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Since the 1950s, when a scientist named Ancel Keys cherry-picked data to support his hypothesis that saturated fat was the main driver of heart disease, we have blamed cholesterol for all our cardiovascular woes. Physicians have urged patients to adopt low-fat diets and take statins to lower cholesterol levels. But this is blaming the messenger.
“Elevated cholesterol is a symptom,” says P. Michael Stone, MD, MS, a family physician in Ashland, Ore., and a faculty member at the Institute for Functional Medicine. He believes the notion of cholesterol as cause is “the biggest misconception surrounding cardiovascular disease.”
“The big focus of the American Heart Association for the last 50 years has been cholesterol, but if it is elevated, there is a root cause for that elevation,” he says. “The answer is not as simple as a low cholesterol level.
“The best approach is to figure out what is driving abnormal or unbalanced cholesterol numbers.”
Guarneri, Stone, and others believe the future of heart-disease prevention and treatment lies not in mere symptom management — lowering cholesterol, blood pressure, and blood sugar via pharmaceuticals — but in identifying the underlying causes of those symptoms. They predict that this approach will transform the way we assess, prevent, and manage cardiovascular disease.
“Understanding the root causes can help you identify and recognize the five patterns we know impact and increase the risk of cardiometabolic syndrome: inflammation, oxidative stress, insulin dysfunction, autonomic dysfunction, and endothelial dysfunction,” says Stone.
In other words, inflammatory conditions, free radicals, high blood sugar, stress overload, and blood-clotting problems all contribute to heart disease. The problem can’t be reduced to the butter on your toast.
In many cases, dietary sources have little to do with elevated serum-cholesterol levels. Rather, the body begins to produce more of the substance on its own to handle an increased demand. For example, when chronic inflammation begins to lower testosterone production, Stone says, the body produces more cholesterol (a key precursor to testosterone) to revive the hormone.
Likewise, an autonomic nervous-system problem can also raise cholesterol production: The body produces more cortisol when it’s in fight-or-flight mode, and it requires more cholesterol to do so.
Sure, there are some people who are genetically predisposed to high cholesterol, Stone says, but they are fairly rare. Most of the time, elevated cholesterol is a response to something else occurring in the body. When we erase the symptom instead of digging for the root cause, we’re ignoring the fact that high cholesterol can also be an immune response.
“If you’re having trouble getting your LDL levels down, that might mean you have an underlying infection. So when we crash somebody’s LDL with statins, are we inhibiting their innate immune system?” Stone asks. “You look at all this and think, ‘What are we doing by willy-nilly treating a number and not looking at root cause?’”
In addition, Stone emphasizes that normal cholesterol levels do not mean no — or even, low — risk. In fact, 25 percent of people who have heart attacks have low cholesterol, he notes, while 25 percent of people with high cholesterol do not have plaque or heart disease.
“It raises the question: Is cholesterol the right marker to check — and is it the best marker to be checked?” asks Stone. “And the resounding answer is that it is a marker, but it’s not the best marker.”
