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.
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 non-fasting 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.”