Exploring “The Great Cholesterol Myth”

I have a strong interest in the prevention of heart disease. I believe healthy nutrition and lifestyle are the keys to our health and well-beingIn my early career as a cardiologist, working in the hospital setting, I was fascinated by the diagnosis and treatment of heart disease. Don’t misunderstand me, I still am. However, as the years have passed I have become more and more interested in disease prevention.

Exploring "The Great Cholesterol Myth"

Helping people stay healthy and avoid disease is very different from diagnosing and treating. Nonetheless, although prevention is important, it is not always easy to practice. It’s time-consuming, results are hard to measure and it deserves both patience and persistence. Therefore, it’s not surprising that doctors are often less interested in prevention than treating and curing. Let me quote Dr. Bernard Lown from his blog, The Lown Conversation: “Diligent prevention, unfortunately, plays second fiddle to heroic cures.”

I believe the most powerful tool to cut the burden of heart disease in our community is education. The remarkable Maya Angelou said: “When you know better you do better”. One of the most important roles for doctors and other medical professionals is educating people about healthy lifestyle, nutrition, exercise and other measures to prevent disease.

All things considered, education is a double-edged sword. Bad education is often worse than no education. A huge number of books and articles have been written on lifestyle, exercise, diet, and nutrition, and there is an overflow of information on the internet. Obviously, some of it is good and some of it is bad. In many cases, education and information is driven by a product line designed to enrich the bank account of the author. Obviously, such information may be misleading.

Much has been said and written about the role of cholesterol in heart disease. Elevated cholesterol is considered a risk factor for cardiovascular disease. Lowering cholesterol, low-density lipoprotein (LDL) cholesterol, in particular, is of key importance. Recently, however, the role of cholesterol in heart disease has been debated.

A few weeks ago a ran into a new book on the subject, called “The Great Cholesterol Myth written by nutritionist Jonny Bowden, PhD, and cardiologist Stephen Sinatra, MD. At first sight, I wasn’t interested in the book. There are so many similar books I thought: The Cholesterol Myths by Uffe Ravnskog, The Great Cholesterol Con by Malcolm Kendrick, The Great Cholesterol Con by Antonio Colpo and The Great Cholesterol Lie by Dwight Lundell. Sounds pretty boring. However, I decided to give Bowden’s and Sinatra’s book a chance.

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Cholesterol and Heart Disease – Can We Ignore Contradictory Evidence?

The role of cholesterol in atherosclerosis and cardiovascular disease is often debated. In my opinion, the so-called lipid hypothesis is an oversimplification of a complex disorder. Sometimes we debate because we disagree on how to simplify complex mechanisms. Cholesterol is just one of many players in the atherosclerotic process. The main reason it has become such a popular player is that it is easy to measure, not because it plays the main role. However, medical debates are often quite interesting, and they may actually have some positives. They often provoke lively discussions, and they may stimulate scientific research. The downside is that if you have already chosen a side, you run the risk of neglecting, or not choosing to accept scientific results or arguments that don’t support your own opinion.

There are different ways for authors to present a hypothesis they believe is true. You can choose to present all available data, and then make an argument for the data you believe support your hypothesis. Such a balanced, informative approach is honest, and it gives the reader a chance to make up his own mind. However, it doesn’t necessarily catch the attention of the news media or make the headlines.

If you believe you’ve found the truth, you may prefer to select data that reinforce your own beliefs. We could call this the preacher’s approach. There is no reason to discuss any contradictory evidence. That’s just confusing.

In my opinion, the recent book by Bowden and Sinatra is a good example oft he preachers approach. Somehow the authors believe they’ve managed to unlock the hidden truth. In fact, you may admire how fearlessly they expose, what they call the misinformation fed by the scientific community. Let me quote the first sentence of the first chapter: “The two of us came together to write this book because we believe that you have been completely misled, misinformed, and in some cases directly lied to about cholesterol”. Interesting and provoking.

Conspiracy theories are likely to get media attention. I presume that’s a part of the procedure. Somehow, we like to read about how we have been cheated and mislead. Consequently, if you manage to convince people they’ve been cheated, they’re more likely to listen to your theories and arguments.

