[Book Summary] The Great Cholesterol Myth: Why Lowering Your Cholesterol Won't Prevent Heart Disease – and the Statin-Free Plan That Will
The Great Cholesterol Myth (2012) takes medical orthodoxy and turns it on its head. Rather than blaming heart disease on cholesterol and dietary fat, this book calls for a more nuanced view of the causes of cardiovascular illnesses. Drawing on cutting-edge research into nutrition and human health, The Great Cholesterol Myth argues that we've misunderstood heart disease for decades.
Introduction: What's in it for me? Discover the truth behind the myths surrounding cholesterol.
The demonization of cholesterol rests on outdated and bad science.
Our ideas about "good" and "bad" cholesterol need a drastic overhaul.
There's no good reason to avoid eating saturated fat.
Sugar is far more dangerous than fat.
Reduce the risk of cardiovascular disease by reducing stress.
More often than not, statins are both harmful and unnecessary.
Final Summary
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Health, Nutrition, Food and Drink, Science, Medical, Self Help, Diets, Heart Disease, Ketogenic Diet
Introduction: Discover the truth behind the myths surrounding cholesterol.
If there's one thing everyone knows about nutrition, it's that too much cholesterol is bad for you. It builds up in your arteries, obstructs your blood and eventually weakens your heart. That's the standard narrative, at least – but these summaries argue that it's totally wrong.
They lay out a reasoned defense of cholesterol and fat, based on longstanding theories and cutting-edge research. The real cause of heart disease, they argue, lies elsewhere in our diet.
They also explain that the usual suspects like saturated fat and "bad" cholesterol don't deserve their shady reputations and that some popular cholesterol-reducing remedies can actually do more harm than good.
In these summaries, you'll learn
why "good" cholesterol isn't always good;
how a Pennsylvanian town kept heart disease at bay for years; and
why an astronaut suddenly forgot decades of his life.
Human beings need cholesterol. In the body, this waxy substance aids the formation of cell membranes, is used to produce hormones like testosterone and estrogen, and even supports digestion.
So why does cholesterol get such bad press? Why do dietary pundits constantly tell us that it's bad for our health?
To answer that question we need to revisit a nutritional controversy from the mid-twentieth century.
The key player was a young biologist named Ancel Keys, who had just formulated a revolutionary new theory; he argued that too much fat in the diet raised cholesterol levels, ultimately leading to heart disease.
Before long, the theory caught on – and health bodies across the US were soon warning citizens to cut down on fat. There was just one problem, though: the theory relied on data that simply didn't add up.
The key message here is: The demonization of cholesterol rests on outdated and bad science.
There were a number of problems with Keys's research. First, let's consider his famous Seven Countries Study, which showed that the nations that ate the most fat also experienced the most heart disease.
Sounds pretty clear-cut, right? Well, let's look a little closer. Keys actually had access to data on 22 countries, not seven – and those he excluded from the study painted an entirely different picture.
For example, the inhabitants of two Greek islands, Crete and Corfu, consumed fat at almost exactly the same rate. According to Keys's hypothesis, you might expect them to have similar levels of heart disease.
The thing is, they don't. In Corfu, death from heart disease was a staggering 17 times higher than it was in Crete.
Clearly, something other than fat consumption was at play. But what?
Enter John Yudkin, a British doctor and nutritionist working at the University of London. Yudkin was skeptical of Keys's findings, so he decided to carry out a similar study himself – but he made sure to include far more data than Keys had.
When Yudkin analyzed the numbers, he found that there was indeed a single dietary factor strongly associated with heart disease. But it wasn't fat. It was sugar.
Unfortunately, the work of scientists like Yudkin was disregarded, and Keys's attack on fat went mainstream. To the public, the defenders of fat seemed all too similar to the crooked scientists who'd spent years defending tobacco.
Maybe you've heard that not all cholesterol is bad. If you've ever had your blood checked by your doctor, she might have told you that HDL cholesterol is actually good for you. It's the nasty LDL cholesterol that she probably warned you against.
