Many people are still being taught by those with vested interests that eating cholesterol will cause heart disease. Some people may be shocked to learn that there are more than a dozen better indicators of artery and heart disease risk than blood cholesterol levels. I have often referred to the “Cholesterol Myth” and “Cholesterolphobia” in this column. As Dr. Stephen Sinatra has pointed out in this column many times, “the broken record of cholesterol keeps playing in the Dark Age of medicine.” It’s time to point out the facts, and fortunately, a new book by Sheldon Zerden does just that—point out the facts. The Cholesterol Paradigm: The Greatest Health Scam of the Century by Sheldon Zerden is scheduled for publication in December 2009 by Benelos LLC. However, a lot of people don’t want to be confused by the facts when it is so obvious that food cholesterol results in arterial deposits of cholesterol—or at least they think so. We will examine the facts in the next two columns.

Many people are still being taught by those with vested interests that eating cholesterol will cause heart disease. Some people may be shocked to learn that there are more than a dozen better indicators of artery and heart disease risk than blood cholesterol levels. I have often referred to the “Cholesterol Myth” and “Cholesterolphobia” in this column. As Dr. Stephen Sinatra has pointed out in this column many times, “the broken record of cholesterol keeps playing in the Dark Age of medicine.” It’s time to point out the facts, and fortunately, a new book by Sheldon Zerden does just that—point out the facts. The Cholesterol Paradigm: The Greatest Health Scam of the Century by Sheldon Zerden is scheduled for publication in December 2009 by Benelos LLC. However, a lot of people don’t want to be confused by the facts when it is so obvious that food cholesterol results in arterial deposits of cholesterol—or at least they think so. We will examine the facts in the next two columns.
 

Readers may remember two chats we have had with Sheldon Zerden reviewing health books. He has written, among others, The Best of Health: The 100 Best Health Books (WholeFoods in 2004) and The Cholesterol Hoax (discussed in WholeFoods in 1997).

Passwater: The discredited hypothesis that eating cholesterol increases the risk of heart disease was based on imperfect circumstantial evidence. As I challenged on the cover of my 1977 book, Supernutrition For Healthy Hearts, “If anyone can step forward and prove that eating cholesterol causes heart disease, I will donate all of the proceeds from my book to the American Heart Association (AHA).”

Needless to say, no one has offered such proof, but the challenge did get me an opportunity to explain the real evidence on media ranging from Good Morning America to major newspapers and television shows around the world. The media took interest in the challenge and tried to find cholesterol proponents to prove the case. They couldn’t be found. More importantly, the challenge earned me frequent guest spots on the radio shows of Dr. Robert Atkins and Carlton Fredericks, which resulted in life-long friendships.

People found it hard to accept the truth after they had been essentially brainwashed for decades into thinking that eating cholesterol caused heart attacks. It seemed so obvious—eat cholesterol and it will automatically zap directly onto your arteries. Your new book, The Cholesterol Paradigm: The Greatest Health Scam of the Century, really brings the evidence to light.

Why did you write the book?

Zerden: I wrote the book as a follow-up effort to The Cholesterol Hoax. I did research on The Cholesterol Paradigm for three years and we edited the manuscript for several more years, while adding new studies and material to make it as up-to-date as possible. It has a great deal of material that can help the reader understand the whole history of the invalidated cholesterol theory. We have to counteract the overwhelming effects of the media and drug companies.

I wanted the public to know the truth about the dangers of low blood cholesterol levels and how dangerous the anti-cholesterol drugs are. People should know that they risk malnutrition when they give up nutritious foods and eat low-cholesterol and low-fat diets thinking they will reduce their risk of heart disease. I wanted to give the scientific evidence proving that the Cholesterol Diet–Heart Hypothesis is totally invalid and that they would only divert their efforts from the real causes of heart disease if they were to follow the guidelines widely promoted by vested interests. Not only would they waste their time and money on anti-cholesterol drugs, but they would also risk their health and lives from their deadly side effects.

Passwater: The decades old “obvious” relationship between dietary cholesterol, plasma cholesterol and atherosclerosis was built on three lines of imperfect circumstantial evidence: animal feeding studies, epidemiological surveys and clinical trials. Over the past quarter century, studies investigating the relationship between dietary cholesterol and atherosclerosis have debunked the idea that dietary cholesterol increases heart disease risk and the validity of dietary cholesterol restrictions based on these lines of evidence. As Dr. Donald McNamara points out, “Animal feeding studies have shown that for most species, large doses of cholesterol are necessary to induce hypercholesterolemia and atherosclerosis, while for other species even small cholesterol intakes induce hypercholesterolemia. The species-to-species variability in the plasma cholesterol response to dietary cholesterol, and the distinctly different plasma lipoprotein profiles of most animal models make extrapolation of the data from animal feeding studies to human health extremely complicated and difficult to interpret” (1).

