The Great Cholesterol Myth, Revised and Expanded

Praise for The Great Cholesterol Myth
“This book reveals the true dietary villain when it “Thanks to the extensive scientific evidence provided
comes to heart disease and it’s not saturated fat! by Bowden and Sinatra, the truth about cholesterol
Backed by scientific research from peer reviewed will hopefully end the utter madness that has plagued
journals, this is an excellent read with potentially our society for far too long. Don’t even think about
life-saving information.” taking another statin drug, cutting your fat and
—NINA TEICHOLZ, New York Times best-selling cholesterol intake, or other ‘heart-healthy’ measures
author of The Big Fat Surprise and executive until you read The Great Cholesterol Myth.”
director of The Nutrition Coalition —JIMMY MOORE, host of Livin’ La Vida Low-Carb, and
co-author of Keto Clarity, Cholesterol Clarity, and The
“Jonny Bowden, Ph.D., and Stephen Sinatra, M.D., Complete Guide to Fasting
have brought the science of cholesterol into the
21st century. This book significantly moves the needle “The Great Cholesterol Myth shows that the primary
on our understanding of health and disease.“ cause of heart attacks is not cholesterol but insulin
—SHAWN BAKER, M.D., author of The Carnivore Diet resistance. Timely and important—it will show you what
steps to take to prevent and reverse heart disease”
“If you want to know the truth about cholesterol, and —STEVEN MASLEY, M.D., FAHA, FACN, C.N.S.,
what you absolutely must do to improve your heart best-selling author of The 30-Day Heart Tune-Up
health, this is the book for you. Jonny Bowden and Dr.
Stephen Sinatra reveal the facts in a compelling and “A must-read for anyone interested in learning how
insightful way. This invaluable book belongs on the deception and financial gain have dominated current
bookshelf of anyone who cares about the truth in diet and cholesterol treatment recommendations, with
medicine and healing.” evidence-based advice on which foods and behavioral
—DANIEL AMEN, M.D., CEO, Amen Clinics, Inc., author of strategies can optimize your health.”
The Daniel Plan, Change Your Brain Change Your Life, —DAVID DIAMOND, PH.D., Professor, Departments
and The End of Mental Illness of Psychology, Molecular Pharmacology
and Physiology, University of South Florida
“There’s a persistent myth in our current culture:
cholesterol and saturated fat are the enemy, leading “Education is the key to health for both the patient
to heart disease and a short life. Jonny Bowden and and the health care provider. The updated ‘Cholesterol
Steven Sinatra break that antiquated paradigm with Myth’ is there for everyone’s education. It is a sign
a hammer of balanced truth! Highly recommended!” of maturity for all to admit when you do not know
—DR. WILL COLE, best-selling author of something and here’s a great introduction to your
The Inflammation Spectrum and Ketotarian learning.”
—GARY FETTKE, once sanctioned Australian
“If you have any lingering fears about cholesterol and orthopedic surgeon and real-food advocate
what it means for your health, read this book! When
you’re done with it, pass it on to your physician!”
—JENNIFER ISENHART, writer/director, Fat Fiction
© 2020 Quarto Publishing Group USA Inc.
Text © 2012, 2020 Jonny Bowden and Stephen Sinatra
Second edition published in 2020
First Published in 2012 by Fair Winds Press, an imprint of The Quarto Group,
100 Cummings Center, Suite 265-D, Beverly, MA 01915, USA.
T (978) 282-9590 F (978) 283-2742 QuartoKnows.com , F.A.C.
All rights reserved. No part of this book may be reproduced in any form without written permission of the copyright owners.
All images in this book have been reproduced with the knowledge and prior consent of the artists concerned, and no
responsibility is accepted by producer, publisher, or printer for any infringement of copyright or otherwise, arising from the
contents of this publication. Every effort has been made to ensure that credits accurately comply with information supplied.
We apologize for any inaccuracies that may have occurred and will resolve inaccurate or missing information in a
GREAT CHOLESTEROL
subsequent reprinting of the book.
Fair Winds Press titles are also available at discount for retail, wholesale, promotional, and bulk purchase.
For details, contact the Special Sales Manager by email at [email protected] or by mail at The Quarto Group,
Attn: Special Sales Manager, 100 Cummings Center, Suite 265-D, Beverly, MA 01915, USA.
24 23 22 21 20 12345
ISBN: 978-1-59233-933-4
Digital ISBN: 978-1-63159-838-8
Digital edition published in 2020

Originally found under the following Library of Congress Cataloging-in-Publication Data
Bowden, Jonny.
The great cholesterol myth : why lowering your cholesterol won’t prevent heart
Revised and Expanded

disease—and the statin-free plan that will / Jonny Bowden and Stephen Sinatra.
p . cm.
ISBN 978-1-59233-521-3
1. Heart--Diseases--Etiology--Popular works. 2. Heart--Diseases--Prevention--Popular
WHY LOWERING YOUR CHOLESTEROL

works. 3. Cholesterol--Physiological aspects--Popular works. 4. Cholesterol--Health
aspects--Popular works. I. Sinatra, Stephen T. II. Title.
WON’T PREVENT HEART DISEASE—

RC682.B68 2012
616.1’2--dc23
2 012023479
Graphs shown on pages 120 and 122 are courtesy of David Diamond, Ph.D. Use with permission. AND THE STATIN-FREE PLAN THAT WILL
Page Layout: Claire MacMaster, barefoot art graphic design
Printed in China
JONNY BOWDEN, PH.D. , C.N.S.
The information in this book is for educational purposes only. It is not intended to replace the advice of a physician or
medical practitioner. Please see your health-care provider before beginning any new health program.
and STEPHEN SINATRA, M.D., F.A.C.C.
© 2020 Quarto Publishing Group USA Inc.
Text © 2012, 2020 Jonny Bowden and Stephen Sinatra
Second edition published in 2020
First Published in 2012 by Fair Winds Press, an imprint of The Quarto Group,
100 Cummings Center, Suite 265-D, Beverly, MA 01915, USA.
T (978) 282-9590 F (978) 283-2742 QuartoKnows.com , F.A.C.
All rights reserved. No part of this book may be reproduced in any form without written permission of the copyright owners.
All images in this book have been reproduced with the knowledge and prior consent of the artists concerned, and no
responsibility is accepted by producer, publisher, or printer for any infringement of copyright or otherwise, arising from the
contents of this publication. Every effort has been made to ensure that credits accurately comply with information supplied.
We apologize for any inaccuracies that may have occurred and will resolve inaccurate or missing information in a subsequent
GREAT CHOLESTEROL
reprinting of the book.
Fair Winds Press titles are also available at discount for retail, wholesale, promotional, and bulk purchase.
For details, contact the Special Sales Manager by email at [email protected] or by mail at The Quarto Group,
Attn: Special Sales Manager, 100 Cummings Center, Suite 265-D, Beverly, MA 01915, USA.
24 23 22 21 20 12345
ISBN: 978-1-59233-933-4
Digital edition published in 2020
Originally found under the following Library of Congress Cataloging-in-Publication Data
Bowden, Jonny.
The great cholesterol myth : why lowering your cholesterol won’t prevent heart
disease—and the statin-free plan that will / Jonny Bowden and Stephen Sinatra.
p . cm.
ISBN 978-1-59233-521-3
1. Heart--Diseases--Etiology--Popular works. 2. Heart--Diseases--Prevention--Popular
works. 3. Cholesterol--Physiological aspects--Popular works. 4. Cholesterol--Health
Revised and Expanded
aspects--Popular works. I. Sinatra, Stephen T. II. Title.
RC682.B68 2012
616.1’2--dc23 WHY LOWERING YOUR CHOLESTEROL
2 012023479
Graphs shown on pages 120 and 122 are courtesy of David Diamond, Ph.D. Use with permission.
WON’T PREVENT HEART DISEASE—
Page Layout: Claire MacMaster, barefoot art graphic design
AND THE STATIN-FREE PLAN THAT WILL
Printed in China
JONNY BOWDEN, PH.D. , C.N.S.
The information in this book is for educational purposes only. It is not intended to replace the advice of a physician or medical
practitioner. Please see your health-care provider before beginning any new health program.
and STEPHEN SINATRA, M.D., F.A.C.C.
CONTENTS
FOREWORD 7
DEDICATION Chapter 1: Why a New Edition of This Book Was Needed 10

To anyone who ever fought against bullying by the medical establishment.
PART ONE 17
I celebrate your courage.
And to every doctor who had the courage to treat the patient instead of the symptom, Chapter 2: Why You Should Be Skeptical of LDL
I celebrate your wisdom. as an Indicator of Heart Disease 18

—Jonny
Chapter 3: Cholesterol Is Harmless 28

To my daughter, Marchann, who is the publisher of www.heartmdinstitute.com, my
Chapter 4: The Real Deal on Cholesterol 43
website. You have assisted me enormously in getting the truth out about integrative

medicine. You are a dedicated patient advocate seeking out the truth in a sea of
Chapter 5: Inflammation and Oxidation 52
camouflage. I’m so blessed to have you in my life. Love, Dad

—SS PART TWO 60
Chapter 6: Sugar: The Real Demon in the Diet 62

Chapter 7: The Truth About Fat: It’s Not What You Think 82

Chapter 8: The Statin Deception 104

Chapter 9: The Real Cause of Heart Disease 129

CONTENTS
FOREWORD 7
DEDICATION Chapter 1: Why a New Edition of This Book Was Needed 10

To anyone who ever fought against bullying by the medical establishment.
PART ONE 17
I celebrate your courage.
And to every doctor who had the courage to treat the patient instead of the symptom, Chapter 2: Why You Should Be Skeptical of LDL
I celebrate your wisdom. as an Indicator of Heart Disease 18

—Jonny
Chapter 3: Cholesterol Is Harmless 28

To my daughter, Marchann, who is the publisher of www.heartmdinstitute.com, my
Chapter 4: The Real Deal on Cholesterol 43
website. You have assisted me enormously in getting the truth out about integrative

medicine. You are a dedicated patient advocate seeking out the truth in a sea of
Chapter 5: Inflammation and Oxidation 52
camouflage. I’m so blessed to have you in my life. Love, Dad

—SS PART TWO 60
Chapter 6: Sugar: The Real Demon in the Diet 62

Chapter 7: The Truth About Fat: It’s Not What You Think 82

Chapter 8: The Statin Deception 104

Chapter 9: The Real Cause of Heart Disease 129

FOREWORD
PART THREE 141
Chapter 10: Beyond the Mediterranean Diet: What Do I Eat? 143
Chapter 11: Help Your Heart with These Supplements 159

Chapter 12: The Science of Healthy Living: Eat, Laugh, Play, Love 182
TWO HUNDRED YEARS AGO physicians routinely bled, actually works. But the fact that the “scientific” basis
APPENDIX A 190 purged, and plastered their patients. Bloodletting was for bloodletting was nonexistent didn’t give pause to
the standard treatment for a host of diseases and had physicians 200 years ago, some of whom applied as
APPENDIX B Beyond Cholesterol Testing: been so since the time of the philosopher-physician many as fifty leeches to a single patient and, in the
What Tests Should I Get? 197
Galen almost 2,000 years before. The theory was that case of George Washington, relieved him of almost

there were four humors: blood, phlegm, black bile, and two quarts of blood in an effort to treat the throat

yellow bile. Blood was dominant, requiring the most infection that, coupled with the physician-caused
ABOUT THE AUTHORS 205
balancing for returning an ill patient to health. anemia, ultimately killed him.
ACKNOWLEDGMENTS 206
Every doctor’s kit was equipped with a variety We look back today and can only shake our
REFERENCES 207
of lancets, brutal–looking scarificators, and, starting heads. And be thankful we, ourselves, don’t have to
INDEX 228
in the early nineteenth century, leeches. In fact, the worry about getting bled by lancet or leech or that
latter were used so often that physicians were them- with today’s modern, truly science-based medicine,
selves commonly referred to as leeches. Learned we would ever be exposed to such nebulously
physicians conferred on the best veins to tap for grounded treatments. Surely with all the scientific
given diseases and the optimal placement of leeches studies performed in great institutions the world
for the most therapeutic value, and countless protocols over, today’s doctors would never ignore the actual
“The mind is like a parachute—it only works if it’s open.” dictated the proper amount of blood to be let or num-
ber of leeches to be applied. Doctors wrote lengthy
evidence and pursue unnecessary and possibly
even harmful treatments. Would they?
—Anthony J. D’Angelo papers describing their own bleeding techniques and Sadly, many doctors today have the same herd
presented them at august medical conferences. mentality as those doctors of yore. By the tens of
The whole idea was nonsense, of course, and has thousands, they treat a nonexistent disease with
been shown to be so in the early 1600s by William drugs that are far from benign. And they do so based
Harvey, the discoverer of how the circulatory system not on any hard scientific data, but because they, like
7
FOREWORD
PART THREE 141
Chapter 10: Beyond the Mediterranean Diet: What Do I Eat? 143
Chapter 11: Help Your Heart with These Supplements 159

Chapter 12: The Science of Healthy Living: Eat, Laugh, Play, Love 182
TWO HUNDRED YEARS AGO physicians routinely bled, actually works. But the fact that the “scientific” basis
APPENDIX A 190 purged, and plastered their patients. Bloodletting was for bloodletting was nonexistent didn’t give pause to
the standard treatment for a host of diseases and had physicians 200 years ago, some of whom applied as
APPENDIX B Beyond Cholesterol Testing: been so since the time of the philosopher-physician many as fifty leeches to a single patient and, in the
What Tests Should I Get? 197
Galen almost 2,000 years before. The theory was that case of George Washington, relieved him of almost

there were four humors: blood, phlegm, black bile, and two quarts of blood in an effort to treat the throat

yellow bile. Blood was dominant, requiring the most infection that, coupled with the physician-caused
ABOUT THE AUTHORS 205
balancing for returning an ill patient to health. anemia, ultimately killed him.
ACKNOWLEDGMENTS 206
Every doctor’s kit was equipped with a variety We look back today and can only shake our
REFERENCES 207
of lancets, brutal–looking scarificators, and, starting heads. And be thankful we, ourselves, don’t have to
INDEX 228
in the early nineteenth century, leeches. In fact, the worry about getting bled by lancet or leech or that
latter were used so often that physicians were them- with today’s modern, truly science-based medicine,
selves commonly referred to as leeches. Learned we would ever be exposed to such nebulously
physicians conferred on the best veins to tap for grounded treatments. Surely with all the scientific
given diseases and the optimal placement of leeches studies performed in great institutions the world
for the most therapeutic value, and countless protocols over, today’s doctors would never ignore the actual
“The mind is like a parachute—it only works if it’s open.” dictated the proper amount of blood to be let or num-
ber of leeches to be applied. Doctors wrote lengthy
evidence and pursue unnecessary and possibly
even harmful treatments. Would they?
—Anthony J. D’Angelo papers describing their own bleeding techniques and Sadly, many doctors today have the same herd
presented them at august medical conferences. mentality as those doctors of yore. By the tens of
The whole idea was nonsense, of course, and has thousands, they treat a nonexistent disease with
been shown to be so in the early 1600s by William drugs that are far from benign. And they do so based
Harvey, the discoverer of how the circulatory system not on any hard scientific data, but because they, like
7
the world over, desperate to find enough actual proof study showed that of almost 140,000 patients admitted
to convert the lipid hypothesis into the lipid fact. But to the hospital for heart disease, almost half of them
Cholesterol is an essential molecule without which so far, they’ve fallen way short. In the process, however, had LDL levels under 100 mg/dL (100 mg/dL has been
there would be no life, so important that virtually they have vastly expanded our knowledge of the bio-
chemistry and physiology of the cholesterol molecule.
the therapeutic target for LDL for the past few years).
Instead of stepping back, scratching their heads, and
every cell in the body is capable of synthesizing it. Thanks to their efforts, we now know that cholesterol thinking, Hmmm, maybe we’re on the wrong track here,
is transported in the blood attached to carrier proteins, the authors of this study concluded that maybe a
and that these protein-cholesterol complexes are called therapeutic level of 100 mg/dL for LDL is still too high
lipoproteins. Their densities now describe these lipo- and needs to be even lower. Such is their lipo-phobic
proteins: HDL (high-density lipoprotein), LDL (low- herd mentality.
their colleagues of 200 years ago, are firmly in the extend their lives by taking these drugs is lost on the density lipoprotein), VLDL (very-low-density lipoprotein), Nutritionist Jonny Bowden, Ph.D., and cardiologist
grip of group think. What is the nonexistent disease? multitude prescribing them, but not, of course, on the and a number of others. Some of these lipoproteins are Stephen Sinatra, M.D., have teamed up in this book
Elevated cholesterol. pharmaceutical industry making and selling them. considered good (HDL) and others bad (LDL). And, of to slash through the tall thicket of misinformation
The vast majority of laypeople have been bombarded How did we come to this sorry state? course, the drug companies have developed medica- surrounding cholesterol, lipoproteins, and the lipid
with so much misinformation about cholesterol that most Sixty years ago a researcher, little known outside tions purported to increase the former while decreasing hypothesis. They wrote their fact-based book using
take it as a given that cholesterol is a bad thing and that of academic circles, singlehandedly set us on this path the latter. easy-to-understand terminology, and present a much
the less they have the better. The reality is that nothing of cholesterol paranoia: Ancel Keys, Ph.D., a proponent But they jumped the gun. Researchers have more valid hypothesis of what really causes heart disease
could be further from the truth. of what has become known as the lipid hypothesis, discovered a type of lipoprotein called small, dense and a host of other diseases such as diabetes, high
Cholesterol is an essential molecule without which concluded that excess cholesterol caused heart disease. (or type B) LDL that may actually end up being a true blood pressure, and obesity, which will open your eyes
there would be no life, so important that virtually every He started out thinking that dietary fat in general drove risk factor for heart disease. Problem is, this small, to the emperor’s state of undress. If you are worried
cell in the body is capable of synthesizing it. Among its cholesterol levels up, but as the years went by, he came dense type B LDL is worsened by the very diet those about your cholesterol level or contemplating taking a
other duties, cholesterol is a major structural molecule, to believe that saturated fat was the true cholesterol- promoting the lipid hypothesis have hailed for decades cholesterol-lowering drug, we urge you to read this
a framework on which other critical substances are raising villain. (This idea of saturated fat as villain is so as the best diet to prevent heart disease: the low-fat, book! This book will put the facts in your hands to make
made. Were we able to somehow remove all its choles- ingrained in the minds of health writers that the words high-carbohydrate diet. Turns out that fat, especially a more informed decision. And we’re confident you will
terol, the body, would, in the words of Shakespeare, “saturated fat” are almost never written alone but saturated fat, decreases the amount of these small, enjoy their book as much as we did.
“melt, thaw and resolve itself into a dew.” And that’s always as “artery-clogging saturated fat.”) Which is dense LDL particles while the widely recommended
not to mention that we wouldn’t have bile acids, vita- more or less the basis for the lipid hypothesis: Saturated low-fat diet increases their number. The opposite of the Michael R. Eades, M.D.
min D, or steroid hormones (including sex hormones), fat runs up cholesterol levels, and elevated cholesterol small dense LDL are large fluffy LDL particles, which Mary Dan Eades, M.D.
all of which are cholesterol-based. leads to heart disease. Nice and simple, but not true. It are not only not harmful but are actually healthful. May 2012
Despite the essential nature of cholesterol, has never been proven, which is why it is still called the But the LDL–lowering drugs lower those, too. Incline Village, Nevada
doctors the world over administer billions of dollars’ lipid hypothesis. Cracks should have appeared in the firm entrench-
worth of drugs to try to prevent its natural synthesis. Because of Keys’s influence, researchers for the ment of the lipid hypothesis (that now basically posits
The fact that only a tiny minority of patients actually past five decades have been beavering away in labs that elevated LDL causes heart disease) when a recent
8 THE GREAT CHOLESTEROL MYTH FOREWORD 9

