SAMA HOOLE: But the cholesterol hypothesis needed a villain. Just saying "cholesterol" wasn't working because cholesterol is essential for life. Solution: Rebrand LDL as "bad cholesterol" and HDL as "good cholesterol." This is marketing, not science.

Before 1980: Cholesterol was just cholesterol. Doctors measured total cholesterol.

1980s: Researchers discover LDL and HDL particles that transport cholesterol.

LDL takes cholesterol to tissues. HDL brings it back to liver. Both are essential transport mechanisms.

But the…

— Sama Hoole (@SamaHoole) December 9, 2025

Before 1980: Cholesterol was just cholesterol. Doctors measured total cholesterol. 1980s: Researchers discover LDL and HDL particles that transport cholesterol. LDL takes cholesterol to tissues. HDL brings it back to liver. Both are essential transport mechanisms. But the cholesterol hypothesis needed a villain. Just saying "cholesterol" wasn't working because cholesterol is essential for life. Solution: Rebrand LDL as "bad cholesterol" and HDL as "good cholesterol." This is marketing, not science. LDL isn't bad. It's a transport vehicle your body requires for delivering cholesterol to cells that need it for membranes, hormones, and repair. But "bad cholesterol" sounds dangerous. It gave the hypothesis a villain that people could understand. The media ran with it: "Bad cholesterol clogs arteries!" "Lower your bad cholesterol!" "Good cholesterol protects you!" Simple narrative. Memorable. Wrong. What actually matters isn't LDL level. It's: - LDL particle size (small dense particles are concerning, large fluffy are benign) - Oxidation status (oxidized LDL causes inflammation, native LDL doesn't) - Inflammatory markers (CRP, IL-6) - Triglyceride/HDL ratio (better predictor than LDL) But explaining that requires nuance. "Bad cholesterol" requires no nuance. The rebrand was so successful that doctors still say "bad cholesterol" and patients understand it as inherently harmful. Half of heart attack patients have normal LDL. Half of people with high LDL never have heart attacks. If LDL was actually "bad" and caused heart disease, this wouldn't be true. But once you've branded something "bad," evidence doesn't matter. The label sticks. "Bad cholesterol" is marketing language that became medical terminology. Your body doesn't have "bad cholesterol." It has LDL particles performing essential transport functions. Calling them "bad" is like calling delivery trucks "bad" because sometimes they're involved in accidents. The truck isn't the problem. What it's carrying and how it's driving matter.

But "bad truck" sells more fear than "check your particle size and oxidation status."