The Cholesterol Story: Are You Fighting Heart Disease? - Part 1

The Cholesterol Story: Are You Fighting Heart Disease? - Part 1

Why High Cholesterol?

Believe it or not, cholesterol is your body’s soap! Your body runs on water, you are about 70% water, and when you eat fat or oil, it takes lots of soap for those dietary fats (saturated fats, trans fats, refined fats, high fat diet) to become soluble in the water environment of your body.1 If you are accustomed to washing dishes at home by hand, I am sure you find some fats harder to “wash” off your plates than others. Just realize that the fats that are the hardest to wash off your dishes are also the fats that will take the most cholesterol “soap” to dissolve in your body. Cholesterol dissolves the fats or oils you eat into the water environment of your blood. Hard fats, like animal shortening, hydrogenated vegetable oils and oils that have been browned by heating, are more difficult for the body to dissolve. These fats cause the liver to make more cholesterol “soap”. This ultimately results in increased blood stream cholesterol.234 The more fat of any kind you eat, the more cholesterol it will take for your body to process it. For each additional 1% fat you include in your diet, your total cholesterol will go up 11⁄2 points.5

Enterohepatic Circulation: The Liver Soap Cycle

The source of cholesterol “soap” is the liver, and the soap bottle or reservoir is the gallbladder. The cholesterol soap mixture is called bile. This bile is squirted into the small intestine when the need for soap is detected, i.e. fat in the digestive tract. This “soap” then tries to make the fat compatible with absorption into your water-based blood stream. The cholesterol component of the “soap” is re- absorbed in the small intestine and returned to the liver for processing. There are several things that can reduce “soap”/cholesterol in the system. Eat less fat, so less “soap” is called for. Eat more fiber, which will soak up some of the “soap” and carry it out in your stools so less “soap” is reabsorbed and returned to the blood stream and liver.

Eat more plants that are high in sterols.

These plant sterols compete with “soap” for re-absorption, thus reducing “soap” re-absorption.

Cholesterol In Many Forms

Cholesterol is cholesterol, but its packaging tells you its role. LDL or low density lipoprotein is the packaging marked for export form the liver to the tissues. HDL or high density lipoprotein is the clean up crew that takes cholesterol from the tissues back to the liver. LDL trucks it out into circulation and HDL retrieves it, removing it from the blood and tissues. As you might imagine low HDL is predictive of mortality form heart disease—without sufficient clean up crews working, junk piles up.6

Recently there has been discussion about the size of LDL and the impact of that size on health. Larger LDL particle size is associated with greater longevity.7 Smaller, denser, LDL particles have been shown to be associated with an increased risk of cardiovascular events.8 While all this size discussion makes for more laboratory testing, positive lifestyle approaches to heart disease risk factors can improve LDL particle size, which will reduce heart attack risks.9101112

The Fats We Eat

Trans-fat, a byproduct of hydrogenation of vegetable oils,13 increases the risk of high cholesterol by 65%.14 In one study, heart attack victims had 13% more trans fat in their cell walls.15 Trans fat lowers the “good” HDL-cholesterol more than saturated fat and decreases anti-oxidant activity in the body. This makes patients more susceptible to atherosclerosis and heart attacks. Additionally, trans fat increases the harmful LDL cholesterol.16 You may not be aware of where the trans fat in your diet is coming from. Sources of trans fat in the American diet by percentage include: cakes, cookies, crackers, pies, bread 40%; animal products 21%; margarine 17%; fried potatoes (like French fries and hash browns) 8%; Potato chips, corn chips, popcorn 5%; household shortening 4%; other (breakfast cereals, candy, etc.) 5%.17 Avoiding trans fat may take some investigation on your part.

The saturated fat found in milk, cheese, egg yolks, meat and sausage has an even more deleterious effect on cholesterol and coronary heart disease than trans fat.18 High saturated fat diet can raise total cholesterol by 23%.19 When cholesterol is a part of the diet, the total blood cholesterol will be worse if the other fats in the diet are saturated than if they are unsaturated.20 For example, because of its high fat and cholesterol content, 40gm of butter per day will raise
your cholesterol by 20 points.21 Palm oils differ little from other saturated fats in raising blood stream cholesterol.2223

Compared to the harder fats, monounsaturated oils tend to lower cholesterol.24 Polyunsaturated fats tend to favorably affect cholesterol, but be less resistant to oxidation.25

Another factor, which is often overlooked, is the form of the fat or oil consumed. Refined oils absorbed early in the small intestine are esterified with cholesterol and enter the lymphatics to be deposited in the heart.

Oils residing naturally in whole foods are digested and absorbed later in the small intestine as phospholipids and enter the portal circulation where they are conducted directly to the liver. Thus they have less of an impact on total blood cholesterol.26

Animal Product Consumption And Cholesterol

People who consume animal products every day experience higher cholesterols, and have on average, a total cholesterol of 255 mg/dL. Those who limit their consumption of animal products to once weekly have a total cholesterol of around 205 mg/dL.27 Compared to vegetarians, animal product users (meat, eggs and dairy) eat 50% more fat, have: 30% higher total cholesterols, have 42% higher LDL cholesterols, have 38% higher triglycerides, have 32% higher blood sugars, and are five times more likely to have high blood pressure.28 People who drink cow’s milk or eat dairy products such as yoghurt and cheese everyday have 7 mg/dL higher total cholesterols and 5 mg/dL higher LDL cholesterols.29 A diet with animal protein and low fiber intake has been shown to significantly increase cholesterol levels.30 Casein, the protein in milk, makes your liver produce more cholesterol.3132 People on a unrefined, high fiber, high carbohydrate diet have significantly lower LDL cholesterols than those on a refined carbohydrate diet or a low carbohydrate, high protein diet.33 On the other hand, substituting 30 to 50 grams of soy protein for animal protein in the daily diet produces a 13% reduction in LDL, 10% reduction in triglycerides, 9% reduction in cholesterol, and a 2.4% increase in HDL.34 This nutritional advice has also been shown to be helpful in cases considered to have a “genetic” predisposition to high cholesterol.35

Refined Foods For Refined People?

