Research references for this series appear at
www.wafreepress.org/82/cholesterolReferences.shtml

"All published efforts to help by drug or dietary reduction of blood cholesterol have uniformly failed." Sir John McMichael, Professor Emeritus of Medicine, University of London

Is coronary heart disease really the major killer it's made out to be? It is true that a large percentage of deaths in Britain, the US, and other developed countries are attributed to coronary heart disease (CHD). The question is: Is this a cause for concern? As you can see in Table VI, CHD deaths have increased in people over seventy-five years of age. But does this illustrate a problem?

It is a fallacy to believe that if these people had modified their diet or lifestyle, they would still be alive. Despite what the health industry tells us, we are not an immortal species and cannot expect to live forever. I suggest that these figures merely show that people tended to live longer in 1995 than in 1975. This is true of both sexes and that, surely, is a good thing.

Premature death from CHD is a legitimate concern. If dietary change can reduce premature deaths it is arguably to their advantage that people be urged to change their ways. However, Table VII illustrates clearly that CHD deaths have fallen considerably in all under-seventy age groups and both sexes over the past two decades.

Some say that this is evidence that "healthy eating" is working. Do not be misled. This reduction cannot be the result of governmental "healthy diet" recommendations--such official recommendations only began in Britain with the Committee on Medical Aspects of Food and Nutrition Policy (COMA) report of 1984. But premature CHD deaths had started to decline nearly twenty years before in 1965, as is graphically illustrated below in men aged 40-44.

This was a time when people were brought up or spent the greater part of their lives with recommendations for a high-fat diet. They had free, full-cream milk at school, ate bread and dripping and fried breakfasts. During the period after World War II when deaths from CHD peaked and started to fall, rationing had ended and a diet that was relatively high in fat was the vogue.

Not that this will come as any surprise to the Medical Research Council. In its report on the Caerphilly Study published in 1993, the MRC's Epidemiology Unit at Cardiff showed that men who drank more than a pint of full-cream milk a day had only one tenth the incidence of heart disease as those who drank none. They also demonstrated that those who ate a high-energy diet lived longer than those who cut dietary fats. Their findings indicate that far from being a killer, the diet we are told to avoid by the nutritionists may actually protect us against heart disease!

These findings confirmed a Japanese study of 1992. Japan has low levels of death from coronary heart disease but Okinawa has the lowest of all. While blood cholesterol levels are generally low in Japan, Okinawa's levels are much higher, similar to those in Scotland. In 1994 a paper examined the relationship of nutritional status to further life expectancy and health in the Japanese elderly based on three epidemiological studies. It found that Japanese who lived to the age of one hundred got their protein more from meat rather than from rice and legumes. The centenarians also had higher intakes of animal foods such as eggs, milk, meat and fish. Significantly, their carbohydrate intake was lower than that of their fellow countrymen who died younger.

I have noticed, as I preach my gospel, that many women say "I'd rather drink skim milk. I don't like the taste of full-cream milk now, it's too rich". This is a trend that worries me.

We all need calcium but women need a good supply to prevent osteoporosis in later life. Milk is the best dietary source of calcium. As all the calcium in milk is in the milk, not in the cream, skim milk contains slightly more calcium than full-cream milk. On the face of it, therefore, it looks like a good idea to drink skim milk. But for calcium to be absorbed from the gut, it has to be there in the presence of fat and vitamin D--and skim milk contains neither. As a result, while just over fifty percent of the calcium in full-cream milk is absorbed, only about five percent is absorbed from skim milk. (It will make little difference if the milk is artificially fortified with vitamin D, because the necessary fat will still not be present.) And if you drink your skim milk with bran muesli for breakfast, you probably won't absorb even that five percent.

In 1979 the late Professor Sir John McMichael performed an inquest on the diet/heart hypothesis. Pointing out that

"All published efforts to help by drug or dietary reduction of blood cholesterol have uniformly and convincingly failed.... we need a fresh approach to the problem at the scientific level and should avoid further public speculation and confusion by repeated propaganda through the media until we have clarified our own professional minds and shaken off what most critical doctors are likely to regard as an untenable hypothesis of causation."

