The Great Cholesterol Con
Why Everything You've
Been Told About Cholesterol, Diet and Heart Disease is Wrong!
By Anthony Colpo
Fourth Edition
Copyright © 2011 by Anthony Colpo
Smashwords
Edition
This eBook is licensed for your personal enjoyment only.
This eBook may not be re-sold or given away to other people. If you
would like to share this book with another person, please purchase an
additional copy for each recipient. If you’re reading this book and
did not purchase it, or it was not purchased for your use only, then
please return to Smashwords.com and purchase your own copy. Thank you
for respecting the hard work of this author.
All rights reserved. No part of this book may be reproduced, in whole or in part, without written consent of the author; nor may any part of this book be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or by an information storage and retrieval system, without written permission from the author.
Medical
Disclaimer
The
contents of this book are presented for information purposes only and
are not intended as medical advice, nor to replace the advice of a
physician or other health care professional. Anyone wishing to embark
on any dietary, drug, exercise or lifestyle change for the purpose of
preventing or treating a disease or health condition should first
consult with, and seek clearance and guidance from, a competent
health care professional.
The decision to utilize any information in this book is ultimately at the sole discretion of the reader, who assumes full responsibility for any and all consequences arising from such a decision. The author and publisher shall remain free of any fault, liability or responsibility for any loss or harm, whether real or perceived, resulting from use of information in this book.
Financial
Disclosure
The
author does not, and never has, received any form of financial
assistance from industry groups that may stand to benefit from the
information presented in this book. This includes those from the
meat, egg, dairy, nutritional supplement, food, beverage, drug, and
agriculture industries. The author does not hold, trade or speculate
in the stock of companies whose financial status or share price could
potentially be affected by the information presented in this book.
The author is a certified fitness professional who has worked in the capacity of both salaried fitness instructor and freelance personal fitness consultant. The author does not sell food products, nutritional supplements, medical apparatus or fitness equipment.
Table of Contents
Foreword
by Uffe Ravnskov, M.D., Ph.D.
Foreword
by Duane Graveline, M.D., M.P.H.
SECTION
ONE
Why Saturated Fat and Cholesterol Do Not
Cause Heart Disease
Chapter
1: The Big Fat Lie
Why
claims of a coronary heart disease 'epidemic' caused by saturated fat
and cholesterol are completely false
Chapter
2: Cholesterol is Not a Killer
The
true relationship between cholesterol, heart disease, and mortality
Chapter
3: Lower is Not Better
Your
longevity versus the mainstream cholesterol agenda
Chapter
4: Irrelevant Rabbits and the Ungrateful Dead
Why
autopsy and animal studies do not support the lipid hypothesis
Chapter
5: The Vilification of Saturated Fat
How
selective science gave birth to the anti-fat theory
Chapter
6: The Studies You Weren't Told About
The
research linking saturated fat with low rates of CHD and stroke
Chapter
7: Even More Studies You Weren't Told About
Yet
more conflicting epidemiological evidence!
Chapter
8: The Cholesterol Theory on Trial
The
fallacy that clinical trials have proven saturated fat to be harmful
Chapter
9: Diet, Drugs, and Wishful Thinking
Erroneously
equating the effects of diet and drugs
Chapter
10: Money, Politics and Cholesterol
An
unproven theory becomes accepted dogma
Chapter
11: Creating a 'Consensus'
How
scientists 'agreed' to let shady science validate the
anti-cholesterol agenda
Chapter
12: "If We Want Your Opinion, We'll Give it to You!"
How
the food and drug industries actively perpetuate the wildly
profitable cholesterol hypothesis
SECTION
TWO:
What Really Causes Heart Disease?
Chapter
13: Beyond Cholesterol
If
not cholesterol, then what?
Chapter
14: Don't Stress!
Your
heart will be forever thankful
Chapter
15: It's the Food, Stupid!
Real
health requires real food
Chapter
16: The Pseudo-Foods
You
are what you eat--so don't eat junk
Chapter
17: Revenge of the Radicals
How
free radicals can wreck your arteries
Chapter
18: High Blood Sugar
Your
arteries' worst nightmare?
Chapter
19: A Matter of Fats
Why
the type of fat you eat is far more important than the amount
Chapter
20: Just Say Yes to NO
Why
your arteries can't live without nitric oxide
Chapter
21: The Infection Connection
Do
infections cause heart disease?
Chapter
22: The Irony of Iron
Can
you get too much of a good thing?
SECTION
THREE:
Preventing Heart Disease the
Drug-Free Way
Chapter
23: Disrobing the Drug Myth
Do
drugs really provide the most effective protection against CHD?
Chapter
24: If Not Drugs, Then What?
Clinically
proven drug-free methods for preventing CHD
Chapter
25: Heart Frauds
Identifying
the unproven and the useless
Chapter
26: So What Should I Eat?
Constructing
a heart-healthy diet you can live with
Chapter
27: Micronutrient Magic
A
supplement routine that could truly save your life
Chapter
28: An Exercise in Longevity
A
little activity can go a long way
Chapter
29: No Worries
Taking
the sting out of stress
Chapter
30: What About Alcohol?
Is
drinking really good for your heart?
The 'Twelve Commandments' For a Healthy Heart
Appendix A: The Myth of Vegetarianism
Appendix B: The Low Fat 'Gurus': Dean Ornish and Nathan Pritikin
Appendix C: Coronary Intervention: Lifesaver, or Waste of Time?
Appendix D: Testing Your CHD Risk
Appendix E: What About Homocysteine?
Appendix F: Copper Deficiency versus Copper Overload
Appendix G: Is Vitamin E a Heart-Saver?
Appendix H: Familial Hypercholesterolemia: No Indictment of Cholesterol
Appendix I: Why You Should Avoid Ketogenic Diets
The publication of this book would not have been possible without the valued insight, help and encouragement of a number of very special individuals. Foremost among these is Dr. Uffe Ravnskov, M.D., Ph.D., author of the groundbreaking The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. Uffe's book was nothing short of a revelatory experience for me, one that ignited my own desire to conduct a thorough investigation into the cholesterol theory of heart disease. I am most grateful to Uffe for his valued advice and warm praise for my own writing and research efforts.