Refined (processed) foods tend to make your blood sugar rise precipitously—making it go very high at a very rapid a rate. We categorize foods by their effect on the blood sugar according to the “glycemic index”.36 Glycemic load quantifies the amount of a high glycemic food you eat. High glycemic index or load foods make your blood sugar rise higher and faster then low glycemic index or load foods. Most refined foods are high glycemic load foods. High glycemic load diets drive LDL cholesterol up and HDL down.3738 On the other hand, reducing the glycemic load, by eating more whole plant foods, has the affect to reduce LDL levels.39 We recommend a high complex carbohydrate diet, a diet without refined/processed foods.

Disease and Elevated Cholesterol

The more cholesterol, (the higher your average cholesterol), you harbor in your blood stream, the higher will be your risk of dying of a heart attack.40414243 In fact, one high blood cholesterol measurement in your lifetime can mean a higher risk of coronary heart disease the rest of your life!44 The more cholesterol you carry in your blood the sicker your heart becomes.45 When your cholesterol goes up cells lining the blood vessels, called macrophages, fill up with fat and contribute to plaque formation.46 When you lower the fat (cholesterol and triglycerides) in your blood it virtually halts the progression of lesions in your blood vessels.47 People with genetically low LDL live 5-12 years longer and almost never have heart attacks.4849 The more fat and cholesterol you tolerated in you blood stream the shorter your life will be.5051 Here are some numbers that illustrate increase in risk: Cholesterol above 280 mg/dL increases likelihood of angina 5 1⁄2 times.52

Cholesterol above 240 mg/dL increases the risk of death from heart attack by 350%.53 On the positive side, each 2 mg/dl drop in cholesterol reduces the risk of heart attack by 1%.54 One of the reasons for this rise in heart disease and fatal heart attacks with increased blood cholesterol, besides the obvious increase in atherosclerosis, is that when your cholesterol goes up it impairs the heart’s ability to form collateral blood vessels which could help you survive a heart attack.55

Triglycerides also play a role. Elevated triglycerides are associated with increased risk of heart attack and death.5657 Triglycerides greater than 200 mg/dL significantly increase the risk of stroke or transient ischemic attack.5859

Caldwell Esselstyn, Jr., MD, of the Cleveland Clinic has shown on angiography that blockages in coronary arteries can be reversed by changes in diet. “The optimal diet”, according to him, “consists of grains, legumes, vegetables, and fruit, with less than 10%-15% of its calories coming from fat.” He goes on to say that, “This diet minimizes the likelihood of stroke, obesity, hypertension, type 2 diabetes, and cancers of the breast, prostate, colon, rectum, uterus, and ovary.”60 Did

Medicare ever promise anything like that? This sounds like a real insurance program!

What about cancer and cholesterol? Elevated cholesterol and triglycerides significantly increase breast cancer risk.61 The risk of breast cancer rises 88% when one eats foods with cholesterol, 125% for high intake of animal protein, 143% for high saturated fat intake, and 169% if you eat more calories than you need!62 Pancreatic cancer is the fourth leading cause of cancer death with a five-year relative survival rate of less than 4%, making it one of the most fatal cancers.

Eating cholesterol increases the risk of pancreatic cancer 50%. Eggs, a rich source of cholesterol, increase the risk by 60%.63

Other disease risks escalate with cholesterol. Elevated cholesterol and triglycerides together with low HDL significantly increase the risk of autoimmune inflammatory arthritis like rheumatoid arthritis.64 High cholesterol is a significant risk factor for macular degeneration and resultant blindness.65666768 A cholesterol of 240 mg/dL increases the risk of macular degeneration by 80%.69 A cholesterol level of 220 mg/dL or more increases the risk of migraine by 280%.70 Having elevated cholesterol levels increases the risk of high blood pressure 90%.71 Even hypothyroidism can result from elevated cholesterol levels.7273

The brain and nerves are not happy when cholesterol increases. Hypertension and hypercholesterolemia work together to increase brain dysfunction.74 When rabbits, confirmed herbivores, consume cholesterol, they develop Alzheimer’s disease-like lesions in their brains.75 Patients with elevated LDL Cholesterol have a 106% higher risk of cognitive impairment.76 Obesity and high triglycerides produce cognitive impairment.77 Elevated triglycerides predict increased peripheral neuropathy in diabetics.78 Elevated cholesterol levels are significantly associated with major depression.7980 Lowering cholesterol levels through lifestyle changes, has been shown to decrease depression, hostility, and severity of psychological symptoms.81

Dietary Cholesterol: The Cholesterol Entering Our Mouths

When you eat cholesterol, eventually some of it will end up in you blood stream. It has been said, “we are what we eat.” However, cholesterol is the soap, so, while eating cholesterol does not raise the soap level dramatically like eating fats does, dietary cholesterol still results in increased blood stream cholesterol.82 Eating 100 mg of cholesterol per day can increase total cholesterol concentrations by 2.2 mg/dL.83 Most people eat far more than 100 mg of cholesterol per day.

What foods have cholesterol? Nearly all animal foods have some cholesterol in them, some have more than others. Plant based foods do not have cholesterol. This is because it takes a liver to produce cholesterol and plants do not have livers!

Fruits and vegetables, nuts and seeds, beans and grains do not contain cholesterol. One cup of 2% Milk has 18 mg of cholesterol. One half cup of ice cream has 29 mg, most of which is oxidized. One tablespoon of butter would have 31 mg, and 3 ounces of clams 57 mg. In a three ounce serving, chicken breast has 73 mg, pork 76 mg, sirloin beef 80 mg, oyster 84 mg, shrimp 165 mg, one large egg 213 mg, beef liver 410 mg, and beef brains, which often end up as animal shortening, 1697 mg.84 Your body does not need a dietary source of cholesterol, it makes its own, fresh.

