Your blood work.

HDL. LDL. Triglycerides. Fasting glucose. Pattern A vs. pattern B. What matters, what doesn't? And why does the answer seem to keep changing?

Nothing has confused Americans more than the confusing advice we have been given regarding diet, cholesterol, and heart disease. Scientists learn more every month. The complete picture is far more complicated than it was when presented three decades ago when we were all told to try to lower our total cholesterol. In 2015, the understanding is much more nuanced, and total cholesterol has become an all but meaningless number, except in extreme cases of hyperlipidemia.  

Here are some basic facts that might help you worry less about your blood cholesterol:

Good news about eating more saturated fat:

  • High HDL ('good cholesterol') is strongly correlated with heart health. (Eating less whole wheat bread and more butter raises HDL.)
  • Low triglycerides are strongly correlated with heart health. (Eating less whole wheat bread and more butter lowers triglycerides.)
  • Happy, fluffy LDL (Pattern A) does not seem to promote atherosclerosis. (Eating less whole wheat bread and more butter increases happy, fluffy LDL.)
  • For women, higher total cholesterol is associated with less mortality. (Eating less whole wheat bread and more butter will raise total cholesterol.) See graph, below, or link to NHLBI data - table 3, page 1050.

Bad news about eating more saturated fat:

  • Higher LDL ('bad cholesterol') is weakly (4X less predictive than high HDL and low triglycerides) correlated with more heart disease, although this is increasingly viewed as a Pattern A/Pattern B difference. (Eating less whole wheat bread and more butter slightly raises LDL cholesterol.)

Links to more information on cholesterol:

From Dr. Peter Attia on his personal blog, theeatingacademy.com:

What is Cholesterol?

The Straight Dope on Cholesterol - Part I  (Note that you can keep reading... there are nine or ten parts, but it all gets very technical...)

And, from Mark Sisson on his blog, marksdailyapple.com:

The Definitive Guide to Cholesterol

How to Interpret Cholesterol Test Results

A 50 minute lecture about cholesterol from Dr. Jeffry Gerber, a member of the American Society of Bariatric Physicians:

Cholesterol OMG presentation, Jeffry Gerber MD, 05/31/2014 at the Weston A. Price Denver chapter meeting. An entertaining look at the history of cholesterol and cardiovascular disease. Discussing cholesterol, cardiovascular risk assessment and non-standard high quality nutrient dense diets including low carb high fat (LCHF), Paleo, Primal and WAPF.