While reading “The Great Cholesterol Myth”, I had this strong urge that I had to play the devil’s advocate. It’s not necessarily because I dislike the book or disagree with everything the authors write. On the contrary, I think they have some great tips on healthy lifestyle and diet. It’s just because I believe people have the right to hear both sides of the story, and then make up their own mind. I’m not a book critique, so whether I liked the book or not is irrelevant. However, taking on the role of the devil’s advocate I want to bring forward some of my thoughts while reading the book.

“Cholesterol Does Not Cause Heart Disease” – The Main Arguments

In the first two chapters, the role of cholesterol in heart disease is discussed. The authors believe that cholesterol numbers are a poor predictor of heart disease. They point out that more than half of the people hospitalized with heart attacks have what they call “perfectly normal cholesterol levels”.  The importance of cholesterol for different bodily functions is underlined. The message is; because cholesterol is essential for life it can’t be bad. Let me quote the book: “Both of us became skeptical of the cholesterol theory at different points in our careers, traveling different pathways to arrive at the same conclusion: Cholesterol does not cause heart disease.

Exploring "The Great Cholesterol Myth"

The second chapter is called “Cholesterol is harmless“. In this chapter the people who write the special reports and guidelines, meant to help doctors make treatment decisions get a fierce amount of critique. A quote from the book: “When the National Cholesterol Education Program lowered the optimal cholesterol levels in 2004, eight of the nine people on the panel had financial ties to the pharmaceutical industry, most of them to the manufacturers of cholesterol-lowering drugs who would subsequently reap immediate benefits from these same recommendations”.

Atherosclerosis is the underlying cause of cardiovascular disease. It leads to the building of plaques within the walls of our arteries. These plaques are composed of several substances, among them is cholesterol.

Atherosclerosis typically affects the coronary arteries, the vessels supplying blood to the heart muscle. In medical school, I was taught that the exact cause of atherosclerosis was unknown. However, there were certain risk factors, which if present increased the likelihood of developing atherosclerosis and coronary artery disease. The main risk factors were family history of heart disease, smoking, high blood cholesterol, high blood pressure, diabetes, and obesity. None of these risk factors was considered to be the cause of heart disease. However, by modifying the risk factors, the likelihood of developing heart disease could be reduced.

I have never believed that cholesterol is the sole cause of heart disease. However, it is certainly involved, and it is quite clear that cardiovascular disease as we know it would not exist if cholesterol was not present. Is a tsunami caused by water? No, but it won’t happen without it. Is heart disease caused by cholesterol? No, but it won’t occur without it.

The fact that cholesterol is a very important biologic substance and essential to life, does not prove that high levels may not promote a disease process. There are many examples of this phenomenon. Iron, for example, has important biologic functions. However high levels of iron in the body can cause a disease called hemochromatosis. Although insulin is essential for our metabolism, research indicates that high levels are undesirable and may promote obesity. A certain level of blood glucose is essential for life. If we don’t get glucose through our diet, the body produces it. However, high blood levels of glucose are undesirable and associated with the disease we call diabetes. So, although cholesterol is an important biologic substance, high levels could certainly be associated with disease.

In animal models, atherosclerosis does not occur in the absence of greatly elevated blood cholesterol. Furthermore, heart attacks have been shown to be uncommon in humans with very low plasma levels of LDL cholesterol due to a sequence variation in the PCSK9 gene. In cell cultures, according to Nobel prize winners Brown and Goldstein, cellular needs for cholesterol can be met with an LDL cholesterol level of 25 mg/dl (0.65 mmol/L). Human newborns have an LDL cholesterol in the range of 40-50 mg/dl (1.1-1.3 mmol/L). Healthy adult levels are 3-4 times higher. The normal LDL cholesterol range is 50 to 70 mg/dl (1.3-1.5 mmol/L) for native hunter-gatherers, healthy human newborns, free-living primates, and other wild mammals, all of whom do not develop atherosclerosis. Randomized trial data suggest atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to <70 mg/dl (1.8 mmol/L). No major safety concerns have surfaced in studies that lowered LDL to the range of 50 to 70 mg/dl.

