The Great Cholesterol Myth: Why Lowering Cholesterol Won’t Prevent Heart Disease
Trying to prevent heart disease by lowering cholesterol is like trying to prevent obesity by cutting out lettuce.
Surprised? Read on.
Last year, cardiologist Stephen Sinatra, M.D., and I came together to write a book titled The Great Cholesterol Myth: Why Lowering Cholesterol Won't Prevent Heart Disease–And The Statin-Free Plan That Will. 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, and sugar. These are things we can actually do something about using food, supplements and lifestyle changes, none of which have the costs—or the side effects—of prescription drugs.
First, let's start with some surprising facts:
- 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.
It turns out that cholesterol is actually a minor player in heart disease, and that lowering cholesterol has a surprisingly 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.
Yet getting the information out there is difficult. The two top cholesterol-lowering medications, Lipitor and Zocor, together bring in roughly $34 billion each year for their makers, who have a vested interest in keeping the cholesterol theory alive. And they're hardly the only ones who do.
The Lyon Diet-Heart Study
In the 1990s, French researchers decided to run an experiment to test the effect of different diets on heart disease.1 The Lyon Diet-Heart Study took two groups of men who had every risk factor imaginable for heart disease. 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), while the other half were advised to eat a Mediterranean diet high in fish, omega-3 fatty acids, vegetables, and monounsaturated fats such as olive oil.
The study was stopped midway because the reduction in heart attacks in the Mediterranean group was so pronounced—70 percent!—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 a 70 percent reduction in deaths? You'd think those levels must have dropped like a rock, right?
Think again. Their cholesterol levels didn't budge; they 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—which can be caused by anything from high blood pressure to toxins—cause oxidized (damaged) LDL particles take up residence in the area. The immune system responds by sending inflammatory cytokines to the "rescue," eventually resulting in plaque and an increased risk for heart disease. If there were no inflammation, the arteries would be clear.
The following is my six-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. Stress hormones create inflammatory events that may explain why 40 percent of atherosclerotic patients have no other risk factors.
Pay attention to these six 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.
- Reduce intake of grains, starches, sugar and omega-6 fatty acids.
- Manage your stress.
- Don't smoke.
- Supplement with antioxidants, vitamin C, Coenzyme Q10, omega-3 fatty acids.
The Case for Supplementation
Ask your typical mainstream doctor about nutritional supplements, and the first thing you're likely to hear is this: "There's no good research showing they work." I've heard this refrain time and time again when I discuss nutritional medicine with my more conservative colleagues.
It's not true.
You or your doctor can go online to the National Institute of Medicine's library, www.pubmed.com, put into the search box virtually any vitamin or herb you can think of and, depending on what you choose, hundreds to thousands of citations will pop up. So the problem isn't an absence of research.
The problem is twofold. One, the conventional training of medical doctors in this country is highly biased toward pharmaceuticals. From the time they enter med school, doctors are courted by the pharmaceutical companies in myriad ways, some subtle, some not-so-subtle.
Free lunches, symposiums, honorariums, consulting and lecturing contracts, vacations, perky pharmaceutical reps showing up at offices with the latest studies that show their products in a favorable light, and free samples all create a culture in which pharmaceuticals are the first choice in any treatment plan.
Most docs will tell you these practices have no influence on them or what they choose to prescribe, but the research tells a very different story.2,3
The other part of the problem is that much of the research on vitamins flies beneath the radar. Your overworked doctor barely has time to scan the abstracts of the New England Journal of Medicine every month, let alone dig deeply into the hundreds of studies that are published every year on vitamins and nutrients in journals such as the American Journal of Clinical Nutrition.
The vast majority of doctors in this country get no training whatsoever in nutrition, and those who do receive only the most rudimentary and superficial introduction to the subject. Put this together with the built-in medical school bias in favor of patent medicines, and it's easy to see why doctors often fail to think of natural substances as legitimate tools for keeping people healthy.
The New "Medicine" Cabinet
Many supplements are beneficial for heart health. Here's a short guide to the most important ones. If you're not taking these, perhaps you should be.
Omega-3's are among the most anti-inflammatory substances on the planet and should be part of everyone's heart-healthy nutrition program. Come to think of it, they should probably be part of everyone's nutrition program, period!
