What is the real cause of heart disease?
Now 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. He 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 certainly 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 always want to read about heroes and those who dare. We tend to admire them and they have our sympathy, like David when he met Goliath.
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 on earth 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. Progress in medicine can often be traced to people who dare think outside the box. 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, what is the real cause of heart disease according to Dr. Lundell? He actually 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 overused in primary prevention. It is also quite 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 as bad as sometimes thought.
Here are a few things I want you to think about when you read the heart surgeons article.
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 actually 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 proved that it is a causative factor. We still don´t know whether prognosis will be improved by inhibiting or preventing inflammation.
Dr Lundell´s 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 states that without inflammation, cholesterol might not be harmful at all. This time he might actually be spot on. Cholesterol may actually play an important role in inducing an inflammatory responses in the arterial wall. Thus, without cholesterol there would probably be no inflammation. Therefore, it is quite likely that cholesterol and inflammation both play an important role for the genesis of 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”. I totally disagree. 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 is actually 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? There are many different types of polyunsaturated fatty acids, some may be pro-inflammatory while others may have anti-inflammatory properties.
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 a bit 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.