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In last week’s article about the ineffectiveness of statin drugs in reducing mortality in most populations I promised I would follow-up with an article on drug-free prevention of heart disease. I will do that this week, but it occurred to me that the first article in this series should have been one that dispels the myth that cholesterol causes heart disease. Understanding that is the key to the prevention strategies that will follow in the next article. So without further ado…

butterYou are all no doubt acquainted with the popular hypothesis on cholesterol and heart disease. It has two parts: first, that eating cholesterol in the diet raises cholesterol levels in the blood; and two, that high cholesterol levels in the blood cause heart disease.

You might be surprised to learn that neither of these statements is true. The first one is relatively easy to dispatch. In the Framingham Heart Study, which is the longest-running and perhaps most significant study on heart disease done to date, it was demonstrated that intake of cholesterol in the diet had absolutely no correlation with heart disease. If you look at the graph below, you’ll see that both men and women with above average intake of cholesterol had nearly identical rates of heart disease as men and women with below average intake of cholesterol.


In fact, the “diet-heart hypothesis”, which is the scientific name for the idea that eating cholesterol causes heart disease, has even been discounted by the researchers who were responsible for its genesis. Ancel Keys, who in many ways can be considered the “father” of the cholesterol-heart disease hypothesis, had this to say in 1997:

“There’s no connection whatsoever between the cholesterol in food and cholesterol in the blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

This is a reference to early studies performed on chickens and rabbits where they force-fed these animals high-levels of cholesterol. Since rabbits and chickens are mostly vegetarian, their physiology is not adapted for processing such large amounts of dietary cholesterol, so it’s no surprise they developed atherosclerosis. The mistake was assuming that the results of this experiment could be extrapolated to humans, who are omnivores with significant differences in physiology.

The second tenet of the cholesterol-heart disease hypothesis, the notion that high cholesterol levels in the blood cause heart disease, is referred to as the “lipid hypothesis” in the scientific community. Though it still accepted as gospel truth by the general public and many medical professionals, most researchers now believe the primary causes of heart disease are inflammation and oxidative stress. Unfortunately, the rest of us haven’t gotten the memo, so to speak, that cholesterol isn’t the cause of heart disease.

It would take several articles to explain this in complete detail, but I’d like to give at least a brief summary here.

If cholesterol caused heart disease, it should be a risk factor in 1) all ages, 2) both sexes and 3) all populations around the world (barring any protective factor, of course). Also, if cholesterol caused heart disease we would expect that lowering cholesterol would reduce heart disease. But none of these assumptions turn out to be true.

The rate of heart disease in 65-year old men is ten times that of 45-year old men. Yet a recent study in the Journal of American Medical Association indicated that high LDL cholesterol is not a risk factor for from coronary heart disease (CHD) mortality or total mortality (death from any cause). It is extremely unlikely that a risk factor for a disease would stop being a risk factor at a time when that disease kills the greatest number of people. That is akin to suggesting that smoking causes lung cancer in young men, but somehow stops doing so in older men!

Another consistent thorn in the side of supporters of the “lipid hypothesis” is that women suffer 300% less heart disease than men, in spite of having higher average cholesterol levels. At the recent Conference on Low Blood Cholesterol, which reviewed 11 major studies including 125,000 women, it was determined that there was absolutely no relationship between total cholesterol levels and mortality from cardiovascular or any other causes.

Nor is cholesterol a risk factor in all populations around the world. In fact, some of the populations with the highest levels of blood cholesterol have among the lowest rates of heart disease, and vice versa. Dr. Malcom Kendrick, a well-known skeptic of the lipid-hypothesis, explains this very well in the video below:

Finally, more than 40 trials have been performed to determine whether lowering cholesterol levels can prevent heart disease. In some trials heart disease rates went down, in others they went up. But when the results of all of the trials were taken together, just as many people died in the treatment groups (who had their cholesterol levels lowered by drugs) as in the control groups (who had no treatment).

If you’re still skeptical after reading all of this, perhaps William Castelli, the director of the famed Framingham Heart Study mentioned above can convince you:

“Serum cholesterol is not a strong risk factor for CHD, in the sense that blood pressure is a strong risk factor for stroke or cigarette smoking is a risk factor for lung cancer.”

Or how about Frederick Stare, a long-time American Heart Association member and (former) proponent of the lipid hypothesis:

“The cholesterol factor is of minor importance as a risk factor in CVD. Of far more importance are smoking, hypertension, obesity, diabetes, insufficient physical activity, and stress.”

So there you have it. Contrary to popular belief, cholesterol is not a dangerous poison that causes heart disease. Rather, it is an essential nutrient present in the cell membranes of all tissues of all mammals, and has some very important functions in the body. In fact, in many studies low cholesterol has been associated with an increase in total mortality!

Again, the Framingham Study which followed 15,000 participants over three generations:

“There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years.”

In other words, as cholesterol fell death rates went up.

The Honolulu Heart Program study, with 8,000 participants, published in 2001:

“Long-term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier the patients start to have lower cholesterol concentrations, the greater the risk of death.”

