Colpo's Journal Article

Running a Cholesterol Confusionist Gauntlet, Part 3 –
Colpo’s Journal Article

I’ve talked to you already about Mr Colpo’s attempt at a serious journal article and the not-very-serious journal in which he published it. Let’s look a bit at its content.

Much of its content relates to various drugs. I’ll save my comments about drug trial findings for my last video of this set.

It would take too long for me to comment on everything in his article, in addition to his blog post about me, so I’ll just make some general observations. Here is an example of his scrambled thought process. See if you can follow his logic. He starts this paragraph by saying that what he calls “the war on cholesterol” has been lucrative for the drug companies even though it has delivered no benefit to public health. That’s a pretty unequivocal statement. No benefit. I should be unable to find any evidence of any favorable health trends related to cholesterol lowering in recent decades if he is right. Then he says that the number of deaths from coronary heart disease, the leading cause of death, has indeed decreased. Well, I don’t know, Mr Colpo. Fewer deaths? That sounds like a benefit to public health to me.

Then he says that modern medicine has indeed extended the lives of people who have already had heart attacks. Mr Colpo, are you including those greedy drug companies in “modern medicine”? Are you saying that maybe their drugs work and therefore they have earned their money? Lastly, he retreats to the position that the rate of heart disease incidence, rather than the rate of mortality, has not been affected by the “war on cholesterol”. Is that your final position, Mr Colpo? It’s quite a bit different from saying that the war on cholesterol has had no benefit to public health.

Colpo’s claim is not worth a lot of effort for me to debunk. It is just clearly wrong. But let’s look at it anyway.

Do you remember this slide from my earlier video? Do you see how heart disease deaths started dropping in the 1970s?

That drop in mortality coincided with a drop in cholesterol.

This study sought to explain the reasons for falling death rates from coronary disease in the following years. The researchers attributed some of that drop in deaths to cholesterol lowering.

What about the incidence of coronary disease? Remember, this is Colpo’s final position in that paragraph. He says incidence rates have not changed. Here is a study that found a 31% decrease in the incidence of coronary disease between the early eighties and the early nineties. Improvements in diet, which means a lowering of saturated fat and cholesterol, explained 16% of the decline.

Just between the years 2006 and 2010, prevalence has had a measurable decline. The editorial to this study makes a great point. Mr Colpo, don’t miss this. One might think that with a decrease in coronary deaths, there should be an increase in the number of people receiving treatment for heart disease. There should be more prevalence because people are not exiting the treated population by dying. If people with coronary disease are dying less, these patients are alive and can be counted in the prevalence statistics. But instead, prevalence rates are going down. One of the reasons for this is said to be improvements in LDL levels.

You can see here that in recent years the treatment of people with high LDL has increased substantially. So we see that heart disease deaths have decreased, prevalence of coronary heart disease has decreased, cholesterol levels have decreased, and either drugs or diet have been a part of the explanation for this. This totally refutes Colpo’s ill-informed claims.

He links to this factually challenged journal article of his in his blog post about me, and he also links to a reply made to his article by researchers who he calls “Pee Pee-minded doctors”.

Here is the response from the said doctors who criticized his paper. They said it was critically flawed.

They fairly stated that his paper revealed major gaps in his knowledge. I agree with these comments. I’ll add some observations of my own.

Here’s an example of his difficulties in this article. Colpo does know that cholesterol is insoluble in water, so it must be transported in lipoproteins.

He should know that this very property makes cholesterol very dangerous. If it forms a deposit where it does not belong, it cannot be readily removed. This is why cholesterol is so carefully regulated by its lipoproteins and receptors. We have evolved systems to tightly control it.

Here’s another basic gap in his knowledge. He breaks out the scare quotes again for the phrase “fatty deposits”. Apparently he doesn’t buy the idea that atheromas are filled with lipids. He goes on to say that plaques contain many things, and cholesterol and various fatty acids are merely some of them. How he could question that they contain substantial fatty deposits, I have no idea. Atheromas are said to have lipid-rich cores for a good reason.

I’ve covered this already. There is a lot of cholesterol in there.

The lipid-rich core is the most obvious characteristic of the atheroma. Its cholesterol does not remain neatly sequestered in macrophages and lipoproteins, as Colpo would have you think.

Those fatty deposits are filled with extracellular cholesterol that Colpo should know is not water soluble and not easily removed. This is true of preatheromas as well.

The bigger the fat-laden core of the atheroma, the more likely the plaque is to rupture and cause a heart attack.

That cholesterol gets there in part as the macrophages disintegrate during a maladaptive immune response.