Familial hypercholesterolemia (FH) is a disorder characterized by high cholesterol levels, specifically levels of LDL-cholesterol. Many individuals with this disorder die prematurely of atherosclerotic cardiovascular disease. I have found no mention of this disorder in Bowden’s and Sinatra’s book. The most common problem in FH is the development of coronary artery disease at a much younger age than would be expected in the general population. So, try telling a thirty-year-old woman with FH, and an acute heart attack that cholesterol is harmless. Statin drugs have improved prognosis and quality of life in patients with FH.

It is important to emphasize, that it is lipoproteins that interact with the arterial wall and initiate the cascade of events that leads to atherosclerosis. Cholesterol is only one of many components of lipoproteins. LDL, the major carrier of cholesterol in the circulation, is the most atherogenic lipoprotein. High levels of LDL in the blood may lead to increased transport of this substance into the vessel wall. When inside the arterial wall, LDL can undergo a variety of modifications including oxidation, uptake by white blood cells called macrophages, formation of so-called foam cells and the initiation of inflammation. This cascade of events may ultimately result in an atherosclerotic plaque within the vessel wall.

Obviously, cholesterol is not the cause of all this, but it is always involved. So, could it be that atherosclerosis is more likely to occur if plasma concentration of LDL-cholesterol is high than if it is low? The answer is yes. A number of scientific studies indicate that this is definitively the case. However, this does not mean that cholesterol causes heart disease. That’s an oversimplification.

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What Else Is Important?

The authors claim that inflammation is the true cause of heart disease. Let me quote the book: “So if cholesterol isn’t the cause of heart disease, what is? The primary cause of heart disease is inflammation”.

The authors point out that chronic inflammation is a significant component of virtually every single degenerative condition, including heart disease, Alzheimer’s, diabetes, obesity, arthritis, cancer, and many other diseases. They believe oxidation is an important contributor to inflammation and atherosclerosis.

Bowden and Sinatra consider the size of the atherogenic LDL particles to be important. Thus, the more of the large fluffy particles, the better. The more of the small dense particles, the higher your risk. They even suggest these parameters may be considered the “new good and bad” cholesterol, instead of the traditional HDL and LDL cholesterol.

Nature is complex and so are biological mechanisms that control bodily functions. A disease often occurs during specific conditions that involve many different biological pathways. Of course, environmental and genetic factors play a role as well. So, why should there be one simple cause of heart diseases such as chronic inflammation or cholesterol? Isn’t it more likely that lipoproteins, cholesterol, oxidation, inflammation and many other factors are all involved at the same time? So, again, we may disagree because our methods of simplifying complex mechanisms are different.

An association between LDL particle size and cardiovascular risk has been found in some studies. However, measurements reflecting the number of LDL particles appear to be a stronger predictor of risk than particle size in itself. LDL-P and apolipoprotein B reflect the number of LDL-particles. Interestingly, patients with FH usually have large LDL-particles, but their risk of heart disease is very high, and so is their LDL-particle number. It is likely that the association between small LDL and heart disease reflects an increased number of LDL particles in patients with small particles. Therefore, particle size in itself may be unimportant.

Bowden and Sinatra say the benefits of statin drugs have been widely exaggerated. Furthermore, they believe the side effects of these drugs to be much more common than previously thought. They point out that statin therapy may be associated with cancer and diabetes. Other common side effects may be memory problems, lack of energy and sexual dysfunction. They believe that much of the side effects of statin therapy may be traced to depletion of coenzyme Q-10. Dr. Sinatra only uses statin drugs for high-risk middle-aged men.

I share some of the author’s thoughts on statin therapy. I think side effects are underreported and doctors should be much more alert on the possible adverse effects on muscle, diabetes risk, energy, memory and cognitive function. However, most people tolerate statin therapy quite well.

Furthermore, I believe these drugs certainly reduce cardiovascular risk in patients with documented cardiovascular disease, and in many high-risk individuals without disease. However, in my opinion, statins are used too often in low-risk patients. We, doctors, should take the time to inform these low-risk individuals about possible alternatives to statin therapy, such as diet, exercise, and healthy lifestyle.