Helping me along my investigative path were the research and writings of numerous other individuals including, but not limited to, Duane Graveline, M.D., MPH, Mary Enig, Ph.D., Sally Fallon, George V. Mann, Sc.D., M.D., the late Russell L. Smith, Ph.D., and the late John Yudkin, M.D. All of these individuals have my utmost admiration and respect for their willingness to question and criticize faulty paradigms already accepted as gospel truth by their peers. By publishing their contrarian findings, these individuals risked the alienation, derision and financial disadvantages that can arise from speaking out against the status quo--a status quo propagated by extremely powerful vested interests. Thankfully, the risk of ruffling some very well connected feathers was of less concern to them than their allegiance to the truth and to public health.
A huge thank you is owed to Anna Dimasi, who did a terrific job of putting together the cover design for this book at short notice.
Last but definitely not least, I am deeply indebted to my wonderful, selfless mother Eleonora for her never-ending love and encouragement, and for adding to her already long list of known talents by proving to be a valuable research assistant. During the research for this book there were a number of key scientific papers that I could not find in the Melbourne libraries I frequented. Mum's readiness to hunt down and retrieve, at short notice, many of these papers from the well-stocked medical libraries of Adelaide was invaluable, and allowed the writing of this book to continue at a relatively smooth pace.
The assertion that animal fat and high cholesterol cause atherosclerosis and coronary heart disease, known as the 'lipid hypothesis', is probably one of the greatest and most harmful misconceptions in the history of medicine. As a result of this hypothesis, millions of people around the world have made drastic changes to their eating habits and exposed themselves to the many well-documented side effects of cholesterol-lowering drugs. Their efforts have been almost entirely in vain.
An endless stream of studies, published in renowned medical journals, has shown that the anti-cholesterol campaign is not based on scientific evidence, yet it continues to flourish. It is exceedingly difficult to abandon a hypothesis when large numbers of supporting scientists are guaranteed generous financial support from the incredibly prosperous and powerful food and drug producers. Instead, there is great incentive to ignore contradictory studies or misquote them as if they were in fact supportive, which is just what many scientists in this area have done. Most doctors and members of the public, who rarely examine these studies for themselves, remain blissfully unaware of the true facts concerning cholesterol, diet and heart disease.
For decades, a steady procession of concerned, critical researchers has tried to inform the rest of the scientific community and the public about the many fallacies of the diet-heart idea, but with little success. In recent years, however, an increasing proportion of the public has embraced high-fat/low-carbohydrate diets, with their subsequent positive experiences on these diets stimulating an increased scepticism towards the low fat paradigm. Concern is also mounting with each passing day over the ill effects of widely prescribed cholesterol-lowering drugs, the aggressively promoted cash cows of the pharmaceutical industry. The time is ripe, therefore, for an able commentator to demonstrate to the public in no uncertain terms that the lipid hypothesis is scientifically invalid, and why it is so dangerous.
Anthony Colpo is just such a person.
In this timely and urgently needed book, Colpo starts by pointing out the many contradictions inherent in the lipid hypothesis. Meticulously, he dissects the numerous fallacies of the anti-cholesterol campaigners and highlights their blatant misuse of statistics. Colpo presents the reader with numerous examples of how these campaigners have misleadingly presented insignificant findings as 'strong evidence' and kept quiet or explained away any finding that runs counter to their pet hypothesis.
Colpo doesn’t stop there. After having thoroughly demolished the cholesterol hypothesis, he tells the reader what really matters. One of the truly sad effects of the preoccupation with the reigning diet-heart idea is that progress in the search for the real causes of atherosclerosis and cardiovascular disease has been retarded. In his book, Colpo reviews the most important theories; the harmful effects of inactivity and stress, the dangers associated with high blood sugar, nutrient imbalances, homocysteine, trans fats and smoking, the intriguing question about the influence of too much iron and the fascinating research that points to infections as the initiator of arterial damage. Most important of all, Colpo has many suggestions as to how we can improve our chances of living to a ripe old age and maintaining good health without using expensive and dangerous drugs. He tells us about the benefits of vitamins, antioxidants, exercise, stress avoidance and good food. He explains in clear, easy-to-understand terms what exactly constitutes healthful eating and why.
If you are thinking that Colpo is just another guru peddling unsubstantiated claims about health and disease, you are wrong. The most amazing thing about this book’s author is that, although he lacks a formal university education, his writing bears witness of an analytic and critical mind far superior to that of most doctors and medical researchers. And as a true scientist, Colpo gives you a chance to question his conclusions. All of them are based on thorough studies of the medical literature to which he refers. If you find something hard to believe, you can go to a medical library with the relevant references (there are over 1400!) and check for yourself.
–Uffe Ravnskov, MD, PhD.
Independent researcher, spokesman for The International Network of Cholesterol Skeptics (www.thincs.org) and author of The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease.
For over thirty years, the anti-fat, anti-cholesterol paradigm has formed the cornerstone of heart disease prevention policy the world over. I recall clearly, as a medical graduate in 1955, the first rumblings of the cholesterol juggernaut. I remember vividly the novelty and newness of this fledgling theory, and just how quickly it ascended to its present-day exalted status. As the cholesterol tsunami proceeded to sweep over America and subsequently the rest of the world, my colleagues and I rode happily along. We strove to keep our blood cholesterol levels under control by eating low-fat diets, and enthusiastically admonished our patients to do the same. When the first inklings of the Atkins diet surfaced in the media in the early seventies, we heartily laughed at the absurd concept of a liberal-fat, liberal-protein diet. When cholesterol-lowering medicines hit the market around the same time, we wasted no time in prescribing them to patients with elevated cholesterol levels. Like one giant collective sponge, we doctors readily soaked up the anti-cholesterol propaganda, so easily brainwashed by the powers that be.
Because of my unswerving belief in the cholesterol theory, I offered no protest in 1990 when my medical colleagues at NASA instructed me to begin taking the cholesterol-lowering drug Lipitor. After commencing this popular statin drug, I twice experienced an unsettling form of memory loss known as transient global amnesia (TGA). This rare phenomenon can last anywhere from fifteen minutes to twelve hours, in which time sufferers fail to recognize familiar surroundings and even their own families, often becoming disorientated and confused. In the worst of my two TGA episodes associated with Lipitor use, my memory loss extended for twelve terrible hours and transported me all the way back to my high school days. During that interval, my entire adult life had been eradicated and I had no awareness of my marriage and four children, my medical studies, nor my adventure-filled career with NASA.
