Cholesterol Is Not a Myth

Updated July 2026

High cholesterol is not a joke, and it is not a myth. Anyone who tells you otherwise, regardless of their credentials, is either ignoring the data or simply trying to create controversy where there is none.

Is high cholesterol actually a myth?

No. As a physician who tries to prevent and manage disease with as little medication as possible, I meet many patients who would rather not take any drugs at all. When it comes to cholesterol, the reason most often given for refusing a statin, even when one is clearly warranted, is that "cholesterol is a myth." That may echo the title of a popular book, but it does not match reality. Cholesterol matters. It is one of the most extensively studied risk factors for heart and vascular disease, and the findings are remarkably consistent: the lower your LDL, the bad cholesterol, the better. Whether you get there through medication, diet, or a favorable set of genes, a lower LDL means a lower risk of cardiovascular events.

What does the evidence actually show?

That across large trials, populations with lower average LDL have fewer heart events. Below is a summary of ten randomized controlled trials plotting heart-event rates against average LDL levels, and the pattern is hard to miss. The lower a population's average LDL, the fewer events it experiences.

Extended out, the line suggests that an average LDL around 30 mg/dL would nearly eliminate events. And there are people who prove the point. Those born without much PCSK9, the protein that blunts LDL-receptor activity, spend their whole lives with LDLs in the 30s, and they almost never develop heart disease.

If cholesterol is not the whole story, does that make it a myth?

No. It just means cholesterol is one of several drivers, not the only one. The body is enormously complex, and no single risk factor, or single nutrient, controls everything. Lectins are not the sole reason someone is sick, and cholesterol is not the sole reason someone has a heart attack or a stroke. I have seen plenty of normal coronary calcium scans in people with high LDL. Reductionist thinking misleads on both sides of the argument. "The Great Cholesterol Myth" argues that inflammation is what really drives risk. Of course it does. So does high blood pressure. So does smoking. So does diabetes. And so does high LDL. Heart disease is multifactorial, the product of many risk factors, some still unknown, layered on a person's genes and their environment.

So what should you actually do about it?

Focus on the principles that hold up despite all the complexity. Controlling a risk factor like LDL is not an absolute guarantee against a cardiovascular event, but the overwhelming weight of the evidence says it helps. Medications are effective, and for some people transformative, yet they are an incomplete solution, because they address one thing at a time. A perfect cholesterol number from a pill does little if you have not touched your other risk factors, or the reason your cholesterol was high to begin with.

And food is both your greatest vulnerability and your greatest opportunity. Eating poorly raises more than your LDL, it worsens several risk factors at once. But eating well to lower your cholesterol also lowers your blood pressure and blood sugar, helps you lose weight, and reduces inflammation. Food is the comprehensive answer to a complex problem, which is the whole idea behind Step One Foods.

Cholesterol is not a myth. Together with other risk factors, it is a potent mediator of a serious, potentially life-threatening disease. The people who tell you cholesterol does not matter, while insisting that some single other thing does, are the real myth-peddlers.

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