There may be no such thing as 'bad' cholesterol. LDL is called "bad cholesterol" but there's little to no evidence that LDL hurts us, and there's reason to believe that lowering LDL with either medications or a high polyunsaturated fat diet hurts our health. Just as it's better to have high HDL than low HDL, recent studies on people hospitalized with coronavirus are consistent with numerous studies showing people with high LDL are healthier overall, including a superior ability to fight infection.
Study 1: Pre-infection Cholesterol Predicts Disease Severity
A March study in Wuhan, China compared pre infection cholesterol levels in hospitalized patients with mild versus severe coronavirus. Having a low HDL was a significant predictor, as was having a low total cholesterol (see chart). The study group was small, only 97 patients. The pre-infection cholesterol data was collected from information available in the public health system.
© REF: https://www.medrxiv.org/content/10.1101/2020.03.24.20042283v1.full.pdfLow HDL and Total Cholesterol Associated with More Deadly Coronavirus
An April study in Wuhan China extends the investigation into the connection between low cholesterol and worse outcome during coronavirus infection. This study on 21 patients looked back to check pre-infection cholesterol levels just like study number one above, and then they tracked what happened to cholesterol levels during the course of their infection. They found that cholesterol levels had dropped significantly at the time of admission, suggesting the body somehow 'uses up' cholesterol during infection. Interestingly, a distinguishing factor between the 17 who survived and the 4 who didn't was found by tracking cholesterol during the hospital stay.
Supplementary data downloaded from study published https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166305/
Why is Cholesterol Related to Severity of Coronavirus Infection?
Cholesterol helps stabilize the fats carried in lipoproteins. The authors suggest that oxidation reactions could explain the declining lipoprotein levels during infection. It appears that an inability to eventually gain control of the oxidation so that cholesterol levels can climb higher again may be a distinguishing feature between those who will recover and those who will not.
This is consistent with the idea that your response to coronavirus depends on the health of your body fat.
Slightly oxidation-prone body fat released into circulation during an infection may cause cholesterol levels to fall, disabling the immune system's ability to seek and destroy virus and possibly making the difference between a person who can fight the infection at home and a person who needs to be hospitalized.
More severely oxidation prone body fat puts inflammation into overdrive, causing the worst complications of ARDS (fluid in the lungs), cytokine storm and the blood clots associated with stroke. These complications are not the virus itself, but what happens when an ineffective immune system combines with an out of control inflammatory response.
HDL 60+ Reflects Healthy Body Fat
These studies also confirm my own limited experience with patients suffering from severe coronavirus infections, all of whom had low HDL and followed a high-PUFA diet. In my experience, HDL reflects the health of your body fat more than any other single marker. And an HDL of 60+ seems to be a dividing line between those with inflammation prone body fat and those with healthy body fat.
A high-PUFA diet also makes your body fat pro-inflammatory. If your body fat is pro-inflammatory, your HDL goes down. If your body fat is healthy, your HDL stays high.
This Saturday, I'll be discussing the connection between seed oil, low cholesterol, inflammation and sugar addiction in the upcoming Quit Sugar Summit.
Inflammation is not always a bad thing. In fact, our immune system fights off infections using inflammatory processes that kill foreign organisms invading the body. But on a modern diet a person fighting a serous infection like pneumonia is likely to suffer from an inability to control inflammation once it starts. When inflammation in your lungs gets out of control, fluid can fill your airways and you have extreme difficulty breathing.
How to Raise HDL
If you want to raise your HDL, all you need to do is start swapping out highly processed unstable seed oils, the 3Cs and the 3Ss on my list of good fats and bad, for stable, whole-food fats like those in butter and eggs or traditional cooking oils like olive and coconut or the other good fats on the list.
A few easy ways to add healthy fats into your diet:
- Steam veggies and pour over melted butter, 1-2 Tbsp per person eating the veggies. If you want to get fancy, use compound butter.
- Add shredded coconut and nuts to whole milk yogurt, one of my favorite combinations here
- Make your own salad dressing. For easy made from scratch Ranch, click here.
Then, no matter what, nor when, when we're gone, we'll learn (or will be able to inquire) "Which of the two was right?"
(If we phrase it that way, we'll only hear laughter.)