Interestingly, the chapter on statin therapy ends with a final cautionary note, let me quote: “Look, there’s not much doubt that statin therapy can significantly reduce the incidence of coronary morbidity and mortality for those who are at great risks of developing coronary artery disease“. Here I definitively agree with Dr. Bowden and Dr. Sinatra, but I have to wonder if they disagree with themselves.

What About the Supplements?

The seventh chapter of the book is called “Help your heart with these supplements”, and deals with different nutritional supplements.

There are a number of supplements the authors believe improve the health of our hearts. Among these are coenzyme Q10, which the authors call the spark of life, D-ribose, L-carnitine, magnesium, niacin, vitamin E, fish oils and Omega-3.

Interesting list, but somehow I could not help thinking that, if the authors owned companies that were selling these products on-line, it would seriously affect the credibility of the book and reduce its educative value.

However, keeping in mind they believe that the lipid hypothesis is kept alive by medical professionals getting paid by pharmaceutical companies, I will have to assume that Dr. Bowden and Dr. Sinatra have no conflict of interest.

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bhrdoc
Guest

This is a very balanced, accurate and authoritative review of the Bowden/Sinatra book and the whole cholesterol controversy. Well done Dr. Sigurdsson.

Lizzie Clark
Guest

Walking round graves in Europe from 19th Century I wonder how all those people managed to live to be 88 working the whole time usually, without ever having a blood test in their lives!!! Years ago, a study was done linking stress to raised Cholesterol levels using Tax Accountants in March and early April. We have seen cholesterol bars lowered more and more ditto for bone density testing. I am now reading about how we are getting inflammation and fatigue due to not spending enough time in the sun sans sunscreen, and I do recall women gobbling down HRT meds… Read more »

Steve Peterson
Guest
Steve Peterson

It is a controversy, indeed. I have done extensive research and all I see is one contrary opinion after another. Same thing about statin drugs vs. red yeast rice. I cannot draw any conclusions at all.

Madeleine Morrow
Guest

Great to read such a balanced view. You have addressed in some detail many of the controversial areas confounding the relationship between cholesterol and cardiovascular disease. I will be encouraging my friends to read this article.

neilfeldman
Guest

I am in the middle of the book so I appreciate your review. However I do not fault the authors for their spin. I found they repeatedly emphasized the value of statins for those cardiovascular patients who actually can benefit from them. But not for the vast majority of the population who are being put on these drugs “just because” we are aging and “may” have high cholesterol numbers (but without corresponding high Triglycerides). I agree there is a whole lot more to this “controversy”. But it is important that ordinary people not be put on drugs arbitrarily. Especially when… Read more »

Ted M
Guest
Ted M

Dr. Bowden does indeed sell supplements on his website. Does this disqualify him from being an impartial voice? I don’t know, but writing the book with a Cardiologist was a good move on his part.

Harry
Guest
Harry

It appears that both Dr Bowden an Dr Sinatra sell nutrition supplements on the internet, among them are those they promote in their book. They never mention this as a possible conflict of interest. One of the main message of their book is that people should not take statins, but should take the nutrition supplements they are selling.

At the same time they consider it a problem that some of the doctors who write the clinical guidelines have financial ties with the pharmaceutical industry.

In ethical terms, is there any real difference between these two, I can´t see it?

Lilyrose
Guest
Lilyrose

What about Dr. Siggurdson, isn’t he trying to sell you something? Yes he is selling something. He is selling his medical services. He’s His entire website is about cholesterol. What would happen, if he were wrong about cholesterol? I venture to guess his reputation and pride would be on the line. Perhaps Dr. Sinatra and Johnny Bowden saw the handwriting on the wall. I saw where cardiologists are abandoning LDL targets and just giving statins to everyone over a certain age. https://www.medscape.com/viewarticle/814152

Andrés
Guest

Actually statins are being pushed on everyone with a little high cholesterol (conveniently redefining normal to sell more of them), even here in Spain. I am not an MD, just a patient without any intention of taking them (CT=332mg/dl, HDL=110mg/dl, TG=79mg/dl; yes, I am quite low-carb high-dairy, hence these numbers). I’ll take my chances replicating effective clinical experience by myself.

