Everything You Thought You Knew About Cholesterol Is Wrong

The experts give us the real deal about eggs, butter and more

Jodi Helmer,

AARP

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Published February 20, 2015

Cholesterol Level Myths Fat Butter Heart Toast Plate Knife

The saturated fat found in butter may help to increase HDL "good" cholesterol.

Brian Jackson / Alamy

Ninety-nine million Americans have high cholesterol, and most of what they know about their condition is probably wrong. We've asked medical experts to weigh in on seven common cholesterol misconceptions.

Myth: Cholesterol is bad

Truth: Cholesterol is like cake, good in moderation. It's misleading to call cholesterol an evil, artery-clogging fat because cholesterol performs a lot of important functions.

The waxy substance helps produce hormones, cell membranes and vitamin D, and aids in digestion. It also plays a role in cognitive function, helping to form memories. Most of the cholesterol in your bloodstream is, in fact, created by your body, not your diet.

Still, this doesn't mean you should skip fruit in favor of steak. To keep your cholesterol levels under 200 milligrams per deciliter, or mg/dL, it's essential to exercise, eat a balanced diet, maintain a healthy weight and quit smoking.

Myth: A low-fat diet is best

Truth: Bring back the butter. Research is challenging the decades-old notion that saturated fat — found primarily in meat, butter and cheese — is the leading cause of clogged arteries and heart disease. While saturated fat does increase LDL ("bad") cholesterol, it also increases HDL ("good") cholesterol. Plus, there are other dietary villains — such as too much sugar and carbohydrates — that can also lead to a buildup of artery-clogging particles. A study published last year in the Annals of Internal Medicine found no link between eating saturated fats and increased risk of heart attacks. Foods high or low in saturated fat can be harmful, beneficial or neutral, depending on the type of food, says Dariush Mozaffarian, M.D., a coauthor of the study and dean of the Friedman School of Nutrition Science and Policy at Tufts University. A low-carb diet — meaning low in foods like white bread, white rice, potatoes, crackers and sugar — is more effective for raising "good" cholesterol and reducing triglycerides, he says. Adding healthy fats, such as nuts and olive oil, can also help reduce the risk of heart attack and stroke.

Myth: You must fast before a cholesterol test

Truth: There is no need to show up for a cholesterol test on an empty stomach. Research published in the journal Circulation compared the blood lipid panels of fasting and nonfasting patients and found that the results for LDL, triglycerides and total cholesterol are equally accurate. Additionally, there was no difference in the ability of fasting or nonfasting tests to predict death from heart disease.

"People spend most of their time in a nonfasting state," says Sripal Bangalore, M.D., lead researcher and associate professor of medicine at New York University. "It doesn't make sense to measure their cholesterol levels when they're on their best behavior."

The fasting requirement isn't just inconvenient, it could also affect treatment options. Bangalore notes that patients who fail to fast are often asked to reschedule the test, which may delay treatment. "I hope that the [study] will change practices for cholesterol tests, and more doctors will feel comfortable looking at nonfasting results," he says.

Myth: Statins will solve the problem

Truth: For some people, including those with heart disease, cholesterol-lowering drugs are an important part of treatment. But some people could skip statins — and their side effects — and achieve the same results with lifestyle changes.

In a 2013 study published in BMJ, Harvard health care policy expert John Abramson, M.D., found that people with less than a 20 percent risk of heart disease over the next 10 years had no significant reduction in death as a result of taking statins.

Although the research showed that statins had no overall health benefit in those at low risk of heart disease, doctors continue prescribing the drugs. The risk, according to Abramson, is that patients will take the pill instead of focusing on lifestyle changes that will be just as effective in reducing their risk of heart disease.

"In many cases, exercise, eating a healthy diet and not smoking are going to be far more effective at reducing the risk of heart disease than taking a statin," he says.

Myth: Cholesterol-lowering drugs might wreck your sex life

Truth: They might improve it. Although there have been some worries that statins might interfere with testosterone production because of cholesterol's role in producing the hormone, a 2014 study published in the Journal of Sexual Medicine found that statins actually increased erectile function by nearly 25 percent.

The science works like this: Cholesterol clogs the arteries, restricting blood flow. Statins lower cholesterol, improving the ability of arteries to dilate, which may help increase erectile function. John B. Kostis, M.D., lead researcher and associate dean of cardiovascular research at the Robert Wood Johnson Medical School at Rutgers University, warns that statins should not be used explicitly to improve erectile function. But if you're on a statin anyway, men may see an improvement "within a couple of weeks."

Myth: If you're watching your cholesterol, eggs are the enemy

Truth: Put eggs back on your menu. The federal Dietary Guidelines Advisory Committee recently dropped its recommendation that healthy adults limit foods high in cholesterol, like eggs and shellfish, because research shows they only have a slight effect on blood cholesterol. In fact, researchers at Yale University found that even those with coronary heart disease could safely consume two eggs per day for six weeks and experience no adverse effects on cholesterol levels. Plus, the "incredible, edible egg" is also a good source of choline, a nutrient that plays an important role in memory, and the yolk is packed with antioxidants such as lutein and zeaxanthin, which help prevent macular degeneration.

Myth: Statins are the only cholesterol-lowering medication on the market

Truth: While statins are still the most popular, a new class of drugs called PCSK9 inhibitors show promise for sharply reducing levels of LDL ("bad") cholesterol. A 2014 study published in the Lancet found that the drugs, which are currently undergoing clinical trials, reduced levels of LDL cholesterol up to 60 percent more than placebo medications. If proven safe, the drugs would be a welcome alternative for patients who can't tolerate the side effects from traditional statins.

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Jodi Helmer is a contributing writer who covers gardening, health and the environment. She has also written for Scientific American, National Geographic Traveler and NPR.