The Great Cholesterol Debate

[tnumrych]

I was looking through the list of Dr. Kilgore's posts on this forum looking for a draft of a completely cholesterol-unrelated review article (with no avail I might add). As is often the case however, the search resulted in another question arising.

One of the search results was a thread by the title Statins and Muscle Damage (http://startingstrength.com/resources/forum/showthread.php?t=8668&highlight=cholesterol). A poster in that thread asked if Dr. Kilgore cared to comment on the work of Uffe Ravnskov MD, PhD The Cholesterol Myths, whom, if I am correct, has done much of the leg work dispelling the status quo belief of cholesterol = instant death. The question was probably lost in the shuffle and was never answered. But I think this would be a good question to have answered given the nature of much of the dietary concerns the poster's on this forum exhibit (I have searched the forum for an answer and read MOMG and didn't find a satisfactory answer). A number of additional books of a similar theme have been published in recent years, particularly Malcolm Kendrick's The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It (2008), and Anthony Colpo's The Great Cholesterol Con (2006).

I personally have not read Ravnskov's, or Colpo's books, but I did recently finish reading Malcolm Kendrick's (Scottish MD) and found it quite compelling (at least until his theory), especially his interpretation of large scale epidemiological studies to dispel the link between cholesterol and heart disease.

However I may be easily compellable for reasons such as my rudimentary understanding of lipid biochemistry, difficulty to discern what may constitute dubious interpretation to the trained eye, the distrust for all things status quo that you've fostered within me, low mental capacity on account of being Polish (just playing into the stereotype), and my own unwillingness to give up delicious, cholesterol filled foods I've grown up eating and loving.

So I guess I would like an opinion of someone more knowledgeable than myself on the matter. Would you, Dr. Kilgore or Dr. Bradford care to comment on an the accuracy and relevancy of the works of Uffe Ravnskov (The Cholesterol Myths), Malcolm Kendrick (The Great Cholesterol Con), and Anthony Colpo (also The Great Cholesterol Con)? Are they just successful at promoting their dogma? Maybe you care to add something yourselves?

Thank you for taking your time answering this.

Disclaimer:
I am not, and have never been one of "those" people afraid to eat large amounts of saturated fat or cholesterol ("Smalec", a staple in Polish cuisine, is lard laced with bacon bits and fried onion, spread on bread and served as an appetizer :D) or lose his six pack (unless its my Guinness). I'm simply curious.

[Mark Rippetoe]

That would require that we've read the books, and I can tell you that we haven't. What specifically did you have a question about regarding this material?

[matclone]

Last year on Charlie Rose, I heard a famous heart surgeon (who's name I forget) say that one's chance of having a heart attack or stroke is almost nil if you are on the good side of all these factors:
--blood pressure
--blood sugar
--obesity
--exercise
--smoking
--cholesterol

There may have been another factor, but I can't remember what it was. He indicated that while heredity may have some influence, it's not as significant as the factors above. In any case, note that cholesterol is one of the risk factors. This is well established, no matter how many people are selling books claiming there's a cholesterol "con" (also see what the American Heart Assoc has to say, or ask your family doctor or cardiologist). There's also people out there claiming that obesity is not a health hazard (Paul Campos) and that vaccines are a hazard--in spite of overwhelming evidence to the contrary. In short, there's no shortage of bullshit on the wire. That's not to say we should never be skeptical of "common knowledge" (we should) but beware of snake oil salesmen. They haven't gone away. They've just changed their threads and the style of their presentation.

On the other hand, there appears to be some controversy over the use of statin drugs (used to treat cholesterol).

[Mark Rippetoe]

What is your clinical/research experience, Mat?

[Need2Lift]

Last year on Charlie Rose, I heard a famous heart surgeon (who's name I forget) say that one's chance of having a heart attack or stroke is almost nil if you are on the good side of all these factors:
--blood pressure
--blood sugar
--obesity
--exercise
--smoking
--cholesterol

There may have been another factor, but I can't remember what it was. He indicated that while heredity may have some influence, it's not as significant as the factors above. In any case, note that cholesterol is one of the risk factors. This is well established, no matter how many people are selling books claiming there's a cholesterol "con" (also see what the American Heart Assoc has to say, or ask your family doctor or cardiologist). There's also people out there claiming that obesity is not a health hazard (Paul Campos) and that vaccines are a hazard--in spite of overwhelming evidence to the contrary. In short, there's no shortage of bullshit on the wire. That's not to say we should never be skeptical of "common knowledge" (we should) but beware of snake oil salesmen. They haven't gone away. They've just changed their threads and the style of their presentation.

On the other hand, there appears to be some controversy over the use of statin drugs (used to treat cholesterol).

