TPNS 40-41: Playing Games With Your Heart

Primitive Nutrition 40:
Playing Games with Your Heart, Part I

In researching this topic it has become clear to me that those who promote saturated fat and cholesterol are just playing games with people's health. 

Here is an example of the use of misleading graphs in the cholesterol games.  This comes from a website called Perfect Health Diet.  This graph purports to show the relationship between healthy life expectancy on the y-axis along the left, and the ratio of animal to vegetable foods consumed on the x-axis at the bottom, with each point on the graph representing a country.  It appears that in countries that eat more animal foods people live longer, with Iceland all the way to the top right.  The Perfect Health Diet people think this is pretty powerful stuff.  "Take that, vegetarians!," they say.

This graph is misleading, partly because it basically represents the food ladder, where wealthier countries eat more animal foods because they can afford to. 

Look at the countries with the shortest life spans down at the bottom left and you'll see countries afflicted with poverty and infectious disease like Angola, Mozambique, and Swaziland.  At the other end of the spectrum you'll see industrialized nations with top health care systems like France, Sweden, and Denmark.  I guess the very smart people at this site think the only difference between Lesotho, with its rampant HIV epidemic, and Iceland, with its complete universal health care system, is the amount of saturated fat they eat.  Yes, I'm sure the vegetarians find this graph absolutely devastating.  Good job, Perfect Health people!

My question to confusionists who make this argument is why do you think cholesterol is more important in controlling infectious disease than sanitation?  40% of the world's population doesn't even have a hygienic toilet to use.  Don't you think that might be just a bit more important in affecting life expectancy than whether they eat butter or not?

By the way, if you are wondering what the people look like who have the audacity to say they have the perfect health diet, here you go.  For me, the words "perfect" and "diet" don't belong anywhere near each other.

Here's another graph they liked on that site.  This one shows all-cause mortality along the left and total blood cholesterol along the bottom.  As you might expect, what's happening here becomes obvious when you again look closely at the countries.  The countries with the highest mortality to the top left are places like Barundi, Mali, and Guinea.  The countries with the lowest mortality at the bottom of the curve are places like Germany, France, and Belgium.  Mortality rises again with cholesterol at the bottom right with places like Colombia, Uruguay, and Belarus.  You see the same phenomenon is at work.

There is more to this, though.  Look closely and you can see the creator of this graph chose to plot infectious and parasitic diseases separately.  It doesn't follow a U-shape like all-cause mortality does.  It starts high at around the 1000 mark on the left and then just plunges to zero near the middle. This effect is behind claims you may see online that high cholesterol protects against infectious disease.  If you buy into that belief then would have to believe that people with high cholesterol don't get sick much.  That's an argument I'd love to hear a cholesterol confusionists make.

Especially when evidence suggests lower cholesterol enhances immune function.

Not only does low cholesterol not increase mortality, statins don't either.  While cholesterol lowering through diet is preferrable on every level to drugs, drugs are still safer than high cholesterol.

When you see visuals like those two from the Perfect Health people trying to get you to doubt guidelines from responsible health institutions, remember these graphs.  This is an example of a similar use of graphs to deceive, in this case in regard to vaccinations. Upon first glance it appears the introduction of vaccines had nothing to do with past triumphs over infectious diseases.  The creators of these graphs don't want you to research any further than this.  If you do, you'll see these graphs are lies.

The downward trends in mortality rates were due to improved medical treatments, like the iron lung, or antibiotics that made vaccines unnecessary.  They don't account for improvements in sanitation that preceded the vaccinations.  These graphs show mortality rates but not infection rates, so you don't see the sickness and suffering the diseases were causing even if they were killing fewer people.   

Graphs like these are cynically intended to manipulate you and undermine your trust in responsible institutions.  The cholesterol graphs are no different.

The Perfect Health Diet couple were just getting warmed up with those misleading graphs.

Here they select a table from a study to argue that there is a Goldilocks range for cholesterol between 180 and 260.  Go lower and deaths increase, therefore lower cholesterol is less safe.  This is an interesting conclusion to draw from something they are calling the Japan Lipid Intervention Trial, which you see at the top.  What do you think the intervention was?  Broccoli or drugs?  Who do you think received the intervention?  The sick and weak or the young and fit?

Here is the table a bit closer.  These were people taking a drug called Simvastatin for six years.

