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Heart Disease III -What To Do

In Part I we discussed the many reasons why conventional wisdom about heart disease is leading us astray.  The single minded emphasis on LDL cholesterol and saturated fat was found wanting.  In Part II we examined a number of factors which modern science has proven are much more strongly related to heart disease than either LDL or saturated fat.  Unfortunately, conventional wisdom has not kept apace of this science, therefore most doctors and dietitians fail to recognize the significance of these more prevalent risk factors.  In this segment, we will discuss how you can adjust your lifestyle and diet to control these risk factors.  In so doing, you will be capable both of preventing and/or reversing heart disease.

“IT IS A WISE MAN’S PART, RATHER TO AVOID SICKNESS THAN TO WISH FOR MEDICINES” – Thomas More

I said it earlier and I’ll say it again…for most people, heart disease is entirely preventable, it is just a matter of taking care of yourself and taking the right medicine if needed, the problem is that most of us don’t pay attention to our health care provided and that’s where the problem is, anyone interested on learning more about a very reputable medical provided can view here for more information!
  Unfortunately, Thomas More lived in a time before multi-billion dollar pharmaceutical companies controlled both the media and the medical establishment.  Today, you need more than just wisdom to differentiate between medical truth and medical mythology.  Mostly, you need something the average person has very little of…time.  Time to read.  Time to think.  Time to be critical.  Unfortunately, if you don’t have the luxury of time, you are left at the mercy of the so called professionals; doctors, dietitians and media health “experts”.  The sad truth is, many of these professionals are just  as strapped for time as the rest of us.  Consequently, they are influenced, not by sound reasoning and thorough research,  but by the dogma of their professional associations and the media power of pharmaceutical and food processing corporations.

At the risk of sounding like a conspiracy theorist, I will illustrate my point with a short tale of the NCEP.  Bare with me.  I am not making this point to malign pharmaceutical companies…they are just doing what large multi-national companies do best – making money for their investors.  Nor am I making this point to disparage the medical establishment…they are just doing the best they know how with the limited time and resources they have at hand.  I am making this point because I would like to encourage a little skepticism to counterbalance the sometimes overwhelming power conventional medical wisdom has over scientific knowledge.

 ”Why don’t we know about this stuff?”

The National Cholesterol Education Program (NCEP) is a branch of the US National Institute of Health (NIH), probably one of the largest government health institutions in the world.  The NCEP is tasked with reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol.  Their web site raves about their success in reducing saturated fat intake, reducing total cholesterol, reducing LDL cholesterol, and reducing death from coronary heart disease.  Nowhere do they mention the inconvenient fact that despite all this perceived success, most of these improvements are due to significant decreases in smoking  (down about 25%) and significant increases in medical procedures (up 30%).  So are they “reducing illness” or are they just getting better at stretching that illness out?  And at what cost are they “succeeding” in stretching it out?

The NCEP has been around for more than 20 years now.  In that time, it has produced 3 sets of guidelines (called ATP, ATPII and ATP III) for assessing and treating blood cholesterol.  Please note the emphasis.  The primary goal of the NCEP is lowering cholesterol…not decreasing the incidence or prevalence of heart disease!  Each of their 3 ATP guidelines has significantly reduced the blood LDL level at which intervention is recommended.  Correspondingly, each of the ATP guidelines has placed 1os of millions more Americans on a list of those for whom expensive cholesterol lowering drugs are recommended.  It is estimated that ATPIII will increase the number of Americans taking cholesterol lowering drugs from 13 million to 35 million. http://www.bmj.com/cgi/content/extract/322/7297/1270/a 

 

Notice how “evolution” leads to more people taking more statins.  I wonder if this is what Darwin had in mind?

When so many lives are at stake and so much money is up for grabs, one would think that steps would be taken to ensure some control over conflict of interest.  One would expect the pharmaceutical companies to do their utmost to lobby the NCEP and “sell” the necessity for increasingly aggressive LDL control through their products…that, like I said, is just what they do.  In return, though, one would expect the NCEP, as a fiscally and morally responsible government entity, to ensure that the majority of the members responsible for setting cholesterol lowering guidelines were not beholding to the pharmaceutical companies.  After all, if you were running a company requiring billions of dollars of supplies, would you want all the people responsible for selecting and purchasing those supplies to be receiving money on the side from the suppliers?  Probably not the best way to get an unbiased opinion on the quality of your suppliers!

Unfortunately, the NCEP doesn’t see it that way.