the world over, desperate to find enough actual proof study showed that of almost 140,000 patients admitted
to convert the lipid hypothesis into the lipid fact. But to the hospital for heart disease, almost half of them
Cholesterol is an essential molecule without which so far, they’ve fallen way short. In the process, however, had LDL levels under 100 mg/dL (100 mg/dL has been
there would be no life, so important that virtually they have vastly expanded our knowledge of the bio-
chemistry and physiology of the cholesterol molecule.
the therapeutic target for LDL for the past few years).
Instead of stepping back, scratching their heads, and
every cell in the body is capable of synthesizing it. Thanks to their efforts, we now know that cholesterol thinking, Hmmm, maybe we’re on the wrong track here,
is transported in the blood attached to carrier proteins, the authors of this study concluded that maybe a
and that these protein-cholesterol complexes are called therapeutic level of 100 mg/dL for LDL is still too high
lipoproteins. Their densities now describe these lipo- and needs to be even lower. Such is their lipo-phobic
proteins: HDL (high-density lipoprotein), LDL (low- herd mentality.
their colleagues of 200 years ago, are firmly in the extend their lives by taking these drugs is lost on the density lipoprotein), VLDL (very-low-density lipoprotein), Nutritionist Jonny Bowden, Ph.D., and cardiologist
grip of group think. What is the nonexistent disease? multitude prescribing them, but not, of course, on the and a number of others. Some of these lipoproteins are Stephen Sinatra, M.D., have teamed up in this book
Elevated cholesterol. pharmaceutical industry making and selling them. considered good (HDL) and others bad (LDL). And, of to slash through the tall thicket of misinformation
The vast majority of laypeople have been bombarded How did we come to this sorry state? course, the drug companies have developed medica- surrounding cholesterol, lipoproteins, and the lipid
with so much misinformation about cholesterol that most Sixty years ago a researcher, little known outside tions purported to increase the former while decreasing hypothesis. They wrote their fact-based book using
take it as a given that cholesterol is a bad thing and that of academic circles, singlehandedly set us on this path the latter. easy-to-understand terminology, and present a much
the less they have the better. The reality is that nothing of cholesterol paranoia: Ancel Keys, Ph.D., a proponent But they jumped the gun. Researchers have more valid hypothesis of what really causes heart disease
could be further from the truth. of what has become known as the lipid hypothesis, discovered a type of lipoprotein called small, dense and a host of other diseases such as diabetes, high
Cholesterol is an essential molecule without which concluded that excess cholesterol caused heart disease. (or type B) LDL that may actually end up being a true blood pressure, and obesity, which will open your eyes
there would be no life, so important that virtually every He started out thinking that dietary fat in general drove risk factor for heart disease. Problem is, this small, to the emperor’s state of undress. If you are worried
cell in the body is capable of synthesizing it. Among its cholesterol levels up, but as the years went by, he came dense type B LDL is worsened by the very diet those about your cholesterol level or contemplating taking a
other duties, cholesterol is a major structural molecule, to believe that saturated fat was the true cholesterol- promoting the lipid hypothesis have hailed for decades cholesterol-lowering drug, we urge you to read this
a framework on which other critical substances are raising villain. (This idea of saturated fat as villain is so as the best diet to prevent heart disease: the low-fat, book! This book will put the facts in your hands to make
made. Were we able to somehow remove all its choles- ingrained in the minds of health writers that the words high-carbohydrate diet. Turns out that fat, especially a more informed decision. And we’re confident you will
terol, the body, would, in the words of Shakespeare, “saturated fat” are almost never written alone but saturated fat, decreases the amount of these small, enjoy their book as much as we did.
“melt, thaw and resolve itself into a dew.” And that’s always as “artery-clogging saturated fat.”) Which is dense LDL particles while the widely recommended
not to mention that we wouldn’t have bile acids, vita- more or less the basis for the lipid hypothesis: Saturated low-fat diet increases their number. The opposite of the Michael R. Eades, M.D.
min D, or steroid hormones (including sex hormones), fat runs up cholesterol levels, and elevated cholesterol small dense LDL are large fluffy LDL particles, which Mary Dan Eades, M.D.
all of which are cholesterol-based. leads to heart disease. Nice and simple, but not true. It are not only not harmful but are actually healthful. May 2012
Despite the essential nature of cholesterol, has never been proven, which is why it is still called the But the LDL–lowering drugs lower those, too. Incline Village, Nevada
doctors the world over administer billions of dollars’ lipid hypothesis. Cracks should have appeared in the firm entrench-
worth of drugs to try to prevent its natural synthesis. Because of Keys’s influence, researchers for the ment of the lipid hypothesis (that now basically posits
The fact that only a tiny minority of patients actually past five decades have been beavering away in labs that elevated LDL causes heart disease) when a recent
8 THE GREAT CHOLESTEROL MYTH FOREWORD 9

So the good news is that we have all kinds of cool tes. We will argue that if you catch the signs of diabe-
ways of measuring sophisticated risk factors that tes early enough, you can prevent heart disease—for
CHAPTER 1 most people never heard of a decade or two ago. Ten many, if not most, people. By the end of chapter 12 we
years ago, for example, few people even knew about hope you will agree with us.
(much less understood) the microbiome—a whole eco- And now for the bad news. Most doctors don’t
logical system of microbes that lives in our gut and know this. Even worse, most are still prescribing power-
WHY A NEW EDITION profoundly affects so many areas of our health. Even
genetic testing, still in its infancy, is nonetheless light-
ful drugs for a condition known as “high cholesterol”
that is a lab test, not a disease, and—to add insult to
OF THIS BOOK WAS NEEDED

years ahead of where it was in the early days of 23 injury—is being measured in an antiquated way.
and Me. There are now at least a dozen cardiac mark- Unfortunately for all of us a very high percentage
ers that we can test that influence the likelihood of of doctors practicing conventional medicine in the
you getting heart disease. And best of all, many of United States still think an LDL cholesterol reading of
these risk factors can be strongly modified by our more than 100 is a big problem. They will reach for
own life choices. their prescription pad the moment it creeps north of
A LOT HAS CHANGED IN THE WAY THE MEDICAL ESTABLISHMENT views cholesterol and heart Every year we meet more and more physicians at 129. A very high percentage of doctors practicing con-
disease since we first came together almost a decade ago to write the original version of The Great conferences who are realizing the importance of ventional medicine in this country also continue to
Cholesterol Myth—and most of those changes have been for the better. inflammation and oxidation in making arteries vulner- believe that fat and cholesterol clog your arteries,
We now have technology that allows us to clearly identify at least thirteen different subtypes of able to plaque. Every year we meet more and more that obesity is caused by eating too much fat, that
cholesterol, many of which behave in unique ways in the body. Being able to measure cholesterol with physicians who have come around to the notion that low-fat diets are generally effective, and that choles-
much greater specificity than ever before is good news indeed, because it gives us much more infor- nutrition and diet—the redheaded stepsister of tradi- terol causes heart disease.
mation and far greater accuracy when it comes to predicting future cardiovascular events. tional medical education—can be powerful allies in the All of which tells us we’ve got a heck of a lot more
The sad news is doctors are mostly still measuring it the old way. Which is equivalent to using a fight against heart disease (and not as previously work to do. Many doctors continue to cling to the old
pad and pencil in the age of the smartphone. We’ll return to this point throughout the book. believed, by sticking to a low-fat diet!). technology, an antiquated method of classifying cho-
We now have sophisticated lab tests to tease out risk factors that have been hiding in plain sight In fact, the connection between diabetes and lesterol into large gross categories of “good” and
for decades—factors we now understand are directly and profoundly connected to heart disease. heart disease—sugar, anyone?—is the central thesis of “bad.” Worse, these same doctors are prescribing pow-
this book. Insulin resistance is something that nearly erful drugs—statins—based almost entirely on the read-
always precedes type 2 diabetes, and, as we will out from a test that should have been dumped in the
argue, is an early warning sign of heart disease. dustbin of out-of-date medical ideas a long time ago.
Understanding insulin resistance—and how to pre-
vent, treat, and even reverse it—is one of the most THE PROMISE OF THIS BOOK
important things you can do if you want to prevent The promise of this book is that we are going to set
heart disease. We’ve all heard of pre-diabetes, but we you straight on the subject of cholesterol and heart
suggest that “pre-heart disease” is just as real a disease. We’re probably going to anger a lot of the
phenomenon, and that phenomenon is called diabe- conventional medicine crowd, but we hope we’re also
10 THE GREAT CHOLESTEROL MYTH WHY A NEW EDITION OF THIS BOOK WAS NEEDED 11
So the good news is that we have all kinds of cool tes. We will argue that if you catch the signs of diabe-
ways of measuring sophisticated risk factors that tes early enough, you can prevent heart disease—for
CHAPTER 1 most people never heard of a decade or two ago. Ten many, if not most, people. By the end of chapter 12 we
years ago, for example, few people even knew about hope you will agree with us.
(much less understood) the microbiome—a whole eco- And now for the bad news. Most doctors don’t
logical system of microbes that lives in our gut and know this. Even worse, most are still prescribing power-
WHY A NEW EDITION profoundly affects so many areas of our health. Even
genetic testing, still in its infancy, is nonetheless light-
ful drugs for a condition known as “high cholesterol”
that is a lab test, not a disease, and—to add insult to
OF THIS BOOK WAS NEEDED

