I promised you some info on cholesterol, fat, and heart disease. I apologize in advance for the large amount of information at once, which may be overwhelming, confusing, and perhaps unhelpful. (I actually trimmed this down from an even longer draft, if you can believe that.)
If you want to learn more, I'd be happy to send you more information. Please feel free to ask questions if you have any. Cholesterol is a very confusing substance and frankly, most medical doctors do not have a clue about it (in my humble and non-expert opinion).
Some of the links below to peer-reviewed journal articles may not work for you, since I have access to those articles through IU. If you want a copy of an article you can't access, just let me know.
Best regards,
Jae
Eating Cholesterol does not raise serum cholesterol -- the 1955 peer-reviewed article that demonstrated that increasing dietary intake of cholesterol has an insignificant impact on serum cholesterol in (adult male) humans. Humans self-manufacture the vast majority of the cholesterol they need. Why do the AHA, ADA, ACS all tell us to limit our cholesterol intake? It makes no sense. (The article was actually written by researchers who were trying to prove that eating cholesterol is harmful. When they discovered that it wasn't, they modified their hypothesis to say that eating fat, especially saturated fat, was harmful because it elevated serum cholesterol.)
"What if it's all been a big fat lie?" -- the NYT Magazine article by Gary Taubes, award-winning science journalist. Great summary article about major questions behind the idea that dietary fat causes heart disease.
The French Paradox: French people eat more saturated fat and yet have lower rates of heart disease.
The Israeli Paradox: Israelis eat a lot more polyunsaturated fat, which is supposedly healthy because it lowers serum cholesterol. But they have the highest heart disease rates in the region.
The Diet-Heart Hypothesis -- a great blog post dissecting the lipid hypothesis. The author, Stephan, has a PhD in neurobiology but his passion is nutrition, and his posts are always well thought-out. In the past, some people have told me that they don't take my claims seriously because I keep linking to this blog and not to peer-reviewed articles. I hope you can see that 1) he cites peer-reviewed articles in his blog and 2) the level of thinking he exhibits is far greater than what you see in typical peer-reviewed articles on nutrition science.
Subdividing Lipoproteins -- a blog post by the same guy, about research on saturated fat and its impact on cholesterol profiles. Sat fat seems to improve cholesterol overall. The surprising conclusion is that eating saturated fat is probably the best way to improve your cholesterol profile, in direct opposition to what the AHA suggests. Now, the French/Israeli paradoxes are starting to make more sense.
Most cardiac patients have low or normal LDL. Then why do doctors insist on measuring it and prescribing statins if LDL is high? The article's conclusion is that "well, our guidelines for LDL may be too high. We need to push the LDL guidelines even lower." I think this is completely wrong. LDL is not a good indicator of heart disease risk, period. This makes more sense in light of the blog post above regarding "Subdividing Lipoproteins."
Did you know that most blood tests don't even measure LDL? They calculate it through a (sometimes wildly inaccurate) formula.
Forty eight (!) studies demonstrating that in the elderly, higher cholesterol is associated with lower mortality. (The site is in Portuguese but the studies are summarized in English.) Okay, so lowering your cholesterol might lower your risk of heart disease (although I think not); but what's the good if it increases your risk of dying from cancer, Alzheimer's, and other chronic illnesses? Personally, I'd rather die of a heart attack than after a prolonged and painful fight with cancer. (For info on cholesterol and Alzheimer's see the bonus section at the bottom of this email.)
Women may not benefit from statins. From the always dubious TIME magazine (although they happened to get this mostly right, in my opinion): "Yet there is little evidence that [statins] prevent heart disease in women. In past research, statin therapy has been shown to prolong the lives of people with heart disease. It has also been shown to stave off the onset of heart disease in healthy at-risk adults. But researchers who have broken out and analyzed the data on healthy female patients in these trials found that the lifesaving benefit, which extends to men, does not cross the gender divide. What's more, there's evidence that women are more likely than men to suffer some of the drugs' serious side effects, which can include memory loss, muscle pain and diabetes."
A peer-reviewed study on women and statins:Drug Treatment of Hyperlipidemia in Women: "Conclusions For women without cardiovascular disease, lipid lowering does not affect total or CHD mortality. Lipid lowering may reduce CHD events, but current evidence is insufficient to determine this conclusively. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total mortality."
