Monday, February 28, 2011

Coronary Artery Calcium (CAC) Scanning

Texas Heart Attack Prevention legislation "premature," expert says

February 28, 2011 | Shelley Wood

Dallas, TX - The quiet passage of 2009's Texas Heart Attack Prevention Bill will have ramifications that will "ring loudly" for public health, predicts a Commentary published in the Archives of Internal Medicine this week [1].

As reported in-depth by heartwire, the bill, known as HB 1290, grew out of a bold, unprecedented proposal from the Society for Heart Attack Prevention and Education (SHAPE, a group with no ties to either of the main cardiology professional societies) and mandates insurance coverage at regular intervals for coronary artery calcium (CAC) scanning and carotid ultrasound in the state of Texas. A new bill modeled on the Texas legislation is also poised for consideration in Florida in the coming weeks.

Conspicuously absent, he notes, was any kind of expert testimony from the American Heart Association or American College of Cardiology. As previously reported by heartwire, both societies stayed mum on SHAPE, drawing criticism for their silence, although the ACC told heartwire that their Texas ACC chapter "officially supported this piece of legislation and [was] glad to see that it has passed."

For many prominent cardiologists who were involved in SHAPE—most of whom don't hail from Texas—the bill's passing in some ways validates the work of their organization. Several SHAPE members have told heartwire that they believe their aggressive support for population-based screening fills a void that the professional societies have been too slow to move into.

...that the State of Florida is poised to consider Senate Bill 360, inspired by the Texas bill, which would require insurance reimbursement for up to $200 for CAC and CIMT screening. The bill, sponsored by Florida State Senator Mike Fasano, has been submitted and assigned to committee; the Florida legislature begins its sessions tomorrow.

Asked what he thought about a screening bill now being considered in Florida, Khera said, "In some ways, I can understand why: this is the number-one cause of death, and I certainly appreciate that legislators want to do something, because people are dying from heart disease."

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Read the full article here:

http://www.theheart.org/article/1190599.do?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Theheartorg+%28theheart.org%29&utm_content=Google+Reader

Sunday, February 27, 2011

No-Bologna Facts from Tom Naughton

No-Bologna Facts

There’s never been a single study that proves saturated fat causes heart disease.
As heart-disease rates were skyrocketing in the mid-1900s, consumption of animal fat was going down, not up. Consumption of vegetable oils, however, was going up dramatically.
Half of all heart-attack victims have normal or low cholesterol. Autopsies performed on heart-attack victims routinely reveal plaque-filled arteries in people whose cholesterol was low (as low as 115 in one case).
Asian Indians - half of whom are vegetarians - have one of the highest rates of heart disease in the entire world. Yup, that fatty meat will kill you, all right.
When Morgan Spurlock tells you that a McDonald’s salad supplies almost a day’s allowance of fat, he’s basing that statement on the FDA’s low-fat/high-carbohydrate dietary guidelines, which in turn are based on … absolutely nothing. There’s no science behind those guidelines; they were simply made up by a congressional committee.
Kids who were diagnosed as suffering from ADD have been successfully treated by re-introducing natural saturated fats into their diets. Your brain is made largely of fat.
Many epileptics have reduced or eliminated seizures by adopting a diet low in sugar and starch and high in saturated animal fats.
Despite everything you’ve heard about saturated fat being linked to cancer, that link is statistically weak. However, there is a strong link between sugar and cancer. In Europe, doctors tell patients, “Sugar feeds cancer.”
Being fat is not, in and of itself, bad for your health. The behaviors that can make you fat - eating excess sugar and starch, not getting any exercise - can also ruin your health, and that’s why being fat is associated with bad health. But it’s entirely possible to be fat and healthy. It’s also possible to be thin while developing Type II diabetes and heart disease.
Saturated fat and cholesterol help produce testosterone. When men limit their saturated fat, their testosterone level drops. So, regardless of what a famous vegan chef believes, saturated fat does not impair sexual performance.

Real vs refined food - an example

From Tom Naughton in Real Food Butter vs. Canola Oil: Spot the Real Food

" Canola oil, as you probably know, is the current “It Girl” among the lipophobes because it’s mostly monosaturated, like olive oil."
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" But the big machines are making butter pretty much like your great-grandmother did: taking cream and churning it with some salt. The end result is real food."
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Chemical solvents, industrial steaming, de-waxing, bleaching, and de-odorizing. Yummy. Have you ever heard of anyone having to de-odorize butter?

Real food on one hand, chemically processed industrial food on the other. And yet we’re supposed to believe it’s the real food that’s bad for us.

Your great-grandmother knew better."

Wednesday, February 23, 2011

The harm of low-fat high-carbohydrate diets in cholesterol uptake in the brain.

JustMEinT has a good article on cholesterol, while mostly not referring to it in relation to heart disease, it non-the-less deals with the importance of cholesterol in our bodies and especially the brain. Following is an exerpt.

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Much research is also being uncovered now on the advantages of high HDL cholesterol levels, besides the study we mentioned above in direct relation to Alzheimer’s. A study appearing in the American Journal of Cardiology earlier this month (February 2011) showed that the higher men’s HDL cholesterol levels, the longer they lived and the more likely it was that they would reach the age of 85.4 A diet with adequate amounts of saturated fat is essential to keeping HDL high cholesterol levels. Those with deficiencies and suffering from neurological disorders need to consider a diet that is high in saturated fat, in stark contrast to the mainstream dietary advice for low-fat diets that might be causing many of these late-in-life diseases.
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I find it terribly sad, and at times seriously frustrating that Doctors are still pushing the Fat is Bad philosophy - theory - rubbish! As I have said before on this blog, Ancel Keys has much to answer for.
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Read the full article here

Other links in the article.
Health Impact News Daily
Coconut Oil
Dr. Mary Newport

Sunday, February 20, 2011

Eat It and Enjoy It from Dwight C. Lundell M.D.

The most recent definitive study of all the competent studies regarding saturated fats and heart disease called a meta-analysis and published in the AJCN January 13, 2010 shows that over a 5 to 23 year follow-up of 347,747 subjects, there is no association between the intake of saturated fat and heart disease or stroke.

(Ref )

The bottom line is that there is no connection between the intake of saturated fat and heart disease or stroke. But there is a connection between the currently recommended high carbohydrate diet and heart disease and stroke.

So enjoy bacon and eggs and forgo the oatmeal and bagels, your LDL will come down your HDL will go up, your weight will go down and your satisfaction with your diet will go up. The low fat diet is the worst dietary advice in the last 50 years and it is the proximate cause of our epidemics of heart disease, diabetes and obesity.

Accurate knowledge cannot come from reading abstracts of articles or reporters' interpretation of the abstract.

Dwight C. Lundell M.D.

Coronary Calcium Scoring

Here are selected quotes from Dr. William R. Davis's Track Your Plaque site on CT heart scans.

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On July 17, 2006, the national experts of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force released guidelines for heart disease detection in the American public.

Why is that news? Aren’t there already guidelines in place for heart disease detection?

Shockingly, there are not. There are guidelines for heart disease risk factor assessment, but no set of guidelines that incorporate measures of atherosclerosis itself—a crucial distinction.

"We believe the time has come to replace the traditional, imprecise risk factor approach to individual risk assessment in primary prevention with an approach largely based on noninvasive screening for the disease itself…"

The SHAPE Task Force Report

American Journal of Cardiology, July 17, 2006

After years of political battling and resistance to CT scanning for coronary calcium scoring, the American Heart Association (AHA) has finally released a formal position paper acknowledging the ability of heart scans to predict heart attacks.

"The majority of published studies have reported that the total amount of coronary calcium (usually expressed as the 'Agatston score') predicts coronary disease events beyond standard risk factors [emphasis ours]. . . These studies demonstrate that coronary artery calcified plaque is both independent of and incremental with respect to traditional risk factors in the prediction of cardiac events."

In essence, the AHA finally agrees that CT heart scans provide information about risk for heart disease that is not revealed by conventional cholesterol testing or other risk predictors.

"The coronary calcium scan is quantitative. In other words, you get a specific and precise score that tells just how much plaque your have. Recall that, although calcium is being measured, calcium is simply a means to measure total plaque since it consistently occupies 20% of plaque volume."

