Debunking the “Cholesterol Myth”

Monday Sep 11 | BY |
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A reader asked me two months ago to give a response to two articles on the “myth” that cholesterol is the leading cause of heart disease.

I promised I would, so here’s my response!

The article I will review is by Jon Barron, who proclaims himself to be a “World-leading nutraceutical researcher.” (You can find the original article here.)

So what I will do is start from the top and examine some claims made in the article, one by one. All the sections in bold are his statements.

“In point of fact, the liver is responsible for over 80% of your cholesterol level. Diet accounts for less than 20%”

I have no idea what evidence Mr. Barron has (he gives none) for this claim, but it is somewhat misleading.

In a healthy individual, it may be true, but in most people following a diet high in animal foods and saturated fats, food might account for more than 50% of their cholesterol levels. Why? Because with a change in diet, cholesterol levels can plummet more than 50%.

The misleading part of this statement is the belief that one can only change their cholesterol levels by 20% with dietary changes. However, most people with a cholesterol level of 250 mg/dl can quickly bring it down to under 150 mg through a plant-based diet. This is a change of at least 40%.

In one study, participants went from an average of 237 mg/dL down to 137 mg/dL using a plant-based diet with almost no overt fats. That’s a 42% drop.

“According to the cholesterol theory of heart disease (and despite all that you may have heard, it is only a theory), LDL cholesterol in the blood combines with other substances such as cellular waste products, calcium, and fibrin (a clotting material in the blood) to form arterial plaque, which attaches itself to the inner lining of the arteries. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.”

A better description of what happens is this:

* Atherosclerosis is indeed due to chronic inflammation.
* This situation is trigged by high circulating levels of LDL cholesterol in the blood.
* Once lodged inside of the arterial walls, LDL particles oxidize. White blood cells are rushed by the body to “ingest” the LDL particles.
* This process triggers an immune response. HDL cholesterol tries to clean up the situation but can’t keep up.
* The specialized white blood cells (macrophages), in the process of eating up the oxidized LDL, fail to remove the oxidized LDL cholesterol, they grow and eventually rupture.
* This leaves a big mess behind which is handled by white blood cells, continuing the cycle of inflammation and repair (scarring).

But Mr. Barron doubts the theory as he doesn’t seem to understand it.

“On May 15, 2001, the National Cholesterol Education Panel (NCEP) issued major new clinical practice guidelines on the prevention and treatment of high cholesterol levels in adults, lowering the target optimum level for LDL to less than 100. This was the first major update of the NCEP guidelines since 1993. The NCEP has predicted that the new guidelines will increase the number of Americans requiring treatment for elevated cholesterol levels (from 52 million to 65 million) and will nearly triple the number of Americans who will need to take cholesterol lowering drugs (from 13 million to 36 million).”

We can already see where he’s going with this: the cholesterol “theory” will be framed as some conspiracy to fatten the wallets of the pharmaceutical industry. Although optimal levels of LDL are actually under 70 mg/DL, the lowering of LDL to under 100 mg/dl can easily be done by the vast majority of people, without drugs and with only making some changes to their diet. The choice is not between drugs and high cholesterol.

“But for many doctors, 36 million people under experimental drug therapy are not enough. Many “experts” are now pushing to set target limits for LDL to less than 80, which would mandate that tens of millions more Americans be on moderate to high doses of statin drugs for the rest of their lives – despite the fact that these drugs are known to cause significant liver damage.”

Again, the target of LDL levels under 80 is perfectly reasonable and backed by science. Mr. Barron makes us believe that drugs are the only way to lower cholesterol levels. But let’s see where he’s going with this.

“So what’s my problem? Quite simply, that cholesterol doesn’t cause plaque to accumulate on arterial walls. If it did, why doesn’t anyone ever have clogged veins – only clogged arteries? Think about that for a moment. If high levels of cholesterol promoted the formation of plaque and its accumulation on arterial walls, then why doesn’t it accumulate on the walls of veins? And the answer is – because the problem is centered in the walls of the arteries, not in the cholesterol circulating in the bloodstream.”

Sigh. Big sigh here.

The reason why atherosclerosis does not usually occur in veins is that the blood pressure is not high enough in veins to push the cholesterol into the cell lining (endothelium). Atherosclerosis occurs when there’s damage to the endothelium. For that, you need blood pressure high enough to damage it and force cholesterol to enter its lining.

“To understand what I’m talking about, it’s first necessary to understand the beneficial role that arterial plaque plays in the human body (yes, beneficial), because therein lies the key to understanding a key role that cholesterol plays. So what is the role of plaque? It is “repair cement” for arterial walls. That is to say, if there is any damage to the arterial wall, your body will whip up some plaque from the cholesterol, calcium, and fibrin in the bloodstream to repair the damage before the arterial wall develops a leak and you bleed to death internally.
Cholesterol isn’t part of the problem, it’s part of the solution – to a different problem.”

