Part 1 – Is Cholesterol The True Cause Of Heart Disease?
Part 2 – What Really Causes Heart Disease?
Notes from the presentation:
What Is The Current Medically Accepted View Of Heart Disease?
In coronary heart disease the important arteries and veins to take note of are the coronary arteries and veins.
When your coronary artery gets blocked the result is the dreaded heart attack!
If the blood flow via your coronary arteries is affected for a prolonged time, your heart tissue can actually start to die.
So heart disease is really a disease of your coronary arteries and is often called Artherosclerosis.
Arthero means the build up of grey-white/fatty gunk in your artery walls also known as plaques. Sclerosis means general thickening and hardening.
Plaques are generally thought to progress from the initial “fatty streak”, to getting bigger and thicker, then eventually calcifying, turning your arteries in to still, almost bone like tubes. This process usually takes many years to occur.
But it is not the still calcified plaque that we have to worry so much about. It is actually the intermediate stage, known as the “unstable plaque”
During the plaques development it turns into something that resembles a cyst. Its semi liquid center is full of a goo like substance made up of fats, dead cells and broken down bits of blood clot.
If the thin wall breaks down a strong signal is sent to your bodies clotting system and this results in a thrombus (blood clot) forming over the plaque .
If this clot is big enough it can actually stop the blood flow to the section of your heart it is supposed to supply.
So the heart muscle will become starved of oxygen.
This is known as myocardial infarction which is pretty much what we know as a heart attack.
It is this malfunction in your coronary arteries that is known as coronary heart disease and cholesterol is standing on trial today as the prime suspect for its cause!
What Actually Is Cholesterol?
It is found in all the cells of the body, particularly in the brain and nerve cells. 60% of our brain is cholesterol and essential fats.
Cholesterol is a type of fat also known as a lipid.
Cholesterol is a major building block from which cell walls are made.
Cholesterol is also used to make a number of other important substances: hormones (including the sex hormones), bile acids and, in conjunction with sunlight on the skin, vitamin D3.
The body uses large quantities of cholesterol every day and the substance is so important that, with the exception of brain cells, every body cell has the ability to make it.
‘Good’ and ‘bad’ cholesterol : Cholesterol cannot travel around the body on its own because it does not dissolve in water. Instead, it is carried in your blood by molecules called lipoproteins.
The two main lipoproteins are LDL and HDL.
Low-density lipoprotein (LDL). LDL is the main cholesterol transporter and carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, this can cause a harmful build-up in your blood. Too much LDL cholesterol in the blood can cause cholesterol to build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as ‘bad cholesterol’, and lower levels are better.
High-density lipoprotein (HDL). HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed from the body as a waste product. For this reason, it is referred to as ‘good cholesterol’, and higher levels are better.
Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.
The government recommends that cholesterol levels should be less than 5mmol/L.
Risks Of High Cholesterol
Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attack and stroke.
This is because cholesterol can build up in the artery wall (see Symptoms), restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing.
Your risk of coronary heart disease (when your heart’s blood supply is blocked or disrupted) rises as your blood’s cholesterol level increases. Other factors, such as high blood pressure and smoking, increase this risk even more.
A number of different factors can contribute to high blood cholesterol, including:
Lifestyle factors – diet, exercise, smoking
Treatable factors – diabetes, high blood pressure
Fixed factors – Familial Hypocholesterolaemia
Unhealthy diet. Some foods, such as liver, kidneys and eggs, contain cholesterol (known as dietary cholesterol). However, dietary cholesterol has little effect on blood cholesterol. More important is the amount of saturated fat in your diet. Foods that are high in saturated fat include red meat, meat pies and sausages, hard cheese, butter and lard, pastry, cakes, biscuits and cream, including sour cream and crème fraîche.
The fundamental building block for cholesterol is a substance called Acetyl Coa
It contains phosphorous, sulphur and nitrogen (none of which are found in fats, they are found in proteins)
It has several ring structures none of which are found in fats.
Current Theory On Mechanism Of Saturated Fat – Cholesterol
The liver has an amazing ability to change one molecule into an entirely different molecule.
It can turn protein into sugar, sugar into fats, and so it can turn saturated fats into cholesterol.
Carbohydrate Consumption + VLDL
A study by Duke University, researchers randomly assigned 120 overweight volunteers to the Atkins diet, where volunteers reduced their carbohydrate intake to less than 20 grams a day, with 60% of their calories coming from fat.