Early laboratory animal studies with rodents could not induce atherosclerosis in rodents, so investigators switched to vegetarian rabbits. Since vegetables do not contain cholesterol, rabbits do not handle dietary cholesterol well and thus it is not surprising that in the laboratory, atherosclerosis-like plaque can be artificially induced in rabbits. Dr. McNamara also notes that “Epidemiological surveys often report positive relationships between cholesterol intakes and cardiovascular disease based on simple regression analyses; however, when multiple regression analyses account for the colinearity of dietary cholesterol and saturated fat calories, there is a null relationship between dietary cholesterol and coronary heart disease morbidity and mortality. Analysis of the available epidemiological and clinical data indicates that for the general population, dietary cholesterol makes no significant contribution to atherosclerosis and risk of cardiovascular disease” (1).

So, the great cholesterol myth got its start with the Seven Countries Study that attempted to associate diet with coronary heart disease incidence. However, a critical review of the Seven Countries Study by statisticians Drs. R.L. Smith and E.R. Pinckney revealed “a massive set of inconsistencies and contradictions,” leading to the conclusion that the “study cannot be taken seriously by the objective and critical scientist” (2). As one example, the mortality rate in Finland was almost seven times higher than in Mexico, although the fat consumption was identical. The so-called “French Paradox” is another example. The examples selected were chosen to fit their theory, rather than looking at all the available data.

Zerden: Science recognizes no manifestos; it aspires to the truth. Propaganda, on the other hand, is half-truth and often wishful thinking. There is no scientific or conclusive experimental proof that lowering serum cholesterol in humans results in prevention of atherosclerotic disease or heart attacks (3).

“The diet-heart propaganda was escalated by the American Heart Association (AHA). Soon, dietary dogma became a moneymaker for segments of the food industry, a fundraiser for the AHA and busywork for thousands of fat (lipid) chemists. To be a dissenter was to become unfunded because the peer-review system rewards conformity and excludes criticism” (4).

It is useful to review four lines of evidence:

1. One thousand persons in the Framingham Study were examined with a dietary review. There was no relationship between dietary habits and high blood cholesterol (cholesterolemia).

2. Two thousand persons in the Tecumseh Study were given 24-hour diet recall interviews. Levels of serum (blood) lipids (cholesterol, triglycerides, etc.) were found unrelated to dietary practice.

3. The Finnish Trial based on 29,217 person-years with subjects 34 to 64 years of age showed no effect of the treatment diet on total mortality. No diet therapy has been shown effective for the prevention or treatment of coronary heart disease.

4. Clinical trials with drugs used to reduce high blood cholesterol (cholesterolemia). There is no safe and efficacious drug known for the management of high blood cholesterol (cholesterolemia) (3).

Passwater: Does high blood cholesterol cause heart attacks?

Zerden: No, 80% of the people who have heart attacks have a cholesterol level below 222 mg/dL (5).

Passwater: Does age have an effect on cholesterol as the cause of heart attacks?

Zerden: Forty years of study at Framingham showed “no increased mortality with either high or low cholesterol levels among men after age 47.” The same is true for women regarding cholesterol and total mortality after age 47 or under the age of 40 (4).

Passwater: Dr. Kilmer McCully of homocysteine fame more than agrees. “In spite of the great emphasis on cholesterol levels, the Framingham study made several critical observations that refute the Cholesterol Diet–Heart Hypothesis. In the first place, dietary cholesterol has no relation to cholesterol levels in the blood, and dietary cholesterol has no relation to the risk of developing cardiovascular disease.

“This observation was confirmed by multiple large studies from Chicago, Puerto Rico, Honolulu, Netherlands, Ireland and the massive Lipid Research Clinics study of U.S. citizens. The next astounding finding is that elevated cholesterol is not a risk factor for women of any age or for men over age 47.

“Furthermore, both total mortality and cardiovascular mortality in Framingham participants increases in those with LOW cholesterol levels. This finding has been confirmed by multiple studies from Canada, Sweden, Russia and New Zealand. These contradictory findings have been ignored, distorted and incorrectly reported by supporters of the Cholesterol Diet-Heart Hypothesis (6). How much cholesterol do people have in their blood?

Zerden: In a typical person, the entire body contains about five ounces of cholesterol. Only about 7% (one-third of an ounce) circulates in the blood (7).

