The Great Cholesterol Myth (2 page)

Cholesterol is an essential molecule without which there would be no life, so important that virtually every cell in the body is capable of synthesizing it.

The vast majority of laypeople have been bombarded with so much misinformation about cholesterol that most take it as a given that cholesterol is a bad thing and that the less they have the better. The reality is that nothing could be further from the truth.

Cholesterol is an essential molecule without which there would be no life, so important that virtually every cell in the body is capable of synthesizing it. Among its other duties, cholesterol is a major structural molecule, a framework on which other critical substances are made. Were we able to somehow remove all its cholesterol, the body, would, in the words of Shakespeare, “melt, thaw and resolve itself into a dew.” And that’s not to mention that we wouldn’t have bile acids, vitamin D, or steroid hormones (including sex hormones), all of which are cholesterol-based.

Despite the essential nature of cholesterol, doctors the world over administer billions of dollars’ worth of drugs to try to prevent its natural synthesis. The fact that only a tiny minority of patients actually extend their lives by taking these drugs is lost on the multitude prescribing them, but not, of course, on the pharmaceutical industry making and selling them. How did we come to this sorry state?

Sixty years ago a researcher, little known outside of academic circles, singlehandedly set us on this path of cholesterol paranoia: Ancel Keys, Ph.D., a proponent of what has become known as the lipid hypothesis, concluded that excess cholesterol caused heart disease. He started out thinking that dietary fat in general drove cholesterol levels up, but as the years went by, he came to believe that saturated fat was the true cholesterol-raising villain. (This idea of saturated fat as villain is so ingrained in the minds of health writers that the words “saturated fat” are almost never written alone but always as “artery-clogging saturated fat.”) Which is more or less the basis for the lipid hypothesis: saturated fat runs up cholesterol levels, and elevated cholesterol leads to heart disease. Nice and simple, but not true. It has never been proven, which is why it is still called the lipid
hypothesis
.

Because of Keys’s influence, researchers for the past five decades have been beavering away in labs
the world over, desperate to find enough actual proof to convert the lipid hypothesis into the lipid fact. But so far, they’ve fallen way short. In the process, however, they have vastly expanded our knowledge of the biochemistry and physiology of the cholesterol molecule. Thanks to their efforts, we now know that cholesterol is transported in the blood attached to carrier proteins, and that these protein-cholesterol complexes are called lipoproteins. Their densities now describe these lipo-proteins: HDL (high-density lipoprotein), LDL (low-density lipoprotein), VLDL (very-low-density lipoprotein), and a number of others. Some of these lipoproteins are considered good (HDL) and others bad (LDL). And, of course, the drug companies have developed medications purported to increase the former while decreasing the latter.

But they jumped the gun. Researchers have discovered a type of lipoprotein called small, dense (or type B) LDL that may actually end up being a true risk factor for heart disease. Problem is, this small, dense type B LDL is worsened by the very diet those promoting the lipid hypothesis have hailed for decades as the best diet to prevent heart disease: the low-fat, high-carbohydrate diet. Turns out that fat, especially saturated fat, decreases the amount of these small, dense LDL particles while the widely recommended low-fat diet increases their number. The opposite of the small dense LDL are large fluffy LDL particles, which are not only
not
harmful but are actually healthful. But the LDL–lowering drugs lower those, too.

Cracks should have appeared in the firm entrenchment of the lipid hypothesis (that now basically posits that elevated LDL causes heart disease) when a recent study showed that of almost 140,000 patients admitted to the hospital for heart disease, almost half of them had LDL levels
under
100 mg/dL (100 mg/dL has been the therapeutic target for LDL for the past few years). Instead of stepping back, scratching their heads, and thinking,
Hmmm, maybe we’re on the wrong track here
, the authors of this study concluded that maybe a therapeutic level of 100 mg/dL for LDL is still too high and needs to be even lower. Such is their lipo-phobic herd mentality.

