Cholesterol – The Risks, The Facts And The Politics

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Is Lowering Cholesterol Bad For Your Health?

Cholesterol – The Risks, The Facts and The Politics is part of a three-part series I wrote debunking several myths. These articles will focus on what cholesterol is, the current medical trend of lowering cholesterol, what elevates the “bad” cholesterol, and how to balance blood fats with a healthy diet and lifestyle, without having to resort yet again to pharmaceutical drugs. I also want to explain some other important heart and circulatory disease causing concepts and reveal to you some other blood markers apart from cholesterol which the medical profession chooses to virtually ignore. You can get these fasting blood tests done through your GP, but don’t hold your breath. You may be told that these markers hold little relevance or are not important when it comes to the health of your heart and circulation, more on this later.

Cholesterol is a molecule of fat

which your body uses to make hormones and cell membranes. Despite its bad rap, cholesterol is most essential to the function of your body, and unnecessarily lowering cholesterol below optimal levels can cause detrimental effects on your body. When deposits of cholesterol form unwanted build-ups inside your artery walls, however, they can become inflamed attracting the attention of other cells, including cells from your immune system. These microscopic clumps may break off, triggering clots that block blood flow, causing heart attacks and strokes. To explain more about why the “bad” cholesterol”, or low density lipoprotein (LDL) was singled out, we need to look at the Framingham study; this was a government study conducted in Framingham, Massachusetts USA involving over 5,000 people who consented to be tracked throughout their whole lives in order to solve the riddle of what causes heart attacks. And in 1961, the Framingham study indicated that cholesterol may be a factor. The Framingham study singled out LDL or “low-density lipoprotein” as the villain and, in 1977, concluded that LDL (which quickly came to be known as “bad cholesterol”) was a risk factor. But – it was never proved that LDL was the actual cause of heart disease, but that it was implicated in some sense.

The Effect of Dietary Fats on Lipid Results

Type of Fat Dietary Sources LDL effect HDL effect
 Triglyceride effect
Trans Fats Commercially fried foods & prepared snacks and baked goods Increases LDL Slight decrease in HDL No effect
Saturated fats Red meat, cheese, commercially fried and baked foods. Palm oil & some vegetable oils. Increases LDL No effect No effect
Monounsat. Fats Nuts, olives, avocados, olive & canola oils Decreases LDL No effect No effect
Polyunsat. Omega 6 Corn, soybean and safflower margarine oils Decreases LDL May decrease HDL Unknown
Polyunsat. Omega 3 Salmon, hering, flaxseed, walnuts, walnut oil, soy & soybean oil. Variable No effect Decreases
Sterols Margarines with added plant sterols Decreases LDL No effect No effect

Is LDL cholesterol the “Bad Guy”?

When I did a post graduate course in Seattle in 2003, Dr. Alan Gaby, one of America’s leading doctors said that “cholesterol is no more indicated as a leading cause of heart disease anymore than a fire truck is the cause of a fire”. Whilst it is true that you generally see fire trucks around fires, you can’t really say that they actually caused the fire; you can only see that there is a correlation between them both”. The same goes for high cholesterol, you may see an elevation of LDL with heart disease in some (approx. 50%) but not all people with heart disease. Nobody can categorically state that “LDL (the bad cholesterol) causes heart disease”. Despite popular notions to the contrary, there is absolutely no rock-solid scientific evidence that lowering cholesterol has any benefit towards preventing atherosclerosis (your arteries clogging up). In fact, with so many studies, too numerous to mention – almost the opposite appears to be true.

High fat diets – are they really ‘artery clogging’?