Passwater: Do statin drugs cause cancer?

Zerden: Drs. Thomas Newman and Stephen Hulley from San Francisco published the results of a meticulous review of what we currently know about cancer and cholesterol-lowering drugs. They found that clofibrate, gemfibrozil and all other statins stimulate cancer growth in rodents (8).

Passwater: What are the side effects of low blood cholesterol?

Zerden: Thirty-one studies, including the Framingham Study, Seven-Countries Study and the giant MRFIT Study, reported higher cancer and/or total death rates with subjects who have lower blood cholesterol levels (9).

Passwater: It seems for years that the dieticians’ rule number one to stay in good health has been to avoid eating eggs. “Eggs are okay—just don’t eat the yolks” is often heard. Also, “egg white is just as good of a source of nutrition as egg yolk.”

Egg whites are a rich source of amino acids, but not so much for the micronutrients. I have often felt that the increased incidence of age-related macular degeneration is largely due to the stress on avoiding egg yolk for these last few decades. The macula needs lutein and zeaxanthin, which help give the yellow color to egg yolks.

Zerden: Most health professionals are well aware of the high nutrient density of eggs and the broad range of vitamins and minerals egg contains. What they seem to forget is that the majority of these essential nutrients are concentrated in the yolk (see Table 1). So for good nutrition, it is unwise to throw away these yolks.

Passwater: However, even many nutritionists today mistakenly think that eating cholesterol increases the amount of cholesterol in the blood.

Zerden: Three independent studies have shown that two eggs a day in the diet had no significant effect on blood cholesterol value of normal humans subjects (11–13). Two studies by Dr. Henry Ginsberg and colleagues at Columbia University College of Physicians and Surgeons found that young men and women who ate as many as three to four eggs a day for weeks on end had virtually no change in their blood cholesterol levels.

Passwater: The common “wisdom” claims that the epidemic of coronary heart disease during the first 60 years of the 1900s was caused by increasingly high blood cholesterol levels.

Zerden: This is not true. Please see Figure 1. The fact is that from 1900 to 1965, the cholesterol level of Americans was constant at 220 mg/dL (14).

Passwater: But, people who watch those television drug commercials may be convinced that the Cholesterol Diet–Heart Disease clinical trials have proved conclusively that a high-saturated fat, high-cholesterol diet causes coronary heart disease.

Zerden: There have been 33 clinical trials of the Cholesterol Diet–Heart Disease hypothesis in the last 30 years. The evidence clearly shows this is not a sound hypothesis. We cling to this disproved theory because of “pride, profit and prejudice” (15). How can these people admit they have made such a dreadful error? How can the AHA admit its error? Its fundraising program would self-destruct! How can bureaucrats admit they have wasted hundreds of millions of research money? These people are entangled in a web of deception.

Passwater: Dr. George Mann of Vanderbilt University in Nashville has pointed out many flaws in the cholesterol theory of heart disease. He stated in People magazine on January 22, 1979, “A ‘Heart Mafia’ is misinforming the American public. When we find the real cause and prevention of the cholesterol problem, it will seem to many that there was an unwholesome conspiracy.”

I notice he states the following about your new book: “The Cholesterol Paradigm reveals the biggest medical scam of the century—maybe the biggest scam of all time. It has mushroomed into a trillion dollar business which has compromised the lives of almost everyone.”
How about the role of genetics?

Zerden: If genetics is a primary cause of coronary heart disease, why was there such a great increase in deaths from coronary heart disease between the mid-1920s and 1968? Did our genes change in a matter of a few decades? Please refer to Dr. Christopher Mudd on this subject in Cholesterol and Your Health: The Great American Rip-Off (16).

Passwater: Proper vegetarian diets can be beneficial for general health, especially if they supplement their diets with zinc, CoQ10 and vitamin B12, which do not exist in vegetables. Vegetarians also tend to eat less junk food, follow healthy life styles and not smoke tobacco. Vegetarians have significantly lower blood cholesterol levels than non-vegetarians. Do vegetarians have lower mortality rates than non-vegetarians?

Zerden: No. They have lower blood HDL cholesterol. HDL cholesterol is the cholesterol carried in the blood by a protein-lipid carrier called high-density lipoprotein (HDL). Blood HDL levels are important to heart and artery health. The higher the HDL, the better. Female vegetarians have higher coronary heart disease mortality than female non-vegetarians. Male vegetarians have lower coronary heart disease mortality than male non-vegetarians, but they have higher all-cause mortality. Table 2 compares the rates.