It is a pity that nobody seems to have taken any notice of him.

Fat has over twice the energy value of either carbohydrates or proteins, and other essential nutrients: lipids used in the brain and central nervous system without which we become irritable and aggressive; sterols, precursors of the bile acids and a number of hormones (including the sex hormones); and the fat-soluble vitamins A, D, E and K. The late Dr. John Yudkin, when Professor of Nutrition and Dietetics at London University, called fat the most valuable food known to man. It is both stupid and wasteful to throw it away.

A question of ethics

Is it ethical to impose a regime on people in the hope that heart disease will be reduced? Surely prevention is better than cure, you may say. But is it? Such an attitude ignores the real possibility that such intervention may do more harm than good. 'Preventative' medicine as practiced in the case of heart disease, takes two forms. Firstly we are to change our lifestyles, and secondly we are screened by our doctors on an opportunity basis.

But this screening is not prevention of the disease, it is merely the early detection of it. For such procedures to be of use a number of criteria are well established. One important one is that the disease should be both common and serious, as screening for an uncommon disease will throw up many false results. These will inevitably incur the cost of further testing, and cause unnecessary anxiety which itself is harmful.

The first problem with screening in CHD, is deciding what to test for. As a predictor of coronary risk, total blood cholesterol turns out to be irrelevant, and merely testing for that is regarded by many experts as misguided. Far more reliable, they claim, is measurement of HDL (the "good" cholesterol). However, in a test of the accuracy of checking for HDL at various laboratories, values differed by as much as 40% in 95% of the samples tested. In another study, 16 instruments manufactured by nine companies were tested in 44 laboratories. In this study, although the inaccuracies of the machines were lower at 3.6-4.4%, biases attributed to the methods used ranged from -6.8% to +25%. The accuracy of desktop machines is even more suspect.

A third study to evaluate the ability of cholesterol screening to detect individuals with blood cholesterol abnormalities concluded that 41% of those with abnormal levels would not be detected using present guidelines.

Another criterion is that an effective treatment for the disease is available, as there is little point in early diagnosis or detection of a disease for which there is no effective remedy.

Some will say that we do know the cause of coronary heart disease; it is high cholesterol, or too much fat in our diets, or not enough exercise. Or it could be something else. In 1981, two hundred and forty six "risk factors" for heart disease were listed. That number is now well over three hundred. The current so-called risk factors include having English as a mother tongue, having a diagonal crease in the left earlobe, not taking siestas, not eating mackerel, snoring, and wearing tight underpants. What a list this long really tells us is that we have little idea what causes CHD. And it is certain that if all the 300-plus reasons do play a part, we have no chance of defeating the disease.

A director of the Health Education Program of the American Medical Association denounced the lifestyle changes with their false promise of benefit as a quasi- religious crusade when in 1984 he wrote: "Constant lifestyle self-scrutiny in search of risk factors, denial of pleasure, rejection of the old evil lifestyle and embracing a rigorous new one are followed by periodical affirmations of faith at revival meetings... the self-righteous intolerance of some wellness zealots borders on health fascism. Historically, humans have been at greatest risk while being improved in the best image of their possibilities as seen by somebody else."

Telling people who feel fit and well that they are not and, that if they do not make major changes to their lives, they could drop dead at any moment, not only worries them unnecessarily, it can have a profound effect on their attitudes to life. The benefits of mass screening are doubtful and the risk of harm is high. Such intervention, therefore, can only be justified ethically when either the patient has requested it or symptoms are such as to make it desirable.

If we go to our doctor with a complaint and he treats us with the best medical knowledge, he should not be held responsible for defects in that knowledge. If, however, the doctor initiates treatment without being consulted by the patient, then he is in a very different situation. Cochrane and Holland write that before advocating a course of action in such circumstances, "He should, in our view, have conclusive evidence that screening can alter the natural history of disease in a significant proportion of those screened." If he does not, he may be held responsible for any harm done.

But in the case of heart disease, recognized medical standard tests and ethics have been thrown out the window. The recommendations were forced on the public even before they had been tested, and now the perpetrators are afraid to admit that they could have been wrong. But until they do, whole populations are suffering unnecessarily.

