cholesterolTag Archives

Eat fat, lose fat

I’m currently reading Eat Fat, Lose Fat by Mary Enig and Sally Fallon. Mary Enig was a key scientist in the fight to get trans fats listed on our nutrition labels. She was actively opposed by the Institute for Shortening and Edible Oils (ISEO). This is an organization that pulls political clout to prevent the funding and publication of research intended to study the harm of vegetable oils and shortening. This organization was incensed about the fact that Mary Enig’s initial paper on the subject had gotten published at all. They have industry watchdogs to prevent such an occurrence, but somehow the paper managed to slip through their scrutiny. Doctors and scientists had been questioning the use of vegetable oils and trans fats since the 1920s when they were beginning to come into popular use. Myocardial infarctions (what we know of as heart attacks) were unheard of prior to the advent of the use of these fats. But their concerns got drowned out by the proponents of the cholesterol theory of heart disease, which would include organizations such at the ISEO and the pharmaceutical industry since they stand to gain from it.

According to Mary Enig and Sally Fallon, lack of healthy fats contributes to several diseases including chronic fatigue, low energy, anxiety, depression and mood swings, hypoglycemia, insulin resistance, food cravings, gallbladder ailments, bacterial infections, fungal issues, viral infections, irritable bowel syndrome and Crohn’s disease, gas and bloating, eczema and dry skin, sagging and wrinkled skin, dandruff, and cellulite. They propose a diet that has coconut oil and cod liver oil to correct these issues that they believe to be the result of lack of healthy fats. They also say that dietary cholesterol is important for maintaining the health of the intestinal wall and preventing leaky gut. Their list of sources for healthy fats: coconut oil, butter, cream, nuts, meats, and eggs as well as cod liver oil.

How atherosclerosis develops

I continue to read Deep Nutrition by Catherine Shanahan MD. According to Dr. Shanahan, the most dangerous foods are vegetable oils, sugars, and foods that convert to sugar during digestion. She gave an interesting description of how the two combine to create coronary artery disease. I’ve never seen it laid out quite the same before. It’s a very compelling description of the process if it’s true. It actually explains how the epithelial lining of the arteries becomes injured in the first place, which is something other explanations fail to do.

To sum it up, sugar in the bloodstream damages lipoproteins (HDL, LDL, VLDL). The lipoproteins, in turn, spill their loads into the bloodstream where it should not be. If that load contains mega-trans-fats from damaged vegetable oils (which happens when heat is applied, either during production or cooking), those fats cause oxidative damage to the fats in the membranes of the cells of the epithelial lining of the arteries, resulting in a literal burning of the cells. Gruesome! The body then attempts to repair that damage by sending cholesterol and white blood cells to the injured site. These repairs become the arterial plaques of atherosclerosis.

Diet modification results

Cholesterol results are in.  As you all know too well, I’d been very concerned that my levels might drop too low due to the dieting.  I have made modifications to my NutriSystem plan with the intention of preventing this.  I have decreased the carbohydrateI am pleased to report that what I am doing is working.  The total was 180, which is right where I want it.  HDL was 71, which is high on the lab’s scale.  I believe this is a good thing.  LDL was 100, and VLDL was 9.  Total to HDL ratio was 2.54, which is low on the lab’s reference range.  I believe this is also a good thing.  Triglycerides were 46, which is toward the low end of the scale.  I would say that my diet modifications have been successful.  I’ve been able to maintain healthy cholesterol levels, and that was my goal.  Glucose was 88, which is acceptable.

The diabetes, heart disease, and the lipid hypothesis

It boggles my mind that high-carbohydrate diets are recommended to diabetics even though the carbohydrates will increase their insulin needs. The recommendations come out of a faulty belief in the lipid hypothesis. The intent is to prevent the heart disease that often accompanies diabetes. Those on the lipid hypothesis bandwagon like to cite Ancel Keys, but his study fell apart when confounding factors such as accuracy of the reporting of cause of death country to country were looked at. High- carbohydrate diets do lower cholesterol. I can even attest to that from my own experience with the vegan diet. But more recent studies are showing that there is no clear relationship between cholesterol and heart disease. T. Colin Campbell could not find one in his extensive study of the Chinese, and he very much would have liked to since it would have supported his assertion that a vegan diet is healthier. Never mind that the vegans were dying of infectious diseases and malnutrition at a higher rate.

