Your Cholesterol Matters Less Than You Think

The Cholesterol Hypothesis

The cholesterol hypothesis is the prevailing theory on why human beings develop heart disease. It goes something like this; elevated total cholesterol and, especially, elevated LDL cholesterol, is the primary cause of atherosclerosis and cardiovascular disease. Further, replacing saturated fat in the diet with vegetable oils lowers serum cholesterol and, therefore, lowers cardiovascular disease risk. This information is decades old and has become medical dogma. Unfortunately, it’s not true.

Much of this information comes from the Seven Countries Study originating in the 1950s, although data is still analyzed today to glean more knowledge from it. It tied fat consumption to heart disease. The lead author, Ancel Keys, found the more fat a society consumed the higher the rate of heart attacks. It seemed to be very convincing evidence. This observation helped shape health policies for governments and the medical field. In fact, to some degree, it still does today.

Missing or Unpublished Data

There was a problem with it, though. Data showed that there were populations of people who consumed lots of fat but had low heart attack rates. Conversely, there was data showing there were populations of people who consumed very little fat but had high rates of heart attacks. This information was omitted from the study. The study also failed to account for the fact that the people who consumed the most fat were also most likely to consume the most sugar. While nutrition science is notoriously difficult, these seem like variables that shouldn’t have been ignored.

Superimpose the above inconsistencies with interventional studies conducted in the same time period and you’ll quickly see you’ve been misled. Ancel Keys’ study was an observational study. This means he observed a connection between two sets of data. Observational studies cannot prove cause and effect. For example, imagine this headline; “New science has observed a connection between high heel wearing and breast cancer.” Does wearing high heels cause breast cancer? Of course not. It just happens that people who wear high heels (mostly women) also develop the majority of breast cancer. This silly example shows just how easily an observational study can get it wrong.

The gold standard for proving cause and effect is an interventional study where populations are randomized and given either an experimental intervention or are controls, generally receiving a placebo. In dietary trials, placebos are difficult, if not impossible, to give so participants diets are often left unchanged for the control population.

The Sydney Diet Heart Study and the Minnesota Coronary Experiment

Around the same time that Ancel Keys was doing his work, two interventional studies were conducted. One was called the Sydney Diet Heart Study and the other the Minnesota Coronary Experiment. Both of these studies were incompletely published (data was missing) or went completely unpublished for reasons no one really knows. It is likely because they contradicted accepted dogma and scientific journals were hesitant to put their reputations on the line for something they viewed with skepticism. We know about them now because a group of researchers recently uncovered the unpublished data, reanalyzed it with modern methods and found some shocking results. The reanalysis of both studies was published in the British Medical Journal.

In both of these experiments, totaling about 10,000 participants, saturated fat was removed from the diets of the experimental group and replaced with vegetable oils. This is precisely what the American Heart Association says you should do. What did they find? They found that by removing saturated fat, the participants’ cholesterol went down. This is not unexpected. What they didn’t expect to find was that in both studies the low saturated fat group experienced more cardiovascular disease, more coronary heart disease, and an increase in all-cause mortality.

So let’s summarize; Removing saturated fat and replacing it with vegetable oils lowers cholesterol. But lowering cholesterol raised the risk of heart disease? Yes. This puts an enormous, truck-sized hole in the cholesterol hypothesis. In fact, in the Minnesota Coronary Experiment for every 30 points a person’s cholesterol dropped their risk of death increased by 22%.

This information is counter to everything nutrition science says. Three other randomized controlled trials have confirmed the results. Couple this with another very recent study evaluating over 68,000 elderly people which found an inverse relationship in those over 60 between LDL level and mortality, and I think we seriously need to evaluate the cholesterol hypothesis.