"Many centers acquiring 64-slice devices are hospitals. Hospitals as a general rule are not interested in prevention. They are interested in generating more heart procedures like bypass surgery. Shockingly, even though the 64-slice scanners are able to obtain heart scan scores, many of these centers don’t really care about coronary calcium scoring. They only want the angiograms, since these often lead to costly procedures."

"While not all Track Your Plaque participants can expect zero growth or reduction in heart scan score, the information we provide stacks the odds as heavily as possible in your favor. And we are indeed seeing more and more people obtain plaque regression."

"The principal goal of the Track Your Plaque program is to keep coronary plaque from growing, even reduce the amount of plaque you have. We track the quantity of hidden plaque through your heart scan score. If after one year of effort your score increases >10%, then adjustments to your program should be considered by you and your doctor. Regardless of your starting score or percentile rank, a rate of plaque growth of more than 10% per year is a red flag for escalating risk. It should be taken seriously and a re-examination of your program is in order."

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I am personally working on this powerful technique for myself. I'm newly on board!

The Diet Heart Hypothesis was just that - a Hypothesis.... a thought up scheme, never proven.

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Sunday, January 23, 2011 Here Comes Another $$$ Spinner

Seems there is talk in the food industry that the Fat is bad for you hypothesis is about to lie down and die! Can't say I am sorry, should have happened years ago - sorry Ancel Old Chap!

But why now you may ask...... what could possibly bring on such a huge about face? Couldn't possibly have anything to do with the fact that patents on some pharmaceuticals like Lipitor are or have already run out could it?

The Diet Heart Hypothesis was just that - a Hypothesis.... a thought up scheme, never proven. But because it was making so much money for the investors and companies involved, they fought long and hard to get everyman (grin) and his dog on board and popping their pills.

Now the pills will not make them so much money, they have to look for the next BIG blockbuster drug, with its own peculiar methodology and religion ... to drum up fervor and zeal, thereby making gazillions for the companies and their investors.

Watch out folks the fat is bad religion is about to have a HUGE about face! (please note italics are from the actual article)

However the very foundation of this hypothesis was shaken to the core at the AHA annual conference in Chicago in 2010. Amid great excitement, the pharmaceutical giant Merck revealed results of a preliminary safety study for a drug that could usher in a new age for treatment and prevention of heart disease: a cholesterol raising drug! In the safety study lasting 18 months with 1,600 participants, total cholesterol was raised 20% by the drug anacetrapib without any side effects. An efficacy trail of 30,000 participants with several cardiovascular end-points is scheduled to begin in 2011 and end in 2015 to verify if cholesterol raising can reduce actual incidence of heart disease. But the search for cholesterol raising drugs is not new. Most of the cholesterol lowering statin drugs have reached the limits of their heart protective capabilities (and are near the end of their patent lives). For several years drug companies have been quietly searching for the next blockbuster that will be more effective than statins. One class of candidates is cholesterol raising drugs.

Get ready to throw away your Lipitor folks, they will have a new drug to prescribe you in the near future. I can't wait to see how this unfolds, how they will explain away the untold damage they have done to humankind, by insisting we lower our cholesterol numbers, to unhealthy levels.

But haven't we been told over and over to lower our cholesterol, not increase it? Yes, but the cholesterol story has been repeatedly oversimplified. Total cholesterol is made up of 2 major components, good cholesterol (LDL) and bad cholesterol (HDL). So when your doctor tells you to lower your cholesterol, he really means lower your bad cholesterol – if you inadvertently lower your good cholesterol you could increase your risk of heart disease. The statin drugs selectively lower the bad cholesterol without lowering the good – and they work, reducing risk of heart attack by about 30%. The new class of drugs is designed to increase the good cholesterol, without increasing the bad. So in this case increasing cholesterol is a good thing. The scientific community is hoping that the upcoming Merck study will show a further reduction in risk of heart attack similar in magnitude to the statins – a real breakthrough.

As far as I am concerned, that statement above in red (coloured by me) is a barefaced lie, manufactured by the pharmaceutical industry to keep doctors pushing these drugs onto their patients!

Where does this leave the diet heart hypothesis, saturated fat and the simplified "lower your cholesterol" story? It leaves it in deep trouble. The advent of drugs that increase good cholesterol and thereby reduce risk of heart disease (yet to be proven), will force scientists to take another look at the effects of food ingredients on good cholesterol, not just the total and the bad. Applying this new approach could have a significant impact on national dietary recommendations that are designed to reduce risk of heart disease.

Ohhhh I can hardly wait to see the advertising campaign they work up for this new scheme. Hopefully they will turn the Food Pyramid upside down, while at the same time telling us that fats are good for us! I can dream can't I?

A large body of data showing the effect of food ingredients on both good and bad cholesterol has already been generated over the last 40 years. So far, the evaluation of this data has mostly focused on the bad cholesterol, while neglecting or even ignoring data for good cholesterol. But a review of the data for saturated fat gives a very unexpected result. The food component that increases good cholesterol the most is saturated fat! Yes, the same "artery clogging" saturated fat that has been demonized for decades. Although saturated fat still raises bad cholesterol, it appears that it raises good cholesterol by an equivalent amount and the effect of the bad cholesterol is mostly cancelled out. In this scenario saturated fat is expected to have little or no effect on risk of heart disease.

UFFE was right folks. Eat fat and live!

But good and bad cholesterol are components of blood, and not actual disease. What about direct evidence for the effect of saturated fat on incidence of heart disease? Early in 2010 a large human study measuring the link between intake of food components and heart disease was published. The study included over 340,000 people spanning 23 years. Here is what the authors said about saturated fat: "…there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD." Or in plain English - saturated fats have no effect on heart disease. Although this statement appears to fly in the face of everything we have been taught for decades, it corresponds exactly with powerful ability of saturated fat to increase good cholesterol. Neglect of the positive effect of saturated fat on good cholesterol has made it look worse that it really is.

A convincing body of evidence already exists that saturated fat is not as bad as once thought. Nevertheless public policy continues to demand further big reductions in saturated fat intake. The 2010 Dietary Guidelines Advisory Committee (DGAC) recommended reducing saturates by 5% of the diet. If this huge reduction was ever implemented, the US dairy and meat industries - the main dietary source of saturated fat - would be severely damaged, and all for nothing. Isn't it time to abandon the failed Diet Heart Hypothesis and focus our resources on issues that really make a difference to public health?

The Diet Heart Hypothesis is DEAD folks..... time we buried it and moved on.... be be very very careful, they will make a pill, another blockbuster drug to raise your HDL folks..... when all you need to do is reduce your carbohydrates, white breads, simple starches, junk foods etc, and go back to eating good health fats again.

I wonder how they will breed the fat back into the food chain? Could it be as simple as feeding cattle on grass, and stopping the hormones?

Above Article from: Food Processing.com
Also worth a read:
The Dirty Little Secret of the Diet-Heart Hypothesis
WHY THE CHOLESTEROL-HEART DISEASE THEORY IS WRONG Dr. Malcolm Kendrick M.D.

Friday, February 18, 2011

Eggs and Cholesterol

Article by two I have learned a lot from.

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by Dr. Malcom Kendrick, M.D. and Dr. Duane Graveline, M.D., M.P.H.

According to the U.S. Government's latest guidelines, one egg per day does not result in increased blood cholesterol levels. Nor does it increase the risk of cardiovascular disease in normal people.

What it might have said is that 12 eggs per day will not increase your blood cholesterol or have a significant impact on cardiovascular risk. And the government could say this about many other cholesterol containing foodstuffs such as whole milk and butter.

Four decades ago when the U.S. Government abruptly placed eggs, butter and whole milk on the restricted list, doctors began to counsel patients likewise and warned about the evils of these farm products.

Families were placed on a no egg, margarine instead of butter and low fat milk instead of whole milk diet. The typical farmer's diet from a generation or two ago was homemade butter from Jersey fat, whole milk and plenty of eggs.

For 20 years doctors carried on like this, lackeys to Big Pharma, marching lockstep with medical peers to the music of cholesterol causation of heart disease. When Big Pharma created statins, doctors bowed again in allegiance to them for having given to us this new cholesterol lowering club.