Have you noticed that guidelines relating to cholesterol have been changing? It used to be that they told us that all cholesterol was bad. Then they told us that HDL was a good cholesterol and needed to be high and LDL was the bad cholesterol. Now they’re telling us that not all LDL is bad. It’s only the small dense LDL that’s bad. Such a change over the years! By the way, a high-carbohydrate diet increases the harmful small dense LDL. Some studies do show that heart disease improves when cholesterol is lowered by cholesterol drugs. But there may be another effect at work. The American Heart Association published a study showing that statins decrease inflammation, and this effect may actually be the beneficial action of the drugs.

With the lipid hypothesis falling apart, the rationale for recommending a low-fat/high-carbohydrate diet to diabetics falls by the wayside, or at least it should. Doctors who have suggested anything else have lost their jobs even though their results have proved their recommendations to be valid. So there’s a disincentive in the industry for jumping off the high-carbohydrate bandwagon even if it might actually be wrong. Many doctors are frustrated by the lack of improvement in their diabetic patients, but they’re also afraid to stray from the standard recommendations. A high-carbohydrate diet increases the need for insulin, which is a dangerous situation for a diabetic. Plus, as mentioned, it increases the worst kind of cholesterol. It’s far better to pursue a diet that decreases the need for insulin, I think.

Triglycerides have been shown to be more strongly linked to heart disease than cholesterol is. A high-carbohydrate diet increases triglycerides, too. If you are trying to prevent heart disease and diabetes, a closer look is definitely warranted. The standard protocol may not be the best one.

The positive correlation of wheat to heart disease proved to be interesting. Wheat has a correlation of 0.67 with heart disease—which is the strongest association between any food and heart disease found in the China Study. This is of particular concern given that the recommended high-carbohydrate diet often contains a lot of wheat. I picked the correlation out of a table from a post on animal protein, but apparently I was not the only one to notice. The blogger, Denise Minger, did an entire post on that correlation elsewhere in the blog. She took the data from China Study II and attempted to determine if the wheat/heart disease correlation was confounded by any other factors. With every combination she tried, the wheat/heart disease correlation held up. T. Colin Campbell, an author of China Study II, wrote a paper on the link back in 1996. The theory is that the correlation has something to do with the insulin index of wheat compared to rice. The insulin index of the rice is quite low compared to its glycemic index while the insulin index of wheat is high. In other words, wheat stimulates a higher output of insulin than rice does. I took a look at a chart listing the insulin scores of foods compared with their glucose scores. Rice did indeed have an insulin score much lower than its glucose score, both for brown rice and for white rice, which made it rather unique among carbohydrate sources on the list.

Denise Minger looked through the literature to see if there were any research studies relating to wheat and heart disease. Apparently, there were very few. It isn’t something researchers are looking at. Most wheat related research looked at things like whole grain vs. processed grain. She did find an old rabbit study that looked at wheat germ vs. various oils and atherosclerosis and a human study that looked at wheat bran vs. flaxseed and insulin sensitivity and C-reactive protein. In both studies, the wheat group fared worst. The wheat connection is definitely something that deserves a closer look. Hopefully, other scientists picked up on it and will do some studies.

It would not surprise me if the link held up under closer scrutiny. Gluten, a protein in wheat, has already been found to cause problems in relation to other disorders. I am at present trying to get my daughter to try a gluten free diet to see if it will help improve her neuropathy. The doctors think now that the neuropathy is a rare autoimmune reaction related to her cancer. Supposedly, gluten-free diets have improved neuropathy. Gluten-free diets have been shown to help other autoimmune disorders as well.

References:
T. Colin Campbell. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health. BenBella Books (May 11, 2006).
Denise Minger. “Forks Over Knives”: Is the Science Legit? (A Review and Critique), Raw Food SOS.
Denise Minger. The Truth About Ancel Keys: We’ve All Got It Wrong, Raw Food SOS.
Denise Minger. The China Study: My Response to Campbell, Raw Food SOS.
Denise Minger. Heart Disease and the China Study, Post #1.5, Raw Food SOS.
David J. Lefer, PhD. Statins as Potent Antiinflammatory Drugs, Circulation 2002; 106: 2041-2042, American Heart Association.