When the surgeon discussed cholesterol as a risk factor, was he referring to elevated total and/or LDL cholesterol levels, or ingestion of dietary cholesterol? My understanding is that elevated "bad" cholesterol is clearly recognized as a risk factor, but that it is unclear whether ingestion of cholesterol causes raised cholesterol levels, which is why eggs are not thought of as negatively as they once were. (Note: I don't have a medical or science background, but I try to stay informed on this stuff due to a family history of heart disease.)

[coldfire]

Last year on Charlie Rose, I heard a famous heart surgeon (who's name I forget) say that one's chance of having a heart attack or stroke is almost nil if you are on the good side of all these factors:
--blood pressure
--blood sugar
--obesity
--exercise
--smoking
--cholesterol

There may have been another factor, but I can't remember what it was. He indicated that while heredity may have some influence, it's not as significant as the factors above. In any case, note that cholesterol is one of the risk factors. This is well established, no matter how many people are selling books claiming there's a cholesterol "con" (also see what the American Heart Assoc has to say, or ask your family doctor or cardiologist). There's also people out there claiming that obesity is not a health hazard (Paul Campos) and that vaccines are a hazard--in spite of overwhelming evidence to the contrary. In short, there's no shortage of bullshit on the wire. That's not to say we should never be skeptical of "common knowledge" (we should) but beware of snake oil salesmen. They haven't gone away. They've just changed their threads and the style of their presentation.

On the other hand, there appears to be some controversy over the use of statin drugs (used to treat cholesterol).



I can recognize a misleading argument even if I don't know everything about the subject at hand. This might even be on Heinlein's list of things a man should be able to do. Of course, he died before the advent of the unfiltered internet or talk radio as we know it, but I believe he predicted the former (in some fashion), and a version of the latter (e.g. Tokyo Rose) was already known in his day.


Interesting.

[tnumrych]

That would require that we've read the books, and I can tell you that we haven't. What specifically did you have a question about regarding this material?

I probably should have asked if they are familiar with them first huh. Well in any case I will compose a digested list of arguments Kendrick makes along with some of his proof and post it here.

[matclone]

I have no clinical experience or research. My opinion is based on my experience in ferreting out good information and bad. Of course, I could be totally wrong, but I don't think so. If I were to write a book and claim that the sun rises in the west, or that the Texans won at Alamo, most people would be able to figure out that it was bs on its face without having actually been to the Alamo. But, if I were inclined to pepper the book with fallacious arguments, appeal to my reader's prejudices, and tell them what they wanted to hear, I might yet have a best seller.


Interesting.

Take it for what it's worth.


When the surgeon discussed cholesterol as a risk factor, was he referring to elevated total and/or LDL cholesterol levels, or ingestion of dietary cholesterol? My understanding is that elevated "bad" cholesterol is clearly recognized as a risk factor, but that it is unclear whether ingestion of cholesterol causes raised cholesterol levels, which is why eggs are not thought of as negatively as they once were. (Note: I don't have a medical or science background, but I try to stay informed on this stuff due to a family history of heart disease.)

As I recall, the heart surgeon did not get into that sort of detail. I'm sure you're right about the bad cholesterol. As for what we ingest, the handouts I get from my family doctor still suggest that eggs should be avoided where lowering cholesterol is the goal but there may be some question on that and in any case it sounds like you are well informed on the subject. I was just railing against those claiming that cholesterol is a "con" and all that portends (i.e., ignoring the recommendations of medical doctors).

[Mark Rippetoe]

Mat, post here a link to the study that demonstrates that serum cholesterol causes CVD. Then post a link to the study that demonstrates that serum cholesterol varies directly with dietary cholesterol. We have discussed this before.

[matclone]

I missed the prior discussion. I'm not an expert on the subject of cholesterol and don't pretend to be. Maybe tnumrych will share his findings, and that would be a better starting point for discussion.

[Mark Rippetoe]

Search function catches you up.

[TomC]

Here's a recent study from UCLA showing that serum cholesterol and heart disease are pretty poorly correlated:

http://newsroom.ucla.edu/portal/ucla/majority-of-hospitalized-heart-75668.aspx

From the first paragraph:


A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.

[cycomiko]

without being excited enough to go and look at the actual paper, the lack of association with admission cholesterol is not surprising, as its been known for 50-60 years that a whole heap of measures, including cholesterol, go to all over the place in the time after an MI.
Their other stuff would require more reading to get at what they are on about

[matclone]

Here's a recent study from UCLA showing that serum cholesterol and heart disease are pretty poorly correlated:

http://newsroom.ucla.edu/portal/ucla/majority-of-hospitalized-heart-75668.aspx



Then how do you explain this paragraph?

