Here is What You Really Need to Know About Cholesterol!

Interviewer: Doctor, how did we get to this point? How did cholesterol become the bad guy and why is it still, so many years later, considered the bad guy?

Jonny Bowden, PhD, CNS: That's a long story filled with political intrigue. I'd be happy to answer it. We spend about a chapter of it in the book tracing the origins of this. You guys, the interviewers, are not old enough to remember this probably, but some time ago when we first had home taping, there were two competing technologies; there was VHS and Betamax. Maybe some people do remember this. I'm dating myself.

Interviewer: I do.

Dr. Bowden: Okay, good. So we had VHS and we had Betamax. If you talked to any recording engineer in the world, they will tell you Betamax was the superior technology and it's still used in recording studios today.

Interviewer: Mm-hmm.

Dr. Bowden: But VHS won the war. And it won the war because it had a better ground game. They signed up more manufacturers, they signed up more movie studios to agree to put their stuff on VHS, and they won the game. They won it fair and square. But the wrong technology won.  Well, back in the 70s, we had two competing theories about heart disease.  One was that it was cholesterol and fat. One was that it was sugar that was the main culprit in the diet. The wrong theory won.

The guys who believed in the fat and cholesterol thing were very persuasive. There was a lot of pressure to come up with some government recommendations at the time. There was a perceived epidemic of heart disease. There was a lot of outcry, "What are we going to do about it?" "Well, it looks like . . ." And the research on which this was based has since been looked at, and found to be very... I don't think that research could be published today. But it was published then. It's been re-evaluated and found very wanting.

Interviewer: Mm-hmm.

Dr. Bowden: But the behemoth was started. And trying to turn that around, it's like trying to turn the Queen Mary around. I mean, you've got $31 billion a year in sales of just the two top cholesterol-lowering medications, Lipitor and Zocor. $31 billion according to Forbes.  You can't just turn that around. You've got a cultural meme. You talk to anyone at any cocktail party in America and say, "How's your heart doing?"  They're going to tell you what their cholesterol is. because it has become synonymous with heart disease.

Interviewer: Mm-hmm.

Dr. Bowden: There is a cholesterol story involved in heart disease. But most of us don't know it. And we talked about this in great length on the Dr. Oz show. We used to measure cholesterol. If you went to a health fair in the 1960s, they prick your blood and say, "Oh, Mr. Jones, you've got 220, 240, 190."  You got one number. Early 60s, they kind of realized that cholesterol travels in the body in two different kinds of packages; HDL and LDL. Well, that was a big improvement. They started measuring HDL and LDL. HDL became known as the good cholesterol and LDL became known as the bad cholesterol.  Big improvement over a single number.

Interviewer: Mm-hmm.

Dr. Bowden: That's 20 years out of date. We now know that there's five kinds of HDL, at least, and about five kinds of LDL. And there is a test to measure what kind you have. But it hasn't caught on quite yet. But it's the only test that gives you any valuable information about cholesterol.

See, all LDL is not bad. Some of it is fairly benign. If you look under a microscope, you'll see two major types; LDL-A and LDL-B we'll call them.  LDL-A looks like a big, fluffy cotton ball. It doesn't even stick to anything, it's fairly innocuous. LDL-B is a bad player. That's a little, nasty, BB gun pellet-like, inflamed, little nasty bugger that does get caught in pockets of inflammation.

Interviewer: Okay.

Dr. Bowden: If you don't know whether you have LDL-A, or pattern A, which is mostly the big fluffy balls; or mostly pattern B, mostly the nasty little ones, you're treating a number, not a patient. You're throwing a dart at a dartboard with a blindfold on.  LDL total means nothing. You need to know the number of particles and the size of the particles. That's done by a particle test. Many companies make particle tests. You can Google "particle test for LDL," a million things will come up. It's the only test that matters. So not only are we treating an innocuous molecule, we don't even know what we're treating. Knowing your LDL-B is very helpful to know. But just knowing your overall LDL or HDL/LDL? Out of date information.