As I explained in July 2004 (What’s Your Cholesterol Number? Should you care?), atherosclerotic diseases can be prevented far more effectively by taking antioxidant nutrients, avoiding tobacco smoke, and maintaining a normal homocysteine level than by taking cholesterol-lowering drugs. Nevertheless, many individuals who have been told the truth about heart disease continue to take the medications. I believe they do so to please their physicians and because they mistakenly believe that they are improving their health by doing so. Nothing could be further from the truth.

One of the most closely studied groups of people in the world lives in Framingham, Massachusetts, a western suburb of Boston. In 1948, 5209 of its citizens were recruited to take part in a long-term study to identify the characteristics that predispose to cardiovascular disease. Study participants, who were between the ages of 30 and 62 when first enrolled, agreed to return for a comprehensive examination every two years. The study is ongoing, and is entering its third generation of participants. A great deal of data regarding the emergence of disease has been gathered over the past half-century.

The Framingham study has shown that while high cholesterol levels are associated with an increased risk of heart disease prior to the age of sixty, the correlation progressively weakens as people age. Once a person has reached the age of fifty, the risk of premature death from non-cardiac causes progressively increases as cholesterol levels decrease.

Researchers at Columbia University reported in February, 2005, that people over the age of 65 with the lowest cholesterol levels are twice as likely to die each year than those with the highest cholesterol levels. Their findings revealed that women generally have higher cholesterol levels than men. This apparently has a great deal to do with their increased longevity, as women whose cholesterol levels were similar to those of men did not outlive the men in the study.

This even holds true in heart disease, for which cholesterol-lowering is promoted as life-saving. A study published in the prestigious Journal of the American Medical Association in 1990 found that people over the age of 70 with low cholesterol levels were twice as likely to die of a heart attack than their peers with high cholesterol levels. This information has been ignored, as I consistently see people who, in their 70s and beyond, have been told that they must aggressively lower their cholesterol with prescription drugs.

The conclusion that lower cholesterol levels carry an increased risk of premature death was borne out by the Bezafibrate Infarction Prevention (BIP) study. The study looked at nearly 11,000 individuals and found that those with initial cholesterol readings of 160 mg/dL or less were more than twice as likely to die of non-cardiac diseases than those with levels above 160 mg/dL. Ironically, the risk of dying of a heart attack was the same in both groups.

To fully appreciate the dangers of aggressively working to lower cholesterol levels it is important to understand where cholesterol comes from and what roles it plays in the body. If cholesterol is an undesirable, dangerous substance that builds up when an individual eats the wrong foods, eliminating it from the body has merit. If, on the other hand, cholesterol is essential for optimum health, it would be foolhardy and potentially disastrous to limit its availability.

Most people who consult with me are under the impression that diet plays a major role in determining cholesterol levels. This is simply not the case. While some cholesterol may be obtained from food, nearly all circulating cholesterol is manufactured by the body itself. Most is manufactured by the liver, which produces approximately 1000 mg. each day. The remainder is manufactured by the cells lining the small intestine and various individual cells throughout the body.

Anyone who subscribes to the “cholesterol is harmful” hypothesis should be prepared to answer the question, “If cholesterol is so bad, why is the body designed to manufacture so much of it at so many different sites?” Not surprisingly, “cholesterol is harmful” advocates are silent in this regard.

The answer, of course, is that the body is designed to manufacture cholesterol at multiple sites because it needs so much of it for many different reasons. Cholesterol is required to build cell membranes, to produce hormones, to manufacture fat-digesting bile, to make vitamin D, and to process fat soluble vitamins. It is also needed to maintain the myelin sheaths that insulate and protect nerves throughout the body. It is particularly important in preserving brain function.

Studies have shown that when cholesterol levels are lowered in an attempt to reduce the incidence of coronary artery disease, the number of suicides and deaths from violence increase. This is not surprising, given what is now known about the flow of signals in the brain and how they are affected by the cholesterol content of cell membranes.

Serotonin is a chemical that is needed for smooth transmission of nerve impulses. The point at which nerves meet is called a synapse. Cell membranes at each synapse contain receptors to capture serotonin. When a nerve cell receives serotonin an impulse is triggered to carry a message to the next nerve cell. It is by this mechanism that messages are transmitted throughout the brain. Serotonin plays a critical role in preventing depression, suppressing impulsive behavior, and in the ability to reason clearly.