In the US, blood cholesterol level testing for all is routine and that nation is becoming a nation of "cholesterophobes." More concerned with death than with life, many interviewed said that their lives were ruined; if they simply had a dessert, it was accompanied by feelings of guilt.

One of COMA's diet recommendation principles was that the measures should "afford a reasonable prospect of improvement in life expectancy overall, and in the quality of life for the population as a whole." Experience around the world, and particularly from the US, makes it certain that neither of those principles will be met.

In Britain, general practitioners, practice nurses and health visitors are starting to use desk-top cholesterol testing machines, the majority of which have been loaned by drug companies. A suggestion in the British medical journal Lancet was that this is designed merely to enhance the drug companies' profits by increasing sales of cholesterol-lowering drugs. There is also the question of the psychological harm that could be done to people in view of the experience in the US of the inaccuracy of such machines.

Imagine it is 2:00 am, and you are lying in bed when you hear a noise downstairs that you know is caused by a burglar. You know how quickly your heart starts to race. Well, that is how quickly your cholesterol level can rise--and for the same reason. One of the effects of the "fight or flight" reflex is to raise blood cholesterol. Any form of physical or mental stress has this effect. So if you run to your doctor's, your cholesterol level will be higher than if you walked; if you have been standing it will be higher than if you sat. If you are anxious, or your doctor looks worried, it will be higher. If your blood cholesterol were tested hourly throughout a day, or daily over a month, it would not be unusual to find a wide variation in values.

Blood cholesterol levels also rise naturally as you get older, so that while a reading of 9 mmol/l (equivalent to about 350 mg/dl in the US) is high at the age of twenty, it is perfectly normal if you are fifty.

Cholesterol measurements are not very accurate--less than eighty percent--even when conducted in a laboratory. A survey showed that on the same sample, laboratories could differ by as much as 1.3 mmol/l. When it is tested with a doctor's desktop machine the accuracy will inevitably be lower.

To put it in perspective, let us assume that you are around thirty years old and your cholesterol level is a perfectly respectable 6.0 mmol/l (235 mg/dl). You hurry to the surgery and are anxious about the result. This could raise it by twenty-five percent to 7.5. If it is sent to a laboratory giving the high readings it could be raised by a further 1.3. Your perfectly normal 6.0 is now a high 8.8 (345 mg/dl)!

In fact, so many variables affect cholesterol levels that a one-time test is a waste, and an unnecessary worry for the patient that can do more harm than good. Bear that in mind if you are subjected to a cholesterol test.

The current "diet-heart" strictures and media pressure aimed at ever lower blood cholesterol levels, have driven more people towards unnatural and unhealthy cult diets. Consequently, there has been a rapid rise in the incidence of infant malnutrition, deficiency diseases and other killer or debilitating diseases. Without sufficient dietary fat, the body is unable to use the fat soluble vitamins. Without vitamin D the body cannot utilize calcium. In conjunction with an increase of bran in the diet, this is another possible factor in the growing incidences of diseases such as osteoporosis and rickets.

Vegetarian traits are increasing. As animal products are the only natural source of vitamin B-12, vegans, who eat no such animal products, run a real risk of pernicious anemia. Bottles of pills are not a good substitute as they are generally poorly absorbed. Fermented soy products, such as tempeh, and spirulinas found in health-food shops, which are supposed to contain vitamin B-12, for the most part contain only analogs of the vitamin which are not active for humans and which, in some cases, actually block vitamin B-12 metabolism. Children of vegans also usually have a lower body weight and height and suffer other health problems.

Doctors in Britain are reporting cases in 'the muesli belt' of severe nutritional disorders which include kwashiorkor, marasmus and rickets which are due solely to their parents' food faddism. Until recently, these diseases were only found among severely malnourished children in Africa. In Britain it is becoming so serious that they suggest that such cases should be regarded as forms of child abuse. But are the parents to blame? Could not some of the blame for this deplorable situation be fairly laid at the doors of the nutritionists?

