What is the real cause of heart disease?

The real cause of heart diseaseNow we know what is the real cause of heart disease according to a heart surgeon who recently wrote an article on the internet about this extremely important and delicate subject.

The author, Doctor Dwight Lundell is an experienced heart surgeon who claims he has gained understanding of the underlying cause of atherosclerosis and coronary artery disease by looking at the inside of patients arteries. He has seen with his own eyes how the food we eat damages the inside of our arteries and causes inflammation.

Lundell says:  “I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation”.

Thousands of people have read Dr.Lundells’s article on the internet.  People like what he writes.  Why is that? Is it because he is bearer of the truth? Is it because he is a reliable scientist? Is it because he knows what has to be written to gain popularity? I leave it to you to judge for yourself.

News agencies around the world have presented Dr. Lundell’s article with the notion that this is about someone who at last had the courage to speak the truth. “Heart surgeon speaks out on what really causes heart disease”. People love to read about heroes and those who dare.

For decades scientists have been trying to understand the relationship between heart disease, cholesterol and inflammation. Recent evidence indeed suggests that inflammation may be an important contributor to cardiovascular disease. However, this so-called inflammatory hypothesis has yet to be proven. There are several ongoing trials aiming to test it. Until we have the results, nobody can claim to know the answer.

How can Dr. Lundell see the cause of atherosclerosis with his own eyes in the operating room by looking at he inside of patient arteries? How about all the other surgeons who have had exactly the same view? Why haven’t they had the same vision?

How about all the scientists in the laboratories around the world who are trying to understand the functions of the endothelium and the arterial wall, the role of cholesterol, cholesterol crystals, apolipoprotein B, LDL-particles,  cytokines, macrophages and inflammation.  Why haven’t they seen the same thing as Dr. Lundell by looking at the inside of the artery.

Going against mainstream is a difficult task and you need courage to do it. Very often people who dare think outside the box have made important contribution to medicine. However, if you are going to challenge what we call mainstream medicine and the current beliefs of the scientific community you must do it in a professional way. You must be sure you are standing on solid ground. You must have concrete arguments, otherwise your theories will sound hollow and worthless.

So, is Dr. Lundell a scientist or a preacher? Let’s take a closer look athis arguments.

Dr. Lundell touches on a number of important subjects in his article. I might in fact agree with him about many things. For example, it is quite likely that cholesterol lowering drugs are overprescribed in primary prevention. It is also possible that overeating of unhealthy, processed carbohydrates has contributed to the obesity epidemic. Maybe our emphasis on cholesterol and saturated fats has been too strong, maybe saturated fats are not the enemy.

He starts his article by trying to convince the reader that he is trustworthy. His credibility is important if we are to believe his ideas about what is the real cause of heart disease. The reasons why we should believe what he says are twofold. Firstly, he is a heart surgeon with more than 25 years experience. Secondly, he is an honest person because he admits  he was wrong in the past. So people may think: “Thank god. An honest doctor at last. Someone who dares who speak out”. But, revealing your own honesty isn’t always honest. But I guess it means that if he turns out to be wrong, he will be the first one to admit it.

Dr Lundell states: “The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated”.

Although I think he is far ahead of himself, he actually touches on an important issue. Recent research indicates that inflammation may play an important role in atherosclerosis and cardiovascular disease in general.

There is tremendous research ongoing in order to understand the link between inflammation, cholesterol and heart disease. However, although inflammation seems to be an important component of atherosclerosis it has yet not been proven that it is a causative factor. We still don’t know whether prognosis will be improved by inhibiting or preventing inflammation.

Dr Lundell states that 25% of the population are taking cholesterol lowering drugs (statins).  I do not know of any country where the use of cholesterol lowering drugs is that high. In the United States the number of people taking these drugs is somewhere between 15-30 millions. Although this is an extremely high number, it does not exceed 10% of the population. I wonder where Dr. Lundell gets his statistics from. It has indeed been suggested that among individuals aged 45 and older in the USA, about 25% may be taking statins. I will be the first one to admit that this is a high number.

Dr. Lundell writes that without inflammation, cholesterol might not be harmful at all. This time he might actually be spot on. In fact, cholesterol may play an important role in inducing an inflammatory responses in the arterial wall.

Thus, without cholesterol there would probably be no inflammation and no atherosclerosis. Therefore, it is quite likely that cholesterol and inflammation both play an important role in cardiovascular disease.

He writes: “It is inflammation that causes cholesterol to be trapped”. Here Dr. Lundell s certainly underscoring the importance of cholesterol. However, elsewhere in the article he writes: “Since we now know that cholesterol is not the cause of heart disease….”.