While the risk of cardiovascular events increases substantially with LDL levels above 40–60 mg/dL, current national cholesterol guidelines consider LDL levels less than 100–130 mg/dL acceptable for many individuals. The guidelines are thus not effectively identifying the majority of individuals who will develop fatal and non-fatal cardiovascular events, according to the study's authors.

They seem to be saying that the cholesterol guidelines may be flawed, not there there is a lack of correlation b/t cholesterol and heart disease.

[johnst_nhb]

The largest "heart" study on the planet shows ZERO statistical correlation between serum cholesterol levels and CVD. The cholesterol myth is not a bunch of fake conspiracy theory stuff. There are 2 simple truths that cannot be disputed:

- dietary cholesterol has very little (if not nothing) to do with serum cholesterol

- there is no statistical correlation to show that serum cholesterol causes or is a risk factor for CVD.

(Electrical problems of the heart are responsible for a great deal of heart "events" and inflammation is a major factor in CVD).

*BONUS TRUTH BELOW!*

For the vast majority of americans, [dietary] salt does not cause hypertension. It is extremely rare that people are sensitive to dietary salt. Interestingly, the majority who have sensitivity are African American.

I do not have the data on the salt thing, but I can get it.

Yes, I have a background in molecular biology with a focus on the circulatory system (research with thrombin, fibrinogen and factor X). This does not mean I am right, but it means I know how to read a paper.

[tnumrych]

While I'm compiling the detailed information (there is a lot and it might take a few days) from the book those who are interested in what Dr. Kendrick is saying and his proof can begin by looking at the following:

A decent book review. (http://www.cholesterol-and-health.com/Malcolm-Kendrick-Great-Cholesterol-Con.html)
Short Youtube clip of Dr. Kendrick. (http://www.youtube.com/watch?v=i8SSCNaaDcE)
Part 1 of 5 of Dr. Kendrick's presentation to the British Medical Association. (http://www.youtube.com/watch?v=XPPYaVcXo1I)
Article written by Dr. Kendrick. (http://www.spacedoc.net/malcolm_kendrick_cholesterol)
Many essays written by Dr. Kendrick on the subject of cholesterol. (http://thincs.org/Malcolm.index.htm)

A quick Google search query for "Malcolm Kendrick" resulted in the above links. Strangely, since I have owned the book for several months, I never Googled him before today. I understand that this is a a poor way to prove Dr. Kendrick's views but I assure you that the book outlines plenty of proof in a very well presented manner (and I highly recommend it, whatever that matters).

[Scrofula]

The largest "heart" study on the planet shows ZERO statistical correlation between serum cholesterol levels and CVD.
Do you have the citation handy? That sounds like interesting reading.

[johnst_nhb]

this is a good start:

http://www.framinghamheartstudy.org/

[tnumrych]

Do you have the citation handy? That sounds like interesting reading.

I believe Dr. Kendrick used that study in his book, but I could very well be wrong about that though however. If I recall correctly it might have been the MONICA study conducted by the WHO. Have a look through the links I provided and you may be able to pinpoint it.

[tnumrych]

The largest "heart" study on the planet shows ZERO statistical correlation between serum cholesterol levels and CVD. The cholesterol myth is not a bunch of fake conspiracy theory stuff. There are 2 simple truths that cannot be disputed:

- dietary cholesterol has very little (if not nothing) to do with serum cholesterol

- there is no statistical correlation to show that serum cholesterol causes or is a risk factor for CVD.

(Electrical problems of the heart are responsible for a great deal of heart "events" and inflammation is a major factor in CVD).

*BONUS TRUTH BELOW!*

For the vast majority of americans, [dietary] salt does not cause hypertension. It is extremely rare that people are sensitive to dietary salt. Interestingly, the majority who have sensitivity are African American.

I do not have the data on the salt thing, but I can get it.

Yes, I have a background in molecular biology with a focus on the circulatory system (research with thrombin, fibrinogen and factor X). This does not mean I am right, but it means I know how to read a paper.

Those two facts are basically the gist of what Kendrick states in his book to support his thesis. In the last parts of the book he proposes his theory for the cause, detailing and using the inflammatory response of vascular tissue down to the molecular level as his main argument.

In grad school I also was told that that dietary salt isn't a problem for people unless you already have a preexisting hypertension problem.


this is a good start:

http://www.framinghamheartstudy.org/


In retrospect, I think this might be that study and not the MONICA study. Either way the MONICA study also failed to support the cholesterol hypothesis.

Two of the most interesting presented by Dr. Kendrick (direct quotes from referenced studies - not paraphrases):


There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years. 11% overall and 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels


Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol levels, and show that long term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations the greater the risk of death.