Without exception, all the medical professionals I consulted with refused point blank to even consider the idea that Lipitor had anything to do with my memory loss. Unable to obtain any help from my doctors, and with no other feasible explanation for my TGA, I began my own search for the facts. I didn't know it then, but this search would turn into a remarkable journey, one which would see my story reported in media outlets around the world. I would eventually find out that TGA had befallen hundreds of other patients taking cholesterol-lowering statin drugs. During this time, I would also witness the seminal acknowledgement of statin-induced memory loss in the scientific literature. As a result of my extensive research into the relationship between cholesterol and cognition, I came to realize that cholesterol was in no way the heinous foe we had been led to believe it was. Instead, I realized that cholesterol was the most important substance within our bodies, a substance without which life as we know it would simply cease to exist. That billions of dollars have been spent in an all-out war on a substance that is so fundamentally important to our health is undoubtedly one of the great scientific travesties of our era.
The experiences that led Anthony Colpo to write the book you presently hold in your hands are remarkably similar to those of my own. Like myself, Colpo had fallen hopelessly for the low-cholesterol paradigm, with its golden promise of improved health and freedom from heart disease. Like myself, he was eventually jolted into reality when this baseless paradigm exerted unwelcome and harmful effects upon his health.
In The Great Cholesterol Con: Why Everything You've Been Told About Cholesterol, Diet and Heart Disease is Wrong!, Anthony Colpo presents a damning exposé of one of modern medicine's most deeply-held paradigms. With merciless logic and an unapologetic presentation of the cold, hard facts--facts that the reigning health orthodoxy would rather you did not hear--he thoroughly destroys the claim that elevated blood cholesterol and dietary saturated fats cause coronary heart disease. Citing data from over fourteen hundred published studies, Colpo delivers blow after blow to the cholesterol theory, exposing it for the unscientific myth that it is.
Colpo does not just limit his efforts to destroying the cholesterol theory. He is well aware that medicine's overwhelming focus on cholesterol and saturated fats has given rise to a most regrettable consequence--the diversion of valuable scientific attention and precious research funds away from the factors that really do cause heart disease. One shudders to think how many lost lives could otherwise been saved had the medical establishment not been so obsessed with the mythical cholesterol bogeyman.
The greater part of Colpo's book is devoted to informing readers what really does cause coronary heart disease, and what can be done to halt the march of this insidious killer. Refreshingly, the preventive measures outlined by Colpo are not based on preconceived opinion, dogma, politics, or vested financial considerations---as is so much of popular health advice--but on data obtained from tightly controlled clinical research.
Colpo is a truly independent commentator who has pieced together the most thorough, extensive and up-to-date critique of the anti-cholesterol phenomenon I have ever read. I wholeheartedly urge you to read The Great Cholesterol Con from cover to cover--it could well be your life that is saved by the valuable information gracing the pages of this long overdue book.
–Duane Graveline, M.D., MPH.
Former astronaut, NASA physician, author of Lipitor: Thief of Memory and Statin Drugs, Side Effects and the Misguided War on Cholesterol.
"It seems to be a constant throughout history: In every period, people believed things that were just ridiculous, and believed them so strongly that you would have gotten in terrible trouble for saying otherwise. Is our time any different? To anyone who has read any amount of history, the answer is almost certainly no."
–Paul Graham
The book that you hold in your hands contains information that could quite literally save your life. For it to achieve this goal, however, will depend on your willingness to consider an explanation for heart disease that is very different from the one promulgated by governmental and private health officials. These groups would have us believe that the primary cause of coronary heart disease (CHD) is elevated blood cholesterol. Furthermore, because saturated fat has demonstrated an ability in clinical studies to raise blood cholesterol concentrations, health authorities insist that saturated fat itself is a major cause of CHD. This overly simplistic paradigm has been used to cajole millions of people the world over into consuming low-fat diets and to commence therapy with cholesterol-lowering drugs.
What mainstream health officials have not been so quick to point out is that, despite this massive offensive against saturated fat and cholesterol, the incidence of coronary heart disease has not declined over the past forty years. In The Great Cholesterol Con: Why Everything You've Been Told About Cholesterol, Diet and Heart Disease is Wrong! you will learn that:
• A massive volume of scientific literature proves that heart disease is not caused by saturated fat nor by elevated blood cholesterol levels.
• Despite having no basis in scientific fact, the anti-cholesterol/anti-saturated fat paradigm continues to be promoted for reasons other than the welfare of the general public.
• Many of the dietary recommendations made by health and nutrition 'experts' to reduce heart disease have actually been shown in animal and human studies to increase heart disease, cancer, diabetes and obesity!
The above may be difficult for many readers to fathom initially, but after reading this book they will have no doubt the cholesterol-CHD paradigm is, as University of Vanderbilt Professor George Mann stated, "the public health diversion of this century . . . the greatest scam in the history of medicine."
Rude Awakening
The seeds of my own personal interest in the charade that constitutes modern CHD prevention policy were sown back in 1989 at the tender age of twenty-one, when a blood work-up revealed my cholesterol level to be 213mg/dl. The well-meaning physician who ordered these tests solemnly warned that such a blood cholesterol concentration placed me at 'moderate risk' of future heart disease, and made it clear that this 'elevated' reading had to be reduced.
Telling a healthy young man of twenty-one that he harbors an increased susceptibility to heart disease on the basis of a single test of an essential blood lipid is nothing short of absurd. Unfortunately, I didn't know this back then. Alarmed by this alleged threat to my health, I began religiously following a very low-fat diet. I ate only the leanest meats and fish and, in keeping with advice given to highly active athletes, I began consuming large amounts of 'healthy' complex carbohydrate foods such as wholegrain wheat, rye and brown rice. Almost without exception, mainstream 'experts' were adamant that such an eating pattern would greatly reduce the incidence of heart disease.
It was in 1996 that I began to realize these health authorities had gotten it seriously wrong. Despite my 'wholesome' diet and daily strenuous exercise, my blood pressure had risen from 110/65, a reading characteristic of highly conditioned athletes, to an elevated 130/90. Instead of the lean, athletic look to which I had become accustomed, my physique started to become increasingly ‘smooth’ and bloated. My digestive function began to deteriorate dramatically, with my stomach often feeling heavy, gaseous and distended after meals. I developed a surprisingly long list of food sensitivities, and frequently felt tired and fatigued. My fasting blood glucose level was below the normal range, indicative of reactive hypoglycemia--a manifestation of low blood sugar caused by the consumption of too many high glycemic index carbohydrates.