After 6 months, participants on the Atkins diet had lost 31 pounds, had an 11 percent increase in HDL (good cholesterol) and a 49% drop in their triglyceride levels VLDL
A study from the Oxford group examining the postprandial (after-eating) effects of a low-fat vs. low-carbohydrate diet. (Roberts R et al, 2008)
Carb consumption raises triglycerides & VLDL (bad cholesterol). Fats raise the HDL (good cholesterol). High triglyceride levels & low HDL levels are an indicator of plaque & glycation – the precursors to a heart attack & heart disease.
Nikolai Anitschkov in 1930’s fed rabbits a high cholesterol diet, their arteries thickened and filled up with cholesterol. So hypothesised that this is what must happen in humans too.
Ancel Keys – 7 Countries Study
Took 7 countries and looked at their saturated fat consumption and found a straight line relationship between heart disease, cholesterol levels and saturated fat intake.
Italy, Greece, Former Yugoslavia, Netherlands, Finland, USA, Japan
Framingham Study, 1948
Framingham Study was set up in the town of Framingham, Boston. That continues till today
The whole population was screened for factors that might be involved in causing heart disease.
The findings are that cholesterol in the blood is the best predictor of someone dying of heart disease.
Dr George Mann, 1970’s Food Rationing After WWII.
For 12 years saturated fat consumption was severely restricted
Fruit and fish consumption increased
The rate of heart disease nearly trebled.
The French Paradox
Eat more saturated fat than we do in the UK
They smoke more that we do in the UK
They do less exercise
Have similar cholesterol/HDL and LDL levels
Have a similar average blood pressure
Similar rate of obesity
Consume more saturated fat than any other nation in Europe
But have ¼ of the rate of heart disease
Silagy and Garlic
In 1994 a meta analysis was published by Silagy. He looked at the effect of garlic on blood cholesterol levels and concluded:
There is a 12% reduction with garlic therapy of the total cholesterol between garlic treated subjects and those receiving placebo. This evidence comes from a systematic review of published and unpublished randomized controlled trials of garlic preparation of at least 4 weeks duration.
Studies were identified by a search of MEDLINE and ALTERNATIVE MEDICINE electronic database and through direct contact with garlic manufacturers.
But Silagy changed his mind when he performed his own randomized controlled clinical trial on garlic consumption.
There were no significant differences between the groups receiving garlic and placebo in the mean concentrations of LDL.
The inuit Eskimos have a high saturated fat intake and very low rate of heart disease, but this can be explained by their high consumption of beneficial Omega-3 from fish.
Israel has one of the highest dietary polyunsaturated fats/saturated fat ratios in the world, their consumption of Omega – 6 polyunsaturated fats is about 8% higher than in the USA, and 10-12 % higher than in most European countries.
Despite their “good diet” they have a high prevalence of cardiovascular diseases, hypertension, non insulin dependent diabetes and obesity.
In 2006 Womens Health Intervention USA
48,835 women aged 50 to 79
Study length 8.1 years
Major intervention in diet – randomized interventional controlled clinical study
In 2006 Womens Health Intervention USA
Those randomized to the intervention group were intensively counseled to reduce their daily fat intake to 20% of calories, to increase their intake of fruits and vegetables to at least 5 servings daily and to increase grain consumption to at least 6 servings a day. The control group were consuming on average 37% calories of fat compared to the the intervention group’s 27%
In 2006 Womens Health Intervention USA
Among the study population as a whole there were no significant differences in coronary heart disease, stroke incidence, CHD mortality or stroke mortality or total mortality.
Going back to the NHS website: Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attack and stroke.
In this Japanese study, both rates of heart disease and stroke were reduced by an increase in saturated fat consumption and the increase in cholesterol levels.
1mmol/L fall in cholesterol levels is equal to a 546% increase in risk of dying from cardiovascular disease.
Women and Heart Disease
Women suffer much less than men with heart disease. They also have higher cholesterol levels than men.
This is crudely explained by mainstream medicine by claiming women must produce hormones that must protect themselves against high cholesterol and heart disease
In 1963 a study was carried out on women who had hysterctomies. Half of the women had their ovaries removed at the same time so had no sex hormones and half retained their ovaries.
The results: There was no difference in the prevalence of coronary heart disease between the two groups.
This suggests that there is no link between female hormones and their potential protective effect on the heart.