Now after years of researching the true purpose of cholesterol and the terrible consequences of statin use to lower cholesterol we have discovered that cholesterol is not the cause of cardiovascular disease. It has never truly been Public Health Enemy #1.

Foods containing cholesterol don't raise blood cholesterol for several reasons. The main one is that our bodies, like the bodies of all living creatures, are capable of an amazing thing called homeostasis. Namely, keeping the level of things that are important e.g. temperature or potassium levels, at a constant level. No matter what you do on the outside, things remain calm and in control on the inside.

If your body couldn't do this, you would die in about two seconds flat. Looking at cholesterol, our livers synthesize around five times as much cholesterol as you are ever likely to eat in your diet. If you eat less cholesterol, your liver will synthesize more (of this vital substance). If you eat more cholesterol, you liver will synthesize less. This is homeostasis in action.

Quite how much cholesterol you would need to eat to overwhelm your homeostatic system is unknown. Nobody has managed to do it yet. People fed up to ten eggs a day kept their 'cholesterol levels' constant; something first proven by Ancel Keys - ironically the man who almost single handedly created the diet-heart/cholesterol hypothesis in the 1950s.

The body controls 'cholesterol levels' - actually the level of low density lipoprotein (LDL) through the action of LDL receptors in the liver. If the LDL level rises, LDL receptors on the liver catch hold of it, drag it back into the liver and recycle the cholesterol contained within the LDL.

If you have a lack of LDL receptors - the underlying cause of Familial Hypercholesterolaemia (FH) - your LDL/cholesterol level will rise. Not, because of anything you eat. In fact, despite anything you eat. In short, the body normally controls LDL/cholesterol levels within certain levels, completely independent of diet. If this system fails, it has nothing whatsoever to do with what you eat. It is entirely due to errors within your homeostatic system. It is as simple at that.

Cholesterol is perhaps the most important biochemical in our bodies. The true cause of heart attacks and strokes is a form of inflammation. For the past 40 years our dietary guidelines have been wrong. Is anyone coming out with an apology for all this - some words from our national leadership? Don't hold your breath while you are waiting.

The most we will ever get is this really foolish statement, "One egg a day gets the OK." Meanwhile Big Pharma alone has made some 75 billion in profits from the use of statins to lower cholesterol and no doubt the food industry has taken its share as well.

Meanwhile the game has changed. Statins work to lower cardiovascular risk not by cholesterol reduction, which they do well, but by inflammation reduction. The same doctors who put you on statins for cholesterol reduction are keeping you on statins for their anti-inflammatory properties. And testing your blood for cholesterol? Forget about it! From now on we will be using the C-reactive protein test for the level of inflammation in your bloodstream. Cholesterol is the most important biochemical in your body.

Dr. Malcolm Kendrick, M.D.Dr. Kendrick has worked in family practice for almost twenty years.

He has specialized in heart disease and set up the on-line educational website for the European Society of Cardiology.

He is a peer-reviewer for the British Medical Journal.

Duane Graveline MD MPH

Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

Thursday, February 17, 2011

Coronary artery calcium scoring

Jan 31, 2011 @ 1:30AM (i.e. middle of the night while sleeping) I was in Brooke's Point Palawan, I had my sixth heart attack (they say practice makes perfect and so I'm working on it).

At least I'm here to blog about it.
This one was unique in a couple of ways:

1. It was painful. None of the other 5 were in that category.

2. I was quite a ways from real help. The hospital had an ECG/EKG that did make a chart which they said looked abnormal. Wanted to put me on heparin but said otherwise they could only observe me if I accepted their recommendation to be checked in. It was a 120 mile (almost 4 hour ride) north to the airport, then a one hour plane ride, then a 45min drive to my now favorite hospital St Lukes Medical Center where they were capable of acute care.

Well, I made it. Underwent an ECG, Troponin T blood enzime lab test, catheterization exam, etc. etc. etc.

Where to go from here???????

I think I've got a plan.

While in the hospital this time I accidently discovered that this relatively new hospital had facilities to perform a Cardiac Calcium Scoring procedure that uses computed tomography (CT) scan. I had read of this and had been lurking about a source on the web touting it as an effective tool to actually measure plaque buildup not just crystal balling CVD using factors which hadn't worked worth beans in my case in the past - yeah you guessed it basic old cholesterol!

Doesn't sound like that exciting of a find since I know I have cardiovascular disease and therefore plaque buildup. Well it is exciting given the following. If you can quantify it (the calcium score does that) and identify causes you should be able to take steps to slow down, stop, or (stop the presses) even shrink plaque growth - that is begin healing the disease - WOW!

So here's the plan.

1. Get a calcium score. [DONE] (I'm in the 59th percentile by my score, age and gender and I've heard of much worse results than mine).

2. Begin evaluating causes of my CVD by measuring quantifyable and controllable factors. [PARTIALLY DONE].
Have yet to undergo Lipoprotein Analysis using Nuclear Magnetic Resonance (NMR).
Had a VAP Cholesterol test some years back but my cardiologist hadn't a clue what to do with all those 'new' numbers. But the VAP is more complete and actual measured values as opposed to the Friedewald calculated, but not measured, LDL cholesterol approximation most often used today.

3. Take steps to bring into line those specific factors that have been shown to reduce the growth or even actually reduce the quantity of cardiovascular plaque. [ONGOING]

4. Check interim progress (maybe even using some old Friedewald calculated LDL - since it's cheaper) then eventually have another calcium scoring CT scan to measure artery plaque and compare with the score I got today and make adjustments to the process. [FUTURE]

So that's the plan. Won't be a quick fix or even a magic bullet or likely much more than a more educated attempt at reducing the risk of number 7.

I think I like this approach better than the previous approach that gave me sleep robbing muscle aches, low enough "C" numbers to make the cardiologists pat themselves on the back and smile like Cheshire Cats thinking they had saved another doomed soul (oh and according to some clinical trials, may have had something to do with the cancerous intestinal tumor discovered after almost 20 years on statins).

Stay tuned. I'm determined and committed.

If you are interested more in what I'm doing check here and/or here.

Tuesday, February 15, 2011

Lies, damned lies, and statistics

A blog I follow View from the hill just had a good article titled Lies, damned lies, and statistics which has very good points some of which I've feebly discussed here in the past.

Here's a quote exerpting one small paragraph along with a couple of his summary statements of note.

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"There has been much publicity, about the trials of various drugs recently, highlighting the pro's and the con's (literally) of their worth. The use of statin's, for example, was initially believed to be a panacea for low risk (should that be no risk?) patients in the prevention, of future heart disease. But this has been clearly shown to be of little benefit, whilst at the same time as increasing risks for other diseases such as diabetes. The use of statin's in primary prevention is now pretty much a 'dead parrot', but will GP's stop prescribing them for the achievement of a highly dubious surrogate end point? Well, err, no, because they are paid to achieve them by the QOF (Quality Outcomes Framework). And let not the science, get in the way of a nice little earner!"

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"So, long suffering reader, I would urge scepticism in all data, that is presented to you as 'proof' of anything, especially a drug or treatment, that has been provided as a preventative measure by your 'hard pressed' GP."
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"Finally, be a sceptic, and believe only that, which is proven by real science, not Daily Mail headline drivel, or advocacy research, or perhaps worse, what your Doctor tells you (if it's QOF'ed)."

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Please read the complete article here

Saturday, February 12, 2011

Dr. Duane Gravline interviewed - The Common Drug that Destroys Your Memory

Here are several exerpts.

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Dr. Graveline has an interesting background that makes him particularly suited to speak on the topic of statin drugs. He's a medical doctor with 23 years of experience whose health was seriously damaged by a statin drug. His personal questions brought him out of retirement to investigate statins, which he's been doing for the past 10 years.

Dr. Graveline has since published a book about his discoveries called Lipitor: Thief of Memory.

It's now clear that if you take statin drugs without taking CoQ10, your health is at serious risk as statin drugs deplete your body of this essential co-enzyme. As your body gets more and more depleted of CoQ10, you may suffer from fatigue, muscle weakness and soreness, and eventually heart failure. Coenzyme Q10 is also very important in the process of neutralizing free radicals.

medical professionals. They simply do not know better… which is all the more reason to arm yourself with the information you need to take control of your own health. Shunning statin drugs and addressing your lifestyle is the way to go if you have high cholesterol.