Nutritionist Jonny Bowden, Ph.D., and cardiologist Stephen Sinatra, M.D., have teamed up in this book to slash through the tall thicket of misinformation surrounding cholesterol, lipoproteins, and the lipid hypothesis. They wrote their fact-based book using easy-to-understand terminology, and present a much more valid hypothesis of what really causes heart disease and a host of other diseases such as diabetes, high blood pressure, and obesity, that will open your eyes to the emperor’s state of undress. If you are worried about your cholesterol level or contemplating taking a cholesterol-lowering drug, we urge you to read this book! This book will put the facts in your hands to make a more informed decision. And we’re confident you will enjoy their book as much as we did.

Michael R. Eades, M.D.
Mary Dan Eades, M.D.
May 2012
Incline Village, Nevada

CHAPTER 1

THE TWO OF US CAME TOGETHER TO WRITE THIS BOOK
because we believe that you have been completely misled, misinformed, and in some cases, directly lied to about cholesterol.

We believe that a weird admixture of misinformation, scientifically questionable studies, corporate greed, and deceptive marketing has conspired to create one of the most indestructible and damaging myths in medical history: that cholesterol causes heart disease.

The millions of marketing dollars spent on perpetuating this myth have successfully kept us focused on a relatively minor character in the heart disease story, and created a market for cholesterol-lowering drugs worth more than $30 billion a year. The real tragedy is that by putting all of our attention on cholesterol, we’ve virtually ignored the
real
causes of heart disease: inflammation, oxidation, sugar, and stress.

In fact, as you’ll learn in this book, cholesterol numbers are a pretty poor predictor of heart disease; more than half the people hospitalized with heart attacks have perfectly normal cholesterol levels, and about half the people with elevated cholesterol levels have perfectly normal, healthy tickers.

Many of the general dietary guidelines accepted and promoted by the government and by major health organizations such as the American Heart Association are either directly or indirectly related to cholesterol phobia. These standard guidelines warn us to limit the amount of cholesterol we eat, despite the fact that for at least 95 percent of the population, cholesterol in the
diet
has virtually no effect on cholesterol in the
blood.

These guidelines warn us of the dangers of saturated fat, despite the fact that the relationship between saturated fat in the diet and heart disease has never been convincingly demonstrated, and despite the fact that research shows that replacing saturated fat in the diet with carbohydrates actually
increases
the risk for heart disease.

Both of us became skeptical of the cholesterol theory at different points in our careers, traveling different pathways to arrive at the same conclusion: Cholesterol does not cause heart disease.

We also believe that, unlike trans fat, for example, saturated fat is
not
the dietary equivalent of Satan’s spawn (and we’ll show you why). Finally, and most important, we strongly believe that our national obsession with lowering cholesterol has come at a considerable price. Cholesterolmania has caused us to focus all our energy around a fairly innocuous molecule with a marginal relationship to heart disease, while ignoring the
real
causes of heart disease.

We’re each going to tell you in our own words how we became cholesterol skeptics and why we fervently believe the information contained in this book could save your life.

Before I became a nutritionist and ultimately an author, I was a personal trainer. I worked at Equinox Fitness Clubs in New York City, and the vast majority of my clients were there for one thing: to lose weight. It was 1990. Fat was considered dietary enemy number one, and saturated fat was considered
especially
bad because we all “knew” it clogged your arteries, raised your cholesterol, and led to heart disease. So, like most trainers, I put my clients on low-fat diets and encouraged them to do a ton of aerobics plus a little bit of weight training.

Which worked.

Some
times.

More often than not, the strategy bombed.

Take Al, for example. Al was an incredibly successful, powerful businessman in his early sixties with a huge belly he just couldn’t get rid of. He was eating a very low-fat diet, doing a ton of aerobics on the treadmill in his house, and yet his weight was hardly budging. If everything I had been taught as a personal trainer was right, that shouldn’t have been happening.

But it was.