Doctors in the US also are reporting ever increasing numbers of children suffering from nutritional dwarfing and other deficiency problems attributable entirely to pressures to eat nutrient-poor, low-calorie foods. These children are destined to have far-reaching problems beyond just being smaller than their peers.

It has been shown that adults whose birth-weights and early rates of growth were low have a much higher incidence of CHD. Brain growth and intelligence are also found to be much lower in such undernourished children.

And it is not just humans who suffer side effects. In the constant quest for ever leaner meat, food animals are being engineered which could not survive naturally. Belgian Blue cattle, for example, bred to provide lean meat, have double muscles. This makes the calves too large to pass along the birth canal and they have to be delivered by Cesarean section. Other cattle and pigs are fed hormones to make them grow with less fat. As yet it is anyone's guess what the long-term consequences of this will be on both the animals and humans.

The strictures against red meat also mean that fewer cattle and sheep are being reared and more fields are used to grow cereals, vegetable oil crops such as canola, and other vegetables. Unlike the animals, which on the whole produce natural fertilizer for the pastures, the vegetable and cereal crops require large amounts of manufactured nitrogen fertilizers. These fertilizers leach in ever-increasing quantities out of the soil to pollute our water supplies. Grass, the food of the cattle and sheep, on the other hand, locks the nitrates in the soil, thus preventing pollution.

"Healthy eating" tells us to eat low-fat, high-carbohydrate diets, but in the last few years of the twentieth century, several papers demonstrated the harm this could do.

Back in 1932 obese patients on different diets lost weight thus:

* Average daily losses on high carbohydrate/low fat diet: 49g

* Average daily losses on low carbohydrate/high fat diet: 205g

Drs. Lyon and Dunlop say: "The most striking feature... is that the [weight] losses appear to be inversely proportionate to the carbohydrate content of the food. Where the carbohydrate intake is low the rate of loss in weight is greater and conversely."

It's no coincidence that the numbers of people getting fat has risen dramatically since "healthy eating" was advocated. As long ago as 1863 it was shown that low-fat, high-carbohydrate diets make people fat. The medical world is at last waking up to this fact. In 1994 Professor Susan Wooley of the University of Cincinnati's College of Medicine and David M Garner, Director of Research at the Beck Institute for Cognitive Therapy and Research wrote that: "The failure of fat people to achieve a goal they seem to want and to want almost above all else must now be admitted for what it is: a failure not of those people but of the methods of treatment that are used."

In other words, blaming the overweight for their problem and telling them they are eating too much and must cut down, is simply not good enough. It is the dieticians' advice and the treatment offered that are wrong. Wooley and Garner conclude: "We should stop offering ineffective treatments aimed at weight loss. Researchers who think they have invented a better mousetrap should test it in controlled research before setting out their bait for the entire population. Only by admitting that our treatments do not work and showing that we mean it by refraining from offering them can we undo a century of recruiting fat people for failure."

In 1997 two more Americans, Drs. AF Heini and RL Weinsier noticed the trend and blamed it on low-fat diets saying: "Reduced fat and calorie intake and frequent use of low-calorie food products have been associated with a paradoxical increase in the prevalence of obesity".

Obese people tend to go on to suffer type II diabetes, and diabetics are more prone to heart disease. For this reason patients with type II diabetes are counselled to eat a "healthy" low-fat, high-carb diet. But as a paper in the medical journal Diabetes Care pointed out: "Low-fat, high-carbohydrate diets eaten by patients with diabetes... have been shown to lead to higher day-long plasma glucose, insulin, triglycerides, and VLDL-TG, among other negative effects. In general, study has demonstrated that multiple risk factors for coronary heart disease are worsened for diabetics who consume the low-fat, high-carbohydrate diet so often recommended to reduce these risks."

In June 1999 the 81st Annual Meeting of The Endocrine Society was told: "A very high-fat, low-carbohydrate diet has been shown to have astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles. The thing many diabetics coming into the office don't realize is that other forms of carbohydrates will increase their sugar, too. Dieticians will point toward complex carbohydrates... oatmeal and whole wheat bread, but we have to deliver the message that these are carbohydrates that increase blood sugars, too."