Is a high fat diet primarily the cause of your arteries to clog up leading to heart disease? – Not really, as you will see later this is not the case. It is the type of fats we eat, and the fact that we eat the wrong carbs too. Is cholesterol the bad guy that needs lowering at all costs? Not really, according to many leading experts in this field.  Should you take a drug to lower your cholesterol, because you were told that it would prevent heart disease? This may come as a surprise to you – the answer is again no, not really. The question of cholesterol lowering drugs (Statin drugs) yes or no is an important one because of the sheer numbers of people in NZ who take these drugs is in the many hundreds of thousands. You have a right to be very skeptical, particularly when it concerns your health. I do believe that there is a (tiny) place for these powerful drugs, but I also believe they are over-prescribed at the drop of a hat, just like antibiotics used to be, and still are by some.
There is so much to explain with regards to cholesterol that I thought it may be wise to cover this topic over a period of time. I am passionate about this topic, and whilst I like to present material in an unbiased way and show both sides of the coin, I can’t help but feel that the whole debate of “needing to lower the bad cholesterol at all costs” has become a great way for the pharmaceutical companies to skim the cream yet again. The cholesterol drug debate is a bit like the “you need to drink milk or your bones will crumble” debate. The countries with the highest milk intakes actually have the highest rates of osteoporosis, funny that. People today are faced with so many distorted facts about diet, cholesterol and heart disease, and too many blindingly accept what is on offer. Have you ever wondered exactly so many scientists unquestioningly accept the high-fat diet and heart and cholesterol lowering idea, when there is so much evidence to the contrary by just as many scientists? Let’s take a look at the non-believers:

The “Non-Believers”

Dr. Edward Pinckney is an editor of four medical journals and former co-editor of JAMA, the Journal of the American Medical Association. In 1973 he published a book, called ”The Cholesterol Controversy” which summarised all the inconsistencies of the cholesterol myth. Dr. Pinckney describes all the factors that influence blood cholesterol in healthy people and how difficult it is to get a reliable measure of the cholesterol level because of the uncertainties of the analysis: “The level of one’s blood cholesterol is, at best, nothing more than an extremely rough indication of a great many different disease conditions.  At worst, it can be more the cause of stress and the diseases that stress brings on. To alter one’s life style as a consequence of this particular laboratory test may well cause more trouble than it could relieve.  If you have come to believe that you can ward off death from heart disease by altering the amount of cholesterol in your blood, whether by diet or by drugs, you are following a regime that still has absolutely no basis in fact. Rather, you as a consumer have been taken in by certain commercial interests and health groups who are more interested in your money than your life”.Dr. George Mann, a retired American professor in medicine and biochemistry, along with a growing body of highly qualified scientists worldwide, have been questioning to need to lower cholesterol ever since the debate began. Professor Mann’s comment: “Fearing to lose their funding, the scientists who should speak up and stop this wasteful anti science are strangely quiet. Their silence has delayed a solution for coronary heart disease by a whole generation”. From his studies of the Masai people from Africa he realised that diet couldn’t possibly be the main cause of high cholesterol and coronary heart disease. As long ago as 1977, in The New England Journal of Medicine he published a strong argument against the diet-heart idea citing the lack of relationship between dietary habits and blood cholesterol, the lack of correlation between this century’s trends in fat consumption and death rates in the United States, and the disappointing outcome of the cholesterol lowering trials. Do you still believe that those margarine advertisements on the TV are for real? Can a product like margarine lower your risk of heart disease? Yeah right. I’ll bet the Masai have never heard of heart disease, let alone margarine to “lower cholesterol”.

ufferavnskoffEnter Dr. Uffe Ravnskov – Cholesterol Expert

Take a look at this website: The International Society of Cholesterol Skeptics, or Google Professor Uffe Ravnskov. And before you think that Dr. Ravnskov is yet another “internet crackpot”, check out his credentials here. In fact, Dr. Ravnskov has authored one of the 50 most read internationally read medical journal articles (QJM: An International Journal of Medicine): “High Cholesterol may protect against infections and Atherosclerosis”.  Was this article published in the Mad magazine? no, it was published in the prestigious Oxford Journal of Medicine. I invite all cholesterol skeptics to study Professor Ravnskov’s work, particularly those with fat wallets involved in the production, marketing and distribution of “cholesterol lowering” drugs that over 600,000 New Zealanders now take.

