What caused my heart disease - Part 1
Heart disease is the number one cause of premature death in the industrialised world. Understandably, much time and effort has been expended to understand the causes of and remedies for the disease. Despite this, there still exists much rigorous and sometimes heated debate, especially about the causes of the disease. One thing is clear, however. Each of us responds differently to our environment and the diseases that may ensue. I’ve taken it upon myself to investigate what caused me to develop advanced heart disease. This is the first of a three-part description of what I discovered.
What is heart disease
The heart disease I suffer from is relatively new, having become common just in the past 100 years or so. This form of heart disease involves the unhealthy buildup of abnormal plaque in the arteries. Such plaque gradually hardens through calcification as it has with me. If left untreated, unhealthy buildup of plaque can result in a blood clot, and ultimately a heart attack or stroke. The literature on heart disease contains other terms for the same thing, including cardiovascular disease (CVD) and coronary heart disease (CHD) [1, 2].
What might cause heart disease?
There are two avenues of thought around the cause of heart disease, namely:
The popular and long-standing Diet Heart Hypothesis
The Thrombogenic Hypothesis
I’m going to describe each of these in separate parts. In this, the first of the two, I’ll cover the Diet Heart Hypothesis and lay out why I believe it does not describe the cause of my heart disease.
“There is no such thing as good and bad cholesterol, there is just cholesterol”
Terminology is misleading
The terminology around cholesterol is confusing, so let’s try to clear up at least one thing. When someone describes LDL and HDL as good and bad cholesterol, respectively, they probably don’t know what they are talking about. There is no such thing as good and bad cholesterol, there is just cholesterol. LDL and HDL describe two types of a thing called a lipoprotein which is a very small droplet that contains and can transport cholesterol around our bodies in our blood from where it is made (e.g., our liver) to where it is needed, that is, everywhere else in our bodies.
The term lipoprotein describes what the droplet is made of, namely fat (lipo) and protein. This allows the droplet to surround the fatty cholesterol and transport it in our watery blood. LDL stands for low density lipoprotein and HDL stands for high density lipoprotein.
The Diet Heart Hypothesis
The diet heart hypothesis is the name given to the most popular opinion on the cause of heart disease. Too much blood cholesterol is the root cause of heart disease in this theory. Up until the 1950s, it was thought that dietary cholesterol from things like eggs was the problem. This was disproven and the theory then was changed to eating too much saturated fat from things like beef and dairy raised cholesterol in our blood.
Either way, excess cholesterol was thought to be deposited in our arteries, the arteries narrowed, and eventually they narrowed so much that they cut off blood supply, then we had a heart attack or a stroke.
Prior to my diagnosis of advanced heart disease, I followed the western dietary and lifestyle guidelines. I ate lots of carbohydrates, cooked with seed oils, limited my exposure to red meat and full fat dairy, exercised regularly, and I took statin drugs to lower my cholesterol. Still, I was diagnosed with advanced heart disease. Was it likely that my limited exposure to saturated fat caused my heart disease? Here is what I found in the literature.