Cholesterol levels are not lowered when you replace beef, lamb, or pork in the diet with chicken or fish. Why? Because poultry’s proportion of cholesterol is similar to that of red meat even though it contains less fat.85

Dietary Cholesterol and Disease

Dietary cholesterol together with elevated blood cholesterol dramatically increase oxidized cholesterol. Oxidized cholesterol results in increased whole body inflammation, atherosclerosis and plaque formation.8687 The more cholesterol you eat, the more calcified plaque you can expect in your coronary arteries.88 When you make cholesterol a part of your diet, it increases inflammation in: the lungs leading to asthma;8990 the liver leading to non-alcoholic fatty liver diseases and cirrhosis;919293 and the prostate leading to pain, enlargement and cancer.9495 Cholesterol in the diet can bring about permanent microscopic damage to the kidneys causing them to loose 6 times more protein in the urine than acceptable levels.969798 “But I was eating the extra animal products to increase my protein intake….” When you stop eating cholesterol, blood vessel inflammation actually does subsided and coronary artery plaques become more resistant to rupture.99

Need osteoporosis? A high-cholesterol diet stimulates bone resorption causing osteoporosis.100

Dietary cholesterol seriously decreases mental performance.101102 Six hours after consuming a high fat meal the brain oxygen falls below 70%. What’s more, it does not return to normal for 3 whole days— which means some people have never had fully functioning brains!103

Oxidized Cholesterol In The Blood

“Why me?” a gentleman in his late 50s asked me. My total cholesterol has always been around 140 and my HDL is usually very good. He had had a heart attack and cardiac bypass surgery and was now wondering what he could do to avoid a repeat. As I got to know the gentleman better it became very apparent that the source of his cholesterol included foods high in oxidized cholesterol such as ice cream, pizza, and processed foods, while his diet was not high in fruit and vegetables.

For the same cholesterol level, people who eat fewer fruits and vegetables have a higher risk of a fatal heart attack.104 This is because of the effects of oxidized cholesterol. Oxidized cholesterol can be stabilized by the anti-oxidants found in fresh fruits and vegetables.

My uncle died of heart disease at age 39. He was an anesthesiologist at the University of Texas. He left a wife and two teenage sons behind. His nightly supper: ice cream. Within 24 hours of eating oxidized cholesterol, rabbits and monkeys develop vascular lesions which, if not repaired, would lead to arthrosclerosis and heart attacks.105106107108 Common sources of oxidized cholesterol include custard mixes such as ice cream, pancake mixes, because dried eggs are included,109 Parmesan cheese, and any food where cholesterol, or oils for that matter, come in contact with air and/or oxygen.84110 Serum oxidized cholesterol markedly accelerates atherosclerosis.111112113 Arterial injury caused by oxidized cholesterol leads to arterial wall cholesterol accumulation and plaque enlargement.114

Cholesterol oxidized by the body is negligible compared to oxidized cholesterol obtained from the diet.115116 Oxidized dietary cholesterol increases blood stream cholesterol and is the predominant source of tissue oxidized cholesterol.117125

Oxidized cholesterol favors platelet clot and plaque formation.118119 The more LDL is oxidized, the more cholesterol it transports to the tissues. The more HDL is oxidized, the less cholesterol it removes from the tissues.120121 Oxidized cholesterol markedly delays the clearance of chylomicrons, which transport cholesterol from the intestine to the liver, from the blood.122 The more fast foods; cheese puffs, potato chips and hydrogenated fat you eat, the worse your cholesterol will be, both in oxidation and in quantity.123 Cheese contains high levels of oxidized cholesterol.124125 Compared to vegetable oils, butter and cheese are very atherogenic—causing heart disease.126 Frying, grilling, even just cooking foods with high cholesterol content, such as meat, egg yolk and full fat dairy products, creates massive cholesterol oxidation.127128 As prepared consumer foods are becoming increasingly popular, the consumption of higher levels of oxidized cholesterol in foods is inevitable. Processes, such as pre-cooking, freeze-drying, dehydration and irradiation, have all result in increased production of oxidized cholesterol. Factors known to oxidize cholesterol in foods include: heat, light, radiation, oxygen, moisture, low ph, pro-oxidizing agents, and storage of food at room temperature.129 Cigarette smoke increases LDL cholesterol oxidation and lipid per oxidation.130

Continued in The Cholesterol Story: Are You Fighting Heart Disease? – Part 2


1 Glatz JF, Katan MB. Dietary saturated fatty acids increase cholesterol synthesis and fecal steroid excretion in healthy men and women. Eur J Clin Invest. 1993 Oct;23(10):648-55.

2 Bu SY, Mashek DG. Trans fats: foods, facts, and biology. Minn Med. 2008 Oct;91(10):41-4.

3 Varghese S, Oommen OV. Long-term feeding of dietary oils alters lipid metabolism, lipid peroxidation, and antioxidant enzyme activities in a teleost (Anabas testudineus Bloch). Lipids. 2000 Jul;35(7):757-62.

4 Bertolotti M, Spady DK, Dietschy JM. Regulation of hepatic cholesterol metabolism in the rat in vivo: effect of a synthetic fat-free diet on sterol synthesis and low-density lipoprotein transport. Biochim Biophys Acta. 1995 Apr 6;1255(3):293-300.

5 Hata Y, Nakajima K. Life-style and serum lipids and lipoproteins. J Atheroscler Thromb. 2000;7(4):177-97.

6 Corti MC, Guralnik JM, Salive ME, Harris T, Field TS, Wallace RB, Berkman LF, Seeman TE, Glynn RJ, Hennekens CH, et al. HDL cholesterol predicts coronary heart disease mortality in older persons. JAMA. 1995 Aug 16;274(7):539-44.