In respect to newborns’ and hunter-gatherers’ cholesterol I urge anyone to read Paul Jaminet’s take on the subject: https://perfecthealthdiet.com/2011/07/low-serum-cholesterol-in-newborn-babies/ and https://perfecthealthdiet.com/2011/07/serum-cholesterol-among-hunter-gatherers-conclusion/.

neilfeldman
Guest

Please. We live in a capitalist system. Although they may sell supplements (and it certainly would have been nice if they disclosed that fact) this is not a meaningful “conflict of interest”. First, anyone wishes to take these 4 particular supplements has a large and ever growing field of choice as to where to go to purchase them. These guys do not have any exclusive patents – and the high prices that usually go with them – to prevent competition and/or guarantee any income whatsoever from them. Need I point out how that is NOT generally the case for most… Read more »

pronutritionist
Guest

Thanks for very balanced view on this controversial topic. Your points on FH and iron, insulin & glucose are consistently dismissed by cholesterol denialists. I guess low-grade inflammation is bad, but the elevation of inflammation markers in infections is critical for human survival. So inflammation is equally two-edged sword as is cholesterol, if you wish. I can already see the books of 2020s: ‘all you were told about low-grade-inflammation is lie’. But the bigger question is how would your enthusiasm in prevention spread among cardiologists? Dariush Mozaffarian and yourself are doing wonderful work. Most cardiologists don’t care about nutrition. Where… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@Reijo. You are absolutely right about inflammation. It is a two edged sword. An imbalance between pro-inflammatory and anti-inlammatory factors is certainly present in many diseases, such as psoriasis, inflammatory arthritis, Crohn´s and ulcerative colitis. Anti-inflammatory drugs are usually helpful in these disorders. Studies also indicate, as you suggest that a mild immune system imbalance, or low grade inflammation may be present in atherosclerosis and diabetes. Anti-inflammatory drugs are being tested for coronary artery disease. One of the main concerns is whether the susceptibility to infections or cancer will be increased by suppressing the immune system. So, when it comes… Read more »

Material Guy
Guest
Material Guy

If you (overlysimplily) consider inflammation as the key component of healing, the inability of macrophages to clear the cholesterol residue from the intima/media region is the simple explanation. Failed healing is another way to put it. Intuitively, the small size of certain subspecies of LDL particles is a logical reason for for the association between LDL and CHD. It is easier to penetrate between the cells. Is there a reason to believe that all LDL particles of a given subclass and size are indeed identical? As a retired engineer, I am aware that not all ball bearings of a given… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Interesting thoughts. However, possibly the number of particles is more important than particle size. Individuals with familial hypercholesterolemia (FH) often have large particles but high risk of atherosclerosis. Maybe you´re right about the few bad apples”. There is still much we don´t know.

Richard
Guest
Richard

An excellent article by the editor-in-chief of American Journal of Cardiology, William Clifford Roberts “It’s the cholesterol, stupid” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012294/ “Presently, it is commonly stated that “atherosclerosis is an inflammatory disease.” Inflammatory cells, however, are infrequent in plaques of coronary arteries studied at necropsy or in endarterectomy specimens. When present, the few mononuclear cells—even giant cells—appear to be present due to a reaction to the deposits of lipid (pultaceous debris) present in the plaque.“ Inflammation” appears to be a surrogate for elevation of serum C-reactive protein or various cytokines (interleukins 1 and 6, tumor necrosis factor, etc), not for inflammatory cells… Read more »

Andrés
Guest

Dr. Steinberg’s first phrase: “The long-standing controversy over the validity of the lipid hypothesis of atherosclerosis has been settled.1–3”. Well, for me it has been settled, just it is the opposite conclusion. Just read Richard David Feinman’s take on the main evidence. Within second paragraph of Dr. Roberts piece (well, I have my ideas about stupidity, too): “The best study in my view supporting this thesis is the Seven Countries study [8–10].”. It is ridiculous this example of highly biased selection of countries due to a preconceived idea to be defended keeps being highly considered among some physicians. Even an… Read more »