Dr. Gerald M. Reaven, of Stanford University School of Medicine in California, and colleagues compared the effects of a low-fat, high-carbohydrate diet [25% fat, 60% carb, 15% protein] with a high-fat, low-carbohydrate diet [45% fat, 40% carb, 15% protein], on blood fats and cholesterol. They found their subjects had significantly higher fasting plasma triglyceride concentrations, remnant lipoprotein cholesterol concentrations, and remnant triglyceride concentrations when they were on the high-carbohydrate, low-fat diet, both after fasting and after breakfast and lunch. The study participants also had significantly lower HDL (the "good" cholesterol) concentrations on this diet.

The authors conclude: "...it seems appropriate to question the wisdom of recommending that all Americans should replace dietary saturated fat with [carbohydrates]."

Then, in 1992, the Framingham Heart Study again stated: "In Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol...." and "...we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active."

And in 1997 it was discovered that "Low-fat, high-carbohydrate diets [15% protein, 60% carbohydrate, 25% fat] increase the risk of heart disease in post-menopausal women."

And that's not all. The largest and most comprehensive study on diet and breast cancer to date found that:

* women with the lowest intake of fat had a significantly higher incidence of breast cancer,

* women with the highest intake of starch also had a significantly higher incidence of breast cancer, and

* saturated fats were not implicated in breast cancer.

The biggest study so far into the relation between breast cancer and fat intake is the Nurses' Health Study, conducted by Harvard University Medical School. A total of 88,795 women free of cancer in 1980 were followed up for 14 years. Comparing breast cancer rates in women who derived more than thirty percent of their calorie intake from fat with women who derived less than twenty percent of calories from fat, they show that those on low-fat diets had a higher rate of breast cancer than those who ate more. They went on to look at the various different types of fats and found that breast cancer rates were lower for all types except one: omega-3 fish oils, which are touted as "healthy", but which were the only ones that increased cancer rates. However, the increase was small.

Dr Michelle Holmes and colleagues conclude: "We found no evidence that lower intake of total fat or specific major types of fat was associated with a decreased risk of breast cancer" .

The Mediterranean Diet

The "Mediterranean Diet" is healthier than ours, we are told. We should eat what the French, Italians and Spanish eat. That could be right--but not for the reasons usually given.

The Mediterranean diet is what some health fanatics advocate because, they say, it is low in fat. This is nonsense! Obviously, they have never been there. They don't seem to know that northern Italians love butter, that bowls of pork drippings are sold in Spanish markets or that the Spanish spread it thickly on their toast for breakfast. They don't know that goose fat is used to make cassoulet in the south of France, or that throughout the Mediterranean the sausages, salamis and pates all contain up to fifty percent fat.

The Mediterranean diet may be healthier than the British or American, but, contrary to popular belief, it is very far from being a low-fat diet!

However, there are a number of factors in the Mediterranean countries that may play a significant part in health. Not only is the food eaten by the average working family in southern Europe very different from that eaten by a typical family in Britain or the US; the way it is bought, presented and eaten is also different. The principal differences are briefly listed here below.

Mediterranean Eating Pattern

* The average diet comprises natural, unprocessed meat, vegetables and fruit that are usually bought fresh daily.

* Meat plays an important part in the diet.

* Fats eaten are butter, olive oil and unprocessed animal fats.

* Meals are taken slowly, without hurrying. Lunch usually takes up to two hours--and is followed by a siesta.

* Over sixty percent of energy intake is before 2:00 pm.

* Wine (believed to be protective against heart disease), is drunk during meals as part of that meal.

British & American Eating Pattern

* The average diet is composed of packaged, highly processed foods with chemical additives.

* We are told to eat less meat.

* Fats eaten are highly processed margarines, low-fat fat substitutes, and vegetable oils.

* Food is rushed. Lunches are eaten on the run or combined with work. Often, they are junk-food snacks.

* The largest meal is eaten in the evening.

* Beer, wines and spirits are drunk in the evening after the evening meal.

Toward a sensible diet

As we have seen so far, the emphasis on increasing carbohydrates at the expense of fats has not been an unqualified success. And there are good reasons for this.