More Information

Dr. Graveline covers a lot of information in this interview, so I highly recommend you listen to the entire interview, or read through the transcript. You can also find more information on his web site: www.SpaceDoc.net .

Dr. Graveline's site serves both as a tool for reporting statin complications, and a database of adverse effects, which are then forwarded to the appropriate agencies.

Thursday, February 10, 2011

Saturated Fat Consumption Still isn't Associated with Cardiovascular Disease

Stephan Guyenet on Saturated Fat

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Saturated Fat Consumption Still isn't Associated with Cardiovascular Disease

The American Journal of Clinical Nutrition just published the results of a major Japanese study on saturated fat intake and cardiovascular disease (1). Investigators measured dietary habits, then followed 58,453 men and women for 14.1 years. They found that people who ate the most saturated fat had the same heart attack risk as those who ate the least*. Furthermore, people who ate the most saturated fat had a lower risk of stroke than those who ate the least. It's notable that stroke is a larger public health threat in Japan than heart attacks.

This is broadly consistent with the rest of the observational studies examining saturated fat intake and cardiovascular disease risk. A recent review paper by Dr. Ronald Krauss's group summed up what is obvious to any unbiased person who is familiar with the literature, that saturated fat consumption doesn't associate with heart attack risk (2). In a series of editorials, some of his colleagues attempted to discredit and intimidate him after its publication (3, 4). No meta-analysis is perfect, but their criticisms were largely unfounded (5, 6).

*Actually, people who ate the most saturated fat had a lower risk but it wasn't statistically significant.

Saturated Fat Is Not Associated With Cardiovascular Disease

Anthony Colpo always has very well researched articles. I owe him a lot.

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Saturated Fat Is Not Associated With Cardiovascular Disease

Anthony Colpo

This article originally appeared at AnthonyColpo.com, January 18, 2010.

A couple of weeks back I shared with readers a WHO and FAO-sanctioned review showing that saturated fat and total fat intake were not associated with cardiovascular disease. Hot on the heels of that report comes a similar paper, appearing in the American Journal of Clinical Nutrition, also concluding that saturated fat shows no association with heart disease or stroke.

Researchers from Harvard Univerity and the Children’s Hospital Oakland Research Institute pooled the data from twenty-one prospective epidemiologic studies examining the association of dietary saturated fat with coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) risk.

During 5–23 years’ follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 for CHD, 0.81 for stroke, and 1.00 for CVD. In other words, those who ate the highest amounts of saturated fat had no greater risk of CVD than those who ate the lowest. Consideration of age, sex, and study quality did not change the results[6].

Those of you tempted to dismiss these findings as the work of pro-meat/dairy/egg industry shills or fringe-dwelling skeptics should note that one of the authors, Dr. Ronald Krauss, has worked at the National Heart, Lung, and Blood Institute (NHLBI), has been a Senior Advisor to the National Cholesterol Education Program (NCEP), and is actively involved with the American Heart Association (AHA), having served as Chairman of the Nutrition Committee. He is founder and Chair of the AHA Council on Nutrition, Physical Activity, and Metabolism. The NHLBI, NCEP and AHA have all been key players in gaining global acceptance for the pseudo-scientific absurdity that constitutes the lipid hypothesis of heart disease.

Swedish Farmers Live Longer on Dairy Fat and Veggies

Last year, a study published in the International Journal of Environmental Research and Public Health reported on CHD mortality and morbidity among 1,752 Swedish rural males. During 12-years’ follow-up, 88 died during follow-up, 335 were hospitalized or died due to CVD and 138 were hospitalized or died due to CHD.

When the dietary records of the men were analyzed, the crude unadjusted data showed that consumption of cream and full-fat milk and daily consumption of fruit and vegetables were associated with a lower risk of CHD. When the data was adjusted for confounding factors the only statistically significant dietary factor associated with reduced CHD was the combination of daily fruit and vegetable intake and high dairy fat consumption (relative risk = 0.39). Choosing wholemeal bread or eating fish at least twice a week showed no association with CHD. Farmers developed less coronary heart disease than non-farmers[7].

Japanese with High Cholesterol Live Longer

The Japanese have long been cited in support of the lipid hypothesis, but there is an abundance of research involving Japanese participants showing this hypothesis is in fact complete nonsense. The latest of such studies appeared in the Journal of Lipid Nutrition[8].

Japanese citizens over the age of 40 qualify for free annual health check-ups. The Fukui Study was based on data collected by the Public Health Center of Fukui from such check ups between 1986 and 1990 of residents of Fukui City in Japan. Researchers stratified 22,971 participants into groups according to their cholesterol levels.

Compared with those in the 240-259 mg/dl category, those in the 160-169 mg/dl (both sexes) and the 140-159 mg/dl (women) groups suffered significantly higher all-cause mortality.

Next, the researchers conducted a meta-analysis of five large Japanese studies (including the Fukui Study) with a combined total of over 170,000 subjects to examine cholesterol levels and all-cause mortality.

Participants with cholesterol levels between 160-199 mg/dL were chosen as the reference group. The meta-analysis revealed that the relative risk in the <160 mg/dL group was significantly higher than in the reference group [RR = 1.71], and that the relative risks in the 200-239 mg/dL and >240 mg/dL groups were significantly lower than in the reference group [RRs of 0.83 and 0.78, respectively].

The authors suggest that “Japanese subjects with cholesterol levels >240 mg/dL (>6.22 mmol/L) should not be regarded as hypercholesterolemic or dyslipidemic except when having some genetic disorders like familial hypercholesterolemia because they are in the safest ranges in terms of all-cause mortality”.

NOTE TO JAPAN: Along with muffin tops, Snoop Dogg clothing and Big Brother, cholesterol lowering is one trend from the West you should definitely ignore.

References

1. Siri-Tarino PW, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition. Published ahead of print January 13, 2010. DOI: 10.3945/ajcn.2009.27725.

2. Holmberg S, et al. Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up. International Journal of Environmental Research and Public Health, 2009; 6: 2626-2638.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790097/pdf/ijerph-06-02626.pdf

3. Kirihara Y, et al. The Relationship between Total Blood Cholesterol Levels and All-cause Mortality in Fukui City, and Meta-analysis of This Relationship in Japan. Journal of Lipid Nutrition, 2008; 17 (1): 67-78.

http://www.jstage.jst.go.jp/article/jln/17/1/67/_pdf/-char/ja/

Saturated Fat and Heart Disease

Dwight C. Lundell M.D. has an article at SpaceDoc that reaffirms an important yet under reported fact:

'There never has been any direct evidence that saturated fat caused heart disease or even a mechanism whereby heart disease would happen.'

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Saturated Fat and Heart Disease

by Dwight C. Lundell M.D.

Does the thought of a steak, bacon and eggs, or real milk make you cringe thinking you're instantly clogging up your arteries? How many times have you seen physicians and nutritionists write "artery clogging saturated fats"? For the last 40 years the dietary instructions from governments and other authoritative bodies have told us to avoid all animal fats.

Americans took the message seriously and complied. Average fat consumption decreased, average blood cholesterol levels decreased but their rate of heart disease has continued to rise; the cost of its treatment has continued to rise. Now, in 2011 we have 24 MILLION people diagnosed with diabetes and another 65 million with pre-diabetes and an epidemic of obesity now afflicting over 65% of the population.

The evidence continues to mount that there's no benefit and probable harm from a low fat diet. Two recent examples, the Women's Health Initiative which studied 48,835 women demonstrating no benefit from a low fat diet in terms of heart disease or breast cancer. (Ref 1 ).

The Nurses' Health Study which has followed 90,000 female health professionals, once again demonstrated no reduction in heart disease or cancer, from a low-fat diet. ( Ref 2 ).

Even the famous Framingham study now admits there is no association between dietary fat and heart disease and indeed the association of elevated cholesterol and heart disease is limited to a small segment of the study population. ( Ref 3 ).