[matclone]

this is a good start:

http://www.framinghamheartstudy.org/

From the above link:

Over the years, careful monitoring of the Framingham Study population has led to the identification of the major CVD risk factors - high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity -

So, now I'm confused. How do you square the above statement, from your link, with your prior statements, i.e.,
"The largest "heart" study on the planet shows ZERO statistical correlation between serum cholesterol levels and CVD...The cholesterol myth is not a bunch of fake conspiracy theory stuff. There are 2 simple truths that cannot be disputed:

- dietary cholesterol has very little (if not nothing) to do with serum cholesterol

- there is no statistical correlation to show that serum cholesterol causes or is a risk factor for CVD."

I'm a simple man. Please explain.

[TPrewittMD]

So, I don't treat heart disease but will share some thoughts nevertheless.

For what it's worth, I quit taking Lipitor a few years ago despite an elevated total serum cholesterol. My internist at the time, a good friend, said that the benefit of treating high cholesterol in someone my age (44) with no risk factors wasn't worth the muscular complications related to statins.

The recommendations to which Matt came from the American Heart Association. I discussed this last spring with the dean of our medical school (and recent past president of the AHA), and he said that if BP, smoking, diabetes, cholesterol, etc., were under control when one turns 50, then you effectively compress morbidity and disability to later in life.

In other words, if these components are good at 50, then you will stay in good shape until 80. If these things are bad, then you may still live to 80, but you are going to have chronic, debilitating health problems.

Specifically regarding cholesterol, it is my understanding that we must treat 300 cases of elevated cholesterol to save a single heart attack. That may be seem less than impressive, but it depends on one's perspective. It is not much to worry about on the individual level. But if you look at this from a public health perspective with millions of cases, the potential benefit could be substantial.

Wonder if statins exert a cardioprotective effect independent of serum cholesterol levels........?

[Mark Rippetoe]

From the above link:

Over the years, careful monitoring of the Framingham Study population has led to the identification of the major CVD risk factors - high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity -

So, now I'm confused. How do you square the above statement, from your link, with your prior statements, i.e.,
"The largest "heart" study on the planet shows ZERO statistical correlation between serum cholesterol levels and CVD...The cholesterol myth is not a bunch of fake conspiracy theory stuff. There are 2 simple truths that cannot be disputed:

- dietary cholesterol has very little (if not nothing) to do with serum cholesterol

- there is no statistical correlation to show that serum cholesterol causes or is a risk factor for CVD."

I'm a simple man. Please explain.






This is the part where you have to read the study and data sets, and not the abstract and the conclusions. If you had a science degree, Mat, you'd know this.

(Poke, poke.)

[johnst_nhb]

I probably should not have said "zero correlation" because there is statistical aberration that can skew data. There is simply no statistical correlation. The Framingham study is not the first, or only, study to fail to show correlation. It is certainly not the first to say there is a correlation though.

I don't have a lot of time at the moment to go into it, but this write up pretty much sums it all up and is accurate.

http://www.proteinpower.com/drmike/cardiovascular-disease/framingham-follies/

j

[Scrofula]

This is the part where you have to read the study and data sets, and not the abstract and the conclusions. If you had a science degree, Mat, you'd know this.
I'm looking at the data, and I'm still confused. The regression coefficient for log(total cholesterol) in the CVD prediction model in the paper is about 1.2 for women and 1.12 for men. P-values for both are less than 0.0001. I'm not terribly familiar with proportional hazards regression models, and judging by their Wikipedia page, it seems like a pretty simplistic model, but this study at least seems to say pretty unambiguously that the total cholesterol level is a useful predictive feature (though not necessarily a contributor) for cardiovascular disease.

The 'Famingham follies' article deals with a different issue: the connection between dietary cholesterol and serum cholesterol. I haven't seen this data, so I can't really comment on that.

I did find an interesting article by Uffe Ravsnkov, called 'A hypothesis out-of-date: The diet–heart idea'. I haven't had a chance to read it in detail yet, but it seems to suggest what I was getting at above: total cholesterol appears to be a marker, but not a cause, of heart disease. If this is true, then it doesn't much matter whether diet affects total cholesterol levels.

[tnumrych]

This is the part where you have to read the study and data sets, and not the abstract and the conclusions. If you had a science degree, Mat, you'd know this.

(Poke, poke.)

That, IMHO, is the biggest mistakes people make when reading studies. Dr. Kendrick harshly scrutinized and criticized the level of manipulation and the (seemingly deliberate) misinterpretation of data by the researchers in the studies he referenced in his book.