Here is the study.  It was not called the Japan Lipid Intervention Trial, but it came out of the Japan Lipid Intervention Trial. The drug’s name is right there in the actual title.  They didn’t tell you the name of the specific study because that would tell you right away that this study was just looking at the effects of a drug, not diet.  It was a primary prevention study, meaning people who had no history of heart disease were prophylactically given the Simvastatin.  These were not people lowering their cholesterol through a healthy plant-based diet.  Statins are important drugs in the war on heart disease, but like all drugs, they do have side effects, and not everyone responds to them the same way. Because they were used in this study, this data has no bearing on diet, unless the Perfect Health people think Simvastatin is food. Also notice the last word in the title of the study, hypercholesterolemia.  Every single person in this study started with cholesterol equal to or over 220.  I guess the helpful Perfect Health people forgot to mention that key fact.

The text of the article makes clear what was happening.  Those with the lowest cholesterol were hyper-responders to the drug. 

Not everyone responds the same to drugs.  The effectiveness of statins is influenced by genetics and even the composition of the patient's gut microflora.

They thought the lowest cholesterol scores were likely caused by underlying diseases that ended up increasing mortality.  Of course, the selfless and giving Perfect Health people read this part, but no matter.  Why should they pass this along to you?  This is how the game of deception is played online with cholesterol.

Notice at the bottom right they make reference to a U-shaped curve.  Understanding reverse causation will help us see the deception in other cholesterol confusionist gambits.

Here's an example of how a U-shaped curve, or alternatively a J-shaped curve, appears with cholesterol confusionist propaganda.  This gentleman is of the opinion that low cholesterol will risk your life.  This was a study involving drugs as well, of course.

The American Heart Association has dismissed the J-Curve phenomenon, as they call it.  Co-morbidities, or underlying illnesses, lower cholesterol and increase the chance of death.  Low cholesterol is a sign of poor health in the portion of a population that are old and sick.

J- or U-curves exist for other health risks as well.  They exist for blood pressure, where very low blood pressure may indicate a very weak patient. Sometimes it is argued that you will live longer if you are a bit overweight.  This is usually based on statistics looking at the elderly, an important consideration.  Low BMI in the elderly may reflect poor health and not cause poor health.

This recent study found that body weight measured over a lifetime is more meaningful than body weight at the end of life.  This should be common sense.  It should also be common sense that cholesterol functions the same way.  Yet cholesterol confusionists use measurements in the sick and elderly, relying on the reverse causation fallacy again and again.

This is another example of end-of-life cholesterol measurements being abused by confusionists.  Here we see the logic of our friend Uffe Ravnskov again.  He thinks it is significant that blood cholesterol concentration after death does not predict atherosclerotic plaque, as though your plaque build up is purely a reflection of your lipids right before you die.  It doesn't take much thought to understand the deceptive nature of this argument, but let's look at it anyway.

First, measurements of cholesterol at autopsy are not necessarily accurate for technical reasons.  Here you see that postmortem cholesterol can be 13% lower than cholesterol before death.

This is a comparison of the degree of arteriosclerosis observed at autopsy in Japan compared to Minnesota back in the 1950s.  For the same age, the incidence of heart disease was far lower in Japan.  You can safely assume that their diets were far different.

The Japanese had much lower blood cholesterol as a result. Here you see cholesterol levels and age plotted on a graph.  Notice that the high-fat consuming populations like in Minnesota at the top exhibit the J- or U-curve, as their cholesterol levels plummet at the end of life.  You don't see a similar shape for the two Japanese-derived regression lines at the bottom.  Their cholesterol stayed in a similar range in old age.

So between these last two slides you see that there indeed is a powerful correlation between atherosclerosis at autopsy and blood cholesterol over a lifetime.

A more telling observation of the link between cholesterol and atherosclerosis might be better observed in cadavers of the young, as older individuals are likely to have more health problems to confound any observations.  Here you see the results of an examination of young people who died suddenly.  Fatty streaks which are the first stage of atherosclerosis were found to be strongly related to total and LDL cholesterol levels before death.

At the other end of the fitness spectrum from the aged and infirm were these highly-conditioned runners who suffered sudden death.  None had any evidence of heart disease, yet four of five had high cholesterol.  In spite of their fitness, they had enormous atherosclerotic buildup.

A related canard based on the relationship between cholesterol and mortality is the claim that more heart attacks happen to the elderly despite their diminished cholesterol concentrations.  Of course, lots of things start failing in your later years.  Among them is the stability of arterial plaques.  Once again, cholesterol over a lifetime is more important than cholesterol in old age.