Ironically, the elevated blood pressure and disturbed blood sugar metabolism precipitated by my low-fat diet increased my risk of the very thing I had sought to avoid, the very ailment that had claimed my father's life at only fifty-five years of age: heart disease.
This seemingly paradoxical experience caused me to question everything I had ever learnt about nutrition. Rather than continue to take for granted the existence of data showing saturated fat to be harmful--as does so much of the public, medical and research communities--I became insistent on viewing this data for myself. My burning desire for the unadulterated facts drove me head first into an intensive search of the medical literature.
What I subsequently discovered truly astounded me:
• Of the numerous controlled clinical trials examining dietary interventions for heart disease prevention, none had ever demonstrated a beneficial effect of saturated fat restriction.
• Of the twenty-six long-term studies monitoring selected populations for the occurrence of heart disease, only four were able to demonstrate even desperately weak associations between saturated fat and heart disease.
• Numerous populations consuming high amounts of saturated fat have been observed to enjoy extremely low rates of heart disease. These populations have been consistently ignored by promoters of the anti-fat/cholesterol theory.
• A staggering amount of evidence indicates that by lowering their cholesterol, many people will worsen their physical and mental health and increase their risk of dying prematurely!
Most people would be truly amazed at just how little evidence exists in support of the cholesterol paradigm--the same paradigm that has firmly entrenched itself as a central pillar of modern-day health policy.
How Can We Really Prevent Heart Disease?
The greatest tragedy emanating from the medical establishment's myopic obsession with saturated fat and cholesterol is that the dietary and lifestyle factors that do increase the risk of heart disease have remained neglected or even completely ignored. As a result, the massive amounts of money and scientific manpower that have been poured into the fight against heart disease have so far completely failed to yield any cure for this most common of killers. Despite almost half a century of intense research, the indisputable fact is that heart disease is still the industrialized world's number one killer and occurs with the same frequency as fifty years ago. Millions of precious lives that could have been saved have been lost.
This book, therefore, seeks not just to highlight the falsity of the cholesterol hypothesis, but to inform readers as to what really does contribute to heart disease and what they can do to prevent it. The Great Cholesterol Con reveals the factors that scientists have shown to directly contribute to heart disease, and discusses others that are rapidly emerging as potential culprits. The Great Cholesterol Con describes practical and easily implemented steps that can help neutralize each of these potentially deadly assailants of cardiovascular health.
This book, in short, has been written for those who wish to learn the true facts about heart disease. In Section One, readers will learn about the origins of the cholesterol myth and why it completely lacks any foundation in scientific reality. Section Two discusses the dietary and lifestyle factors that have either been strongly implicated or clearly shown to cause heart disease, while Section Three shows how we can all immediately set about to significantly lower our risk of ever experiencing a cardiovascular crisis.
Good health is the foundation upon which we build our entire lives. To this author, uncovering little known facts that facilitate major improvements in wellbeing is like unearthing hidden treasure; it is one of the most liberating and satisfying sensations he has ever known. It is my sincerest wish that readers gain as much from reading this book as I did researching and writing it.
Join me now, as I explain why modern-day heart disease prevention policy has been built around a big, fat lie.
–Anthony Colpo
SECTION ONE
Why Saturated Fat and Cholesterol Do
Not Cause Heart Disease.
"A lie told often enough becomes the truth"
–Lenin
The Big Fat Lie
Why claims of a coronary heart disease 'epidemic' caused by saturated fat and cholesterol are completely false.
Over the last forty years, billions of dollars have been allocated to research examining the link between saturated fat, cholesterol and heart disease. Despite the staggering amounts of money and time that have been poured into this undertaking, no direct role for these substances in the causation of cardiovascular disease has ever been established. The saturated fat and cholesterol hypothesis remains just that--a hypothesis.
As you shall learn throughout this book, there exists a massive volume of scientific evidence that completely absolves dietary cholesterol, saturated fat, and elevated blood cholesterol of any harmful role in heart disease. This evidence does not stem from a small group of axe-grinding fringe lunatic researchers; some of the most damning evidence against the mainstream anti-cholesterol dogma comes from research that has actually been funded and conducted by the mainstream itself.
Despite the fact that this contradictory research has been published in prestigious, peer-reviewed medical journals, and despite the complete failure of the massive low-fat, anti-cholesterol campaign to lower the overall incidence of heart disease, the cholesterol/saturated fat theory of coronary disease enjoys almost unanimous acceptance among health authorities. These are the same 'experts' that most of us look to for credible, scientifically-sound advice on matters pertaining to diet and health; the same experts who design nutrition guidelines, who tell us whether a particular food is 'heart-healthy' or harmful, and who set the prescribing guidelines for cholesterol-lowering drugs.
The Decline in Heart Disease that Never Was
It is these same authorities who repeatedly tell us that the death rate from coronary heart disease (CHD) climbed rapidly during the twentieth century, reached a peak in the late 1960's, then began a gradual decline that continues to this day. The rise in CHD mortality, so the story goes, was primarily a result of America's predilection for fatty foods--especially those high in 'artery-clogging' saturated fats. While the increase in CHD has been attributed to the nation's gluttony, the subsequent fall in heart disease mortality was, allegedly, a direct result of public awareness campaigns that steered people away from saturated fats and towards 'healthy' low-fat foods. These promotional efforts lowered the population's blood cholesterol and blood pressure levels, reduced the rate of smoking, and provided a shining example of how both government and private health agencies could work together in harmony and save millions of lives in the process.
That is the official version of events. It is, quite frankly, a self-serving fantasy.
It is only natural that health authorities would like us to believe that they were the prime movers behind any drop in CHD, because they have spent astounding amounts of our money researching and promoting dietary measures purported to fight this ubiquitous killer. The National Institutes of Health, the government's foremost diet and medical research agency, is without question the world's biggest spender on diet-heart disease research. The NIH has fervently spent well in excess of a billion taxpayer dollars trying to implicate saturated fat and cholesterol in the causation of heart disease, so far without any success whatsoever.