Cholesterol moves freely between the bloodstream and cell membranes. As blood cholesterol levels fall, cell membrane cholesterol levels fall as well. Serotonin receptors are cholesterol-dependent. As membrane cholesterol levels fall the number of serotonin receptors decreases. As cholesterol levels rise, the number of serotonin receptors increase.

Low membrane cholesterol levels at nerve synapses are directly related to a decline in the ability of the nerve to receive and transmit messages. This is consistent not only with an increase in depression and hostile behavior, but with decreased memory and mental sharpness, symptoms that are being reported with increasing frequency by people taking cholesterol-lowering medications.

The relationship between low or falling cholesterol levels and premature death from non-cardiac causes is also well-documented. For a time it was argued that the drop in cholesterol level was the natural consequence of disease processes, but it is now clear that the low level of cholesterol precedes disease development.

Cancer is an example of a disease that occurs with greater frequency when cholesterol levels are low. This is particularly true in men. One of the first studies to document the link between low cholesterol and cancer was the report of the University of Oklahoma Lipid Research Clinics Program. The program followed 2,753 men and 2,476 women between the ages of 40 and 79 for an average of 8.4 years. Men whose baseline cholesterol readings were 187 mg/dL or less were found to be over five times more likely to die from colon cancer than those whose levels were above 187 mg/dL and nearly five times more likely to die from colon cancer if their baseline LDL (the so-called “bad”) cholesterol levels were less than 120 mg/dL. The low cholesterol group was also found to be more likely to die from smoking-related cancers.

Subsequent studies have found that tumors most likely to be associated with low cholesterol levels are colon and lung cancer in men, cervical and breast cancer in women, and leukemia in both men and women. Low cholesterol levels appear to increase the risk of cancer in men by 30 percent and by 10 percent in women.

Because some areas of China are populated by people who have simultaneously low cholesterol levels and low cancer rates, some question the significance of low cholesterol in cancer development. Differences in lifestyle between Chinese in these areas and people in other areas of China and in the United States can easily explain this apparent discrepancy, however. The areas in question are characterized by a vegan diet that is known to carry the lowest risk for cancer of any dietary regimen. Because the areas are rural and have farm-based economies, the people tend to spend much more time outdoors than people in Chinese cities and most people in the United States. As cholesterol levels decline, the efficiency of vitamin D (the sunshine vitamin) production diminishes. Vitamin D deficiencies have been shown to be a significant risk factor for colon cancer, the most common tumor associated with low cholesterol levels. The greater sun exposure of these groups may allow them to compensate and maintain vitamin D levels at a higher level than other population groups.

It is also quite possible that the increased cancer risk associated with low cholesterol levels has nothing to do with cholesterol itself. A very important chemical, coenzyme Q-10, is manufactured along the same pathway as cholesterol. If low levels of cholesterol are due to a manufacturing defect it is quite likely that coenzyme Q-10 levels will be correspondingly low.

Coenzyme Q-10 deficiencies are known to predispose to cancer of the breast in women and prostate cancer in men. They almost certainly play a role in the development of other tumors as well.

It is therefore not surprising that the Cholesterol and Recurring Events (CARE) study, which demonstrated a reduction in death from heart disease in high risk women who had already experienced at least one heart attack, revealed a significant rise in the incidence of breast cancer in women on the drug. The heart disease benefit was trumpeted and the benefits to women with existing coronary artery disease were used to promote the prescribing of cholesterol-lowering drugs to women in general, most of which are at low risk for heart disease. The breast cancer findings were quietly swept under the carpet and are unknown to all but a handful of physicians who read the complete study rather than relying on the investigator’s summary, which neglected to mention the increased breast cancer incidence.

Low levels of coenzyme Q-10 are also a major cause of a condition called congestive heart failure. Muscles must have an adequate supply of Coenzyme Q-10 if they are to function effectively. This is particularly true of cardiac (heart) muscle.

Congestive heart failure is characterized by an inefficient or ineffective pumping of the heart muscle. Coenzyme Q-10 supplementation has been shown to bring about dramatic improvements in the condition. Given the importance of coenzyme Q-10 in supporting the ability of the heart muscle to beat effectively and the decline in coenzyme Q-10 levels when the enzyme responsible for its production is blocked by cholesterol-lowering medications it should come as no surprise that congestive heart failure the most rapidly growing type of heart disease in the United States today.

Cholesterol is the source of all steroid hormones in the body. These include such substances as cortisol, testosterone, estrogen, and progesterone. As cholesterol levels fall, the body’s ability to manufacture these critical substances is compromised.

