Diet and Disease: Not What You Think
by Sally Fallon and Mary G. Enig, Ph.D.
Heart disease is America's major killer; it's prevention is our
most urgent public health priority. Americans must change their
diet, say the experts. Steer clear of traditional foods like
butter, cream, cheese, eggs, and meat, they tell us. Rich foods
contain cholesterol and saturated fats — "artery clogging
substances."
The accumulation of hardened plaque in the arteries, or
atherosclerosis, is indeed a major cause of heart disease in
Western nations.
The Accepted Explanation for
its prevalence in civilized countries is the lipid hypothesis,
namely that dietary saturated fat and cholesterol lead to elevated
levels of cholesterol in the blood, and that these elevated levels
of cholesterol cause the pathogenic atheromas that block blood
vessels.
This theory has been promoted by the American Heart Association
since the mid-1960s. It forms the basis of governmental
nutritional recommendations, which in turn have spurred consumer
acceptance of a vast array of low-fat, cholesterol free food
products, most of which contain ingredients that are new to the
American diet.
Numerous studies, both national and international, have
explored the lipid hypothesis — and consumed the lion's share of
research dollars in this area — including three major projects
funded by the National Heart Lung and Blood Institute, a division
of the National Institutes of Health (NIH).
The first and best known of these studies was the Framingham
Heart Study, carried out in the town of Framingham, Massachusetts.
Although Framingham is often associated
with proof of the lipid hypothesis, the results of this 40-year
study have been a disappointment to its promoters.
Investigators claimed that there was a 240% increase in "risk"
of coronary heart disease, or CHD, between cholesterol levels of
182 and 244. But the actual rate of increase was only .13%.
Between cholesterol levels of 244 and 294, the rate of CHD
actually declined.
Thus Framingham investigators found virtually
no difference in heart disease for
serum cholesterol levels between 182 and 284 the vast
majority of the U.S. population.
Nor did they find that diets high in fat and cholesterol
predisposed an individual to heart disease.
As Dr. William Castelli, the current director of the Framingham
project, admitted as recently as 1992: "In
Framingham, Massachusetts, the more saturated fat one ate, the
more cholesterol one ate, the more lories one ate, the lower
people's serum cholesterol... we found that the people who ate the
most cholesterol, ate the most saturated fat, ate the most
calories weighed the least and were the most physically active."
The second government-funded study was the Multiple Risk Factor
Intervention Trial (MRFIT) for 362,000 men.
Researchers found that annual heart disease deaths increased
from about 1 per 1,000 for cholesterol levels of 180 to slightly
less than 2 per 1,000 for cholesterol levels of 300 — a 100%
increase in "risk" but a trivial increase in rate of less that
.1%.
A more significant finding was an increase in total deaths for
cholesterol levels below 160.
The final major NIH study was the Lipid Research Clinics
Coronary Primary Prevention Trial (LRC), a project that cost $150
million and received intense media attention.
All subjects in the trial were put on a low-cholesterol,
low-saturated fat diet. One group received a cholesterol lowering
drug, the other a placebo. Average cholesterol reduction for the
drug group was 8.6% which had, according to researchers, a 17%
reduction in rate of heart disease.
This led to the oft repeated statement: "For each 1% reduction
in cholesterol, we can expect a 2% reduction in CHD events." But
when independent researchers tallied the LRC data, they found no
difference in CHD between the two groups. An unequivocal but
rarely published finding of the LRC was an increase in deaths from
cancer, intestinal disease, stroke, violence, and suicide in the
group taking the cholesterol-lowering drug.
Both the popular press and medical journals portrayed the LRC
as the long-sought proof that animal fats and dietary cholesterol
are the cause of heart disease. The 1984 government-sponsored
Cholesterol Consensus Conference called for mass cholesterol
screening and defined all Americans with cholesterol levels
over 200 as "at risk."
Participating scientists recommended the prudent diet for "at
risk" Americans, one low in saturated fat and cholesterol. A
specific recommendation was the replacement of butter with
margarine. The ensuing National Cholesterol Education Program
instructed American physicians in techniques for lowering serum
cholesterol through diet ant drugs.
The estimated current cost for
cholesterol screening and treatment in the United States now
exceeds $60 billion annually.