“The great tragedy of Science is the slaying of a beautiful hypothesis by an ugly fact.”
 
Thomas Huxley   

Myths Abound In Medicine

“The idea that too much animal fat and high cholesterol are dangerous to your heart and vessels is nothing but a myth”.   Dr. Uffe Ravnskov MD PhD   (acclaimed cholesterol expert) This is a bit like the “eggs cause high cholesterol” myth. According to Dr. Ravnskov: “The truth, were it really known, would send pharmaceutical stocks plunging. In most studies, the increased risk is present only above a level of cholesterol that includes just a small percentage of the total population. (These are the approximately 1% of people with a genetic defect called familial hypercholesteremia.) And women can stop worrying immediately because high cholesterol is not a risk factor for the female sex.

Few comments have been made on this peculiar fact in all the vast literature on cholesterol. When it is mentioned at all, it is said that female sex hormones protect against heart attacks. In fact, it seems more dangerous for women to have low cholesterol than high”. Dr. Bernard Forette, a scientist heading a team of French researchers found that old women with very high cholesterol actually live the longest. The death rate was more than 5 times higher for women who had very low cholesterol. In their report, the French doctors warned against cholesterol lowering in elderly women. But they could as well have warned against cholesterol lowering in any woman, or, to be more precise, in anyone at all.” Dr. Ravnskov went on to show that higher levels of high-density-lipoprotein (HDL, “good” cholesterol) are not protective against CHD, and that lower levels of low-density-lipoprotein (LDL,”bad” cholesterol) are not beneficial, although the associations of each with CHD (coronary heart disease) are present. Dr. Ancel Keys was one of the main proponents of the myth that “high-fat foods raise blood cholesterol.” In a paper published in 1958, Keys showed a graph of the per cent calories from fat in the food of various countries vs. the mean serum cholesterol levels. The data points fell on a straight line, showing an excellent correlation. Dr. Ravnskov added data points from a number of countries deliberately ignored by Dr. Keys, and these fall nowhere near the line. Furthermore, CHD death rates among people in Finland, Greece and Yugoslavia with similar serum cholesterol levels varied 5-fold depending on which area of the country they lived in! I have seen many patients over the years from Russia, where LDL blood fats are a lot higher than in the Western countries, and the life spans of many can be quite considerable, with some people living well into their 80 – 90’s.

Eskimos can have their fat and eat it too

eskimodietImagine living right on the top of the world in the Arctic circle in an igloo.  No TV or radio here because the reception is too bad, there are no supermarkets to buy food items from either. You don’t need a deep freezer, because your whole world is your freezer, and you wouldn’t keep fish fingers, frozen TV dinners, pies or frozen fries smothered in animal fats like lard in your freezer up here, you would eat fresh fish and probably whale blubber instead. In fact, you would eat more fat up here than you have ever eaten in your whole life but yet you don’t end up with heart problems or being obese. Your arctic freezer contains more fatty meals than you will ever find in your take-away and local supermarket put together.

In the early 1900’s researchers discovered that the Inuit Eskimos have diets extremely high in fat yet had very low incidence of heart disease. This is completely contrary to what we believe concerning heart disease and fat. But wait, there is more – the Inuit Eskimos actually were found to have had stable cholesterol profiles and low triglycerides. Their blood platelets also were not as sticky as their American and European counterparts. They could eat fatty foods all day long and yet have healthy hearts – no strokes, no heart attacks. Apparently they could teach us a thing or two about cholesterol management, as they never take cholesterol lowering drugs or high blood pressure drugs. They can literally have their fat and eat it too. We have learned that not all fats are equal, and we now know that there are some fats which are known as essential fatty acids which are necessary for proper health and our bodies cannot produce them. The particular essential fatty acids that the Eskimos are getting in abundance are the Omega-3 fats. The also eat the organ meats of animals and fish, including livers, kidneys and more which contain the fat soluble vitamins A,D, E and K which offer protection against not only heart disease, but cancers, diabetes and the other so called “diseases of modern civilisation”.  We only tend to eat the muscle meats and fry our meats in the wrong kind of fats as well and our intake is very low of the Omega 3s and higher in the Omega 6 as well as the artery clogging hydrogenated (processed) fats. The other important aspect of Inuit life is their level of activity. No remote control on the couch in the Arctic, plenty of outdoor activity.