The January 2009 American Heart Journal reported that of the 137,000 people admitted to over 500 hospitals in the United States with heart attack, nearly 75% had "normal" LDL cholesterol levels, that is below 130 ( see cholesterol converter for mg / dL to mmol / L conversion ).

The evidence against saturated fat has always been circumstantial. That is, saturated fat was said to elevate blood cholesterol and elevated blood cholesterol was said to cause heart disease therefore saturated fat would cause heart disease. There never has been any direct evidence that saturated fat caused heart disease or even a mechanism whereby heart disease would happen.

Although there are more than a dozen types of saturated fat, humans predominantly consume three; stearic acid, palmitic acid, and lauric acid. These three fats make up 95% of the saturated fat in a piece of prime rib, a slice of bacon, a piece of chicken skin, and nearly 70% of that in butter and whole milk.

It is well established that stearic acid has no affect on cholesterol levels. In fact stearic acid is converted in the liver to oleic acid which is monounsaturated like olive oil and said to be healthy. Most scientists now consider stearic acid to be benign or potentially beneficial. Palmitic and lauric acid do raise LDL cholesterol levels, but they also raise HDL cholesterol levels, and therefore may be beneficial.

Still worried about clogging up your arteries? The question reflects how most people today have become conditioned to eliminate fat from their diet for fear of clogging their arteries. With doctors and medical establishments recommending the elimination of saturated fat, nutritionists and other authors repeating the phrase "artery clogging saturated fats" the media certainly follows and we have formed a deep ingrained belief that saturated fat is evil and unhealthy.

In March of 2009, researchers from the U.S. National Cancer Institute reported that those whose diets contained the highest proportion of red or processed meat had a higher overall risk of death and specifically a higher risk of cancer and heart disease than those who ate the least processed or red meat. ( Ref 4 ).

The press had a field day as the news circulated the wires quickly. Here are a few of the headlines:

"Eating red meat linked to early death, study finds"

"Study shows red meat consumption linked to higher risk of dying from cancer, heart disease"

"Death linked to too much red meat"

Dr. Michael R. Eades wrote a brilliant reply to the fault in this study and the media overreaction in a blog titled Meat and Mortality. ( Ref 5 ).

Here is a brief excerpt:

"At the same time that this paper appeared, showing increased red meat consumption to be tied to a slight increased risk of death (and showing that those subjects eating white meat had less risk), a couple of other papers came out in the online pre-publication section of the American Journal of Clinical Nutrition (AJCN), arguably the world's most prestigious nutritional scientific journal.

These two AJCN papers saw the light of day at around the same time as this highly-publicized study on meat and mortality, but demonstrated the opposite results. They got no press coverage whatsoever. Which proves what I've been saying all along: the press is biased against meat in general, and especially against red meat."

I completely agree with Dr. Eades about the media bias and am surprised by authors who should know better and continue to write "artery clogging saturated fats".

The most recent definitive study of all the competent studies regarding saturated fats and heart disease called a meta-analysis and published in the AJCN January 13, 2010 shows that over a 5 to 23 year follow-up of 347,747 subjects, there is no association between the intake of saturated fat and heart disease or stroke.( Ref 6 ).

The bottom line is that there is no connection between the intake of saturated fat and heart disease or stroke. But there is a connection between the currently recommended high carbohydrate diet and heart disease and stroke.

So enjoy bacon and eggs and forgo the oatmeal and bagels, your LDL will come down your HDL will go up, your weight will go down and your satisfaction with your diet will go up. The low fat diet is the worst dietary advice in the last 50 years and it is the proximate cause of our epidemics of heart disease, diabetes and obesity.

Accurate knowledge cannot come from reading abstracts of articles or reporters' interpretation of the abstract.

Dwight C. Lundell M.D.
http://www.thecureforheartdisease.net/
Chief Medical Consultant, Asantae Inc.
Chief Medical Consultant at www.realweight.com

Dr. Lundell's experience in Cardiovascular & Thoracic Surgery over the last 25 years includes certification by the American Board of Surgery, the American Board of Thoracic Surgery, and the Society of Thoracic Surgeons.

Dr. Lundell was a pioneer in off-pump coronary artery bypass or "beating heart" surgery reducing surgical complications and recovery times.

He has served as Chief resident at the University of Arizona and Yale University Hospitals and later served as Chief of Staff and Chief of Surgery.

He was one of the founding partners of the Lutheran Heart Hospital which became the second largest Heart hospital in the U.S.

Ref 1. http://www.pcrm.org/health/prevmed/pdfs/modest_diet.pdf

Ref 2. http://www.channing.harvard.edu/nhs/

Ref 3. http://www.framinghamheartstudy.org/

Ref 4. http://www.ncbi.nlm.nih.gov/pubmed/19307518

Ref 5. http://www.proteinpower.com/drmike/fast-food/meat-and-mortality/

Ref 6. http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract

Tuesday, February 8, 2011

Therapy versus Life

Much in this article by Dr Harris to make you think, evaluate, agree with or not and for sure consider.

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from PāNu Blog by Kurt G. Harris MD

I mean, when did this happen, really? When did our default self-concept make the turn from life to therapy?

I used to think this was a narcissistic "American" trait. Maybe we yanks spread it to the rest of the post-industrial world, but it seems to be everywhere now. And in the nutrition blogosphere I think it is the biggest dividing line - magical (bs) and neurotic yearning for immortality on one hand and the simple desire to live a good life without premature crippling diseases on the other.

We have people who want to eat healthy, and we have people who are living some perpetual existential crisis where they think you can cheat death and all disease if you just get all the numbers right. I confess these latter people drive me nuts. A huge contingent who think there is a "secret" to health and longevity the way there must be a secret to wealth, early retirement, being happy and finding love. They want to believe none of these worthy things are as hard or elusive as thousands of years of history, if not our own lives, have taught us.

These are the people who buy "The Secret" and books by Tim Ferriss. People who fantasize that life is all about "tricks" and "hacks". Perpetual youth and effortless happiness. Little study or real work required. Everyone can outsource everything and no real value need ever be produced.

Go through your blogroll of nutrition websites and books, and for each one, count how many special supplements are recommended. Then add the number of numerical recommendations for dietary parameters (wide ranges don't count) that are presented as if you might come to harm if you don't follow them. Then add the fraction of food items in our environment that are portrayed as being problematic, if not deadly. Then, add up the annual number of laboratory tests that are described as being critical to monitoring your health and square it. Then, add the total number of drugs that are suggested for otherwise healthy people who have never had a heart attack, cancer or a stroke, intended to treat these laboratory numbers as if they were diseases (they are not), and square that.

Then add them up S + DP + % F + Labs*Labs + Drugs*Drugs = TI

We can call this the "therapy index". I suggest that this therapy index will give you a good insight into the way the writer envisions health. A high TI means the writer thinks you are sick. That we are all sick. That anyone who has ever lived is born sick and needs therapy - their therapy - to be fixed. A catalogue of tricks and hacks and supplements and drugs and obsessive monitoring.

The writer has a weltanshaaung - a world view - that is Cartesian and mechanistic in proportion to the TI. Thinking about health like an engineer or keynesian economist instead of a biologist.

Now if the human diet in the 21st century were just fine, then a score of 0 on the TI might be achievable. PaNu certainly makes proscriptions, but the default stance is life, not therapy. You don't need fixing so much as to just stop injuring yourself.

A Cartesian view of the human organism is most opposed to the primary evolutionary assumption that should inform our thinking - the baseline assumption of a biologically informed view of humans. That there is a dietary metabolic milieu that we are adapted to, and the best chance we have of optimizing our health is to try and emulate it, not arbitrarily "improve" it.

The likelihood that we can "improve" upon this EM2 by doing something or adding something that was not a part of it already is similar to the probability that adding novel organic compounds to the gas tank or oil pan of my Porsche will "improve" its performance.

Not bloody likely.

