Your favorite news outlet probably skipped reporting on the "Be The Research" experiment that showed eating Oreo cookies far exceeded statin medication in lowering LDL cholesterol.  The experiment was done by Dr. Nicholas Norwitz, who has a PhD from Oxford University in Human Metabolism and is also in his 3rd year at Harvard Medical School to obtain his MD.  He's not only accomplished in the academic world but also in the athletic world.  He holds an unbroken push-up record, doing 427 push-ups...without stopping.  

He is considered a "Lean-Mass Hyper-Responder."  In other words, he has very low body fat, with very high lean muscle mass, and eats a very low carbohydrate diet (fewer than 20 grams per day).  These types of people will exhibit a shift in their lipid profile of LDL rising (above 200), HDL rising (above 80), and triglycerides lowering (below 70).  For people that doing lower carb eating that aren't super lean, you may also see these trends, just not to the level that someone with a "hyper-responder" profile will.  Does this mean you're doomed to develop cardiovascular disease because LDL is increasing?  We shall see.

Prior to the experiment, his baseline LDL numbers were over 380.  He wanted to see if eating a sleeve of Oreo cookies could at least match the lowering effect on LDL cholesterol compared to high intensity statin intervention.  Just imagine what your primary care would say if your labs came back with LDL levels over 380?   

Part 1 of his experiment was to keep his regular ketogenic diet consistent and add in 12 Oreo cookies per day (about 100 grams of carbs) for 16 days.  Once that period was done, he returned to his baseline weight and eating patterns for 3 months and then did 6 weeks of Rosuvastatin and compared the 2 outcomes. 

He dropped his LDL values from 384 mg/dl to 111 mg/dl by eating 12 Oreo cookies per day (a 71% reduction).

Using the statin medication (20 mg of Rosuvastatin), he also lowered his LDL to 284 mg/dl from a 421 mg/dl starting point.  That's a reduction of 32.5%.  

That means the Oreo cookies were almost 2x more effective at lowering his LDL numbers.  

Does this mean that Nabisco should slap a label of "helps lower cholesterol" on every package of Oreos?  No.   

It shows that lipid levels are highly variable based on an individual and should be approached with the question "what is my body adapting to that requires an increase or decrease in cholesterol?" as opposed to the hammer solution of "cholesterol bad, smash it!"

In his case, his lipids are very high because of the "Lipid Energy Hypothesis."  As body fat decreases on a low carbohydrate, ketogenic diet, LDL will rise in order to meet energy demands.

Instead of asking "is cholesterol good or bad?", start with the question of, "what's the role of cholesterol?"  

If you ask the latter, you'll quickly see that cholesterol is a building block for many essential structures and hormones within the body.  It's the building block of cortisol, vitamin D, estrogen, progesterone, testosterone, aldosterone, brain tissue, and the protective layer of all your cells. 

HDL and LDL are just vehicles of delivery.  There is nothing pathogenic about cholesterol.  Just because it's observed at the scene of an accident, doesn't mean it's disease-causing.  I would argue it's at the crime scene to repair the damage.  Blaming cholesterol is like blaming the fire department.  Those pesky fire trucks are always at the scene of emergencies when I show up, they must be the cause of all these fires and car accidents. 

After asking about the role of cholesterol, then start asking, why does my body feel the need to make more or make less?  In the case of Nicholas, because he was so low-carb, his liver produced a ton of cholesterol as a fuel source.  As he increased his fuel source (100 grams of carbohydrates with Oreos), his liver didn't need to produce as much and therefore his numbers decreased.   

We've seen these physiological changes back in 1958 and chose to ignore them.  There was a study done where they drew blood on accountants every 2 weeks from January until June.  One group were corporate accountants and the other were regular tax accountants.  They also studied blood clotting times. 

Guess what happened to cholesterol levels when accounting deadlines were due?  Not a shocker.  Their cholesterol levels spiked (Cortisol production) and their clotting times got faster (thicker blood).  This doesn't mean they have pathology.  This means the shifts in lipids are due to adapting to the increase in stress.   That's not a disease state.  These shifts occur to save your life and buy you time to escape the potential danger.

The long-term issues arise when you're in that perpetual state of protection.

This is more just to ease the mind.  I've had countless people over the years, when they go lower in carbohydrate intake, and come back after their yearly blood work all freaked out because their total cholesterol and LDL numbers increased.  That's expected. 

Put those values in the context of other metabolic markers.  If you're seeing cholesterol and LDL go up, but your triglycerides are improving, A1C is improving, fasting insulin improving, your body composition improving, and even liver enzymes improving, it falls into normal expected shifts with the "Lipid Energy" model.  

If you need some other ways to assess cardiac risk that isn't dependent on total cholesterol and LDL, here are three things I have done. 

When in doubt, "Be The Research."