Atherosclerosis is an ailment characterised by “hardening” of the arteries in which atherosclerotic plaque (raised patches) develop on the (normally thin) inner walls (endothelium) of arteries and obstruct blood circulation. Atherosclerosis would appear to be caused by problems with the blood clotting mechanisms of the body and in particular most likely caused by stress, diabetes, and the heavy consumption of refined carbs and inactivity. There is a growing body of evidence from serious scientists like Dr. Ravnskov and medical research professionals that show the whole war against cholesterol to be completely misguided.

Factors Affecting LDL

  • Insulin. Did you know that even the sugar found in fruit called fructose may increase LDL Cholesterol levels by up to 11% in diabetics? Diabetics need extra caution with fruit and foods found to be high in sugars, as these foods can really increase their LDL and triglyceride levels significantly. Insulin, the hormone which regulates your blood sugar levels can bump up these levels when it is over-secreted or becomes poorly controlled. This will happen with obese people more easily who eat the wrong foods, particularly those who are inactive.
  • Unfiltered (instant) coffee may increase LDL levels. Trials using filtered coffee demonstrated very little increase in serum cholesterol, but the consumption of unfiltered coffee increased serum levels of total and LDL cholesterol.
  • Fish oils may actually increase LDL cholesterol levels marginally – but don’t worry. I often find that when I place a patient on 3000mg of Omega 3 daily, their LDL will go up slightly, and it has never concerned me anyway. Omega3 fish oils are not bad for the heart, and this goes to show that even though fish oils can increase LDL marginally, they confer so many other benefits (probably many we don’t even know about) to the heart and circulation that these effects over ride the increase of LDL. Besides – the Eskimos don’t die of high cholesterol levels. And yet another reason to believe that LDL is not the villain that should not be lowered “at all costs”.
  • Trans-unsaturated fatty acids (TFA) have been consistently shown in multiple and rigorous trials to have adverse effects on blood fats, most notably on the LDL to HDL (bad to good) cholesterol ratio, which is a strong marker of cardiovascular risk. Trans fatty acids – also known as trans fats – are formed when liquid vegetable oils are partially hydrogenated or ‘hardened’ for use as spreads such as margarine, cooking fats for deep-frying, and shortening for baking. Mind you, very low levels of trans fatty acids are also found naturally in meat and milk. Trans fatty acids can be found in various supermarket foods like butter, margarine, crackers, biscuits, snack foods, muesli bars, fried foods, baked goods and other processed foods made with partially hydrogenated vegetable oils. The average impact of TFA induced changes corresponds to tens of thousands premature deaths in America alone. Do you still eat margarine?, whilst touted as being “good for the heart”, margarine may actually increase LDL cholesterol levels due to the large quantity of trans-fatty acids present. As you can see, science in the developed world is responsible for TFAs, people in the undeveloped world (the real world) have no need for supermarkets and their preserved and highly refined foods – and consequently have a much less chance of dying of a stroke or heart attack.

The history of the development of cholesterol lowering drugs

If you want to see the other side of the issue other than what drug companies are claiming, it will literally scare you. More than 100 years ago a German pathologist named Virchow discovered that cholesterol was to be found in the artery walls of people that died from diseases like heart attacks, in which their arteries were blocked. The cholesterol “was found to be responsible” for the thickening of the arterial walls and thus decreasing the diameter in the arteries which leads in most cases to high blood pressure and increased risk of diseases affecting the blood vessels. One of Virchow’s major contributions to medical education was to encourage the use of microscopes by medical students and he was known for constantly urging his students to ‘think microscopically’. Most of the germs which enter our bodies from the outside are quickly killed by the immune system.

