for eating fats continue to be confusing as the basic premise was wrong. Dietary fat is associated with heart disease, but it is processed vegetable oils loaded with trans fats and damaged omega-6 fats that are producing the problem, not saturated fats.

An international team of 17 experts analyzed the results from three large reviews published by statin advocates. The three studies attempted to validate the current belief that statin treatment helps prevent cardiovascular disease. The international team was unable to satisfy criteria for causality and found fault in the conclusions the three studies made.⁶

The international team wrote there may be an association between young and middle-aged people with high total or LDL cholesterol that may potentially raise the risk of heart disease.

However, they point out an association is not the same as causation, and few previous studies have adjusted for other factors linked to heart disease such as coagulation, inflammation, infections and endothelial sensitivity. Specifically, the authors found:⁷

• There was no association between total cholesterol and the degree of atherosclerosis severity.
• Total cholesterol levels are generally not predictive of the risk of heart disease and may be absent or inverse in many studies.
• In many studies LDL was not associated with atherosclerosis and in a large U.S. based study of nearly 140,000 patients who suffered an acute myocardial infarction, LDL levels at the time of admission were lower than normal.
• Adults over the age of 60 with higher LDL levels generally live longer.
• Few adults who experience familial hypercholesterolemia die prematurely.

The researchers concluded that high cholesterol levels cannot be the main cause of heart disease as those with low levels have nearly the same degree of sclerosis as those with high levels, and the risk of having a heart attack is the same or higher when cholesterol levels are low.

They believe the hypothesis has been kept alive by reviewers using misleading statistics and excluding results from unsuccessful trials while ignoring numerous contradictory observations.⁸

Statins Raise Risks Without Benefits

In dire cases, physicians may prescribe a medication with significant side effects when the potential benefits outweigh the possible risks, such as a strong antibiotic known to potentially trigger kidney damage when you suffer a life-threatening infection. In this instance, although there is significant risk with the antibiotic, without it you will likely die.

However, as statin drugs are designed to reduce cholesterol levels and cholesterol does not cause heart disease, all risks associated with the medication come without any benefit to your health. The trend for prescribing statin drugs is concerning, and is particularly relevant to diabetics whose underlying disease increases their risk of heart disease.

Recommendations suggest high dose statins should be automatically started in anyone 40 to 75 years of age with diabetes but no other risk factors for heart disease.⁹ This, despite the fact that statins have been shown to increase fasting blood glucose levels in diabetics.¹⁰ While statin supporters claim the drug is safe and effective, research has uncovered multiple side effects, some of which are deadly:^11,12

• General — Urinary tract infections, dizziness, partial loss of sensitivity to sensory stimuli, distortion of the sense of taste, amnesia and headache
• Gastrointestinal — Diarrhea, indigestion, nausea, intestinal gas, constipation, abdominal discomfort, abdominal pain, vomiting and pancreatitis
• Metabolic — Abnormal liver function tests, hyperglycemia, hepatitis, anorexia, hypoglycemia and weight gain
• Musculoskeletal — Joint pain, pain in extremity, musculoskeletal pain, muscle spasms, myalgia, joint swelling, back pain, elevated creatine phosphokinase, neck pain and muscle fatigue, muscle wasting and amyotrophic lateral sclerosis (ALS)¹³
• Cardiovascular — Death in up to 10% of patients,¹⁴ contributes to heart disease¹⁵

Strikingly, the expert reviewers in the featured study noted claims of effective and safe treatment with statin drugs are invalid, saying:¹⁶

“In our analysis of three major reviews, that claim the cholesterol hypothesis is indisputable and that statin treatment is an effective and safe way to lower the risk of CVD [cardiovascular disease], we have found that their statements are invalid, compromised by misleading statistics, by exclusion of unsuccessful trials, by minimizing the side effects of cholesterol lowering, and by ignoring contradictory observations from independent investigators.”

Inflammation Drives Cardiovascular Disease

Biased research launched a low-fat myth and reshaped the food industry for decades to come. As saturated fat and cholesterol were rejected, manufacturers switched to using trans fats and sugar to add taste to processed foods. These changes increased inflammatory levels and drove a new level of disease.

A study from Brigham and Women’s Hospital was the culmination of a nearly 25-year cardiovascular research work designed to test if reducing inflammation would also reduce the risk of recurrent heart attack or stroke. The study enrolled 10,000 people with a history of heart attack and a persistently elevated C-reactive protein level, a strong biomarker of inflammation.

At the conclusion of the study, the researchers noted that using medication to reduce inflammation also reduced the risk of cardiovascular disease, lung cancer and death.¹⁷ However, the medications used in the study came with significant side effects. In contrast to acute inflammation after an injury, chronic inflammation does not produce immediate symptoms.

Over an extended period of time, chronic inflammation silently damages your tissues and arterial walls, which your body attempts to repair. These repairs may build over time and create plaque, potentially breaking off and blocking smaller arteries in the heart or brain, triggering a heart attack or stroke.

This process may go on for years without being noticed, as chronic inflammation has few apparent symptoms. Research has demonstrated deficiencies and excesses of certain micronutrients, such as folate, vitamin E and zinc, may result in an ineffective or excessive inflammatory response. Researchers note:¹⁸

“Inflammation acts as both a ‘friend and foe’: it is an essential component of immunosurveillance and host defense, yet a chronic low-grade inflammatory state is a pathological feature of a wide range of chronic conditions, such as the metabolic syndrome, nonalcoholic fatty liver disease, Type 2 diabetes mellitus and CVD.”

Assessment of Heart Disease Risk More Effective Using These

Specific ratios and blood level values tell you more about your risk of heart disease than your total cholesterol number. The size of your LDL cholesterol and your LDL particle number, for example, is more important than your overall total LDL value.