Russian Women vs British Men
Aboriginal Men vs British Men
Emigrant Indians have the worst cases of stroke and heart disease in the UK and USA
Native Americans have the worst rates of heart disease.
A study in Russia in response to the dramatic increase in deaths due to heart disease in the latter half of the 20th century by Shetov showed that a low level of LDL was the most important risk factor for dying of heart disease.
Atorvastatin / ASCOTT-LLA
A couple of years ago a major trial that was supposed to last 5 years called ASCOTT-LLA was stopped early.
The reason for this is because of the massive reduction in cardiovascular deaths in those given statins compared to those taking placebo. The drug under trial was Lipitor (atorvastatin).
Looking At The Data More Closely
The most important statistic was not talked about, the overall mortality rate, as in the total number of deaths from any cause.
This however when charted shows no statistical significance between placebo and the drug
So although people are perhaps not dying as a result of cardiovascular reasons, they are dying as a result of something else instead.
Crestor / Rosuvastatin Trial
A study in 2008 showed that treatment with rosuvastatin (Crestor) at a dose of 20 mg per day almost halved the risk of ‘vascular events’ (such as heart attack, stroke, and death from these conditions) in middle-aged and elderly men and women.
Overall risk of death was down too in those taking the rosuvastatin, to the tune of 20 per cent. Average length of treatment was a shade under two years.
Let’s Look At This Data More Closely
The participants picked for the study were essentially healthy, and so their risk of things like heart attacks and strokes are pretty small.
The risk of vascular events were 2.2% in the group taking the statin and 2.8 percent in the placebo group.
So the absolute risk reduction as opposed to the relative risk reduction was only 0.5%. You can work this out by the difference of 0.6 / 2.8 x 100 = 20%.
Alarm Bells! What also is worth mentioning is that those who were treated with the Rosuvastatin had a significantly increased risk of developing diabetes.
Lets go even deeper…..
Individuals had to have LDL cholesterol levels of less than 130 mg/L (3.37 mmol/L) to qualify
To qualify for the study individuals did have to have elevated levels of a substance known as C-reactive protein (CRP). CRP is a marker for inflammation in the body.
Significant benefits were seen individuals who had elevated CRP levels, but no other major risk factors for cardiovascular disease
A review from 2005 assessing the impact of cholesterol reducing therapy on overall mortality:
Statins – statistically significant reduction in risk of overall mortality
Fibrates – NO statistically significant reduction in risk of overall mortality
Resins – NO statistically significant reduction in risk of overall mortality
Niacin – NO statistically significant reduction in risk of overall mortality
Diet – NO statistically significant reduction in risk of overall mortality
University of British Columbia Study
If cardiovascular serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3-5 years to prevent one myocardial infarction or stroke.
This cardiovascular benefit is not reflected in two measures of overall health impact, total mortality and total serious adverse events. Therefore statins have not been shown to provide an overall health benefit in primary prevention trials.
Dr Graham Jackson, UK
Long term use of statins for primary prevention of heart disease produced a 1% greater risk of death over 10 years vs placebo when the result of all the big controlled trials reported before 2000 were combined.
Royal College of Psychiatry
“Lower cholesterol levels were related to higher levels of self reported impulsivity. The finding of a lower average cholesterol in the Depression and Self harm group confirms other published studies”
“It is thought that cholesterol may influence serotonin, a neurotransmitter in the brain, low levels of which are associated not only with depression and suicide, but also aggression and impulsivity.”
Dr Marcia Angell, New England Journal Of Medicine (one of the most influential journals)
“It used to be that drug companies simply gave grants to academic medical centeres for the use of their clinical researcher to do a study and that was it. It was at arm’s length. Now it is very different, the drug companies increasingly design the studies. They keep the data. They don’t even let the researchers see the data at the end of it. They sign contracts with the researchers and with academic medical centers saying that they don’t get to publish their work unless they get permission from the drug company”
An Article published in the New York Times, 2009
In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.
Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.
Summary Of Evidence For Cholesterol Causing Heart Disease
Countries with high saturated fat consumption have higher cholesterol levels and high death rates from heart disease – Ancel Keys
People with high cholesterol in the blood have high rates of heart disease – Framingham study and familial hypercholesterolaemia.
Rationing in WW11 was followed by a fall in heart disease rates
Plaques in the arteries are full of cholesterol – Virchow, Anitschkov
Rabbits fed on high fat diets develop high cholesterol levels and heart disease.