But it is the continual bio-chemical imbalances like fungi, bacteria and faulty blood fat metabolism, continually poor and/or nutrient stripped diets, continued stress and low levels of physical activity which affect our bodies on a continual basis that cause us to get chronically sick eventually. They continually transform themselves into pathological processes.So you see, whether or not we get sick and die has very little to do with what germs we “catch”, but has everything to do with whether we keep our bodies free of the dead matter which these germs feed on.
In the 1950s the famous Framingham heart study did reveal the correlation between high blood cholesterol levels and coronary heart diseases. Following up from that study the researchers explored a novel way to lower blood cholesterol levels but here is the crunch – without modifying the diet and lifestyle of subjects suffering with elevated blood cholesterol levels. Again, medicine has chosen the lazy way- give a pill and let the person eat and live the way they chose. A bit like the drug Xenical ®, the drug which helps you to lose weight. I can remember a rather large lady coming to our practice once, asking if me if we had a natural alternative to this drug as she didn’t like the side-effects. Her practitioner told her that “you can eat whatever you want; when you take this drug yet you will still lose weight”. How convenient

Once I read that the American Pediatric Association were recommending wider cholesterol screening for children and more aggressive use of cholesterol-lowering drugs like Statins, starting as early as the age of 8 in hopes of preventing adult heart problems I hit the roof. Whatever happens in America sooner or later happens in NZ. Please tell me that this isn’t true….Children should NOT ever, ever receive a statin drug, sorry, I think we are stooping pretty low as a society if we actually believe and accept that we should be trying to prevent heart disease in an 8 year old with a drug. Cholesterol is an essential chemical for brain and muscle function, and I certainly wouldn’t mess with that for growing minds and bodies. But – the younger you start a person, the higher the profits I suppose.
Michael Oliver, a former professor for metabolic research in London was one of the first to demonstrate that, on average, patients with coronary heart disease more often had abnomal levels of various fats in the blood than healthy individuals did. But professor Oliver in several papers has actually warned against campaigns for cholesterol lowering drugs in the general population, and firmly believes that cholesterol lowering is only sensible in the very few who are at an extremely high risk of heart disease. Professor Oliver like many experts, believes that the very lowering of blood cholesterol may actually be dangerous: “Very little is known about the long-term effects of lowering cholesterol concentrations on the composition of cell membrane”.

Do you really need those drugs to lower the blood fats?

Lowering cholesterol is important and extremely profitable business. But there is a down side to drug therapy; drugs can have many quite severe negative side-effects. If given the choice, would it not be better if you could reduce your cholesterol risk without drug therapy? Next Cholesterol article I will take a good look at the various approaches to conventional cholesterol lowering therapy and the potential side-effects they produce, and explain some more ways you can test to find out what is a more comprehensive way to more fully assess your risk of a stroke or heart attack, other than just checking the cholesterol levels. Read Sarah’s story, her liver was in failure and a Statin drug nearly cost her life.

References

  • Dr. Uffe Ravnskov : http://www.ravnskov.nu/uffe.htm
  • The International Network of Cholesterol Skeptics (THINCS): http://www.thincs.org
  • Jee, S. H., et al. Coffee consumption and serum lipids: a meta-analysis of randomized controlled clinical trials. American Journal of Epidemiology. 153(4):353-362, 2001.
  • Abbey, M., et al. Effect of fish oil on lipoproteins, lecithin:cholesterol acyltransferase, and lipid transfer protein activity in humans. Arteriosclerosis. 10(1):85-94, 1990.
  • Harris, W. S. n-3 fatty acis and serum lipoproteins: human studies. American Journal of Clinical Nutrition. 65(5 Supplement):1645S-1654S, 2000
  • Katan, M., et al. Trans fatty acids and their effects on lipoproteins in humans. Annual Review of Nutrition. 15:473-93, 1995.
  • Mauger, J. F., et al. Effect of different forms of dietary hydrogenated fats on LDL particle size. American Journal of Clinical Nutrition. 78(3):370-375, 2003.

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