Large particle LDLs are not harmful to your health while small, dense LDL particles may create injury as they squeeze through the lining of your arteries, oxidize and trigger inflammation.

An NMR LipoProfile, which measures your LDL particle number, is a better assessment of your risk of heart disease than total or total LDL cholesterol level. The following tests may also give you a better assessment of your potential risk for cardiovascular disease:

• High sensitivity C-reactive protein (HS-CRP) — This is one of the best overall measures of inflammation and an excellent screen for your risk of heart disease. Ideally your level should be below 0.7 and the lower the better.
• Cholesterol ratios — Your HDL/cholesterol ratio and triglyceride/HDL ratio are both strong indicators of your risk. For your HDL/cholesterol ratio divide your HDL by your total cholesterol and multiply by 100. The percentage should ideally be above 24%. For your triglyceride/HDL ratio divide your triglyceride total by your HDL. The ideal percentage is below 2%.
• Fasting insulin level — As sugar and carbohydrates are metabolized they trigger a release of insulin, which creates triglycerides and promotes the accumulation of fat. This process increases inflammation and makes it more difficult to lose or maintain an ideal weight. Excess fat around your midsection is one of the major contributors to heart disease.¹⁹ Your fasting insulin level can be determined by a simple, inexpensive blood test. A normal fasting blood insulin level is below 5 microunits per milliliter (mcU/ml) but, ideally, you’ll want it below 3 mcU/ml. If your insulin level is higher than 3 to 5, the most effective way to optimize it is to reduce net carbs.
• Fasting blood sugar level — Studies have demonstrated people with higher fasting blood sugar levels have a higher risk of having coronary heart disease.²⁰ When your fasting blood sugar is between 100 and 125 mg/dl, your risk of coronary artery disease increases by 300% compared to having a level below 79 mg/dl.
• Iron level — Iron creates an environment for oxidative stress, so excess iron may increase your inflammation and increase your risk of heart disease. An ideal iron level for adult men and nonmenstruating women is between 40 and 60 nanograms per milliliter (ng/ml). You do not want to be below 20 ng/ml or above 80 ng/ml.

Manage Your Heart Disease Risk With Effective Choices

To effectively manage your cardiovascular risk, it is critical to reduce chronic inflammation. Magnesium plays a vital role in biological function and mitochondrial health, and is a culprit in the development of inflammation when your levels are low. It may also play a role in inhibiting the deposit of lipids on arterial walls and plaque formation.²¹

In one double-blind, placebo-controlled trial, patients who received intravenous magnesium within 24 hours of their heart attack experienced 24% fewer deaths within the following five years.²² Researchers concluded the benefits of magnesium intake on chronic disease may be explained by the effect it has on inhibiting inflammation.

There are multiple factors affecting the inflammatory process in your body. Some of the more significant over which you have control, include:

• Hyperinsulinemia — An excess of insulin in your blood triggered by a diet high in net carbohydrates. What you eat tends to be the deal-breaker in how much insulin your body secretes. However, there are other factors contributing to your insulin levels, such as smoking, sleep quality, exercise and vitamin D level.
• Unbalanced fatty acids — Your body needs a balance of omega-3 and omega-6 fats. Unfortunately, most diets have an overabundance of omega-6 fats leading to greater levels of inflammation. Strive for a 1-to-1 ratio of omega-3 to omega-6 fats to reduce inflammation and your risk of heart disease.
• High iron stores — Ensure your ferritin blood levels are below 80 ng/ml. If elevated, the simplest and most efficient way to lower your iron level is to donate blood. If you can’t donate, then therapeutic phlebotomy will effectively eliminate the excess iron.
• Leaky gut — Food particles and bacteria leaking from your intestines increase your level of inflammation and your risk of heart disease. By eliminating grains, sugars and lectin-rich legumes, while adding fermented foods, you may heal your gut and reduce your level of inflammation.
• Inadequate levels of magnesium — A century ago your diet provided nearly 500 milligrams (mg) of magnesium per day. Today, courtesy of nutrient-depleted soil, you may be getting only 150 mg per day. Your body flushes excess magnesium through your stool, so using magnesium citrate and monitoring stool consistency, consider starting with 200 mg of oral magnesium citrate and gradually increasing until you develop slightly loose stools.

My personal preference for magnesium supplementation is magnesium threonate, as it appears to more efficiently penetrate cell membranes, including your mitochondria. It penetrates your blood-brain barrier and may help improve memory. It also may be a good alternative to reduce migraine headaches.

• ¹ Berkeley Wellness, September 1, 2011
• ² Eating Well, How much does eating cholesterol in my food really affect my blood cholesterol?
• ³ Washington Post June 16, 2015
• ⁴ The Seven Countries Study, Ancel Keys
• ^{5, 6, 7, 8, 16} Expert Review of Clinical Pharmacology, September 10, 2018, doi: 10.1080/17512433.2018.1519391
• ⁹ American College of Cardiology, May 22, 2017
• ¹⁰ Journal of Investigative Medicine, 2009;57(3)
• ^11, 14 Drugs.com, Atorvastatin
• ¹² WebMD, Simvastatin Side Effects by Likelihood, 2018
• ¹³ Drug Safety, 2007;30(6):515
• ¹⁵ Expert Reviews of Clinical Pharmacology 2015;8(2):189
• ¹⁷ Forbes, August 27, 2017
• ¹⁸ British Journal of Nutrition, 2015;114(7)
• ¹⁹ Critical Pathways in Cardiology, 2007;6(2):51
• ²⁰ The American Journal of Cardiology, 2002;89(5):596
• ²¹ Dr. Sircus, July 17, 2015
• ²² European Journal of Clinical Nutrition, 2014;68: 510