What distinguishes these two types of cholesterol is the density of the proteins they're made up of. HDL stands for high-density lipoproteins; LDL, for low-density lipoproteins. A lipoprotein is simply a bundle of protein and cholesterol capable of traveling through the bloodstream.
According to most doctors, we just need to raise our "good" HDL levels while lowering our levels of "bad" LDL. Simple, right?
Well, yes – it's simple. But it's wrong.
The key message here is: Our ideas about "good" and "bad" cholesterol need a drastic overhaul.
Simply put, HDL and LDL cholesterol are outdated measures of cardiovascular health.
Take so-called "good" HDL. Since doctors constantly tell us that we need more of it, you might expect that it has some clear benefits for your heart. But you'd be wrong.
A 2011 study found that when you raise your levels of HDL, you don't actually reduce your chances of experiencing heart attacks, strokes, or even death.
So there goes the idea that increasing HDL is always good for you. But surely lowering "bad" LDL still offers some benefits?
Well, not exactly. Focusing solely on LDL and HDL leaves out some significant details. More important than your levels of HDL and LDL is the question of what subtypes your cholesterol is made up of.
This means that some "good" HDL cholesterol can actually be bad for you and that some "bad" LDL cholesterol can be totally harmless! What matters is the type of HDL and LDL in your blood.
Let's reconsider HDL, the "good" one. A subtype of this cholesterol, called HDL-2, is indeed good for you. It travels as large, protective molecules that cause few problems – so raising the levels in your blood is typically helpful.
But HDL-3, another subtype, is often dangerous. Unlike HDL-2, HDL-3 takes the form of small and dense molecules that sometimes lead to harmful inflammation.
LDL cholesterol, the "bad" one, also needs to be reconsidered. A subtype called LDL-A is normally totally harmless.
LDL-B and Lp(a), on the other hand, are both bad subtypes of LDL cholesterol. Over time, they can lead to atherosclerosis, the buildup of gunk on your artery walls. Unsurprisingly, this is very dangerous.
So you're getting to grips with the idea that fat isn't necessarily bad for your heart. We've seen that the demonization of fat doesn't make much sense, and that the notion of "good" HDL cholesterol and "bad" LDL cholesterol is overly simplistic.
But you're probably still holding onto some misguided beliefs. Take saturated fats, for example, the kind you find in animal foods like meat, dairy, and eggs – as well as in coconut and palm oil.
This type of fat has become the bogeyman of cardiovascular health. In fact, the phrase "artery-clogging saturated fat" is almost the default label for this kind of nutrient!
There must be a reason saturated fats are so disapproved of, right? Once again, the science says there's really not.
The key message here is: There's no good reason to avoid eating saturated fat.
Let's examine the claim that saturated fat can clog your arteries. It might surprise you to learn that this truism has never been fully proved.
The argument against saturated fat rests on the idea that LDL cholesterol is always a bad thing – and, as we've seen, this is a notion that science no longer supports.
In fact, saturated fat can actually have a beneficial effect on the cholesterol in your body.
In the previous chapter, we established that we don't want hard and dense cholesterol molecules like HDL-3 and LDL-B in our bloodstream. And, believe it or not, saturated fat can actually help keep them out.
When we consume saturated fats, the level of harmful, dense cholesterol molecules in our bloodstream decreases – and our levels of large, protective molecules, like HDL-2 and LDL-A, go up!
Of course, this baffles people who continue to think in terms of "good" HDL and "bad" LDL. Because saturated fats increase the levels of LDL in our bloodstream, they expect increased consumption to lead to cardiovascular disease.
Luckily for us, this hypothesis has been tested– and disproven! A recent study gathered together all the available data on the relationship between saturated fat and cardiovascular disease, including information on more than 300,000 people.
The results of this huge study? Saturated fat was shown to have no effect on cardiovascular disease.
Remember John Yudkin, the doctor from the first chapter? He's the man who was so skeptical about the attack on fat that he conducted his own research into cardiovascular disease – and ended up pointing the finger, not at dietary fats, but at sugar.
At the time, Yudkin's theory had little effect on orthodox dietary thinking. As we've seen, nutritional bodies fell over themselves in their haste to condemn fat as the primary cause of heart disease.