7 Heijmans BT, Beekman M, Houwing-Duistermaat JJ, Cobain MR, Powell J, Blauw GJ, van der Ouderaa F, Westendorp RG, Slagboom PE. Lipoprotein particle profiles mark familial and sporadic human longevity. PLoS Med. 2006 Dec;3(12):e495.

8 Halle M, Berg A, Baumstark MW, Keul J. LDL subfractions and coronary heart disease—an overview. Z Kardiol. 1998 May;87(5):317- 30.

9 Decewicz DJ, Neatrour DM, Burke A, Haberkorn MJ, Patney HL, Vernalis MN, Ellsworth DL. Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy. Lipids Health Dis. 2009 Jun 29;8:26.

10 van Ee JH. Soy constituents: modes of action in low-density lipoprotein management. Nutr Rev. 2009 Apr;67(4):222-34.

11 Shimabukuro T, Sunagawa M, Ohta T. Low-density lipoprotein particle size and its regulatory factors in school children. J Clin Endocrinol Metab. 2004 Jun;89(6):2923-7.

12 Hartwich J, Malec MM, Partyka L, Pérez-Martinez P, Marin C, López-Miranda J, Tierney AC, Mc Monagle J, Roche HM, Defoort C, Wolkow P, Dembinska-Kieć A. The effect of the plasma n-3/n-6 polyunsaturated fatty acid ratio on the dietary LDL phenotype transformation – insights from the LIPGENE study. Clin Nutr. 2009 Oct;28(5):510-5.

13 Willett WC, Ascherio A. Trans fatty acids: are the effects only marginal? Am J Public Health. 1994 May;84(5):722-4.

14 Bevilacqua MR, Gimeno SG, Matsumura LK, Ferreira SR.Hyperlipidemias and dietary patterns: transversal study of Japanese Brazilians. Arq Bras Endocrinol Metabol. 2007 Jun;51(4):547-58.

15 Block RC, Harris WS, Reid KJ, Spertus JA. Omega-6 and trans fatty acids in blood cell membranes: a risk factor for acute coronary syndromes? Am Heart J. 2008 Dec;156(6):1117-23.

16 Mozaffarian D, Aro A, Willett WC. Health effects of trans-fatty acids: experimental and observational evidence. Eur J Clin Nutr. 2009 May;63 Suppl 2:S5-21.

17 Katcher HI, Hill AM, Lanford JL, Yoo JS, Kris-Etherton PM. Lifestyle approaches and dietary strategies to lower LDL-cholesterol and triglycerides and raise HDL-cholesterol. Endocrinol Metab Clin North Am. 2009 Mar;38(1):45-78.

18 Bassett CM, McCullough RS, Edel AL, Maddaford TG, Dibrov E, Blackwood DP, Austria JA, Pierce GN. Trans-fatty acids in the diet stimulate atherosclerosis. Metabolism. 2009 Dec;58(12):1802-8.

19 Tan MH, Dickinson MA, Albers JJ, Havel RJ, Cheung MC, Vigne JL. The effect of a high cholesterol and saturated fat diet on serum high-density lipoprotein-cholesterol, apoprotein A-I, and apoprotein E levels in normolipidemic humans. Am J Clin Nutr. 1980 Dec;33(12):2559-65.

20 Lichtenstein AH, Ausman LM, Carrasco W, Jenner JL, Ordovas JM, Schaefer EJ. Hypercholesterolemic effect of dietary cholesterol in diets enriched in polyunsaturated and saturated fat. Dietary cholesterol, fat saturation, and plasma lipids. Arterioscler Thromb. 1994 Jan;14(1):168-75.

21 Nestel PJ, Chronopulos A, Cehun M. Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2005 Sep;59(9):1059-63.

22 Grande F, Anderson JT, Keys A. Comparison of effects of palmitic and stearic acids in the diet on serum cholesterol in man. Am J Clin Nutr. 1970 Sep;23(9):1184-93.

23 Fisher EA, Blum CB, Zannis VI, Breslow JL. Independent effects of dietary saturated fat and cholesterol on plasma lipids, lipoproteins, and apolipoprotein E. J Lipid Res. 1983 Aug;24(8):1039-48.

24 Berglund L, Lefevre M, Ginsberg HN, Kris-Etherton PM, Elmer PJ, Stewart PW, Ershow A, Pearson TA, Dennis BH, Roheim PS, Ramakrishnan R, Reed R, Stewart K, Phillips KM; DELTA Investigators. Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr. 2007 Dec;86(6):1611-20.

25 Diniz YS, Cicogna AC, Padovani CR, Santana LS, Faine LA, Novelli EL. Diets rich in saturated and polyunsaturated fatty acids:metabolic shifting and cardiac health. Nutrition. 2004 Feb;20(2):230-4.

26 Crane, MG. Plugged Arteries & A clogged Immune System!!Teach Services, 1998.

27 Bodenmann A, Ackermann-Liebrich U, Keller U. Meat consumption and serum cholesterol concentration. Dtsch Med Wochenschr. 1991 Jul 12;116(28-29):1089-94.

28 Teixeira Rde C, Molina Mdel C, Zandonade E, Mill JG. Cardiovascular risk in vegetarians and omnivores: a comparative study. Arq Bras Cardiol. 2007 Oct;89(4):237-44.

29 Chi D, Nakano M, Yamamoto K. Milk and milk products consumption in relationship to serum lipid levels: a community-based study of middle-aged and older population in Japan. Cent Eur J Public Health. 2004 Jun;12(2):84-7.

30 Steenkamp HJ, Jooste PL, Rossouw JE, Benadé AJ, Swanepoel AS. Hypercholesterolaemia in a rural white population and its relationship with other coronary risk factors. S Afr Med J. 1990 Jul 21;78(2):85-8.

31 Kurowska EM, Carroll KK.Hypercholesterolemic responses in rabbits to selected groups of dietary essential amino acids. J Nutr. 1994 Mar;124(3):364-70.