Living in ketosis 24/7 - even though this requires persistent avoidance of starches or peculiar amounts of coconut

Multivitamins - even though you eat real, whole foods

Antioxidants - even though there is not a shred of evidence for a benefit, and some evidence of harm

Prebiotics and Probiotic supplements - even though you already eat real, whole foods

Fish Oil, Krill Oil, or even copious fish - even though a minority of hominin evolution could have had an excess of marine n-3s and grass fed beef fat and butter is all you need if you avoid TemPOs

Iodine - even though humans evolved the capability to live with a huge range of iodine in the diet - a nonsense book by Brownstein claims that 90% of the population is iodine deficient - actual science shows that iodine downregulates thyroid hormone synthesis and can flare Hashimoto's

Eating well beyond satiety - even though you are getting fat and feel like shit, you have been told by someone that this will "heal" your metabolism

Thyroid hormone - You feel fine and have normal thyroid labs but you take thyroid hormone from pigs every day to "improve" your LDL levels

Here is how it works in my world. When you come to me and tell me my car will last longer if I put some new compound in the gas tank, and the engineers in Stuttgart have never heard of it, and the manual tells me the car was not designed for it and doesn't need it, I say "prove it". Don't theorize, actually prove it. The burden of proof is on you to prove your artificial maneuver that defies the design of the car will make it "better". I have no similar burden - you are the one claiming magic, not me.

PaNu is the precise opposite of this totally speculative therapeutic approach. The car comes into the shop. The owner tells us about how it ran fine until he bought some (bs) elixir and started adding it to the gas tank a few years ago. The first thing we do in my shop is stop adding the elixir.

Here is the important part. Even if we stop adding the damaging elixir, and we are still a bit broken, it does not follow that any other (bs) elixir added to the tank will fix any damage. It might, but there is no more evidence for that than there was for adding some (bs) elixir to the car when it ran fine.

Of course, the car metaphor is apt but incomplete. The human body is not a machine, it is self-regulating biological system. So the fact that this is biology means there is even less reason to add unproven nonsense to our tanks.

My car cannot fix itself. The human body often can if we just stop ruining it.

So I would encourage you to ask yourself, what are you looking for? Do you think there is a "secret"? Are you fantasizing about immortality? Is everything a tweak or a hack or a trick? Do you think every problem in your life can be fixed by changing your diet?

Or do you see life as complex and tragic but sweet and rewarding, and are happy just to stack the odds in your favor with diet and then get on about your other business?

You do have other business than obsessing about what you eat, don't you?
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Visit his blog to hear more from him here.

Monday, February 7, 2011

Athletes And Statins

Tom Naughton writes on statins.

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Athletes And Statins
from Fat Head by Tom Naughton
I spent a good chunk of today dealing with computer issues — both PC and Mac, so while I agree that Macs are generally more stable, the belief that they’re trouble-free has more to do with good advertising than with reality. Anyway, because so much of my day was eaten up, this will be a brief post.

It was yet another bang-up Super Bowl. I love it when the game is in doubt until the very end … although as a Bears fan, I didn’t mind seeing them blow away the Patriots back in 1986. I like the pomp of the Super Bowl, the hype, the buzz, the commercials, the halftime shows, the whole experience. And of course I enjoy the game itself, watching athletes at the very top of their games giving it everything they’ve got.

As I was watching recaps of the game today, it occurred to me that I recently downloaded an article from the British Journal of Clinical Pharmacology on how statins affect professional athletes. I think the title pretty much says it all:

Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

The paper’s authors are from Austria and examined case histories of Austrian professional athletes who attempted to go on statin therapy to treat genetically high cholesterol. Out of 22 athletes, only three were able to tolerate the first statin they were prescribed. Three more were able to eventually tolerate a statin other than the first one prescribed. The remaining 16 — 72% of the total — ended up refusing statin therapy. You can probably guess what it was about statins that most of the athletes couldn’t tolerate: muscle pain and muscle weakness.

The authors noted that in reviews of multiple clinical trials, muscle problems were reported in 5% of those taking statins on average. They also noted that in a study of statin-takers who engage in strenuous exercise, muscle problems affected closer to 25%. Now in this study we’ve got 72% of professional athletes (in an admittedly small sample size) saying they can’t tolerate statins because of muscle problems.

So here’s what I think is happening: statins are probably causing at least some degree of muscle weakness in a large percentage of those taking them. But not everyone whose muscles are weakened will feel pain or even notice the damage, as Dr. Duane Graveline wrote in an article on his web site:

In the Journal of Pathology 210: 94-102, 2006, Draeger A and others of the University of Bern, Switzerland report: Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia.

Draeger’s group did skeletal muscle biopsies from statin treated and non-statin treated patients and examined them using electron microscopy and biochemical approaches. They reported clear evidence of skeletal muscle damage in statin treated patients despite their being asymptomatic. Although the degree of overall damage was minimal, it was the characteristic pattern of damage, including rupture of critical structures that caught the attention of the investigators.

The more you depend on your muscles, the more likely you are to notice minor damage. Most people who sit for a living and aren’t dedicated to exercising could probably become a bit weaker without ever noticing, which would explain why only 5% percent of all statin-takers report muscle problems. But if you limit the study to people who engage in strenuous exercise — and are therefore more likely to track their speed or strength — the number goes up to 25%. Limit the study to professional athletes, and now you’re looking at 72% reporting muscle problems.

For professional athletes, an almost-imperceptible loss of muscular ability can mean the difference between winning and losing. Think about some of the key plays in last night’s Super Bowl, if you watched. A wide receiver catches a pass because he managed to outrun a cornerback by an extra six inches over the course of 30 yards. A linebacker misses a tackle because the tailback was a split-second quicker. “It’s a game of inches” is a cliché in sports, but it’s a cliché because it’s true. The professional athlete who loses a tiny fraction of his speed or strength can find himself sitting on the bench or looking for another job.

So I don’t think professional athletes are especially vulnerable to statin-induced muscle damage. I think they’re just far more likely to notice that damage is being done.
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Check out his web site for the latest here.

The Growth of Cardiovascular Disease

The rest of the story...
By Jon Barron - health researcher.

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Published on The Baseline Of Health Foundation (http://www.jonbarron.org)

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The Growth of Cardiovascular Disease -- Heart Health Newsletter

By jonbarron Created 02/01/2011 - 8:36pm

Heart Health Program & Cardiovascular Disease
Natural Health Newsletter

The Growth of Cardiovascular Disease

Earlier this month, the American Heart Association in its official journal, Circulation, published its forecast of "The Future of Cardiovascular Disease in the United States." For anyone who takes the time to look it over, it makes for depressing reading. According to the forecast, one in three Americans has been diagnosed with some form of heart disease. We're talking about high blood pressure, coronary heart disease, heart failure and stroke, among others. By 2030, the cost to treat heart disease in the United States (in real 2008 dollars) will triple, rising from $273 billion to $818 billion. In addition, it is also estimated that the costs resulting from lost productivity due to cardiovascular disease (CVD) will climb by 61% in that same time period from $172 billion to $276 billion.

That means that the costs of heart disease alone in the United States will climb to over $1 trillion dollars a year. Forget cancer. Forget diabetes. Forget Alzheimer's. Forget hospital errors. Heart disease alone will cost over $1 trillion dollars a year in the US. Needless to say, the AHA report concluded by saying, "Effective prevention strategies are needed if we are to limit the growing burden of CVD."

As the study went on to explain, currently, CVD is the leading cause of death in the United States and constitutes 17% of overall national health expenditures. Even more significant, though, was the study's statement that US medical expenditures are the highest in the world and rose from 10% of the Gross Domestic Product in 1985 to 15% of the Gross Domestic Product in 2008. And in just the last decade, the medical costs of CVD have grown at an average annual rate of 6% and have accounted for 15% of the increase in medical spending. (This is something to think about as Republicans in the House of Representatives promise to return us to the "best healthcare system in the world." As I've said before, the current healthcare bill is terrible, but it's far better than the status quo. Keeping the current system in place is guaranteed bankruptcy. Obamacare needs to be drastically overhauled, not repealed.)

According to the study, the prevalence of cardiovascular disease will increase, based on the status quo, by 10% over the next 20 years assuming there is no change in current policy or lifestyle across the general public, whereas the direct costs will increase almost 3-fold. By 2030, the study estimates, 40% of US adults, or 116 million people, will have one or more forms of CVD.