But times have changed – and the results of modern research suggest that John Yudkin might well have been onto something.
The key message here is: Sugar is far more dangerous than fat.
Sugar can be bad for our health because of the way it interacts with a hormone called insulin.
Insulin works in tandem with a hormone called glucagon to keep our blood-sugar levels in order. Given an ideal diet, the two hormones cooperate, and keep each other in a kind of healthy balance.
The problem is that we reduce the effectiveness of insulin when we consume too much sugar – an all-too-common feature of modern, Western diets.
To maintain healthy blood-sugar levels, our oversugared bodies produce more insulin. And this, in turn, leads to elevated levels of insulin in our bloodstream. The effects of increased insulin? Raised triglycerides and increased glycation.
Let's start with triglycerides. Unlike your overall cholesterol levels, triglycerides are a fairly reliable measure of cardiovascular health. In general, the lower your triglycerides, the better.
So guess what sugar does to your triglycerides? That's right – it raises them. And high triglycerides are associated with exactly the type of LDL cholesterol that we want to avoid: that is, dense and dangerous LDL-B particles.
The other unwanted result of excess sugar intake is glycation. Remember we said that LDL-A is normally a harmless type of cholesterol? Well, glycation is one of the processes that can turn benign forms of LDL into the dangerous kind.
In glycation, excess sugar binds with LDL cholesterol, making it more likely to obstruct your arteries and to lead to cardiovascular disease.
So John Yudkin wasn't exaggerating when he named his book about sugar Pure, White and Deadly!
What do you think is on people's minds when they suffer fatal heart attacks? Lifelong regrets? Happy memories? The anticipation of heavenly bliss?
If you answered any of the above, you'd be wrong. When most people have heart attacks, they're only experiencing one thing: severe stress.
We know this because people are sometimes resuscitated after experiencing sudden cardiac death – when the heart stops completely – and 91 percent of those people report feeling "acute psychological stress" just as the incident kicks in.
The key message here is: Reduce the risk of cardiovascular disease by reducing stress.
Before we get into the details, a proviso: stress isn't always a bad thing. In fact, it was often beneficial for our ancestors. If you're roaming the African savannah and you suddenly spy a lion, an acute dose of the fight-or-flight hormones cortisol and adrenaline might be just what you need to spur you to run to a safe distance.
But nowadays, we suffer from stress day in, day out. Work is stressful. Social media is stressful. Modern life is stressful. And, since we can't simply outrun these things, our stress becomes chronic and our heart pays the price.
How? Well, excessive amounts of cortisol in the bloodstream can cause our arteries to harden, making us more vulnerable to heart attacks and arrhythmias – meaning abnormal rhythms of the heart.
When this happens, we've essentially "overdosed" on our own stress hormones. But things don't have to be this way: the way of life in Roseto, a Pennsylvanian town that flourished in the 1960s, provides an alternative.
In a number of ways, Roseto defied all the odds. This Italian-American community combined the most harmful aspects of their traditional cuisine with equally unhealthy elements of American cooking.
But looking at their medical records, you'd never think it; in Roseto, almost nobody under the age of 65 died of heart disease.
So what was their secret? It came down to two things: connection and community. In Roseto, the elderly weren't consigned to lonely nursing homes. Instead, they lived under one roof with their children and grandchildren, playing an active role in family life.
In fact, Roseto was a fundamentally tight-knit community. Everyone had a part to play, and everybody felt connected to the wider community.
Establishing similar, meaningful connections is one way of reducing stress and, by extension, the risk of cardiovascular disease.
Duane Graveline had a pretty impressive résumé. As both an MD and an astronaut, he had worked hard to improve his already able mind. So you can imagine his distress when, for a couple of painful hours, Graveline lost all cognitive control.
One day, without warning, Graveline's memory transported him back to the world of his thirteen-year-old self. He was suddenly able to recall the names of all his childhood classmates – but he couldn't recognize his wife or recall anything that had happened in the last 56 years.
Luckily, Graveline's amnesia subsided after a few hours. But what had caused this sudden mental malfunction? He later learned that the culprit was a type of drug called a statin, which NASA had prescribed him for his cholesterol.
