Trying to prevent heart disease by lowering cholesterol is like trying to prevent obesity by cutting the lettuce out of your Big Mac.
Surprised? Read on.
Recently, cardiologist Stephen Sinatra and I came together to write a book—“The Great Cholesterol Myth: Why Lowering Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will” (now the number 1 best-seller on Amazon in the category of heart disease).
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 real tragedy is that by putting all our attention on cholesterol, we’ve virtually ignored the real causes of heart disease:
- inflammation
- oxidative damage
- stress
- sugar
These are things we can actually do something about using food, supplements and lifestyle changes, none of which have the costs—nor the considerable side effects—of drugs.
First, let’s start with some surprising facts.
- Cholesterol is a minor player in heart disease
- Cholesterol levels are a poor predictor of heart attacks
- Half of heart attacks happen to people with normal cholesterol
- Half the people with elevated cholesterol have healthy hearts
- Lowering cholesterol has an extremely limited benefit
I haven’t come to these conclusions lightly, and I wouldn’t expect you to take them at face value. The case against cholesterol as a cause of heart disease (or even as an important marker for it) has been crumbling steadily for decades, but getting the information out there is difficult. (The two top cholesterol lowering medications, Lipitor and Zocor, together bring in roughly 34 billion dollars a year for their makers, who have a strong vested interest in keeping the cholesterol theory alive. And they’re hardly the only ones who do.)
But if you’re willing to consider breaking with conventional thinking for a minute, consider the following study, just one of the many we discuss in the book.
The Lyon Diet-Heart Study
In the 1990’s, French researchers decided to run an experiment- known as the Lyon Diet-Heart Study— to test the effect of different diets on heart disease.
They took two groups of men who had every risk factor for heart disease imaginable. All of them had survived a heart attack. They had high cholesterol, they smoked, they didn’t exercise and they had high levels of stress.
- Half the men were advised to eat the American Heart Association “prudent diet” (low saturated fat and cholesterol)
- The other half were advised to eat a Mediterranean diet high in fish, omega-3’s, vegetables and monounsaturated fat like olive oil
The study was stopped midway because the reduction in heart attacks in the Mediterranean group was so pronounced—70%!!—that researchers decided it was unethical to continue.
So what do you think happened to the cholesterol levels in the men who ate the Mediterranean diet and had 70% reduction in deaths? You’d think they must have dropped like a rock, right?
Think again. Their cholesterol levels didn’t budge, and were just as high when the study was stopped as they were when the study began. The men just stopped dying. Cholesterol had nothing to do with it.
So if cholesterol isn’t the cause of heart disease, what is?
The Real Cause of Heart Disease
Here’s the short answer: The primary cause of heart disease is inflammation. Small injuries to the vascular wall that can be caused by anything from high blood pressure to toxins attract all sorts of metabolic riff-raff, from bacteria to oxidized (damaged) LDL particles; the immune system sends inflammatory cytokines to the area, and more oxidation and inflammation takes place eventually resulting in the growth of plaque and, ultimately, to an increased risk for heart disease. If there were no inflammation, the arteries would be clear.
The following is my seven point program for reducing the risk of heart disease. Note that lowering cholesterol isn’t on it. Note also that managing stress is.
Stress is a powerful contributor to heart disease. The stress hormones create inflammatory events that may explain why 40% of atherosclerotic patients have no other risk factors.
Pay attention to these seven action items, and you just may find that you don’t need to worry quite so much about cholesterol after all.
- Eat an anti-inflammatory diet. The fruit and vegetable kingdom is teeming with natural anti-inflammatories like quercetin (apples and onions) and curcumin (turmeric). Drink green tea and pomegranate juice. Balance your protein and fat with tons of vegetables. And eat dark chocolate—it’s cocoa flavanols help lower blood pressure and keep the cardiovascular system healthy.
- Reduce grains, starches, sugar and omega-6’s (vegetable oils). Every one of these has the power to increase inflammation—a lot!
- Manage Your Stress. Stress is an enormous risk factor for heart disease, and is inflammatory as well. Find a way to manage it. Anything from regular walks in the park to deep breathing exercises to warm baths can help.
- Exercise. It’s probably the best anti-aging (and heart protective) drug on the planet
- Drink only in moderation. And if you don’t process the word “moderation” very well, don’t drink at all.
- Don’t smoke. Probably the number one recommendation for heart disease prevention.