2022 - “We infer red and processed meat intakes are not causally related to cardiovascular disease outcomes due to consistently weak associations and a lack of coherence with experimental evidence” [4]
2022 – Findings from the studies reviewed in this paper indicate that the consumption of [saturated fat] is not significantly associated with [cardiovascular disease] risk, events, or mortality. Based on the scientific evidence, there is no scientific ground to demonize [saturated fat] as a cause of [cardiovascular disease]. [Saturated fat] naturally occurring in nutrient-dense foods can be safely included in the diet. [5]
2020 – LDL cholesterol that is too low is associated with higher deaths from infection and higher deaths from cancer [6]
2018 – High blood cholesterol concentrations don’t cause CVD. People with low levels became as affected as people with high levels and had the same or higher levels of CVD. High LDL-C appears to be unrelated to the risk of CVD in both genetically vulnerable and in the general populations [7]
2018 - “The current literature does not support the notion that dietary cholesterol increases the risk of heart disease in a healthy individual” [8]
2016 – Data from study conducted between 1968 and 1973. Replacing saturated fats with polyunsaturated fats reduced cholesterol. Replacing saturated fats with polyunsaturated fats had no impact on cardiovascular disease. The greater the fall in cholesterol, the greater the risk of death [9]
2015 – High LDL-C is associated with lower deaths in people older than 60 [10]
2013 – Replacing saturated fat with polyunsaturated fat increased deaths. All cause – 62% increase. Cardiovascular – 70% increase. Heart disease – 74% increase [11]
2012 – In men, high cholesterol made no difference to life expectancy. In women, the higher cholesterol levels, the longer they lived and suffered less CVD [12]
2009 – The largest study examining more than 140,000 people admitted to hospital with heart attacks in America showed that average LDL-cholesterol of those admitted was lower than that of the general population [13]
1992 – In men and women, the greatest risk of death occurred at the lowest level of cholesterol tested [14]
“We now know that eating dietary fat does not raise blood cholesterol, and anyway raised blood cholesterol is not associated with heart disease”
The first part of the diet heart hypothesis (eating too much saturated fat) is not supported by research conducted. The same goes for the second part, raising blood cholesterol. We now know that eating dietary fat does not raise blood cholesterol, and anyway raised blood cholesterol is not associated with heart disease. At this stage, the diet heart hypothesis is no longer supported by real-world evidence.
A special note on cholesterol
I wish I’d known this a long time ago. Cholesterol is so important to our bodies that all of our cells (except neurons) can manufacture the stuff and a key function of our liver is to do the same to the tune of about 80% of what we need each day all day long [3].
“Cholesterol is vital to human health, and without it we would not exist”
Consider the major roles played by cholesterol in our bodies [3, 15]:
Early development – mother’s milk is rich in cholesterol and an enzyme that helps baby use it. Babies and children need cholesterol as they grow to ensure proper brain and nervous system development
Injury repair – scar tissue contains high levels of cholesterol. When our arteries are injured, cholesterol is used to fix things
Cell membrane health – cholesterol and saturated fat provide structural integrity. When our diets contain too much polyunsaturated fat from things like seed oils, our cell membranes can become flabby and lose structure. Our bodies push cholesterol into those cells as a means to provide structure again and re-establish good health
Gut wall strength – helps maintain the health of our intestines and avoid leaky gut
Hormone production – involved in the production of hormones that affect sexual reproduction, our ability to handle stress and protect against heart disease and cancer
Essential substance production – helps produce vitamin D and bile salts for fat absorption
Anti-oxidant – acts against the harmful effects associated with old age and chronic disease
Proper function of brain serotonin – serotonin is one of our feel-good chemicals. Low cholesterol has been associated with poor mental health and anti-social behaviour
“Dietary fat guidelines have no evidence base: where next for public health nutritional advice?”
How did we get things so wrong?
The answer to this question is dealt with in the books listed below (1-3) and in my opening post in this series entitled “Is my heart disease a symptom of modern malnutrition?”. To help you cut to the chase, take a look at a 2017 review paper entitled “Dietary fat guidelines have no evidence base: where next for public health nutritional advice?” [16].
I’m not interested in dwelling on why following dietary guidelines may have sickened millions of people like me. I prefer to understand what caused my heart disease, how to arrest its progression, and how might others avoid it in the first place? I’ll address these topics in parts two and three of this series.
“It is easy to conflate simple ideas and the truth, repeating those simple ideas embeds them in our collective memory, and they are very difficult to change”
Summary
I don’t believe that the diet heart hypothesis explains the cause of my heart disease. I have two reasons for this position. Firstly, I followed the lifestyle and pharmaceutical drug guidelines designed to avoid heart disease with this hypothesis in mind and I developed a serious heart condition. Secondly, when I investigated the possible causes I quickly discovered that cholesterol isn’t harmful, and this is supported by evidence amassed over many decades. Cholesterol is vital to human health, and without it we would not exist.