The American Heart Association (AHA), the first prominent health organization to officially embrace the lipid hypothesis, is an incorporated entity with assets totaling over one billion dollars and revenue that exceeds 650 million dollars per year(1). Of this, 540 million dollars is derived from public support, while another 115 million dollars is earned through activities that include the sale of educational materials and the lucrative 'heart check' program. The latter is a licensing agreement in which food manufacturers can capitalize on the AHA's 'credibility' by paying a first-year fee of $7,500 per product, and a subsequent annual renewal fee of $4,500 per year. This permits them to display the Association's logo on their product labels and to market their wares as 'heart healthy'(2). Despite its ‘non-profit’ status, top-level executives at the AHA receive six-figure salaries that would be the envy of many CEOs heading for-profit firms; during the 2005 fiscal year, the AHA's CEO, M. Cass Wheeler, received a hefty $656,608 in compensation. Remuneration to the AHA’s five Vice-Presidents ranged from $249,235 to $414,928(3).
Clearly, fighting CHD is big business. And there is nothing worse for business than the realization by customers that one's products and services are ineffective. Imagine the potential financial repercussions for an organization that has invested heavily in a product or service of questionable worth, that has unwisely promoted the new offering with unbridled enthusiasm, and has begun to draw criticism from some quarters that it acted prematurely. To compound this organization's woes, published scientific findings have emerged which strongly suggest these critics are correct. Imagine further that this entity has no foreseeable way of improving upon this product or service. Impending doom, in terms of prestige and financial loss, is a very real possibility--unless of course, the entity in question can prevent the paying public from ever discovering that there was anything wrong with its offering in the first instance.
This is the exact situation in which promoters of the saturated fat and cholesterol theory of CHD have found themselves for the last four decades. Despite massive propaganda efforts to convince the medical profession and public alike of the validity of their theory, numerous independent commentators over the years have questioned its scientific tenability. In order to counter such concerns, the reigning health orthodoxy has formulated several key arguments that have been repeated with such prolific frequency they are now deeply ingrained in the public psyche. As a result, they have come to be accepted by much of the population as self-evident facts.
The notion that increasing saturated fat consumption precipitated an 'epidemic' of CHD, and that the low-fat, anti-cholesterol campaign has played a major role in reversing this epidemic, is one such 'fact'. The ubiquity of this myth is sad testimony to the ease with which so many of us uncritically accept the information presented to us from authoritative-sounding figures. It can readily be disrobed using national vital statistics data freely available to anyone with an internet connection.
The Real Story Behind the Rise and Fall of CHD
Before we begin to dismantle the 'Big Fat Lie', it is important to define the difference between coronary and non-coronary heart disease. When we talk of CHD, also known as ischemic heart disease, we are referring to the blockage of a coronary artery that impairs or completely blocks blood flow to the heart. This blockage can be caused by the build-up of arterial plaque, the formation of blood clots, or arterial spasm, and if severe enough causes a heart attack, also referred to as a myocardial infarction.
Non-CHD heart stoppage is most commonly referred to as heart failure, and can occur from such conditions as cardiac arrhythmia, cardiomyopathy, endocarditis, myocarditis and pericarditis. It is CHD that is invariably the focus of diet-heart theories, for heart failure has long been attributed mostly to non-dietary causes such as viral infection, aging, and genetic defects of the heart.
Having made this vital distinction, let us now cast our eyes upon Figure 1a. It presents the death rate from CHD, non-coronary heart disease and all heart conditions combined, for the period 1900-1993. When we glance at the plotted line for CHD, we see that it does indeed travel an upward path throughout most of the twentieth century, sometimes swinging violently skyward, before reversing direction in 1968.
[Figure 1a below]
The death rates depicted in Figure 1a are derived from the National Center for Health Statistics, and are based on the International Classification of Diseases (ICD). The ICD provides a standardized system for classifying causes of death in an effort to ensure uniformity of reporting amongst different regions and nations. The first ICD came into effect in 1900, and has since been modified about once every ten years, the last revision occurring in 1999. These frequent revisions are necessary to keep the ICD current with rapidly growing scientific knowledge about life-threatening diseases.
At the beginning of the 1900's, doctors and scientists knew very little about CHD. It was not until 1912 that a Dr. James B. Herrick first described an unusual form of heart disease resulting from hardening of the arteries(4). The paucity of knowledge surrounding this 'new' condition was reflected in the ICD system, where deaths attributable to CHD were classified as "Angina pectoris". Angina is actually a symptom of CHD and not the disease itself (angina pectoris literally means 'pain in the chest' and results from inadequate blood flow to the heart).
It was not until 1929 that the classification was changed to "Diseases of the coronary arteries, Angina pectoris", and it was at this point that the number of recorded CHD deaths, which had shown little change since 1900, underwent a sudden and sharp increase. This increase was accompanied by a leveling-off in the number of recorded non-coronary heart disease deaths, as can be seen in Figure 1a.
In 1948, the sixth ICD introduced a major new category, entitled "Arteriosclerotic heart disease, including coronary disease". This new classification included three subcategories; 1) "Arteriosclerotic heart disease so described", 2) "Heart disease specified as involving coronary arteries", and 3) "Angina pectoris without mention of coronary disease". As you can see in Figure 1a, this new addition was accompanied by a massive vertical leap in CHD death rates, and a similarly massive drop in non-coronary heart disease deaths.
In 1968, the eighth ICD came into effect. For the first time ever, heart attack was given an explicit listing, under the category "Acute myocardial infarction". This landmark change was immediately followed by yet another abrupt jump in the CHD mortality curve.
The ninth ICD update in 1979 introduced five new sub-categories to the "All other forms of heart disease" category. This is the umbrella classification into which all non-CHD categories of heart disease are placed. Among the new arrivals were heart failure and arrhythmia, which refers to a disturbance in the normal rhythm of heartbeat. Nowadays, both heart failure and arrhythmia are known to be major causes of cardiac death. The establishment of specific categories for these was accompanied by a sudden downturn in CHD mortality and an instantaneous upswing in non-CHD deaths.