32 Satoh T, Goto M, Igarashi K. Effects of protein isolates from radish and spinach leaves on serum lipids levels in rats. J Nutr Sci Vitaminol (Tokyo). 1993 Dec;39(6):627-33.

33 McMillan-Price J, Petocz P, Atkinson F, O’neill K, Samman S, Steinbeck K, Caterson I, Brand-Miller J. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial. Arch Intern Med. 2006 Jul 24;166(14):1466-75.

34 Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med. 1995 Aug 3;333(5):276-82.

35 Weghuber D, Widhalm K. Effect of 3-month treatment of children and adolescents with familial and polygenic hypercholesterolaemia with a soya-substituted diet. Br J Nutr. 2008 Feb;99(2):281-6.

36 Kendall CW, Augustin LS, Emam A, Josse AR, Saxena N, Jenkins DJ. The glycemic index: methodology and use. Nestle Nutr Workshop Ser Clin Perform Programme. 2006;11:43-53.

37 Levitan EB, Cook NR, Stampfer MJ, Ridker PM, Rexrode KM, Buring JE, Manson JE, Liu S. Dietary glycemic index, dietary glycemic load, blood lipids, and C-reactive protein. Metabolism. 2008 Mar;57(3):437-43.

38 Ma Y, Li Y, Chiriboga DE, Olendzki BC, Hebert JR, Li W, Leung K, Hafner AR, Ockene IS. Association between carbohydrate intake and serum lipids. J Am Coll Nutr. 2006 Apr;25(2):155-63.

39 Dickinson S, Brand-Miller J. Glycemic index, postprandial glycemia and cardiovascular disease. Curr Opin Lipidol. 2005 Feb;16(1):69-75.

40 Dietschy JM. Dietary fatty acids and the regulation of plasma low density lipoprotein cholesterol concentrations. J Nutr. 1998 Feb;128(2Suppl):444S-448S.

41 Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000 Jul 19;284(3):311-8.Click here to read Links

42 Lloyd-Jones DM, Wilson PW, Larson MG, Leip E, Beiser A, D’Agostino RB, Cleeman JI, Levy D. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med. 2003 Sep 8;163(16):1966-72.

43 Menotti A, Lanti M, Kromhout D, Blackburn H, Jacobs D, Nissinen A, Dontas A, Kafatos A, Nedeljkovic S, Adachi H. Homogeneity in the relationship of serum cholesterol to coronary deaths across different cultures: 40-year follow-up of the Seven Countries Study. Eur J Cardiovasc Prev Rehabil. 2008 Dec;15(6):719-25.Links

44 Menotti A, Lanti M, Kromhout D, Kafatos A, Nedeljkovic S, Nissinen A. Short and long term association of a single serum cholesterol measurement in middle-aged men in prediction of fatal coronary and other cardiovascular events: a cross-cultural comparison through Europe. Eur J Epidemiol. 2005;20(7):597-604.

45 Klag MJ, Ford DE, Mead LA, He J, Whelton PK, Liang KY, Levine DM. Serum cholesterol in young men and subsequent cardiovascular disease. N Engl J Med. 1993 Feb 4;328(5):313-8.

46 Lehr HA, Sagban TA, Kirkpatrick CJ. Atherosclerosis—progression by nonspecific activation of the immune system. Med Klin (Munich). 2002 Apr 15;97(4):229-35.

47 Brown BG, Zhao XQ, Sacco DE, Albers JJ. Lipid lowering and plaque regression. New insights into prevention of plaque disruption and clinical events in coronary disease. Circulation. 1993 Jun;87(6):1781-91.

48 Glueck CJ, Gartside P, Fallat RW, Sielski J, Steiner PM. Longevity syndromes: familial hypobeta and familial hyperalpha lipoproteinemia. J Lab Clin Med. 1976 Dec;88(6):941-57.

49 Chhatriwalla AK, Nicholls SJ, Wang TH, Wolski K, Sipahi I, Crowe T, Schoenhagen P, Kapadia S, Tuzcu EM, Nissen SE. Low levels of low-density lipoprotein cholesterol and blood pressure and progression of coronary atherosclerosis. J Am Coll Cardiol. 2009 Mar 31;53(13):1110-5.

50 Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA. 1987 Apr 24;257(16):2176-80.

51 Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000 Jul 19;284(3):311-8.

52 Rosengren A, Hagman M, Wedel H, Wilhelmsen L. Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris. A 16-year follow-up of the Primary Prevention Study in Göteborg, Sweden. Eur Heart J. 1997 May;18(5):754-61.

53 Pekkanen J, Linn S, Heiss G, Suchindran CM, Leon A, Rifkind BM, Tyroler HA. Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med. 1990 Jun 14;322(24):1700-7.

54 Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005 Oct 8;366(9493):1267-78.

55 van Weel V, de Vries M, Voshol PJ, Verloop RE, Eilers PH, van Hinsbergh VW, van Bockel JH, Quax PH. Hypercholesterolemia reduces collateral artery growth more dominantly than hyperglycemia or insulin resistance in mice. Arterioscler Thromb Vasc Biol. 2006 Jun;26(6):1383-90.

56 Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007 Jul 18;298(3):299-308.

57 Assmann G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol. 1996 Jun 1;77(14):1179-84.

58 Ogunrin OA, Unuigbe E. Serum lipids in patients with stroke—a cross-sectional case-control study. J Natl Med Assoc. 2008 Sep;100(9):986-90.

59 Tanne D, Koren-Morag N, Graff E, Goldbourt U. Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) Registry: high triglycerides constitute an independent risk factor. Circulation. 2001 Dec 11;104(24):2892-7.

60 Esselstyn CB Jr. Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Prev Cardiol. 2001 Autumn;4(4):171- 177.

61 Ray G, Husain SA. Role of lipids, lipoproteins and vitamins in women with breast cancer. Clin Biochem. 2001 Feb;34(1):71-6.

