Unclog Your Arteries

August 31, 2008 at 8:56 am (Hamilton-Craig, Prof. Ian, Non Fiction)
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Sub-title: Prevent heart attack and stroke and live a longer, healthier life.

This is straight down the line establishment medical advice on prevention and treatment of heart disease and strokes.  I am sure that no-one with a conventional view of medicine and coronary heart disease would have any objection to the messages of this book:  Be aware of your risk factors, have your cholesterol checked, eat a low fat diet, (recipes are included,) mind your blood pressure, don’t smoke, take your statins, they are good for you (even if you are a child) modern medicine is magical and modern treatment/prevention regimes for coronary heart disease and stroke saves countless thousands of lives.

Certainly I would have to say that a good bit of the advice that Prof H/C gives is sound and you would have to be more than a little daft to disagree with him.  Don’t smoke, don’t drink to excess, excercise, reduce sugar consumption, eat decent foods, maintain a healthy weight, take care of blood pressure, stress and the like. 

Beyond this, however, if you tend towards the skeptical end of the scale on matters relating to prevailing theories of coronary heart disease, much of what he has to say in the book will be about as popular as a concrete parachute.

Prof H-C is obviously completely sold on the cholesterol theory of heart disease.  High cholesterol causes atherosclerotic plaque, which clogs arteries and zap – coronary heart disease.  Others have questioned this theory.  The reader may wish to take a look at the site for The International Network of Cholesterol Skeptics THINCS and follow some of the articles there, particularly in the “news” section.  Dr Malcolm Kendrick, author of The Great Cholesterol Con, (reviewed on this site) also wrote this article on cholesterol and heart disease, which is both controversial and thought provoking.

Throughout the book, I noted a number of statements or assertions which I thought were dubious, in the light of other information I have read, and were not supported by references.  For example, on page 99, he states:

“…. saturated fats in the diet have a powerful effect on increasing LDL levels.  On average, for every 1% increase of total energy as saturated fats, a 2% increase in LDL levels occurred.”

Thus, we are told to eschew saturated fats, but which research shows this?  I would like to know and check it out myself.  Malcolm Kendrick in The Great Cholesterol Con, spends quite some time on the saturated fats issue and pokes holes in the notion that saturated fat has a direct link to heart disease.  (The Seven Nations study by Ansel Keys was, according to Kendrick, badly flawed.)  Kendrick, also points out that some researchers state conclusions that are exactly the opposite of what their data indicate.

In the book we are also told to avoid foods high in cholesterol.  Again, from what I have read, the amount of cholesterol in our diet makes very little difference to serum cholesterol levels.  Our liver makes cholesterol and adjusts blood cholesterol levels depending on how much of the stuff we eat.  (Prof H-C does actually point this out, which seems a little contradictory.)

It is part V of the book, however, which I would imagine would provoke the most howls of dissent  from the skeptics.  Here prof H-C discusses the statins and other medications for cholesterol lowering, describing them as “magic bullets,” “oldies but goodies” (aspirin, fibrates, resins) and generally considering them to be “life saving drugs.”

Well… maybe, but take a look at this article by Sandy Szwarc on the THINCS site, which raises a few doubts about the efficacy and safety of statins.  See also this wonderful rant by Shane Ellison “The Peoples Chemist” on the Amazon site, about the wonders of modern medicines, including those for heart disease. 

I am not knowledgeable enough, (or arrogant enough) to say, as some do, that the whole cholesterol theory of heart disease, and its treatment, is a crock of schtook, nor would I say that the alternatives people have got it all right.  As always, the truth probably lies somewhere in the middle.  I do know, however how such matters can be hijacked by ideologies and obfuscated by big business (with eye watering profits as Malcolm Kendrick puts it.)

And I am putting my own mortality on the line.  From the age of 20, possibly earlier, my cholesterol levels have always hovered around the 8 mark and my doctor looks at me with burial casket eyes every time I have a blood test.  I am now nearly 60 and refuse to take statins – high cholesterol is my only “risk” factor and I am well aware of some of the nasty side effects of statins.  (And yes, I am careful to eat quite a sensible and healthy diet.)  I have looked at the mortality figures for a number of studies purporting to show the benefits of taking statins.  Long-term there is sod-all difference.  Get your cholesterol down and die of something else!

OK, this book contains some good sound advice and I do suspect there is some benefit to taking statins – if you already have heart disease.  They seem to be effective not because of their cholesterol lowering properties, but because of their anti-inflammatory effects and perhaps their plaque coating effects.  I am all for fully informed choices, however and unfortunately I think we are often not fully informed in this (and other) branches of medicine.

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The Great Cholesterol Con

March 8, 2008 at 7:58 am (Kendrick - Dr - Malcolm, Non Fiction)
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This book is not in our library, but I do think it should be.  I bought my own copy via Amazon.

Dr Malcolm Kendrick is a Scottish GP, who sets out to puncture, or at least severely dent, the prevailing notion that cholesterol is the villain causing coronary heart disease.  And he lays on the facts, thick and fast, with an outrageous and irreverent sense of humour.  A small sample of his offerings:

We all know, don’t we (we are told often enough) that saturated fat in our diet causes heart disease – the research shows it?  Well it doesn’t actually.  The research showing this was carefully “cherry picked” to “prove” the notion and Kendrick provides “twice as much” evidence to prove that the opposite is in fact true.