Richard
Guest
Richard

Andre, If Richard Feinman was correct and there was controversy in the lipid theory it would follow that: a) Humans are the only mammalian specimen in the biosphere that is immune to dyslipidemia, elevation of LDL-cholesterol in particular. b) LD-lipoproteins make up the only substance in human body that do not cause harm in excess. To conclude that lipid theory is not valid equals an implicit statement against the darwinian foundation of our biomedical research paradigm. Moreover, it’s rather irrelevant what cholesterol denialists such as Feinman or de Lorgil thinks in their rather silly editorials. None of the people are… Read more »

Kevin Criswell
Guest
Kevin Criswell

And here it is 5 years later and evidence proves Ancel Keys cherry picked those countries because he was paid to come to a particular conclusion.

Richard
Guest
Richard

Continues… “Explain now to me why is a good idea to medicate a healthy subject (elevated cholesterol is not a disease, sorry) before any coronary event has taken place. Not to mention how anyone has arrived to think that statinizing healthy women is an act of intelligence”. Andre, you are little behind your times. Here are the fresh mega meta-analysis from least year (2012). Elevated cholesterol is a pathway to disease, and no mammalian specimen should carry LDL-C above 2mmol/l (80mg/dl) and TC cholesterol above 3,88mmol/l (150mg/dl). Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin… Read more »

Andrés
Guest

Intriguing the Helsinki study. From the study commented on your link Statins reduce cardiovascular events and all-cause mortality in women: Meta-analysis, Meta-Analysis of Statin Effects in Women Versus Men: “Previous meta-analyses, most conducted before the publication of the JUPITER trial, have implied that some of the benefits of statins do not pertain to women in primary prevention and that all-cause mortality is not decreased in women.” Well, it doesn’t let me at ease the inclusion of the JUPITER trial, stopped just when mortality curves were converging. Moreover, take a look at page 1072 (page 5 of the pdf) in Statins… Read more »

Richard
Guest
Richard

Andrés, I am glad you find at least some of my material useful. The relationship of serum cholesterol to the risk of CHD and stroke is strong, independent, continuous and log-linear. This association starts from very low-levels, around 3mmol/l and it’s well-established in all high-quality prospective cohort studies that adjust for regression dilution bias. We can see this clearly even among populations that have very low levels of cholesterol compared to Western people. Lowering LDL with statin and non-statin therapy definitively lowers the risk of acute myocardial infarction, stroke, and premature cardiovascular death. The benefits have been demonstrated in older… Read more »

Richard
Guest
Richard

Here’s an excellent interview with the chief inspector of SATURNUS-trial, Dr Nicholls. These drugs are nothing short of miracle and in terms of safety concerns, high-dose statins match with aspirin.

Great, illustrative graph from the SATURNUS-trial, demonstrating the relationship of median % change in atheroma volume and LDL lowering. This ought to be viewed by every single cholesterol skeptic out there:
comment image

Best,
Richard

Andrés
Guest

Just a quick response. It will take me several days in order to have the time necessary to look at all your links. I suppose you are aware that LDL-C is a worse predictor of cardiovascular problems than LDL-P, just like Dr. Sigurdsson has commented. I like also the visual impact driven by Dr. Attia’s recollection of figures from cited sources on his blog. My point?: it seems having LDL-C < 60mg/dl may be not enough (LDL-C discordant with LDL-P, low the former high the latter) or even unnecessary (LDL-C high and LDL-P low, just look at third Dr. Attia's… Read more »

Richard
Guest
Richard

Andrés, if only did you watch the illustration from SATURNUS powerpoint slides I wired to you….:) The discordance with LDL-P and LDL-C is pretty much issue for only diabetic patients as cocluded by a large expert panel on advanced lipid testing (1). LDL-P is the LDL theory with a twist of metabolic syndrome. The LDL-P story was never made for Peter Attia to push his twisted relationship to food. I don’t have diabetes, LDL-C works very well with me. Friedewald works very well if your triglycerides are <200mg/dl. And no, there's no upside for having LDL cholesterol any more than… Read more »