Critiques of the science behind plant-based diets

I’ve been reading a lot of blogs about dietary studies. A blog of particular interest is Raw Food SOS by Denise Minger. One of her posts tore apart Ancel Keys’ 22 country data. That data is often cited as proof that dietary fat causes heart disease. By the time Denise Minger got done with it, the data from the 22 countries more likely proved only that richer countries that could afford better medical care were better able to determine cause of death. In other words, the Keys study and data were rendered meaningless.

And another post dissects the movie Forks over Knives and critiques the science in that movie. So far, it isn’t looking good for the movie. Forks over Knives promotes a plant-based or vegan diet. I tried a vegan diet for about three months not so long ago. I ran into problems with it. I began developing a physical form of depression. Fortunately, my mood was still generally good. I had my blood checked, and my cholesterol had dropped too low. The total was 147. My psychiatrist was concerned. He wants to see the total be at least 160. Low cholesterol is associated with depression and other mental disorders. So I stopped being vegan and eventually recovered. As you can tell, I am not a fan of veganism. For me, at least, veganism is a dangerous diet. Generally, though, depression is more common among vegans, so it isn’t just me. One of my lowest total cholesterol readings, 125, coincided with my first round of NutriSystem back in 1990 or so. It also coincided with my diagnosis of bipolar disorder. And that, folks, is why I have adjusted my diet. I’m trying to keep my cholesterol levels from falling. I’ll have blood drawn to test cholesterol on Thursday to see if my strategy is working. I’m optimistic. My mood has been good so far this round.

References:
Denise Minger. The Truth About Ancel Keys: We’ve All Got It Wrong, Raw Food SOS.
Denise Minger. “Forks Over Knives”: Is the Science Legit? (A Review and Critique), Raw Food SOS.
Chris Masterjohn. My Experience With Vegetarianism, cholesterol-and-health.com.
Shin JY, Suls J, Martin R. Are cholesterol and depression inversely related? A meta-analysis of the association between two cardiac risk factors. Ann Behav Med. 2008 Aug;36(1):33-43. Epub 2008 Sep 12.
Michael Pekker. Could Eating A Vegan Diet Cause Depression? Clinical Depression: Symptoms and Treatment.

Challenging the current diet advice paradigm

I am currently rereading “Why We Get Fat and What To Do About It” by Gary Taubes. I saw Gary Taube’s lecture online in Dr. Mercola’s article, “These Vilified Foods Help Build Hormones and Tame Your Appetite,” and wanted to review his book. Gary reported on how the low-fat advice for heart health became a government recommendation. Back in 1984, the National Heart, Lung, and Blood Institute launched a massive health campaign. “At the time, the NHLBI experts lacked confidence in the fat/heart-disease connection, for good reason: the institute had spent $115 million on a huge, decade-long clinical trial to test the idea that eating less saturated fat would curb heart disease, but not a single heart attack had been prevented. This could have been taken as reason to abandon the idea entirely, but the institute had also spent $150 million testing the benefits of a cholesterol-lowering drug, and this second trial had succeeded. So the institute’s administrators took a leap of faith, as one of them, Basil Rifkind, later described it: They had spent twenty years and an inordinate amount of money trying to demonstrate that cholesterol-lowering, low-fat diets would prevent heart disease, Rifkind explained, and they had, up until then, failed. Trying again would be too expensive and would take at least another decade, even if the institute could afford it. But once they had compelling evidence that lowering cholesterol with a drug would save lives, it seemed like a good bet that a low-fat, cholesterol-lowering diet would as well. ‘It’s an imperfect world,’ Rifkind had said. ‘The data that would be definitive are ungettable, so you do your best with what is available.’” They declared the diet study to be flawed and went ahead with their health campaign.

But here’s the thing: the effect of a drug is not limited to the purpose it was developed for. When the cholesterol lowering drug trial succeeded, it was assumed that the cause of the success was the lowering of the cholesterol, but that may not actually be the case. In 2003, the American Heart Association reported this: “Statins Promote Potent Systemic Antioxidant Effects Through Specific Inflammatory Pathways.” In the conclusion, they state, “Statins promote potent systemic antioxidant effects through suppression of distinct oxidation pathways. The major pathways inhibited include formation of myeloperoxidase-derived and nitric oxide–derived oxidants, species implicated in atherogenesis. The present results suggest potential mechanisms that may contribute to the beneficial actions of statins.” So now we have a major health organization reporting a cause of benefit for statins other than its cholesterol lowering effects. Given that multiple studies have not shown a heart health benefit for following a cholesterol-lowering low-fat diet, perhaps the original NHLBI study on low-fat diets was not flawed after all. In other words, following a low-fat diet may not actually be heart-healthy as we’ve been led to believe for the past nearly 30 years.

