TPNS 34-35: Cholesterol Denialism

Primitive Nutrition 34:
Cholesterol Denialism, Part I

Search Amazon for books about cholesterol and saturated fat and you will see an interesting pattern emerge.  Bucking the conventional wisdom on diet and heart health is popular these days.  Maybe this will seem confusing and you'll want to find the truth...

If you search the words "cholesterol" and "truth" you’ll get more of the same.  That's the funny thing about the internet.

There are apparently people gullible enough to think that websites that say they have the "truth" really do. 

Fear is a great way to connect with an audience if you lack scruples. 

There are responsibly written books about vaccines that are accessible to the public, but in the world of vaccinology, there is no controversy, and the most cutting edge books are beyond the budgets and education of almost everyone.

With cholesterol it's no different.  Titles are targeted at emotions and priced to sell.

And just like with vaccines, the community of experts on cholesterol are not having a debate.  The science has moved forward.

The one thing all the cholesterol confusionists are sure about is that the conventional wisdom about saturated fat and cholesterol is wrong.  That doesn’t mean they agree on much beyond that. 

Heart disease is our number one killer.  Surely they must agree it's a problem.  So what do they think causes it?

The Weston Price Foundation is full of ideas and they seem to be hoping at least one of them will stick.  Chlorine, fluoride, artificial lighting, pasteurized milk.  All these need further study.  Why, they don't say.  Interestingly, they don't yet appear to be sold on smoking as a cause of heart disease, either.  They leave open the possibility that the urge to smoke is due to a nutritional problem, which for them is probably a lack of raw milk.  There is some creative thinking at this website.  I'll admit that.

Loren Cordain thinks it's whole wheat.  Maybe he hasn't gotten around to studying the evolutionary discordance of fluoridated water yet, as the Weston Price folks apparently have.

The deep thinkers at the International Network of Cholesterol Skeptics think it's stress, especially eating under stress.

Cholesterol skeptic in chief Uffe Ravnskov think heart disease is an infectious disease.  This is an interesting idea considering that it is most common in rich countries that otherwise don't have big problems with infectious disease.

No, they may not agree what causes heart disease, but they all agree that the most obvious contributors to it couldn't possibly be to blame.  Dietary saturated fat and cholesterol have been unfairly accused.  The funny thing is, virtually all international medical institutions see things differently.

The USDA has declined to set a minimum daily recommended intake for saturated fat due to its effect on cholesterol.

And the National Institutes of Health says that cholesterol causes arteriosclerosis.

The American Heart Association is also clear about the role of cholesterol in heart disease.

They are trying to raise your awareness of its dangers.

The World Health Organization says there is no dietary requirement for cholesterol.  The less you eat, the better.

A recent summit of international experts in dietary fats met to affirm the scientific consensus.  Saturated fat and cholesterol in the diet are strongly associated with heart disease.

How did this scientific consensus develop?  Through experimentation and observation stretching back more than 100 years.  Even if it were possible to show you all the evidence for the consensus view in a video series, I would not be the person to do it.  But I can show you a few highlights.

First, borrowing a slide from this presentation of Anton Stalenhoef...

We see the range of blood cholesterol concentrations in various mammals.  Newborn humans are way down there with the other mammals.  Adult humans can go quite high, however.  The letters "FH" here refer to familial hypercholesterolemia, or inherited high cholesterol.  Notice the broken Y-axis at the left.  That means the positions on the graph of those with inherited high cholesterol are actually deceptively low here.  Otherwise, they'd be literally off the chart.

As you saw, our cholesterol begins quite low.  Newborns in this study had total cholesterol way down at around 72 mg per dL. This is true even though the mothers in this study were all the way up at 297.  Milligrams per deciliter is the usual way cholesterol is measured in the US.  If you know your cholesterol number, how close are you to 72?

By the way, that 297 score for the moms is really high. 