8 of the 9 members of the NCEP ATPIII reveal conflicts of interest.  They’re not ashamed of it either…you can see their individual claims to fame right here http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04_disclose.htm#disclose  And not just a little conflict of interest.  Almost all of them list a veritable “who’s who” of pharmaceutical companies as their supporters.  Here’s a sample:

“Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.”

Gee, I wonder what she’ll do when they say “Hands up if you think we should lower cholesterol levels a little more.”

It’s not just the Americans either.  The Canadian Cardiovascular Society had 23 panelists involved in producing the “Guidelines for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease 2009″.  21 of the 23 admit to conflicts of interest.  Like the NCEP ATPIII, the Canadian guidelines are also extremely LDL-centric.  Surprise surprise when 21 of the panelists work for the pharmaceutical companies.

All this despite the fact that there are plenty of dissenters:   http://annals.org/content/145/7/520.abstract     http://www.ravnskov.nu/ncep_guidelines.htm      http://www.msnbc.msn.com/id/5454275  

So what does all this have to do with you? 

Here’s the thing.  Almost every doctor’s office in North America has a copy of the NCEP ATPIII guidelines (or something very similar) tucked away in a desk somewhere.  And when your doctor gets your blood test results, he or she takes out that copy and plugs your numbers into its complicated formulas.  And those formulas, created by a bunch of pharmaceutical bag-men, determine what your doctor thinks about your risk for heart disease.  Because of the way these guidelines have been set up, your doctor’s determination will be heavily weighted by your LDL numbers…despite clear evidence that LDL is not a reliable indicator of heart disease.  Why is it set up that way?  Does it have anything to do with the fact that drugs which lower LDL cholesterol are the biggest pharmaceutical profit makers ever?  Does it have anything to do with the fact that most of the other significant measures we have discussed react very well to lifestyle manipulations (LDL, by the way, does not) and therefore do not require powerful and expensive pharmaceuticals?  I’ll leave that one up to you to decide.

How you should take cholesterol guidelines.

 

DON’T GET ME WRONG

I’m not saying that high LDL doesn’t mean anything.  It is easy to measure and in some cases will predict heart disease.  But it is only a starting point, and it is certainly not definitive.  High LDL simply indicates that perhaps you should start looking a little more carefully into your arterial health.  More importantly, diagnosis based on LDL may miss a significant percentage of people who have heart disease but not high LDL.  Most importantly we all need to make the causal distinction.  If LDL is correlated to heart disease, it is probably as a symptom of the disease and almost certainly not as a cause.  It should not be treated as a cause.

My issue, then, is not with the use of LDL as a diagnostic tool (although I do believe there are much better ones available).  No, my issue is with the treatment of LDL as a means of preventing or reversing heart disease.  Treatment of LDL is just treatment of a number, and it is simply wrong.  It is wrong because it does nothing to answer the question “why do I have heart disease?”  It is wrong because it initiates a cascade of myopic dietary interventions which often only serve to aggravate the underlying cause.  And it is wrong because it leads almost inevitably to a path of pharmaceutical dependency and future health complications. 

 WE CAN DO BETTER!

 

 SO LET’S PREVENT SOME HEART DISEASE!

Here is the summary from Part II of this series.  There are simple dietary and lifestyle manipulations which can quickly and effectively alter the factors outlined here.  It is these simple manipulations that we will focus on.

  •  Total cholesterol and LDL, while perhaps of some interest, are clearly not effective tools for determining risk of heart disease.  Lowering LDL should certainly not be a primary target for risk reduction in heart disease.
  • HDL and triglycerides are a better measure of cardiovascular risk.  This is particularly true because high HDL and low triglycerides seem to reflect a lower percentage of small dense LDL.  We should try to keep HDL high and triglycerides low.
  • Small dense LDL and oxidized LDL are bad characters.  It would be nice to be able to track them with more advanced blood tests.  Regardless, we should try to implement lifestyle changes which will minimize their expression.
  • Inflammation plays a significant role both in the development of atherosclerosis and in the extent to which it becomes deadly.  Knowing what your C-reactive protein levels are would be useful.  Any effective program geared towards reducing cardiovascular disease should include steps to reduce inflammation.
  • Advanced glycation end products are also bad characters.  They are critically involved both in the development of oxidized LDL and the progression of inflammation.  It would be good to know your HbA1c levels.  Keeping HbA1c levels down should be one of the targets of cardiovascular risk reduction. 