The Real Cause of Heart Disease

If cholesterol doesn’t cause heart disease, what does? It’s quite simple actually – endothelial damage. The endothelia are the cells that line your blood vessels. There are things that are known to damage this lining – high blood pressure, inflammation, high blood sugar, smoking, oxidative stress, and aging. These triggers, and pursuant damage, set into motion a cascading set of events that allows your immune system (in the form of white blood cells) to infiltrate the lining of the vessels. Only after they do this do they begin the process of engulfing cholesterol, which eventually leads to arterial plaque formation. Control those triggers and you will never develop heart disease. If you do not control those processes, it doesn’t matter how low your cholesterol is. You will still develop heart disease. I hear you saying, “But how do I control aging?” That is more difficult as we will all age, but living a healthy lifestyle helps with all of those factors, including aging. Plus, aging alone is unlikely to be a significant cause of heart disease.

It’s important to recognize that cholesterol is not your enemy. Sedentary lifestyle, smoking, a diet high in refined food, the excess consumptions of sugar, and poor stress management are much more serious concerns. Lowering cholesterol for the sake of lowering it has no beneficial effect on your heart. As a matter of fact, the research shows it could be downright dangerous for it. So if you’ve been told you have high cholesterol and that lowering it will lower your risk, you might want to consider the information above and seek an alternative.

The Knock On Niacin – Big Pharma At It Again

Two new reports recently came out that said niacin, vitamin B3, is not effective for the prevention of heart disease or stroke. And, in fact, it might be dangerous. The studies also concluded that it might be so dangerous is shouldn’t be recommended at all. This is not an uncommon response when nutrients are studied, especially ones that reduce the market share for billion dollar statin medications.

Two studies recently published in the New England Journal of Medicine found that while niacin does reduce triglycerides, raise “good” (HDL) cholesterol, and reduce “bad” (LDL) cholesterol, it did not reduce the risk of heart attack or stroke.

I have several problems with the new information that’s been plastered all over the media recently about the recent studies:

Problem #1:

While two studies were performed, the largest of the two was funded by Merck Pharmaceuticals. It had over 25,000 participants while the other study, funded by the NIH, had just over 3,000 people. Merck clearly has an interest in driving down the sales of niacin as it would likely increase the sales of their cholesterol lowering drugs Zocor and Zetia. As an added note, niacin sales have tripled since 2002. Wouldn’t it be a perfect time to get a study that shows it’s dangerous or ineffective?

Problem #2:

These published trials do not reflect the clinical experience of doctors around the country who’ve been recommending niacin for decades. Research and a doctor’s clinical observations are often different. Which one do you believe?

Problem #3:

These trials focused on high-risk patients, almost all of whom were already taking statins and had low LDL levels. Would you see more benefit in clinical trials if these patients had different lipid profiles, or in those who did not already have heart disease? The populations they studied were already being treated intensively. It’s unlikely they were going to benefit by just one more treatment (niacin in this case).  As a matter of fact, in the Merck funded study they clearly state they cannot say whether niacin might be beneficial for patients at even higher risk of having a heart attack or stroke or those with higher LDL levels.

Problem #4:

Statins are particularly ineffective with potentially serious side effects, yet we don’t see reports on the news telling us to stay away from them. This is likely the powerful pull Big Pharma has on media and medicine. A full 98% of people who take statins see no benefit. Zero percent avoid death by taking a statin and only 1.6% avoid a survivable heart attack, and 0.4% are helped by preventing a stroke. Compare that to the side effects where 2% develop diabetes and 10% develop muscle damage as a result of taking that statin and the numbers don’t add up.

I think the real lesson of these studies (both on niacin and ones published on statins) is that inflammation, not necessarily the cholesterol itself, is the problem. If you address those factors, you will live a long, cardiovascular disease-free life.

Health Doesn’t Come In A Pill

We live in an instant gratification society. It permeates every aspect of our lives. From the way we consume our news with 24 hours news networks or online surfing, to the way we gossip with Facebook, our desire for things to be done now(!) is staggering.

The same applies to our health. We want results, and we want it yesterday. The problem? There is no quick fix for anything in terms of your health. We’ve become accustomed to seeing the ads on TV that promise results with just one simple pill per day. We’re so accustomed to it, we’re starting to believe it. Heck, some people believe it so much, they demand it! Unfortunately, health doesn’t come in a pill.

But my doctor promises me that if I take my high blood pressure medication, my statin, and my baby aspirin just once per day, I’ll live a long, healthy life!