Here's one that may be of particular interest to you: Japanese subjects with total cholesterol higher than 240 mg/dL have the lowest risk of overall mortality (PDF, 2.2 mb). Particularly interesting for you may be this sentence: "We suggest that Japanese subjects with cholesterol levels ≥ 240... should not be regarded as hypercholesterolemic or dyslipidemic except when having some genetic disorders like familial hypercholesterolemia because they are in the safest ranges in terms of all-cause mortality." How confident can we be that a TC of 250 or even 300 is pathological? Not very. "What if it's all been a big fat lie?" -- the NYT Magazine article by Gary Taubes, award-winning science journalist. Great summary article about major questions behind the idea that dietary fat causes heart disease.
The French Paradox: French people eat more saturated fat and yet have lower rates of heart disease.
The Israeli Paradox: Israelis eat a lot more polyunsaturated fat, which is supposedly healthy because it lowers serum cholesterol. But they have the highest heart disease rates in the region.
The Diet-Heart Hypothesis -- a great blog post dissecting the lipid hypothesis. The author, Stephan, has a PhD in neurobiology but his passion is nutrition, and his posts are always well thought-out. In the past, some people have told me that they don't take my claims seriously because I keep linking to this blog and not to peer-reviewed articles. I hope you can see that 1) he cites peer-reviewed articles in his blog and 2) the level of thinking he exhibits is far greater than what you see in typical peer-reviewed articles on nutrition science.
Subdividing Lipoproteins -- a blog post by the same guy, about research on saturated fat and its impact on cholesterol profiles. Sat fat seems to improve cholesterol overall. The surprising conclusion is that eating saturated fat is probably the best way to improve your cholesterol profile, in direct opposition to what the AHA suggests. Now, the French/Israeli paradoxes are starting to make more sense.
Most cardiac patients have low or normal LDL. Then why do doctors insist on measuring it and prescribing statins if LDL is high? The article's conclusion is that "well, our guidelines for LDL may be too high. We need to push the LDL guidelines even lower." I think this is completely wrong. LDL is not a good indicator of heart disease risk, period. This makes more sense in light of the blog post above regarding "Subdividing Lipoproteins."
Did you know that most blood tests don't even measure LDL? They calculate it through a (sometimes wildly inaccurate) formula.
Forty eight (!) studies demonstrating that in the elderly, higher cholesterol is associated with lower mortality. (The site is in Portuguese but the studies are summarized in English.) Okay, so lowering your cholesterol might lower your risk of heart disease (although I think not); but what's the good if it increases your risk of dying from cancer, Alzheimer's, and other chronic illnesses? Personally, I'd rather die of a heart attack than after a prolonged and painful fight with cancer. (For info on cholesterol and Alzheimer's see the bonus section at the bottom of this email.)
Women may not benefit from statins. From the always dubious TIME magazine (although they happened to get this mostly right, in my opinion): "Yet there is little evidence that [statins] prevent heart disease in women. In past research, statin therapy has been shown to prolong the lives of people with heart disease. It has also been shown to stave off the onset of heart disease in healthy at-risk adults. But researchers who have broken out and analyzed the data on healthy female patients in these trials found that the lifesaving benefit, which extends to men, does not cross the gender divide. What's more, there's evidence that women are more likely than men to suffer some of the drugs' serious side effects, which can include memory loss, muscle pain and diabetes."
A peer-reviewed study on women and statins:Drug Treatment of Hyperlipidemia in Women: "Conclusions For women without cardiovascular disease, lipid lowering does not affect total or CHD mortality. Lipid lowering may reduce CHD events, but current evidence is insufficient to determine this conclusively. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total mortality."
Coronary heart disease is extremely rare -- nearly unheard of -- in "primitive" populations that do not eat industrially produced foods (processed food, sugar, trans fats, industrially produced "vegetable" oils such as corn oil, soybean oil, canola oil). Links:
Ischemic Heart Attacks: Disease of Civilization
Masai and Atherosclerosis
The Kitavans: Wisdom from the Pacific Islands
If you really want to dig deeper into a reputable source who has done research on cholesterol, I'd recommend checking out Gary Taubes's Good Calories, Bad Calories. He also has a shorter book called Why We Get Fat, which presents the same ideas and more research, but in language that is easier to read. In these books, Taubes criticizes the conventional medical thinking on cholesterol, fat, obesity, and heart disease (loosely speaking, the "lipid hypothesis"). He also presents his own ideas about what is really going on: the carbohydrate hypothesis. I happen to think that the carbohydrate hypothesis is incorrect, or at least very incomplete. However, his criticisms of the lipid hypothesis (and the related "diet-heart hypothesis") are excellent.