Please note:  I call the following lifestyle and dietary manipulations simple – not easy.  They are simple because they are clear of the confusion which blurs many of the more conventional recommendations.  They are simple because they work.  But they are not easy.  Most of them require major restructuring of the way people eat and live.  They require commitment and will power.  The human body gets used to doing whatever it does.  And, for some reason, it doesn’t like to change.  Unfortunately, for most of us, our bodies havebeen doing the wrong things for a long time.  If we want to live to a ripe and vigorous old age, we will haveto make the choice to live differently.  If that is too difficult, we can stick with the status quo and resign ourselves to EATING PHARMACEUTICALS FOR BREAKFAST ON A DAILY BASIS!

 

This is the status quo.  Do you want to improve on it, or just start eating pharmaceuticals for breakfast?

HERE’S WHAT YOU NEED TO DO

Quit Smoking:  Everything else being equal, smoking is probably the worst thing you can do to your body.  It is easily the best way to induce heart disease.  20% of all heart attack mortality is attributed to smoking.  The risk of dying of a heart attack is 20% higher in smokers.  Smoking drives HDL down and triglycerides up.  Smoking increases the rate of oxidation of LDL.  Smoking damages arterial linings, possibly creating holes in the epithelium into which small dense LDL find their way and certainly initiating inflammatory conditions.  Smoking depletes anti-oxidants in the blood, contributing to both oxidation and inflammation.  It seems the only real mystery is how smokers manage to live at all, never mind for thirty or forty years…the body has wonderful ways of compensating.

Manage Your Stress:  For many years, scientists presumed that atherosclerosis caused high blood pressure.  It makes sense.  Atherosclerosis narrows the arterial lumen.  Anybody who knows anything about water pressure knows that if you push the same amount of water through a narrower pipe, the pressure inside the pipe goes up.  Likewise, it makes sense that if your heart pushes the same amount of blood through narrower arteries, blood pressure goes up.  While this may still hold true, recent research indicates that some other mechanism is at work as well.  Stress, as we all know, increases blood pressure.  This is the classical “fight or flight” response to acute stress.  Chronic stress disturbs something called angiotensin II, a protein that constricts blood vessels.  Under chronic stress conditions, angiotensin II up regulates, blood vessels constrict, and blood pressure goes up. That’s why we give ACE (angiotensin converting enzyme) inhibitors to people with high blood pressure.  It seems that angiotensinII does more than just drive your blood pressure up though.  It seems that angiotensin II also directly influences the oxidation of LDL http://ndt.oxfordjournals.org/cgi/content/full/14/11/2585 .  And not in a good way. 

So chronic stress pushes your blood pressure up at the same time as it increases the oxidation of LDL.  What else does it do?  It increases blood levels of a hormone called cortisol.  High levels of cortisol in your blood predispose you to inflammation, abdominal weight gain and insulin resistance.  Abdominal obesity, high blood pressure, insulin resistance, high rate of LDL oxidation, inflammation…5 strikes and you’re definitely out!

Sleep More:  No matter how many times you try to justify it, lack of sleep will kill you.  In a recent study published in the Journal of the American Medical Association  http://www.time.com/time/health/article/0,8599,1868406,00.html researchers found that 27% of young people (35 to 47 years old) who slept less than 5 hours per night had calcified coronary arteries.  11% of those sleeping 5 to 7 hours had calcification.  Only 6% of those sleeping more than 7 hours had calcification.  And that’s just in young people.  It would be interesting to see the results if they studied these people again in twenty years.

Sleep deprivation does the same thing as chronic stress does.  Funny enough, the 2 usually go hand in hand.  If you don’t sleep, your cortisol levels go up.  If your cortisol is chronically high, you get to have a fat belly, systemic inflammation, and the dubious distinction of an imminent interview with a cardiologist.

Lose Weight:  Obesity is thought to contribute to 75% of hypertension and 50% of insulin resistance, two of the most reliable risk factors for heart disease.  Obesity drives HDL down and triglycerides up.  It increases oxidative stress, thereby depleting blood anti-oxidant levels and increasing the likelihood of oxidized LDL.  Adipose cells express inflammatory cytokines which produce a state of systemic inflammation.  Obese people have 2 to 6 times the levels of C-reactive protein as normal weight people.  Adipose tissue also secretes a hormone called resistin which increases insulin resistance.   This hormonal double whammy is likely the foundation of metabolic syndrome, another powerful risk factor for heart disease.