I am quite certain that the demand for drugs like Viagra and Levitra is driven to a great extent by the use of cholesterol-lowering agents. I see men who come to me with erectile dysfunction or loss of libido consistently regain normal sexual function simply by discontinuing their cholesterol-lowering medication. My observations are supported by studies in France and Spain in which 85 percent of men experiencing sexual difficulties resumed normal sexual function when their cholesterol-lowering medication was discontinued. The rise in demand for “Female Viagra” products suggests that many women are experiencing a similar decline in sex drive and responsiveness as they are placed cholesterol-lowering drugs.

Strong evidence also exists that cholesterol protects the body from invading organisms. In 1992, epidemiologists at the University of Minnesota reviewed 19 studies involving 68,000 patients and found that those with low cholesterol levels were more likely to die from gastrointestinal and respiratory diseases than those with high cholesterol levels.

Since infections are responsible for most gastrointestinal and respiratory deaths, the study raised the possibility that cholesterol protects against infection. To answer the question, the same researchers, collaborated with others from Kaiser Permanente in Oakland, California. The study was large, involving 55,300 men and 65,271 women. The results confirmed that as cholesterol levels rise the incidence of infectious disease falls. For each 39 point rise in cholesterol the risk of infection fell by 8 percent.

The experience with HIV and AIDS is even more striking. The University of Minnesota researchers found that young, unmarried men with the lowest cholesterol levels were twice as likely to test positive for HIV in the future than those with the highest cholesterol levels.

A study that is known as the MRFIT study looked at the cholesterol levels of over 300,000 men. Among the MRFIT study’s many findings was that the number of men whose initial cholesterol level was below 160mg/dL subsequently died of AIDS at a rate four times that of their peers whose initial cholesterol reading was over 240 mg/dL.

The relationship between cholesterol and infectious disease is further supported by the experience of individuals who, due to a genetic defect, have either very high or very low cholesterol. A group of people with a condition known as familial hypercholesterolemia are born with extremely high cholesterol levels. As a group they experience infections less often than the rest of the population.

On the other end of the cholesterol spectrum are individuals born with an inability to manufacture cholesterol normally. Known as Smith-Lemli-Opitz Syndrome, the disease is characterized by severe deformities of the central nervous system that usually result in being stillborn or dying early in life. Children with the condition typically suffer from frequent and often severe infections. If they are given cholesterol supplementation, their infections decrease in severity and frequency.

Laboratory studies using toxic substances produced by bacteria have demonstrated that when LDL cholesterol (the so-called “bad” cholesterol) is present the toxic effect is reduced by up to 90 percent. The protective benefit cannot be demonstrated when the toxin is exposed to HDL cholesterol (the so-called “good” cholesterol).

The benefits of LDL cholesterol in protecting the body against infections appear to go beyond the ability of the substance to neutralize bacterial toxins. A University of Pittsburg study found that men with cholesterol levels below 160 mg/dL had significantly lower numbers of various white blood cells than men with cholesterol levels above 160 mg/dL. Since white blood cells play a critical role in protecting the body from infections the discovery that low cholesterol levels are associated with higher infection rates should not be surprising.

When one considers the role cholesterol plays in building cell membranes, producing hormones, manufacturing vitamin D, processing fat soluble vitamins, maintaining the health of nerve cells, preserving brain function, and supporting the body’s immune system the wisdom of blocking the body’s ability to produce it needs to be questioned. When body’s need for cholesterol, including LDL cholesterol, is understood, the finding that people over the age of 65 are twice as likely to die prematurely if their cholesterol levels are low should is no longer puzzling. Yet, the pressure upon individuals of both sexes and of all ages to aggressively lower their cholesterol level continues unabated.

The “cholesterol is harmful” hypothesis is wrong. There is no justification for lowering cholesterol under any but the most extreme circumstances. The argument that cholesterol levels must be lowered to prevent heart disease is false. Atherosclerosis, with its complications of heart attacks, strokes, and peripheral vascular disease can be prevented far more effectively by preventing oxidation of LDL cholesterol and by maintaining the integrity of arterial linings.

There are, in the final analysis, only two reasons for people who did not inherit familial hypercholesterolemia to lower their cholesterol levels. The first is to keep their physicians happy and the second is to support the pharmaceutical industry. Whether those reasons justify accepting an increased risk of premature death, senility, loss of sexual function, cancer or serious infection is an individual decision. Sadly, the vast majority of Americans choose to accept the consequences of lowering their cholesterol rather than taking the risk of offending their personal physicians who have been schooled in the “cholesterol is harmful” belief system.