years ahead of where it was in the early days of 23 injury—is being measured in an antiquated way.
and Me. There are now at least a dozen cardiac mark- Unfortunately for all of us a very high percentage
ers that we can test that influence the likelihood of of doctors practicing conventional medicine in the
you getting heart disease. And best of all, many of United States still think an LDL cholesterol reading of
these risk factors can be strongly modified by our more than 100 is a big problem. They will reach for
own life choices. their prescription pad the moment it creeps north of
A LOT HAS CHANGED IN THE WAY THE MEDICAL ESTABLISHMENT views cholesterol and heart Every year we meet more and more physicians at 129. A very high percentage of doctors practicing con-
disease since we first came together almost a decade ago to write the original version of The Great conferences who are realizing the importance of ventional medicine in this country also continue to
Cholesterol Myth—and most of those changes have been for the better. inflammation and oxidation in making arteries vulner- believe that fat and cholesterol clog your arteries,
We now have technology that allows us to clearly identify at least thirteen different subtypes of able to plaque. Every year we meet more and more that obesity is caused by eating too much fat, that
cholesterol, many of which behave in unique ways in the body. Being able to measure cholesterol with physicians who have come around to the notion that low-fat diets are generally effective, and that choles-
much greater specificity than ever before is good news indeed, because it gives us much more infor- nutrition and diet—the redheaded stepsister of tradi- terol causes heart disease.
mation and far greater accuracy when it comes to predicting future cardiovascular events. tional medical education—can be powerful allies in the All of which tells us we’ve got a heck of a lot more
The sad news is doctors are mostly still measuring it the old way. Which is equivalent to using a fight against heart disease (and not as previously work to do. Many doctors continue to cling to the old
pad and pencil in the age of the smartphone. We’ll return to this point throughout the book. believed, by sticking to a low-fat diet!). technology, an antiquated method of classifying cho-
We now have sophisticated lab tests to tease out risk factors that have been hiding in plain sight In fact, the connection between diabetes and lesterol into large gross categories of “good” and
for decades—factors we now understand are directly and profoundly connected to heart disease. heart disease—sugar, anyone?—is the central thesis of “bad.” Worse, these same doctors are prescribing pow-
this book. Insulin resistance is something that nearly erful drugs—statins—based almost entirely on the read-
always precedes type 2 diabetes, and, as we will out from a test that should have been dumped in the
argue, is an early warning sign of heart disease. dustbin of out-of-date medical ideas a long time ago.
Understanding insulin resistance—and how to pre-
vent, treat, and even reverse it—is one of the most THE PROMISE OF THIS BOOK
important things you can do if you want to prevent The promise of this book is that we are going to set
heart disease. We’ve all heard of pre-diabetes, but we you straight on the subject of cholesterol and heart
suggest that “pre-heart disease” is just as real a disease. We’re probably going to anger a lot of the
phenomenon, and that phenomenon is called diabe- conventional medicine crowd, but we hope we’re also
going to win over a few converts. Like politics, • Lowering cholesterol does not save lives—and this If this book has one single, actionable takeaway, case heart disease. And if the HDL-LDL cholesterol
nutrition and medicine are very polarized. But unlike has been shown in study after study. it’s this: Get tested for insulin resistance. There are test did in fact predict whether a given patient is
politics, there is a large group of “independent • Problematic blood measurements, such as high many ways to test for insulin resistance—we’ll discuss likely to get heart disease, there’d be no reason for
voters” in the fields of nutrition and medicine, doctors blood sugar, are actually markers of dysfunction them all in chapter 9—but test for it you must. It can this discussion.
and patients alike, who look for the truth wherever that show up fairly late in the game. By the time reveal problems years, or even decades, before you But it doesn’t.
it’s to be found and don’t cling stubbornly to official these traditional red flags show up on your get a diagnosis of either diabetes or cardiovascular Sorry to be the bearer of bad news, but the test—
talking points. It’s those independents that we hope annual blood test, you could already be well on disease. which, back in the 1960s, was considered state-of-the-
we can win over with our message that it’s time to the road to pre-diabetes. And remember, The best news is that you can stop insulin resis- art—has become obsolete. Given the far more accu-
move beyond—way beyond—conventional cholesterol pre-diabetes is diabetes; it’s just not official yet. tance—and most often reverse it—with diet. Really. rate measures we now have at our disposal, the old-
testing and conventional dietary prescriptions for And diabetes is pre-heart disease. You cannot You won’t need a single pharmaceutical drug to fashioned HDL-LDL test is long past its expiration
heart disease. ignore the early warning signs of diabetes, and reverse insulin resistance if you get it early enough date. The prescription you got from your doctor to
Which, if you haven’t already noticed, don’t work unfortunately, most doctors only look for the and make the right dietary changes. And if you do prevent heart disease was very likely based on a test
very well. ones that show up after the damage has already identify insulin resistance early, you can probably that’s just about as useful as a horoscope from
We feel the message of this book is so impor- started. prevent it from morphing into a heart attack down People magazine.
tant—and so potentially life-saving—we want you to the road. Researchers writing in the medical journal How do we know this? Because when you plug in
hear it right now, on the first few pages. Maybe it will Fully one-third of those with full-blown diabetes Diabetes Care said it eloquently: “Insulin resistance is the other, far more accurate predictors of heart dis-
prompt a conversation with your doctor, or even moti- don’t know they have it, and the vast majority of likely the most important single cause of coronary ease—which we’ll talk about throughout this book—it
vate you to consider a different approach to the pre- those with early signs of diabetes are utterly clueless artery disease,” adding that in young adults prevent- turns out many people with “high LDL” actually have
vention of your own heart disease. If our book has about their condition and the disaster that may await ing insulin resistance would prevent approximately 42 very low risk for heart disease. Conversely, many
3
some small part in accomplishing that, we will con- them further down the path. We’ll explain the rela- percent of heart attacks! people with “low LDL” can have a very high risk for
sider our mission accomplished. Here’s what you need tionship between diabetes and heart disease through- a cardiovascular event. (This was true for one of
to know: out the book, but for now just keep in mind that more NOW LET’S TALK ABOUT STATINS the authors.)
• Cholesterol does not cause heart disease. than 80 percent of diabetics die of cardiovascular Are you on a statin drug? The danger of continuing to rely on this obsolete
Cholesterol is involved in heart disease, but not disease. Do the math. If you are, it’s almost certainly because your doc- test cuts both ways—many people who have “high
in the way most people think it is. Cholesterol Insulin resistance is diabetes’ first metabolic foot- tor was worried about your LDL cholesterol number LDL” but are actually at low risk are being over-
levels—as currently measured—do not even predict print, the clue that shows up well before things go being too high. And if you aren’t on a statin drug, it’s treated with powerful medications that come with a
1
heart disease (let alone cause it). deeply south. Insulin resistance syndrome more than probably because your doctor thought your LDL cho- long list of side effects (see chapter 8). Meanwhile,
• The cholesterol test your doctor currently gives doubles the risk of diabetes, which in turn more than lesterol number was just fine, hence no need for pre- many people who have “low LDL,” but actually have a
2
you— the one for “good” and “bad” cholesterol”— doubles the risk of dying of heart disease or stroke. ventive treatment. high risk for an event, are walking around untreated,
is obsolete. There are at least thirteen identified The good news: Insulin resistance itself can be In both cases, there’s an excellent chance that your thinking everything’s just fine. And that’s tragic.
subtypes of cholesterol—not two—making it all the detected many years before an official diagnosis of doctor was dead wrong. This book will explain why. Think of it this way: Knowing someone’s HDL and
more mystifying that doctors continue to stick to diabetes or heart disease, which means you can inter- Remember, the only real importance of the HDL- LDL is like knowing their political party. But political
measuring two. rupt the path of heart disease for a double-digit LDL cholesterol test is to predict an outcome—in this party does not always predict the way someone is
percentage of the population.
going to win over a few converts. Like politics, • Lowering cholesterol does not save lives—and this If this book has one single, actionable takeaway, case heart disease. And if the HDL-LDL cholesterol
nutrition and medicine are very polarized. But unlike has been shown in study after study. it’s this: Get tested for insulin resistance. There are test did in fact predict whether a given patient is
politics, there is a large group of “independent • Problematic blood measurements, such as high many ways to test for insulin resistance—we’ll discuss likely to get heart disease, there’d be no reason for
voters” in the fields of nutrition and medicine, doctors blood sugar, are actually markers of dysfunction them all in chapter 9—but test for it you must. It can this discussion.
and patients alike, who look for the truth wherever that show up fairly late in the game. By the time reveal problems years, or even decades, before you But it doesn’t.
it’s to be found and don’t cling stubbornly to official these traditional red flags show up on your get a diagnosis of either diabetes or cardiovascular Sorry to be the bearer of bad news, but the test—
talking points. It’s those independents that we hope annual blood test, you could already be well on disease. which, back in the 1960s, was considered state-of-the-
we can win over with our message that it’s time to the road to pre-diabetes. And remember, The best news is that you can stop insulin resis- art—has become obsolete. Given the far more accu-
move beyond—way beyond—conventional cholesterol pre-diabetes is diabetes; it’s just not official yet. tance—and most often reverse it—with diet. Really. rate measures we now have at our disposal, the old-
testing and conventional dietary prescriptions for And diabetes is pre-heart disease. You cannot You won’t need a single pharmaceutical drug to fashioned HDL-LDL test is long past its expiration
heart disease. ignore the early warning signs of diabetes, and reverse insulin resistance if you get it early enough date. The prescription you got from your doctor to
Which, if you haven’t already noticed, don’t work unfortunately, most doctors only look for the and make the right dietary changes. And if you do prevent heart disease was very likely based on a test
very well. ones that show up after the damage has already identify insulin resistance early, you can probably that’s just about as useful as a horoscope from
We feel the message of this book is so impor- started. prevent it from morphing into a heart attack down People magazine.
tant—and so potentially life-saving—we want you to the road. Researchers writing in the medical journal How do we know this? Because when you plug in
hear it right now, on the first few pages. Maybe it will Fully one-third of those with full-blown diabetes Diabetes Care said it eloquently: “Insulin resistance is the other, far more accurate predictors of heart dis-
prompt a conversation with your doctor, or even moti- don’t know they have it, and the vast majority of likely the most important single cause of coronary ease—which we’ll talk about throughout this book—it
vate you to consider a different approach to the pre- those with early signs of diabetes are utterly clueless artery disease,” adding that in young adults prevent- turns out many people with “high LDL” actually have
vention of your own heart disease. If our book has about their condition and the disaster that may await ing insulin resistance would prevent approximately 42 very low risk for heart disease. Conversely, many
3
some small part in accomplishing that, we will con- them further down the path. We’ll explain the rela- percent of heart attacks! people with “low LDL” can have a very high risk for
sider our mission accomplished. Here’s what you need tionship between diabetes and heart disease through- a cardiovascular event. (This was true for one of
to know: out the book, but for now just keep in mind that more NOW LET’S TALK ABOUT STATINS the authors.)
• Cholesterol does not cause heart disease. than 80 percent of diabetics die of cardiovascular Are you on a statin drug? The danger of continuing to rely on this obsolete
Cholesterol is involved in heart disease, but not disease. Do the math. If you are, it’s almost certainly because your doc- test cuts both ways—many people who have “high
in the way most people think it is. Cholesterol Insulin resistance is diabetes’ first metabolic foot- tor was worried about your LDL cholesterol number LDL” but are actually at low risk are being over-
levels—as currently measured—do not even predict print, the clue that shows up well before things go being too high. And if you aren’t on a statin drug, it’s treated with powerful medications that come with a
1
heart disease (let alone cause it). deeply south. Insulin resistance syndrome more than probably because your doctor thought your LDL cho- long list of side effects (see chapter 8). Meanwhile,
• The cholesterol test your doctor currently gives doubles the risk of diabetes, which in turn more than lesterol number was just fine, hence no need for pre- many people who have “low LDL,” but actually have a
2
you— the one for “good” and “bad” cholesterol”— doubles the risk of dying of heart disease or stroke. ventive treatment. high risk for an event, are walking around untreated,
is obsolete. There are at least thirteen identified The good news: Insulin resistance itself can be In both cases, there’s an excellent chance that your thinking everything’s just fine. And that’s tragic.
subtypes of cholesterol—not two—making it all the detected many years before an official diagnosis of doctor was dead wrong. This book will explain why. Think of it this way: Knowing someone’s HDL and
more mystifying that doctors continue to stick to diabetes or heart disease, which means you can inter- Remember, the only real importance of the HDL- LDL is like knowing their political party. But political
measuring two. rupt the path of heart disease for a double-digit LDL cholesterol test is to predict an outcome—in this party does not always predict the way someone is
percentage of the population.
going to vote. In fact, on many important issues, if cholesterol” test replaced by measures that do a far
you want to make an accurate prediction on how better job of accurately predicting cardiovascular dis-
“WHAT DOES MY CHOLESTEROL TEST MEAN?”
someone is going to vote, it’s far more important to ease than “LDL cholesterol.”
Dr. Jonny: A friend of mine recently brought me his cholesterol test. He showed me four
know their age, sex, and whether or not they’re mar-
measurements: total cholesterol, HDL, LDL, and triglycerides. He asked me, based on these
ried than it is to know whether they’re a Republican A GUIDE TO USING THIS BOOK
numbers, to tell him whether or not I thought he was at a risk for an “event.”
or a Democrat. In this first part of the book, you’ll learn exactly what
I explained that, based on these numbers, there was no way to tell.
And it’s the same thing with heart disease. Except cholesterol is, and what it isn’t, and how it really
Let me explain.
it’s far more serious that your predictions be accu- works in the body. (Be prepared to be surprised.) In
Let’s say you’re playing poker against someone who has two deuces showing. What can you
rate. Make a mistake predicting how someone’s going clear understandable terms you’ll learn how
positively say about that hand? Not much, really. You can say for sure that he doesn’t have a
to vote and it’s not really a big deal. Make a mistake atherosclerosis actually develops, and you’ll
royal flush or a straight. But without knowing the other three cards, there’s no way you can
about whether someone is at risk for heart disease understand the critical role of chronic inflammation
predict whether he has a winning (or losing) hand. You have to decide to bet (or not bet) based
and, well, it’s a very big deal—especially if that some- and oxidative damage.
on incomplete evidence, which is why poker is ultimately a game of “chance.”
one is you or a member of your family. Then in part two, we’ll introduce the real villain of
But you don’t want guessing about heart disease to be a game of chance. And you don’t
That is exactly why we want to see the “HDL-LDL” the heart disease story: sugar. You’ll see why sugar
want it to be based on incomplete evidence. HDL and LDL are like the visible two cards in a
test retired forever, replaced by the far more sophisti- got a free pass all these past few decades while fat
poker hand. Your doctor is “betting” on whether or not you’re going to get heart disease
cated and accurate measures of cardiovascular risk was blamed for our health woes, and you’ll come to
based on this woefully incomplete information.
that we now have available. These measures include see what a huge mistake that was. (And it’s still going
This is a tragedy for two reasons. One, because whether or not you’re at risk for a heart
ApoB, total particle number, and insulin resistance, all on.) You’ll see the clear lines from sugar and starch
attack is way more consequential than whether or not you have a winning poker hand. And
of which we will go over during the course of this book. intake to diabetes, and the frighteningly short line
two, because your doctor now has an easily accessible way to check the other three cards so
If you are one of the millions of people who got a from diabetes to heart disease. You’ll also come to
she doesn’t have to guess!
clean bill of health because of low LDL, but your total understand the very insignificant role dietary fat plays
particle number was actually very high, you are at in all of this. Finally, you’ll learn a lot about the real
great risk and are going untreated. (This was exactly effects of statin drugs and how clever and insidious
the case with Jonny.) Similarly, if you’re one of the marketing has made them into the blockbuster drugs
millions of people on a statin because of high LDL but they are today.
your total particle number is actually very low, you’re In part three, we’ll tell you the way to combat the years of combined experience in the health field—have you play.
probably on a medication you don’t need and putting real promoters of heart disease—inflammation and firmly and independently concluded that it’s not just They are all related. They all matter. And every
up with side effects that you don’t have to endure. insulin resistance. We’ll talk about the things you can what you eat and how you exercise that determines one of them has an impact on the health of your
Study after study shows us that relying on LDL do to build and maintain a healthy heart for decades your health, though those things certainly matter. But heart. A lot more than your cholesterol level does.
alone misses an awful lot of heart disease. That’s a lot and decades: food, supplements, activity, relation- it’s also how you love, how you think, how you feel, Enjoy the journey of discovery that awaits you.
of people dying because they were diagnosed using ships, community. We kiddingly referred to this last how you digest, how you manage stress, how you con-
an obsolete test. Our hope is that this book will section of the book as our “Eat-Play-Love” section, tribute, how you sleep, how you kick back and relax,
change that. It’s our mission to see the “good and bad but only half in jest. Both of us—with more than eighty how you meditate, how you contemplate, and how
going to vote. In fact, on many important issues, if cholesterol” test replaced by measures that do a far
you want to make an accurate prediction on how better job of accurately predicting cardiovascular dis-
“WHAT DOES MY CHOLESTEROL TEST MEAN?”
someone is going to vote, it’s far more important to ease than “LDL cholesterol.”
Dr. Jonny: A friend of mine recently brought me his cholesterol test. He showed me four
know their age, sex, and whether or not they’re mar-
measurements: total cholesterol, HDL, LDL, and triglycerides. He asked me, based on these
ried than it is to know whether they’re a Republican A GUIDE TO USING THIS BOOK
numbers, to tell him whether or not I thought he was at a risk for an “event.”
or a Democrat. In this first part of the book, you’ll learn exactly what
I explained that, based on these numbers, there was no way to tell.
And it’s the same thing with heart disease. Except cholesterol is, and what it isn’t, and how it really
Let me explain.
it’s far more serious that your predictions be accu- works in the body. (Be prepared to be surprised.) In
Let’s say you’re playing poker against someone who has two deuces showing. What can you
rate. Make a mistake predicting how someone’s going clear understandable terms you’ll learn how
positively say about that hand? Not much, really. You can say for sure that he doesn’t have a
to vote and it’s not really a big deal. Make a mistake atherosclerosis actually develops, and you’ll
royal flush or a straight. But without knowing the other three cards, there’s no way you can
about whether someone is at risk for heart disease understand the critical role of chronic inflammation
predict whether he has a winning (or losing) hand. You have to decide to bet (or not bet) based
and, well, it’s a very big deal—especially if that some- and oxidative damage.
on incomplete evidence, which is why poker is ultimately a game of “chance.”
one is you or a member of your family. Then in part two, we’ll introduce the real villain of
But you don’t want guessing about heart disease to be a game of chance. And you don’t
That is exactly why we want to see the “HDL-LDL” the heart disease story: sugar. You’ll see why sugar
want it to be based on incomplete evidence. HDL and LDL are like the visible two cards in a
test retired forever, replaced by the far more sophisti- got a free pass all these past few decades while fat
poker hand. Your doctor is “betting” on whether or not you’re going to get heart disease
cated and accurate measures of cardiovascular risk was blamed for our health woes, and you’ll come to
based on this woefully incomplete information.
that we now have available. These measures include see what a huge mistake that was. (And it’s still going
This is a tragedy for two reasons. One, because whether or not you’re at risk for a heart
ApoB, total particle number, and insulin resistance, all on.) You’ll see the clear lines from sugar and starch
attack is way more consequential than whether or not you have a winning poker hand. And
of which we will go over during the course of this book. intake to diabetes, and the frighteningly short line
two, because your doctor now has an easily accessible way to check the other three cards so
If you are one of the millions of people who got a from diabetes to heart disease. You’ll also come to
she doesn’t have to guess!
clean bill of health because of low LDL, but your total understand the very insignificant role dietary fat plays
particle number was actually very high, you are at in all of this. Finally, you’ll learn a lot about the real
great risk and are going untreated. (This was exactly effects of statin drugs and how clever and insidious
the case with Jonny.) Similarly, if you’re one of the marketing has made them into the blockbuster drugs
millions of people on a statin because of high LDL but they are today.
your total particle number is actually very low, you’re In part three, we’ll tell you the way to combat the years of combined experience in the health field—have you play.
probably on a medication you don’t need and putting real promoters of heart disease—inflammation and firmly and independently concluded that it’s not just They are all related. They all matter. And every
up with side effects that you don’t have to endure. insulin resistance. We’ll talk about the things you can what you eat and how you exercise that determines one of them has an impact on the health of your
Study after study shows us that relying on LDL do to build and maintain a healthy heart for decades your health, though those things certainly matter. But heart. A lot more than your cholesterol level does.
alone misses an awful lot of heart disease. That’s a lot and decades: food, supplements, activity, relation- it’s also how you love, how you think, how you feel, Enjoy the journey of discovery that awaits you.
of people dying because they were diagnosed using ships, community. We kiddingly referred to this last how you digest, how you manage stress, how you con-
an obsolete test. Our hope is that this book will section of the book as our “Eat-Play-Love” section, tribute, how you sleep, how you kick back and relax,
change that. It’s our mission to see the “good and bad but only half in jest. Both of us—with more than eighty how you meditate, how you contemplate, and how
PART ONE
In part one, we tell you how we came together to write the original edition
of The Great Cholesterol Myth. We’ll take you on our own personal journeys
of discovery, when our suspicions were (independently) raised about
whether we had been told the whole story about fat and cholesterol.
You’ll see how we went from being true believers in the low-fat diet and
in the cholesterol hypothesis, to disrupters and challengers of conventional
thinking about heart disease, cholesterol, and statin drugs.
17
PART ONE
In part one, we tell you how we came together to write the original edition
of The Great Cholesterol Myth. We’ll take you on our own personal journeys
of discovery, when our suspicions were (independently) raised about
whether we had been told the whole story about fat and cholesterol.
You’ll see how we went from being true believers in the low-fat diet and
in the cholesterol hypothesis, to disrupters and challengers of conventional
thinking about heart disease, cholesterol, and statin drugs.
17
Many of the general dietary guidelines accepted DR. JONNY
and promoted by the government and by major Before I became a nutritionist and ultimately an
CHAPTER 2 health organizations such as the American Heart author, I was a personal trainer. I worked at Equinox
Association are either directly or indirectly related to Fitness Clubs in New York City, and the vast majority
cholesterol phobia. These standard guidelines warn us of my clients were there for one thing: weight loss. It
to limit the amount of cholesterol we eat, despite the was 1990. Fat was considered dietary enemy number
WHY YOU SHOULD BE fact that for at least 95 percent of the population,
cholesterol in the diet has virtually no effect on cho-
one, and saturated fat was considered especially bad
because we all “knew” it clogged your arteries, raised
SKEPTICAL OF LDL
lesterol in the blood. your cholesterol, and led to heart disease. So, like
These guidelines warn us of the dangers of satu- most trainers, I put my clients on low-fat diets and
AS AN INDICATOR
rated fat, despite the fact that the relationship encouraged them to do a ton of aerobics plus a little
between saturated fat in the diet and heart disease bit of weight training.
has never been convincingly demonstrated, and Which worked.
OF HEART DISEASE despite the fact that research shows that replacing
saturated fat in the diet with carbohydrates actually
Sometimes.
More often than not, the strategy bombed.
1
increases the risk for heart disease. Take Al, for example. Al was an incredibly suc-
THE TWO OF US CAME TOGETHER TO WRITE THIS BOOK because we believe that you have Both of us became skeptical of the cholesterol cessful, powerful businessman in his early sixties with
been completely misled, misinformed, and in some cases, directly lied to about cholesterol. theory at different points in our careers, traveling a huge belly he just couldn’t get rid of. He was eating
We believe that misinformation, scientifically questionable studies, and corporate greed have different pathways to arrive at the same conclusion: a very low-fat diet, doing a ton of aerobics on the
created one of the most indestructible and damaging myths in medical history: that cholesterol Cholesterol does not cause heart disease. treadmill in his house, and yet his weight was hardly
causes heart disease and that statins are the answer. We also believe that, unlike trans fat, for example, budging. If everything I had been taught as a personal
The millions of marketing dollars spent on perpetuating this myth have successfully kept saturated fat is not the dietary equivalent of Satan’s trainer was right, that shouldn’t have been happening.
us focused on a relatively minor character in the heart disease story—and created a market for spawn (and we’ll show you why). Finally, and most But it was.
cholesterol-lowering drugs worth more than $30 billion a year. The real tragedy is that by putting important, we strongly believe that our national Then Al decided to do something I didn’t approve
all of our attention on cholesterol, we’ve virtually ignored the real causes of heart disease: obsession with lowering cholesterol has come at a of. He went on the Atkins diet.
inflammation, oxidation, sugar, and stress. considerable price. Cholesterolmania has caused us to Remember, those were the days when all of us
In fact, as you’ll learn in this book, cholesterol numbers as they are now tested—i.e. “HDL” focus all our energy around a fairly innocuous mole- were taught that fat, especially saturated fat, was
and “LDL”—are a pretty poor predictor of heart disease; up to 70 percent of people hospitalized with cule with a marginal relationship to heart disease, pure evil. We had been taught that we “need” carbo-
heart attacks have perfectly normal cholesterol levels, and about half the people with elevated choles- while ignoring the real causes of heart disease. hydrates for energy and survival. We had been taught
terol levels have perfectly normal, healthy tickers. (Those numbers might change if doctors used the We’re each going to tell you in our own words that diets such as the Atkins diet were dangerous and
much more modernized version of cholesterol tests, which we’ll talk about throughout the book—but how we became cholesterol skeptics and why we fer- damaging, largely because all that saturated fat would
they continue to use the old-fashioned “good” and “bad” test that predicts about as accurately as vently believe the information contained in this book clog your arteries, raise your cholesterol, and lead to
flipping a coin.) could save your life. a heart attack.
18 THE GREAT CHOLESTEROL MYTH WHY YOU SHOULD BE SKEPTICAL OF LDL AS AN INDICATOR OF HEART DISEASE 19
Many of the general dietary guidelines accepted DR. JONNY
and promoted by the government and by major Before I became a nutritionist and ultimately an
CHAPTER 2 health organizations such as the American Heart author, I was a personal trainer. I worked at Equinox
Association are either directly or indirectly related to Fitness Clubs in New York City, and the vast majority
cholesterol phobia. These standard guidelines warn us of my clients were there for one thing: weight loss. It
to limit the amount of cholesterol we eat, despite the was 1990. Fat was considered dietary enemy number
WHY YOU SHOULD BE fact that for at least 95 percent of the population,
cholesterol in the diet has virtually no effect on cho-
one, and saturated fat was considered especially bad
because we all “knew” it clogged your arteries, raised
SKEPTICAL OF LDL
lesterol in the blood. your cholesterol, and led to heart disease. So, like
These guidelines warn us of the dangers of satu- most trainers, I put my clients on low-fat diets and
AS AN INDICATOR
rated fat, despite the fact that the relationship encouraged them to do a ton of aerobics plus a little
between saturated fat in the diet and heart disease bit of weight training.
has never been convincingly demonstrated, and Which worked.
OF HEART DISEASE despite the fact that research shows that replacing
saturated fat in the diet with carbohydrates actually
Sometimes.
More often than not, the strategy bombed.
1
increases the risk for heart disease. Take Al, for example. Al was an incredibly suc-
THE TWO OF US CAME TOGETHER TO WRITE THIS BOOK because we believe that you have Both of us became skeptical of the cholesterol cessful, powerful businessman in his early sixties with
been completely misled, misinformed, and in some cases, directly lied to about cholesterol. theory at different points in our careers, traveling a huge belly he just couldn’t get rid of. He was eating
We believe that misinformation, scientifically questionable studies, and corporate greed have different pathways to arrive at the same conclusion: a very low-fat diet, doing a ton of aerobics on the
created one of the most indestructible and damaging myths in medical history: that cholesterol Cholesterol does not cause heart disease. treadmill in his house, and yet his weight was hardly
causes heart disease and that statins are the answer. We also believe that, unlike trans fat, for example, budging. If everything I had been taught as a personal
The millions of marketing dollars spent on perpetuating this myth have successfully kept saturated fat is not the dietary equivalent of Satan’s trainer was right, that shouldn’t have been happening.
us focused on a relatively minor character in the heart disease story—and created a market for spawn (and we’ll show you why). Finally, and most But it was.
cholesterol-lowering drugs worth more than $30 billion a year. The real tragedy is that by putting important, we strongly believe that our national Then Al decided to do something I didn’t approve
all of our attention on cholesterol, we’ve virtually ignored the real causes of heart disease: obsession with lowering cholesterol has come at a of. He went on the Atkins diet.
inflammation, oxidation, sugar, and stress. considerable price. Cholesterolmania has caused us to Remember, those were the days when all of us
In fact, as you’ll learn in this book, cholesterol numbers as they are now tested—i.e. “HDL” focus all our energy around a fairly innocuous mole- were taught that fat, especially saturated fat, was
and “LDL”—are a pretty poor predictor of heart disease; up to 70 percent of people hospitalized with cule with a marginal relationship to heart disease, pure evil. We had been taught that we “need” carbo-
heart attacks have perfectly normal cholesterol levels, and about half the people with elevated choles- while ignoring the real causes of heart disease. hydrates for energy and survival. We had been taught
terol levels have perfectly normal, healthy tickers. (Those numbers might change if doctors used the We’re each going to tell you in our own words that diets such as the Atkins diet were dangerous and
much more modernized version of cholesterol tests, which we’ll talk about throughout the book—but how we became cholesterol skeptics and why we fer- damaging, largely because all that saturated fat would
they continue to use the old-fashioned “good” and “bad” test that predicts about as accurately as vently believe the information contained in this book clog your arteries, raise your cholesterol, and lead to
flipping a coin.) could save your life. a heart attack.
So I was pretty sure Al was headed for disaster. my client Al was on would produce disastrous results. more saturated fat—but nothing bad was happening at by an even more impressive 76 percent, all without
Except he wasn’t. Right around this time, a biochemist named Barry all, unless, of course, you count feeling better and making as much as a dent in cholesterol levels. The
Not only did he start shedding weight and losing Sears came to New York City to give a workshop at getting slimmer as nothing. Nurses’ Health Study3 found that 82 percent of coro-
his substantial “apple-shaped” belly, but he also had Equinox, which, of course, I eagerly attended. Sears, Which got me thinking. nary events were attributable to five factors, none of
more energy and was feeling better than he had in whose Zone diet books have sold millions, had a novel Why weren’t we seeing consistent results with our which had anything to do with lowering cholesterol.
decades. I, meanwhile, was impressed with Al’s results, approach that can be summed up in four words: eat clients who were faithfully following low-fat diets and And that was just the tip of the ever-growing iceberg.
but I was convinced he was paying a huge price and fat, lose weight. If Sears had been anything but an getting plenty of aerobic exercise? Conversely, why Study after study on high-protein, low-carb diets—
that once he got the blood test results from his MIT-trained biochemist, he probably would have been were our clients who were going on low-carb diets including those rich in saturated fat—showed that the
annual physical, I would be vindicated. laughed out of the room. But given his credentials getting such high marks on their blood tests and blood tests of people on these diets were similar to
I wasn’t. and remarkable knowledge of the human body, he astonishing their doctors? What if everything we’d Al’s. Their health actually improved on these diets.
Al’s triglycerides—a type of fat found in the blood- was pretty hard to dismiss. been told about the danger of saturated fat wasn’t Triglycerides went down. Other measures that indi-
stream and elsewhere—had dropped, his blood pres- Now Sears wasn’t the first one to embrace fat exactly correct? And—if what we’d been taught about cated heart disease risk also improved.
sure had gone down, and his cholesterol had risen and protein in the diet and recommend that we eat saturated fat wasn’t the complete truth—what about In the mid-90s I went back to school for nutrition,
slightly, but his “good” cholesterol (HDL) had gone up fewer carbs. Atkins, whose original diet was the one this relationship between fat and cholesterol? Was it ultimately earning a Ph.D. in what was then called
more than his “bad” cholesterol (LDL), so overall his Al had tried so successfully, had been saying similar really all as simple as I’d been taught? “holistic” (integrative) nutrition and a C.N.S. (certified
doc was pretty happy. things since 1972. But the whole rap against Atkins After all, even back in the early 1990s when peo- nutrition specialist) certification from the Certification
Right around this time, Dr. Barry Sears—the MIT- was that his diet was high in saturated fat and would ple only talked about “good” and “bad” cholesterol, Board for Nutrition Specialists, which is associated
trained biochemist and creator of the Zone diet—came therefore likely cause heart disease. So even though it was still obvious that, overall, saturated fat had a with the American College of Nutrition. During my
to give a workshop at Equinox. It was there, thirty many people grudgingly admitted that you could lose positive effect on Al’s cholesterol, as it did on the studies, I talked to many other health professionals
years ago, that I first learned this critical lesson: Food weight easily following his program, everyone (includ- cholesterol levels of so many of my other clients. who shared my concerns, including one of the top
has a hormonal effect. ing me) believed that the cost would include a hugely Saturated fat raised folks HDL much more than it did lipid biochemists in the country, the late Mary Enig,
When it comes to gaining and losing weight, it’s increased risk for heart disease. their LDL, which, by the standard of the day, was a Ph.D. She did some of the early research on trans fats
hormones—even more than calories—that control good thing. Could this whole cholesterol issue be a and fervently believed that it is trans fats, not satu-
the show. What If the Whole Theory That little more complicated than I and everyone else had rated fats, that are the real villains in the American
And hormones are controlled by food. Cholesterol Causes Heart Disease previously believed? diet; I wholeheartedly agree.
For example: Carbs in general stimulate hor- Was Wrong in the First Place? Eventually, I thought—going way out on a limb Enig was hardly alone in thinking that we have
mones that promote weight gain; fat does not. Ergo, Meanwhile, my eyes were telling me something very here—what if the whole theory that cholesterol causes been collectively brainwashed on the subject of satu-
up the fat in the diet a bit and reduce the carbs a bit. different, and it wasn’t just because of what I had heart disease was wrong in the first place? If that rated fat and cholesterol. When Americans were con-
It’s a way better approach to hormone management. seen happen with Al. It was happening with other were the case, the effect of saturated fat on choles- suming whole, full-fat foods such as cream, butter,
But conventional medicine argued that fat would clients as well. Sick of not getting results on low-fat, terol would be pretty much irrelevant, wouldn’t it? pasture-raised meats, raw milk, and other traditional
raise your cholesterol, which, of course, would eventu- high-carb diets, they threw caution to the wind and Then I began reading the studies. foods, the rate of heart disease was a fraction of what
2
ally kill you. In the end, the argument against high-fat embraced the Atkins diet and the Protein Power diet The Lyon Diet Heart Study found that certain it is now. Many of us began to wonder whether it was
diets always hinged on cholesterol. Conventional medi- and other diets that had in common that they limited dietary and lifestyle changes were able to reduce a coincidence that the twin global pandemics of obe-
cine collectively thought that a high-fat diet like the one carbohydrate intake. They were eating more fat—even deaths by 70 percent and reduce cardiovascular deaths sity and diabetes just happened to occur around the
So I was pretty sure Al was headed for disaster. my client Al was on would produce disastrous results. more saturated fat—but nothing bad was happening at by an even more impressive 76 percent, all without
Except he wasn’t. Right around this time, a biochemist named Barry all, unless, of course, you count feeling better and making as much as a dent in cholesterol levels. The
Not only did he start shedding weight and losing Sears came to New York City to give a workshop at getting slimmer as nothing. Nurses’ Health Study3 found that 82 percent of coro-
his substantial “apple-shaped” belly, but he also had Equinox, which, of course, I eagerly attended. Sears, Which got me thinking. nary events were attributable to five factors, none of
more energy and was feeling better than he had in whose Zone diet books have sold millions, had a novel Why weren’t we seeing consistent results with our which had anything to do with lowering cholesterol.
decades. I, meanwhile, was impressed with Al’s results, approach that can be summed up in four words: eat clients who were faithfully following low-fat diets and And that was just the tip of the ever-growing iceberg.
but I was convinced he was paying a huge price and fat, lose weight. If Sears had been anything but an getting plenty of aerobic exercise? Conversely, why Study after study on high-protein, low-carb diets—
that once he got the blood test results from his MIT-trained biochemist, he probably would have been were our clients who were going on low-carb diets including those rich in saturated fat—showed that the
annual physical, I would be vindicated. laughed out of the room. But given his credentials getting such high marks on their blood tests and blood tests of people on these diets were similar to
I wasn’t. and remarkable knowledge of the human body, he astonishing their doctors? What if everything we’d Al’s. Their health actually improved on these diets.
Al’s triglycerides—a type of fat found in the blood- was pretty hard to dismiss. been told about the danger of saturated fat wasn’t Triglycerides went down. Other measures that indi-
stream and elsewhere—had dropped, his blood pres- Now Sears wasn’t the first one to embrace fat exactly correct? And—if what we’d been taught about cated heart disease risk also improved.
sure had gone down, and his cholesterol had risen and protein in the diet and recommend that we eat saturated fat wasn’t the complete truth—what about In the mid-90s I went back to school for nutrition,
slightly, but his “good” cholesterol (HDL) had gone up fewer carbs. Atkins, whose original diet was the one this relationship between fat and cholesterol? Was it ultimately earning a Ph.D. in what was then called
more than his “bad” cholesterol (LDL), so overall his Al had tried so successfully, had been saying similar really all as simple as I’d been taught? “holistic” (integrative) nutrition and a C.N.S. (certified
doc was pretty happy. things since 1972. But the whole rap against Atkins After all, even back in the early 1990s when peo- nutrition specialist) certification from the Certification
Right around this time, Dr. Barry Sears—the MIT- was that his diet was high in saturated fat and would ple only talked about “good” and “bad” cholesterol, Board for Nutrition Specialists, which is associated
trained biochemist and creator of the Zone diet—came therefore likely cause heart disease. So even though it was still obvious that, overall, saturated fat had a with the American College of Nutrition. During my
to give a workshop at Equinox. It was there, thirty many people grudgingly admitted that you could lose positive effect on Al’s cholesterol, as it did on the studies, I talked to many other health professionals
years ago, that I first learned this critical lesson: Food weight easily following his program, everyone (includ- cholesterol levels of so many of my other clients. who shared my concerns, including one of the top
has a hormonal effect. ing me) believed that the cost would include a hugely Saturated fat raised folks HDL much more than it did lipid biochemists in the country, the late Mary Enig,
When it comes to gaining and losing weight, it’s increased risk for heart disease. their LDL, which, by the standard of the day, was a Ph.D. She did some of the early research on trans fats
hormones—even more than calories—that control good thing. Could this whole cholesterol issue be a and fervently believed that it is trans fats, not satu-
the show. What If the Whole Theory That little more complicated than I and everyone else had rated fats, that are the real villains in the American
And hormones are controlled by food. Cholesterol Causes Heart Disease previously believed? diet; I wholeheartedly agree.
For example: Carbs in general stimulate hor- Was Wrong in the First Place? Eventually, I thought—going way out on a limb Enig was hardly alone in thinking that we have
mones that promote weight gain; fat does not. Ergo, Meanwhile, my eyes were telling me something very here—what if the whole theory that cholesterol causes been collectively brainwashed on the subject of satu-
up the fat in the diet a bit and reduce the carbs a bit. different, and it wasn’t just because of what I had heart disease was wrong in the first place? If that rated fat and cholesterol. When Americans were con-
It’s a way better approach to hormone management. seen happen with Al. It was happening with other were the case, the effect of saturated fat on choles- suming whole, full-fat foods such as cream, butter,
But conventional medicine argued that fat would clients as well. Sick of not getting results on low-fat, terol would be pretty much irrelevant, wouldn’t it? pasture-raised meats, raw milk, and other traditional
raise your cholesterol, which, of course, would eventu- high-carb diets, they threw caution to the wind and Then I began reading the studies. foods, the rate of heart disease was a fraction of what
2
ally kill you. In the end, the argument against high-fat embraced the Atkins diet and the Protein Power diet The Lyon Diet Heart Study found that certain it is now. Many of us began to wonder whether it was
diets always hinged on cholesterol. Conventional medi- and other diets that had in common that they limited dietary and lifestyle changes were able to reduce a coincidence that the twin global pandemics of obe-
cine collectively thought that a high-fat diet like the one carbohydrate intake. They were eating more fat—even deaths by 70 percent and reduce cardiovascular deaths sity and diabetes just happened to occur around the
time we collectively banished these foods because of ters very much.” low as 150 mg/dL!—develop heart disease. terol. I stopped believing. Here’s why:
the phobia about cholesterol and saturated fat in the As you can imagine, that was met with a collec- In those days we pushed patients to undergo I found that life can’t go on without cholesterol, a
diet and began to replace them with vegetable oils, tive startle. My publishers were more than a little angiograms (invasive arterial catheterization imaging) basic raw material made by your liver, brain, and almost
processed carbs, and, ultimately, trans fats. curious. “How can lowering cholesterol not be impor- if they had sufficient symptoms of chest pain, border- every cell in your body. Enzymes convert it into vitamin
Study after study has shown that lowering the tant?” they wanted to know. “Don’t doctors believe line exercise tests, and especially cholesterol readings D, steroid hormones (such as our sex hormones—estro-
risk for heart disease has very little to do with lower- high cholesterol is the cause of heart disease? Don’t of greater than 280 mg/dL. We did this because our gen, progesterone, and testosterone—and stress hor-
ing cholesterol. And more and more studies reports they believe that lowering it is the most important profession believed that all people with high choles- mones), and bile salts for digesting and absorbing fats.
were coming out demonstrating that the real initia- thing you can do when it comes to preventing heart terol were in danger of having a heart attack. It makes up a major part of the membranes surround-
tors of damage in the arteries were oxidation and attacks?” We did the imaging to see how bad their arteries ing cells and the structures within them.
inflammation. These factors, along with sugar and, “They do indeed,” I replied, “and they’re wrong.” were. And, indeed, sometimes we found diseased The brain is particularly rich in cholesterol and
were clearly what aged the human body the most. The book I wanted to write reveals the truth arteries. But just as often we didn’t. Many arteries accounts for about a quarter of all the cholesterol we
These were the culprits we should be focused on. about cholesterol and heart disease. To do it, I joined were perfectly healthy. These results were telling me have in our bodies. The fatty myelin sheath that coats
In my career, I have examined the strategies that forces with my friend Steve Sinatra, a board-certified something different than the establishment message— every nerve cell and fiber is about one-fifth choles-
seemed to work for the healthiest, longest-living peo- cardiologist, trained psychotherapist, and nutritionist. that it wasn’t just a simple cholesterol story. terol. Neuronal communication depends on choles-
ple on earth and found that lowering cholesterol has Faced with these discrepancies I began question- terol. It is not surprising that a connection has been
almost nothing to do with reducing heart disease, and DR. SINATRA ing and investigating conventional thinking about cho- found between naturally occurring cholesterol and
definitely nothing to do with extending life. One of the Most doctors today will recommend that you take a lesterol and looking at the cholesterol research more mental function. Lower levels are linked to poorer
greatest frustrations I experienced was trying to reas- statin drug—they might even nag you to do so—if your closely. I found other doctors who had made similar cognitive performance.
sure my clients that with a higher-protein, higher-fat cholesterol numbers are high. They will do so whether discoveries on their own and heard about how study I remember one patient—a federal judge I’ll call
diet they’d see significant improvements in their or not you have evidence of arterial disease and are a findings were being manipulated. For example, bio- Silvio—who came to see me. He was taking a statin
weights and the health of their hearts. I was con- man or woman, and despite your age. In their minds, chemist George Mann, M.D., of Vanderbilt University, drug and complained that his memory had gone to
stantly butting heads with my clients’ doctors, who you prevent heart disease by lowering cholesterol. who participated in the development of the world- pot, so much so that he voluntarily took himself off
completely bought into the myth that saturated fat Once upon a time I used to believe that, too. It famous Framingham Heart Study, later described the the bench. His LDL level was down to 65 mg/dL. I
will kill you by clogging your arteries, raising your made sense, based on the research and information cholesterol-as-an-indicator-of-heart-disease hypothe- took him off the statin, told him to eat a lot of
cholesterol, and ultimately leading to heart disease. that was promoted to doctors. I believed it to the sis as “the greatest scam ever perpetrated on the organic, cholesterol-rich eggs, and within a month got
And that anyone who thought otherwise was clearly a extent that I even lectured on behalf of drug makers. I American public.” his LDL level up above 100 mg/dL. His memory came
whack job or at the very least “anti-science.” was a paid consultant to some of the biggest manufac- These and other dissenting voices were drowned roaring back. (Memory loss is one potential side effect
Fast-forward to 2010. Fair Winds Press—my pub- turers of statin drugs, lecturing for hefty honorariums. out by the cholesterol chorus. To this day, practically of cholesterol-lowering drugs.)
lisher for thirteen books over the course of seven I became a cholesterol choirboy, singing the refrain of all of what has been published—and receives media Some researchers suggest that doctors should be
years—came to me with an idea. “How about a book high cholesterol as the big, bad villain of heart disease. attention—supports the cholesterol paradigm and extremely cautious about prescribing statin drugs to
on how to lower cholesterol with food and supple- Beat it down with a drug, and you cut your risks. My appears to have the backing of the pharmaceutical the elderly, particularly those who are frail. I totally
ments?” they asked. thinking changed years ago when I began seeing con- and low-fat industries along with leading regulatory agree. I have seen frail individuals become even
To which I replied, “I’m probably not the guy to flicting evidence among my own patients. I saw, for agencies and medical organizations. frailer and much more prone to infections. Though
write that one. I don’t think lowering cholesterol mat- instance, many patients with low total cholesterol—as However, I stopped being a choirboy for choles- that surprised me at the time, it no longer does.
time we collectively banished these foods because of ters very much.” low as 150 mg/dL!—develop heart disease. terol. I stopped believing. Here’s why:
the phobia about cholesterol and saturated fat in the As you can imagine, that was met with a collec- In those days we pushed patients to undergo I found that life can’t go on without cholesterol, a
diet and began to replace them with vegetable oils, tive startle. My publishers were more than a little angiograms (invasive arterial catheterization imaging) basic raw material made by your liver, brain, and almost
processed carbs, and, ultimately, trans fats. curious. “How can lowering cholesterol not be impor- if they had sufficient symptoms of chest pain, border- every cell in your body. Enzymes convert it into vitamin
Study after study has shown that lowering the tant?” they wanted to know. “Don’t doctors believe line exercise tests, and especially cholesterol readings D, steroid hormones (such as our sex hormones—estro-
risk for heart disease has very little to do with lower- high cholesterol is the cause of heart disease? Don’t of greater than 280 mg/dL. We did this because our gen, progesterone, and testosterone—and stress hor-
ing cholesterol. And more and more studies reports they believe that lowering it is the most important profession believed that all people with high choles- mones), and bile salts for digesting and absorbing fats.
were coming out demonstrating that the real initia- thing you can do when it comes to preventing heart terol were in danger of having a heart attack. It makes up a major part of the membranes surround-
tors of damage in the arteries were oxidation and attacks?” We did the imaging to see how bad their arteries ing cells and the structures within them.
inflammation. These factors, along with sugar and, “They do indeed,” I replied, “and they’re wrong.” were. And, indeed, sometimes we found diseased The brain is particularly rich in cholesterol and
were clearly what aged the human body the most. The book I wanted to write reveals the truth arteries. But just as often we didn’t. Many arteries accounts for about a quarter of all the cholesterol we
These were the culprits we should be focused on. about cholesterol and heart disease. To do it, I joined were perfectly healthy. These results were telling me have in our bodies. The fatty myelin sheath that coats
In my career, I have examined the strategies that forces with my friend Steve Sinatra, a board-certified something different than the establishment message— every nerve cell and fiber is about one-fifth choles-
seemed to work for the healthiest, longest-living peo- cardiologist, trained psychotherapist, and nutritionist. that it wasn’t just a simple cholesterol story. terol. Neuronal communication depends on choles-
ple on earth and found that lowering cholesterol has Faced with these discrepancies I began question- terol. It is not surprising that a connection has been
almost nothing to do with reducing heart disease, and DR. SINATRA ing and investigating conventional thinking about cho- found between naturally occurring cholesterol and
definitely nothing to do with extending life. One of the Most doctors today will recommend that you take a lesterol and looking at the cholesterol research more mental function. Lower levels are linked to poorer
greatest frustrations I experienced was trying to reas- statin drug—they might even nag you to do so—if your closely. I found other doctors who had made similar cognitive performance.
sure my clients that with a higher-protein, higher-fat cholesterol numbers are high. They will do so whether discoveries on their own and heard about how study I remember one patient—a federal judge I’ll call
diet they’d see significant improvements in their or not you have evidence of arterial disease and are a findings were being manipulated. For example, bio- Silvio—who came to see me. He was taking a statin
weights and the health of their hearts. I was con- man or woman, and despite your age. In their minds, chemist George Mann, M.D., of Vanderbilt University, drug and complained that his memory had gone to
stantly butting heads with my clients’ doctors, who you prevent heart disease by lowering cholesterol. who participated in the development of the world- pot, so much so that he voluntarily took himself off
completely bought into the myth that saturated fat Once upon a time I used to believe that, too. It famous Framingham Heart Study, later described the the bench. His LDL level was down to 65 mg/dL. I
will kill you by clogging your arteries, raising your made sense, based on the research and information cholesterol-as-an-indicator-of-heart-disease hypothe- took him off the statin, told him to eat a lot of
cholesterol, and ultimately leading to heart disease. that was promoted to doctors. I believed it to the sis as “the greatest scam ever perpetrated on the organic, cholesterol-rich eggs, and within a month got
And that anyone who thought otherwise was clearly a extent that I even lectured on behalf of drug makers. I American public.” his LDL level up above 100 mg/dL. His memory came
whack job or at the very least “anti-science.” was a paid consultant to some of the biggest manufac- These and other dissenting voices were drowned roaring back. (Memory loss is one potential side effect
Fast-forward to 2010. Fair Winds Press—my pub- turers of statin drugs, lecturing for hefty honorariums. out by the cholesterol chorus. To this day, practically of cholesterol-lowering drugs.)
lisher for thirteen books over the course of seven I became a cholesterol choirboy, singing the refrain of all of what has been published—and receives media Some researchers suggest that doctors should be
years—came to me with an idea. “How about a book high cholesterol as the big, bad villain of heart disease. attention—supports the cholesterol paradigm and extremely cautious about prescribing statin drugs to
on how to lower cholesterol with food and supple- Beat it down with a drug, and you cut your risks. My appears to have the backing of the pharmaceutical the elderly, particularly those who are frail. I totally
ments?” they asked. thinking changed years ago when I began seeing con- and low-fat industries along with leading regulatory agree. I have seen frail individuals become even
To which I replied, “I’m probably not the guy to flicting evidence among my own patients. I saw, for agencies and medical organizations. frailer and much more prone to infections. Though
write that one. I don’t think lowering cholesterol mat- instance, many patients with low total cholesterol—as However, I stopped being a choirboy for choles- that surprised me at the time, it no longer does.
Cholesterol plays a big role in helping fight bacteria wonder fatigue, low energy, and muscle pain are such By now my conversion from cholesterol true earlier—the Lyon Diet Heart Study.
and infections. A study that included 100,000 healthy frequent accompaniments to statin drug use. believer to cholesterol skeptic is complete. I still pre- In the early 1990s, French researchers decided to
participants in San Francisco over a fifteen-year It wasn’t until the mid-1990s that statin drugs scribe statins—but only on occasion, and almost exclu- run an experiment—known as the Lyon Diet Heart
period found that those with low cholesterol values really took off, but before then physicians had other sively to middle-aged men who’ve already had a first Study—to test the effect of different diets on heart
were much more likely to be admitted to hospitals go-to drugs for lowering cholesterol. Many research heart attack, coronary intervention (e.g., bypass, disease.5
with infectious diseases.4 studies were conducted using these drugs, and in stent, angioplasty), or coronary artery disease. They took 605 men and women who were prime
Life can’t go on without cholesterol, a basic raw 1996 the U.S. Government Accountability Office eval- I’ve come to believe that cholesterol is a minor candidates for heart attacks. These folks had every risk
material made by your liver, brain, and almost every uated these trials in a publication titled Cholesterol player in the development of heart disease and that factor imaginable. All of them had already survived a
cell in your body. Many such patients told me after- Treatment: A Review of the Clinical Trials Evidence. whatever good statin drugs accomplish has very little first heart attack. Their cholesterol levels were through
ward that their strength, energy, appetite, and vitality The report explained that though some trials showed to do with their cholesterol-lowering ability. (We dis- the roof, they smoked, they ate junk food, they didn’t
returned after going off statin drugs. They obviously a reduction in cardiovascular-related deaths (primar- cuss this at great length in chapter 8.) Statin drugs exercise, and they had high levels of stress. People like
needed their cholesterol. ily among those who entered the studies with exist- are anti-inflammatory, and their power to reduce this give insurance underwriters nightmares. To be
In addition to being a board-certified cardiologist, ing heart disease), there was a corresponding inflammation is much more important than their abil- frank, these folks were “dead men walking.”
I’ve had a lifelong interest in nutrition. I’d been using increase in non-cardiovascular-related deaths across ity to lower cholesterol. But we can lower inflamma- The researchers divided the participants into two
nutritional supplements in my practice since the early the trials. “This finding, that cholesterol treatment tion (and the risk for heart disease) with natural sup- groups. The first group was counseled (by the
1980s, particularly coenzyme Q10 (CoQ10), an abso- has not lowered the number of deaths overall, has plements, a better diet, and lifestyle changes such as research cardiologist and the dietician during a one-
lutely vital nutrient that is made in every cell in the been worrisome to many researchers and is at the managing stress. Best of all, none of these come with hour session) to eat a Mediterranean-type diet that
body and is a major chemical participant in the pro- core of much of the controversy on cholesterol pol- the growing laundry list of troubling symptoms and emphasizes fresh fruit and vegetables, whole grains,
duction of cellular energy. CoQ10 is critically important icy,” the authors wrote. side effects associated with statin drugs and choles- legumes, nuts, healthy fats such as olive oil, and sea-
for the strong pumping action of the heart, which It was also quite clear from the report that those terol lowering. food. The second group was the control group and
gobbles the stuff up. And in the early 1990s I discov- who benefited the most from lowering their choles- received no dietary advice from the investigators but
ered something that shook my belief in statin drugs terol levels were middle-aged men who already had LIKE DEAD MEN WALKING was advised, nonetheless, to follow a prudent diet by
to the core—they depleted the body of CoQ10. heart disease. “The trials focused predominantly on So there you have it. Two individuals with very their attending physicians.
That fact is widely known now, but it wasn’t then. middle-aged white men considered to be at high risk different journeys arriving at the same conclusion. What was this prudent diet, you ask? Pretty much
And it certainly gave me pause. How could these of coronary heart disease,” the report stated. “They And because that conclusion may be pretty hard to the standard (and, as we shall see, useless) diet that
miracle drugs that were believed to be the answer provide very little information on women, minority swallow if you’ve been brainwashed by the cholesterol doctors have been recommending for decades: Eat no
to heart disease be good for you in the long run if men and women, and elderly men and women.” establishment—and who hasn’t?—it might be helpful to more than 30 percent of your calories from fat, no
they depleted the very nutrient upon which the It’s been more than a decade since that report take a moment and talk about a study we alluded to more than 10 percent from saturated fat, and no more
heart depends? was written, but it remains true that lowering choles-
Even today, many doctors aren’t aware of the terol has a very limited benefit in populations other
effect that statin drugs have on CoQ10 levels. How than middle-aged men with a history of heart disease.
Lowering cholesterol has a very limited benefit in populations
ironic that the very drug they prescribe to reduce Yet doctors continue to prescribe statin drugs for
the likelihood of a heart attack actually deprives the women and the elderly, and, shockingly, many are other than middle-aged men with a history of heart disease.
heart of the fuel it needs to perform properly? No arguing for treating children with statins as well.
Cholesterol plays a big role in helping fight bacteria wonder fatigue, low energy, and muscle pain are such By now my conversion from cholesterol true earlier—the Lyon Diet Heart Study.
and infections. A study that included 100,000 healthy frequent accompaniments to statin drug use. believer to cholesterol skeptic is complete. I still pre- In the early 1990s, French researchers decided to
participants in San Francisco over a fifteen-year It wasn’t until the mid-1990s that statin drugs scribe statins—but only on occasion, and almost exclu- run an experiment—known as the Lyon Diet Heart
period found that those with low cholesterol values really took off, but before then physicians had other sively to middle-aged men who’ve already had a first Study—to test the effect of different diets on heart
were much more likely to be admitted to hospitals go-to drugs for lowering cholesterol. Many research heart attack, coronary intervention (e.g., bypass, disease.5
with infectious diseases.4 studies were conducted using these drugs, and in stent, angioplasty), or coronary artery disease. They took 605 men and women who were prime
Life can’t go on without cholesterol, a basic raw 1996 the U.S. Government Accountability Office eval- I’ve come to believe that cholesterol is a minor candidates for heart attacks. These folks had every risk
material made by your liver, brain, and almost every uated these trials in a publication titled Cholesterol player in the development of heart disease and that factor imaginable. All of them had already survived a
cell in your body. Many such patients told me after- Treatment: A Review of the Clinical Trials Evidence. whatever good statin drugs accomplish has very little first heart attack. Their cholesterol levels were through
ward that their strength, energy, appetite, and vitality The report explained that though some trials showed to do with their cholesterol-lowering ability. (We dis- the roof, they smoked, they ate junk food, they didn’t
returned after going off statin drugs. They obviously a reduction in cardiovascular-related deaths (primar- cuss this at great length in chapter 8.) Statin drugs exercise, and they had high levels of stress. People like
needed their cholesterol. ily among those who entered the studies with exist- are anti-inflammatory, and their power to reduce this give insurance underwriters nightmares. To be
In addition to being a board-certified cardiologist, ing heart disease), there was a corresponding inflammation is much more important than their abil- frank, these folks were “dead men walking.”
I’ve had a lifelong interest in nutrition. I’d been using increase in non-cardiovascular-related deaths across ity to lower cholesterol. But we can lower inflamma- The researchers divided the participants into two
nutritional supplements in my practice since the early the trials. “This finding, that cholesterol treatment tion (and the risk for heart disease) with natural sup- groups. The first group was counseled (by the
1980s, particularly coenzyme Q10 (CoQ10), an abso- has not lowered the number of deaths overall, has plements, a better diet, and lifestyle changes such as research cardiologist and the dietician during a one-
lutely vital nutrient that is made in every cell in the been worrisome to many researchers and is at the managing stress. Best of all, none of these come with hour session) to eat a Mediterranean-type diet that
body and is a major chemical participant in the pro- core of much of the controversy on cholesterol pol- the growing laundry list of troubling symptoms and emphasizes fresh fruit and vegetables, whole grains,
duction of cellular energy. CoQ10 is critically important icy,” the authors wrote. side effects associated with statin drugs and choles- legumes, nuts, healthy fats such as olive oil, and sea-
for the strong pumping action of the heart, which It was also quite clear from the report that those terol lowering. food. The second group was the control group and
gobbles the stuff up. And in the early 1990s I discov- who benefited the most from lowering their choles- received no dietary advice from the investigators but
ered something that shook my belief in statin drugs terol levels were middle-aged men who already had LIKE DEAD MEN WALKING was advised, nonetheless, to follow a prudent diet by
to the core—they depleted the body of CoQ10. heart disease. “The trials focused predominantly on So there you have it. Two individuals with very their attending physicians.
That fact is widely known now, but it wasn’t then. middle-aged white men considered to be at high risk different journeys arriving at the same conclusion. What was this prudent diet, you ask? Pretty much
And it certainly gave me pause. How could these of coronary heart disease,” the report stated. “They And because that conclusion may be pretty hard to the standard (and, as we shall see, useless) diet that
miracle drugs that were believed to be the answer provide very little information on women, minority swallow if you’ve been brainwashed by the cholesterol doctors have been recommending for decades: Eat no
to heart disease be good for you in the long run if men and women, and elderly men and women.” establishment—and who hasn’t?—it might be helpful to more than 30 percent of your calories from fat, no
they depleted the very nutrient upon which the It’s been more than a decade since that report take a moment and talk about a study we alluded to more than 10 percent from saturated fat, and no more
heart depends? was written, but it remains true that lowering choles-
Even today, many doctors aren’t aware of the terol has a very limited benefit in populations other
effect that statin drugs have on CoQ10 levels. How than middle-aged men with a history of heart disease.
Lowering cholesterol has a very limited benefit in populations
ironic that the very drug they prescribe to reduce Yet doctors continue to prescribe statin drugs for
the likelihood of a heart attack actually deprives the women and the elderly, and, shockingly, many are other than middle-aged men with a history of heart disease.
heart of the fuel it needs to perform properly? No arguing for treating children with statins as well.
than 300 mg of cholesterol a day (about the amount and there is a massive amount of it, as you will soon had more plaque growth than the people taking the Wait, didn’t they miss something? Where’s the
in two eggs). So what happened with the study? find out—has to be ignored or explained away. standard cholesterol drug. The patients on Vytorin part about lowering cholesterol?
Actually, it was stopped. Lower heart disease rates? And no movement in had almost twice as great an increase in the thickness It’s not there. Lowering cholesterol didn’t even
Why? Because the reduction in heart attacks in cholesterol numbers? of their arterial walls, a result you definitely don’t make the list of the five most important things you
the Mediterranean diet group was so pronounced that Something has to be wrong! want to see if you’re trying to prevent heart disease. can do to prevent heart attacks.
the researchers decided it was unethical to continue. Actually something was wrong, but not with the So their cholesterol was wonderfully lowered and Of course, there’s not roughly $30 billion plus a
To be precise, the Mediterranean diet group had a study. What was—and is—wrong is the blind belief that their risk for heart disease went up—shades of “the year to be made peddling that advice (a number that
whopping 70 percent reduction in deaths and an even cholesterol simply makes a huge difference. operation was a success but the patient died.” the gross revenue from statin drugs alone), and pop-
more impressive 76 percent reduction in cardiovascular There are countless other examples, many of ping a pill is a lot easier than changing your lifestyle,
deaths. What’s more, angina, pulmonary embolism, AN INCONVENIENT FACT which we’ll discuss later on, but let’s just mention one but there it is. The inconvenient fact that lowering
heart failure, and stroke were also much lower in the Not convinced? Fast-forward to a drug study of them right now. It’s known as the Nurses’ Health cholesterol has almost no effect on extending life is
intervention group. A huge victory for the Mediter- completed in 2006, the widely publicized ENHANCE Study, and it’s one of the longest-running studies of simply ignored by the special interests that profit
6
ranean diet and a big dunkin’ for the prudent diet. trial. If you were following the news in 2008 you diet and disease ever undertaken. Conducted by enormously from keeping you in the dark.
So what happened to these folks’ cholesterol couldn’t have missed this one, because it made the Harvard University, the study has followed more than As the writer Upton Sinclair said, “It is very diffi-
levels? Gosh, you’d imagine they dropped like crazy, front pages of the newspapers and all of the 120,000 females since the mid-1970s to determine cult to get a man to understand something, when his
7
because so few of them were dying of heart disease. television news shows. Here’s what happened. risk factors for cancer and heart disease. In an salary depends upon his not understanding it.”
Um, not so much. Their levels didn’t budge. A combination cholesterol-lowering medication exhaustive analysis of 84,129 of these women, pub-
Let’s repeat that one more time: a 76 percent called Vytorin had been the subject of a huge lished in the New England Journal of Medicine,8 five
reduction in deaths from heart disease but not a whit research project, the results of which were finally factors were identified that significantly lowered the
of change in cholesterol levels. Neither in their total coming to light and receiving an enormous amount of risk for heart disease. In fact, wrote the authors,
cholesterol levels nor in their levels of LDL (the so- negative attention. One of the many reasons for this “Eighty-two percent of coronary events in the
called “bad” cholesterol). You’d think this would shake negative attention was the fact that the companies study . . . could be attributed to lack of adherence to
up the cholesterol establishment a bit, wouldn’t you? jointly making the drug (Merck and Schering-Plough, (these five factors).”
 WHAT YOU NEED TO KNOW
Think again. The prestigious New England Journal who’ve since merged) waited almost two years before • Cholesterol levels are a very poor
of Medicine refused to publish the study. (It was even- releasing it. Are You Ready for the Five Factors? predictor of heart attacks.
tually published in another highly regarded journal, No wonder. The results stunk. Which was the 1. Don’t smoke. • More than half the people admitted to
The Lancet.) We have a hunch that the reason the New other reason this drug test made the front pages. 2. Drink alcohol in moderation. hospitals for cardiovascular disease
England Journal of Medicine didn’t publish the study The new “wonder” drug lowered cholesterol just 3. Engage in moderate-to-vigorous exercise for at have normal cholesterol as it’s
was precisely because there was no difference in cho- fine. In fact, it lowered it better than a standard statin least half an hour a day on average. conventionally measured.
lesterol levels between the two groups of people, the drug. So you’d think everyone would be jumping for 4. Maintain a healthy weight (BMI under 25). • Lowering cholesterol has extremely
ones who did so well and the ones who did not. The joy, right? Lower cholesterol, lower heart disease, let’s 5. Eat a wholesome, low-glycemic (low-sugar) diet limited benefits, does not save lives,
American medical establishment is so firmly locked have a party for the shareholders. with plenty of omega-3 fats and fiber. and should no longer be the focus of
into the notion that cholesterol and fat cause heart dis- Um, not quite. Although the people taking Vytorin our efforts to prevent heart disease.
ease that any inconvenient evidence to the contrary— saw their cholesterol levels plummet, they actually
than 300 mg of cholesterol a day (about the amount and there is a massive amount of it, as you will soon had more plaque growth than the people taking the Wait, didn’t they miss something? Where’s the
in two eggs). So what happened with the study? find out—has to be ignored or explained away. standard cholesterol drug. The patients on Vytorin part about lowering cholesterol?
Actually, it was stopped. Lower heart disease rates? And no movement in had almost twice as great an increase in the thickness It’s not there. Lowering cholesterol didn’t even
Why? Because the reduction in heart attacks in cholesterol numbers? of their arterial walls, a result you definitely don’t make the list of the five most important things you
the Mediterranean diet group was so pronounced that Something has to be wrong! want to see if you’re trying to prevent heart disease. can do to prevent heart attacks.
the researchers decided it was unethical to continue. Actually something was wrong, but not with the So their cholesterol was wonderfully lowered and Of course, there’s not roughly $30 billion plus a
To be precise, the Mediterranean diet group had a study. What was—and is—wrong is the blind belief that their risk for heart disease went up—shades of “the year to be made peddling that advice (a number that
whopping 70 percent reduction in deaths and an even cholesterol simply makes a huge difference. operation was a success but the patient died.” the gross revenue from statin drugs alone), and pop-
more impressive 76 percent reduction in cardiovascular There are countless other examples, many of ping a pill is a lot easier than changing your lifestyle,
deaths. What’s more, angina, pulmonary embolism, AN INCONVENIENT FACT which we’ll discuss later on, but let’s just mention one but there it is. The inconvenient fact that lowering
heart failure, and stroke were also much lower in the Not convinced? Fast-forward to a drug study of them right now. It’s known as the Nurses’ Health cholesterol has almost no effect on extending life is
intervention group. A huge victory for the Mediter- completed in 2006, the widely publicized ENHANCE Study, and it’s one of the longest-running studies of simply ignored by the special interests that profit
6
ranean diet and a big dunkin’ for the prudent diet. trial. If you were following the news in 2008 you diet and disease ever undertaken. Conducted by enormously from keeping you in the dark.
So what happened to these folks’ cholesterol couldn’t have missed this one, because it made the Harvard University, the study has followed more than As the writer Upton Sinclair said, “It is very diffi-
levels? Gosh, you’d imagine they dropped like crazy, front pages of the newspapers and all of the 120,000 females since the mid-1970s to determine cult to get a man to understand something, when his
7
because so few of them were dying of heart disease. television news shows. Here’s what happened. risk factors for cancer and heart disease. In an salary depends upon his not understanding it.”
Um, not so much. Their levels didn’t budge. A combination cholesterol-lowering medication exhaustive analysis of 84,129 of these women, pub-
Let’s repeat that one more time: a 76 percent called Vytorin had been the subject of a huge lished in the New England Journal of Medicine,8 five
reduction in deaths from heart disease but not a whit research project, the results of which were finally factors were identified that significantly lowered the
of change in cholesterol levels. Neither in their total coming to light and receiving an enormous amount of risk for heart disease. In fact, wrote the authors,
cholesterol levels nor in their levels of LDL (the so- negative attention. One of the many reasons for this “Eighty-two percent of coronary events in the
called “bad” cholesterol). You’d think this would shake negative attention was the fact that the companies study . . . could be attributed to lack of adherence to
up the cholesterol establishment a bit, wouldn’t you? jointly making the drug (Merck and Schering-Plough, (these five factors).”
Think again. The prestigious New England Journal who’ve since merged) waited almost two years before • Cholesterol levels are a very poor
of Medicine refused to publish the study. (It was even- releasing it. Are You Ready for the Five Factors? predictor of heart attacks.
tually published in another highly regarded journal, No wonder. The results stunk. Which was the 1. Don’t smoke. • More than half the people admitted to
The Lancet.) We have a hunch that the reason the New other reason this drug test made the front pages. 2. Drink alcohol in moderation. hospitals for cardiovascular disease
England Journal of Medicine didn’t publish the study The new “wonder” drug lowered cholesterol just 3. Engage in moderate-to-vigorous exercise for at have normal cholesterol as it’s
was precisely because there was no difference in cho- fine. In fact, it lowered it better than a standard statin least half an hour a day on average. conventionally measured.
lesterol levels between the two groups of people, the drug. So you’d think everyone would be jumping for 4. Maintain a healthy weight (BMI under 25). • Lowering cholesterol has extremely
ones who did so well and the ones who did not. The joy, right? Lower cholesterol, lower heart disease, let’s 5. Eat a wholesome, low-glycemic (low-sugar) diet limited benefits, does not save lives,
American medical establishment is so firmly locked have a party for the shareholders. with plenty of omega-3 fats and fiber. and should no longer be the focus of
into the notion that cholesterol and fat cause heart dis- Um, not quite. Although the people taking Vytorin our efforts to prevent heart disease.
ease that any inconvenient evidence to the contrary— saw their cholesterol levels plummet, they actually
To understand the cholesterol myth—and to fully But how, exactly, did cholesterol and saturated fat
appreciate how the related health advice is obsolete— come to be branded as the twin demons of heart
CHAPTER 3 you’ll need to know a lot more about cholesterol than disease in the first place? To answer that question, we
the average person knows. Understanding the full need to go back to 1953. And if every story needs a
story of cholesterol touches on medicine and villain, one person in particular has been christened
research, as well as politics, economics, psychology, the arch-dietary nemesis of the twentieth century:
CHOLESTEROL and sociology. It’s got a cast of characters ranging