Andrés
Guest

The Friedewald approximation seems to be quite good for triglycerides between 100 and 400mg/dl (from Dr. Eades’ blog, as this case study… yes, I know, just don’t shoot the messengers). My tryglicerides were 79mg/dl last year, as I said on my first comment. Not that a probable elevated LDL-C worries me, since I bet that my LDL-P would be discordant given my CT/HDL proxy. It seems that discordance due to diabetes is just in the opposite direction, that is, low LDL-C and high LDL-P. Perhaps I will look into possible ApoB direct measure around here, though. I have finished taking… Read more »

Richard
Guest
Richard

Hey Andrés, everything that Ravnskov says is close to 100% nonsense. This is the man who started the nonsense about Keys. Again, I won’t even go there. Cholesterol denialism equals creationism and obviously a disassociation from Darwinian legacy of biomedicine. Good luck with that. Most, the majority of heterozygous hypobbetalipoproteinemia people do very well, and as said, they are immune to CHD and live 9-12 longer than others. Some of them indeed have problem; we need small amounts of LDL cholesterol for cell functions (around 0,3mmol/l), some of these folk have their LDL-C cholesterol around ~0mmol/l. Homegenous hypobetalipoproteinemia patients are… Read more »

Richard
Guest
Richard

Andrés,

you appear to be a smart guy, just eat a diet based on healthy starches (brown rice, maize, oatmeal, ryebread, whole-wheat pasta, potatoes, etc) & vegetables and low in saturated fats and refined oils. I would not gamble on the fancy ratio’s the low carb online echo-chamber produces. Everything goes for them apart from the good o’le LDL. Healthy starches have never failed a population, from rural China and Guatemala to Central-Africa they’ve kept chronic disease at bay.

Andrés
Guest

Ok! I have taken a look at some results about mortality from coronary heart disease (I think that overall mortality is the only relevant measure, though) from Seven Countries Study, 25 yr Follow-up: “The RRs for the highest compared with the lowest cholesterol quartile ranged from 1.5 to 2.3, except for Japan’s RR of 1.1. For a cholesterol level of around 5.45 mmol/L (210 mg/dL), CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to about 15% in Northern Europe. However, the relative increase in CHD mortality due to a given cholesterol increase was similar… Read more »

Richard
Guest
Richard

The 7CS is powerfull, coronary heart disease mortality, a direct function of SFA’s & serum cholesterol. Now wonder the cholesterol confusionists hate the study and act like the Cremlin revisionist towards it. As stamler (2010) pointed out, it’s indeed very bizarre that 7CS was not included in the Siri-Tarino meta-analysis. After all, it is a prospective cohort study. The biological mechanisms which would link sucrose to CHD are not there: Cultures that have traditionally showed high sugar consumption Cuba, Costa Rica, Ecuador hace traditionally showed low levels of cardiovacular mortality. In animal models sucrose feeding open up the arteries of… Read more »

NFP
Guest
NFP

First, the first 5 of 6 six paragraphs of your blog contain no relevant information — length of blog post does not equal intelligent analysis. Second, I suspect you didn’t actually read the entire book. The authors never suggest that cholesterol is ONLY good for you, no matter the levels. They instead explain why cholesterol should not be part of the heart attack prediction/prevention equation. Furthermore, the authors clearly explain that LDL does contribute to heart disease, as you suggest, if it is oxidized and glycated. The list goes on and on. If you want to challenge new medical ideas,… Read more »

Michael
Guest
Michael

While I think your review shows some balance, too many seem to suggest you offer a better balance than do the book’s authors; I am not sure that is proven. The authors present both sides of the debate and simply put forth their analysis and argument against the mainstream thought process. What else would you expect a book like this to do? The authors point out many studies to support their view and I didn’t see one that you presented as a false report or analysis. So you simply seem to have a somewhat different opinion than do the authors.… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Michael. Thanks for your interest in my article. I do appreciate your comments and I find them completely valid. I don´t have a lock on the truth, no more than the authors of the book do. However, I don´t think there is enough scientific evidence to dismiss the lipid hypothesis completely as the authors seem to do. Furthermore, the inflammatory hypothesis remains to be proven and can not at this point in time be accepted as a scientifically proven concept. Atherosclerosis is a complicated disorder. Without doubt, lipoproteins and inflammation are both part of the mechanisms involved. It is quite… Read more »