The report speculated that the largest increases will be in the rate of stroke and heart failure, which will climb to 24.9 percent and 25 percent, respectively. The aging of the population (the elderly are more susceptible to heart disease) combined with the growth in per capita medical spending are the primary drivers of increased CVD costs, which are expected to grow the fastest for ages 65 and over. "These increases translate to an additional 27 million people with hypertension [we'll talk more about that later], eight million with CHD [coronary heart disease], four million with stroke, and three million with heart failure in 2030 relative to 2010."

The costs related to hypertension alone are set to increase $130.4 billion (in 2008 dollars), with a total projected annual cost of $200.3 billion by 2030. If the costs of hypertension are expanded to include how much the presence of hypertension adds to the treatment of other diseases and conditions triggered by hypertension, the increase in annual spending from 2010 to 2030 is $258.3 billion, with a projected annual total cost of $389.0 billion by 2030. All in all, the researchers note, the real medical costs of CHD and heart failure are estimated to increase by 200 percent over the next 20 years with stroke having the highest cost increase in real annual medical costs of 238 percent.

Commenting on the study, Paul Heidenreich, MD, the chair of the AHA expert panel that conducted the study, said, "Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself."

The study's recommendations

So how did the study suggest we cope with this financial tsunami? Its authors, not surprisingly, recommended throwing even more money into the mix. They said that what was needed were more personalized, medically-based approaches to prevention that include assessments of genetic variants, biomarkers, and imaging modalities that could help tailor prevention methods and recommendations to specific individuals. On the other hand, the researchers qualified their recommendation and said, "Despite the great enthusiasm for personalized medicine, further studies are needed to determine whether these personalized approaches are superior (or complementary) to population-based approaches to cardiovascular disease prevention."

The authors also suggested that population-based strategies such as decreasing smoking rates, reducing dietary fat intakes, and improving lipid levels, among others, have in the past, and can continue in the future, help treat high-risk individuals and help prevent their risk for cardiovascular disease. Expanding on this idea, they stated, "Although these projections are sobering, they need not become reality, because CVD is largely preventable. Several studies have demonstrated that individuals with favorable levels of major atherosclerotic risks have a marked reduction in the onset of CHD and heart failure. Similarly, people who follow a healthy lifestyle experience a comparably reduced risk of CHD and stroke. Therefore, a greater focus on prevention may alter these CVD projections in the future."

Why is it that whenever I hear the medical community talk about diet and lifestyle, I'm always reminded of the cholesterol ads that conclude with, "When diet and exercise aren't enough, adding Vytorin can help." In other words, there's always an undertone from the medical community that diet and lifestyle are okay choices if you don't have a serious problem, but drugs and surgery are the only "serious" options when life and death are on the line. As if!

In conclusion, the report stated, "In the public health arena, more evidence-based effective policy, combined with systems and environmental approaches should be applied in the prevention, early detection, and management of cardiovascular disease risk factors…Through a combination of improved prevention of risk factors, and treatment of established risk factors, the dire projection of the health and economic impact of cardiovascular disease can be diminished."

Questioning the study's assumptions

First, let me explain that I have no complaints with the study's primary assumptions:

•That the costs of heart disease are increasing dramatically over the next several decades. (Heck, I've been saying the same thing for the past several decades.)

•There are steps that can be taken that can lower these costs. (No argument here. The whole purpose of the Baseline of Health Foundation is to report on those steps.)

So which assumptions do I have a problem with?

•The study's basic, underlying assumption is that medical care has already dramatically impacted the incidence and mortality rates associated with heart disease (as in Dr. Heidenreich's statement regarding the medical community's "successes in reducing and treating heart disease over the last half century").

•Thus the study also projects that improvements in medical care can further improve patient outcomes and bring costs down…As long as we continue to head down that road, but at an accelerated rate??!

Unfortunately, the simple truth is that the facts on the ground do not support these two assumptions.

On a quick reading, the study might seem to downplay the role of drugs and medical intervention in lowering cholesterol VS the benefits of dietary changes. For example, the study says, "Modest improvements in risk factors earlier in life can have a greater impact than more substantial reductions later in life." Reading further would seem to support the assumption, "If everyone received the 11 recommended prevention activities, myocardial infarctions and strokes would be reduced by 63% and 31%, respectively, in the next 30 years. At more feasible levels of performance, myocardial infarctions and strokes would be reduced by 36% and 20%. Unfortunately, the current use of these prevention activities is suboptimal."

Now you might think these prevention activities refer to diet and lifestyle, but you would be mistaken. A good hint lies in the use of the word "received."

So what, one might ask, are these magical 11 prevention activities? Are they the diet and lifestyle associations we might first have surmised the study seemed to be alluding to or are they medical interventions as I am suggesting? Interestingly, one has to go to another study, also published in Circulation some two years earlier, entitled The Impact of Prevention on Reducing the Burden of Cardiovascular Disease, to find the answer. And what we learn from this study is, "Of the specific prevention activities, the greatest benefits to the US population come from providing aspirin to high-risk individuals, controlling pre-diabetes [two activities that involve controlling blood sugar with medication], weight reduction in obese individuals, lowering blood pressure in people with diabetes [two separate pharmaceutical activities], and lowering LDL cholesterol [four pharmaceutical activities] in people with existing coronary artery disease (CAD)." Not surprisingly, with its heavy emphasis on doctor visits, testing, and lifelong medication, the study also concluded, "As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years." How expensive are we talking about? We'll touch on that a bit later.

The bottom line is that the facts on the ground don't support the study's conclusions. No, I'm not saying that high blood pressure isn't a problem -- just that drug "prevention activities" may not be the best way to lower it. And no, I'm not saying that thick, clotty blood is not a problem -- just that aspirin may not be the best way to alleviate it. And likewise for diabetes and cholesterol. Let's examine.

High blood pressure

According to the Future of Cardiovascular Disease study, "Overall, hypertension has the greatest projected medical cost. The increased prevalence of hypertension is in part attributable to the aging of the population." The study also states that, "Increasing body mass index contributed to 50% of the increase in hypertension. Reversing the obesity epidemic will play a pivotal role in favorably impacting the projected hypertension trends."

That said, the primary recommendation for dealing with high blood pressure (based on the 11 prevention activities), other than weight-loss, is the use of pharmaceuticals -- notably:

•Diuretics, which reduce blood pressure by making you eliminate water from your body. Reduce the volume of fluid in the blood, and you reduce the pressure. Unfortunately, side effects can include dizziness, weakness, and impotence. (Not to worry, there are more medications to alleviate these side effects.) It's also probably worth mentioning that a recent analysis of hypertension drugs found that hydrochlorothiazide, the diuretic of choice for most physicians, actually doesn't even work that well. Now, that's an effective strategy!

•Calcium channel blockers, which work to relax and widen the arteries, thus reducing blood pressure. Unfortunately, studies consistently show an increased risk of heart attacks associated with all types of calcium channel blockers, including short, intermediate, and long acting. Another effective strategy!

•Beta blockers, which work by weakening the heart so it won't pump as strongly, thereby reducing blood pressure. What genius thought this one up? Several major problems associated with beta blockers, in addition to the fact that they don't work that well, is the increased risk of diabetes, sudden and profound weight gain, and increased risk of heart attack during the first two-three months of use. Nevertheless, despite these risks, leading doctors have recommended putting every single heart attack survivor on beta blockers. Brilliant!

•ACE inhibitors (the new drug of choice), which like calcium channel blockers also work to relax and widen the arteries, but with fewer side effects (just "minor" things such as kidney impairment, upper respiratory problems, headache, dizziness, and congenital "anomalies").

Keep in mind that, in addition to all of the side effects that these drugs cause, which require further medication, there is a fundamental flaw in these pharmaceutical treatments. All that these drugs do is treat the "manifest" symptom -- high blood pressure -- but do nothing to deal with the underlying cause -- clogged or hardened arteries. So, eventually, as your arteries continue to clog and harden to the point where even the medication no longer helps, you start getting the inevitable chest pains. Your doctor then chases the next set of symptoms and performs a coronary bypass or angioplasty to relieve those symptoms -- until the next, even more radical, intervention.