from the obnoxious and egotistical to the well-mean-
Ancel Benjamin Keys.
Keys was a public health scientist and is often con-
IS HARMLESS
ing and misguided. sidered the granddaddy of the low-fat movement. He is
Sadly, much to the story has little to do with saving best remembered for launching the Seven Countries
lives, though it may have started out that way. Instead, Study—the first major international study investigating
it involves staggering amounts of money, the politics of links between diet, lifestyle factors, and heart disease.
publication, and the sociology of belief—i.e., why bad The massive study seemed to confirm a link between
ideas continue to survive past their expiration dates. saturated fat consumption and cardiovascular disease,
NOW LET’S TALK ABOUT YOU We’ll also shine a light on the revolving door that and Keys spent the latter part of his career pushing
Unless you’re an information junkie, there’s a good chance that you’re reading this book because you exists between government advisory committees and the newfangled (at the time) idea that too much satu-
have something at stake here. Let us guess: You’re concerned about your cholesterol. the industries they’re supposed to police. For example, rated fat in the diet was harming our tickers.
Maybe you’re a woman whose doctor has read you the riot act because your cholesterol is when the National Cholesterol Education Program Highly successful by any metric we could imagine,
approaching 300 mg/dL, and your doc has convinced you that you’ll drop dead of a heart attack if lowered the “optimal” cholesterol levels in 2004, Keys managed to spread his ideas to the public and
you don’t go on medication right away. eight out of nine people on the panel had financial steer scientific consensus toward saturated fat pho-
Maybe you’re a middle-aged man who has already had a heart attack, and your doctor is adamant ties to the pharmaceutical industry, most of them to bia. But Keys has also been the butt of some serious
about putting you on a cholesterol-lowering drug. the manufacturers of cholesterol-lowering drugs who allegations. Depending on who you ask, the whole
Or maybe you’re a fit guy in your sixties whose cholesterol is 240 mg/dL and whose doctor is would subsequently reap immediate benefits from Seven Countries Study was a sham because he chose
“worried” about that number. these same recommendations. only countries he knew would confirm his hypothesis.
Only one of the three hypothetical cases listed above has any business being on a cholesterol- Or that he made a famous graph by cherry-picking six
lowering drug. Can you guess which one? Don’t worry: By the time you finish this book, you’ll know THE BIRTH OF THE DIET-HEART countries out of twenty-two countries that had avail-
the answer. And you’ll also know a heck of a lot more about cholesterol than most doctors in the HYPOTHESIS able diet and mortality data, making it look like there
United States. And, no, we don’t make that statement lightly. Neither of us buys into the myth that cholesterol is was a near-perfect correlation between national fat
Okay, so you’re concerned about your cholesterol—but you don’t want to blindly follow recommen- the proper target for the prevention of heart disease. consumption and heart disease. Or, even better, that
dations without doing your own research. If you did, you’d simply follow your doctor’s orders and have
no interest in reading this book. When the National Cholesterol Education Program lowered the
“optimal” cholesterol levels in 2004, eight out of nine people
on the panel had financial ties to the pharmaceutical industry.
28 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 29
To understand the cholesterol myth—and to fully But how, exactly, did cholesterol and saturated fat
appreciate how the related health advice is obsolete— come to be branded as the twin demons of heart
CHAPTER 3 you’ll need to know a lot more about cholesterol than disease in the first place? To answer that question, we
the average person knows. Understanding the full need to go back to 1953. And if every story needs a
story of cholesterol touches on medicine and villain, one person in particular has been christened
research, as well as politics, economics, psychology, the arch-dietary nemesis of the twentieth century:
CHOLESTEROL and sociology. It’s got a cast of characters ranging