And finally, the huge Japanese Lipid Intervention Trial with over 47,000 participants:

“The highest death rate observed was among those with lowest cholesterol (under 160mg/dl); lowest death rate observed was with those whose cholesterol was between 200-259mg/dl”

In other words, those with the lowest cholesterol had the highest death rate, and those with cholesterol levels that would today be called “dangerous” had the lowest death rate.

As you can see, not only does high cholesterol not cause heart disease, low cholesterol can actually be dangerous to your health. So toss out your vegetable oil and start eating butter and eggs again! But more on that next week…

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egg The persistent myth that cholesterol causes heart disease has scared many of us away from eating eggs on a regular basis. But there is absolutely no research that links egg consumption to heart disease.

A recent review of the scientific literature published in Current Opinion in Clinical Nutrition and Metabolic Care clearly indicates that egg consumption has no discernible impact on blood cholesterol levels in 70% of the population. In the other 30% of the population (termed “hyperresponders”), eggs do increase both circulating LDL and HDL cholesterol.

You’ve probably been conditioned to believe that anything that raises LDL cholesterol (so-called “bad” cholesterol) should be avoided like the plague. But even the medical mainstream has come to recognize that all LDL cholesterol is not the same. It’s true that small, dense LDL particles have been linked to heart disease. This is primarily due to the fact that they are much more susceptible to oxidative damage than normal LDL cholesterol particles.

However, egg consumption increases the proportion of large, buoyant LDL particles that have been shown to be protective against heart disease. Egg consumption also shifts individuals from the LDL pattern B to pattern A. Pattern B indicates a preponderance of small, dense LDL particles (risk factors for heart disease), while pattern A indicates a preponderance of large, buoyant LDL particles (which protect us from heart disease). This is a good thing.

Eggs one of the most nutrient-dense foods available. One egg provides 13 essential nutrients, all in the yolk (contrary to popular belief, the yolk is far higher in nutrients than the white).

Eggs are an excellent source of B vitamins, which are needed for vital functions in the body, and also provide good quantities of vitamin A, essential for normal growth and development.

The vitamin E in eggs protects against heart disease and some cancers; eggs also contain vitamin D, which promotes mineral absorption and good bone health.

Eggs are rich in iodine, for making thyroid hormones, and phosphorus, essential for healthy bones and teeth.

Eggs are also good sources of antioxidants known to protect the eye. Therefore, increased plasma concentrations of lutein and zeaxanthin in individuals consuming eggs are also of interest, especially in those populations susceptible to developing macular degeneration and eye cataracts.

There’s absolutely no reason to limit your consumption of eggs to three to four per week, as recommended by “heart-healthy” nutritional guidelines. In fact, consuming two to three eggs per day would provide a better boost to your health and protection against disease than a multivitamin supplement. Eggs truly are one of nature’s superfoods.

It’s important, however, to make sure that you buy organic, pasture-raised eggs. Studies show that commercially-raised eggs are up to 19 times higher in pro-inflammatory omega-6 fatty acids. Unfortunately, almost all eggs sold in supermarkets – even the organic eggs sold at chains such as Whole Foods and Wild Oats – are not truly pasture-raised. To find these eggs, check your local farmer’s market or visit the Eat Wild website to locate a source in your area.

Attention Bay Area HEALTHY SKEPTIC readers!

I am offering a free public talk next week in Berkeley, CA which debunks the myth that cholesterol causes heart disease. We’ll also explore the true causes of heart disease as well as simple dietary and lifestyle changes you can make to protect yourself and your loved ones. See below for details. Hope to see you there!

Wednesday, May 21st from 7:00 – 9:00 PM
Acupuncture & Integrated Medicine College, Berkeley (AIMC Berkeley)
2550 Shattuck Avenue (at Blake)
10-minute walk south on Shattuck from Downtown Berkeley BART
510.666.8248 ext. 106

For over 50 years, the medical establishment has vigorously promoted the notion that high cholesterol is a primary risk factor for coronary heart disease, and that a diet high in saturated fat and cholesterol causes heart disease. These hypotheses are widely accepted as fact by physicians and the general public alike, despite the overwhelming body of evidence that suggests otherwise.

During this two-hour talk, we’ll review scientific studies demonstrating that:

  1. High cholesterol doesn’t cause heart disease
  2. Low cholesterol worsens your physical and mental health and increases your chances of dying prematurely
  3. Diets high in saturated fat and cholesterol don’t cause heart disease, but they do promote health and longevity
  4. Consumption of so-called “heart healthy” vegetable oils is linked to heart disease, cancer and many other conditions

You’ll also learn the latest theories on what causes heart disease and a truly “heart healthy” approach to diet and lifestyle that is supported by both modern science and centuries of traditional wisdom.

The presentation draws on more than 150 peer-reviewed studies published in major journals and the work of an impressive list of physicians, scientists and researchers who question the connection between cholesterol and heart disease.

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