Passwater: As Dr. Al Sears points out, “Dr. C.V. Felton and colleagues have shown that the plaque in arteries that causes heart disease is mostly made of unsaturated fats, especially polyunsaturated ones (in vegetable oil), not the saturated fat of animals like vegetarians believe (18). In fact, the body needs saturated fats to be able to use other key nutrients, like fatty-acids and fat-soluble vitamins.”

Any blood cholesterol reading of 200 mg/dL or higher is considered dangerous. Is there a direct association between blood cholesterol levels and the coronary heart disease death rate?

Zerden: The Framingham Study has found virtually identical death rates for subjects of either sex across a range of blood cholesterol levels from 205 to 265 mg/dL. Please see Table 3.

Passwater: Did the Multiple Risk Factor Intervention Trial (MRFIT) demonstrate a strong relationship between high blood cholesterol levels and the coronary heart disease death rate?

Zerden: No! In the largest trial (362,000 men screened to select 12,000 overweight, hypertensive smokers with high blood cholesterol), the MRFIT Study proved that across the entire range of blood cholesterol levels (150 to 350 mg/dL), the coronary heart disease death rate increased only 0.13%. This trivial difference in deaths makes the blood cholesterol numbers meaningless!

Passwater: The seven-year MRFIT Study should have stopped the dietary cholesterol nonsense, but it didn’t. The men were given a low-fat diet, smoking cessation, exercise and anti-hypertensive drugs. At the end of the trial, blood pressure was down, smoking decreased and average cholesterol levels were down 7%. When the results of this $100-million trial were analyzed, 115 in the treatment group had died of heart disease, compared with 124 in the control group. This is an insignificant difference. Looking at mortality from all causes, there were 265 deaths in the treatment group, compared with 260 in the control group. The investigators found minor benefits from smoking cessation, no benefit from lowering blood pressure, and no effect of lowering cholesterol levels by 2% compared with the control group.

Yet, the MRFIT Study is used as the basis of the widely repeated myth that “a one percent reduction in blood cholesterol level produces a two percent reduction in heart attacks.”

Zerden: The MRFIT study screened 362,000 men to find subjects with cholesterols above 265. The study failed even with the dishonest statistical analysis. Please look again at the Seltzer findings from the 30-year Framingham Study in Table 3 (19).

Passwater: In November 1985, the National Heart, Lung and Blood Institute (NHLBI) inaugurated the National Cholesterol Education Program (NCEP), which comprised of many scientists who receive funds from vested interests. If you go to the NCEP Web site, the group unequivocally states, “240 mg/dL and above is ‘High’ blood cholesterol. A person with this level has more than twice the risk of heart disease compared to someone whose cholesterol is below 200 mg/dL.”

Zerden: This is certainly refuted by other studies such as the Seltzer Study that formed the basis for Table 3. Dr. Seltzer in his study of 30 years in Framingham showed no difference in mortality with cholesterol of 205 up to 265 (19). The AHA and the NHLBI are so powerful that Dr. Seltzer had to publish this study in an Italian journal of cardiology. The European medical profession was not so smitten by the Cholesterol Diet–Heart nonsense.

Passwater: It seems that every couple of years, the NCEP lowers the target number for acceptable cholesterol levels as the preceding level was found not to be meaningful. This also has the effect of putting more and more people onto statin anti-cholesterol drugs each time to meet the lowered guidelines, yet the death rate doesn’t fall in clinical studies designed to test this theory. The “Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults,” also known as Adult Treatment Panel (ATP) III, appears in the May 16, 2001, issue of the Journal of the American Medical Association. These guidelines substantially expanded the number of Americans being treated for high cholesterol, including raising the number on dietary treatment from about 52 million to about 65 million and increasing the number prescribed a cholesterol-lowering drug from about 13 million to about 36 million.

Zerden: They find that their previous goals were ineffective, so the long-time proponents try yet another attempt with even lower numbers as goals. Other members of the group do it to sell statins. Most of the principles of these groups are on the payroll of the pharmaceutical companies.
 
Passwater: Death rates for coronary disease and stroke have dropped about 30% since 1999 according to Heart Disease and Stroke Statistics—2009 Update by the American Heart Association. They correlate this to total cholesterol levels having declined for women 60 and older and men over 39. They state that total cholesterol levels for these older Americans declined from 204 mg/dL to 199 mg/dL.

Zerden: The 5-mg/dl reduction is so trivial that it is pointless to give credence to this update.