------
In summary:
I think the idea that serum cholesterol causes heart disease is probably incorrect. Cholesterol is probably more like the firefighters who are dispatched to the fire. Elevated LDL is not a cause of heart disease. It is probably a marker of something else that has gone wrong in your body. The best hypotheses we have now are that it is a sign of inflammation or of oxidizative damage. LDL is your repair staff, not your body's attempt to kill you.
I think that statins are frankly dangerous and do more harm than good for the vast majority of people who take them, especially women who have never had a cardiac event.
If there is any marginal benefit of taking statins (for men), it is probably due to the statin's anti-inflammatory effect. You can get the same benefit (actually much more) from avoiding inflammatory foods -- namely, industrially produced vegetable oils, trans fats, sugar, wheat. (I suppose wheat is more of an agricultural product than an industrial one. Still, it tends to be pro-inflammatory.) The traditional Masai do not take statins, and they subsist on a high-saturated-fat and high-cholesterol diet. Same goes for the traditional Inuit. And the Tokelau. And their rate of heart disease is near zero. And it's not just genetics, because when these people start eating more industrialized foods, they start getting heart disease just like us.
Please keep in mind I am not a medical professional and am not qualified to give medical advice. However, as a person of reasonable intelligence who has read a lot of research that most medical doctors have not, I think it is reasonable to question whether the current medical thinking on cholesterol and statins is wholly incorrect.
Some of the evidence presented here is rock-solid, while in others it is more controversial (e.g., in the articles on dementia and suicide, below). If you look for confounding or contradictory evidence, you will find it, and I encourage you to do so.
My goal is not to show you that my ideas about cholesterol are correct, but rather to demonstrate that the evidence behind the demonization of fat/cholesterol is weak and inconclusive at best, not incontrovertible as the AHA, AMA, ACS, ADA and the other abbreviated agencies would have you believe.
-----
Bonus links: I almost didn't include this because this email is already too long, but it's important information:
Low serum cholesterol is linked with dementia in hundreds of studies, as well as with depression, suicide, violent behavior, and even increased risk of deaths from accidents. Your brain needs cholesterol to function properly. Taking statins to lower cholesterol may increase your risk of Alzheimer's as well as other unpleasant things. Links:
Depression: Association of low serum total cholesterol with major depression and suicide.
RESULTS: Low serum total cholesterol was associated with low mood and subsequently a heightened risk of hospital treatment due to major depressive disorder and of death from suicide. CONCLUSIONS: Our resultssuggest that low serum total cholesterol appears to be associated with low mood and thus to predict its serious consequences.
Suicide: Low serum cholesterol in suicide attempters
Cholesterol concentrations in suicide attempters were found to be significantly lower compared with both psychiatric and normal controls, when sex, age, psychiatric diagnosis, and physical conditions (serum total protein and red blood cell count) were adjusted for. This significant relationship was observed in mood disorders and personality or neurotic disorders, but not in schizophrenia spectrum disorders. These results support the previous claim that lowercholesterol level is associated with an increased risk of suicidal behavior.
Violent behavior: Cholesterol and violence: is there a connection? This one is especially interesting because the data include experimental studies (meant to establish causation rather than mere association).
DATA SYNTHESIS:
Observational studies (including cohort, case-control, and cross-sectional studies) consistently showed increased violent death and violent behaviors in persons with low cholesterol levels. Some meta-analyses of randomized trials found excess violent deaths in men without heart disease who were randomly assigned to receive cholesterol-lowering therapy. Experimental studies showed increased violent behaviors in monkeys assigned to low-cholesterol diets. Human and animal research indicates that low or lowered cholesterol levels may reduce central serotonin activity, which in turn is causally linked to violent behaviors. Many trials support a significant relation between low or lowered cholesterol levels and violence (P < 0.001).CONCLUSIONS:
A significant association between low or lowered cholesterol levels and violence is found across many types of studies. Data on this association conform to Hill's criteria for a causal association. Concerns about increased risk for violent outcomes should figure in risk-benefit analyses for cholesterol screening and treatment.
Dementia and Alzheimer's: too many to wade through, but here's one article:
Twenty-six-year change in total cholesterol levels and incident dementia : The Honolulu-Asia aging Study
Results: Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents. Conclusion: A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.
No comments:
Post a Comment