Lowering blood cholesterol levels with statins reduces the rate of heart disease.
Summary Of Evidence Against Cholesterol Being The Cause Of Heart Disease
There is no association between average cholesterol levels, saturated fat consumption and the heart disease rate between countries, 14 country study, Dr Kendrick and many paradoxes found in countries such as Sweden, France
National center for health statistics: Over the age of 50 the relationship between heart disease and cholesterol levels is gone.
Emigrant asian indians: A falling cholesterol level is associated with a greater risk of heart disease.
When closely examining statin trials you can clearly see that statins offer no benefit to those who do not have heart disease, but show some benefit to those who have already got heart disease in preventing heart attacks.
The actual risk reductions have been spiced up with clever statistical adjustments and there is also a very strong link between drug companies and the research into statin development indicating many results of trials could be misleading, inaccurate and biased with dangerous consequences to the public.
There is no explanation for the mechanism by which “good” cholesterol actually mops up excess cholesterol in the arteries.
There is no clear explanation for the actual role “bad” cholesterol plays in forming atherosclerotic plaques.
People get heart disease even with low levels of LDL such as the Australian Aborigines.
The fact that cholesterol serves such a vital role in the body could explain why many people are shown to be protected by a higher cholesterol level after a certain age, as it is likely to be involved in the healing process when injury occurs in the coronary artery due to many other risk factors.
But very low cholesterol levels are associated with an increased risk of many other diseases such as depression, cancer and stroke.
Not to mention the recent increases in diseases of the brain where cholesterol is found in the highest levels, such as Alzeimers and Dementia.
It seems that high cholesterol does not in fact cause heart disease, it is something entirely different.
In young men, a high cholesterol level could be an indicator that something is going wrong, rather than the actual cause. It seems whenever this idea that high cholesterol causes heart disease, as it is still just an idea, is questioned with strong evidence to suggest otherwise, more and more ad-hoc theories are added on, when it would probably be easier and healthier or everyone to just admit that high cholesterol does not cause heart disease, it is something else entirely.
Here are some current alternative hypothesis for what really causes heart disease.
The response to injury theory:
- A factor or series of factors damages the endothelium of the artery wall
- This stimulates a blood clot to form over the area of damage
- The endothelium regrows over the blood clot to repair the damage
- The blood clot is removed and broken down by white blood cells
If however this goes on and on for many years, then more and more clots get drawn into the artery wall, a plaque eventually grows, breaks off and you get a heart attack.
Factors that can damage the wall
- High blood pressure
- Possibly LDL – but problem here is that heart disease is found in both people with low and high LDL levels. Arteries and veins both have same exposure to LDL, but only arteries get arteriolosclerosis.
Sugar Consumption / Visceral Fat / Belly Fat
When you eat food, it enters your gut where it is digested, it goes into your small bowel and some of it is absorbed through the walls where the portal vein transports it to the liver. If its good healthy food, your liver is happy and then takes it to other places around your body for nourishment to your cells.
If it is bad food, your liver gets toxic, and it churns out bad fats like LDL. This then gets stored in your belly fat cells, or the omentum. This is what leads to an increase in your waist size.
Calories are the energy values of food and this energy gets stored as fat in your body when its unused. But not all calories are ma de equal. There are good calories and bad calories.
Bad calories lead to the production of bad fats.
So what is a bad calorie? Glucose is the type of sugar our body loves. It gets metabolised by every cell in our body and is very easy to burn with very few toxic by products. It also tells the brain to stop eating when you are full. Fructose on the other hand is another type of sugar and is found in sucrose which breaks down to glucose and fructose. It is also found in high fructose corn syrup which is added to many processed and refined foods.
Fructose is actually only metabolised by the liver and its very similar to ethanol (the alchohol in drinks) When you consume it, its actually like ethanol but without the high. It confuses the liver and ends up making lots of bad fats in the process. It also doesn’t signal your brain that you are full, this is why people can drink massive cups of fizzy drinks which are high in fructose and still eat huge meals containing refined foods that are also full of fructose.
Many fruits also contain fructose, but nature has provided the antidote, as these fruits are also packed with fibre which prevents your body from absorbing too much of it.
When your liver is poisoned it produces bad cholesterol that causes heart disease.
Belly fat is also so bulky that it presses on your kidneys.