There are two possible explanations for the CHD mortality pattern shown in Figure 1a. The first one is that, during the twentieth century, coronary and non-coronary heart disease victims were doing an outstanding job of timing their deaths to correspond precisely with the new ICD classification changes--a highly unlikely occurrence to say the least. The second and far more realistic explanation is simply that doctors were increasingly classifying victims into CHD- and non-CHD-related categories as the classifications became more specific, ECG machines became more widely used, and medical knowledge of heart disease increased. When the 1968 additions to the ICD criteria allowed doctors to assign the maximum possible percentage of heart disease deaths to the CHD category, CHD mortality hit its 'peak' then immediately began to decline in line with the overall heart disease trend(5,6).
Adjusted Versus Unadjusted Data
CHD fatalities occur most commonly in old age. In 1900, the average life expectancy in the US was only forty-nine years, due in no small part to a rate of infant mortality far higher than that seen today. As ninety-four percent of CHD deaths occur after the age of fifty-five, and because average life expectancy in the US had increased to seventy-seven years by the year 2000, one need not be a genius to identify a major reason why so many more people began dying of CHD throughout the last century. Quite simply, many more people were living long enough to die of CHD.
To gain insight into whether any increase in mortality from a specific disease is real or simply an artifact of increased life expectancy, researchers calculate what are known as 'age-adjusted' death rates. These are figures that have been arrived at only after making allowances for any increase in average life span. The heart disease trend lines seen in Figure 1a--the same figures cited by health authorities when commenting on the rise and decline of CHD--are not age-adjusted. Those in figure 1b are.
In Figure 1b, the plot for CHD mortality (for which age-adjusted data is only available from 1960 onwards) hits a peak in 1968 before turning around and heading southeast, similar to what we saw in Figure 1a. Take a closer look, though, at the trend line for overall heart disease mortality. It hits a peak, not in the late sixties, but in 1950. We know that the 1968 peak for CHD mortality is simply an artifact of changing diagnostic criteria; that when the maximum possible number of deaths were finally being placed into this category, its trajectory instantly fell into line with that of overall heart disease mortality. We therefore have every reason to believe that the historical age-adjusted peak for CHD occurred, not in 1968, but somewhere around 1950. As such, the true decline in CHD appears to have begun over a decade before the health establishment launched its campaign against saturated fat and cholesterol!
Postponing the Inevitable
It is an extremely interesting exercise to sit back and take in all the proffered explanations for the reduction in CHD mortality. While orthodoxy assures us its anti-fat, anti-cholesterol efforts have helped instigate the drop in CHD, others have tried to link the decline with the increased or decreased consumption of specific food items, or to food fortification with certain vitamins. There's just one problem with all these theories, and that's the little- publicized fact that while CHD deaths have been declining, numerous studies show that the overall age-adjusted incidence of CHD--which includes non-fatal disease--is remaining steady or even increasing(7-10). In other words, people are having just as many heart attacks as ever--if not more--but emergency medical care has become increasingly adept at saving their lives(11-14).
[Figure 1b below]
The authors of the famous Framingham study, frequently cited in support of the cholesterol hypothesis, wrote in a 1990 article; "Our data indicate that the decline in mortality was primarily the result of improved survival among persons with new cases of cardiovascular disease, rather than the result of a substantial decrease in the incidence of the disease"(9).
In 1996, a high-ranking member of the health orthodoxy revealed at an annual gathering of his colleagues that deaths from heart disease had not dropped nearly as much as officials had claimed and that the prevalence of the disease may actually be increasing. So why the erroneous assertions about an establishment-led drop in CHD?
"Our philosophy was that to get more money from politicians, we had to show that good things were happening". The individual responsible for these words, quoted in a 1996 edition of the Wall Street Journal, was none other than Jan L. Breslow, the then newly-appointed president of the AHA(15).
Ambulance and paramedic networks, the development of CPR techniques and electrical defibrillators, anti-clotting drugs, coronary care units, and campaigns to raise awareness of heart attack symptoms are the true stars responsible for the decline in CHD deaths. If highly touted 'risk factor' changes were responsible for the decline in CHD mortality, they would surely reduce the incidence of CHD itself.
The Anti-Cholesterol Campaign Has Been Counter-Productive
Throughout the twentieth century, there has been a steady and substantial decline in the number of people smoking cigarettes(16). Because smoking unarguably contributes to heart disease, the incidence of CHD should, by all rights, have undergone a marked decline during this same period--but it hasn't! Clearly, some other factor(s) has acted to counter the beneficial impact of this reduction in cigarette smoking. As we will explore in later chapters, a number of the establishment's recommended dietary modifications actually encourage the onset of CHD (and various other lethal diseases).
The Increase in Saturated Fat that Never Was
Even after adjusting the mortality data for increased life expectancy, a substantial increase in coronary and overall heart disease mortality is still evident during the first half of the last century. Is this increase in any way due to increasing saturated fat consumption?
Absolutely not.
Take a good look at Figure 1c, which shows the consumption of various types of fats during the last century(17). Beginning in the 1920's, total fat consumption increased steadily, due entirely to the accelerating use of vegetable oils, shortenings, and margarines. The increasing popularity of these unsaturated fat-rich vegetable fats also explains the rise in polyunsaturated and monounsaturated fat intake. Saturated fat intake, on the other hand, has remained relatively stable in the face of increasing total fat intake. While vegetable fats do contain some saturates, the richest source of these in the American diet is animal fats, whose consumption slightly declined during the twentieth century(18). As can readily be seen from the graph, saturated fat is the only type of fat whose consumption did not rise during the twentieth century. Whether you choose to believe the historic peak in CHD mortality occurred in 1950 or in 1968, saturated fat intake during the decades prior to either of these dates shows no increase. Neither animal fats nor saturated fat can be logically blamed for any increase in CHD deaths.
[Figure 1c below]
Much Ado About Nothing
It seems that, during the last four decades, saturated fats from animal foods have been implicated in just about every health ailment to have ever befallen humankind. However, for the same reason that animal fats cannot possibly be associated with any increase in CHD, they cannot logically be implicated in any real or imagined increases in cancer, diabetes, obesity, teenage acne, falling sperm counts or global warming.
In the next chapter, we will examine the relationship between cholesterol and CHD, and find out why efforts to lower cholesterol via dietary means are more likely to cause harm than good.
"To arrive at a contradiction is to confess an error in one's thinking; to maintain a contradiction is to abdicate one's mind and to evict oneself from the realm of reality."
–Ayn Rand.
Cholesterol is Not a Killer
The true relationship between saturated fat, cholesterol, heart disease, and mortality.