I'll show you more of the tricksy tactics of the confusionists if you stay with me for Part II of Playing Games with Your Heart.

Primitive Nutrition 41:
Playing Games with Your Heart, Part II

You haven't seen all the shenanigans of the cholesterol confusionists yet.

Here's Mark Sisson again.  He is one of many to claim that cholesterol doesn't matter because half of first time heart attack sufferers have nominally "normal" cholesterol. He has a particular study in mind when he makes this claim.

I do find it appropriate his top supplement is called Damage Control, given the diet advice he gives.

Robb Wolf is another Paleo guru who thinks this same study tells us cholesterol levels don't matter.  Let's look at the study and see if we should agree with his carefully reasoned conclusion that "we", which I'm guessing Wolf doesn't think includes himself, are dumb when it comes to cholesterol.

Here's the news release for their study, which is linked within Wolf’s article.  We quickly see that the heart attack sufferers were deemed to have safe cholesterol levels based on current US guidelines.  The principal investigator of this study, Gregg Fonarow, did not conclude, as our two broscientists did, that cholesterol is a red herring in the fight against heart disease.  Instead he thinks the targets for cholesterol may be too high and should be lowered.  He also commented that very few patients had ideal cholesterol ratios by current standards. 

Like practically every other modern cholesterol study the confusionists embrace, cholesterol-lowering medications were involved, complete with their side effects - side effects you can be sure  the prescribing health care providers decided were worth the risks for these patients.  All this can be gleaned from the link Wolf provides himself, yet he didn't think any of this was worth mentioning.

Let's look beyond the press release to the actual study.  Pause the video if you like and have a look at the patient population's overall characteristics on the right.  Look at all those health problems. Do you see the third line down, prior myocardial infarction?  Those are heart attacks.  When Mark Sisson talks about people who are first time heart attack sufferers, he is only eliminating 16.5% of the people in this study.  What about the rest?  The authors weren't kidding when they wrote that "cardiovascular risk factors and comorbidities were frequently present."  I see overweight people. I see many with a history of high cholesterol for which only some have been given medication to control it. I see smokers, diabetics, and high blood pressure sufferers.  I see people as old as 79.

So let me ask you, in this patient population, do you think their cholesterol levels were normal by the standards of the Japanese in the Fifties?  Do you think they had stable low cholesterol their whole lives because they were eating plant based diets?  Or do you think this 100% American overweight group of heart attack sufferers mostly ate diets that were more likely to raise their cholesterol, only to have it fall at the end of life like you see at the top of this graph?  Who do these guys think they are kidding?  Abuse of the J-Curve phenomenon is a handy distraction for the illusions of the confusionists once again.

Here is an interpretive remark at the end of this study.  Perhaps LDL goals should be lowered even more, they say. 

Fonarow’s suggestion of lowering targets for LDL was met with derision by the low carbers.  Here we have a comedian, Tom Naughton, saying a cardiologist was practicing bad science.  This must be some kind of meta-joke.

Since then an important new study has provided support for the lowering of LDL targets in at-risk patients.  The latest and best research says Fonarow is probably right, even though he isn’t a comedian.

The accompanying editorial to this recent study could not have been more supportive of the plant-based nutrition strategy.  Humans are not anatomically or metabolically designed to be meat eaters, it said, not that I would put it that way.  This may be why we have heart disease. 

The suggestion that cholesterol targets be lowered has been met with derision by less amusing pro-fat bloggers as well.  Complaints like these have been heard before.  The very same arguments were made back when guidelines were lowered only to the point that total cholesterol of 300 mg per dL was considered normal.  We know that 300 is dangerous today.  In a country that loves its fatty animal foods, this knee-jerk response is predictable.  This is why judgment calls on public health standards are not left to fad diet promoters with audiences to please.  Yes, Robb Wolf, some of us have always been "dumb" when it comes to cholesterol.

Cancer is another favorite talking point for the cholesterol confusionists.  They want you to think low cholesterol makes it more likely you will develop cancer.  Low cholesterol in cancer patients is yet another example of a ploy based on the J-curve.  Low cholesterol is caused by cancer, not the other way around.

Here is an example of a study that makes this clear.

Actually, low cholesterol has been shown to lower your risk of developing cancer.  You didnt think a diet of cancer-fighting plant based foods could somehow cause cancer did you?  That would really be dumb.

Depression is yet another problem pinned on low cholesterol.  Once again, there are other explanations for any correlation between the two.