from the obnoxious and egotistical to the well-mean-
Ancel Benjamin Keys.
Keys was a public health scientist and is often con-
IS HARMLESS
ing and misguided. sidered the granddaddy of the low-fat movement. He is
Sadly, much to the story has little to do with saving best remembered for launching the Seven Countries
lives, though it may have started out that way. Instead, Study—the first major international study investigating
it involves staggering amounts of money, the politics of links between diet, lifestyle factors, and heart disease.
publication, and the sociology of belief—i.e., why bad The massive study seemed to confirm a link between
ideas continue to survive past their expiration dates. saturated fat consumption and cardiovascular disease,
NOW LET’S TALK ABOUT YOU We’ll also shine a light on the revolving door that and Keys spent the latter part of his career pushing
Unless you’re an information junkie, there’s a good chance that you’re reading this book because you exists between government advisory committees and the newfangled (at the time) idea that too much satu-
have something at stake here. Let us guess: You’re concerned about your cholesterol. the industries they’re supposed to police. For example, rated fat in the diet was harming our tickers.
Maybe you’re a woman whose doctor has read you the riot act because your cholesterol is when the National Cholesterol Education Program Highly successful by any metric we could imagine,
approaching 300 mg/dL, and your doc has convinced you that you’ll drop dead of a heart attack if lowered the “optimal” cholesterol levels in 2004, Keys managed to spread his ideas to the public and
you don’t go on medication right away. eight out of nine people on the panel had financial steer scientific consensus toward saturated fat pho-
Maybe you’re a middle-aged man who has already had a heart attack, and your doctor is adamant ties to the pharmaceutical industry, most of them to bia. But Keys has also been the butt of some serious
about putting you on a cholesterol-lowering drug. the manufacturers of cholesterol-lowering drugs who allegations. Depending on who you ask, the whole
Or maybe you’re a fit guy in your sixties whose cholesterol is 240 mg/dL and whose doctor is would subsequently reap immediate benefits from Seven Countries Study was a sham because he chose
“worried” about that number. these same recommendations. only countries he knew would confirm his hypothesis.
Only one of the three hypothetical cases listed above has any business being on a cholesterol- Or that he made a famous graph by cherry-picking six
lowering drug. Can you guess which one? Don’t worry: By the time you finish this book, you’ll know THE BIRTH OF THE DIET-HEART countries out of twenty-two countries that had avail-
the answer. And you’ll also know a heck of a lot more about cholesterol than most doctors in the HYPOTHESIS able diet and mortality data, making it look like there
United States. And, no, we don’t make that statement lightly. Neither of us buys into the myth that cholesterol is was a near-perfect correlation between national fat
Okay, so you’re concerned about your cholesterol—but you don’t want to blindly follow recommen- the proper target for the prevention of heart disease. consumption and heart disease. Or, even better, that
dations without doing your own research. If you did, you’d simply follow your doctor’s orders and have
no interest in reading this book. When the National Cholesterol Education Program lowered the
“optimal” cholesterol levels in 2004, eight out of nine people
on the panel had financial ties to the pharmaceutical industry.
his Seven Countries Study data actually showed that So, where do we go next?
sugar, not saturated fat, was the real heart-killer—and First, it’s important to understand how nutritional
THE SNACKWELL PHENOMENON
he simply ignored those findings and drowned out dis- research is actually done—then you will have a far
Low-fat had become the new mantra of the times, something we like to call the “Snackwell
senting voices, like that of his rival nutritionist John greater understanding of how all the diet “experts”
Phenomenon.” Food companies rushed to create low-fat versions of every food imaginable, all
Yudkin, in order to preserve his ideology. come to their conclusions. And be forewarned:
marketed as “heart-healthy,” with no cholesterol. (No one seemed to notice that manufacturers
Full disclosure: We have been among the Keys- Understanding the studies on which most nutritional
replaced the missing fat with tons of sugar and processed carbs, both of which are far more
bashers. We’ve leveled some of these very charges advice is based will be like watching sausage made.
dangerous to our hearts than fat ever was.)
against the guy. We’ve given him a whole lot of credit And we can promise you this: You’ll never feel the
Butter was demonized and replaced with margarine, one of the most supremely stupid
for fostering the biggest nutritional experiment in his- same way about eating sausage again.
nutritional swap-outs in recent memory. Only much later did we discover that the supposedly
tory—the low-fat high-carb diet—and being single-
healthier margarine was laden with trans fats, a really bad kind of fat created by using a kind
handedly responsible for the epidemics of obesity, MYTHS AND TRUTHS ABOUT DIET
of turkey baster to inject hydrogen atoms into a liquid (unsaturated) fat, making it more solid
diabetes, and heart disease that followed in the wake RESEARCH
and giving it a longer shelf life. (Any time you read “partially hydrogenated oil” or
of the very recommendations he tirelessly promoted. First things first: Most diet research stinks.
“hydrogenated oil” in a list of ingredients, that means the food in question contains trans fats.)
Today, We’re Doing Things A Little Differently. There, we’ve said it. Now we’ll show you why
Unlike saturated fats from whole foods such as butter, trans fats (at least the man-made kind)
See, history is rarely as black and white as we’d much of the nutrition research you hear about in the
actually do increase the risk for heart disease and strokes!
like to believe—and the Keys debacle is no exception. news is so misleading, inadequate, often irrelevant,
About 80 percent of trans fats in the American diet come from factory-produced partially
Many of the claims slung against him, it turns out, and sometimes truly dangerous.11 This includes—most
hydrogenated vegetable oil.1 Yet vegetable oils were (and are!) aggressively promoted as the
are a mix of myth and fact. But, when it comes to especially—the research that claims to show that satu-
healthy alternative to saturated fats, even though most of these oils are highly processed, pro-
getting out of our current health crisis, none of that rated fat will kill you and that cholesterol categori-
inflammatory, and easily damaged when reheated over and over again, which is standard
really matters. cally causes heart disease.
procedure in many restaurants.
That’s right. No matter which part of the “villain”
Think it’s a coincidence that the obesity and diabetes epidemics went into overdrive around
narrative is true or false—the fact remains that we got How to Do a Randomized,
the same time that we started pushing low-fat, high-carb diets as an alternative to those
to where we are somehow. When all is said and done, Controlled Study
containing more fat and protein? We don’t.
the dietary recommendations are the dietary recom- Let’s say I’m a drug company, and I want to find out if
But by now, fat—and, by extension, cholesterol— had become the new bogeyman of the
mendations and the widespread cultural bias against the new blood pressure drug my company has come
American diet, defended only by people who clearly had a horse in the race (e.g., the dairy and
dietary fat is not disappearing anytime soon. That’s up with actually works in humans.
meat industries). Meanwhile, low-fat had become the new religion of the masses. Now it was
what we need to live with. That’s what we need to So, I design a study: I take a group of people. I
left for the science to catch up. The National Institutes of Health (NIH) funded half a dozen
combat. What matters is not how we got into this pre- make sure they’re as “identical” as people can be—i.e.,
studies that were published between 1980 and 1984, hoping it would find persuasive evidence
dicament, but that we’re in it. And now that we’re here, “30-year-old nonsmoking men from the Northeast
that low-fat diets prolonged lives.
it’s time to roll up our sleeves and undo the damage. with no previous health issues, but moderately high
Did they?
You want to understand the widespread fear of blood pressure.”
Hardly.
cholesterol, and you want to make intelligent, science- In other words, I match the subjects for age, sex,
based, rational choices about diet and lifestyle. You medical history, and so on—all the things that could
want to know what to eat to prevent heart disease. possibly skew the results make it hard to determine