The inconsistencies in his somewhat opinionated arguments are quite stunning. Maybe he should have written: “Since we now know that cholesterol is not the sole cause of heart disease…”

He writes: “inflammation is not complicated”.

In fact, inflammation is extremely complicated. Scientists have for many years been doing ambitious and complicated research in order to understand the mechanisms behind inflammation and atherosclerosis. Lately we have been gaining important information about cytokines and other mediators of inflammation. These mechanisms are not simple.

Dr. Lundell says: “The injury and inflammation in our blood vessels is caused by the low-fat diet recommended for years by mainstream medicine”.

This is a huge statement.  Where is the scientific evidence behind this serious conclusion?

Dr. Lundell claims there is lack of evidence indicating that saturated fats promote heart disease and he could be right about that. There are however studies available indicating that monounsaturated and polyunsaturated fats may be a healthier food choice than saturated fats.

His statement that polyunsaturated fatty acids are likely to cause inflammation is in my view an oversimplification. This subject is a matter of debate. Both omega-3 and omega 6 polyunsaturated fats are important for health.

Finally, I tend to agree with Dr. Lundell when he recommends choosing the foods your grandmother served and avoid manufactured foods. Fresh unprocessed foods are usually a better choice.

Dr. Lundell’s article has received huge attention and it has caught the eye of the news media. It touches on a number of important issues concerning cardiovascular disease in general.

To me the article unfortunately appears like it is written by a preacher or a politician who has to sell a message whatever the costs. The article lacks the professional approach of a scientist who carefully examines available scientific data before drawing conclusions.

I can’t help but wonder what his motives are.

Comments

  1. Johannah says

    Do you have an opinion about LDL-P being the biggest predictor of heart disease? Dr. Peter Attia has a recent and extensive series on this subject at his website http://eatingacademy.com/ that I found very fascinating.

    • Doc´s opinion says

      The traditional LDL-C is a measure of plasma concentration (mg/dl or mmol/l) while LDL-P is a measure of the actual number of LDL particles. LDL-P can be further divided into small LDL-P and large LDL-P. Small LDL-P is the number of total LDL particles that are small and dense. The theory is that the larger this percentage and the more small LDL, the higher your risk for heart disease. A diet high in carbohydrates may increase small LDL-P. Large LDL-P is the number of total LDL particles that are large and fluffy. It has been proposed that this type of LDL is actually protective.

      It appears that LDL-P may be a stronger predictor of cardiovascular events than LDL-C. Low LDL-P is a much stronger predictor of low risk than low LDL-C. In fact, about 30 – 40% of those with low LDL-C may have elevated LDL-P. Therefore you can have low LDL-C but still be at risk for vascular disease, more so if your LDL-P is elevated.

      I have no experience from measurements of LDL-P in clinical practice. I don´t think many practicing cardiologists have been using it. Although it may be a strong predictor of risk, the clinical usefulness of LDL-P measurements reamins to be proven.

      • Marsha says

        Thank you. My last blood test showed very low LDL. I think I’ll get further blood tests

  2. jake3_14 says

    Dr. Christopher Masterjohn, a U.S. lipid researcher, suggests the the size of LDL particles is not directly related to cardiovasular health. Instead, he speculates, LDL-P is a marker for the health of LDL receptors. The healthier they are, the less time LDL spends in the bloodstream, and the less time it has to surrender its cholesterol for normal bodily functions. Therefore, the number of large LDL particles is greater than the number of small ones.

    You are correct in that clinical use of the LDL-P measurement is limited, at least in the U.S. The U.S. firm LipoScience, however, has a page of citations (http://www.liposcience.com/about/clinicalevidence/) related to this topic that might interest you.

  3. kentc33 says

    Stress and poor diet are certainly major contributors to heart disease–esp., stress.
    Blessings

  4. says

    Thanks for this article.

    What do you think would happen to the rate of CV disease if most of Europe at 75% natural foods?

    Problems may be that the profit margins and shelf life are limited.

    This is such a big money area with so mnay big players that would resist i think like Big Pharma, processed food industry, CocaCola + insurance $ ect…

    It will be hard for them to give up this area

  5. says

    I appreciate your balanced analytical view of this complex issue. Looking forward to following you and your writing.

  6. Paul says

    Thanks for your analysis, I had the same reservations on the science being presented in Dr Lundell’s article as he seemed to make many sweeping statements not backed up by anything. I feel a lot of what he said is probably true, when you look at how the health of average western people has deteriorated since the low-fat mantra began. I find it extremely frustrating trying to understand what to eat when there is so much conflicting information around. I once gave up all animal products and dropped 20lbs, but is that the answer? I am so confused. I guess the idea of eating only what your great grandmother would have served is a good start. Thanks for the article.