CoEnzyme Q10 is fuel for the heart. It's made in every cell in the body, and your ability to make it diminishes with age. It's virtually unavailable in any meaningful amount from food. It's also depleted by cholesterol-lowering medications, so if you're on one of those you simply must consider supplementing with Coenzyme Q10 on a daily basis!
D-Ribose is a five-carbon sugar and one of the components of ATP, the energy molecule the body uses to power all activities. Without D-ribose, there is no ATP; without ATP, there is no energy.
Carnitine acts as a kind of shuttle bus, loading up fatty acids and transporting them into tiny structures within the cell called the mitochondria, where they can be burned for energy. Because the heart receives 60 percent of its energy from fat, it's very important that the body has enough L-carnitine to shuttle the fatty acids into the heart's muscle cells.
Magnesium supplements are a must for those who want to protect their heart. Magnesium lowers blood pressure, helps control blood sugar and relaxes the lining of the blood vessels. And almost all dietary surveys show that Americans aren't getting nearly enough.
When magnesium is depleted, intracellular calcium rises. Magnesium also inhibits platelet aggregation, an important step toward the development of clots.
Calcium channel blockers like Procardia, Adalat, Plendil, and Cardene widen and relax the blood vessels by affecting the muscle cells found in the arterial walls, which is exactly what magnesium does—splendidly, we might add.
Magnesium dilates the arteries, reducing blood pressure. This makes it far easier for the heart to pump blood, and for blood to flow freely.
Pantethine is a metabolically active—and somewhat more expensive—form of Vitamin B-5, or pantothenic acid. The blood tests of patients with dyslypiemia—meaning their blood cholesterol levels are too high—significantly improve with pantethine. And though it's not seen on a blood test, pantethine also reduces the oxidation of LDL.4
No fewer than 28 clinical trials in humans have shown that pantethine produces significant positive changes in triglycerides, LDL cholesterol, and VLDL, along with increases in HDL cholesterol.5 In all of these trials, virtually no adverse effects were noted. The mean dose of pantethine in these studies was 900 milligrams a day, given as 300 mg three times daily. That appears to be the optimal dose, and it's the one I recommend.
Vitamin C is one of the most powerful antioxidants in the world, and because heart disease is initiated by oxidative damage caused by free radicals, any help you can get in the antioxidant department is a good thing.
And it's not just theoretical: a large 2011 study in the American Heart Journal found that the lower the level of vitamin C in the blood, the higher the risk for heart failure.6 Take 1,000 to 2,000 mg a day.
This extract from the Indian spice turmeric has multiple benefits, not the least of which is that it's highly anti-inflammatory. Scientific research has demonstrated its anti-inflammatory, anti-oxidant, anti-thrombotic, and cardiovascular protective effects.7 It also reduces oxidized LDL cholesterol.8
Resveratrol is the ingredient in red wine that's best known for its "anti-aging" activity. It helps protect the arteries, improves their elasticity, inhibits blood clots, and lowers both oxidized LDL and blood pressure.9 Not a bad resume!
It's both a strong anti-oxidant and a strong anti-inflammatory, inhibiting a number of inflammatory enzymes that can contribute to heart disease. It also inhibits the ability of certain molecules to stick to the walls of the artery, where they can take up residence and contribute to inflammation.10
The recommended dose is 200 mg a day of trans-resveratrol, the active component of resveratrol. Read labels carefully; many won't tell you how much resveratrol is of the trans variety.
Plant chemicals in cocoa known as flavanols help the body synthesize the compound nitric oxide, which is critical for healthy blood flow and healthy blood pressure. Nitric oxide improves platelet function, meaning it makes your blood less sticky. It also makes the lining of the arteries less attractive for white blood cells to attach to and stick around.
Researchers in Germany followed more than 19,000 people for a minimum of 10 years and found that those who ate the highest amount of flavanol-rich dark chocolate had lower blood pressure and a 39 percent lower risk of having a heart attack or stroke compared to those who ate almost no chocolate.11
The Bottom Line
Lowering cholesterol and lowering the risk of heart disease are very far from the same thing.
The former is almost irrelevant. The latter is important, and there's a lot you can do about it that doesn't involve taking prescription drugs for the rest of your life.
- DeLorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779-785.
- Eric G. Campbell, PhD, Doctors and Drug Companies-Scrutinizing Influential Relationships, N Eng J Med 2007; 357: 1795-1797 Nov. 1, 2007
- Chren, MM., Interactions between physicians and drug company representatives. American Journal of Medicine. 1999;107:182-183.