One of the major reasons for the continual barrage of vitriol against saturated fats is that they possess the ability to raise blood cholesterol levels. These elevated cholesterol levels, in turn, are alleged to increase the risk of heart disease. According to health authorities, if we could all hammer our cholesterol levels down to 150 or lower then freedom from heart disease and a long, healthy life would be ours for the asking.
You are now about to find out why such a contention is little more than a deluded pipe dream, and how an abundance of published research has shown that lowering your blood cholesterol levels may actually increase your risk of dying prematurely!
What is Cholesterol?
Before we examine the many problems with the 'saturated fat-raises-cholesterol-which-causes-heart-disease' theory, known in research circles as the 'lipid hypothesis', it is imperative that we take a quick look at cholesterol. What exactly is it, and what does it do?
Cholesterol is most accurately defined as a sterol or alcohol, but because it is a waxy substance that has little in common with the merchandise sold in liquor stores, it is typically referred to as a lipid. It is produced mainly in the liver, although smaller amounts are generated in the intestines and other organs. Far from being a poisonous substance that must be avoided at all costs, cholesterol is a critical substance that we simply cannot live without.
Because cholesterol's unique structure makes it impossible to dissolve in water, it forms a crucial component of cell membranes, which rely heavily on its waterproofing properties in order to function efficiently in a fluid environment. The ability of cells to resist saturation from external fluids is especially important for nerve cells and, not surprisingly, the highest concentrations of cholesterol are found in the brain and nervous system. Cholesterol also acts as an antioxidant, protecting cell membranes from free radical damage.
Because cholesterol is water-resistant, and because blood is a water-based medium, cholesterol must be carried through our bloodstream inside special water-soluble particles known as lipoproteins. There are different types of lipoproteins, the two most abundant being HDL (high density lipoprotein) and LDL (low density lipoprotein). The main function of LDL is to transport cholesterol from the liver to our organs and tissues, where it is incorporated into cell membranes. In contrast, HDL carries 'old' cholesterol that has been discarded by the body's cells back to the liver for recycling or excretion. The liver does a number of things with recycled cholesterol; it can be incorporated into bile (which is used to break down the fat we eat), or used to produce hormones that are essential for our continued wellbeing, such as testosterone, estrogen, dehydroepiandrosterone (DHEA), progesterone and cortisol. Cholesterol is also deployed to the nervous system, where it enables the facilitation of messages along our nerve pathways. The brain, in particular, is especially rich in cholesterol.
Cholesterol is, quite simply, one of the most important substances within our bodies.
The Association Between Cholesterol and CHD
Amongst free-living individuals in the real world, it is difficult to find a consistent, uniform correlation between saturated fat consumption and serum cholesterol levels. Individuals with similar saturated fat intakes can possess markedly different serum cholesterol concentrations, and individuals with high saturated fat intakes can have serum cholesterol readings far lower than individuals with low intakes. Serum cholesterol levels are influenced by a whole host of factors aside from fat intake, including stress, physical activity, obesity, illness, smoking, genetics, alcohol, and medicine usage. However, in clinical studies where all these other variables are controlled to the greatest possible extent, saturated fats do tend to raise total serum cholesterol in comparison to monounsaturated fats, which have a neutral effect. Polyunsaturated fats, on the other hand, exert a lowering effect(1).
Those of you adhering to Spartan low-fat diets in the hope of lowering your cholesterol levels should be aware that, when caloric intake is held constant, fat restriction itself is useless for lowering cholesterol. In a carefully controlled study, researchers fed a group of healthy men diets that were identical in every respect except that one contained twenty-two percent fat, the other thirty-nine percent. Unlike previous experiments, where researchers had modified the ratio of saturated and unsaturated fatty acids in the low-fat diet, both diets in this study featured an identical saturate/monounsaturated/polyunsaturate ratio. Only the overall amount of fat varied between the low- and high-fat diets. Each subject served as their own control by consuming both diets for fifty days each. The study was conducted with the utmost scientific rigor; the participants were housed in a research facility for the entire duration of the study, and had no opportunity to consume any food other than that supplied by the researchers. All food was monitored and weighed, and the participants were required to consume all the food provided. A spatula was even provided to ensure that all food was scraped from the plates and eaten. To avoid the confounding effects of weight loss, the participants were fed sufficient calories to maintain their weight throughout the study.
The particpants’ cholesterol levels at the start of the study ranged from 133 to 240 mg/dl. During the study, the researchers observed that cholesterol levels barely changed from baseline. They also found no difference in mean serum cholesterol levels during the low- and high-fat diets (173 versus 177 mg/dl, respectively). When put through the wringer of tightly controlled clinical examination, the low-fat diet—so aggressively promoted for its alleged cholesterol-lowering capabilities—is promptly shown to be a fraud(2).
So while fat restriction itself has little effect on cholesterol levels, saturated fat restriction can affect blood cholesterol. Does the potential cholesterol-raising action of saturated fat have any actual impact upon CHD? According to the purveyors of the lipid hypothesis, the answer is an uncontestable "yes!". The 'strong' association between serum cholesterol and CHD deaths, they say, leaves no doubt that the cholesterol-raising effects of saturated fat increase the risk of CHD.
Before we discuss the studies examining the cholesterol-CHD association, readers should carefully consider one of the most fundamental rules of science: Association does not automatically equate to causation. What this means is that even if a certain factor, like high cholesterol, is frequently observed in CHD patients, this does not mean it actually causes the disease. To illustrate the folly of equating association with causation, researcher John Yudkin published a study in 1957 showing that TV and radio ownership were far more closely associated with coronary mortality in England than any dietary factor(3). Despite the strength of Yudkin's correlation, we know that TV sets and radios do not cause heart disease; none of us seriously believe that throwing our television sets out in the trash will grant us immunity from CHD. The association between television and radio ownership and CHD demonstrated by Yudkin was secondary, meaning that some other causal factor--reduced physical activity, perhaps--was more prevalent among owners of these appliances than non-owners.