62 Alothaimeen A, Ezzat A, Mohamed G, Muammar T, Al-Madouj A. Dietary fat and breast cancer in Saudi Arabia: a case-control study. East Mediterr Health J. 2004 Nov;10(6):879-86.

63 Chan JM, Wang F, Holly EA. Pancreatic cancer, animal protein and dietary fat in a population-based study, San Francisco Bay Area, California. Cancer Causes Control. 2007 Dec;18(10):1153-67.

64 de Carvalho JF, Bonfá E, Bezerra MC, Pereira RM. High frequency of lipoprotein risk levels for cardiovascular disease in Takayasu arteritis. Clin Rheumatol. 2009 Jul;28(7):801-5.

65 Wierzbowska J, Figurska M, Stankiewicz A, Sierdziński J.Risk factors in age-related macular degeneration and glaucoma—own observations. Klin Oczna. 2008;110(10-12):370-4.

66 Król W, Smuzyńska M. The assessment of the lipidogram and the proteinogram profile in patients with nonexudative age-related macular degeneration. Wiad Lek. 2007;60(9-10):415-7.

67 Belda Sanchís JI, Quijada González A, Muñoz Ruiz G, Rodríguez-Galietero A, Romero Gómez FJ, Díaz-Llopis M.Are blood lipids a risk factor for age-related macular degeneration? Arch Soc Esp Oftalmol. 2001 Jan;76(1):13-7.

68 Hyman L, Schachat AP, He Q, Leske MC. Hypertension, cardiovascular disease, and age-related macular degeneration. Age-Related Macular Degeneration Risk Factors Study Group. Arch Ophthalmol. 2000 Mar;118(3):351-8.

fn69. Tomany SC, Wang JJ, Van Leeuwen R, Klein R, Mitchell P, Vingerling JR, Klein BE, Smith W, De Jong PT. Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology. 2004 Jul;111(7):1280-7.

70 Monastero R, Pipia C, Cefalù AB, Liveri ET, Rosano R, Camarda R, Camarda C. Association between plasma lipid levels and migraine in subjects aged > or =50 years: preliminary data from the Zabùt Aging Project. Neurol Sci. 2008 May;29 Suppl 1:S179-81.

71 Borghi C, Veronesi M, Cosentino E, Cicero AF, Kuria F, Dormi A, Ambrosioni E. Interaction between serum cholesterol levels and the renin-angiotensin system on the new onset of arterial hypertension in subjects with high-normal blood pressure. J Hypertens. 2007 Oct;25(10):2051-7.

72 Sasaki S, Kawai K, Honjo Y, Nakamura H.Thyroid hormones and lipid metabolism Nippon Rinsho. 2006 Dec;64(12):2323-9.

73 Duntas LH.Thyroid disease and lipids. Thyroid. 2002 Apr;12(4):287-93.

74 Goldstein FC, Ashley AV, Endeshaw YW, Hanfelt J, Lah JJ, Levey AI. Effects of hypertension and hypercholesterolemia on cognitive functioning in patients with alzheimer disease. Alzheimer Dis Assoc Disord. 2008 Oct-Dec;22(4):336-42.

75 Ghribi O. Potential mechanisms linking cholesterol to Alzheimer’s disease-like pathology in rabbit brain, hippocampal organotypic slices, and skeletal muscle. J Alzheimers Dis. 2008 Dec;15(4):673-84.

76 Carlsson CM, Nondahl DM, Klein BE, McBride PE, Sager MA, Schubert CR, Klein R, Cruickshanks KJ.Increased atherogenic lipoproteins are associated with cognitive impairment: effects of statins and subclinical atherosclerosis. Alzheimer Dis Assoc Disord. 2009 Jan-Mar;23(1):11-7.

77 Farr SA, Yamada KA, Butterfield DA, Abdul HM, Xu L, Miller NE, Banks WA, Morley JE. Obesity and hypertriglyceridemia produce cognitive impairment. Endocrinology. 2008 May;149(5):2628-36.

78 Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated Triglycerides Correlate with Progression of Diabetic Neuropathy. Diabetes. 2009 Jul;58(7):1634-40.

79 Nakao M, Ando K, Nomura S, Kuboki T, Uehara Y, Toyooka T, Fujita T. Depressive mood accompanies hypercholesterolemia in young Japanese adults. Jpn Heart J. 2001 Nov;42(6):739-48.

80 Nakao M, Yano E. Relationship between major depression and high serum cholesterol in Japanese men. Tohoku J Exp Med. 2004 Dec;204(4):273-87.

81 Weidner G, Connor SL, Gerhard GT, Duell PB, Connor WE. The effects of dietary cholesterol-lowering on psychological symptoms: a randomised controlled study. Psychol Health Med. 2009 May;14(3):255-61.

82 Ginsberg HN, Karmally W, Siddiqui M, Holleran S, Tall AR, Rumsey SC, Deckelbaum RJ, Blaner WS, Ramakrishnan R. A dose- response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men. Arterioscler Thromb. 1994 Apr;14(4):576-86.

83 Weggemans RM, Zock PL, Katan MB. Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a meta-analysis. Am J Clin Nutr. 2001 May;73(5):885-91.

84 Nedley N, Proof Positive (Ardmore, Okla.: Nedley Publishing, 1998).

85 O’Brien, B.C.; Reiser, R. Human plasma lipids responses to red meat, poultry, fish, and eggs. Am J Clin Nutr. 1980 Dec;33(12):2573-80. 86 Hodis HN, Crawford DW, Sevanian A. Cholesterol feeding increases plasma and aortic tissue cholesterol oxide levels in parallel: further evidence for the role of cholesterol oxidation in atherosclerosis. Atherosclerosis. 1991 Aug;89(2-3):117-26.

