As some of you know, my father-in-law, Fox, died of a heart attack three years ago. It wasn't his first major heart attack. He'd already had one eleven years previously (aged 48), and was saved by major heart surgery.
Without that surgical intervention, I would never have met my husband's wonderful Dad. As it is, my girls won't get the chance to meet their Grandad this side of heaven.
Fox's own father also died of a heart attack, in his early 70s. Given this family history of heart disease, you can understand why I'm more than a little concerned for my husband and children.
When Paul and I were first married, I followed the same advice most people do to try and prevent heart disease, ie. reduce saturated fat and cholesterol intake. I wasn't really worried for myself, but I distinctly remember arguing with Paul in the supermarket because he wanted to buy full-fat cream cheese and milk, and I wanted him to buy reduced fat versions because of his family history of heart disease.
You can imagine his relief and mine, when I learned cholesterol and saturated fats are not only good for you, but essential for health and life.
However, it is so engrained in people's mindsets that cholesterol is bad for us, I felt I needed to do more research in order to understand why cholesterol is our friend, not our enemy.
Enter stage left: The Great Cholesterol Con, by Dr Malcolm Kendrick.
I got this book out of the library at the same time I got out Sweet Poison. Because I read Sweet Poison first, it took me a while to get around to The Great Cholesterol Con. I actually considered returning it without reading it as I figured I probably already knew most of what it was going to say.
Boy I'm glad I decided to open that first page. It had me at, "hello".
I devoured the book in a couple of nights and was going to do a post on it for you immediately, but got too sick to even sit up. Unfortunately, that means I don't have the book in front of me now as I write this, since I had to return it to the library.
I'll do my best to capture its essence.
The Great Cholesterol Con was a fantastic first full book to read on the subject of cholesterol as it translates medical jargon and research with clarity and humour. Kendrick's snappy comebacks to mainstream dogma reminded me of interchanges between Lorelai and anybody else on the Gilmore Girls.
I learned so much about how the human body works, and what is going on when a stroke or heart attack occurs.
Why do people think saturated fat and cholesterol cause heart disease?
In the 1950s, a man named Ancel Keys wrote a very flawed paper entitled: Atherosclerosis: a problem in new public health. Journal of Mount Sinai Hospital, 1953; 20:118-139
In it, Keys hand-picked data from six countries that showed a clear link between heart disease and the dietary intake of fat.
He actually had data from 22 countries available to him, but left out the rest as they told a completely different story. He was a man on a mission to prove that dietary intake of saturated fat causes heart disease, and he wasn't going to let mere facts get in his way.
Unfortunately, Keys was an influential advisor to the American Heart Association because of some previously excellent scientific work he had done. This meant his flawed "Lipid Hypothesis" was widely publicised and used as the basis for US dietary guidelines from then on.
You can read more about controversy surrounding the Lipid Hypothesis here.
In The Great Cholesterol Con, Kendrick cites study after study disproving the Lipid Hypothesis. For example, in Japan incidents of stroke and heart disease both decreased when total serum cholesterol increased. That's because the human brain is almost entirely made of cholesterol, so people in Japan on very low fat/cholesterol diets were stroking out early.
When the population purposefully increased its dietary intake of saturated fat and cholesterol, stroke rates plummeted. Surprisingly, so did rates of heart disease. That is because cholesterol also gives veins and arteries their integrity, and it helps repair damage.
Ancel Keys noticed cholesterol was always found on the scene of heart attacks, and he became convinced it was the cause.
The truth is, cholesterol doesn't cause heart disease, it's helps to heal it.
Before returning The Great Cholesterol Con to the library, I managed to copy down one quote for you:
"I sometimes remark to those who think my ideas on heart disease are entirely batty, 'Why do you think that an egg yolk is full of cholesterol? Answer: because it takes one hell of a lot of cholesterol to build a healthy chicken. It also takes a hell of a lot of cholesterol to build, and maintain, a healthy human being. In fact, cholesterol is so vital that all cells, apart from neurones, can manufacture cholesterol, and one of the key functions of the liver is to synthesize cholesterol. We also have an entire transportation system dedicated to moving cholesterol around the body." p.12.
If cholesterol is good, why are we always told to lower it?
As with most areas of health today, money is a bigger motivator than actual good health. As Kendrick points out, cholesterol-lowering statins are the number one selling drug of ALL time.
And statins have been proven to help men with pre-existing heart disease.
They have NOT, however, been proven to help any women, ever. In fact, total morbitity increases in women taking statins, because of all their nasty side effects. Statins also DO NOT help men without pre-existing heart disease.
The cholesterol-lowering aspect of statins likely does more harm than good. Kendrick points to many studies that show people with heart disease whose cholesterol levels are high have a better chance of surviving than people who have naturally lower cholesterol levels, or who purposefully try to reduce their levels.
Kendrick argues that the reason statins work at all in men with pre-existing heart disease is because they are blood thinners - much like aspirin. Since most heart attacks occur when clots burst, thinning those clots can help reduce a person's chance of dying of a heart attack.
However, pharmaceutical companies prefer people to think statins work by lowering cholesterol because then they capture a bigger market - women, men without heart disease, anyone with a total serum cholesterol level over whatever pharmaceutical companies can convince us is "safe". (A level they're constantly arguing downwards so that they can sell ever more statins.)
But we talk to doctors, not pharmaceutical companies? Kendrick writes about the influence that pharmaceutical companies have over the medical profession. It is insidious, and worse than I would have believed possible.
If cholesterol isn't to blame, what is?
Kendrick does a neat job of building suspense in The Great Cholesterol Con, as he dismantles current arguments for why cholesterol causes heart disease, without letting on too early what he views to be the main cause - stress.
He makes a convincing argument for why stress causes heart disease. Social displacement, he argues, is one of the biggest stressors known to man and Kendrick gives numerous examples of socially displaced peoples with elevated rates of heart disease.
I think he's onto something with his argument, However, other reading I've done has convinced me that the Western diet also has a lot to answer for when it comes to all aspects of health. We eat too much processed food, refined sugar and trans-fatty acids, and this also causes our bodies to run amuck.
Where to now?
One thing that I felt was never fully resolved in The Great Cholesterol Con is the issue of familial atherosclerosis, which is the genetic mutation I think my husband's family suffers from. I would really like to get to the bottom of that one, to learn what I can do to help my family. I guess I'll have to keep researching and reading.
Apparently there's another book of the same title, The Great Cholesterol Con, by another author. Perhaps I'll read that one next and compare notes.
What's your take on the cholesterol debate?
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