Here is more on that. This is common knowledge yet he puts the phrase “fatty deposits” in sarcastic quotes. Unbelievable. We know that the inflammatory process that causes this cholesterol to penetrate the artery wall is not self-sustaining in a low-LDL environment, as I have shown you already.

Colpo is evidently a believer in the oxidative modification hypothesis, conceding that oxidized LDL may be a cause of atherosclerosis. I covered this issue a bit in video 44. It is indeed true that the oxidative modification of LDL is a part of the pathogenesis of atherosclerosis. Oxidized LDL is not easily cleared. These particles attach to the artery wall and provoke an immune response. It is true that statins deliver an antioxidant benefit. But if you saw my video, you may remember that Daniel Steinberg, a top researcher who accepts the oxidation hypothesis, does not consider it to be contradictory to the lipid hypothesis in any way. Only someone with a confusionist agenda would pretend these ideas are in opposition. If Colpo really wanted to be true to his belief in the oxidative modification hypothesis and if he wanted to help people avoid heart disease he would have to change his diet recommendations.

Dietary saturated fat promotes the adhesion of immune cells to the artery wall. Dietary saturated fat promotes LDL oxidation.

Fatty meats typically contains high levels of advanced glycation end products, and these cause uncontrolled and damaging oxidation reactions.

If you want to reduce LDL oxidation, improving your antioxidant status is not the only way to do that. Here’s where the obvious must be said. If you reduce your saturated fat intake, you will have lower plasma LDL, and consequently less LDL will be exposed to oxidative modification. This is a simple idea, isn’t it? If Colpo believes oxidized LDL causes atherosclerosis, why does he think we should eat foods that raise LDL far beyond our body’s needs?

Again, this should be obvious. More LDL in the blood plasma means more LDL exposed to oxidation in the artery wall.

Moreover, dietary cholesterol itself increases LDL oxidative modification.

If you lower dietary saturated fat, you have less oxidation of LDL. Are you taking all this in, Mr Colpo?

Colpo puts a lot of faith in antioxidant status. I remarked in video 18 that antioxidants can be either good or bad under different circumstances, and I said in video 44 that trials of antioxidants for the prevention of cardiovascular events have produced disappointing results. Just to remind you that the oxidative modification hypothesis isn’t the simple explanation for heart disease the confusionists want you to think it is, this paper tells us that oxidized LDL might have favorable effects.

This paper tells us that it would be overly simplistic to consider all oxidative reactions of lipoproteins to be adverse. The authors suggest utilizing a heart healthy diet over antioxidant supplements. That seems like very good advice to me.

When something is said to be endogenous, that means it is produced from within us. We don’t get it from outside sources like food.

With that in mind, let’s contemplate this slide. As you can see, an endogenously produced antioxidant, uric acid, is by far the most important antioxidant in the human body. The levels of antioxidants from food are dwarfed by your levels of uric acid. If you buy in on the antioxidant strategy for preventing heart disease, as Anthony Colpo does, you might suspect that the higher your uric acid levels are, the better your heart health is. But the opposite is true. Elevated uric acid levels are often observed in patients with heart disease and metabolic syndrome. What foods elevate uric acid? The same ones that contribute advanced glycation end products. The same ones with heme iron. The same ones with artery destroying saturated fat. They include all the Weston Price Foundation favorite foods, like organ meats. They include the supposedly heart-healthy meats like chicken breast and lean beef and fish. They are the foods you don’t bother with when you are a whole food vegan.

Colpo’s belief seems to be that your cholesterol can be as high as you want as long as you consume enough antioxidants. But supplemental antioxidants have actually been shown to be harmful in some trials. The argument he makes is illogical and weak compared to the lipid hypothesis.

Of course, I think it is great to eat lots of antioxidant-rich plant foods. Practically every single thing I eat could be described that way. However, antioxidant power is only one asset of plant foods, and their other benefits, such as their effects on gene signaling or cholesterol lowering, may be more important. Whole plant foods have one enormous advantage over animal foods: they do no harm. It is the relentless, three-times-a-day damage done to the body by meat and saturated fat that I avoid entirely with my strategy. A diet composed of whole plant foods actually gives your body the opportunity to heal itself.

Fatty animal foods raise LDL. LDL is central to the pathogenesis of heart disease. I’m not going to accept high LDL in my body just because I’m crossing my fingers hoping that the antioxidant fairy that Anthony Colpo believes in will be my guardian angel, keeping my heart out of trouble. Consuming antioxidant-rich foods while tolerating high cholesterol is an incomplete strategy for long term health at best.

Colpo wants me to talk about fish oil and some fish-eating cultures. I’ll do that next.