86 Hodis HN, Crawford DW, Sevanian A. Cholesterol feeding increases plasma and aortic tissue cholesterol oxide levels in parallel: further evidence for the role of cholesterol oxidation in atherosclerosis. Atherosclerosis. 1991 Aug;89(2-3):117-26.

87 Subramanian S, Chait A. The effect of dietary cholesterol on macrophage accumulation in adipose tissue: implications for systemic inflammation and atherosclerosis. Curr Opin Lipidol. 2009 Feb;20(1):39-44.

88 Oh KW, Nam CM, Jee SH, Choe KO, Suh I. Coronary artery calcification and dietary cholesterol intake in Korean men. Acta Cardiol. 2002 Feb;57(1):5-11.

89 Yeh YF, Huang SL. Enhancing effect of dietary cholesterol and inhibitory effect of pravastatin on allergic pulmonary inflammation. J Biomed Sci. 2004 Sep-Oct;11(5):599-606.

90 Yeh YF, Huang SL. Dietary cholesterol enhances pulmonary eosinophilic inflammation in a murine model of asthma. Int Arch Allergy Immunol. 2001 Aug;125(4):329-34.

91 Yasutake K, Nakamuta M, Shima Y, Ohyama A, Masuda K, Haruta N, Fujino T, Aoyagi Y, Fukuizumi K, Yoshimoto T, Takemoto R, Miyahara T, Harada N, Hayata F, Nakashima M, Enjoji M. Nutritional investigation of non-obese patients with non-alcoholic fatty liver disease: The significance of dietary cholesterol. Scand J Gastroenterol. 2008 Dec 4:1-7.

92 Wouters K, van Gorp PJ, Bieghs V, Gijbels MJ, Duimel H, Lütjohann D, Kerksiek A, van Kruchten R, Maeda N, Staels B, van Bilsen M, Shiri-Sverdlov R, Hofker MH. Dietary cholesterol, rather than liver steatosis, leads to hepatic inflammation in hyperlipidemic mouse models of nonalcoholic steatohepatitis. Hepatology. 2008 Aug;48(2):474-86.

93 Kleemann R, Verschuren L, van Erk MJ, Nikolsky Y, Cnubben NH, Verheij ER, Smilde AK, Hendriks HF, Zadelaar S, Smith GJ, Kaznacheev V, Nikolskaya T, Melnikov A, Hurt-Camejo E, van der Greef J, van Ommen B, Kooistra T. Atherosclerosis and liver inflammation induced by increased dietary cholesterol intake: a combined transcriptomics and metabolomics analysis.Genome Biol. 2007;8(9):R200.

94 Homma Y, Kondo Y, Kaneko M, Kitamura T, Nyou WT, Yanagisawa M, Yamamoto Y, Kakizoe T. Promotion of carcinogenesis and oxidative stress by dietary cholesterol in rat prostate. Carcinogenesis. 2004 Jun;25(6):1011-4.

95 Kanner J. Dietary advanced lipid oxidation endproducts are risk factors to human health. Mol Nutr Food Res. 2007 Sep;51(9):1094-101. 96 Ogawa T, Yoshida J, Kokuba Y. Influence of a long-term load of dietary cholesterol on the rat kidney. Nippon Jinzo Gakkai Shi. 2003;45(4):361-6.

96 Ogawa T, Yoshida J, Kokuba Y. Influence of a long-term load of dietary cholesterol on the rat kidney. Nippon Jinzo Gakkai Shi. 2003;45(4):361-6.

97 de Boer IH, Astor BC, Kramer H, Palmas W, Seliger SL, Shlipak MG, Siscovick DS, Tsai MY, Kestenbaum B. Lipoprotein abnormalities associated with mild impairment of kidney function in the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol. 2008 Jan;3(1):125-32.

98 Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med. 1998 May 11;158(9):998-1004.

99 Verhamme P, Quarck R, Hao H, Knaapen M, Dymarkowski S, Bernar H, Van Cleemput J, Janssens S, Vermylen J, Gabbiani G, Kockx M, Holvoet P. Dietary cholesterol withdrawal reduces vascular inflammation and induces coronary plaque stabilization in miniature pigs. Cardiovasc Res. 2002 Oct;56(1):135-44.

100 Sanbe T, Tomofuji T, Ekuni D, Azuma T, Tamaki N, Yamamoto T. Oral administration of vitamin C prevents alveolar bone resorption induced by high dietary cholesterol in rats. J Periodontol. 2007 Nov;78(11):2165-70

101 Micale V, Scapagnini G, Colombrita C, Mazzola C, Alkon DL, Drago F.Behavioral effects of dietary cholesterol in rats tested in experimental models of mild stress and cognition tasks. Eur Neuropsychopharmacol. 2008 Jun;18(6):462-71.

102 Granholm AC, Bimonte-Nelson HA, Moore AB, Nelson ME, Freeman LR, Sambamurti K. Effects of a saturated fat and high cholesterol diet on memory and hippocampal morphology in the middle-aged rat. J Alzheimers Dis. 2008 Jun;14(2):133-45.

103 Swank RL, Nakamura H. Oxygen availability in brain tissues after lipid meals. Am J Physiol. 1960 Jan;198:217-20.

104 Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, Karvonen MJ, Nedelijkovic S, Nissinen A, Toshima H. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995 Jul 12;274(2):131-6.

105 Peng SK, Taylor CB, Hill JC, Morin RJ. Cholesterol oxidation derivatives and arterial endothelial damage. Atherosclerosis. 1985 Feb;54(2):121-33.

106 Yuan XM, Li W, Brunk UT, Dalen H, Chang YH, Sevanian A. Lysosomal destabilization during macrophage damage induced by cholesterol oxidation products. Free Radic Biol Med. 2000 Jan 15;28(2):208-18.

107 Al Kanhal MA, Ahmad F, Al Othman AA, Arif Z, Al Orf S, Al Murshed KS. Effect of pure and oxidized cholesterol-rich diets on some biochemical parameters in rats. Int J Food Sci Nutr. 2002 Sep;53(5):381-8.