his Seven Countries Study data actually showed that So, where do we go next?
sugar, not saturated fat, was the real heart-killer—and First, it’s important to understand how nutritional
THE SNACKWELL PHENOMENON
he simply ignored those findings and drowned out dis- research is actually done—then you will have a far
Low-fat had become the new mantra of the times, something we like to call the “Snackwell
senting voices, like that of his rival nutritionist John greater understanding of how all the diet “experts”
Phenomenon.” Food companies rushed to create low-fat versions of every food imaginable, all
Yudkin, in order to preserve his ideology. come to their conclusions. And be forewarned:
marketed as “heart-healthy,” with no cholesterol. (No one seemed to notice that manufacturers
Full disclosure: We have been among the Keys- Understanding the studies on which most nutritional
replaced the missing fat with tons of sugar and processed carbs, both of which are far more
bashers. We’ve leveled some of these very charges advice is based will be like watching sausage made.
dangerous to our hearts than fat ever was.)
against the guy. We’ve given him a whole lot of credit And we can promise you this: You’ll never feel the
Butter was demonized and replaced with margarine, one of the most supremely stupid
for fostering the biggest nutritional experiment in his- same way about eating sausage again.
nutritional swap-outs in recent memory. Only much later did we discover that the supposedly
tory—the low-fat high-carb diet—and being single-
healthier margarine was laden with trans fats, a really bad kind of fat created by using a kind
handedly responsible for the epidemics of obesity, MYTHS AND TRUTHS ABOUT DIET
of turkey baster to inject hydrogen atoms into a liquid (unsaturated) fat, making it more solid
diabetes, and heart disease that followed in the wake RESEARCH
and giving it a longer shelf life. (Any time you read “partially hydrogenated oil” or
of the very recommendations he tirelessly promoted. First things first: Most diet research stinks.
“hydrogenated oil” in a list of ingredients, that means the food in question contains trans fats.)
Today, We’re Doing Things A Little Differently. There, we’ve said it. Now we’ll show you why
Unlike saturated fats from whole foods such as butter, trans fats (at least the man-made kind)
See, history is rarely as black and white as we’d much of the nutrition research you hear about in the
actually do increase the risk for heart disease and strokes!
like to believe—and the Keys debacle is no exception. news is so misleading, inadequate, often irrelevant,
About 80 percent of trans fats in the American diet come from factory-produced partially
Many of the claims slung against him, it turns out, and sometimes truly dangerous.11 This includes—most
hydrogenated vegetable oil.1 Yet vegetable oils were (and are!) aggressively promoted as the
are a mix of myth and fact. But, when it comes to especially—the research that claims to show that satu-
healthy alternative to saturated fats, even though most of these oils are highly processed, pro-
getting out of our current health crisis, none of that rated fat will kill you and that cholesterol categori-
inflammatory, and easily damaged when reheated over and over again, which is standard
really matters. cally causes heart disease.
procedure in many restaurants.
That’s right. No matter which part of the “villain”
Think it’s a coincidence that the obesity and diabetes epidemics went into overdrive around
narrative is true or false—the fact remains that we got How to Do a Randomized,
the same time that we started pushing low-fat, high-carb diets as an alternative to those
to where we are somehow. When all is said and done, Controlled Study
containing more fat and protein? We don’t.
the dietary recommendations are the dietary recom- Let’s say I’m a drug company, and I want to find out if
But by now, fat—and, by extension, cholesterol— had become the new bogeyman of the
mendations and the widespread cultural bias against the new blood pressure drug my company has come
American diet, defended only by people who clearly had a horse in the race (e.g., the dairy and
dietary fat is not disappearing anytime soon. That’s up with actually works in humans.
meat industries). Meanwhile, low-fat had become the new religion of the masses. Now it was
what we need to live with. That’s what we need to So, I design a study: I take a group of people. I
left for the science to catch up. The National Institutes of Health (NIH) funded half a dozen
combat. What matters is not how we got into this pre- make sure they’re as “identical” as people can be—i.e.,
studies that were published between 1980 and 1984, hoping it would find persuasive evidence
dicament, but that we’re in it. And now that we’re here, “30-year-old nonsmoking men from the Northeast
that low-fat diets prolonged lives.
it’s time to roll up our sleeves and undo the damage. with no previous health issues, but moderately high
Did they?
You want to understand the widespread fear of blood pressure.”
Hardly.
cholesterol, and you want to make intelligent, science- In other words, I match the subjects for age, sex,
based, rational choices about diet and lifestyle. You medical history, and so on—all the things that could
want to know what to eat to prevent heart disease. possibly skew the results make it hard to determine

In 1986 the NIH held what’s called a “consensus conference” to basically justify the dietary “These studies are revolutionary,” said Jules Hirsch, M.D., physician-in-chief emeritus at the
recommendations, yet it was anything but a consensus. Several experts pointed to significant Rockefeller University in New York City and an expert on how diets influence weight and
defects in the studies and even called into question their accuracy. But you’d never know it health. The studies “should put a stop to this era of thinking that we have all the information
from the final report, which made it seem like everyone had unquestioningly hitched their we need to change the whole national diet and make everybody healthy.”8
collective stars to the low-fat bandwagon. Of course, none of these questionable findings stopped the cholesterol-lowering, fat-
Well, not exactly everyone. avoiding juggernaut that went into full swing in the late 1970s and continues, albeit bruised
Consensus? Not Exactly. and battered, to this day. And we have to give the misguided researchers kudos for their
George Mann, M.D., associate professor of biochemistry at Vanderbilt University College of motives—by reducing cholesterol levels, they sincerely believed they would be reducing heart
Medicine and a participating researcher in the Framingham Heart Study, was one of the doubters. disease. As Dwight Lundell, M.D., author of The Cure for Heart Disease, wryly put it, “They
The diet-heart idea is the “greatest scam” in the history of medicine, he said. “[Researchers] have were taking the bull by the horn—but it was the wrong bull.”9
held repeated press conferences bragging about this cataclysmic breakthrough, which the study When we first met about this project, Steve brought to the meeting a series of papers by
directors claim shows that lowering cholesterol lowers the frequency of coronary disease. They one of the most respected researchers in the world, Michel de Lorgeril, M.D., a French
2
have manipulated the data to reach the wrong conclusions.” cardiologist and researcher at the prestigious National Centre for Scientific Research, the
Mann also declared that NIH managers “used Madison Avenue hype to sell this failed trial in largest public organization for scientific research in France.
3
the way that media people sell an underarm deodorant!” Michael Oliver, a highly respected De Lorgeril has authored dozens of papers in peer-reviewed journals, and he was the lead
British cardiologist, concurred. “The panel of jurists . . . was selected to include experts who researcher for the Lyon Diet Heart Study. The following quotation comes from his only book
would, predictably, say that . . . all levels of blood cholesterol in the United States are too high written in English, and it’s a perfect way to end this chapter:
4
and should be lowered. Of course, this is exactly what was said.” “We can summarize . . . in one sentence: Cholesterol is harmless!”10
But the dissenting voices met with radio silence. With pompous certainty, the committee
made clear in its final report that low-fat diets would afford significant protection against
what the drug itself is doing. stress, aren’t taking any other medications, and are
coronary heart disease for men, women, and children over two years old. “The evidence
I don’t really care about how these folks might be more or less uniform on all other important health
justifies . . . the reduction of calories from fat . . . to 30 percent, calories from saturated fat to
different in terms of their television viewing habits, or metrics I can think of.
10 percent or less, and dietary cholesterol to no more than 250 to 300 mg daily,” it declared.5
if they prefer iPhones over Androids, or if they had a If you’re thinking this is pretty hard to do, you’re
As Dr. Phil might ask, “And how’s that workin’ for you?”
really bad haircut in high school. But I do want to right: It’s next to impossible. But it’s the research
One study that attempted to answer this hypothetical question was the Women’s Health
make sure they’re similar on any measure that could “ideal,” and people who get most of it right publish
Initiative, the same program that has suggested that hormone therapy after menopause has
likely affect blood pressure (which probably doesn’t better research than those who get less of it right.
more risks than benefits. This $415-million NIH study involved close to 49,000 people, aged
include smartphone preferences or bowl cuts). So, we’re trying to “match” our subjects so
fifty to seventy-nine, who were followed for eight years in an attempt to answer the question,
Because blood pressure can easily be influenced they’re as similar as possible. We’re trying to do the
“Does a low-fat diet reduce the risk of getting heart disease or cancer?”6
by factors such as smoking and obesity and lifestyle, I human equivalent of an experiment that uses lab rats
They got their answer.
make sure—just to keep things even—that all my sub- with identical genes bred in an identical environment.
“The largest study ever to ask whether a low-fat diet reduces the risk of getting cancer or
jects are nonsmokers, not overweight, don’t have pre- It’s the “sameness” of subjects that is important here.
heart disease has found that the diet has no effect,” the New York Times reported in 2006.7
viously existing heart disease, have a similar level of Next, I randomly assign these very similar

In 1986 the NIH held what’s called a “consensus conference” to basically justify the dietary “These studies are revolutionary,” said Jules Hirsch, M.D., physician-in-chief emeritus at the
recommendations, yet it was anything but a consensus. Several experts pointed to significant Rockefeller University in New York City and an expert on how diets influence weight and
defects in the studies and even called into question their accuracy. But you’d never know it health. The studies “should put a stop to this era of thinking that we have all the information
from the final report, which made it seem like everyone had unquestioningly hitched their we need to change the whole national diet and make everybody healthy.”8
collective stars to the low-fat bandwagon. Of course, none of these questionable findings stopped the cholesterol-lowering, fat-
Well, not exactly everyone. avoiding juggernaut that went into full swing in the late 1970s and continues, albeit bruised
Consensus? Not Exactly. and battered, to this day. And we have to give the misguided researchers kudos for their
George Mann, M.D., associate professor of biochemistry at Vanderbilt University College of motives—by reducing cholesterol levels, they sincerely believed they would be reducing heart
Medicine and a participating researcher in the Framingham Heart Study, was one of the doubters. disease. As Dwight Lundell, M.D., author of The Cure for Heart Disease, wryly put it, “They
The diet-heart idea is the “greatest scam” in the history of medicine, he said. “[Researchers] have were taking the bull by the horn—but it was the wrong bull.”9
held repeated press conferences bragging about this cataclysmic breakthrough, which the study When we first met about this project, Steve brought to the meeting a series of papers by
directors claim shows that lowering cholesterol lowers the frequency of coronary disease. They one of the most respected researchers in the world, Michel de Lorgeril, M.D., a French
2
have manipulated the data to reach the wrong conclusions.” cardiologist and researcher at the prestigious National Centre for Scientific Research, the
Mann also declared that NIH managers “used Madison Avenue hype to sell this failed trial in largest public organization for scientific research in France.
3
the way that media people sell an underarm deodorant!” Michael Oliver, a highly respected De Lorgeril has authored dozens of papers in peer-reviewed journals, and he was the lead
British cardiologist, concurred. “The panel of jurists . . . was selected to include experts who researcher for the Lyon Diet Heart Study. The following quotation comes from his only book
would, predictably, say that . . . all levels of blood cholesterol in the United States are too high written in English, and it’s a perfect way to end this chapter:
4
and should be lowered. Of course, this is exactly what was said.” “We can summarize . . . in one sentence: Cholesterol is harmless!”10
But the dissenting voices met with radio silence. With pompous certainty, the committee
made clear in its final report that low-fat diets would afford significant protection against
what the drug itself is doing. stress, aren’t taking any other medications, and are
coronary heart disease for men, women, and children over two years old. “The evidence
I don’t really care about how these folks might be more or less uniform on all other important health
justifies . . . the reduction of calories from fat . . . to 30 percent, calories from saturated fat to
different in terms of their television viewing habits, or metrics I can think of.
10 percent or less, and dietary cholesterol to no more than 250 to 300 mg daily,” it declared.5
if they prefer iPhones over Androids, or if they had a If you’re thinking this is pretty hard to do, you’re
As Dr. Phil might ask, “And how’s that workin’ for you?”
really bad haircut in high school. But I do want to right: It’s next to impossible. But it’s the research
One study that attempted to answer this hypothetical question was the Women’s Health
make sure they’re similar on any measure that could “ideal,” and people who get most of it right publish
Initiative, the same program that has suggested that hormone therapy after menopause has
likely affect blood pressure (which probably doesn’t better research than those who get less of it right.
more risks than benefits. This $415-million NIH study involved close to 49,000 people, aged
include smartphone preferences or bowl cuts). So, we’re trying to “match” our subjects so
fifty to seventy-nine, who were followed for eight years in an attempt to answer the question,
Because blood pressure can easily be influenced they’re as similar as possible. We’re trying to do the
“Does a low-fat diet reduce the risk of getting heart disease or cancer?”6
by factors such as smoking and obesity and lifestyle, I human equivalent of an experiment that uses lab rats
They got their answer.
make sure—just to keep things even—that all my sub- with identical genes bred in an identical environment.
“The largest study ever to ask whether a low-fat diet reduces the risk of getting cancer or
jects are nonsmokers, not overweight, don’t have pre- It’s the “sameness” of subjects that is important here.
heart disease has found that the diet has no effect,” the New York Times reported in 2006.7
viously existing heart disease, have a similar level of Next, I randomly assign these very similar