This disrupts their function and this will make your blood pressure go up.
So how do you know if you have too much belly fat?
Well besides seeing that visible pot belly, here is a way to see if you are at risk:
- Get a tape measure and then put it around your belly button.
- This waist measurement should be ½ of your height in inches
- If you are 6ft (72 inches) your waist should be no more than 36 inches
2 different types of stress:
Eustress / Healthy Stress
- Roller coaster rides
- Job dissatisfaction
- Financial Worries
- Steroid use
- Diseases such as Diabetes
- Social dislocation / seperation from normal communities as in Emigrant Asians
Whats happens during unhealthy stress?
Release of stress hormones is controlled by the hypothalamus and pituitary gland in unison.
Hypothalamus signals pituritary gland to release hormonal messengers to your adrenal glands to release adrenaline and cortisol.
This is known as the HPA axis.
You have two different divisions to your nervous system – sympathetic and parasympathetic neither of which is under your conscious control.
Sympathetic deals with “Flight or Fight”
- Speeds up your heart rate
- Redirects blood flow away from your gut and to your muscles
- Stimulates your liver to release glucose so higher blood glucose levels
- Triggers the release of various blood clotting factors
Parasympathetic however does the opposite and relaxes you. It helps you to get ready to eat, digest and store energy.
Consequences of a dysfunctional HPA axis:
Cushing syndrome is one extreme example of a body under extreme stress causing the HPA axis to go completely out of sync and produces excess cortisol.
- Increased visceral fat
- Heart disease
Depression is another example of an initiator of HPA axis dysfunction:
“There is compelling evidence for the involvment of the HPA axis abnormalities in depression.” Kunugi H et al Neuropsychopharmacology January 2006
Smoking is also proven to disrupt the HPA axis, although not as chronic in its effect as depression.
My Own Experience With Patients On Statin Medication:
I would like to go back to my own experiences as a pharmacist when performing medicine use reviews.
Anecdotally I would find that a large proportion of the patients I saw on Statin medication had been put on it without experiencing any problems with their health. They had been put on the treatment routinely by their G.P’s. Every so often you would find a complaint of feeling tired and leg cramps since being on the medication. I would immediately send these patients back to the G.P to assess their medication. Usually simvastatin was the culprit.
More interesting was the patients who had one or more risk factors such as high blood pressure or existing disease.
Nearly every single one of these patients complained of feeling under stress. Either from an emotional trauma previously in their life such as divorce, or working long hours, not sleeping properly and so eating the wrong food.
Now what I did that I believe was different from what they were normally used to, was that I actually took a little bit of time to listen to their problems.
Then I offered solutions, usually in the form of a little shopping list of things to buy that would help them that they could easily find from their local supermarket, such as healthier food and drinks.
Many consumed large quatities of fizzy drinks so I suggested a few healthier swaps they could make.
I would also direct them to website with more information that could help them fit exercise into their lives more easily, be able to cook healthier meals and this is the biggy, I would recommend they take up Yoga, Meditation and listen to music that would help them to relax more.
Those who followed through on my advice reported feeling much better and some even came off their medications completely as a result.
A study, published in Journal of The Association of Physicians of India (JAPI), establishes the reversibility of heart disease through yoga. Study was on angiographic ally proven CAD patients, of whom 71 formed the study group and 42 the control group.
And the results proved that the serum total cholesterol levels had reduced by 23.3%, disease had regressed in 43.7% and progression was arrested in another 46.5% of the patients. Some marked improvements were noticed in anxiety levels of patients.
Controlled yoga combining calming and stimulating measures resulted in reduced serum cholesterol, LDL and triglyceride levels.
Other ways to reduce stress and relax:
Music and sound therapy
Listening to music may benefit patients who suffer severe stress and anxiety associated with having and undergoing treatment for coronary heart disease. A Cochrane Systematic Review found that listening to music could decrease blood pressure, heart rate, and levels of anxiety in heart patients.
The researchers reviewed data from 23 studies, which together included 1,461 patients. Two studies focused on patients treated by trained music therapists, but most did not, using instead interventions where patients listened to pre-recorded music on CDs offered by healthcare professionals.
So in my opinion a more holistic approach is required when treating heart disease. Medication merely acts like applying ice on the bruise. If you keep banging your head on the wall, it doesn’t matter how much ice you apply, your bruise will just get bigger and bigger.
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