The application of a modicum of common sense could have
prevented the massive expenditures lavished on the lipid
hypothesis during the past 30 years.
The lipid hypothesis implies that animal fat consumption must
have increased significantly since 1920 to correlate with the rise
in heart disease, but in fact the consumption of saturated animal
fats in America declined steadily during that period, while use of
vegetable fats increased dramatically.
Autopsy studies of vegetarians reveal
that although they have lower serum cholesterol values than
non-vegetarians, they have as much atherosclerosis as
non-vegetarians.
In fact, the International Atherosclerosis Project, which
analyzed 31,000 autopsies from l5 countries, found no
correlation between animal fat intake and degree of
atherosclerosis or serum cholesterol level.
Michael DeBakey, the famous heart surgeon, surveyed 1,700
patients with atherosclerosis and found no relation between levels
of serum cholesterol and degree of hardening of the arteries.
Other U.S. studies — the Veterans Clinical Trial, the Minnesota
State Hospital Trial, the Honolulu Heart Program, and the Puerto
Rico Heart Health Study — found no significant relation between a
diet high in cholesterol and saturated fats with CHD.
Unfortunately, these studies do not receive front page
coverage in American newspapers, and dissenting voices must
content themselves with publication in obscure medical journals.
One of these voices is the eminent researcher Dr. George Mann, who
states categorically:
"The diet-heart hypothesis has been
repeatedly shown to be wrong, ant yet, for complicated reasons of
pride, profit, and prejudice, the hypothesis continues to be
exploited by scientists, fund-raising enterprises, food companies,
and even governmental agencies. The public is being deceived by
the greatest health scam of the century."
Michael Gurr, Ph.D., renowned expert on lipids and author of
the authoritative textbook on lipid biochemistry, recently stated
that "whatever causes coronary heart
disease, it is not primarily a high intake of saturated fat."
He criticized "...the degree of self
delusion in research workers wedded to a particular hypothesis
despite the contrary evidence!"
So if it ain't saturated fats ant cholesterol, what causes
heart disease? There are, in fact, a number of dissenting
theories, most of which dovetail into a compelling list of dietary
and lifestyle factors that are unique to civilized societies.
Consider the following:
- In the 1940s and 1950s, researchers
Yudkin and Lopez discovered a link between consumption of
refined sugar and heart disease. Sugar consumption lowers
the body's resistance to bacteria, viruses, and yeasts that
may cause inflammation in both the heart and the arteries.
Excess sugar leads to deficiencies in the entire B-vitamin
complex, needed for healthy arteries. Ongoing research at
the U.S. Department of Agriculture indicates that fructose
may be even more dangerous than sugar. Fructose, mainly in
the form of high-fructose corn syrup (HFCS), has become the
sweetener of choice for soft drinks, condiments and many
so-called health foods.
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- Also in the 1960s, a researcher named
Annand discovered a correlation between the consumption of
heated milk protein and a tendency to thrombosis — the
formation of blood clots — and noted that the rise in
coronary heart disease began in the 1920s with laws
requiring milk pasteurization.
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- Researcher Kilmer McCulley has found
a positive relationship between deficiencies in folic acid,
B 6 and B l2 , and severity of hardening or stiffness of the
arteries, as well as the buildup of pathogenic plaque. B 6
and B 12 are found almost exclusively in animal products —
the very foods that proponents of the lipid hypothesis
advise us to avoid. B 6 deficiency is also associated with
hardening of the tendons leading to carpal tunnel syndrome.
Deficiencies of this heat-sensitive vitamin are widespread
in America, partly because B 1 and B 2 added to white flour
interfere with its proper use, and partly because it is
destroyed during milk pasteurization. (Although
pasteurization may help prevent foodborne illness, the
process destroys nutrients.) Although McCulley's research
has gained widespread, albeit grudging, recognition in the
scientific community, it continues to lack appropriate
funding and public recognition.
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- Vitamin C deficiency makes arterial
walls more subject to inflammation and tearing. A diet rich
in natural vitamin C complex helps maintain the integrity of
both blood vessels and heart muscle. Vitamin C also plays a
role in collagen synthesis, along with copper, through the
enzyme lysyl oxidase. Deficiencies occur in diets that lack
fresh fruits and vegetables.