- G. Bon et al., Effects of Pantethine on in Vitro Peroxidation of Low-Density Lipoproteins. Atherosclerosis 57, no. 1 (1985): 99-106
- Mark Houston et al., Nonpharmocologic Treatment of Dyslipidemia. Progress in Cardiovascular disease 52, no 2 (2009): 61-94
- R. Pfister et al., Plasma Vitamin C Predicts Incident Heart Failure in Men and Women in European Prospective Investigation into Cancer and Nutrition-Norfolk Prospective Study. American Heart Journal 162, no. 2 (2011): 246-53
- W. Wongcharoen and A. Phrommintikul, The Protective Role of Curcumin in Cardiovascular Diseases. International Journal of Cardiology 133, no. 2 (2009): 145-41
- Mark Houston, MD, What Your Doctor May Not Tell You About Heart Disease (New York: Grand Central Life & Style, Hatchette Book Group, 2012)
- M.A. Carluccio et al., Olive Oil and Red Wine Antioxidant Polyphenols Inhibit Endothelial Activation: Antiatherogenic Properties of Mediterranean Diet Phytochemicals. Atherosclerosis, Thrombosis, and Vascular Biology 23, no. 4 (2003): 622-29
- European Society of Cardiology, "Study Shows Chocolate Reduces Blood Pressure and Risk of Heart Disease", European Society of Cardiology, March 31, 2010, http://www.escardio.org/about/press/press-releases/pr-10/Pages/chocolate-reduces-blood-pressure.aspx
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I don't think Dr. Oz came up with the blood type diet, If I remember correctly it was Dr. Peter D'Adamo. I do think that the information spewed on his show is questionable, but that may be more network influence than anything, basically trying to get viewers based on what is popular (fat loss, anti-aging, etc.)
Came in to basically say this. Dr. Oz is a fraud. Its amazing how every week he has the top five foods to boost your metabolism but every week they are different.
Dr. Oz is still the acting director of the Cardiovascular Institute and Complementary Medicine Program at New York-Presbyterian Hospital, which you might recognize as one of the 10 best hospitals in the country
According to The New York Times, Dr. Oz is "one of the most accomplished cardiothoracic surgeons of his generation." Over the course of his career, he has performed 5,000 open-heart surgeries, has successfully transplanted people's lungs and is just generally in the upper fraction of the top one-tenth of a percent of doctors you want standing over your split-open chest cavity in life-and-death situations.
He is a good doctor and not a fraud, he might not be bodybuilding friendly and his stlye might not suit you, but he is not full of it.
Based on your comment and information above ("Dr. Oz is "one of the most accomplished cardiothoracic surgeons of his generation"."), this makes Dr. Oz nothing more than a good surgeon. A good DOCTOR is one whose patients will not need these invasive, life-rescuing surgeries as their doctor will have advised them properly on a nutritional regimen that is beneficial for their overall health and well-being.
Thus in response to your comment, he is in fact NOT a good doctor, but simply a well decorated surgeon whose nutritional information is as biased as the information provided by modern-day Western Medical Schools who indeed seek to treat with patients first with pharmaceuticals before ever considering positively changing dietary habits or incorporating natural, safe, and simply homeopathic supplementation.
It is not that he is "unfriendly to bodybuilders" as you are stating, Dr. Oz is simply unfriendly to any human looking to make a fully-informed decision on nutrition and supplementation in order to live a healthy lifestyle in general. He is, in fact in the most pure sense of the term, A SELLOUT.
Except, of course, that all the info you voluntarily consume here is free, free, free. A healthy diet of whole foods is indeed the most important nutritional factor; these supplements he mentions may offer benefits as well. I'd suggest that maintaining a healthy heart is worth any investment of time, energy and resources one could make.
I think this article was meant as a evaluation tool for those that may not get these particular vitamins/minerals. For those that do-- have nothing to worry about or buy for that matter.
Wantaripbod, yes a well balanced will diet is a fantastic way in order to decrease your risk for heart disease. But the supplements shown are actually quite cheap particulary EFA'S. Ive had to write multiple research articles on this exact topic and all of what they say is true. Nice article BB.com!
Best advice "Eat an anti-inflammatory diet.
Reduce intake of grains, starches, sugar and omega-6 fatty acids.
Manage your stress.