Well, how about “good HDL cholesterol” and “bad LDL cholesterol.”  There are no such substances.  There is High Density Lipidoprotein (which contains cholesterol) and Low Density Lipidoprotein (which contains cholesterol) – same cholesterol.  (Semantics, I hear you say, but what does this say about the cholesterol theory of heart disease?

OK, but we know that eating a diet high in cholesterol raises our blood cholesterol levels doesn’t it – the research shows it?  No it doesn’t actually – on both counts.  Our bodies make cholesterol, which is essential to life.  If we eat less, our bodies make more and vice versa.  The amount of the stuff in our diets makes little or no difference. 

So what about the cholesterol/heart disease connection?  Surely there is lots of research that shows this?  No again.  It is clear that cholesterol is present in coronary disease, but the causes are not clear at all.  Just because two things occur together does not mean that one is causing the other.

And, of course, there are the cholesterol lowering drugs, the statins, which make, in Dr K’s words, “eye watering profits” for their manufacturers and which, in his opinion are virtually worthless, or downright harmful.  Find out why women should never take them and why anyone who has not had a heart attack should not take them.  And find out how many statins have been hastily withdrawn from the market for the annoying little side effect of killing people!  Find out how often the research data says one thing, but the published outcomes recommend exactly the opposite. 

Dr K’s take on the causes of heart disease is that stress is the biggest culprit and he produces lots of data to back up this assertion.  I agree, with reservations, (see musings below.)

All this and more.  This is a hugely informative and entertaining book, though it does suffer from the lack of an index.  I have spent quite some time on the net, looking for something – anything, from someone like a cardiologist, heart foundation, physician, etc, along the lines that Kendrick is talking through his hat, for the following reasons:….. I have not found anything.  Perhaps the establishment is treating him with an old medical approach – ignore him and perhaps he will go away.

Dr K is not a lone voice, however – have a look at the Cholesterol Skeptics site for similar information.  There is also another book by the same name, written by Anthony Colpo, which I have not yet read. 

 Further musings, for those who may be interested:

I must confess a vested interest in this subject – my cholesterol levels are in the outer stratospheric range and have been so for the last 40 years.  Every time I have a blood test I get panic stricken phone calls from the medical centre, but I flatly refuse to take statins, for the reasons Dr K outlines.  A bit galling really as I have always been slim, fit, eat reasonably healthy and have that rugged New Zealand handsomeness. (Well the first three are true and we’ll just ignore the shrieks of feminine laughter in relation to the last one, shall we!)

Statins have nasty side effects, at least for some people.  Cognitive (thinking,) problems, memory problems, muscle and joint pain, sleep disturbances, to name but a few – and they can cause a potentially fatal condition known as rhabdomyolosis. I am astonished at the number of people I find taking them who have no real idea of why they are doing so and have never had heart disease.  I am equally astonished at doctors who prescribe them and don’t tell their patients about side effects – or worse yet, claim there are none. 

Dr K puts forward the notion that stress is the major causative factor in heart disease.  He tends to discount (with supporting data) smoking, high fat diets, high blood pressure and a number of other factors and discounts the “protective” factors such as the French diet, alcohol, women’s hormones etc.

I am a psychologist, with a pretty good working knowledge of stress.  I think Dr K is quite right – stress can be a killer, but I suspect it is not the whole answer to heart disease.  To stress, I would add smoking, trans-fats and damaged rubbish “foods.”  I recently had a client whose heart is pretty well stuffed (to use an old medical term.)  He was grossly obese and his diet consisted almost entirely of sausage rolls, pies, fries and pizza and he was drinking three litres of coke a day!!  You simply can’t do that to your sytem on a long-term basis and get away with it. 

There are also different forms of stress and people make different responses.  I know lots of people who are very stressed, but they aren’t keeling over with heart disease.  The worst forms of stress seem to be those driven by unresolved anger, guilt, anguish and despair.  When the stress is unremitting and/or when there is a sense of hopelessness and no way out.  Also when there are enormous unexpected shocks in a person’s life. Then there are body, biochemical changes and harmful substances like cortisol get produced, there is inflammation and the likelihood of heart disease soars. 

I do think that risk factors can act in combination – stress with smoking; stress with lousy diet; stress with high blood pressure etc.  And many of our foods are simply rubbish, or have the superficial appearance of being healthy.  Have a look in any supermarket and note the enormous volume of “foods” which are almost entirely for entertainment or distraction – the chips, sweets, biscuits, soft drinks, alcohol, spreads, toppings, ice-creams and so on.  And then there are the foods that advertising tries to convince us are healthy – the breakfast cereals, milk and milk products, refined and processed products, fast foods, the so-called healthy oils, margarine type spreads etc etc.  For more insights into this sort of thing see The Omnivore’s Dilemma, by Michael Pollan, reviewed on this site.

So apart from eating healthy food, managing stress positively and keeping fit and slim, what am I doing to maintain cardiac health?  I drive carefully!

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