Passwater: Yes, we have more than a 10% daily fasting variation just with the time of day.
The Cholesterol Myth was recognized by many cardiologists from the start, but vested interests, money and repetition eventually have their effects. Did the famous heart surgeon, Dr. Michael Debakey buy into the Cholesterol Myth?

Zerden: Absolutely not! He not only ate bacon and eggs everyday, but he was quoted in the Washington Star on June 15, 1972, “Much to the chagrin of my colleagues who believe this polyunsaturated oil and cholesterol business, we have put our patients on no anti-cholesterol medications. About 80% of my 1,700 patients with severe atherosclerosis requiring surgery have cholesterol levels of normal people.” Dr. Debakey died recently at 99 years of age.

Passwater: Is a high blood cholesterol level a strong risk factor for dying young?

Zerden: Absolutely not! In fact, Dr. Bernard Forette and a team of French researchers from Paris found that old women with very high blood cholesterol levels live the longest. The death rate was more than five times higher for women who had very low cholesterol. (20).

Passwater: Exercisers believe that vigorous and even punishing exercise leads to better health and longer life. They feel that cardiovascular health is promoted by vigorous and strenuous exercise and protects against heart attacks, the leading cause of death. Is exercise truly a way to prolong life?

Zerden: The sober truth should be stated. You may enjoy exercise, it may help you socially, you may look and feel better, but all the rest is myth. Exercise will not make you healthy. Exercise will make you fit. Fitness and health are not the same thing.

Fitness is measured physiologically by oxygen consumption. This doesn’t mean a thing to your heart. Running conditions the muscles and improves oxygen uptake and utilization, but does little for the health of the lungs. If cardiovascular health were a product of physical training, then fit people wouldn’t die of heart disease. Exercise may improve longevity up to a point, but exercisers suffer the same ills that plague us all. The leading cause of exercise-related deaths in well-trained people is coronary heart disease. You can be fit and healthy. You can also be physically fit and ill with coronary heart disease. Finally, you can be unfit and unhealthy as well. Please refer to the book, The Exercise Myth by Henry A. Solomon, M.D.

Passwater: On October 18 of this year, three marathoners died of heart attacks near the 12-mile marker within 16 minutes of each other during the Detroit Marathon. A study by Dr. Siegel and colleagues found several following risks for marathon runners (see Table 4).

Also, Dr. Al Sears, author of PACE: Rediscover Your Native Fitness, explains the heart hazards of vigorous exercises such as marathons. “This happens because adding repeated ‘cardio’ to our busy days and pushing for greater endurance produces the opposite result of what we need in the modern world. Routinely forcing your body to perform the same continuous cardiovascular challenge, by repeating the same movement, at the same rate, thousands of times over, without variation, without rest, is unnatural.

“Long-distance running shrinks your lungs and downsizes your heart’s output. Nature designed your body to adapt to whatever environment it encounters. If you ask it to run long distances repeatedly and routinely, it will adapt to meet the challenge more effectively.

When you run long distances like in a marathon you’re actually training your heart to get weaker. “Your body downsizes your heart and lungs to enable a long-distance run. A smaller output will take you long distances more efficiently in the same way an economy car with a small engine gets you better gas mileage.”

Was the epidemic of coronary heart disease caused by Americans increasing their consumption of animal fats and cholesterol?

Zerden: Absolutely not! During the so-called epidemic from 1920 through 1969, animal fat consumption decreased. Animal fat consumption declined from 25 pounds per capita. Vegetable fats (polyunsaturated oils) increased from 10 pounds per capita to 50.4 pounds per capita; that’s a 500% increase. Please see Figure 2, which shows the consumption of animal and vegetable fats.

Passwater: Well, that’s a lot of upsetting news for many people. They are spending their time and money addressing a strategy of low-cholesterol, low-fat diets that in themselves have been proven scientifically not to reduce the death rate. Moreover, millions are taking statin drugs, which also have been shown to reduce blood cholesterol levels, but have not been shown to reduce the death rate as a result of any cholesterol-lowering actions. Yet, they have dangerous side effects on mental cognition, muscle function and energy.There are healthier diets of moderation and low-inflammatory diets that are more effective. Let’s pause here. We will look into statins, cholesterol and more science of the Cholesterol Diet–Heart Hypothesis next month. WF

References
The complete references for parts one and two of this article will be published in January 2010 with the second half of the column.

Dr. Richard Passwater is the author of more than 40 books and 500 articles on nutrition. He is the vice president of research and development for Solgar, Inc. Dr. Passwater has been WholeFoods Magazine’s science editor and author of this column since 1984. More information is available on his Web site, www.drpasswater.com

Published in WholeFoods Magazine, Dec. 2009