Here we can see that Mr. Barron misunderstands the process of atherosclerosis. The cholesterol is not “sent to repair the damage.” White blood cells are sent to eat up the cholesterol that is oxidized, lodged in plaque and causing damage.

“With that in mind, let’s now look at some of the underlying assumptions of the cholesterol theory of heart disease.”

• Does eating a high cholesterol diet automatically lead to heart disease? Absolutely not. Look at the results seen on the Atkins Diet.

People may lose weight on the Atkins Diet, but they do not cure their heart disease. In fact, many followers of the Atkins Diet have died of heart attacks. To my knowledge, this diet has never been used to reverse heart disease.

“Does eating a high saturated fat diet automatically lead to heart disease? Again, absolutely not. Consider the traditional Eskimo diet, probably the highest saturated fat diet in the world because of all the whale and seal blubber consumed. And yet Eskimos on that diet have virtually no heart disease – until they shift to a modern Western diet. The same positive results are seen with the Atkins diet with its high consumption of saturated fats. (Both diets, however, are associated with different problems long term. Eskimos, on the traditional diet, for example, have an extremely high rate of osteoporosis because their diet promotes high acid levels in body tissue.)”

While it’s true that eating a high saturated fat diet does not automatically lead to heart disease (just like drinking alcohol does not automatically lead to liver cirrhosis), it does not negate the fact that a diet high in saturated fats tends to increase heart disease risk on a population level.

As for the Eskimo diet, it’s a myth to claim that they had no coronary disease.

“I would like to propose now the “arterial damage” theory of heart disease. Quite simply, it says that since your body produces arterial plaque in response to arterial damage, excessive plaque build-up and the concomitant hardening and narrowing of the arteries is the result of excessive damage, scarring, and inflammation in the arterial walls. And why only the arteries and not the veins? Because, as we shall see shortly, arterial walls contain muscle tissue that is particularly susceptible to damage. Veins contain much less muscle tissue and are less likely to suffer damage.. So what causes damage or inflammation to the arterial walls? Well, among other things.”

Here Mr. Barron regains some of his senses, but his theory misses the point. Let’s see below.

“• High homocysteine levels. (…)
• Too much Omega-6 fatty acid in the diet. (…)
• Eating high levels of meats and animal fat from grain fattened animals saturates the body with large amounts arachidonic acid. (…)
• High acid diets. (…)
• High levels of circulating immune complexes in the blood. (…)
• Inflammation in general. (…)”

I have abbreviated Mr. Barron’s more detailed explanations on the factors he thinks damage the arterial walls and cause inflammation.

He’s not completely wrong by pointing out those elements. But the critical point he’s missing is that all of those factors are only aggravating factors. With perhaps the exception of high homocysteine levels, those factors are not enough on their own to cause atherosclerosis.

For atherosclerosis to occur, there needs to be a high level of LDL cholesterol circulating in the blood. When one has an LDL cholesterol level of 70 mg/dl, it’s virtually impossible to develop atherosclerosis even if there’s a lot of inflammation present in the body.

How do we know that?

The final part of the article I will review is his conclusion. Mr. Barron wants to give you a few questions you can ask your doctor on cholesterol, to supposedly make them look like fools. If your doctor knows anything about it, he will only laugh, with reason, at these questions, making you the fool.

“Just for Fun – Questions for Your Doctor

Remember, the cholesterol theory of heart disease is only a theory – a theory that is increasingly being discredited. For those of you who enjoy tormenting your doctor, or if you just want to see them get flustered and angry, be sure and ask them the following questions.
• If cholesterol is the main culprit in heart disease, why don’t veins ever get narrowed and blocked?”

Doctor’s answer: because the blood pressure in vein isn’t high enough to damage the endothelium.

“If high cholesterol foods are responsible for raising cholesterol levels, then why do people on the high-cholesterol Atkins Diet experience such a significant drop in cholesterol levels?”

Doctor’s answer: because they lose weight. Any significant weight loss causes cholesterol levels to drop.

“Why do Eskimos who eat a traditional diet of almost pure saturated fat (whale and seal blubber) have almost a zero incidence of heart disease?”

Doctor’s answer: There’s no evidence that Inuit populations did not suffer from atherosclerosis.

“If the liver is responsible for regulating up to 80% of my cholesterol levels, why would I want to take statin drugs for lowering cholesterol – considering that the number one known side effect of statin drugs is liver damage?”

Doctors’ answer: You can decrease your cholesterol levels by more than 50% (if you start with a very high cholesterol) with diet changes alone.

Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.

Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.

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