Then Al decided to do something I didn’t approve of. He went on the Atkins diet.

Remember, those were the days when all of us were taught that fat, especially saturated fat, was pure evil. We had been taught that we “need” carbohydrates for energy and survival (we don’t, but that’s a discussion for another book). We had been taught that high-protein diets such as the Atkins diet were dangerous and damaging, largely because all that saturated fat would clog your arteries, raise your cholesterol, and lead to a heart attack.

So I was pretty sure Al was headed for disaster.

Except he wasn’t.

Not only did he start shedding weight and losing his substantial “apple-shaped” belly, but he also had more energy and was feeling better than he had in decades. I, meanwhile, was impressed with Al’s results, but I was convinced he was paying a huge price and that once he got the blood test results from his annual physical, I would be vindicated.

I wasn’t.

Al’s triglycerides—a type of fat found in the bloodstream and elsewhere—had dropped, his blood pressure had gone down, and his cholesterol had risen slightly, but his “good” cholesterol (HDL) had gone up more than his “bad” cholesterol (LDL), so overall his doc was pretty happy.

Right around this time, a biochemist named Barry Sears came to New York City to give a workshop at Equinox, which, of course, I eagerly attended. Sears, whose Zone diet books have sold millions, had a novel approach that can be summed up in four words:
eat fat, lose weight
. (If Sears had been anything but an MIT-trained biochemist, he probably would have been laughed out of the room. But given his credentials and remarkable knowledge of the human body, he was pretty hard to dismiss.)

Now Sears wasn’t the first one to embrace fat and protein in the diet and recommend that we eat fewer carbs. Atkins, whose original diet was the one Al had tried so successfully, had been saying similar things since 1972. But the whole rap against Atkins was that
his diet was high in saturated fat and would therefore likely cause heart disease. So even though many people grudgingly admitted that you could lose weight easily following his program, everyone (including me) believed that the cost would include a hugely increased risk for heart disease.

What if the whole theory that cholesterol causes heart disease was wrong in the first place?

Meanwhile, my eyes were telling me something very different, and it wasn’t just because of what I had seen happen with Al. It was happening with other clients as well. Sick of not getting results on low-fat, high-carb diets, they threw caution to the wind and embraced the Atkins diet and the Protein Power diet and other protein- and fat-friendly diets. They were eating more fat—even more saturated fat—but nothing bad was happening at all, unless, of course, you count feeling better and getting slimmer as nothing.

Which got me thinking.

Why weren’t we seeing consistent results with our clients who were faithfully following low-fat diets and getting plenty of aerobic exercise? Conversely, why were our clients who were going on low-carb diets getting such high marks on their blood tests and astonishing their doctors? What if everything we’d been told about the danger of saturated fat wasn’t exactly correct? And—if what we’d been taught about saturated fat wasn’t the complete truth—what about this relationship between fat and cholesterol? Was it really all as simple as I’d been taught?

After all, even back in the early ‘90s when people only talked about “good” and “bad” cholesterol, it was still obvious that, overall, saturated fat had a positive effect on Al’s cholesterol, as it did on the cholesterol levels of so many of my other clients. Saturated fat raised their HDL much more than it did their LDL. Could this whole cholesterol issue be a little more complicated than I and everyone else had previously believed?

Eventually, I thought—going way out on a limb here—what if the whole theory that cholesterol causes heart disease was wrong in the first place? If that were the case, the effect of saturated fat on cholesterol would be pretty much irrelevant, wouldn’t it?

Then I began reading the studies.

The Lyon Diet Heart Study
¹
found that certain dietary and lifestyle changes were able to reduce deaths by 70 percent and reduce cardiovascular deaths by an even more impressive 76 percent, all without making as much as a dent in cholesterol levels. The Nurses’ Health Study
²
found that 82 percent of coronary events were attributable to five factors, none of which had anything to do with lowering cholesterol. And that was just the tip of the evergrowing iceberg.