    • Adrian says

      I understand your frustration, I once gave up almost all carbs and just ate natural foods and animal products and lost 15Kilos.

  7. says

    Curious if you have been following Professor Uffe Ravnskov work in this area. He hypothesises a factor below the inflammation – what may cause the inflammation – and it is different to the so called cholesterol theory of heart disease.

    The easiest way for people to read about and understand (in simpler terms) his theory is to read chapter 15 of his most recent published book “Ignore the Awkward! How the Cholesterol Myths Are Kept Alive“.

    Uffe posits a bacterial/viral causation.

    I am not certain I can put a link to that here… but I can pass along the following:

    http://mercola.fileburst.com/PDF/Ravnskov%20McCully%20Vulnerable%20plaque%20formation.pdf

    is there a away I can send you the transcript via email?

    Clare in Tasmania

    • Doc´s opinion says

      Thanks Clare. I´ve read a lot of what Uffe Ravnskov has written. Indeed I think everyone interested in the role of cholesterol and the lipid hypothesis should read his stuff. There is a lot of difference between his arguments and Dr. Lundell´s, although they reach a similar conslusion. I believe that inflammation s important when it comes to coronary artery disease. I´ve actually written a lot about this on my website.

  8. says

    I was curious , and should perhaps look up your site to see if you have already stated some thoughts the connection between sugars and artery damage. Was the idea that cholesterol was actually trying to repair damage by sugars or other inflammation totally dismissed or proven completely wrong?

    I had never heard of it until I ran in to the Atkins diet. And then a theory again presented on Dr. Oz.

    I am not a doctor.. just a curious person who wishes to live long and well, preferably healthy and active.

    I like the idea of eating what my Grandmother would have served. Except that she ate gobs of butter and her green beans were always cooked with a fat ham hock. yikes…. She lived to be 92 but …

  9. spaceandopportunity says

    Your asking “Why haven’t other doctors had the same vision” is like asking why other expert physicists didn’t have the same vision as Einstein. We are all unique, and maybe he just saw things others couldn’t. Happens all the time. Other than that, thanks for the critique!

  10. Karl Arman says

    I had a HA two years ago a few months after being told that I was in better shape than most men half my age. I had low BP, good Cholesterol numbers, never smoked and exercised and no family history of heart disease. My only vise was lots of pasta and bread.
    It playes right into the theory of Dr Lundell.

  11. Karl Baba says

    Not the greatest debunking. You mostly attack his method of writing and assert his claims are unproven while when it comes to much of what he actually states, you generally agree while maybe stating he is exaggerating or being unclear. It really is nitpicking to attack his numbers on statins. Of course babies and youths aren’t taking statins! He would have been more accurate saying 25% of the “at risk” population of 45+ year olds is taking statins If his article is worth debunking, I would expect some items to be clearly refuted using data.

    Status quo medicine is doing a poor job managing heart disease. Checking deeper into the statin issue the Journal of the American Medical Association said (April 2013) that “However, a 2010 analysis combined the results of 11 studies and found that taking statins did not lower the death rate for people who did not have heart disease. If your physician recommends taking a statin, talk to him or her about the risks and benefits for your individual situation.’”

    95% of people taking statins do not have established heart disease. But let’s suppose you do. “An analysis by Dr. David Newman in 2010 which drew on large meta-analyses of statins found that among those with pre-existing heart disease that took statins for 5 years:
    96% saw no benefit at all
    1.2% (1 in 83) had their lifespan extended (were saved from a fatal heart attack)
    2.6% (1 in 39) were helped by preventing a repeat heart attack
    0.8% (1 in 125) were helped by preventing a stroke
    0.6% (1 in 167) were harmed by developing diabetes
    10% (1 in 10) were harmed by muscle damage”

    • Axel F Sigurdsson says

      Karl.

      Lundell’s problem here is that his claims are not supported by scientific evidence.
      Is it possible that he is promoting some anti-inflammatory magic formula?
      “At Asantae, under the guidance and leadership of our Chief Medical Officer, cardiovascular surgeon, Dr. Dwight Lundell, we have a program and a product line that can lower cardiovascular risk while generating more vitality, energy and fitness!”

      If you look a bit further on my blog you can see I’ve written a lot about statins and maybe we don’t disagree on that issue.

      Thanks for the comment, appreciate it.

Let me know what you think!