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The Cholesterol Myth

The cholesterol myth: Is sugar the big culprit?

By Steve Milano, Tribune Brand Publishing

If you want to reduce your risk for the type of coronary heart disease often referred to as “clogging” or “hardening” of the arteries, should you reduce the amount of cholesterol, saturated fat or sugar in your diet?

If you’ve been trying to reduce high blood cholesterol levels, you might be surprised to learn that sugars, even more than saturated fats, are the main culprits contributing to your problem. It’s also not the cholesterol you eat. That’s because the cholesterol that causes atherosclerosis, or plaque in your arteries, is mainly manufactured by your body, not a result of the dietary cholesterol contained in the foods you eat, explains cardiologist and cholesterol expert Dr. Seth Baum, founder of Preventive Cardiology in Boca Raton, Florida.

Even more confusing is that the amount of “bad” cholesterol (known as LDL) in your blood is not as important as the number of LDL particles you create. LDL particles transport LDL cholesterol throughout your body. The more LDL particles in your blood, the more likely LDL cholesterol will penetrate your arteries, create plaque, and then cause the arterial problems, including inflammation, that can lead to heart attack and stroke.

Dietary cholesterol isn’t the bad guy

Eating high-cholesterol food, such as eggs, doesn’t significantly increase the production of LDL particles, says Dr. Baum, who treats patients with severe cholesterol problems. “Consumption of cholesterol generally does not increase your cholesterol very much. That’s why the American Heart Association has very significantly changed its recommendation on how often you can eat eggs.”

Even saturated fat isn’t as big a contributor to heart disease as experts once thought. “Saturated fats tend to increase your cholesterol much more than dietary cholesterol, but unless you’re consuming large quantities of saturated fat, it’s not as bad as we once thought,” says Dr. Baum. “If you look at all the clinical trials and sum them up, saturated fats are not as bad as we used to think. Unfortunately, there has been an attempt to interpret that as, ‘Hey, you don’t have to avoid saturated fats; we can all go out and have bacon cheeseburgers’ but that’s not true because we know that saturated fats lead to some increase in LDL cholesterol.”

“There’s so much confusion and misinformation about this subject even among people who are very informed because the results of dietary studies on cholesterol have been oversimplified, when the reality is, there are so many variables that the issue becomes extraordinarily complicated.”

Avoiding cholesterol can cause problems

“When people try to change their diet based on reducing cholesterol, the substitutes they choose often contain more sugar, which leads to the overproduction of LDL particles,” says Dr. Baum. “So, if you decide, ‘Instead of having that steak, I’m going to have a piece of salmon,’ that’s a good move. If you say, ‘Instead of having that steak, I’m going to have a carb-heavy meal with potatoes and bread and pasta, then that’s a bad move. Be careful what you’re substituting.”

Adding dietary fiber to reduce cholesterol is another common strategy for improving heart health, but even that’s misunderstood, says Dr. Baum. While dietary fiber helps remove the cholesterol you eat from your body, it also removes byproducts from our internal production of cholesterol, leading to a more robust reduction of LDL particles from your bloodstream.

Basics still count

While reducing the amount of sugar you eat and getting your sugar from natural sources, such as fruit, can be the biggest contributors to lowering your risk for cholesterol-related heart disease, the general population should still follow common-sense recommendations for good heart health, says Dr. Baum. “I always go back to a very simplistic approach for treating cholesterol – that balance is key. I would suggest that you maintain an optimal weight, exercise on a regular basis, and eat a balanced, healthful diet of natural foods, predominantly of vegetables, chicken, fish and small quantities of lean cuts of meat. Stay away from the hormones, artificial ingredients and processed foods, especially the cookies, cakes, candies and ice creams.

“Most people will do well with that approach, but to do that seems to be very difficult nowadays and too few people do it. Then there are people with genetic problems, who are quite different from the average overweight and sedentary Americans. Their heart health is minimally improved with this strategy, so these people need the right medications very badly,” says Dr. Baum, whose practice is one of approximately 70 in the U.S. that offer specific treatments such as LDL apheresis to patients with genetic cholesterol problems.

If you’ve been struggling with lowering your cholesterol, ask your doctor about a strategy of reducing sugar and saturated fat consumption and adding dietary fiber to your meals. Also, don’t be afraid of cholesterol-lowering medications when they are needed. You might learn that you don’t have to give up your favorite shellfish and egg dishes after all.