The Great Cholesterol Myth (3 page)

Contrary to what everyone thought, study after study on high-protein, low-carb diets, including those rich in saturated fat, showed that the blood tests of people on these diets were similar to Al’s. Their health actually
improved
on these diets. Triglycerides went down. Other measures that indicated heart disease risk also improved.

In the mid-‘90s I went back to school for nutrition, ultimately earning a C.N. (certified nutritionist) designation and later a Ph.D. in holistic nutrition and a C.N.S. (certified nutrition specialist) certification from the Certification Board for Nutrition Specialists, which is associated with the American College of Nutrition. During my studies, I learned that I wasn’t the only one questioning the links among saturated fat, cholesterol, and heart disease. I talked to many other health professionals who shared my concerns, including one of the top lipid biochemists in the country, Mary Enig, Ph.D., whose entire academic career has been spent studying fat and who believes that we have nothing to fear whatsoever from saturated fat. (Enig, by the way, did some of the early research on trans fats and fervently believes that it is trans fats, not saturated fats, that are the real villains in the American diet; I wholeheartedly agree.)

Enig is hardly alone in thinking that we have been collectively brainwashed on the subject of saturated fat and cholesterol. She has pointed out that when Americans were consuming whole, full-fat foods such as cream, butter, pasture-raised meats, raw milk, and other traditional foods, the rate of heart disease was a fraction of what it is now. She had wondered aloud, as so many have since, whether it was indeed a coincidence that the twin global pandemics of obesity and diabetes just happened to occur around the time we collectively banished these foods because of the phobia about cholesterol and saturated fat in the diet and began to replace them with vegetable oils, processed carbs, and, ultimately, trans fats.

Enig was very active in a group for which I have come to have great respect: The Weston A. Price Foundation. Named after a pioneering researcher in the fields of diet and health, the foundation is an outspoken advocate for “traditional” unprocessed foods, including butter, raw milk, grass-fed meat, and other foods that have been demonized by the cholesterol establishment because of their relatively high saturated fat content. The foundation has also called much-needed attention to the fact that when Americans ate these foods regularly—for example, in the early part of the twentieth century—heart disease was much less common than it is now.

In my career, I have examined the strategies that seemed to work for the healthiest, longest-living people on earth and found that lowering cholesterol has almost
nothing
to do with reducing heart disease, and definitely nothing to do with extending life. Study after study, including the Lyon Diet Heart Study, mentioned above, has shown that lowering the risk for heart disease has just about nothing to do with lowering cholesterol.

And more and more studies and reports were coming out demonstrating that the real initiators of damage in the arteries were oxidation and inflammation, with cholesterol more or less in the role of innocent bystander. Oxidation and inflammation,
along with sugar and stress (more on that in
chapters 4
and
8
), were clearly what aged the human body the most. It seemed to me then—and it seems to me even more now—that
these
were the culprits we should be focused on, not on a fairly innocent molecule that is utterly essential to human health.

One of the greatest frustrations I experienced was trying to reassure my clients that not only would they not die if they went on higher-protein, higher-fat diets, but they’d also see significant improvements in their weights and the health of their hearts.

By now, I was pretty convinced that we had been massively misled about the role of cholesterol in heart disease, and we had been misled about the dangers of saturated fat as well. One of the greatest frustrations I experienced during this time was trying to reassure my clients that not only would they not die if they went on higher-protein, higher-fat diets, but they’d also see significant improvements in their weights and the health of their hearts. But I was constantly butting heads with my clients’ doctors, who completely bought into the myth that saturated fat will kill you by clogging your arteries, raising your cholesterol, and ultimately leading to heart disease.

Fast-forward to 2010.

In 2010, Fair Winds Press—my publisher for thirteen books over the course of seven years—came to me with an idea. “How about a book on how to lower cholesterol with food and supplements?” they asked.

To which I replied, “I’m probably not the guy to write that one. I don’t think lowering cholesterol matters very much.”