Babies have been proven to develop safely and normally on diets low in saturated fat and cholesterol, but without the rise in blood cholesterol usually seen in infancy.  Kids raised this way have a healthier start in life.

Atherolsclerosis, which is the most common form of hardening of the arteries, starts with fatty streaks in the artery wall that look like this.

These fatty streaks start a process of thickening and hardening in the artery walls that begins in childhood.

This thickening process has been observed in the arteries of young people who died of unrelated causes.

For American ages 6 to 20 fatty streaks cover 25% of the lining of the aorta. The Japanese have half this amount.

Atherosclerotic lesions progress rapidly between 15 and 34 years of age. 

By the time Americans were old enough to fight and die in the Korean War, they had already developed extensive cardiovascular disease.

This is what atherosclerosis looks like.  I don't know about you but I don't want it.  Any of it.

Some top health institutions say they don't know what causes it, but this should be understood to mean that they don't understand the precise mechanism at a molecular level that causes it yet.  Therefore, it may be technically correct to say it has not been proven that saturated fat and cholesterol cause heart disease, but that would be misleading.   The same institutions will also tell you what risk factors raise your odds of experiencing it.  One of those risk factors is an unhealthy diet, which in part means a diet that includes too much saturated fat and cholesterol.

Since I don't want any of this, it is my choice to eat a diet that has no saturated fat or cholesterol.  Diet is a risk factor I can control, so I choose to eliminate that part of my risk.  That's my choice.  How much risk do you want?

Cholesterol research has an interesting history.  We'll look at that a bit in Part II.

Primitive Nutrition 35:
Cholesterol Denialism, Part II

The effects of diet on heart disease risk are seen across different ethnicities...

And across different cultures.

As you have seen, Loren Cordain wants us to have low cholesterol, much to his credit. 

That humans should have much lower cholesterol than is typical now is becoming a mainstream view.  Hunter gatherer populations with parasite burdens and vegetarians without parasites burdens both serve as the models here.  I'll pass on the parasites in favor of option B.

Lower is better because blood cholesterol has been shown to directly relate to rates of death from heart disease, even at the low end of the scale.

Cholesterol confusionists routinely start their chicanery by pretending to educate us about the important roles cholesterol plays in the body...

As if this would be news to the global community of medical researchers and scholars.  Of course, cholesterol has critically important functions in the body.  The question is, is it healthy to have chronically elevated concentrations of it?

Is high cholesterol unhealthy?  Let's look at other factors beside diet and genetic defects that can raise your cholesterol.  Being overweight can raise your LDL or bad cholesterol.  Old age is associated with higher cholesterol.

Chronic inflammatory disease can raise your cholesterol.

Acute mental stress can raise your cholesterol...

and this is well established.

This is one of the ways work-related stress makes you vulnerable to heart disease.

The threat of unemployment is stressful, too, so it can raise cholesterol as well.

Steroid use will raise cholesterol in body builders.  This is a great example of how the appearance of health and actual health are not necessarily same thing.

Higher cholesterol is also associated with Alzheimer's Disease.

The same goes for sleep apnea.

And of course, high blood cholesterol is also associated with metabolic syndrome, the consumption of an unhealthy diet, and cardiovascular disease.

This is all guilt by association, of course, but it is enough to convince me that lower is indeed better.

On the other hand, exercise and weight loss lower your cholesterol. 

Many plant foods lower your cholesterol as well.  There have been many studies showing this, which raises a question for the confusionists: If it's healthy to have high blood cholesterol and if plant foods like almonds and blueberries lower your cholesterol, does that make almonds and blueberries damaging to your health?

Cholesterol research has a fascinating history.  I recommend reading the articles in this series by Daniel Steinberg, author of The Cholesterol Wars.  I'll refer to this valuable material repeatedly.

In their lecture at the awarding of their Nobel Prize in Physiology or Medicine in 1985, Brown and Goldstein gave us perhaps the most often-repeated quote about cholesterol:  "Cholesterol is the most highly decorated small molecule in biology."  Among the thirteen Nobel Prizes it helped scientists earn, one never went to this man.