[tnumrych]

I did find an interesting article by Uffe Ravsnkov, called 'A hypothesis out-of-date: The diet–heart idea'. I haven't had a chance to read it in detail yet, but it seems to suggest what I was getting at above: total cholesterol appears to be a marker, but not a cause, of heart disease. If this is true, then it doesn't much matter whether diet affects total cholesterol levels.

Kendrick did not contest that point and it seems that him and Ravsnkov are of the same school of thought on the subject.

[BIGGUY6FT6]

My wife was a vegetarian for years and had a cholesterol range in the 300's. She married me and discovered that meat is good. Her cholesterol is still in 300's. The Doc put her on statins and got her numbers to 250's but her Liver Function took a shit so she said to hell with them. Now she is off the Lipitor and her liver function is good and her cholesterol is in 300's. Food for thought.

[gordonrumble]

This makes me very curious as to why cholesterol is a marker for heart disease. It could be that Lipitor treats something that causes higher cholesterol, and that is a cause of heart disease? Maybe cholesterol is a reactive response to some kind of other risk? People with high cholesterol have it normally without the associated risk, or high levels to fix some kind of genetic risk?

These are the kinds of questions that made me wish I was in medical research.

[confuzzl3don3]

My wife was a vegetarian for years and had a cholesterol range in the 300's. She married me and discovered that meat is good. Her cholesterol is still in 300's. The Doc put her on statins and got her numbers to 250's but her Liver Function took a shit so she said to hell with them. Now she is off the Lipitor and her liver function is good and her cholesterol is in 300's. Food for thought.

Genetics, genetics, genetics.

[cycomiko]

I probably should not have said "zero correlation" because there is statistical aberration that can skew data. There is simply no statistical correlation. The Framingham study is not the first, or only, study to fail to show correlation. It is certainly not the first to say there is a correlation though.

Sop its not zero correlation, but there is a statistical abberation that skews data, which means there is no statistical correlation...

Its not the first to fail to show correlation but its not the first to say there is a correlation...

excellent waving hands

[Craig B.]

There is a good look at Framingham in the first section of Good Calories, Bad Calories. The whole book is quite excellent. Roots of it, in a published sense, start here:

http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html?pagewanted=1

My doc has basically said that unless you are not concerned with quality of life, to avoid all statin drugs. You need the cholestoral for normal brain and hormone function.

[Krump]

Tnumrych, thanks for those links to Kendrick. TGCC is on my read list but I havn't gotten to it yet. As interesting as the cholesterol-health controversy is, for me it's just a personal interest, not an imperitive. Couple that with the fact that I don't have a science degree and don't feel I am compentant at discerning primary research (let alone have access to it for the most part), leads me to get a lot of my info from secondary sources that synthesize and interpret the data for me. Of course now I have to discern writer bias but its still more practical for me. Thus the appeal of books like TGCC. Again, thanks for the links.

One secondary source I have found extremely valuable is Stephan Guyenet's work at the Whole Health Source blog. It is filled with tons of info about the relationship between serum and dietary cholesterol, sat-fat, CVD, and other diet-health relationships. He really helps make sense of piles of studies.

[brittf]

There is a good look at Framingham in the first section of Good Calories, Bad Calories. The whole book is quite excellent. Roots of it, in a published sense, start here:

http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html?pagewanted=1

My doc has basically said that unless you are not concerned with quality of life, to avoid all statin drugs. You need the cholestoral for normal brain and hormone function.

I have to support this argument.

My entire life revolves around reading and researching data; comes with the territory if you chose to become a professor. Unfortunately, my profession mostly sucks at helping the general population understand subtle scientific arguments.

Enter the role of the (qualified and intelligent) "Science Writer."

If they do a good job of researching ALL relevant materials and are not predisposed towards supporting a particular answer, their books are amongst the best available. Several come to mind, including Michael Pollan and Gary Taubes. Michael Pollan has had a great deal of popular success with his books; Gary Taubes less so...

However, IMHO Taubes' book "Good Calories, Bad Calories" is one of the best books out there on the topic of nutrition. He is a wonderful writer and his research is top-notch.

Anyone interested in understanding the ACTUAL data from the available nutrition research would be foolish to bypass this book.

With the (perhaps temporary) popular demise of low-carb diets, his book has not received the attention or success that it deserves. However, the readers of this board are NOT the general population who accept and then discard fads, depending on what is "cool" at the time.

Just remember that, in the same way that being a Physician DOES NOT imply profound knowledge about strength-training, the same goes for Nutrition as well. The typical MD who suggests particular methods for "healthy eating" knows very little about the current research on nutrition. My PhD is in math - which makes me knowledgeable about analytical problems but doesn't say squat about what I know regarding strength-training, nutrition, politics, whatever. The same goes for MDs. With a little effort, you will know more about how to eat and how to train than your MD will ever know.