I have learned an important lesson as I’ve tried to understand the root cause of my heart disease. There exists great power in simple ideas. It is easy to conflate simple ideas and the truth, repeating those simple ideas embeds them in our collective memory, and they are very difficult to change.
References
Kendrick, M. (2021) The clot thickens: The enduring mystery of heart disease. London: Columbus Publishing
Malhotra, A (2021) A statin free life: A revolutionary life plan for tackling heart disease – without the use of statins. London: Hodder and Stoughton
Kendrick, M (2007) The great cholesterol con: the truth about what really causes heart disease and how to avoid it. London: John Blake Publishing
Erica R. Hill, Lauren E. O’Connor, Yu Wang, Caroline M. Clark, Bethany S. McGowan, Michele R. Forman & Wayne W. Campbell (2022) Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill’s criteria, Critical Reviews in Food Science and Nutrition, DOI: 10.1080/10408398.2022.2123778
Reimara Valk, James Hammill, Jonas Grip, (2022) Saturated fat: villain and bogeyman in the development of cardiovascular disease?, European Journal of Preventive Cardiology, https://doi.org/10.1093/eurjpc/zwac194
Johannesen C D L, Langsted A, Mortensen M B, Nordestgaard B G. Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study BMJ 2020; 371 :m4266 doi:10.1136/bmj.m4266
Uffe Ravnskov, Michel de Lorgeril, David M Diamond, Rokuro Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Luca Mascitelli, Kilmer S McCully, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan & Ralf Sundberg (2018) LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology, 11:10, 959-970, DOI:10.1080/17512433.2018.1519391
Soliman GA. Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients. 2018 Jun 16;10(6):780. doi: 10.3390/nu10060780. PMID: 29914176; PMCID: PMC6024687.
Ramsden C E, Zamora D, Majchrzak-Hong S, Faurot K R, Broste S K, Frantz R P et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) BMJ 2016; 353 :i1246 doi:10.1136/bmj.i1246
Ravnskov U, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N, Kendrick M, Langsjoen PH, Malhotra A, Mascitelli L, McCully KS, Ogushi Y, Okuyama H, Rosch PJ, Schersten T, Sultan S, Sundberg R. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016 Jun 12;6(6):e010401. doi: 10.1136/bmjopen-2015-010401. PMID: 27292972; PMCID: PMC4908872
Ramsden, C.E., Zamora, D., Faurot, K., Majchrzak, S. and Hibbeln, J. (2013), The Sydney Diet Heart Study: a randomised controlled trial of linoleic acid for secondary prevention of coronary heart disease and death. The FASEB Journal, 27: 127.4-127.4. https://doi.org/10.1096/fasebj.27.1_supplement.127.4
Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract. 2012 Feb;18(1):159-68. doi: 10.1111/j.1365-2753.2011.01767.x. Epub 2011 Sep 25. PMID: 21951982; PMCID: PMC3303886.
University of California - Los Angeles. (2009, January 13). Most Heart Attack Patients' Cholesterol Levels Did Not Indicate Cardiac Risk. ScienceDaily. Retrieved March 29, 2023 from www.sciencedaily.com/releases/2009/01/090112130653.htm
Jacobs D, Blackburn H, Higgins M, Reed D, Iso H, McMillan G, Neaton J, Nelson J, Potter J, Rifkind B, et al. Report of the Conference on Low Blood Cholesterol: Mortality Associations. Circulation. 1992 Sep;86(3):1046-60. doi: 10.1161/01.cir.86.3.1046. PMID: 1355411.
Fallon, S. and Enig, M. (2001) What Causes Heart Disease? The Weston A. Price Foundation. https://www.westonaprice.org/health-topics/modern-diseases/what-causes-heart-disease/#gsc.tab=0
Harcombe Z (2017) Dietary fat guidelines have no evidence base: where next for public health nutritional advice? British Journal of Sports Medicine;51:769-774