As you can imagine, that was met with a collective startle. My publishers were more than a little curious. “How can lowering cholesterol
not
be important?” they wanted to know. “Don’t doctors believe high cholesterol is the cause of heart disease? Don’t they believe that lowering it is the most important thing you can do when it comes to preventing heart attacks?”

“They do indeed,” I replied, “and they’re wrong.”

Intrigued, my publishers asked me for more information. I suggested they start by exploring the website of The International Network of Cholesterol Skeptics,
www.thincs.org
. I sent them a number of peer-reviewed studies that cast doubt on the relationship between saturated fat and heart disease. And I sent them the impeccable investigative work of award-winning science writer Gary Taubes, whose exhaustive investigations of the role of fat in heart disease (beginning with his
seminal
New York Times
article, “What If It’s All Been a Big Fat Lie?”) has been so instrumental in calling attention to the profound weaknesses in the saturated fat–cholesterol–heart disease connection.

My friend Steve Sinatra is not only a board-certified cardiologist but also a trained psychotherapist and nutritionist. Like me, he’s also a member of the American College of Nutrition. And Steve has long believed that we’ve been sold a bill of goods on cholesterol. The story of how he came to the same conclusion that I did is fascinating and includes his own personal experience as a lecturer/educator for some of the biggest pharmaceutical companies on earth.

Steve promoted statin drugs and fully bought into the cholesterol-causes-heart-disease mythology that both of us have since abandoned.

Listen to his story in his own words, and you will begin to appreciate why we are both so passionate about revealing the truth about cholesterol and heart disease.

Most doctors today will recommend that you take a statin drug—they might even nag you to do so—if your cholesterol numbers are high. They will do so whether or not you have evidence of arterial disease and are a man or woman, and despite your age. In their minds, you prevent heart disease by lowering cholesterol.

Once upon a time I used to believe that, too. It made sense, based on the research and information that was promoted to doctors. I believed it to the extent that I even lectured on behalf of drug makers. I was a paid consultant to some of the biggest manufacturers of statin drugs, lecturing for hefty honorariums. I became a cholesterol choirboy, singing the refrain of high cholesterol as the big, bad villain of heart disease. Beat it down with a drug, and you cut your risks. My thinking changed years ago when I began seeing conflicting evidence among my own patients. I saw, for instance, many patients with low total cholesterol—as low as 150 mg/dL!—develop heart disease.

In those days we pushed patients to undergo angiograms (invasive arterial catheterization imaging) if they had sufficient symptoms of chest pain, borderline exercise tests, and especially cholesterol readings of greater than 280 mg/dL. We did this because our profession believed that all people with high cholesterol were in danger of having a heart attack.

We did the imaging to see how bad their arteries were. And, indeed, sometimes we found diseased arteries. But just as often we didn’t. Many arteries were perfectly healthy. These results were telling me something different than the establishment message—that it wasn’t just a simple cholesterol story.

Faced with these discrepancies I began questioning and investigating conventional thinking about cholesterol and looking at the cholesterol research more closely. I found other doctors who had made similar discoveries on their own and heard about how study findings were being manipulated. For example, biochemist George Mann, M.D., of Vanderbilt University,
who participated in the development of the world-famous Framingham Heart Study, later described the cholesterol-as-an-indicator-of-heart-disease hypothesis as “the greatest scam ever perpetrated on the American public.”

These and other dissenting voices were drowned out by the cholesterol chorus. To this day, practically all of what has been published—and receives media attention—supports the cholesterol paradigm and appears to have the backing of the pharmaceutical and low-fat industries along with leading regulatory agencies and medical organizations.

However, I stopped being a choirboy for cholesterol. I stopped believing. Here’s why:

I found that life can’t go on without cholesterol, a basic raw material made by your liver, brain, and almost every cell in your body. Enzymes convert it into vitamin D, steroid hormones (such as our sex hormones—estrogen, progesterone, and testosterone—and stress hormones), and bile salts for digesting and absorbing fats. It makes up a major part of the membranes surrounding cells and the structures within them.