Exercise:   Exercise increases HDL.  Exercise decreases triglycerides.  Exercise improves insulin resistance.  Exercise (if not excessive) decreases inflammation.  Exercises also contributes to weight loss which, as we have seen, significantly reduces susceptibility to heart disease.  There is no down side to exercise.  We were designed to move, and every study I have ever seen has proven that we remain sedentary at our own peril. 

There is plenty of debate over things like type, intensity or duration of exercise.  I have my own opinions about these, but the truth is, for most people, just moving is a good place to start.  A recent meta-analysis http://www.ncbi.nlm.nih.gov/pubmed?term=%22International+journal+of+epidemiology%22%5BJour%5D+AND+2010%5Bpdat%5D+AND+Woodcock%5Bauthor%5D&cmd=detailssearch strongly suggests that this is certainly the case.  After studying the activity patterns of almost a million people, the authors found that the most substantial risk improvements were between the people who did nothing and the people who had low levels of activity.  2.5 hours a week of moderate intensity exercise (1/2 hour per day, 5 days a week)  gave participants a 19% decrease in total mortality.  Although higher durations of activity did provide increased risk reduction, the rate of return certainly diminished significantly.  5 1/2 hours of extra activity each week only improved mortality by 5%.  Take home message…just start moving!

Eat More Fat and Less Carbohydrate:  I know, everybody wants a reference for this one.  How about 10?

There’s plenty more where that came from!  Again, study after study after study proves overwhelmingly that a high fat/low carbohydrate diet is better for your heart health.(and, for that matter, total health)  This is particularly true when you put small dense LDL, inflammation and insulin resistance at the top of your list of risk factors…where, as we’ve seen, they should be.  The only questions left open for debate are how high in fat, how low in carbohydrate, and what kinds of fat and carbohydrate.  More on those questions below.

Minimize Refined Carbohydrates:  Refined carbohydrates are the primary cause of insulin resistance, high triglycerides and glycation.  They are also among the most significant factors in the development of inflammation and obesity.  We all need to stop eating so much of them.  Here is a list of the biggest culprits in order of their toxicity:

  1. High Fructose Corn Syrup …pop, juice, candy
  2. Sugar
  3. Baked goods…bread, muffins, bagels, cookies, cakes
  4. Pasta
  5. Breakfast cereals
  6. Fructose…Agave syrup, honey, maple syrup
  7. Fruit…yes, even fruit

Stop Eating So Much Fructose:  I know, Fructose was on top of the refined carbs list.  But it is such a pernicious substance, I had to give it a heading of its own.  In small doses (as in 2 or 3 pieces of fruit a day) fructose can be beneficial.  But when we eat over a hundred grams a day – as the average North American does – fructose is deadly.   Fructose, just so you know, has become the #1 source of calories for Americans…that’s how pervasive it is!  Many dietitians still recommend it to diabetics because it does not increase blood sugar.  That’s because it gets metabolized by the liver, causing non alcoholic fatty liver disease and hepatic (liver) insulin resistance!  Maybe not the best advice. 

What else?  A 200% increase in triglyceride levels for 24 hours after drinking one drink sweetened with High Fructose Corn Syrup.  10 to 17 times the amount of glycation as glucose.  So are 2 or 3 pieces of fruit a day really that bad for you?  Probably not.  Add a can of coke or a couple of glasses of orange juice and you’re well over the 30 or 40 grams a day that is generally deemed safe.  If you’re already diabetic, you should probably limit even the fruit.

Cut Out the Grains…Especially Wheat:  Why grains?  Well, first, any grain, even a whole grain, is speedily reduced to glucose, a refined carbohydrate with all the negative heart consequences described above.  So although whole grains may have some redeeming factors (and I am being generous saying may) I believe that in general they are not supportive of good health.  See here  http://wholehealthsource.blogspot.com/2008/12/gluten-sensitivity-celiac-disease-is.html for an interesting article on testing for gluten intolerance which indicates that 57% of people with digestive complaints and even 29% of asymptomatic people turn out to be intolerant of gluten.  The truth is, as I’ve said before, the only thing grains provide that cannot be provided by meat and vegetables is convenience.  Is that a good enough reason to risk inflammation, insulin resistance, heart disease, vitamin and mineral mal-absorption, glycation and obesity?  Not for me!