Get the book, READ it (don't skim), understand the data and the logical thought processes described therein, and LEARN...

You won't regret it.

Regards,
brittf

[johnst_nhb]

Sop its not zero correlation, but there is a statistical abberation that skews data, which means there is no statistical correlation...

Its not the first to fail to show correlation but its not the first to say there is a correlation...

excellent waving hands

I don't know what you mean.

Regarding the statement, "Its not the first to fail..." was this. Often times scientists are too close to their objective to actually see what the data is telling them.

[eh9]

However, IMHO Taubes' book "Good Calories, Bad Calories" is one of the best books out there on the topic of nutrition. He is a wonderful writer and his research is top-notch.Another book in this category is The Queen of Fats (http://books.google.com/books?id=xOv6T5QF2uIC) by Susan Allport. It's the book on the science of omega-3 fatty acids. It's without a question the best-written single volume of science reporting I've read. As a disclaimer, I can't say I read huge amounts of science reporting (I'm more likely to go read the introductory textbook in whatever field I've gotten myself curious about), but nevertheless this book is excellent. She present the science cleanly and in detail, and her narratives about the researchers are just as good. Thanks to Michael Pollan for praising this book in a footnote, where I found out about it.

And, apropos this thread, it's utterly illuminating on the topic of chronic inflammation.

[Scrofula]

This makes me very curious as to why cholesterol is a marker for heart disease. It could be that Lipitor treats something that causes higher cholesterol, and that is a cause of heart disease? Maybe cholesterol is a reactive response to some kind of other risk? People with high cholesterol have it normally without the associated risk, or high levels to fix some kind of genetic risk?


The Ranvskov paper briefly addresses this:

The reason why high cholesterol has been found to be predictive of CHD in many studies may be that the true causes of CHD may also raise cholesterol. Several factors can do this; most important are, probably, mental stress [60], physical inactivity [61], and smoking [62]. It is a general belief that the cardiovascular risk associated with these factors is mediated through their effects on LDL- and high-density lipoprotein (HDL)-cholesterol. However, their effect on CHD may be more direct. Mental stress affects adrenal function, smoking may increase the burden of oxidants and thus directly damage the endothelium, and physical inactivity may prevent the formation of collateral vessels in the coronary arterial system [63] and/or compromise coronary endothelial function [64].
A rather speculative answer, but oh well.

[Mark Rippetoe]

I hope you guys realize that Linus Pauling and Matthias Rath addressed this many years ago.

http://www.google.com/url?sa=t&source=web&ct=res&cd=6&ved=0CB8QFjAF&url=http%3A%2F%2Fwww.orthomolecular.org%2Flibrary% 2Fjom%2F1992%2Fpdf%2F1992-v07n01-p005.pdf&rct=j&q=pauling+rath+theory&ei=oVNFS4PDFs2vtgfcl9DvAQ&usg=AFQjCNFuvpyGrR_Bejm-DreE30jzSwXneQ

[ab9302]

Isn't it true that the correlation between insulin resistance and heart disease is much stronger than the correlation between elevated serum cholesterol levels and heart disease?

My very simplistic understanding of the overall process is this:

- chronic systemic inflammation causes damage to the lining of the blood vessels
- through a complex process, cholesterol "patches" the damage in the vessels, and this occurs regardless of how low cholesterol levels are
- continuing systemic inflammation keeps making the damage worse
- the body continues to try to repair the damage with cholesterol
- before you know it, you have a very narrowed coronary artery due to the continuing "repairs"
- the systemic inflammation that induces this whole process is very closely correlated with insulin resistance....

I'm sure this info is nothing new to most reading this thread, but it just seems incomplete to discuss the issue of blood cholesterol & coronary artery disease without touching on the bigger issue of chronic systemic inflammation and the important role that insulin resistance appears to play.

I'd like to hear someone (with a much more complete understanding than me) explain better how all these factors tie together.

[cycomiko]

I don't know what you mean.

Regarding the statement, "Its not the first to fail..." was this. Often times scientists are too close to their objective to actually see what the data is telling them.

your comment went around in circles

[cycomiko]

I have to support this argument.