subjects to one of two groups. For the length of this studies you hear about in the media resemble our increase in cholesterol,” or “Eating 1 ounce of nuts a for generating hypotheses. Epidemiology is like the
ideal clinical study, both groups would eat identical hypothetical blood pressure drug study about as day is associated with lower incidence of heart dis- preliminary detective work one does when gathering
food, sleep identical hours, and live pretty much iden- much as West Virginia resembles West Hollywood. ease.” In short, the goal is to take a lot of data from a up clues at a crime scene, clues that suggest a hypoth-
tical lives, with one notable exception. One group lot of people, and then see which things tend to be esis of what might have gone down. But that’s just the
would get the treatment I’m trying to study—in this Enter Epidemiology found together. But the fact that two things are found beginning. No one is convicted of a crime based on
case, the blood pressure medication—and the other Contrary to what alarmist news headlines might together doesn’t mean one caused the others (for clues—you use the clues to build a case. In science, that
would get a placebo. At the conclusion of the study, suggest, not all studies are created equal—even if example, rain and umbrellas, or firefighters and fires). “case” is built with the bricks of randomized, double-
we’d measure their average blood pressure and match when they’re published in prestigious peer-reviewed You might notice, for example, that in countries blind, placebo-controlled, peer-reviewed research stud-
it against the baseline levels measured before the journals. The vast majority of the studies that make it where they eat a lot of fiber, there is less incidence of ies. The case isn’t built with a few random “clues”—in
study began. to the mainstream media are not rigorously controlled colon cancer. Or that people who have lower levels of science, those are the equivalent of circumstantial evi-
(The control group gets a placebo because the clinical trials (e.g., our hypothetical blood pressure vitamin D tend to have higher rates of multiple sclero- dence and would be thrown out of court.
very act of getting a pill can influence the results. medication). Instead, they are epidemiological studies, sis. Or that diabetes incidence exploded upward under When epidemiology is used as it should be—for
That’s right: Simply thinking you’re taking medication also known as observational studies. These are the the Clinton administration. Or that people who eat generating hypotheses—it’s terrific. For example, if two
can be enough to cause some health improvements. If kinds of studies that Ancel Keys conducted, and more saturated fat have higher total cholesterol. variables keep showing up hand-in-hand across differ-
that doesn’t attest to the power of the human mind, virtually all of the nutrition advice we get from major Whether these correlations matter at all—and ent human populations in multiple epidemiological
we don’t know what does!) health organizations around the world comes from what they actually mean, if anything—is a topic for studies, we can start forming and testing ideas about
If, by the end of the study, there were any signifi- studies that are just like the Seven Countries Study. a different day. For now we’re just talking about the why that’s happening. Does one cause the other? If
cant differences between the two matched groups in They are associational and observational—a type of data, not whether that data is clinically important. so, which is cause and which is effect? We can also
actual blood pressure—like if the blood pressure medi- study that is, by its very design, fundamentally unable The idea that smoking causes lung cancer, for investigate whether a third, hidden factor drives them
cine group had significantly lower blood pressure at to show cause and effect. example, came out of epidemiology. And that was a both. For example, living in a high-rise building is
the end of the study than the placebo group—we’d Observational studies are exactly what they great example of the true value of epidemiology, associated with more frequent bronchitis—but in real-
have a darn good reason to assume that the blood sound like: Researchers observe. They don’t intervene, which is to generate hypotheses. Epidemiologists ity, both those things are due to a third factor com-
pressure drug was the cause, and the stockholders in they don’t randomize, they don’t treat, and they cer- noticed consistently higher levels of lung cancer mon to both—bad air quality.
the company that makes that medicine would be tainly don’t manipulate variables. They simply watch among smokers, which was an interesting observa-
breaking out the champagne and kazoos. large groups of people going about their regular day- tion—but only because this repeated observation led EPIDEMIOLOGY IS OUR STARTING
We tested the hypothesis “this blood pressure to-day lives. Over several years, they collect copious to the hypothesis that cigarette smoking causes lung POINT
medication lowers blood pressure,” and, in the case of data on what these groups of people do, what they cancer. That hypothesis was then tested in a rigorous When it comes to figuring out links between diet,
this hypothetical study, we confirmed the hypothesis. eat, and—eventually—what diseases or deaths befall way, time and time and time again in study after lifestyle, and disease, epidemiology is our starting
The blood pressure medicine did indeed perform as them. Then the researchers apply sophisticated statis- study around which (unlike cholesterol) there is little point—not our final destination. There’s a reason all
hoped. We can market our drug with a clear con- tical tools to tease out associations between what controversy. And it is now considered to be true that scientists worth their weight in petri dishes abide by
science and FDA approval! those folks were doing and what was happening to cigarettes wildly increase your risk for lung cancer in the wisdom, correlation does not equal causation. As
Wouldn’t it be nice if nutrition studies were done their bodies. a directly causal fashion. exciting as new findings can be, observational studies
like this? The answer is, “Yes, it sure would be!” Typical findings of these kinds of studies include: So epidemiology is terrific for observing things, for rarely give us the full story.
Too bad they’re not. In fact, most of the nutrition “Eating bacon every day is associated with a 21% noticing what’s found together, and, most importantly, So clearly, epidemiology has its place. The prob-

subjects to one of two groups. For the length of this studies you hear about in the media resemble our increase in cholesterol,” or “Eating 1 ounce of nuts a for generating hypotheses. Epidemiology is like the
ideal clinical study, both groups would eat identical hypothetical blood pressure drug study about as day is associated with lower incidence of heart dis- preliminary detective work one does when gathering
food, sleep identical hours, and live pretty much iden- much as West Virginia resembles West Hollywood. ease.” In short, the goal is to take a lot of data from a up clues at a crime scene, clues that suggest a hypoth-
tical lives, with one notable exception. One group lot of people, and then see which things tend to be esis of what might have gone down. But that’s just the
would get the treatment I’m trying to study—in this Enter Epidemiology found together. But the fact that two things are found beginning. No one is convicted of a crime based on
case, the blood pressure medication—and the other Contrary to what alarmist news headlines might together doesn’t mean one caused the others (for clues—you use the clues to build a case. In science, that
would get a placebo. At the conclusion of the study, suggest, not all studies are created equal—even if example, rain and umbrellas, or firefighters and fires). “case” is built with the bricks of randomized, double-
we’d measure their average blood pressure and match when they’re published in prestigious peer-reviewed You might notice, for example, that in countries blind, placebo-controlled, peer-reviewed research stud-
it against the baseline levels measured before the journals. The vast majority of the studies that make it where they eat a lot of fiber, there is less incidence of ies. The case isn’t built with a few random “clues”—in
study began. to the mainstream media are not rigorously controlled colon cancer. Or that people who have lower levels of science, those are the equivalent of circumstantial evi-
(The control group gets a placebo because the clinical trials (e.g., our hypothetical blood pressure vitamin D tend to have higher rates of multiple sclero- dence and would be thrown out of court.
very act of getting a pill can influence the results. medication). Instead, they are epidemiological studies, sis. Or that diabetes incidence exploded upward under When epidemiology is used as it should be—for
That’s right: Simply thinking you’re taking medication also known as observational studies. These are the the Clinton administration. Or that people who eat generating hypotheses—it’s terrific. For example, if two
can be enough to cause some health improvements. If kinds of studies that Ancel Keys conducted, and more saturated fat have higher total cholesterol. variables keep showing up hand-in-hand across differ-
that doesn’t attest to the power of the human mind, virtually all of the nutrition advice we get from major Whether these correlations matter at all—and ent human populations in multiple epidemiological
we don’t know what does!) health organizations around the world comes from what they actually mean, if anything—is a topic for studies, we can start forming and testing ideas about
If, by the end of the study, there were any signifi- studies that are just like the Seven Countries Study. a different day. For now we’re just talking about the why that’s happening. Does one cause the other? If
cant differences between the two matched groups in They are associational and observational—a type of data, not whether that data is clinically important. so, which is cause and which is effect? We can also
actual blood pressure—like if the blood pressure medi- study that is, by its very design, fundamentally unable The idea that smoking causes lung cancer, for investigate whether a third, hidden factor drives them
cine group had significantly lower blood pressure at to show cause and effect. example, came out of epidemiology. And that was a both. For example, living in a high-rise building is
the end of the study than the placebo group—we’d Observational studies are exactly what they great example of the true value of epidemiology, associated with more frequent bronchitis—but in real-
have a darn good reason to assume that the blood sound like: Researchers observe. They don’t intervene, which is to generate hypotheses. Epidemiologists ity, both those things are due to a third factor com-
pressure drug was the cause, and the stockholders in they don’t randomize, they don’t treat, and they cer- noticed consistently higher levels of lung cancer mon to both—bad air quality.
the company that makes that medicine would be tainly don’t manipulate variables. They simply watch among smokers, which was an interesting observa-
breaking out the champagne and kazoos. large groups of people going about their regular day- tion—but only because this repeated observation led EPIDEMIOLOGY IS OUR STARTING
We tested the hypothesis “this blood pressure to-day lives. Over several years, they collect copious to the hypothesis that cigarette smoking causes lung POINT
medication lowers blood pressure,” and, in the case of data on what these groups of people do, what they cancer. That hypothesis was then tested in a rigorous When it comes to figuring out links between diet,
this hypothetical study, we confirmed the hypothesis. eat, and—eventually—what diseases or deaths befall way, time and time and time again in study after lifestyle, and disease, epidemiology is our starting
The blood pressure medicine did indeed perform as them. Then the researchers apply sophisticated statis- study around which (unlike cholesterol) there is little point—not our final destination. There’s a reason all
hoped. We can market our drug with a clear con- tical tools to tease out associations between what controversy. And it is now considered to be true that scientists worth their weight in petri dishes abide by
science and FDA approval! those folks were doing and what was happening to cigarettes wildly increase your risk for lung cancer in the wisdom, correlation does not equal causation. As
Wouldn’t it be nice if nutrition studies were done their bodies. a directly causal fashion. exciting as new findings can be, observational studies
like this? The answer is, “Yes, it sure would be!” Typical findings of these kinds of studies include: So epidemiology is terrific for observing things, for rarely give us the full story.
Too bad they’re not. In fact, most of the nutrition “Eating bacon every day is associated with a 21% noticing what’s found together, and, most importantly, So clearly, epidemiology has its place. The prob-

lem is when it’s forcibly removed from that place researcher lingo, the notorious FFQ,). questionnaire that was used by NHANES: That hypothesis can now be tested clinically in a vari-
(where it lived happily as a hypotheses generator) and FFQ stands for food frequency questionnaire, and You might be thinking, “This is the worst and ety of settings—such as by feeding people controlled
gets inserted somewhere it really doesn’t belong— here’s how it works. Researchers ask people to fill out most unreliable way I can possibly imagine to collect diets with different levels of saturated fat, and mea-
such as at the helm of public policy. a form every three, six, or twelve months, stating data on what people eat.” And guess what? You’re suring what happens to their blood lipids.
Now hold on to your hats, because we’re about to what they’ve been eating by checking boxes that ask right. And everyone knows it. The point is that the epidemiological observa-
show you what sausage-making looks like when it things like, “Over the past twelve months, how often People’s long-term diet recall is notoriously inac- tion generates something that can then be analyzed
comes to nutritional epidemiology. did you eat butter on potatoes, cooked vegetables, curate. It’s also often skewed by wishful thinking: in a more controlled manner to determine cause and
You might at this moment be forgiven, for exam- rice, grains, or beans?” think “Of course I only eat ice cream once a month!” effect. So, fire up the Bunsen burners!
ple, for wondering how researchers can observe what If that seems like a ridiculous example, here’s the This leads to chronic underreporting of “bad” foods, But testing the hypothesis generated by an epide-
thousands—sometimes hundreds of thousands—of peo- scary part: That question comes straight from the and sometimes over-reporting of “good” ones. miological study is frequently not what happens next.
ple are eating on a daily basis. The answer is: They NHANES Food Frequency Questionnaire, developed by Scientists themselves have written papers roast- Instead, there is a wildly premature leap to decla-
12
can’t. So, they collect data using a tried-and-true tool the National Cancer Institute. ing the almighty FFQ for its failures as a data-gather- rations of causation based on nothing but a pile of
known as the food frequency questionnaire (or, in Here’s an example of the actual food frequency ing tool. In an editorial by researchers from the Fred associations. The media airwaves start filling with “Red
Hutchinson Cancer Research Center in Seattle—tell- meat causes cancer!” “Bacon causes heart attacks!”
ingly titled, “Is It Time to Abandon the Food and other sensationalist claims that haven’t even come
National Health and Nutrition Examination Survey (NHANES) FFQ Frequency Questionnaire?”—the authors noted that close to being confirmed (or refuted) by more rigorous,
Over the past 12 months . . . 33. How often did you eat string beans or green diet and cancer links that showed up loud and clear controlled experiments. In turn, the perception of con-
28. How often did you eat COOKED greens beans (fresh, canned, or frozen)? using dietary biomarkers were totally undetectable sumers—that’s folks like you and me—gets shaped by
(such as spinach, turnip, collard, mustard,
c NEVER when using food frequency questionnaire data. They13
totally preliminary findings. And, too often, this
chard, or kale?
c 1–6 times per year c 2 times per week concluded that it’s “possible that epidemiologists becomes the basis of public health policy.
c NEVER c 7–11 times per year c 3–4 times per week
have been deluded in their acceptance of food fre-
c 1–6 times per year c 2 times per week c 1 time per month c 5–6 times per week
c 7–11 times per year c 3–4 times per week
quency questionnaires.” Yellow Finger Syndrome
c 2–3 times per month c 1 time per day
c 1 time per month c 5–6 times per week I can’t tell you how many times I’ve discussed this We’ve seen association studies miss the most obvious
c 1 time per week c 2 or more times per day
c 2–3 times per month c 1 time per day with researchers, and every single time the verdict is connections and fail to account for many other
c 1 time per week c 2 or more times per day 34. How often did you eat peas (fresh, canned, the same: It’s absolutely awful, but it’s all we’ve got. plausible ones. For example, there is a statistically
29. How often did you eat RAW greens (such as or frozen)? And this, dear reader, is the very method that significant positive correlation between a noticeable
spinach, turnip, collard, mustard, chard, or kale)? nutritional epidemiology hangs its hat on. See the yellowing on the fingertips and lung cancer. For years,
c NEVER
(We’ll ask about lettuce later.) c 1–6 times per year c 2 times per week problem? those with a strange yellowing on their fingertips
c 7–11 times per year c 3–4 times per week Here’s what happens when epidemiology is used developed lung cancer at a much higher rate than
c NEVER
c 1 time per month c 5–6 times per week for studying diet. Data will show that, for example, those who did not have yellowish fingertips. Beginning
c 1–6 times per year c 2 times per week
c 2–3 times per month c 1 time per day over a period of twenty-five years, saturated fat con- statistics students were taught this association to
c 1 time per month c 5–6 times per week sumption went up in a population, and so did choles- illustrate the concept of a confounding variable. The
c 2–3 times per month c 1 time per day terol. Now that should generate a hypothesis—i.e., that confounding variable in this case is smoking. Smoking
c 1 time per week c 2 or more times per day saturated fat consumption causes cholesterol to rise. causes both lung cancer and yellow fingers. Yellow

lem is when it’s forcibly removed from that place researcher lingo, the notorious FFQ,). questionnaire that was used by NHANES: That hypothesis can now be tested clinically in a vari-
(where it lived happily as a hypotheses generator) and FFQ stands for food frequency questionnaire, and You might be thinking, “This is the worst and ety of settings—such as by feeding people controlled
gets inserted somewhere it really doesn’t belong— here’s how it works. Researchers ask people to fill out most unreliable way I can possibly imagine to collect diets with different levels of saturated fat, and mea-
such as at the helm of public policy. a form every three, six, or twelve months, stating data on what people eat.” And guess what? You’re suring what happens to their blood lipids.
Now hold on to your hats, because we’re about to what they’ve been eating by checking boxes that ask right. And everyone knows it. The point is that the epidemiological observa-
show you what sausage-making looks like when it things like, “Over the past twelve months, how often People’s long-term diet recall is notoriously inac- tion generates something that can then be analyzed
comes to nutritional epidemiology. did you eat butter on potatoes, cooked vegetables, curate. It’s also often skewed by wishful thinking: in a more controlled manner to determine cause and
You might at this moment be forgiven, for exam- rice, grains, or beans?” think “Of course I only eat ice cream once a month!” effect. So, fire up the Bunsen burners!
ple, for wondering how researchers can observe what If that seems like a ridiculous example, here’s the This leads to chronic underreporting of “bad” foods, But testing the hypothesis generated by an epide-
thousands—sometimes hundreds of thousands—of peo- scary part: That question comes straight from the and sometimes over-reporting of “good” ones. miological study is frequently not what happens next.
ple are eating on a daily basis. The answer is: They NHANES Food Frequency Questionnaire, developed by Scientists themselves have written papers roast- Instead, there is a wildly premature leap to decla-
12
can’t. So, they collect data using a tried-and-true tool the National Cancer Institute. ing the almighty FFQ for its failures as a data-gather- rations of causation based on nothing but a pile of
known as the food frequency questionnaire (or, in Here’s an example of the actual food frequency ing tool. In an editorial by researchers from the Fred associations. The media airwaves start filling with “Red
Hutchinson Cancer Research Center in Seattle—tell- meat causes cancer!” “Bacon causes heart attacks!”
ingly titled, “Is It Time to Abandon the Food and other sensationalist claims that haven’t even come
National Health and Nutrition Examination Survey (NHANES) FFQ Frequency Questionnaire?”—the authors noted that close to being confirmed (or refuted) by more rigorous,
Over the past 12 months . . . 33. How often did you eat string beans or green diet and cancer links that showed up loud and clear controlled experiments. In turn, the perception of con-
28. How often did you eat COOKED greens beans (fresh, canned, or frozen)? using dietary biomarkers were totally undetectable sumers—that’s folks like you and me—gets shaped by
(such as spinach, turnip, collard, mustard,
c NEVER when using food frequency questionnaire data. They13
totally preliminary findings. And, too often, this
chard, or kale?
c 1–6 times per year c 2 times per week concluded that it’s “possible that epidemiologists becomes the basis of public health policy.
c NEVER c 7–11 times per year c 3–4 times per week
have been deluded in their acceptance of food fre-
c 1–6 times per year c 2 times per week c 1 time per month c 5–6 times per week
quency questionnaires.” Yellow Finger Syndrome
c 2–3 times per month c 1 time per day
c 1 time per month c 5–6 times per week I can’t tell you how many times I’ve discussed this We’ve seen association studies miss the most obvious
c 2–3 times per month c 1 time per day with researchers, and every single time the verdict is connections and fail to account for many other
c 1 time per week c 2 or more times per day 34. How often did you eat peas (fresh, canned, the same: It’s absolutely awful, but it’s all we’ve got. plausible ones. For example, there is a statistically
29. How often did you eat RAW greens (such as or frozen)? And this, dear reader, is the very method that significant positive correlation between a noticeable
spinach, turnip, collard, mustard, chard, or kale)? nutritional epidemiology hangs its hat on. See the yellowing on the fingertips and lung cancer. For years,
c NEVER
(We’ll ask about lettuce later.) c 1–6 times per year c 2 times per week problem? those with a strange yellowing on their fingertips
c 7–11 times per year c 3–4 times per week Here’s what happens when epidemiology is used developed lung cancer at a much higher rate than
c NEVER
c 1 time per month c 5–6 times per week for studying diet. Data will show that, for example, those who did not have yellowish fingertips. Beginning
c 1–6 times per year c 2 times per week
c 2–3 times per month c 1 time per day over a period of twenty-five years, saturated fat con- statistics students were taught this association to
c 1 time per month c 5–6 times per week sumption went up in a population, and so did choles- illustrate the concept of a confounding variable. The
c 2–3 times per month c 1 time per day terol. Now that should generate a hypothesis—i.e., that confounding variable in this case is smoking. Smoking
c 1 time per week c 2 or more times per day saturated fat consumption causes cholesterol to rise. causes both lung cancer and yellow fingers. Yellow