A closer look at the effects of a low-fat diet reveal that the opposite may be the case. A low-fat high-carbohydrate diet will:

  • decrease HDL cholesterol
  • increase triglycerides
  • increase the harmful small dense LDL cholesterol while decreasing the large fluffy healthy LDL cholesterol
  • increase insulin in the blood, thereby increasing the risk of insulin insensitivity and metabolic syndrome

The A TO Z Weight Loss Study published in The Journal of the American Medical Association in 2007, gives an indication of what may actually be the best diet for losing weight and improving heart health. The winner in the study surprised even the researchers. This study compared four diets: the Atkins diet, a traditional low-fat diet, the Ornish diet, and the Zone diet. Those on the Atkins diet lost the most weight, and they had the best results for heart disease risk factors. Keep in mind that the Atkins dieters did this while eating as much food as they wanted while those on the other diets were restricting their calories. “The point man on this trial was Christopher Gardner, director of Nutrition Studies at the Stanford Prevention Research Center. Gardner presented the results of the trial in a lecture that’s now viewable on YouTube—“The Battle of Weight Loss Diets: Is Anyone Winning (at Losing)?” He begins the lecture by acknowledging that he’s been a vegetarian for twenty-five years. He did the study, he explains, because he was concerned that a diet like the Atkins diet, rich in meat and saturated fat, could be dangerous. When he described the triumph of the very low-carbohydrate, meat-rich Atkins diet, he called it ‘a bitter pill to swallow.’”

Video: Gary Taubes—Why We Get Fat and What To Do About It

Video: Christopher Gardner—The Battle of Weight Loss Diets: Is Anyone Winning (at Losing)?

Your doctor’s advice may not be so great

While reading Trick And Treat by Barry Groves, I found information about an important study of heart disease interventions done in Finland. This study is important because the intervention group in this study was given the current standard of care for the prevention of heart attacks. One group was given the standard heart disease interventions: blood pressure medications, cholesterol medications, advice about diet and exercise. The other group was given no interventions. The study shows that while risk factors were improved, the number of deaths including from heart disease was actually higher in the intervention group. In other words, the standard interventions ultimately had the reverse effect of what was intended. Something in the standard treatments isn’t right.

From the book:

One [study] that did seem to support the “healthy” recommendations was a Finnish trial involving 1,222 men published in 1985. Men in the intervention group were seen regularly and advised about diet, physical activity and smoking. Those with high blood pressure or high cholesterol levels were treated with drugs. The men in this group did as they were advised and, as a result, the “predicted risks” for CHD were halved during the trial. It was hailed as a great success because: “The program markedly improved risk factor status.” In other words, they succeeded in changing their subjects’ diets, and so on. In December 1991, the results of a 15-year follow-up to that trial were published. During this period the intervention group had continued to be instructed on diet, smoking and exercise and treated for high blood pressure and cholesterol when present. Were they healthier? Did they live longer? The results are show in the table:

Deaths during 15-year follow-up
Intervention group Control group
Total deaths 67 46
Heart disease deaths 34 14

These figures show that not only did those who continued to follow the carefully controlled, cholesterol-lowering diet had more deaths in total, they were also more than twice as likely to die of heart disease as those who didn’t – some success!

Dr Michael Oliver, Professor of Cardiology at Edinburgh University’s Cardiovascular Research Unit, commenting on these results in the British Medical Journal, wrote that:

This runs counter to the recommendations of many national and international advisory bodies which must now take the recent findings from Finland into consideration. Not to do so may be ethically unacceptable. We must now face the fact that the evidence from large, well conducted trials gives little support to hopes that altering the lifestyle of the community at large, when started in middle age, will reduce cardiac deaths or total mortality.

References:
Barry Groves. Trick And Treat – how ‘healthy eating’ is making us ill. 2008.
Barry Groves’ site: http://www.second-opinions.co.uk/
Miettinen TA et al. Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men, JAMA. 1985;254(15):2097-2102.
Strandberg TE, et al. Long-term Mortality After 5-Year Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men, JAMA. 1991;266(9):1225-1229.
Oliver MF. Doubts about preventing coronary heart disease. BMJ 1992; 304: 393-4.