My entire life revolves around reading and researching data; comes with the territory if you chose to become a professor. Unfortunately, my profession mostly sucks at helping the general population understand subtle scientific arguments.

professor of what? as

Taubes book "Good Calories, Bad Calories" and "understanding the ACTUAL data from the available nutrition research" do not match

[brittf]

Another book in this category is The Queen of Fats (http://books.google.com/books?id=xOv6T5QF2uIC) by Susan Allport. It's the book on the science of omega-3 fatty acids. It's without a question the best-written single volume of science reporting I've read. As a disclaimer, I can't say I read huge amounts of science reporting (I'm more likely to go read the introductory textbook in whatever field I've gotten myself curious about), but nevertheless this book is excellent. She present the science cleanly and in detail, and her narratives about the researchers are just as good. Thanks to Michael Pollan for praising this book in a footnote, where I found out about it.

And, apropos this thread, it's utterly illuminating on the topic of chronic inflammation.

Thanks for the heads-up. I have read Udo Erasmus' excellent treatise on fats (Fats that Heal, Fats that Kill), but not the book you reference. I will order that from Amazon immediately.

Regards,
brittf

[SerusMournstar]

Isn't it true that the correlation between insulin resistance and heart disease is much stronger than the correlation between elevated serum cholesterol levels and heart disease?

I do recall them telling us in our cardiology module that those with type 2 diabetes that have never had an MI are at as high a risk for a cardiac event as those who previously suffered an MI.

[brittf]

I hope you guys realize that Linus Pauling and Matthias Rath addressed this many years ago.

http://www.google.com/url?sa=t&source=web&ct=res&cd=6&ved=0CB8QFjAF&url=http%3A%2F%2Fwww.orthomolecular.org%2Flibrary% 2Fjom%2F1992%2Fpdf%2F1992-v07n01-p005.pdf&rct=j&q=pauling+rath+theory&ei=oVNFS4PDFs2vtgfcl9DvAQ&usg=AFQjCNFuvpyGrR_Bejm-DreE30jzSwXneQ

Hi Mark,

In fact, you can go back even further than this for early signals on the relationship between diet and physical health (although not quite so specific on heart disease). The dentist, Dr. Weston Price, DDS, wrote a fascinating book way back in 1939 that is a classic. "Nutrition and Physical Degeneration" is STILL a good read, even today, and the photographs showing the variation in jaw and tooth formation based on different dietary practices are stark and revealing.

I am well-aware of the fact that Dr. Price MAY have only shown pictures and data that supported his position. That is the risk of a relatively unstructured "anecdotal" argument, such as he presents. However, it is a very interesting early look at the impact of the "modern diet" versus a more "classic diet". It also presages the current line of research on "paleolithic nutrition."

I find this stuff almost as interesting as research on strength-training. I would argue that, as we age, nutrition may be an equal partner to physical activity and training in the pursuit of long-term active health. It may be heretical, but I also maintain that some degree of specific cardiovascular training (especially high-intensity training that elevates LT) becomes fairly important.

Regards,
brittf

[brittf]

Isn't it true that the correlation between insulin resistance and heart disease is much stronger than the correlation between elevated serum cholesterol levels and heart disease?

My very simplistic understanding of the overall process is this:

- chronic systemic inflammation causes damage to the lining of the blood vessels
- through a complex process, cholesterol "patches" the damage in the vessels, and this occurs regardless of how low cholesterol levels are
- continuing systemic inflammation keeps making the damage worse
- the body continues to try to repair the damage with cholesterol
- before you know it, you have a very narrowed coronary artery due to the continuing "repairs"
- the systemic inflammation that induces this whole process is very closely correlated with insulin resistance....

I'm sure this info is nothing new to most reading this thread, but it just seems incomplete to discuss the issue of blood cholesterol & coronary artery disease without touching on the bigger issue of chronic systemic inflammation and the important role that insulin resistance appears to play.

I'd like to hear someone (with a much more complete understanding than me) explain better how all these factors tie together.

This is, more or less, my understanding as well. While nutrition is not my vocation, it is a very important avocation for me. I read constantly on the topic and correspond relatively regularly with researchers in the field.

I would add to your statements above that there are MANY pathways to chronic inflammation, aside from just insulin resistance/metabolic/Type-X syndrome. That is what makes the field so confusing and contradictory at times. As well, inflammation is probably not the only pathway to cardiovascular disease. There may not actually BE a single "golden bullet" indicator of propensity towards heart disease.

For the past several years, many researchers in the field thought that serum Homocysteine levels and serum CRP (C-reactive protein) were direct indicators of inflammation and, by extension, proximate indicators of potential cardiovascular disease.

However, it appears that all "inflammation" in not created equal, at least as a pathway to cardiovascular disease. A fascinating recent paper in one of the major journals (I need to go look up the reference, but I "think" it was JAMA) gave data on some indigenous peoples in the rain forests of Brazil. Their "inflammation" markers were extremely high (Homocysteine and CRP) due to the typical "life accidents" inherent in living in such an environment, but heart disease was very low. So, apparently chronic inflammation from diet and lack of exercise and insulin resistance/metabolic/Type-X syndrome (the typical "Western" constellation) has a different impact on the cardiovascular system than episodic but more-or-less continuous inflammation of "paleolithic life".