- Supplement with antioxidants, vitamin C, Coenzyme Q10, omega-3’s, curcumin, citrus bergamont. Antioxidants like vitamin C protect against oxidative damage (one of the promoters of heart disease) while omega-3’s are one of the most anti-inflammatory molecule on earth. Curcumin does just about everything—it’s an anti-inflammatory and antioxidant.
The Statin Scam
And one more thing—if your doctor wants to put you on a statin drug, push back. Ask for the newer (and far more important) cholesterol particle tests, which go well beyond old-fashioned measurements like “good” and “bad” cholesterol and actually tell you what type of LDL you have. (LDL-a is pretty harmless; LDL-b is not.) If you’re a woman, be aware that there’s no evidence that statin drugs save lives in women (or children!) Know that in a number of studies, statin users have a higher risk for diabetes. And that in older people, higher cholesterol is actually protective. (If your doctor doubts that, refer him to the Framingham Study!)
Statin drugs have many potential side effects, including muscle pain and weakness, memory loss, diminished libido and fatigue. Finally, know that the only population for which a modest—repeat, modest—benefit for statin drugs has been consistently shown is middle aged men with existing cardiovascular disease (previous heart attack). And many health professionals suspect that even this extremely modest benefit is probably due to the anti-inflammatory nature of statins, rather than their ability to lower cholesterol.
The Bottom Line
Lowering cholesterol and lowering the risk of heart disease are very far from the same thing.
The latter is important.
The former is almost irrelevant.
Since we’re doing metaphors, ignoring cholesterol relating heart disease is like ignoring the corner pieces when building a puzzle. It’s not EVERYTHING, but it’s a contributing factor to several issues. Most cholesterol is made by your liver, just a side note.
This article also completely ignores the different types of cholesterol, like high/low density lipoproteins and chylomicrons (which carry triglycerides). Cholesterol can contribute to atherosclerosis, which can cause heart disease, heart attack, stroke, and the issues that come with triglycerides. Low cholesterol (non-dietary) can mean other problems.
Seriously, this just seems like a pitch for a book.
Good analysis as far as it goes. I have a mild hypoglycemia. I must stay away from all processed sugar and alcohol drink to be at my best. Cholesterol is needed to repair damage and must be kept over 100 or violence is indicated!
I fear your analysis is limited.
Thanks for this info.!!
I have just been diagnosed with high Triglycerides about 400. Have been trying to find a diet to lower this, any suggestions. They try to put me on zocor, I am unable to take chemicals, I have an allergy list like you wouldn’t believe to medicine, so I have to dig to find a natural way. I do take most of the vitamins you suggest taking above
Hi – I’ve read a number of your books and think you are on track. When I saw this today in the NYT, I wondered if you had thoughts on this study. My first question was “What type of beef did they consume and would it make a difference?”
http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?smid=pl-share
Thank you!
Gale
My father had his first heart by-pass in 1972. His total cholesterol count was at about 380 (specific types weren’t measured then). So first he was put on an 80 (that’s not a typo) calorie diet until his weight was in the range to operate… although he’d been skinny the vast majority of his life. He was 52 years old and most of his male relatives had died early of heart attacks. Dad died at the age of 92 thanks to modern medicine and the fact that he exercised against doctor’s orders… and that he had a total of 3 heart bypass surgeries and a couple of angioplasties. Yet I wondered why his body kept clogging his arteries–he followed the low fat but otherwise balanced diet meticulously for all those years and it didn’t help. It became clear to me that this kind of heart disease was a chronic condition like diabetes. From books like these I have learned that my dad’s chronic condition had nothing to do with his cholesterol. Cholesterol lowering medications did nothing for his heart health. I waited months for our library to provide a copy of your book and it was well worth reading… although this blog entry does a wonderful job of capturing the important points. I have been following the book’s suggested diet for months and have lost 10 lbs and dropping. I could not lower my weight until I accepted that I wasn’t eating enough fat! Fearing diabetes as a side effect I have decided to not use cholesterol lowering drugs (although I’m what’s thought to be borderline high). Thank you so much for making this information so available and writing such a clear and understandable work.
Dr. Bowden, you are right on, and providing a great service to inform people about the real culprit behind heart disease.
In regards to hearth health, it’s not just cholesterol and triglycerides, but inflammation that puts us at risk.
What if I told you we have developed a new way to lower CRP by 65% in one month with one small softgel and no side effects. Also lowers triglycerides by 30%, bad cholesterol by 10%, and increases good cholesterol by 4%.
Visit our Physical Activity and Fitness website Start! a walking program Obesity and overweightPeople who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart’s work because often the blood pressure is higher. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (“good”) cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even 10% from your current weight, you can lower your heart disease risk.
