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Missing or Unpublished Data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.

How to develop healthy eating habits in a child: Start early and eat your vegetables

A healthy diet promotes success in life — better concentration and alertness, better physical health that translates into good mental and emotional health.

But even the best intentioned parents can expect food fights with their children, said Tanda Kidd, associate professor of human nutrition and extension specialist at Kansas State University. Developing good eating habits in your children is worth the effort, she said.

Good eating habits also are a front-line defense against obesity, a scourge of the nation that happens when a child eats many more calories than he or she uses up.

Nearly 1 in 4 children ages 2 to 5 is overweight or obese, said Paula Peters. An obese child is at risk for developing diabetes, high blood pressure, asthma and sleep apnea. Peters is an associate professor of human nutrition and assistant extension director for family and consumer sciences at Kansas State University.

“No parent wants her child to be sick. No parent wants her child to feel like an outsider in social situations, or be teased or bullied because of her weight,” Kidd said.

Peters and Kidd both conduct research in the area of childhood obesity prevention.

A primary key to teaching a child to make healthy food choices, Peters said, is to start early.

“Give the child a wide variety of healthy food options and let her choose which and how much to eat. A child may start by eating nothing or eating too much, but she has an innate ability to know when she’s hungry and when she’s full.”

A child learns about new foods at a time when she is exploring the world around her. And she learns to make decisions for herself.

Make the selection nutrient dense — not calorie dense. That means fruits and vegetables, not cookies for snacks. A glass of soda and a glass of 100 percent juice may have the same number of calories, but a juice is a healthier choice because it does not contain added sugars, said Kidd, a registered dietitian.

Soda and other sugar-sweetened drinks have empty calories, meaning they are “empty” of nutritional value.

According to the Centers for Disease Control, empty calories from foods high in added sugars, such as ice cream, cookies, candy, fruit drinks and some breakfast cereals and solid fats such as donuts, pastries, hot dogs, sausages, bacon and regular ground beef, contribute to 40 percent of daily calories for children and adolescents ages 2 to 18 years.

Kidd and Peters offer other suggestions:

• Do not use food as a reward for good behavior or other achievements. Kidd suggested other awards like reading a book together or playing a child’s favorite game.

• Eat your veggies, Dad. A child learns food habits — what to eat, how much to eat, when to eat, where to eat — from parents.

• Eat with your children so they can see you making good food choices.

• Be aware of what a child is eating away from home. Peters said that more than 25 percent of children ages 2 to 4 are in day care 20 to 40 hours a week. Check out meals and snacks offered to your child.

• Limit screen time — television — that encourages “mindless” eating.

• Avoid putting a child on a diet, even if he or she is slightly overweight. “That sets up the child for issues such as eating disorders later in life,” Kidd said. Instead, offer healthier food options and increase physical activity.

Kidd and Peters also encourage parents to teach their children about healthy food choices in other ways:

• Planning and taking a trip to the grocery store gives a child ownership in food choices. Reading labels and comparing costs offer other lessons.

• Plant a garden. Peters said a child is more likely to eat vegetables he or she helped grow and harvest.

• Cook together. During special time with Mom or Dad in the kitchen the child will learn more than cooking skills.

Kidd and Peters are concerned about both food deserts and food swamps. The former defines area where fresh foods are hard to get, perhaps because grocery stores are far from the family home.

Food swamps describes areas that are so crowded with fast food options that making healthy eating choices is more challenging.

They also stress the vital role that physical activity plays in childhood health. Although there is no specific recommendation for kids ages 2-5 years old, parents should offer opportunities several times a day for active play. However, kids 6 and over are encouraged to be physically active at least 60 minutes each day, Kidd said.

“Parenting styles and family characteristics affect what a child eats, of course,” Peters said. “So do community, demographic and societal characteristics such as school physical education programs, access to recreational facilities, school lunch programs and neighborhood safety.

“Weight gain is an indicator of an unhealthy society,” she said. “We have to focus on ways to be healthier.”

Week of the Young Children, sponsored by the National Association for the Education of Young Children April 12-18, focuses on the foundation for a child’s success in school and later life.

via How to develop healthy eating habits in a child: Start early and eat your vegetables — ScienceDaily.

Dr. Court’s Comments:

I agree with everything written above with one exception. I do not believe fruit juice should be a regular part of a child’s diet. On occasion, it’s fine. However, the vast majority of time, water should be the choice. Parents often are concerned that their children are somehow “missing” something if they aren’t given juice or sweet snacks. They are missing something; they’re missing the opportunity for cavities. They’re missing the increased risk of being overweight or obese. They’re missing out on poorer brain function. They’re missing out on learning healthy habits.