Eliminate Trans Fats:  Saturated fats are good.  Mono-unsaturated fats are good.  Poly-unsaturated fats are debatable.  Trans fats are toxic.  They are man-made fats which man should never have made, and there exists plenty of evidence to indict them.  Despite this evidence, doctors, dietitians and health authorities advised us to eat them for over 30 years!  They drive LDL up.  They drive triglycerides up.  They drive insulin resistance up.  They drive C-Reactiveprotein up.  They drive small dense LDL up.  They drive oxidized LDL up.  They drive anti-oxidant levels down.  They drive HDL down.  If ever there was an evil food, Trans fat is it.  And despite recent efforts to reduce consumption, it remains pervasive.  Anything fried in a restaurant is probably loaded with it.  (For an interesting story on trans fats that will put you off eating fried foods in restaurants forever, read this http://www.proteinpower.com/drmike/lipids/dining-out-and-bad-fats/  )  And even all those processed foods which say they have no trans fats …still do.  They just make their serving sizes so small that they can get the trans fat down below 0.5 g/serving so they don’t have to list it.  Ever wonder why a serving of potato chips is 12 chips?  Who eats 12 potato chips? 

Stop With the Vegetable Oil:  Vegetable oil, one of the essential fatty acids, consisting primarily of a polyunsaturated fat (PUFA) called linoleic acid (LA) is a tough one.  It is clear that PUFA in LDL oxidize more rapidly than other fatty acids (saturated fatty acids do not oxidize).  It is also clear that the amount of PUFA in LDL is directly related to PUFA in the diet.  From one study http://atvb.ahajournals.org/cgi/content/full/16/11/1347 the outcome of 4 different dietary interventions are plotted below.  The saturated fat (SFA) diet clearly beats out both the vegetable oil (PUFA n-6) diet and the vegetable oil/fish oil (PUFA n-6/3) diet when it comes to oxidized LDL. 

In another study, http://atvb.ahajournals.org/cgi/content/abstract/24/3/498 two dietary interventions involving increasing the levels of PUFA both resulted in increased levels of oxidized LDL.  The authors summarized their results clearly enough:  “The median plasma OxLDL-EO6 increased by 27% (P less than 0.01) in response to the low-fat, low-vegetable diet and 19% (P less than 0.01) in response to the low-fat, high-vegetable diet. Also, the Lp(a) concentration was increased by 7% (P less than 0.01) and 9% (P=0.01), respectively.” 

Pay attention…a low fat /high vegetable diet with most of the fat coming from vegetable oil increases oxidized LDL by 19%….this is the exact type of diet which most doctors and dietitians recommend to people with heart disease!

And then there’s inflammation.  PUFA from vegetable oils convert readily in the body to something called Arachidonic Acid (AA).  AA is a precursor to inflammatory prostaglandins.  When a large amount of vegetable oil is regularly consumed, there is a tendency for the body to experience systemic inflammation.  This is particularly true when levels of another PUFA, this time from fish oil, are low.  It seems the ratio of vegetable oil (omega-6) to fish oil (omega-3) is critical to the secretion of inflammatory prostaglndins.  http://www.jacn.org/cgi/content/full/21/6/495 It should be about 4:1 omega -6 to omega-3.  In our society, it tends to be more than 10:1. 

Despite all this, there are a number of epidemiological studies often cited in support of using vegetable oil to prevent heart disease.  While this may be the case, most of these studies, being epidemiological, are riddled with confounding factors.  Even an American Heart Association review of the topic http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.191627 admits that most of the science is either seriously compromised or inconclusive.

Get Your Fish Oil:  Fish oil, otherwise known as omega-3 polyunsaturated fat, appears to be a miracle food.   It is a powerful anti-inflammatory, it improves all blood lipids (decreased LDL, increased HDL, decreased triglycerides, decreased small dense LDL), it improves insulin resistance, it acts as an anti-coagulant and it even seems to prevent obesity.  The only real questions are how much and what kind?  They are good questions.

It seems that small doses of fish oil are as protective as larger doses.  Remember that fish oil is still polyunsaturated, and, therefore, is still highly prone to oxidation….too much and you will still tend to deplete anti-oxidants in  an effort to protect it.  For most people, 3-5 grams of fish oil per day, in conjunction with decreased consumption of vegetable oil, will do the trick.  Remember, though, if you are on blood thinners, you must introduce fish oil under supervision of your doctor (fish oil also acts as a blood thinner, so take the two together and you may end up bleeding to death from a paper cut!)

 How about just eating more fish?  You can get your fish oil by eating fatty cold water fish 2 or 3 times a week.  The problem is that it will often come with a substantial dose of such toxins as mercury or dioxin.  There is significant debate on this topic, but for my money, finding quality fish oil is much easier and cheaper than finding quality fish. 