It never seems to have occurred to promoters of the lipid hypothesis that any rise in cholesterol associated with CHD may not necessarily be the cause of the aforementioned ailment, but may actually be part of the body's response to some other destructive process that was truly causing coronary deterioration. No-one in their right mind would suggest that the dramatic rise in white blood cell count that often accompanies infection is the 'cause' of infection; everyone knows that pathogenic microbes are the guilty party. Increased white blood cell activity is simply an important part of the body's effort to destroy the invading pathogens. No authority with even a micron of intelligence would recommend 'white-blood cell-lowering' diets for the prevention of infection, no sooner than they would recommend drink-driving to improve road safety. Millions around the world, however, have been coaxed and cajoled into following cholesterol-lowering diets and taking dangerous cholesterol-lowering drugs in an effort to reduce blood cholesterol levels.
Does cholesterol cause heart disease, or are cholesterol elevations part of the body's response to whatever else causes heart disease? Can lowering blood cholesterol levels improve one's survival prospects--or does it actually cause more harm than good?
Let's find out…
Framingham Follies
One of the studies most frequently mentioned by proponents of the lipid hypothesis is the famous Framingham study. This project commenced in 1948 and proceeded to monitor the occurrence of CHD in over 5,000 Framingham, Massachusetts, residents who were initially free of any outward signs of CHD. After following these folks for sixteen years, the Framingham researchers claimed to have found that the risk of CHD in those under 50--but not over--was "strikingly related to the serum total cholesterol level."
Exactly how "striking" was this relationship? Take a look at Figure 2a, which shows the distribution of serum cholesterol levels among residents who developed CHD and those who remained free of the disease. Notice that the range of cholesterol amongst the majority of subjects in both groups was very similar. The mean serum cholesterol level of those with CHD was a mere eleven percent higher than those without. The majority of patients were in the normal range, with CHD afflicting those whose cholesterol levels were as low as 150(4). Despite what some claim, low cholesterol levels do not guarantee immunity against CHD, and high cholesterol levels are anything but a sure sign of impending coronary disaster.
In 1987, the Framingham researchers published a thirty-year follow-up paper, reporting on the incidence of all-cause mortality and cardiovascular disease mortality. The researchers again found that higher cholesterol levels were associated with increased mortality before the age of fifty, but after this age
cholesterol levels in men and women showed no relationship with CVD or total mortality(5).
[Figure 2a below]
The Framingham study is hardly alone in demonstrating that cholesterol is not a risk factor for older folks. Study upon study has repeatedly shown that higher cholesterol levels do not increase the risk of CHD, nor stroke, nor overall mortality, in seniors(6-24). In fact, several studies have found that higher cholesterol levels are predictive of increased survival and greater longevity in older age groups!(20-24) As we learnt in chapter one, ninety-five percent of CHD deaths occur in those over fifty-five, which means that only a miniscule percentage of CHD deaths can claim to have even a statistical relationship with blood cholesterol!
If you are over fifty, and starting to become a little agitated by the idea that for years you have abstained from many of your favorite foods for no good reason, wait--it gets worse! The above-mentioned lack of association in older Framingham adults was for those whose cholesterol levels had remained constant. Those whose cholesterol levels had decreased during the study experienced an increase in both total and CVD mortality. That's right--an increase! Even the researchers had to admit; "There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years…"
For every 1mg/dl per year drop in cholesterol levels during the first fourteen years of the Framingham study, there was a fourteen percent increase in cardiovascular death and an eleven percent increase in overall mortality during the subsequent eighteen years. The authors tried to dismiss this astounding revelation by claiming; "After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling--perhaps due to diseases pre-disposing to death". This unconvincing piece of doublespeak inferred that people over 50 were dying of diseases that also happened to lower their cholesterol levels.
There are at least two factors that make such a proposition highly unlikely. Firstly, the considerable fourteen-year time lag employed by the researchers weighed heavily against the possibility of cholesterol reductions occurring due to the development of disease. Secondly, CVD mortality, which includes deaths from CHD and ischemic stroke--the very diseases that are supposedly caused by high cholesterol levels--increased to a greater degree than overall mortality!
Thus, the data from the Framingham Study, the longest-running project examining the connection between cholesterol and CHD, has shown that declining cholesterol does not increase longevity, but instead increases one's risk of death from all causes, including cardiovascular disease! This fact should have brought the entire cholesterol campaign to a screeching halt, but of course, it didn't. After 30 years of vigorously pushing the idea that elevated cholesterol levels promoted heart disease, attacking animal fats with unbridled venom, and convincing generations of people to drastically alter their diets and even take lipid-lowering drugs, proponents of the lipid hypothesis apparently could not find it within themselves to admit to the public that they might have been wrong.
Instead, they went into denial.
Witness the following statement in the study's conclusion: "We believe those who would argue that low serum cholesterol levels should be avoided--because they pose an increased risk from cancer or other causes--cannot support such a stand when the pattern of mortality during a 30-year follow-up period is considered".
According to the authors, it is unreasonable to infer from their study that cholesterol lowering may increase mortality, even though that is exactly what their results indicated. The establishment's irrational, reality-evading tendencies were also manifest in a joint statement by the American Heart Association and the NIH's National Heart, Lung, and Blood Institute (the Framingham project's sponsor) entitled The Cholesterol Facts, where one finds the following claim, supported by a citation from the above study: "The results of the Framingham study indicate that a 1% reduction…of cholesterol [corresponds to a] 2% reduction in CHD risk"(25). This, evidently, was their interpretation of a study that showed an eleven percent increase in total mortality and a fourteen percent increase in CVD mortality for every 1mg/dl reduction in cholesterol! The extreme lengths to which our 'trusted' guardians of public health will go to preserve the status quo are nothing short of mind-boggling.
Healthy Hearts in Honolulu: Low Versus High Cholesterol
Proponents of the lipid hypothesis love citing the Japanese, a population that eats less animal fat and displays lower average cholesterol levels than most Western nations. According to many 'experts', it is these qualities that largely explain the greater longevity and lower rates of CHD in Japan. I also like citing the Japanese, but for starkly different reasons. The Japanese experience actually helps to illustrate why the claims of anti-cholesterol campaigners are totally false.
The Honolulu Heart Program is a long-running epidemiological study of cardiovascular disease that began in 1965 with 8,006 Japanese/American men living on the island of Oahu, Hawaii. The men were born between 1900 and 1919, and were therefore aged 45 to 68 years old at the start of the study. Since the late sixties, this group has undergone several check-ups. The fourth of these was performed in the early nineties and involved over 3,700 men aged 71-93.