Yes, yes. That is a comforting thought isn’t it? The problem is it isn’t true. Check out this information:

Statins: For those who took statins for at least 5 years with no history of heart disease:*

• 98% saw no benefit
• 0% were helped by being saved from death
• 1.6% were helped by preventing a heart attack
• 0.4% were helped by preventing a stroke
• 2% were harmed by developing diabetes
• 10% were harmed by muscle damage

Aspirin: For those who took it daily for a year with no history of heart disease:*

• 99.94% saw no benefit
• 0% were helped by avoiding death
• 0.05% were helped by preventing a non-fatal heart attack
• 0.01% were helped by preventing a non-fatal stroke
• 0.03% were harmed by developing a major bleeding event

Blood Pressure Medications: For those who took them for mild hypertension:*

• 100% saw no benefit
• 9% were harmed by medication side effects and stopped the drug

(*Statistics gathered from www.thennt.com)

Isn’t it amazing that you’re more likely to be harmed by these medications than you are to be helped? So, given that these drugs are so popular and prescribed so widely, why don’t they work? Health doesn’t come in a pill. Our medical model is flawed and flawed greatly. There are too many factors to assume one can take a pill and live longer or healthier. And most medical doctors receive very little, if any, training in nutrition.

You must fuel your body properly. This means a healthy diet and exercise. Those things work. Those things take time and effort. Obviously, time and effort don’t fit with our current lifestyle of “I want it now.” We need to change our lifestyle.

New Guidelines on Cardiovascular Disease Miss Mark

Well, they’re at it again. New guidelines on reducing cardiovascular disease risk have been released. They’ve called these “much anticipated,” however, I call them “inconsistent with research” and “likely to cause more harm than good.” The guidelines, appearing in Circulation, are likely to change clinical practice, unfortunately. They are the result of collaborations among the American Heart Association, the American College of Cardiology, and other organizations.

Essentially, it makes it far easier for physicians to prescribe statins (cholesterol lowering medication). It will likely result in tens of millions more Americans begin put on these medications.

Let’s start with the things that I do agree with in the new recommendations.

Obesity

There’s no single, ideal diet for weight loss. Intensive, supervised lifestyle changes for at least 6 months received strong endorsement. This is important. We offer professionally supervised weight loss programs at our office for the simple reason that it reduces the risk of many diseases and it can be very difficult to manage alone.

That’s it. That’s all I agree with. The rest of the recommendations fail to actually focus on the problem: INFLAMMATION! They focus far too much on treating cholesterol without any actual targets in mind to treat.

Inflammation

“The traditional view of atherosclerosis [hardening of the arteries] as a lipid storage disease [cholesterol accumulation] crumbles in the face of extensive and growing evidence that inflammation participates centrally in all stages of this disease, from the initial lesion to the end-stage thrombotic [clot forming] complications.” This quote is from a great study that reviews the mechanism behind cardiovascular disease. I added the information in the brackets to make it easier to understand.

The pharmaceutically-driven marketing and media would have you believe that high cholesterol alone will cause it simply to accumulate in your vessels eventually narrowing them so much they can no longer deliver enough blood to your brain or heart. Or alternatively, the narrowing causes a clot to form only to be dislodged and sent “downstream” where it gets caught in smaller arteries causing a heart attack or stroke.  This just isn’t true! Want to know what actually happens!!!?

How you actually get atherosclerosis:

Inflammation is central to this process. It begins with inflammatory changes in the cells that line your blood vessels. These cells are collectively called the endothelium. The cells begin to express adhesion molecules. These molecules do what they sound like – they make things stick! However, they don’t make cholesterol stick, they attract monocytes (a type of white cell), which then travel through the walls of our arteries (BAD) under the influence of various proinflammatory molecules designed to attract more white cells. Once within the arterial wall, the monocytes continue to undergo inflammatory changes, transform into another type of white cell called a macrophage, swallow up cholesterol, and they become what is called a foam cell. T lymphocytes (another type of white cell) also migrate into the arterial wall, where they release proinflammatory cytokines (messengers) that amplify the inflammatory activity. Through these inflammatory processes, the initial lesion of atherosclerosis, called the fatty streak, is formed. This continues to evolve to cause the dangerous atherosclerotic plaque, but every step along the way involves inflammation!