We have known since 1863 that carbohydrates cause obesity, since 1935 that they cause diabetes, and since 1941 that they increase aggressiveness and criminality in children. We've known for more than 35 years that they promote coronary heart disease, and more recently that they increase the risk of cancers. So is it merely coincidence that diseases for which carbohydrates are implicated have risen so dramatically since we have eaten more carbohydrates?

No. "Healthy eating" is becoming something of a disaster. The best advice appears to be that we should reduce carbohydrate intake and increase our intake of saturated fats, especially animal fats.

The totality of evidence suggests that we should eat animal fats and saturated fats in preference to vegetable oils because:

1. Polyunsaturated fats found in margarines and cooking oils may lower cholesterol levels but they certainly increase cancer risk.

2. Trans-fats found in margarines and processed oils also increase CHD risk.

3. There is some evidence that "healthy" omega-3 oils may increase cancer risk somewhat.

4. Monounsaturated fats (such as found in olive oil) are no better as far as heart disease is concerned but they may reduce cancer risk.

5. Saturated fats are healthier in CHD, particularly if you have already had a heart attack. They are not implicated as a cause of cancer.

6. Conjugated linoleic acid found only in animal fats is a powerful anti-cancer agent.

7. Animal fats are just under half saturated and just under half monounsaturated, with a small, but sufficient proportion of polyunsaturated fats.

Carbohydrate intake from sugars and starches in breakfast cereals, bread, pasta, rice, et cetera, should be reduced because it increases diseases including obesity, cancer, diabetes and CHD.

Bran (cereal fiber) should be avoided like the plague. Although dietary bran has frequently been touted as a preventive for colon cancer, January 1999 saw the publication of the largest trial into the effects on fiber on colon cancer ever conducted. After studying 88,757 women for sixteen years, doctors at the Brigham and Women's Hospital and Harvard Medical School say that "No significant association between fiber intake and the risk of colorectal adenoma was found.... Our data do not support the existence of an important protective effect of dietary fiber against colorectal cancer or adenoma."

Furthermore, fiber, by speeding food through the gut faster so that less nutrients are absorbed, inhibits the absorption of iron, calcium, phosphorus, magnesium, energy, proteins, fats and vitamins A, D, E and K. More importantly, phytate found in cereal fiber (bran) also binds with calcium, iron and zinc making them indigestible, which in turn causes malabsorption. These findings are a cause for concern in several sections of the population who are at considerable risk from eating too much fiber, bran fiber in particular. Osteoporosis, Alzheimers, anemia, depression, and menstrual dysfunction have all been associated with lack of the nutrients for which bran inhibits the absorption.

Conclusion

An assessment of all the cholesterol-lowering dietary trials published in 1987 showed an aggregate six percent more deaths in those who adopted a cholesterol-lowering diet over those on a free diet. A similar review of drug trials showed an aggregate of over thirteen percent more deaths in those taking cholesterol-lowering drugs.

More resources, time and money have been spent over the last fifty years on coronary heart disease than any other disease in medical history and all it has proved is that doctors don't know as much as they thought they did. If half a century of serious research has failed to find a causal link between a fatty diet and heart disease, it can only be because there is no link.

To make intelligent decisions you must be given advice that is based on proven facts rather than unfounded assumptions. And the facts at present seem to be that milk, cream, butter, meat and fresh fruit and vegetables are the healthy foods, while polyunsaturated spreads and oils, bran flakes and packaged foods are not.

Seventy years after it began we still do not know what caused the dramatic rise in coronary heart disease deaths in the 1920s or why coronary mortality is now falling. But one thing that the last fifty years of studies has demonstrated is that cholesterol has had very little to do with it.

The research has also demonstrated no evidence of a need to endure an unpalatable, fatless, bran-laden diet. Apart from being less pleasurable to eat, it is now clear that "healthy eating" is not so healthy after all.

Barry Groves is an international author based in England. He has devoted himself to dietary research since his retirement from the Royal Air Force in 1982. A doctor in nutritional science, he has written a number of popular and technical books which have been published in countries as far apart as Argentina and Russia. He is also a champion archer. Groves has two websites related to health and diet: second-opinions.co.uk
and theperfectweight.com
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