Go figure...

Lots of interesting stuff to consider.

Regards,
brittf

[tnumrych]

I hope you guys realize that Linus Pauling and Matthias Rath addressed this many years ago.

http://www.google.com/url?sa=t&source=web&ct=res&cd=6&ved=0CB8QFjAF&url=http%3A%2F%2Fwww.orthomolecular.org%2Flibrary% 2Fjom%2F1992%2Fpdf%2F1992-v07n01-p005.pdf&rct=j&q=pauling+rath+theory&ei=oVNFS4PDFs2vtgfcl9DvAQ&usg=AFQjCNFuvpyGrR_Bejm-DreE30jzSwXneQ

Does that mean you subscribe to Pauling's assertions on Vitamin C supplementation?

[Jon Nosferatu]

My understanding was that small LDL particles getting trapped inside the tears in the artery walls prior to the cholesterol "scab" being formed was more of the problem. Either way, chronic damage to the blood vessels (leading to the necessary inflammation response) is probably of much greater concern than arbitrarily attempting to reduce cholesterol levels (particularly since the dietary changes required for reduced damage are largely the same as those required to increase mean LDL particle size).

[eh9]

- chronic systemic inflammation causes damage to the lining of the blood vessels
- through a complex process, cholesterol "patches" the damage in the vessels, and this occurs regardless of how low cholesterol levels are
- continuing systemic inflammation keeps making the damage worse
- the body continues to try to repair the damage with cholesterolTo my eye, a common assumption, usually implicit, is that cholesterol is the rate-limiting step in this process. If it were, then you would see strong correlation between serum cholesterol levels and CVD. Results seem to indicate that it's not ordinarily rate-limiting. If, through intervention, serum cholesterol is lowered, it might become rate-limiting and provide some therapeutic effect, but that doesn't seem nearly as useful as eliminating the inflammation in the first place.

[Mark Rippetoe]

Does that mean you subscribe to Pauling's assertions on Vitamin C supplementation?

The reason I posted it was to remind everybody that the connection between inflammation, CVD, and cholesterol was not new. I tend to think that fatty acids are more important mediators of inflammation that ascorbate, but I do not know.

[eh9]

I tend to think that fatty acids are more important mediators of inflammation that ascorbate, but I do not know.This is the central science in The Queen of Fats. The very short version is that omega-3 and omega-6 fatty acids are both anabolic precursors, and interchangeably so, to prostaglandins (http://en.wikipedia.org/wiki/Prostaglandin), the main cytokines (cellular signaling molecules) responsible for inflammation. There are thus multiple molecular variants of these cytokines in your body, at a ratio governed by diet. The inflammatory activity, however, of these different version is not identical. In particular the inflammatory activity of omega-6 precursor prostaglandins is far higher than that for the omega-3 precursor variant.

The book doesn't mention other cytokines, but I cannot imagine this mechanism isn't of rather larger relevance than just to prostaglandins and inflammation. If it applies more widely, it's hardly a surprise that dietary shift leads to systematic problems; it could hardly be otherwise.

[brittf]

professor of what? as

Taubes book "Good Calories, Bad Calories" and "understanding the ACTUAL data from the available nutrition research" do not match

Hi there...

Well, I did say something about the irrelevance of degrees in the very post that you quoted from -

Just remember that, in the same way that being a Physician DOES NOT imply profound knowledge about strength-training, the same goes for Nutrition as well. The typical MD who suggests particular methods for "healthy eating" knows very little about the current research on nutrition. My PhD is in math - which makes me knowledgeable about analytical problems but doesn't say squat about what I know regarding strength-training, nutrition, politics, whatever. The same goes for MDs. With a little effort, you will know more about how to eat and how to train than your MD will ever know.

For what it is worth, I am a professor in risk management in the Business School at UT-Austin and have been there for 15 years now. However, I am not using my title or education to claim any particular knowledge in this area, as I think the quote above supports.

I am profoundly interested in your reply, however. I try to be well-read in the area of nutrition, but I am certainly an amatuer at best. I am always willing to listen and learn...

So, why are you so disparaging of Taubes' book and why do you think his rather exhaustive reporting of the research data on nutrition is suspect?

I am genuinely interested...

Regards,
brittf

[BWenson]

Wonder if statins exert a cardioprotective effect independent of serum cholesterol levels........?

Ding Ding Ding!

They are anti-inflammatory.