The brain is particularly rich in cholesterol and accounts for about a quarter of all the cholesterol we have in our bodies. The fatty myelin sheath that coats every nerve cell and fiber is about one-fifth cholesterol. Neuronal communication depends on cholesterol. It is not surprising that a connection has been found between naturally occurring cholesterol and mental function. Lower levels are linked to poorer cognitive performance.

I remember one patient—a federal judge I’ll call Silvio—who came to see me. He was taking a statin drug and complained that his memory had gone to pot, so much so that he voluntarily took himself off the bench. His LDL level was down to 65 mg/dL. I took him off the statin, told him to eat a lot of organic, cholesterol-rich eggs, and within a month got his LDL level up above 100 mg/dL. His memory came roaring back. (Memory loss is one potential side effect of cholesterol-lowering drugs.)

Some researchers suggest that doctors should be extremely cautious about prescribing statin drugs to the elderly, particularly those who are frail. I totally agree. I have seen frail individuals become even frailer and much more prone to infections. Though that surprised me at the time, it no longer does. Cholesterol plays a big role in helping fight bacteria
and infections. A study that included 100,000 healthy participants in San Francisco over a fifteen-year period found that those with low cholesterol values were much more likely to be admitted to hospitals with infectious diseases.
³

Life can’t go on without cholesterol, a basic raw material made by your liver, brain, and almost every cell in your body.

Many such patients told me afterward that their strength, energy, appetite, and vitality returned after going off statin drugs. They obviously needed their cholesterol.

In addition to being a board-certified cardiologist, I’ve had a lifelong interest in nutrition. I’d been using nutritional supplements in my practice since the early 1980s, particularly coenzyme Q
₁₀
(CoQ
₁₀
), an absolutely vital nutrient that is made in every cell in the body and is a major chemical participant in the production of cellular energy. CoQ
₁₀
is critically important for the strong pumping action of the heart, which gobbles the stuff up. And in the early ‘90s I discovered something that shook my belief in statin drugs to the core—they depleted the body of CoQ
₁₀
.

That fact is widely known now, but it wasn’t then. And it certainly gave me pause. How could these miracle drugs that were believed to be the answer to heart disease be good for you in the long run if they depleted the very nutrient upon which the heart depends?

Even today, many doctors aren’t aware of the effect that statin drugs have on CoQ
₁₀
levels. How ironic that the very drug they prescribe to reduce the likelihood of a heart attack actually deprives the heart of the fuel it needs to perform properly? No wonder fatigue, low energy, and muscle pain are such frequent accompaniments to statin drug use.

It wasn’t until the mid-1990s that statin drugs really took off, but prior to then physicians had other go-to drugs for lowering cholesterol. Many research studies were conducted using these drugs, and in 1996 the U.S. Government Accountability Office evaluated these trials in a publication titled
Cholesterol Treatment: A Review of the Clinical Trials Evidence
. The report explained that though some trials showed a reduction in cardiovascular-related deaths (primarily among those who entered the studies with existing heart disease), there was a corresponding
increase
in
non
-cardiovascular-related deaths across the trials. “This finding, that cholesterol treatment has not lowered the number of deaths overall, has been worrisome to many researchers and is at the core of much of the controversy on cholesterol policy,” the authors wrote.

It was also quite clear from the report that those who benefited the most from lowering their cholesterol levels were middle-aged men who already had heart disease. “The trials focused predominantly on middle-aged white men considered to be at high risk of coronary heart disease,” the report stated. “They provide very little information on women, minority men and women, and elderly men and women.”

It’s been more than a decade since that report was written, but it remains true that lowering cholesterol has a very limited benefit in populations other than middle-aged men with a history of heart disease. Yet doctors continue to prescribe statin drugs for women and the elderly, and, shockingly, many are arguing for treating children with statins as well.