Stroke reduction in Japan

Cholesterol and animal fat are actually protective against strokes. That’s why Japan has such a high stroke rate. They don’t eat as much animal fat as we do. But they do eat a fair amount of rice, and that can cause damage from the carbohydrates. After the second world war, the Japanese were influenced to eat more like us with more meat and dairy. Their stroke rate went down by 85%.

One of these Japanese studies showed that the benefit came from the animal fat and cholesterol consumed. Those with the highest intake had the lowest incidence of stroke. Animal protein was not significant—just the fat and cholesterol.

The Okinawans, the Japanese people with the longer lifespans, eat more meat and less rice than other Japanese people, and they’re healthier for it.

References:
Barry Groves. Trick And Treat – how ‘healthy eating’ is making us ill. 2008.
Barry Groves. The Dangers of Low Blood Cholesterol, Second Opinions.
Shimamoto T, et al. Trends for Coronary Heart Disease and Stroke and Their Risk Factors in Japan. Circulation. 1989; 3: 503-15.
Adachi H, Hino A. Trends in nutritional intake and serum cholesterol levels over 40 years in Tanushimaru, Japanese men. J Epidemiol 2005; 15:85-89.
Liu L, et al. Changes in stroke mortality rates for 1950 to 1997. A great slowdown of decline trend in Japan. Stroke 2001; 32:1745.
Iso H, et al. Trends of cardiovascular risk factors and diseases in Japan: implications for primordial prevention. Prev Med 1999; 29: S102-S105.
Sauvaget C, et al. Animal protein, animal fat, and cholesterol intakes and risk of cerebral infarction mortality in the Adult Health Study. Stroke 2004; 35: 1351.
Gillman MW, et al. Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997; 278: 2145-2150.
Atkins D, et al. Cholesterol reduction and the risk of stroke in men. A meta-analysis of randomized, controlled trials. Ann Int Med 1993; 119: 136-145.
Dyker AG, et al. Influence of cholesterol on survival after stroke: retrospective study. BMJ 1997; 314: 1584.

Adjusting my diet to avoid potential health issues

It’s important to do the best we can with the plan we’ve invested in. That’s certainly my goal. My big issue with the NutriSystem plan is making sure that my cholesterol level doesn’t tank, and I’m not entirely sure how to do that or even if it can be done. One of my lowest cholesterol readings ever was 125. This was measured following a round of NutriSystem back around 1990, and this also happened to be when I was diagnosed with bipolar disorder. I was suffering with major depression at the time. Somehow, I still managed to function. It’s critical that I don’t let my cholesterol get that low again this time because low cholesterol is a risk factor, and I’ve already seen that my mood dips with my cholesterol readings. My cholesterol readings went down when I was vegan, and I was also beginning to develop depression, so there’s a hint. My intake was very high in fiber while I was vegan, and I know that can lower cholesterol. My guess for this round is that I need to lean my intake toward more fat while, of course, staying in calorie range. I will have blood tests done to make sure that my cholesterol levels stay where they need to be. My mood is good at present at least, so that’s a good sign.

Given the unexpected challenges I have had with my own health, I would advise anyone contemplating making a major dietary change to do so with the assistance of their physician, no matter what your age or how good you think your health is.  At minimum, get a lipid panel done before the change and again a month or two into it.

Critique of studies on which our “healthy diet” advice is based

I just read Dr. Mercola’s critique of the principal studies on which our “healthy diet” advice is based, The Cholesterol Myths that May be Harming Your Health.  It would seem that there’s a lot of misleading information being promulgated.

To start with, Dr. Ancel Keys cherry-picked his cases for the Seven Countries Study back in 1953 when he told us that higher fat intake correlated to higher rates of coronary heart disease.  Had he used data from all 22 countries that had data available, no correlation between dietary fats and coronary heart disease would have been found.

Analysis of the Framingham Study showed that lower blood cholesterol levels were associated with a lower cardiac risk.  What they did not tell us was that the same study determined that the more cholesterol and saturated fat people ate, the lower their blood cholesterol levels.  And yet we were told to lower our cholesterol and saturated fat intakes.

And finally, while the “MrFit” Study did show a marginal decrease in coronary heart disease for those who ate a low-saturated fat and low-cholesterol diet, there was an increased all-cause mortality rate for those who followed such a diet with an increase in deaths from cancer, brain hemorrhage, suicide, and violent death.