This is Nikolay Anitschkow.  Almost 100 years ago as a young experimental pathologist at the Military Medical Academy in St Petersburg, Russia, he demonstrated that atherosclerosis could be induced in rabbits simply by feeding them cholesterol.  Through his research, Anitschkov was the first to describe in detail the progression of heart disease and its connection to dietary cholesterol.  This has made Anitschkow a controversial figure for some, who question the validity of lessons learned from experiments on rabbits.    This theme is recurrent among those who sew confusion over cholesterol.  No animal model is ever good enough for them.  Do they not understand that animals that are especially vulnerable to diet-related diseases have been valuable in research precisely because they are so vulnerable.  Answers to specific questions are found faster this way.

Atherosclerosis had been described long before Anitschkow's work. Rudolph Virchow described its structure, observing that it was not a deposit on the interior surface of the artery, or endothelium.  In 1854 he recognized that it was the product of an inflammatory process.  Cholesterol confusionists usually base their arguments on the idea that inflammation, not cholesterol in the blood or diet, causes heart disease.  This is an either-or fallacy.  Inflammation was seen as important before diet was.  The presence of inflammation is not a matter of controversy today.

A yellowish, fatty substance was recognized as the major constituent in these plaques by Adolph Windhaus in 1910.  This substance is cholesterol.

In this context, we can see how Anitschkow in 1913 guessed correctly that dietary cholesterol could produce this disease.

The connection of diet to heart disease shouldn't be such a hard sell.  Carnivores do not develop atherosclerosis when they eat their natural flesh diets.  But feed an herbivore a carnivore's diet and it will develop atherosclerosis.

The connection of diet to atherosclerosis has been demonstrated in a long list of animal models.

Surprising to me, however, was that a fatty, cholesterol-rich diet has even been shown to induce atherosclerosis in a domestic cat, which is an obligate carnivore.

Steinberg, referring to the mid 1970's

Although virtually the entire medical world accepts and understands the role of saturated fat and cholesterol in the etiology, or causation, of heart disease, it was not always this way.  Opposing theories were preferred through the 1970s.

The pivotal role of blood cholesterol in the development of heart disease, an idea known as the lipid hypothesis, was not widely accepted in the United States until the 1980s.

The controversy over the lipid hypothesis did not abate in the UK until the 1990s.  The old cholesterol deniers are mostly long dead. 

In retrospect, the resistance to the lipid hypothesis is culturally understandable.  People love their fatty foods.  Those who vilify the federal government's role in educating the public about the dangers of cholesterol don't seem to appreciate that government agencies have changed their policies in response to developments in science.  Don't we want our institutions to react to new information?  This old government educational publication gave milk, eggs, meat and cheese, and even butter their own separate food groups.  When we see that it was believed that two tablespoons of butter per day promoted health, we can understand why some people had a long way to go to accept the dangers of such foods.

Animal models were just part of the rationale for the lipid hypothesis. It has been observed directly in humans as well.  In 1916, Cornelius De Langen demonstrated the effect of diet on blood cholesterol in humans.  He had noticed that the mostly vegetarian natives of Indonesia did not seem to suffer from heart disease.  He conducted his own diet experiment, feeding five natives a high-fat, high-meat diet.  This produced a dramatic elevation in blood cholesterol.

Since then at least 395 studies conducted in metabolic wards with carefully controlled experimental diets have collectively made the case for the effects of saturated fat and dietary cholesterol on blood cholesterol levels.

Just as importantly, the lipid hypothesis has been proven in epidemiological studies.  The most famous epidemiologist for the diet-heart idea has been Ancel Keys, and I'll talk about him next.  In the mean time, I suggest you pause the video and read this excellent short description of the role of cholesterol in promoting heart disease, if you don’t know much about it.  It touches on the difference between LDL, or bad cholesterol, and HDL, or good cholesterol.