Supplement with antioxidants, vitamin C, Coenzyme Q10, omega-3 fatty acids."
Among these I would highly recommend eating fermented foods such as kimchi, kefir, etc. Do consume less sugar right after workout because everyone's insulin receptors becomes very responsive, 10-20gram of carbs from fruit would be enough to replenish bodies glucose level
Interesting that this knowledge has finally made it in the mass media. A well formulated low carbohydrate high fat diet is all you need to reduce all markers of metabolic syndrome and reduce CVD risk.
Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal
Effects of a carbohydrate-restricted diet on emerging plasma markers for cardiovascular disease
Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction
The Art and Science of Low Carbohydrate Living
Phinney MD and Volek MD
This article has no scientific fact and only references a study that is inconclusive because they could not finish the study. This article is filled with incorrect information about doctors. The author is not a doctor and has no clue on the education that doctors receive. This guy is a nutritionist, not a doctor. But yet he thinks he know more that them about their own profession. It is people like this guy that write untrue, made up information about people to make them look bad so that he can promote his beliefs. This article is a theory and is not fact.
Utilizing EBCT technology, researchers at the Beth Israel Medical Centre in New York set out to determine if increased cholesterol levels, specifically LDL cholesterol, led to plaque build up. Looking at 182 individuals who may develop CAD, over 1-2 years of treatment with cholesterol lowering drugs, it was discovered that despite lower cholesterol levels there were ZERO differences in the development of atherosclerotic plaque. The researchers concluded "with respect to LDL cholesterol-lowering, 'lower is better' is not supported by changes in calcified plague progression." (American Journal of Cardiology 2003; 92:3)
I would have to agree with LBman on this one. Being a nurse, I can see clearly that this article is full of incorrect information. It is actually LDL that even causes the plaque buildup in the arteries and cause atherosclerosis. Cholesterole IS the problem. The only thing I would agree with in this article is that a good diet will definitely help. Everything else mentioned in the article though, has no scientific base to it. Anybody that works in the healthcare field would know this...
This is a fantastic article. I have shared it on my FB, for I work in a hospital and am surrounded by unhealthy people who would rather pop rx meds than try to make any sort of lifestyle change. Funny thing about that... people are always commenting on my eating habits and positive lifestyle choices, yet don't take it into their own hands to make healthier choices. This is a constant battle that I fight daily at work. At least 75% of the patients that I care for have developed their illness/disease through lifestyle decisions. I guess I just wish that everyone would pay better attention to their health... You only have one body to take you through life.
Very well said. I also enjoyed this article. Absolutely agree with you, and thank you for sharing that stat about the patients you see. Just another sad fact that is becoming normal in this country.
The methods of living a healthier lifestyle are abundant (and often times free), now if we could just get people to stop ignoring it.
Excellent article. Contrary to what some have said, the Dr. Oz show is quite good, unfortunately he has run into what every good medical/fitness show/publications runs into and that's he's essentially run out of topics and has increasingly profiled topics that are bunk. The article above isn't pushing supplements, but makes an extremely good point about modern medicine being heavily influenced by the pharmaceutical industry. I am currently working with a diabetic whose condition has been worsing for the past 12 years. In the last month since we started working together he has changed his diet, began exercising regularly and has gone from 22 units of insulin per day to 14. His doctor is about to take him off insulin (and two other medications) altogether. He told me in 12 years he's "tried everything" and hasn't had a reversal of symptoms. One thing he didn't try - and that his doctor didn't recommend - was changing his diet and exercising. Instead, he was put on a drug (injection) that had a side-effect of weight loss. He was put on it only so that his weight would come down and he could reduce or get off the insulin. I know another good option for weight loss - proper diet and exercise. The amount of preventable disease plaguing North America is staggering. Smarten up people! Of couse, on here I'm preaching to the converted, so...
I doubt a doctor would not recommend that the patient eat a better diet and exercise. Even if he did not, he would have explained the reason he has diabetes is due to poor diet and obesity. It is obvious to the patient that he must change his diet. A doctor can not make you change your diet, he can only recommend it, so when the patient returns to the doctor and his obesity/diabetes has become worse each time, the doctor will prescribe something to help the patient who clearly wont do it himself. Good job on helping the person and it sounds like it is working. Keep it up. But I am sure the doctor made the patient aware of the cause of his situation. Which is why the patient has come to see you.