You must know your blood pressure, cholesterol (lipid) levels (total, LDL, HDL and triglycerides), and blood sugar levels. See your doctor to get these tests if you have not already had them. You also need to know your height, weight, and waist circumference.If you don’t know some of these numbers, the tool will use average data for someone who is your age and gender. Your risk assessment will be much more accurate if you use your own data.This risk assessment tool uses a scoring system from a study know as the Framingham Heart Study to assess your risk of heart attack or dying of coronary heart disease in the next 10 years. It uses national guidelines known as the ATP III guidelines for assessing metabolic syndromeNote: If your risk score is low, it doesn’t mean you’re off the hook. Even one risk factor, such as high cholesterol, that is not treated may lead to a higher risk later in life. Work to modify all your risk factors to improve your overall health.
When there is too much cholesterol in your blood, it builds up in the walls of your arteries, causing a process called atherosclerosis, a form of heart disease. The arteries become narrowed and blood flow to the heart muscle is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain . If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.
Stay away from refined sugar and flour and avoid unhealthy trans fats and a number of vegetable oils.
Personally I have to wonder if the study referenced means anything? Just because something is found in the blood immediately after a meal proves nothing. Immediately after exercising your blood pressure will be elevated but that is normal. I think more studies are needed but I am suspicious they are looking for something else they can treat with a drug so they can sell more drugs.
that is the classic, conventional view, and in my opinion it is highly simplistic, filled with holes, and basically wrong.
warmly
jb
The study by Harvard School of Public Health (HSPH) researchers is the first research to show that a small protein, apolipoprotein C-III (apoC-III), that sometimes resides on the surface of HDL cholesterol may increase the risk of heart disease and that HDL cholesterol without this protein may be especially heart protective.
You must know your blood pressure, cholesterol (lipid) levels (total, LDL, HDL and triglycerides), and blood sugar levels. See your doctor to get these tests if you have not already had them. You also need to know your height, weight, and waist circumference.If you don’t know some of these numbers, the tool will use average data for someone who is your age and gender. Your risk assessment will be much more accurate if you use your own data.This risk assessment tool uses a scoring system from a study know as the Framingham Heart Study to assess your risk of heart attack or dying of coronary heart disease in the next 10 years. It uses national guidelines known as the ATP III guidelines for assessing metabolic syndromeNote: If your risk score is low, it doesn’t mean you’re off the hook. Even one risk factor, such as high cholesterol, that is not treated may lead to a higher risk later in life. Work to modify all your risk factors to improve your overall health.
Much of the advice to avoid heart disease is the same health advice given for other conditions: stop smoking, exercise and eat a diet that is low in cholesterol and salt — cholesterol being the source of blockage and salt contributing to higher blood pressure. Other things to avoid in the diet include saturated fats, which typically come from animal fats and oils, and trans fats, which occur in vegetable oil, but have largely been removed from the marketplace because of consumer demand.
Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.
Your cholesterol levels and other risk factors — lifestyle, hypertension, diabetes, age, gender, etc. — influence your chance of developing heart disease. You can change some of these risk factors; others you can’t. Knowing your personal risk factors is the first step in taking charge of your heart health.
Your cholesterol levels and other risk factors — lifestyle, hypertension, diabetes, age, gender, etc. — influence your chance of developing heart disease. You can change some of these risk factors; others you can’t. Knowing your personal risk factors is the first step in taking charge of your heart health.
High cholesterol itself does not cause any symptoms; so many people are unaware that their cholesterol levels are too high. Therefore, it is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it.
I am desperate. I have naturally high cholesterol. I had it all my life.(low Triglycerides , good HDL, but high LDL) They put me on low fat diets for the past 25 years. I am skinny and an exerciser. Well now my blood sugars are going up. (no family history of diabetes). I quit the statin they had me on. It was making me sick. My blood sugar was 5.7 a1c last time checked.
The only conclusion I have is that it’s the low fat diet. I started eating full fat dairy, more meat, and protein. I ditched all industrial oils and sugars. I cut way back on carbohydrates. I feel lots better. I am even thinner than I was before, but still in a good range. I am terrified of going back to doctor, because every single time I went to doctor in past 10 years, they find a little something. My numbers just keep getting worse and they keep telling me eat low fat, eat low fat. I can’t take it anymore. If I didn’t need thyroid pills, I would just never go to the doctor at all. Everything they do makes me worse. I don’t think they have a clue on how to prevent heart disease. I am not even sure any medication helps unless you actually have heart disease.