As a side note, a study published in 2007 found that angioplasties did not save lives or prevent heart attacks in non-emergency patients. In fact, the study showed angioplasties only give slight and temporary relief from chest pain, and by five years, there was no significant difference in symptoms. Oh yes, we spend $48 billion a year on angioplasties in the U.S. alone.

Then again, in addition to all of the side effects, complications, and dangers of surgery, we are once more presented with yet another fundamental flaw in your doctor's treatment. If all your doctor does is bypass or clear the arteries supplying blood to your heart, doesn't that mean that all of the other arteries in your body are still clogged, including the arteries that supply blood to your brain? You bet it does. Isn't that going to be a problem? Since the arteries are narrowed, won't it be more likely that a small blood clot will get lodged in your brain and cause a stroke? Absolutely! But that's a different "symptom." At this point, your doctor once again prescribes another drug or more dangerous surgery to deal with this problem. . .

Cholesterol

I've covered the issue of cholesterol in detail in my newsletter, The Cholesterol Myth. To better understand the entire issue, check it out. But for now, the following should suffice.

In January of 2008, I wrote about the results from a study sponsored by Merck and Schering-Plough that found that after several years on two types of cholesterol-lowering medications, patients reduced their cholesterol level, but they reaped no significant health benefit at all unless they already had heart disease. (Note: Merck delayed releasing the results for two years, and only when finally pressed to do so.)

But that's not the worst of it. Just a few months later in October 2008, I reported on the results of a study that found that Vytorin may increase the risk of cancer by 50 percent. In fact, this study found that Vytorin increased the risk of cancer in all major areas of the body. In addition, it found that among those who developed cancer, those taking Vytorin had a much higher rate of death than those taking a placebo.

And the bad news on statins just keeps rolling in like the tide in the Bay of Fundy. In July 2009, I talked about a study published in the Canadian Medical Association Journal that confirmed that statin drugs cause structural damage to muscles. Even worse, the study found that muscle damage can continue to progress even after patients stop taking the drugs.

And how much do we pay for these dazzling results? In the US alone, sales of statin drugs generated approximately $19.7 billion in 2005, or about $120 billion when averaged out over a decade.

Aspirin

Even aspirin, the most innocuous of all medications recommended for the prevention of heart attacks, kills. According to the New England Journal of Medicine, "anti-inflammatory drugs (prescription and over-the-counter, which include Advil®, Motrin®, Aleve®, Ordus®, aspirin, and over 20 others) alone cause over 16,500 deaths and over 103,000 hospitalizations per year in the U.S." The simple fact is that even the smallest amount of aspirin, a child's dose, causes at least some degree of intestinal bleeding. In fact, nearly 70% of those taking aspirin daily show a blood loss of ½ to 1½ teaspoons per day, and 10% lose as much as 2 teaspoons per day.

And why would you use aspirin anyway? Proteolytic enzymes such as nattokinase, Endonase, and Seaprose-S are far more effective and far safer. And they do so much more than aspirin, which merely improves the ability of blood to flow. A good proteolytic enzyme formula will:

•Improve the ability of blood to flow.

•Dissolve plaque in the arterial walls by breaking down the protein based fibrin that holds the plaque together.

•Reduce systemic inflammation in the body and in the circulatory system, thus eliminating the prime cause of plaque build-up in the first place.

•And help break down scar tissue in the arterial walls.

And while you're at it, why not significantly reduce consumption of Omega-6 vegetable oils, which includes virtually all of the vegetable oils (corn, safflower, etc.) you buy in the supermarket other than olive oil. If not balanced by sufficient Omega-3 oils in the diet, Omega-6's cause a build-up of non-esterified fatty acids, also known as NEFAs, a significant independent risk factor for sudden death from heart attacks. Switching to more balanced oils costs about the same, not to mention the fact that they actually taste better. It's not like being forced to eat health-food cookies. In fact, the only advantage to using highly processed polyunsaturated cooking oils is that they never go rancid. You can keep them in your cabinet for as long as you live, and they will never go bad. But when you think about it, how comfortable should you feel about eating a food that can "never die?" Does it even qualify as a food anymore?

Diabetes medications

Controlling blood sugar levels makes all the sense in the world. Drugs such as metformin are both reasonably effective and reasonably benign. Insulin injections, not so much. But natural sugar metabolic enhancement formulas are at least as effective, and even more benign, than either medical approach.
But even more important, suppressing high blood sugar numbers addresses neither the cause of the disease nor the other issues associated with it, including insulin resistance, damage from excess insulin, destruction of beta cells, and damage to organs. These are all part of diabetes' "echo effect," and must be addressed if you ultimately want to reverse the disease. In effect, any viable alternative needs to stop all of the echoes -- all of them without exception -- so that nothing bounces back to retrigger problems. Drugs do not do that, which is why diabetes tends to progress over the years, even if you use drugs. Yes, the drugs slow down the progression of the disease, but it still progresses -- unless you actually reverse the cause of the disease itself.
Costs

Amusingly, the cost savings presumed if the medical community gets its way and can implement the 11 prevention activities recommended in both studies with complete success over the next 30 years, would not only not save money -- it would bankrupt us. As the The Impact of Prevention on Reducing the Burden of Cardiovascular Disease study says, "The cost of caring for CVD, diabetes, and CHD over the coming 30 years will be in the order of $9.5 trillion. If all the recommended prevention activities were applied with 100% success, those costs would be reduced by ∼$904 billion, or almost 10%. However, assuming the costs shown in Table 2, the prevention activities themselves would cost ∼$8.5 trillion, offsetting the savings by a factor of almost 10 and increasing total medical costs by ∼$7.6 trillion (162%).

Now that's a brilliant plan!
Salt

And no, I'm not talking about Angelina Jolie's latest movie.

The Forecasting study says, "A reduction in sodium intake is a promising goal for prevention and treatment of hypertension. A recent analysis using the Coronary Heart Disease Policy Model estimated that reducing dietary salt by 3 g per day per person would reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and reduce the annual number of deaths from any cause by 44,000 to 92,000."

At first glance, that statement might seem pretty innocuous and downright commonsensical, but reread it. It talks about reducing dietary salt intake by 3 grams, or 3,000 mg! The United States recommendation for the daily maximum intake of salt is 2,400 mg. Most health experts recommend only 1,500-1,800 mg a day. So what are they talking about? How much salt is actually making its way into people's diets for a recommendation that people reduce consumption by 100-200% of the maximum daily allowance?

Check out this quote from the European Public Health Alliance:

"The current public health recommendations suggest that salt intake should be reduced from 9-12 to 5-6 grams per day for adults. Clinical trials demonstrate a clear link between salt reduction and the fall in blood pressure. A conservative estimate indicates that a reduction of 3 grams per day would reduce strokes by 13% and ischemic heart disease by 10%. The effects would be almost doubled with a 6-gram reduction and tripled with a 9-gram one."

Holy salted beef, Batman! It seems that large numbers of people have become walking salt licks.

All kidding aside, anyone consuming 9-12 g of sodium a day has a problem and is pretty much a walking coronary. But that said, an equally important factor is what type of salt are you consuming? As I've discussed previously, there is a huge difference in how your body handles refined salt and how it handles unrefined, natural sea or Himalayan salt. And be careful, many, many companies are now jumping on the bandwagon and promoting their use of sea salt -- but in many cases, they are using refined sea salt, which is sea salt in name only. Once refined, it is no different from any other commercial salt you can buy...and equally harmful to your body. Make sure that you (or any products you buy) use only unrefined sea or Himalayan salt.

Conclusion

All in all, the report from the American Heart Association on the future of heart disease in the United States (and by extrapolation, anywhere else in the world) is not a bad one. It contains more truth than nonsense -- and when's the last time you heard me say that about a medical study? Unfortunately, it ultimately succumbs to the weight of its medical bias -- the bias that says you can control disease by managing and/or suppressing symptoms. In truth, cardiovascular disease will never truly be controlled (and within any affordable budget for future health care) until medical doctors think more like holistic physicians and deal with the causes of disease rather than just the symptoms.

For more on exactly how the cardiovascular system works, what causes heart disease, and how to reverse it, click here to start reading my series of newsletters on the anatomy and physiology of the cardiovascular system. Also check out our Heart Health page for other related newsletters and blogs
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