There you go – as you can see, it is not caused simply by the accumulation of “too much” cholesterol as it floats through your blood stream. It all starts because of inflammation. Without the inflammatory process the white cells of our body cannot penetrate the walls of our vessels. If they cannot get into the walls of our vessels, they cannot swallow up cholesterol and begin to build plaque. It really is that simple.

So what causes inflammation?

That’s a great question and very easy to answer. Poor diet and low levels of exercise cause inflammation to build leading to atherosclerosis. A diet that is high in refined sugar increases inflammation. A diet that is low in antioxidants (brightly colored fruits and vegetables) increases inflammation. And exercise is inherently anti-inflammatory; therefore, low levels of exercise drive up inflammation. Here are the basic diet and exercise recommendations everyone should follow:

Diet

Every time you eat, have a source of healthy protein (chicken, fish, grass-fed beef, bison, etc.) and a fruit or a vegetable. Make the emphasis on vegetables. Keep grain (yes, even whole grains) to a small portion of your diet (no more than once per day).

Exercise

Combine resistance training with cardiovascular training. Get at least 45 minutes of moderate activity 3 times per week. High intensity interval training is very beneficial.

If you incorporate these things into your life, you’ll avoid inflammation and you’ll live a long, healthy life without statins!!!

The Health Benefits of Chocolate!

Finally! Some good news! Chocolate has some great health benefits and, in moderation, can be a tasty part of a healthy diet. See the video below for more information!

New Warning on Statins and Safe Alternatives

The FDA has come out with new warnings on statin medications.  The more we learn about these drugs, the clearer it becomes they are far over prescribed as the risk outweighs the benefit in many people who are taking them.

Read the transcript:

Hi everybody, this is Dr. Court bringing you another 90 Seconds of Knowledge. Today we’re going to talk about statin medications. This is the most popular class of drugs in the US and people use it to lower their cholesterol levels. And, potentially, although the evidence is not very good, reduce the evidence or the occurrence of heart disease.

Yesterday the FDA’s come out without new warnings. Number one, statins can potentially cause memory loss, confusion and other cognitive deficits. This may take a few weeks or a few years to manifest, and I’ve actually seen this in my patients. We get them off the statins and they do very well. Their cognitive abilities come right back so, it is apparently reversible.

The other warning is it does increase the risk of diabetes. It increases the risk of diabetes pretty significantly. It actually increases it by 27%. That’s a problem because diabetes significantly increases the risk of heart disease, the very thing that statins are supposed to protect us against.

It also increases HA1C or hemoglobin A1C. So, what that means is it prevents you from controlling your blood sugar very well, which is a big problem.

So, if we can’t use statins, what do we do?  Well, first diet and exercise. Those are the biggies. That’s really where we should focus. But if we do need some additional assistance there are some natural substances that work very well. Red yeast rice is one that is a natural statin. It is not without side effect. It is very much lower in side effect anyway, but you should always take CoQ10 when you’re taking any kind of statin whether synthetic or natural like red yeast rice.

There is niacin. Niacin works very, very well. Good old B3. It works exceptionally well. It lowers LDL’s. It lowers total cholesterol. What we want to focus on is the LDL.  And it also lowers lipoprotein A, a very dangerous, particular kind of cholesterol.

There are plant sterols. Plant sterols act by binding up the cholesterol that we eat and preventing us from absorbing it. There are medications that do that but the plant sterols are something that you can buy over the counter.

And then, of course, good old fish oil. We can’t talk about it enough. Fish oil has so much benefit. It reduces cardiovascular disease mortality better than anything. And, it reduces sudden cardiac death by 90%. It’s very, very effective. So, if you do one thing, take some fish oil.  Those are your options. The statins are still out there and they do have side effects but some of the natural options tend to have a lower side effect profile.

If you have any questions, let us know. We’ll be happy to answer them.

The Myth of Eggs and Cholesterol

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Protecting Yourself from Heart Disease – Video blog

Heart disease is the number one killer of Americans.  Find out how to properly assess your risk and what tests you should be having done.