108 Staprans I, Pan XM, Rapp JH, Feingold KR. Oxidized cholesterol in the diet accelerates the development of aortic atherosclerosis in cholesterol-fed rabbits. Arterioscler Thromb Vasc Biol. 1998 Jun;18(6):977-83.

109 Griminger P, Fisher H. The effect of dried and fresh eggs on plasma cholesterol and atherosclerosis in chickens. Poult Sci. 1986 May;65(5):979-82.

110 Taylor CB, Peng SK, Imai H, Mikkelson B, Lee KT, Werthessen NT. Hereditary hyperlipidemia in chickens-model for study of toxic oxidation products found in significant amounts in U.S.P. cholesterol, powdered eggs and milk. Adv Exp Med Biol. 1977;82:252-5.

111 Salonen JT, Nyyssönen K, Salonen R, Porkkala-Sarataho E, Tuomainen TP, Diczfalusy U, Björkhem I. Lipoprotein oxidation and progression of carotid atherosclerosis. Circulation. 1997 Feb 18;95(4):840-5.

112 Miwa S, Inouye M, Ohmura C, Mitsuhashi N, Onuma T, Kawamori R. Relationship between carotid atherosclerosis and erythrocyte membrane cholesterol oxidation products in type 2 diabetic patients. Diabetes Res Clin Pract. 2003 Aug;61(2):81-8.

113 Staprans I, Pan XM, Rapp JH, Feingold KR. The role of dietary oxidized cholesterol and oxidized fatty acids in the development of atherosclerosis. Mol Nutr Food Res. 2005 Nov;49(11):1075-82.

114 Rong JX, Rangaswamy S, Shen L, Dave R, Chang YH, Peterson H, Hodis HN, Chisolm GM, Sevanian A. Arterial injury by cholesterol oxidation products causes endothelial dysfunction and arterial wall cholesterol accumulation. Arterioscler Thromb Vasc Biol. 1998 Dec;18(12):1885-94.

115 Guardiola F, Tres A, Codony R, Addis PB, Bergmann SD, Zavoral JH. Lack of effect of oral supplementation with antioxidants on cholesterol oxidation product concentration of human plasma, as revealed by an improved gas chromatography method. Anal Bioanal Chem. 2007 Sep;389(1):277-89.

116 Staprans I, Pan XM, Rapp JH, Feingold KR. Oxidized cholesterol in the diet is a source of oxidized lipoproteins in human serum. J Lipid Res. 2003 Apr;44(4):705-15.

117 Vine DF, Croft KD, Beilin LJ, Mamo JC. Absorption of dietary cholesterol oxidation products and incorporation into rat lymph chylomicrons. Lipids. 1997 Aug;32(8):887-93.

118 Selley ML, McGuiness JA, Ardlie NG. The effect of cholesterol oxidation products on human platelet aggregation. Thromb Res. 1996 Sep 15;83(6):449-61.

119 Peng SK, Hu B, Peng AY, Morin RJ. Effect of cholesterol oxides on prostacyclin production and platelet adhesion. Artery. 1993;20(3):122-34.

120 Panasenko OM, Vol’nova TV, Azizova OA, Vladimirov IuA. Lipid peroxidation—the factor promoting cholesterol accumulation in cells in atherogenesis. Biull Eksp Biol Med. 1988 Sep;106(9):277-80.

121 Azizova OA, Panasenko OM, Vol’nova TV, Vladimirov YA. Free radical lipid oxidation affects cholesterol transfer between lipoproteins and erythrocytes. Free Radic Biol Med. 1989;7(3):251-7.

122 Vine DF, Croft KD, Beilin LJ, Mamo JC. Effect of dietary cholesterol oxidation products on the plasma clearance of chylomicrons in the rat. Lipids. 2002 May;37(5):455-62.

123 Kelishadi R, Pour MH, Zadegan NS, Kahbazi M, Sadry G, Amani A, Ansari R, Alikhassy H, Bashardoust N. Dietary fat intake and lipid profiles of Iranian adolescents: Isfahan Healthy Heart Program—Heart Health Promotion from Childhood. Prev Med. 2004 Oct;39(4):760-6. 124 Finocchiaro ET, Lee K, Richardson T. Identification and quantification of cholesterol oxides in grated cheese and bleached butteroil. J Am Oil Chem Soc. 1984 May;61(5):877-883.

125 Linseisen J, Wolfram G. Absorption of cholesterol oxidation products from ordinary foodstuff in humans. Ann Nutr Metab. 1998;42(4):221-30.

126 Martin JC, Canlet C, Delplanque B, Agnani G, Lairon D, Gottardi G, Bencharif K, Gripois D, Thaminy A, Paris A. (1)H NMR metabonomics can differentiate the early atherogenic effect of dairy products in hyperlipidemic hamsters. Atherosclerosis. 2009 Sep;206(1):127-33.

127 Lee HW, Chien JT, Chen BH. Formation of cholesterol oxidation products in marinated foods during heating. J Agric Food Chem. 2006 Jun 28;54(13):4873-9.

128 Al-Saghir S, Thurner K, Wagner KH, Frisch G, Luf W, Razzazi-Fazeli E, Elmadfa I. Effects of different cooking procedures on lipid quality and cholesterol oxidation of farmed salmon fish (Salmo salar). J Agric Food Chem. 2004 Aug 11;52(16):5290-6.

129 Savage GP, Dutta PC, Rodriguez-Estrada MT. Cholesterol oxides: their occurrence and methods to prevent their generation in foods. Asia Pac J Clin Nutr. 2002;11(1):72-8.

130 Mahfouz MM, Hulea SA, Kummerow FA. Cigarette smoke increases cholesterol oxidation and lipid peroxidation of human low-density lipoprotein and decreases its binding to the hepatic receptor in vitro. J Environ Pathol Toxicol Oncol.

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