In all seriousness though, parents are legitimately concerned about depriving their children of delicious treats. However, this is purely the parents’ perspective, not the child’s. If the parent believes they would miss those treats themselves (most likely because of their own upbringing and food choices), of course they’re going to believe their children would miss them too. Here’s the caveat though. Children only know what you teach them. They won’t miss out on anything if they’re taught to love the healthy food. They’ll feel just as fulfilled and loved with the good food as they would feel with the unhealthy food.

This is not to suggest treats should never be given. They must, however, be just that – treats. Making a regular habit of bad food choices sets up a child for a lifetime of health issues.

Eight nutrients to protect the brain

Brain health is the second most important component in maintaining a healthy lifestyle according to a 2014 AARP study. As people age they can experience a range of cognitive issues from decreased critical thinking to dementia and Alzheimer’s disease. In the March issue of Food Technology published by the Institute of Food Technologists (IFT), contributing editor Linda Milo Ohr writes about eight nutrients that may help keep your brain in good shape.

1. Cocoa Flavanols: Cocoa flavanols have been linked to improved circulation and heart health, and preliminary research shows a possible connection to memory improvement as well. A study showed cocoa flavanols may improve the function of a specific part of the brain called the dentate gyrus, which is associated with age-related memory (Brickman, 2014).

2. Omega-3 Fatty Acids: Omega-3 fatty acids have long been shown to contribute to good heart health are now playing a role in cognitive health as well. A study on mice found that omega-3 polyunsaturated fatty acid supplementation appeared to result in better object recognition memory, spatial and localizatory memory (memories that can be consciously recalled such as facts and knowledge), and adverse response retention (Cutuli, 2014). Foods rich in omega-3s include salmon, flaxseed oil, and chia seeds.

3. Phosphatidylserine and Phosphatidic Acid: Two pilot studies showed that a combination of phosphatidylserine and phosphatidic acid can help benefit memory, mood, and cognitive function in the elderly (Lonza, 2014).

4. Walnuts: A diet supplemented with walnuts may have a beneficial effect in reducing the risk, delaying the onset, or slowing the progression of Alzheimer’s disease in mice (Muthaiyah, 2014).

5. Citicoline: Citicoline is a natural substance found in the body’s cells and helps in the development of brain tissue, which helps regulate memory and cognitive function, enhances communication between neurons, and protects neural structures from free radical damage. Clinical trials have shown citicoline supplements may help maintain normal cognitive function with aging and protect the brain from free radical damage. (Kyowa Hakko USA).

6. Choline: Choline, which is associated with liver health and women’s health, also helps with the communication systems for cells within the brain and the rest of the body. Choline may also support the brain during aging and help prevent changes in brain chemistry that result in cognitive decline and failure. A major source of choline in the diet are eggs.

7. Magnesium: Magnesium supplements are often recommended for those who experienced serious concussions. Magnesium-rich foods include avocado, soy beans, bananas and dark chocolate.

8. Blueberries: Blueberries are known to have antioxidant and anti-inflammatory activity because they boast a high concentration of anthocyanins, a flavonoid that enhances the health-promoting quality of foods. Moderate blueberry consumption could offer neurocognitive benefits such as increased neural signaling in the brain centers.

via Eight nutrients to protect the aging brain — ScienceDaily.

Reference: Institute of Food Technologists (IFT). “Eight nutrients to protect the aging brain.” ScienceDaily. ScienceDaily, 15 April 2015. <www.sciencedaily.com/releases/2015/04/150415203340.htm>.

Dr. Court’s Comments:

This is a great list. I’d encourage people to consider adding some, if not all, of these to their diet. However, these alone will not be 100% protective. To get much closer to that elusive 100% mark, exercise must be included. The benefits of exercise on the brain are numerous. Exercise is inherently anti-inflammatory. It improves fuel delivery as well as waste removal in the brain. It increases neural feedback which preserves synaptic connections. Remember this fact; 90% of the information coming into the brain on a daily basis is from proprioception. That is, 90% of the information is from our muscles and our joints. A sedentary lifestyle reduces this flow of information, reducing the survivability of neurons in the central nervous system. Exercise also keeps the heart healthy, and a healthy heart means a healthy brain.

