As a Chef and an Interventional Cardiologist I have been silently following along this very interesting thread. I thought I might share a few thoughts with all of you. *Cholesterol is produced naturally in everyone's body as well as being consumed from the diet *Genetics do play a strong role determining your total cholesterol level, LDL (or "bad") cholesterol level and HDL (or "good") cholesterol level. *Everyone is quite correct in commenting that the pathology is actually quite complex. In fact, it does not even directly involve cholesterol. The culprits are what are known as lipoproteins; these are molecules that our bodies manufacture (again with genetic predispositions) that consist of different pieces of proteins and fats. Cholesterol is a component of these molecules. These molecules, as a result of both size and number, can get into the walls of the arteries. Here they can become "oxidized"; a process by which they undergo a chemical transformation. These oxidized particles cause inflammatory changes, which over time can lead to plaque being built up and the arteries both narrowing due to plaque encroachment or the plaque can rupture and cause a clot to form in the artery obstructing blood flow. *Cholesterol is used because it can be measured easily and cheaply, lipoprotein measurements are much more expensive *LDL cholesterol levels, in general and for populations, do seem to predict adverse events Cholesterol can be reduced with diet. In many studies the amount achievable by diet was 10-15%, which often does not reach the targeted levels. We have seen many patients who can get their levels to guideline recommendations through diet alone, but they often had a very poor diet to start. Likewise, many people who do not have a terrible diet to start can not reach target levels without medication due to genetic predisposition. As a chef, I abhor a lot of those diets because it's like eating cardboard (I tried one and it was gastronomic water boarding) *The high cholesterol no heart disease Italian reference refers to what is known as the Milano gene. It is a naturally occurring variant which was used in some clinical trials (genetic engineering of cells). Unfortunately for most of us, the rules for that family do not apply. *Exercise, as mentioned, is an excellent way to increase HDL. Niacin is used to help with low HDL and heart disease, and is of course a naturally occurring vitamin. *I agree with everyone on the more natural dietary choices. As I mentioned, the equation is complex but I suspect that consuming a lot of processed foods invokes the Law of Unintended Consequences, which may result in producing these oxidized compounds; hence many of the reductions seen in heart disease, stroke, etc. by consuming foods rich in anti-oxidants. Having also studied martial arts for many years, I have been exposed to both Eastern Medicine and cuisine. Western medicine has its strengths, when your artery is blocked you want it open fast. Eastern medicine tends to look at why your artery got blocked in the first place. It they are complentary processes, you need not choose between them. I think a generally wise health choice with respect to diet means cutting out as much processed stuff as you can. Eat fresh but eat well. Your diet should not be a source of pain, but pleasure. As a chef I just can't abide eating or serving things that don't taste good-and in the end over the long haul people won't eat them either. A little "dietary indiscretion" every now and then will not kill you-just don't go Tiger Woods over the top doing it 6 out of 7 days and nights. As I tell my patients, you can have your cake and eat it too-you just can't eat the whole damn cake at once. *Hope this was informative-great thread!