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Perhaps you didn't know there is another war going on besides the one in the Middle East.  This one is a public health war, a war against fat and cholesterol that has been going on for more than 30 years.  As befits a major war, the American Heart Association has formed a Task Force on Cholesterol Issues.  Together with the National Heart, Lung and Blood Institute they recently distributed a report entitled "The Cholesterol Facts,"  The purpose of this report is to answer criticism from popular magazine writers and "a small group of physicians" who have questioned whether the 5 to 8 billion dollars expense attached to the National Cholesterol Education Program is a waste of time and money.  I tend to side with those who believe cholesterol can wait.

My bad pun is no worse than the bad joke that the cholesterol campaign seems to be.  Not that I disagree with the 3 key points of the Fact Sheet:  1) High serum cholesterol is a risk factor for coronary heart disease.  2) Lowering cholesterol helps prevent coronary heart disease.  3) People live longer if their serum cholesterol levels are lowered.  All this is certainly true for most people.  The joke is that a diet low in fat, particularly saturated fat, is being advised for everyone, even women and children, for whom the evidence against fat is especially weak, and at great inconvenience, anxiety and loss of pleasure to many. 

The evidence that a low fat diet prescribed for everyone will save lives is just not persuasive.  There is also the real danger that by adhering to a low fat, high complex carbohydrate diet some people will suffer intestinal irritation and malabsorption of nutrients, particularly folic acid and vitamin A, both important agents against blood vessel disease in their own right, not to mention their proven role in fighting cancer and infection.  The war against fat and cholesterol can cause further "collateral damage" to some, who may be treated unnecessarily with cholesterol lowering drugs on the basis of small laboratory error that puts them in a statistical high risk category, mandating drug treatment.   Keep in mind that almost half of normal people have changes in serum cholesterol from week to week, enough to affect their risk category.  Doctors should reserve cholesterol lowering programmes for those with excessively high cholesterol and certainly not for the public in general.

The National Cholesterol Education Program has already had a major impact on America.   Cholesterol has become a household word and fear of fat and cholesterol, once considered a sign of cardiac neurosis, is now considered normal!  It is becoming increasingly difficult to find animal fats at the supermarket: the dairy products are mostly low-fat and the meats have been trimmed in advance.  Vegetable oils are advertised as "cholesterol free," as if to imply that cholesterol has been removed when actually these oils do not contain cholesterol in the first place.  Everyone is on the band-wagon.

Considering the relatively weak evidence in favor of cholesterol as a risk factor and the fact that the controversy about the cause of our heart disease epidemic has been over 40 years in the making and billions of dollars in the spending, it is surprising how little resistance there has been to the present cholesterol juggernaut.  One of the best critiques was authored by Drs. Muldoon, Manuck and Matthews in the British Medical Journal back in 1990. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664099/pdf/bmj00202-0052b.pdf

Their rebuttal hinged on the following well documented medical research reports: 1)  Autopsy results find blood level of cholesterol is not related to the degree of atherosclerosis  2)  Detailed examination of the largest primary prevention trials of cholesterol reduction has failed to show a benefit in over-all survival even though there is a reduction in heart attacks.  For example, in 6 major studies the follow-up totalled 119,000 person years and cholesterol was reduced on average 10 percent.  There were 169 heart attack deaths in the treated groups versus 197 if untreated, a barely 28 in 60,000 difference, ie. about 50 lives saved per 100,000 in treatment for cholesterol.

However, over-all mortality was slightly higher in the treated groups due to a doubled risk of violent death from accident or suicide.  Mortality statistics in the USA for white men age 45 to 54 averages 64 per 100,000 men per year, including motor vehicle accidents, homicides and suicides which occur at about the same rate.  The death rate from these causes in the cholesterol treatment groups was 107 per 100,000 and the higher mortality was about the same for drug treatment as for the low-fat, low-cholesterol diet.

At first this finding was viewed with skepticism, except by those of us in nutrition and molecular medicine who are familiar with low blood sugar (hypoglycemia).  The low fat diet is likely to provoke hypoglycemia in many people and there is a substantial body of research that shows increased violence, seizure disorders and accidents as a result.  Recently, a study of monkeys on a low fat diet has reported similar findings: the monkeys become more aggressive.  Another view of this phenomenon comes from clinical studies in humans with violent or aggressive behavior, including homicide and suicide:  there is a significant trend towards below normal levels of serum cholesterol. 