Recommendation for vitamin D intake was miscalculated, is far too low, experts say

Researchers at UC San Diego and Creighton University have challenged the intake of vitamin D recommended by the National Academy of Sciences (NAS) Institute of Medicine (IOM), stating that their Recommended Dietary Allowance (RDA) for vitamin D underestimates the need by a factor of ten.

In a letter published last week in the journal Nutrients the scientists confirmed a calculation error noted by other investigators, by using a data set from a different population. Dr. Cedric F. Garland, Dr.P.H., adjunct professor at UC San Diego’s Department of Family Medicine and Public Health said his group was able to confirm findings published by Dr. Paul Veugelers from the University of Alberta School of Public Health that were reported last October in the same journal.

“Both these studies suggest that the IOM underestimated the requirement substantially,” said Garland. “The error has broad implications for public health regarding disease prevention and achieving the stated goal of ensuring that the whole population has enough vitamin D to maintain bone health.”

The recommended intake of vitamin D specified by the IOM is 600 IU/day through age 70 years, and 800 IU/day for older ages. “Calculations by us and other researchers have shown that these doses are only about one-tenth those needed to cut incidence of diseases related to vitamin D deficiency,” Garland explained.

Robert Heaney, M.D., of Creighton University wrote: “We call for the NAS-IOM and all public health authorities concerned with transmitting accurate nutritional information to the public to designate, as the RDA, a value of approximately 7,000 IU/day from all sources.”

“This intake is well below the upper level intake specified by IOM as safe for teens and adults, 10,000 IU/day,” Garland said. Other authors were C. Baggerly and C. French, of GrassrootsHealth, a voluntary organization in San Diego CA, and E.D. Gorham, Ph.D., of UC San Diego.

via Recommendation for vitamin D intake was miscalculated, is far too low, experts say — ScienceDaily.

Dr. Court’s Commentary – 

I’ve been recommending anywhere from 4,000-6,000IU/day of vitamin D (supplementally) to my patients for many years. This is consistent with the above recommendations that people get about 7,000IU/day from all sources. Vitamin D deficiency is a culprit in many diseases of aging, and the IOM’s recommendations were far too low. It’s good to see this becoming more well recognized.

Only one study has been done (that I can find) that actually measured how much vitamin D human beings use on a daily basis. The conclusion of that study was that humans use about 4,000-6,000IU per day (hence my recommendation). In that context, the IOM’s recommendation of 600-800IU/day becomes even more startling.

Muscle Mass Beats BMI as Longevity Predictor – Who Knew!?

I’ve written a couple of times (here and here) about my dislike of the imperfect science of body mass index. In particular, I’ve stated that it does not accurately assess the elderly because of low muscle mass. The elderly are likely to have a “healthy” BMI despite being anything but. As people age they lose weight through muscle loss. This brings their BMI down and may even bring it into what is considered an optimal range. The problem is muscle mass loss reduces strength, which increases the likelihood of falls and a reduced ability to exercise. The last point is particularly problematic.

Now new research shows that when it comes to longevity, a focus on weight loss may be misplaced. Because BMI isn’t actually a very reliable indicator of life span. A more useful measure, some physicians say, might be muscle mass. Researchers analyzed BMI and muscle mass data from more than 3,600 seniors in a long-term study. And they tracked which seniors had died, a decade later. Turns out BMI wasn’t much good at predicting chance of death.

But muscle mass was: more muscle meant better odds of survival. The study appears in The American Journal of Medicine. [Preethi Srikanthan and Arun S. Karlamangla,Muscle Mass Index as a Predictor of Longevity in Older-Adults]. For more information see here.

Critics argue that it’s nearly impossible for the elderly to build muscle. I think they are missing the point. It’s not necessarily that the elderly need to bulk up. It’s that they need to minimize muscle loss. This is done through resistance training. Anyone, yes even the elderly, can resistance train. By doing so muscle loss is minimized. This may mean you don’t fit into the BMI scale perfectly, however, it does mean you are healthier. So, here’s to weight lifting!