The key message here is: More often than not, statins are both harmful and unnecessary.
Not everyone who takes a statin will experience a reaction as dramatic as Graveline's, but lots of people do suffer serious side effects as a result of going on these drugs.
This is hardly surprising; statins are designed to lower the level of cholesterol in the body – but we depend on cholesterol for a number of vital functions, including the production of sex hormones and bile.
And while it is true that statins can sometimes be helpful, it seems that any good they do derives from their anti-inflammatory properties, not from their cholesterol-lowering effects.
One of the most alarming consequences of decreasing cholesterol in the body is the depletion of coenzyme Q10. This coenzyme is an important nutrient that helps the body maintain coronary health. A deficiency can lead to fatigue, weakness and severe muscle pain. In fact, the side effects of depleting this nutrient are often worse than the cardiovascular symptoms the statin is meant to tackle!
At this point, you might feel like objecting. Surely statins are beneficial most of the time. Otherwise, they wouldn't be so widely prescribed, right?
Well, not exactly. Statins are one more relic of antiquated ways of thinking about cholesterol – rooted, once again, in decades-old antifat science.
In most cases, the disadvantages of taking a statin vastly outweigh the benefits. And, in all cases, statins are a gamble. So you decide: Do you want to take them and interfere with some of your body's most important processes? Or do you want to avoid them and look after your heart?
The key message in these summaries:
Once we recognize that the notion of "good" and "bad" cholesterol is old-fashioned and misleading, we can redesign our diet to promote the health of our hearts. To start, we can begin consuming less sugar, avoiding chronic stress, and eating saturated fat in moderation.
Actionable advice: Start eating more salmon.
It's vital that humans regularly consume both omega-6 and omega-3 fatty acids, and the ideal ratio of these fatty acids in our bodies is 1:1. These days, however, most of us eat far more omega-6s than omega-3s, which can end up causing harmful inflammation in our bodies. To try to rebalance your ratio, start adding more salmon to your diet. If possible, eat wild Alaskan salmon, which tends to be much cleaner than other salmon and is an excellent source of astaxanthin, an important antioxidant!
Jonny Bowden, Ph.D., C.N.S., a board-certified nutritionist with a master's degree in psychology, is a nationally known expert on nutrition, weight loss, and health. He is the author of several best-selling titles, including The 150 Healthiest Foods on Earth, The Most Effective Ways to Live Longer, and The 150 Most Effective Ways to Boost Your Energy. He is the nutrition editor for Pilates Style, a contributing editor for Clean Eating, and a columnist for both America Online and Better Nutrition. His work has been featured in dozens of national publications (print and online) including The New York Times, The Wall Street Journal, Forbes, Time, Oxygen, Marie Claire, Diabetes Focus, US Weekly, Cosmopolitan, Family Circle, Self, Fitness, Allure, Essence, Men's Health, Weight Watchers, Prevention, Woman's World, Fitness, Natural Health, and Shape. He lives in Woodland Hills, CA. Visit jonnybowden.com.
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Stephen T. Sinatra, M.D., F.A.C.C., is a board-certified cardiologist and certified psychotherapist with 40 years of clinical experience treating and preventing heart disease. He is also certified in anti-aging medicine and nutrition. Dr. Sinatra's focus is integrating conventional medical treatments with complementary nutritional, anti-aging, and psychological therapies. He is a Fellow of the American College of Cardiology, an Assistant Clinical Professor of Medicine at the University of Connecticut School of Medicine, and a former chief of cardiology and medical education at Manchester (Connecticut) Memorial Hospital. A prolific author, Dr. Sinatra has written numerous books, including The Great Cholesterol Myth (Fair Winds Press, 2012), Reverse Heart Disease Now (Wiley, 2008), The Sinatra Solution: Metabolic Cardiology (Basic Health Publications, 3rd ed., 2011), and Earthing: The Most Important Health Discovery Ever? (Basic Health Publications, 2010). He hosts the Internet's # 1 integrative cardiology website, heartmdinstitute.com.
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