The good part about the National Cholesterol Education Program (NCEP) is the emphasis on good nutrition and a return to fresh fruits and vegetables.  The bad part of the anti-cholesterol policy is the fear of food, particularly fat, and the failure to mention the protective effects of the good fats, the omega-3 fatty acids.  Most of all the NCEP fails to acknowledge the importance of other cardiac risk factors--all more dangerous than cholesterol.  Consider that deficiencies of specific nutrients, such as omega 3-essential fatty acids (EFA), essential minerals, such as magnesium and copper, and vitamins, such as C, E and B6 are all known to cause heart attacks.  There is no proof that cholesterol of itself does so.

Excesses of some naturally occurring substances are additional adverse risk factors.  High insulin levels, for example, are induced by excessive dietary sugars   Insulin is a powerful hormone that drives sugars and fats into cells, including those in the walls of blood vessels.  It also activates a cholesterol synthesizing hormone in the blood vessel walls, thus initiating cholesterol plaque, the hallmark of atherosclerosis. 

Cooking and food processing produce oxidized fatty acids, particularly linoleic acid hydroperoxide as a by-product from vegetable oils used in salads and in frying.  Frying in an iron skillet, which catalyzes the production of fat peroxides, is a worst case situation.  For some people, a high protein diet provides more amino acids than they can safely use.  One of these, methionine is converted to a toxic intermediate, homo-cysteine, which is known to cause blood vessel damage and heart attacks in up to 20 percent of the cases in men and also in post-menopausal women.  This hazard is aggravated by dietary deficiency of vitamin B6 and folic acid, which are needed to get rid of the excess homo-cysteine.http://www.drinkyourvitamins.com/homocysteine-the-key-to-heart-attack-stroke-cancer.html

PCB and DDT residues dissolve in fats and cholesterol plaque where they can damage blood vessel walls to an extent greater than cholesterol by itself.  In fact, cholesterol is now known to have a protective antioxidant function and injections of pure cholesterol appear to be harmless.  Only oxidized cholesterol, as from over-heated foods, particularly scrambled eggs, omelettes and broiled meats, is directly toxic,

Cholesterol is produced by every cell in the animal body and is essential for stable membrane structure and control of the membrane electronics.  A recent study showed that in diabetics a high cholesterol diet gave extra protection to the kidney cells and improved kidney function.

Cholesterol is the substrate from which steroid hormones are made.  Without cholesterol our bones would dissolve from lack of vitamin D, our ability to adapt would cease due to lack of cortisone and our human species would die out due to lack of sex hormones.  Cholesterol is an essential substance for animals.  Vegetables and plants do not need it and vegetable fats are free of cholesterol.  It is hard to think of something so important to life as dangerous; but an overdose of anything, even air or water, can be toxic. 

The orthomolecular question is:  what is the optimal level of cholesterol for the best of health?  This is a matter based on your individual needs.  The proponents of the war on fat advise that above 200 mg per 100 ml of blood is dangerous and that under 150 mg heart attacks virtually cease.  I think the well established statistics for men between 40 and 65 years of age, showing a doubling of risk of heart attack above 240 and quadrupling above 260 are more realistic.  The additional predictive power of the ratio of cholesterol and HDL, the protective lipoprotein that prevents cholesterol deposits is even better.  There is very little question that a high total cholesterol and a low HDL, such that the ratio approaches 6.7 or more, is dangerous.  And ideally it approaches 3.5.

The laboratory offers powerful weapons in the war for health.  Blood tests to verify vitamin, mineral, hormone and enzyme levels are extremely helpful in fine-tuning if you are well or in diagnosing the defects and deficiencies that cause mal-function of blood vessels, immune cells, nerves or other organs, thus causing the symptoms of illness.  A simple blood test of vitamin E is now known to be the best predictor of death from heart attack.  And vitamin C has recently been demonstrated to be the most potent agent in extending the duration of antioxidant action of vitamin E.  Measurement of blood levels of essential fatty acids can demonstrate the actual need and proportions of these powerful molecules, which prevent the platelet clots that cause atherosclerosis and blockage in the first place.  Measurements of mineral status, particularly magnesium, chromium and selenium, are invaluable.  Magnesium alone has proved to be one of the most powerful treatments, reducing death from heart attack by over 70 percent.  It should be measured in every case of suspected coronary heart disease.

Every one of these orthomolecules is a more powerful health risk factor than cholesterol.  That is why I say: "Cholesterol Can Wait".   If there is to be a war for health, let it be a war for total health, not a war focused on cholesterol only.  Just as nutrition comes first in personal health, so nutrient testing should come first in medicine.  This orthomolecular approach to diagnosis identifies a more complete list of health factors, almost all of which are correctable.  Vitamins, minerals and hormones are your most powerful weapons in your personal war for health.  Use them.

Richard A. Kunin, M.D. ©2011

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