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- Heart disease has been correlated
with mineral deficiencies. Coronary heart disease rates are
lower in regions where drinking water is naturally rich in
trace minerals, particularly magnesium, which acts as a
natural anti-coagulant and aids potassium absorption,
thereby preventing heartbeat irregularities. Mineral-rich
water and soil also supply iodine, needed for a healthy
thyroid gland. People with poor thyroid function are very
prone to heart disease. Calcium also plays a role in
protecting the heart and arteries. Potassium helps maintain
proper blood pressure. Traditional meat broths are rich in
magnesium, potassium, calcium, and iodine. In America, these
have largely been replaced by imitation broth products
containing MSG and hydrolyzed protein.
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- The most important change in the
American diet during the years of CHD increase has been the
gradual substitution of vegetable fats for those of animal
origin. Hydrogenated fats — in the form of margarine and
shortening — have replaced butter and lard, while the
consumption of vegetable oils has increased more than
10-fold. Since as early as 1956, a number of researchers
have found that consumption of trans-fatty acids in
hydrogenated oils contributes to heart disease, including
most recently Mensink and Katan in the Netherlands, and
Walter Willett at Harvard University.
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- An excess of vegetable oils, even
when not hydrogenated, seems to play a role in causing heart
disease because they cause an imbalance in the production of
prostaglandins, localized tissue hormones that play a role
in all of the body's complex chemical processes; and because
industrially processed vegetable oils contain bee radicals
that damage the arteries, thereby initiating plaque
deposits.
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- Arterial plaque contains cholesterol
because the body actually uses cholesterol to repair
injuries, tears, and irritations to artery walls. However,
like rancid vegetable oils, cholesterol that has been
oxidized by high temperatures and exposure to air can itself
irritate the arterial walls and initiate pathological
buildup. High temperature spray production of powdered milk
and eggs, used as additives in many processed foods, began
in the early part of the century. Consumption of both
hydrogenated fats and products containing oxidized
cholesterol increased greatly after the war.
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- A recent study found that excess
consumption of omega-6 fatty acids, the kind found in
commercial vegetable oils made from corn, soy, safflower,
and canola, increases the amount of oxidized cholesterol in
the arterial plaque. Like sugar and white flour, these
vegetable oils, produced by high temperature industrial
processing, are new to the human diet. It is the
polyunsaturated omega-6 fatty acids — not saturated fat —
that form the major fat component of arterial plaque, yet
for many years the American Heart Association and many
establishment nutrition writers advocated consumption of
polyunsaturated oils for the heart.
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- The role of vitamin D in protecting
against heart disease has been neglected. Vitamin D is
essential for the intestinal absorption of many minerals,
but particularly calcium and magnesium. Vitamin D deficiency
is associated with defective calcification of the bones and
pathogenic calcification of the arteries. Synthetic vitamin
D added to milk has the same effect as vitamin D deficiency
— it causes abnormal calcification of the soft tissues,
particularly the blood vessels. Our bodies can manufacture
vitamin D from cholesterol by the action of sunlight on the
skin, but natural dietary sources give added protection.
Vitamin D is found only in animal fats.
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- Short- and medium-chain saturated
fatty acids have anti-microbial effects and protect against
the kind of viruses and bacteria that contribute to heart
disease. Best sources of these helpful fats are the tropical
oils, especially coconut oil, which have largely disappeared
from the American food supply due to unfounded assertions
that these healthy fats contribute to heart disease.
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- Caffeine in coffee causes the body to
excrete calcium and stresses the adrenal glands, leading in
some cases to general exhaustion, including exhaustion of
the heart muscle. This theory has been subject to intense
criticism. Detractors note that heavy coffee drinkers tent
to indulge in a number of habits considered unhealthy by
orthodox researchers — such as smoking and lack of exercise
— as well as consumption of sugar and processed foods,
leading to deficiencies not yet accepted by the medical
establishment as being contributors to CHD.
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- Anti-oxidants such as beta-carotene,
selenium, and vitamin E may protect us against damage from
highly processed vegetable oils and oxidized cholesterol.
Orthodox medicine has ignored or ridiculed vitamin E therapy
for heart disease, pioneered by the Shute brothers,
physicians in Canada, who found that 100 mg of natural
vitamin E from wheat germ oil gave excellent long-term
protection from coronary heart disease. Fresh fruits and
vegetables supply beta-carotene and hundreds of other
carotenoids; butter is a particularly rich source of
selenium.