If low cholesterol caused depression, then why are people in Asian countries, with their low cholesterol levels, so much less likely to suffer from depression.  Depression, and the diagnosis of depression, are too complex to be explained through cholesterol. 

The next time you hear this argument, remember this slide.  It seems cholesterol correlates directly with completed suicide.

Often the pro-saturated fat propagandists will find a study here or there that seems to support their ideas.  I have to give them credit for looking so hard.  Misleading studies like theirs must be hard to find hidden among all the other studies they try to ignore.  Usually they will point to some small scrap of epidemiological data, where some population during a particular period of time seemed to do better in some health outcome in spite of eating more saturated fat.  They find these scattered studies to be highly significant, unlike the vast bulk of data they like to either nit-pick or pretend doesn’t exist.  Their studies are usually easy to dismiss.  I'll show you a good example of that. 

But first, have a look at this slide.  Here, epidemiological data seem to indicate that smoking prevents Parkinson's Disease.  Does that mean smoking is good for you?  No.  Epidemiology can never prove causation because there are always possible confounders that may skew results.  Here's another factor to keep in mind.  You should expect to see random results that defy expectations.  It would be unrealistic to believe there could be no statistical noise in data drawn from the real world.  Any gleeful trumpeting of aberrant and insignificant studies supporting cholesterol or saturated fat is best seen as confusionist desperation.

Here's another factor to help you weed through their garbage blogs.  Most of the studies the confusionists like to cite come from the post-statin era.  Any study conducted in the industrialized world attempting to compare diet with heart disease needs to account for the use of cholesterol lowering drugs.  As you see here, they are widely used.  I chose evidence from Sweden to set us up for one of those confusionist studies that are so easy to dismiss.

Here is a blog post excerpt from saturated fat apologist Anthony Colpo in which he finds validation for his fringe views with a fringe study.  Swedish farmers were followed over 12 years to see what dietary patterns lead to heart disease.  Fruits and vegetables were associated with lower heart disease but only if consumed with a lot of dairy fat.  If you think that sounds like a strange result, it is.  There are plenty of other studies linking saturated fat to heart disease in Swedes that the confusionists ignore.

To be left out of this study a farmer had to have been actually hospitalized with heart disease.  So if you had a history of heart disease in your family, or if you had high cholesterol and were put on statins, or if your heart disease had not yet put you in the hospital, you would be put in this study's cohort anyway.  As you can see, statins are not mentioned in this study, nor are any other lipid-lowering drugs.  This study lacks basic and necessary information, so it should be viewed with skepticism.

Ignore the abstract and look at the data.  Here you have a population with a mean age at the end of the study of only 62 years old. They collectively started with what would very conservatively be called borderline high LDL cholesterol.  More than a quarter of them were either hospitalized or died due to cardiovascular disease or coronary heart disease.  Remember, that age of 62 is the mean.  This does not seem like a very healthy bunch, does it?  Are you really going to base your personal choices on these people? And what are the chances that no one in this vulnerable group used cholesterol-lowering drugs that would have muddled any associations with diet?

So these men did worse if they used lower fat dairy products.  Are we to assume that the people opting for lower fat intake always ate lower fat over their whole lives?  Don't you think the people told by their doctors that they were at risk for heart disease might be the same ones who disproportionately chose to eat less saturated fat?  No adjustment is made for something so obvious. 

Here’s something else that’s strange.  Saturated fat was looked at in detail for dairy, but no other sources of saturated fat, beside fish, were mentioned.  Therefore, if someone preferred skim milk but ate many more high-saturated fat meats than the rest, eating bacon and burgers and liver every day, they would fall in the low dairy fat segment of this study anyway.  And of course, because Sweden is such a big dairy-consuming country, there is no dairy-free group.

So you see, there isn't a lot to be learned from this study.

Which is why it has only two citations in its search results.  The second search result is from professionally invested cholesterol confusionist Colpo, who thinks this study proves something about saturated fat in general.  Colpo is really cutting edge, I guess.

What about those two citations this study received?  Evidently at least two scholars thought this was quality research, right?

Well it turns out both are for the same author, who has her own theories to push about fat's connection to Alzheimer's and ADHD. Her expertise is in electrical engineering.

One off topic remark: Here is where Sweden stacks up in dairy consumption.  You would think with all that calcium they have amazing bones, right?

Nope.  They have a very high prevalence of osteoporosis.

Are you starting to wonder about the thought process of someone who would buy into all this garbage science on cholesterol?  I'll give you a peek into the confusionist mind in the next video.