 

 WOW!  THAT’S A LOT OF INFORMATION!

 

Feeling overwhelmed by all this information?  Not sure what to make of it?  I can’t say I blame you.  I’ve been studying this stuff for years and it still took me almost six months to put together this trilogy of articles.  My wife will tell you that my search for the truth has generated a pile of papers rivalling the ones shown in the picture above.  Along the way, some of my own preconceptions have been challenged.  Others have been strengthened.  In the end, though, I hope that my readers will take home a few critical messages:

On conventional medical wisdom:  Don’t take for granted that what your doctor (or anybody else…including me) tells you about heart disease reflects the best scientific evidence.  Like any large bureaucratic institution, the medical establishment is mired  both in historical precedent and pharmaceutical patronage.  Change happens very slowly, and usually only if it benefits those who have financial interest in it.  Your health and vitality demands that you do your own research…only you should be able to convince yourself of the truth.

On pharmaceutical drugs:  Half the people I know over 65 take a handful of pills every day.  A quarter of the people I know over 45 take at least a few daily pharmaceuticals.  Most don’t even know exactly what they are taking them for.  In some cases, the pills may be keeping them alive.  But if they think for one second that these pills have no side effects, they are sorely mistaken.  In most cases, the pills simply mask the cause of the problem.  They keep taking the pills so they can keep living their crappy lifestyle for a few more years.  In the meantime, the damage done by the crappy lifestyle continues, often exacerbated by the side effects of the pharmaceuticals.  And then they wonder why they fail to thrive in their retirement!

On LDL:  The pre-occupation with LDL is the biggest reason why heart disease continues to kill more people than any other disease.  It is not particularly effective as a diagnostic marker…certainly there are much better diagnostic tools available.  Even the simple ratio of HDL to triglycerides, already available in the same test that measures LDL would be a significant improvement.  More importantly, though, the obsession with treating LDL should be recognized as a pharmaceutical sales job and discarded.  Where powerful pharmaceuticals do prevent heart disease, it is almost certainly because of their anti-inflammatory effects and not because they lower LDL.  Perhaps we should be focusing on inflammation instead of LDL.

On saturated fat:  If saturated fat caused heart disease, there should be plenty of randomized controlled studies to prove it.  I challenge anybody to provide me with these studies….I’ve looked long and hard for them….I can’t find any.  How about epidemiology?  Even though epidemiology can’t prove anything, it does show association.  So if saturated fat does cause heart disease,  reviews of the epidemiological studies should find a significant association…they don’t.  Two recent meta-analysis of the epidemiological evidence, one done by the University of McMaster and one done by the World Health Organization, come up with the same conclusions:  No significant association between saturated fat and heart disease.  All the evidence implicating saturated fat with heart disease is forced to make a huge leap of logical faith.  That leap always includes LDL as a causative factor.  In other words, saturated fat makes LDL go up…LDL causes heart disease…therefore saturated fat causes heart disease.  But LDL does not cause heart disease.  And even if it did, saturated fat plays only a very minimal role (if any) in regulating LDL levels.

On the cause of heart disease:  Undetermined.  We know a lot more about heart disease than we did even 20 years ago.  But as rapper K’Naan aptly puts it:  “Any man who knows a thing knows he knows not a damn damn thing at all”  So it is with heart disease.  Here’s what I do know:  Inflammation, glycation, stress and obesity all play significant and probably interwoven parts in this complex disease.  Eliminate these factors and your chances of dying from something other than heart disease will dramatically improve.

On preventing heart disease:  The average North American has about a 1 in 3 chance of dying of heart disease.  I’m not sure what the average North American’s chance of getting heart disease (but dying of something else) is, but I suspect it is significantly higher.  Want to prevent heart disease?  Here’s a clue.  Don’t be an average North American!  Don’t be over-weight and under-exercised.  Don’t be over-stressed and under-slept.  Don’t eat food which is over-processed and under-nutriented (OK, I know that’s not a word, but it fits…you get the point).  Don’t drink carbs when you should be drinking water.  Don’t breath smoke when you should be breathing air. Don’t mistake french fries for vegetables.  Don’t believe everything you read or see on TV.  Certainly don’t believe it if it is coming from a food processing company or a pharmaceutical company.  And whatever you do, never, ever, believe that you lack the intelligence or strength of will to take charge of your own health.

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