35 Points From A Body Transformation Contest

Recently, I entered into a 6-week body transformation challenge at the gym I belong to. It’s called KDR Fitness. Great place. It began February 10th and ended March 22nd. It was technically 41 days long. I decided to enter because I needed a kick in the butt to get back to the gym. In the previous year gym days were hard to come by. With a brand new baby and practice, my gym time was way down. To top it off, I had a neck injury that took me completely out of the gym for 3 months at the end of the year. As a consequence my body fat had increased to 21.7%. Not ideal for me. During the contest, I recorded my diet and exercised in order to lose body fat and gain lean mass. I wore a heart rate monitor for all of my workouts to calculate my calories burned and generally keep track of my workouts. Here are the things I learned:

1. I started at 21.7% body fat.
2. By the 4th week I was down to 19.4%
3. By the end of the 6th week, I was down to 18.4%
4. I gained 3.7 pounds of muscle in 6 weeks.
5. I lost 7 pounds of fat in 6 weeks.
6. I missed the gym.
7. I worked out 25 times in 41 days.
8. That’s 4 workouts per week with an occasional 5th thrown in.
9. I ate MORE food than I had been eating and was able to lose fat and gain muscle.
10. I burned 15,655 calories in 25 workouts.
11. Each workout was about 1 hour.
12. Each workout burned an average of 626.2 calories.
13. The range of calories burned was 273 all the way up to 958.
14. It is not that hard for me to avoid grain.
15. I can count on one hand how many times I ate grain in 41 days (and it’s less than the whole hand).
16. Cheat meals are important.
17. This was a typical day in terms of food intake:
    Wake Up: 6:15
    Food for the day:
    Breakfast: 6:45 – 3 eggs, mixed veggies, and cheese cooked in butter. Coffee with organic half and half.
    Snack: 10:15 – 3 large beef and veggie meatballs, carrots, celery, and hummus.
    Lunch: 12:20 – Chicken breast, mixed peppers, 1 whole avocado.
    Snack: 3:30 – Protein shake, steamed broccoli.
    Workout – 60 minutes – protein/carbohydrate workout drink
    Dinner: 6:45 – Meatloaf, steamed broccoli and cauliflower with olive oil.
    Snack: 9:15 – Greek yogurt and banana.
18. Food preparation is key.
19. Eating 6 times per day isn’t that hard IF you’re prepared.
20. Eating a lot of vegetables is fairly easy IF you’re prepared.
21. You don’t necessarily have to count calories if the quality of your food is good.
22. You can eat A LOT of food if you are working out hard and still lose weight.
23. Burpees get easier the more you do them.
24. Working out more consistently makes you want to workout more consistently.
25. Using the scale to measure your progress is a bad idea.
26. My weight changed from 190.9 to 187.6 in 6 weeks. Hardly encouraging if you’re just looking at the scale.
27. Body fat analysis is far more informative.
28. You only have time for the gym if you make time for the gym.
29. You don’t need to be in the gym 7 days/week.
30. Two busy people (my wife and I) can each take turns working out during the week and get great results.
31. You should be willing and able to do an extra workout or two from home if you need to.
32. You can turn snow blowing and shoveling your driveway into a workout quite easily.
33. Body mass index (a measure of height to weight) is a terrible health assessment tool. According to it, I am “overweight.” This is because my lean mass is high, not because I am actually overweight.
34. My basal metabolic rate (calories I burn at rest over 24 hours) increased from 1,835 to 1,870 over six weeks.
35. The area of my body that gained the most muscle (as percent growth) was my left arm.

I was on a team of three and our entire team (Bro’s before Hoho’s) did very well. The winning team will win $3,000. I’ll find out in a couple of days which of the 18 teams won the contest. That’s not the important part, but it sure would be nice!

Sugar, Sugar, Sugar

Do you eat “healthy?” Or, perhaps a better question should be ‘DID you think you ate healthy,’ before this post?

Food labeling is VERY misleading. Don’t be fooled. Get educated! High sugar consumption increases the risk of diabetes, heart disease, high blood pressure and Alzheimer’s disease!

Is this really a “healthy” diet?

 

 

Time Saving Tips For Healthy Eating

If you want to be healthy, eating correctly is a critical part of the equation. Often, eating healthy is associated with taking too much time. It doesn’t have to be that way! Click below for some awesome tips!

Nutrition and Health Guidelines

Last month was national nutrition month and we posted some staggering statistics on the health of the nation. Today we’d like to give you some guidelines to help improve those statistics.

It’s not enough to just change your diet. It’s important to get out and move your body too. In addition, if you are under a lot of stress either emotional or physical it can affect your health. Lack of sleep is often overlooked when people are struggling to meet their health goals. If you would like more information on how these affect you, don’t hesitate to contact Dr. Court in the office.

 

National Nutrition Month

As the first of a two-part infographic series, below are some of the scary, yet changeable, statistics we are facing in this country regarding health. March is National Nutrition Month so it’s a great time to make a change for yourself. Check it out!

We need to make some changes, and quickly!