CHOLESTEROL: WHY IT NEEDS A RETHINK

In last week’s column, cardiologist Dr Aseem Malhotra made a statement that will astonish many readers used to the conventional wisdom that cholesterol is an enemy to our health and we should take every means to lower it. ‘That is plain wrong,’ says Dr Malhotra, author of The Pioppi Diet. ‘Cholesterol is our friend.’ Here, he explains why.

Cholesterol, a fatty, wax-like substance, is present in every cell in your body and has many vital functions: ● Producing vitamin D, which we need for strong bones. ● Connecting brain cells; the links between the nerve cells in our brains are made almost entirely of cholesterol. ● Maintaining cell membranes, the coating that keeps our cells intact. ● Helping to produce bile acids, which enable the absorption of fat-soluble vitamins. ● Producing the sex hormones oestrogen, testosterone and progesterone. ● Aiding the immune system to fight infections.

The association between low-density lipoprotein (LDL), the so-called ‘bad’ cholesterol, and heart disease is weak. For those older than 60 (when people are more likely to suffer a heart attack), there is no link. In fact, the higher your LDL, the less likely you are to die from any cause. This does not apply with familial hypercholesterolaemia, a genetic condition that causes high cholesterol.

The large-scale US Framingham study, which monitored three generations, revealed little difference in cholesterol levels between the majority of those who did and did not develop heart disease. Further research found that of more than 130,000 patients hospitalised with a heart attack, 75 per cent had normal total cholesterol and LDL levels.

The most important risk factor was metabolic syndrome, which leads to inflammation, the root cause of heart disease. Metabolic syndrome, which is linked to high consumption of sugar and other carbohydrates, is diagnosed when a patient has three or more of these conditions: ● Type 2 diabetes or a pre-diabetic state known as impaired glucose tolerance. ● Raised blood pressure (higher than 140/90mmHg). ● Low levels of high-density lipoprotein (HDL), so-called ‘good’ cholesterol. ● High triglyceride levels (the third fat measured in total cholesterol, along with HDL and LDL). ● Increased waist measurement (more than 90cm for men and 84cm for women).

Taking statins does not prolong life in people who have not had a heart attack. Neither does reducing saturated fat (found in meat, cream, butter, cheese and some plant oils). In one study, patients with heart disease who replaced saturated fats with vegetable oils high in omega-6 fats significantly reduced their LDL cholesterol but had increased rates of heart attacks and death.

You can reduce your risk of coronary artery disease most effectively by stopping smoking, following a Mediterranean diet, reducing stress and taking moderate exercise. ■ The Pioppi Diet: A 21-Day Lifestyle Plan by Dr Aseem Malhotra and Donal O’Neill is published by Penguin, price €11.99