Mie
Guest
Mie

Michael, “You also comment about the importance of cholesterol on atherosclerosis. The authors do not ignore this, their claim is that very high concentrations continually circulate throughout the vascular system without any ill-effects; they claim it is only cholesterol that has been damaged that actually forms the plaque. You did not address this contention at all.” This is a false dilemma. Yes, when LDL-particles are retained in the arterial intima, they are more susceptible to e.g. oxidation. However, more particles –> bigger risk of that happening. Therefore, high concentrations of LDL are harmful, period. “They claim and you mention “They… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Mie. You took the words right out of my mouth. Couldn´t agree more. Thanks for responding.

mikepapp52
Guest

There have been intriguing developments in the Cholesterol saga with the expose published by the Catalyst science program this week. See it here: https://healingwithintent.com/self-healing/heart-disease-risk-with-high-cholesterol/

Matt
Guest
Matt

High cholesterol means your body is unhealthy and the cholesterol is used as a bandaid to try and repair the damage. As usual western medicine focuses on the symptom not the root cause. The root cause is internal unhealthiness. The answer? Bring the body back to a healthy state…the same answer for ANY issue you might have. I alledgedly have an incurable skin disorder in psoriasis, yet I have cleared over 50% in the past year focusing on nutrition, clearing toxins and other things I read about in study after study. I did a good job of connecting the dots.… Read more »

David Stewart
Guest
David Stewart

I believe in the inflammation hypothesis and believe that insulin resistance is the root cause of obesity and heart disease. The explanations of cholesterols importance to fighting infection and it’s importance to the brain ring true to me. I have eliminated processed foods, most starches and eat a steady diet of eggs, organic non-cured meats, vegetables and a variety of fats from nuts, coconuts, avocado and butter and have never felt or looked better in my life. Allergies and colds are gone, muscle recovery is rapid and sleep is better as well as concentration. Dr. Sears ( Protein Power) and… Read more »

robertbeal
Guest
robertbeal

Other variables? Stress, exercise…

Chaviva Friedman
Guest

Being just a normal, average American, I reacted to my recent result of a 236 overall cholesterol with alarm and quickly made plans to eliminate all animal products from my diet and lose tons of weight and try to get it down below 150 to “eliminate” heart disease risk. Anyways, then I came upon the Great Cholesterol Myth and was suspicious but decided I must research more as the people recommending ultra low blood cholesterol (i.e., Joel Fuhrman) are also making tons of money with books/selling stuff online. I very much appreciate this balanced, intelligent post and also the thoughtful… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks Chaviva for bringing this up. That’s why it’s so often difficult for people to get useful information. So many health writers are trying to sell something or promote a product line designed to enrich their bank account.

Ravanov
Guest
Ravanov

Hi,

Nice review. At one point, you write ” Randomized trial data suggest [LINK] atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to <70 mg/dl (1.8 mmol/L). No major safety concerns have surfaced in studies that lowered LDL to the range of 50 to 70 mg/dl." However, the link is broken. Can you please provide the correct link (and fix the one in your blog entry)?

Thanks!

MaterialGuy
Guest
MaterialGuy

The quote “No major safety concerns have surfaced in studies that lowered LDL to this range of
50 to 70 mg/dl.” appears in the abstract (BUT NOT THE TEXT) of the paper…. “Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal.” J Am Coll Cardiol. 2004 Jun 2;43(11):2142-6.

https://www.ncbi.nlm.nih.gov/pubmed/15172426

Thanks to your previous writings, I am aware of this significant “cheap trick” used in medical literature.

CHEAP TRICK # 12 — Insert strong claims in the abstract that are nowhere included in the text or references.

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