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- Other theories related to heart
disease include lack of exercise, overweight, high blood
pressure, smoking, and exposure to carbon monoxide gas.
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Heart Disease Has Many Forms
What emerges is a clear association of heart disease with the
increased consumption of devitalized, processed, fabricated food
items, including sugar and fructose, pasteurized milk, soft
drinks, fortified white flour, miller and egg powders, caffeine,
imitation broth products, synthetic vitamins, vegetable oils, and
hydrogenated fats.
The lipid hypothesis not only clouds this picture, but inhibits
necessary research that could illuminate these connections more
clearly. Instead of adding to medical and nutritional
understanding, it may be undermining public health — promoting the
substitution of newfangled, altered, imitation products for
nourishing traditional whole foods, including butter, cream,
cheese, eggs, and meat.
Although not unknown, heart disease was relatively rare at the
turn of the century, accounting for approximately 8% of all deaths
in the United States.
Today coronary heart disease, or CHD,
accounts for about 45% of all deaths.
Incidence of heart disease rose precipitously between 1920 and
1960. Since that time, mortality rates from CHD have declined
somewhat. This means that victims of heart disease are living
longer, due most likely to improved surgical techniques and the
advent of angioplasty; but morbidity rates — the incidence of
heart disease — continue to rise, although at a lower rate than
before.
Of greatest concern is the high
rate of heart disease in American men between the ages of 45 to
65.
Heart disease is not a single malady, but a complex of disease
coming under a single rubric.
Damage to the heart muscle or myocardium may be due to a
congenital defect, or result from inflammation and damage
associated with any number of viral, bacterial, fungal,
rickettsial or parasitic diseases; from rheumatic fever or
syphilis; from toxic chemicals such as carbon monoxide or drugs;
from auto-immune reactions or genetic disorders in which important
cellular proteins in the heart muscle are deranged; or from
disruption of enzymes affecting cardiac function.
The heart may also be damaged by an imbalance between the blood
supply and the demands of the heart muscle leading to ischemia, a
local deficiency of blood supply, and infarction, the death of an
area of heart tissue.
Such deficiency may be caused by physical exertion or emotional
trauma, increasing the heart's need for blood; or from a drop in
blood supply due to excess bleeding, a spasm in an artery, a blood
clot (thrombus) or by coronary artery disease, a condition in
which the arteries become gradually blocked by the buildup of
abnormal plaque (atheromas) and hardened through calcification.
Blockage often occurs in the large arteries feeding the heart (the
coronary arteries), or in those supplying the brain, increasing
the risk of stroke.
In cases of moderate blockage of the coronary arteries, the
patient may suffer from angina pectoris, bouts of brief chest
pain; moderate blockage combined with increased demands on the
heart, due to exertion or trauma; or severe blockage due to
arterial plaque, a clot, a spasm, or any combination of these, may
lead to a myocardial infarction, the dreaded heart attack,
resulting in cardiac dysfunction and often rapid death. Sudden
death is often triggered by an acute arrhythmia — disruption in
the rhythms of the heart beat — during a heart attack.
While coronary artery disease is a common cause of heart
attack, myocardial infarction may also occur in the absence of
arterial blockage, due to a spasm, clot or organic failure of the
heart muscle.
Heart disease due to syphilis and infectious disease has been
around a long time and probably accounts for a good portion of CHD
deaths before 1920. Fatty streaks, lesions, and plaque in the
arteries are found in many primitive people, but coronary artery
disease, the pathological buildup of hardened plaque leading to
partial or total occlusion of major arteries, seems to be a
disease of civilization, and probably accounts for a great deal —
though not all — of the increase in heart disease between 1920 and
1960, and its continued menace to the present day.
Sally Fallon is the author of
Nourishing Traditions: The Cookbook that Challenges Politically
Correct Nutrition and the Diet Dictocrats (NewTrends
Publishing 877-707-1776) and Mary G. Enig, Ph.D. is the author of
Know Your Fats: The Complete Primer for
Understanding the Chemistry of Fats, Oils and Cholesterol
(Bethesda Press 301-680-8600).
Reprinted with the permission of the authors.
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