fingers don’t cause lung cancer, even though they are No one we know of can debunk a study better, all the
Evidence That Facebook Cancelled Out the
frequently found together (correlated). more remarkable because she does it with the kind of
Cholesterol-Lowering Effects of Justin Bieber
Researchers love to think they’re very sophisti- style and wit rarely found in the world of health. And
cated, and have all kinds of statistical magic to per- she does all this armed with nothing but absolutely (B) serum Cholesterol
6,5 -
form on the data to rule out this kind of “confound- ironclad data, which she is happy to show you.
ing.” We think they’re overly optimistic. There’s also a Take, for example, this graphic illustrating the
6,0 -
good deal of confirmation bias in research as well— craziness of making assumptions and health policy
people frequently find what they look for and find from epidemiological, observational studies.
Facebook invented
what they expect to find, paying close attention to I’ll let the graph speak for itself. It looks like per- 5,5 -
any correlations that support their hypothesis and fect evidence that Justin Bieber has been really good
mmol/L
throwing out the many that don’t. for cholesterol levels, but Facebook cancelled out his 5,0 - Justin Bieber born
magical statin-like properties. And because we already
THE FABULOUS PUNCH LINE “know” cholesterol causes heart disease, it seems an 4,5 -
YOU’VE ALL BEEN WAITING FOR open-and-shut prescription:
So, what does all this have to do with the great Wanna wipe out heart disease? Shut down
4,0 -
cholesterol myth? Simple. An observational study—like Facebook. men
the Seven Countries Study—notes an association women
between saturated fat consumption and heart disease. The Fascinating (and Relatively 0,0 -
-
The relationship is assumed to be causal—that is, Unknown) Story of Dr. Ivan Frantz 86 88 90 92 94 96 98 000 02 004 006 008 10
19 19 19 19 19 19 19 2 20 2 2 2 20
eating saturated fat causes heart disease. This I can think of no better illustration of the difference YEAR
ultimately results in a massive public health effort to between associational studies and honest-to-goodness
get everyone to eschew saturated fat-rich foods and scientifically sound clinical studies than the following oil”—was indeed “associated” with a 14 percent reduc- named Ivan Frantz. Frantz was a meticulous
replace them with seed oils (i.e., “vegetable” oil), story, uncovered by the writer and podcaster Malcolm tion in coronary artery disease when compared with a researcher and scientist, a medical doctor who was
which is assumed to be far better for us and will Gladwell, who generously allowed us to retell it in our standard diet with higher amounts of saturated fat. firmly in the camp that believed “it’s all about the
result in improved health and longer lifetimes. own words. The stockholders in the vegetable oil companies broke saturated fat!” This was a man who tested his kids’
At the end of the day, we’ve made massive, Around the same time that the Seven Countries out the bubbly. If there had been any lingering doubt blood regularly to make sure their cholesterol wasn’t
sweeping changes to the American diet (and beyond) Study was on its way to becoming the most referenced about the evils of saturated fat and the superiority of too high. In the Frantz household, butter and fatty
based on little more than two variables that happen and revered study in nutritional history, another big vegetable oil, this study erased them. Canola oil for meat were blacklisted. Frantz, a friend of Keys, was a
to show up alongside each other. And as it turns out, observational study was commencing. It was called the everyone! true believer.
some of those changes have made the problem National Diet Heart Study, and it involved research But he was also a serious scientist, and he recog-
worse, not better. 14
teams in six major cities. Ancel Keys himself super- Malcolm Gladwell Dug into This Story nized the second-class citizenship of epidemiology in
There are very few writers in the health-and-well- vised the Minneapolis arm of the study. and Here’s What He Found15 the scientific world. So, he wanted to do the Faribault,
ness space that are better than Denise Minger, whom The study concluded that a diet lower in saturated The researcher in charge of the Faribault, Minnesota, Minnesota, arm of the Diet Heart study differently. He
we were delighted to be able to work with on this book. fat and higher in polyunsaturated fat—i.e. “vegetable arm of the National Diet Heart Study was a guy wanted to do a real, clinical study, not a mere obser-

fingers don’t cause lung cancer, even though they are No one we know of can debunk a study better, all the
Evidence That Facebook Cancelled Out the
frequently found together (correlated). more remarkable because she does it with the kind of
Cholesterol-Lowering Effects of Justin Bieber
Researchers love to think they’re very sophisti- style and wit rarely found in the world of health. And
cated, and have all kinds of statistical magic to per- she does all this armed with nothing but absolutely (B) serum Cholesterol
6,5 -
form on the data to rule out this kind of “confound- ironclad data, which she is happy to show you.
ing.” We think they’re overly optimistic. There’s also a Take, for example, this graphic illustrating the
6,0 -
good deal of confirmation bias in research as well— craziness of making assumptions and health policy
people frequently find what they look for and find from epidemiological, observational studies.
Facebook invented
what they expect to find, paying close attention to I’ll let the graph speak for itself. It looks like per- 5,5 -
any correlations that support their hypothesis and fect evidence that Justin Bieber has been really good
mmol/L
throwing out the many that don’t. for cholesterol levels, but Facebook cancelled out his 5,0 - Justin Bieber born
magical statin-like properties. And because we already
THE FABULOUS PUNCH LINE “know” cholesterol causes heart disease, it seems an 4,5 -
YOU’VE ALL BEEN WAITING FOR open-and-shut prescription:
So, what does all this have to do with the great Wanna wipe out heart disease? Shut down
4,0 -
cholesterol myth? Simple. An observational study—like Facebook. men
the Seven Countries Study—notes an association women
between saturated fat consumption and heart disease. The Fascinating (and Relatively 0,0 -
-
The relationship is assumed to be causal—that is, Unknown) Story of Dr. Ivan Frantz 86 88 90 92 94 96 98 000 02 004 006 008 10
19 19 19 19 19 19 19 2 20 2 2 2 20
eating saturated fat causes heart disease. This I can think of no better illustration of the difference YEAR
ultimately results in a massive public health effort to between associational studies and honest-to-goodness
get everyone to eschew saturated fat-rich foods and scientifically sound clinical studies than the following oil”—was indeed “associated” with a 14 percent reduc- named Ivan Frantz. Frantz was a meticulous
replace them with seed oils (i.e., “vegetable” oil), story, uncovered by the writer and podcaster Malcolm tion in coronary artery disease when compared with a researcher and scientist, a medical doctor who was
which is assumed to be far better for us and will Gladwell, who generously allowed us to retell it in our standard diet with higher amounts of saturated fat. firmly in the camp that believed “it’s all about the
result in improved health and longer lifetimes. own words. The stockholders in the vegetable oil companies broke saturated fat!” This was a man who tested his kids’
At the end of the day, we’ve made massive, Around the same time that the Seven Countries out the bubbly. If there had been any lingering doubt blood regularly to make sure their cholesterol wasn’t
sweeping changes to the American diet (and beyond) Study was on its way to becoming the most referenced about the evils of saturated fat and the superiority of too high. In the Frantz household, butter and fatty
based on little more than two variables that happen and revered study in nutritional history, another big vegetable oil, this study erased them. Canola oil for meat were blacklisted. Frantz, a friend of Keys, was a
to show up alongside each other. And as it turns out, observational study was commencing. It was called the everyone! true believer.
some of those changes have made the problem National Diet Heart Study, and it involved research But he was also a serious scientist, and he recog-
worse, not better. 14
teams in six major cities. Ancel Keys himself super- Malcolm Gladwell Dug into This Story nized the second-class citizenship of epidemiology in
There are very few writers in the health-and-well- vised the Minneapolis arm of the study. and Here’s What He Found15 the scientific world. So, he wanted to do the Faribault,
ness space that are better than Denise Minger, whom The study concluded that a diet lower in saturated The researcher in charge of the Faribault, Minnesota, Minnesota, arm of the Diet Heart study differently. He
we were delighted to be able to work with on this book. fat and higher in polyunsaturated fat—i.e. “vegetable arm of the National Diet Heart Study was a guy wanted to do a real, clinical study, not a mere obser-

vational one. That meant creating two matched The raw data would have probably remained in
groups of subjects and controlling exactly what they Frantz’s basement . . . if it hadn’t been for Christopher
THE TRANS FAT FACTOR
ate, with one group getting the “saturated fat” diet Ramsden. Years after Frantz died and his study had
There’s another reason to suspect that vegetable oils and margarines were contributing to
and one group getting the “vegetable oil” diet. Frantz faded from scientific memory, Ramsden—a researcher
the problem of heart disease rather than helping to prevent it: trans fat. Remember that when
was—along with most of the medical establishment at at the National Institutes of Health—was investigating
the dietary and medical powers that be collectively decided that saturated fat was the enemy,
the time—convinced that people who substituted mar- linoleic acid, the primary fat found in vegetable oil.
they had to replace it with something. That something turned out to be hydrogenated vegetable
garine for butter and corn oil for lard would live lon- Ramsden wanted to know more about what happens
oil, hydrogenated so that it would have a nice long shelf life and remain stable for years.
ger, have less heart disease, and generally be health- when “vegetable oil”—a “food” product that wasn’t
Hydrogenated vegetable oil—also known as trans fat—turned out to be a Frankenfat that some
ier on most major indices. even around 100 years earlier—was consumed in the
authors (notably our friend, Dr. Steven Masley) have referred to as metabolic embalming fluid.
But, Frantz wondered, how am I going to get amounts that were now being recommended.
Trans fat has been implicated as a risk factor in both stroke and heart disease.16 It was
thousands of people to agree to eat the assigned Ramsden wanted to do a clinical study on linoleic
officially “banned” by the U.S. Government in 2015 when the Food and Drug Administration
diet—and how would I even be sure that they stuck to acid—the main polyunsaturated fat found in vegetable
ruled that artificial trans fats were unsafe to eat.17
it? In a flash of ingenuity, Frantz got the idea to do oil—to help answer the gnawing question, “What really
In the study done by Ivan Franz (see text), the margarine they used was almost certainly
his arm of the study in an institutional setting. happens when you replace natural, traditional satu-
high in artificial trans fat, though at the time, few scientists knew the dangers associated with
He recruited seven institutions that were willing rated fats with vegetable oils?” Ideally, he would have
that particular substance.
to participate. Patients were separated into matched liked to take two matched groups of subjects, feed
It’s also ironic that the food that was so demonized that it had to be replaced on our menu—
groups and given either the “saturated fat” diet or them the identical diet—same number of calories,
butter—turns out to have more mono unsaturated fat than saturated fat! (Monounsaturated fat
the “polyunsaturated fat” (vegetable oil) diet. The same amount of protein, fat, and carbs—except that
is the same kind found in olive oil.)
only food the patients got was delivered on trays by one group’s meals would be prepared with saturated
The margarine fiasco in the late 1980s and '90s is a perfect example of backward medicine
hospital staff, and Frantz arranged for the two groups fats and one group’s meals would be prepared with
and dumb solutions to nonexistent problems. First, make people worried about the saturated
to have meals that looked absolutely identical—even vegetable oil.
fat in butter (even though there’s no need to be). Next, solve the “problem” you’ve just created
though one tray was composed of meals prepared the “But who’s going to fund a study like that?”
with a profitable “solution”—margarine loaded with trans fat—that’s way worse than the original
conventional way, and the other tray was composed Ramsden probably thought. And then he remembered:
“problem.” Boom! You’ve got “I can’t believe it’s not butter”!
of meals in which saturated fat had been replaced That study has already been conducted! It’s exactly
with vegetable oil. The study was truly a randomized, what Dr. Ivan Frantz had done for his part of the Diet
double-blind design. Superb. Heart Study!
The study went on from 1968 to 1973, with quite a Ramsden tracked down Ivan Frantz’s son, Robert He went to work analyzing it. And Frantz had fact, in people over sixty-five, there was a distinct
long period of follow-up. But when the raw data came Frantz, a cardiologist at the Mayo Clinic, who agreed been right: The data were kind of weird. trend, and not at all in the direction that was
in, Frantz was—to put it mildly—surprised. The data were to help him. After much searching, they hit pay dirt It turned out that not only was there no advan- expected: Those who lowered their cholesterol the
equivocal at best. There was no clear advantage for and Ramsden had the original data from the superbly tage to replacing saturated fat with vegetable oil, most had the highest risk of dying.
the people who had eaten the diet in which saturated constructed, randomized control trial that tested the there was a distinct disadvantage, particularly if you Ramsden knew he was about to call into question
fat had been replaced with vegetable oil. In fact, Frantz then-current notion that people who replace satu- were over sixty-five. Vegetable oil lowered cholesterol Ivan Frantz’s life’s work. What did Ivan Frantz’s son,
thought, the data were kind of weird. Replacing saturated fat with vegetable fat would be healthier and just fine—which was what everybody thought would Robert Frantz, have to say? “Publish it.” He explained:
rated fat with vegetable oil produced zero benefit. would live longer. happen. What vegetable oil didn’t do was save lives. In “My father believed in science, and he believed in

vational one. That meant creating two matched The raw data would have probably remained in
groups of subjects and controlling exactly what they Frantz’s basement . . . if it hadn’t been for Christopher
THE TRANS FAT FACTOR
ate, with one group getting the “saturated fat” diet Ramsden. Years after Frantz died and his study had
There’s another reason to suspect that vegetable oils and margarines were contributing to
and one group getting the “vegetable oil” diet. Frantz faded from scientific memory, Ramsden—a researcher
the problem of heart disease rather than helping to prevent it: trans fat. Remember that when
was—along with most of the medical establishment at at the National Institutes of Health—was investigating
the dietary and medical powers that be collectively decided that saturated fat was the enemy,
the time—convinced that people who substituted mar- linoleic acid, the primary fat found in vegetable oil.
they had to replace it with something. That something turned out to be hydrogenated vegetable
garine for butter and corn oil for lard would live lon- Ramsden wanted to know more about what happens
oil, hydrogenated so that it would have a nice long shelf life and remain stable for years.
ger, have less heart disease, and generally be health- when “vegetable oil”—a “food” product that wasn’t
Hydrogenated vegetable oil—also known as trans fat—turned out to be a Frankenfat that some
ier on most major indices. even around 100 years earlier—was consumed in the
authors (notably our friend, Dr. Steven Masley) have referred to as metabolic embalming fluid.
But, Frantz wondered, how am I going to get amounts that were now being recommended.
Trans fat has been implicated as a risk factor in both stroke and heart disease.16 It was
thousands of people to agree to eat the assigned Ramsden wanted to do a clinical study on linoleic
officially “banned” by the U.S. Government in 2015 when the Food and Drug Administration
diet—and how would I even be sure that they stuck to acid—the main polyunsaturated fat found in vegetable
ruled that artificial trans fats were unsafe to eat.17
it? In a flash of ingenuity, Frantz got the idea to do oil—to help answer the gnawing question, “What really
In the study done by Ivan Franz (see text), the margarine they used was almost certainly
his arm of the study in an institutional setting. happens when you replace natural, traditional satu-
high in artificial trans fat, though at the time, few scientists knew the dangers associated with
He recruited seven institutions that were willing rated fats with vegetable oils?” Ideally, he would have
that particular substance.
to participate. Patients were separated into matched liked to take two matched groups of subjects, feed
It’s also ironic that the food that was so demonized that it had to be replaced on our menu—
groups and given either the “saturated fat” diet or them the identical diet—same number of calories,
butter—turns out to have more mono unsaturated fat than saturated fat! (Monounsaturated fat
the “polyunsaturated fat” (vegetable oil) diet. The same amount of protein, fat, and carbs—except that
is the same kind found in olive oil.)
only food the patients got was delivered on trays by one group’s meals would be prepared with saturated
The margarine fiasco in the late 1980s and '90s is a perfect example of backward medicine
hospital staff, and Frantz arranged for the two groups fats and one group’s meals would be prepared with
and dumb solutions to nonexistent problems. First, make people worried about the saturated
to have meals that looked absolutely identical—even vegetable oil.
fat in butter (even though there’s no need to be). Next, solve the “problem” you’ve just created
though one tray was composed of meals prepared the “But who’s going to fund a study like that?”
with a profitable “solution”—margarine loaded with trans fat—that’s way worse than the original
conventional way, and the other tray was composed Ramsden probably thought. And then he remembered:
“problem.” Boom! You’ve got “I can’t believe it’s not butter”!
of meals in which saturated fat had been replaced That study has already been conducted! It’s exactly
with vegetable oil. The study was truly a randomized, what Dr. Ivan Frantz had done for his part of the Diet
double-blind design. Superb. Heart Study!
The study went on from 1968 to 1973, with quite a Ramsden tracked down Ivan Frantz’s son, Robert He went to work analyzing it. And Frantz had fact, in people over sixty-five, there was a distinct
long period of follow-up. But when the raw data came Frantz, a cardiologist at the Mayo Clinic, who agreed been right: The data were kind of weird. trend, and not at all in the direction that was
in, Frantz was—to put it mildly—surprised. The data were to help him. After much searching, they hit pay dirt It turned out that not only was there no advan- expected: Those who lowered their cholesterol the
equivocal at best. There was no clear advantage for and Ramsden had the original data from the superbly tage to replacing saturated fat with vegetable oil, most had the highest risk of dying.
the people who had eaten the diet in which saturated constructed, randomized control trial that tested the there was a distinct disadvantage, particularly if you Ramsden knew he was about to call into question
fat had been replaced with vegetable oil. In fact, Frantz then-current notion that people who replace satu- were over sixty-five. Vegetable oil lowered cholesterol Ivan Frantz’s life’s work. What did Ivan Frantz’s son,
thought, the data were kind of weird. Replacing saturated fat with vegetable fat would be healthier and just fine—which was what everybody thought would Robert Frantz, have to say? “Publish it.” He explained:
rated fat with vegetable oil produced zero benefit. would live longer. happen. What vegetable oil didn’t do was save lives. In “My father believed in science, and he believed in

truth. He valued those things far more than he did his out nutritional history (i.e., the villainous caricature of
own ‘beliefs.’ Publish the data—my father would have Ancel Keys). The problem goes much deeper than any
wanted you to.” individual researcher or pet theory. It’s rooted in our CHAPTER 4
So he did. And here’s what Ramsden said when very relationship with science itself—the way we use
he published it in the British Medical Journal: (and abuse) observational findings; the way the media
“Available evidence from randomized controlled trials and policymakers alike confuse correlation for causa-
shows that replacement of saturated fat with linoleic
acid effectively lowers serum cholesterol—but does
tion; the way the public’s dearth of scientific literacy
keeps us vulnerable to misleading information. THE REAL DEAL
ON CHOLESTEROL
not support the hypothesis that this translates to a There’s nothing wrong, per se, with epidemiology.
lower risk of death from coronary heart disease” We simply need to understand where observational
(emphasis ours). In fact, Ramsden pointed out, the studies land in the hierarchy of scientific research
best clinical trials we have reached the exact opposite (spoiler alert: pretty low down on the totem pole). We
conclusion. also need to take the necessary steps to determine
causation. Sure, conducting controlled trials might be WHEN WE WERE KIDS, DOCTORS STILL MADE HOUSE CALLS.
SO, WHAT DO WE TAKE AWAY slower, more expensive, and trickier to pull off than One of us—Jonny—vividly remembers “Dr. Leo” coming to the house, always dressed in a suit and
FROM ALL THIS? running a bunch of food frequency questionnaire tie, with black satchel at the ready. He’d take out his trusty tongue depressor, tell you to say “ah,” put
As Esther Perel once said, “Human beings have a answers through a statistical model—but isn’t our a flashlight in your eye and a stethoscope on your chest and voilà, he’d pronounce his verdict—a flu, a
tendency to search for truth in the places where it is health worth it? bug, strep throat. He’d dash off an unreadable prescription and within a day or two the “bug” would
easiest to look rather than where it is likely to be We need to be much more critical readers of be gone.
18
found.” We might all do well to be less attached to media messages about health. Don’t take them at Now imagine, if you will, that instead of being a boy of ten you are a grown person, age forty-
our beliefs and more devoted to the truth. face value. Dig deeper. Do your own research and lis- seven, living in Southern California. You have a strange pain, dizziness, and a wicked headache. You
Our current state of cholesterol confusion isn’t ten to competing views. The headlines are almost definitely don’t feel “right.” You wonder if you’re having a stroke, or possibly a heart attack. You call
simply due to “bad guys doing bad things” through- never the whole story. an ambulance and they take you to Cedars Sinai in Los Angeles, one of the best-equipped and most
highly rated hospitals in the country.
They wheel you in past the gleaming high-tech machines that can take a picture of virtually any
 WHAT YOU NEED TO KNOW organ in your body, past the electron microscopes that can measure virtually any metabolic process at
the subcellular level, past the Harvard-trained physicians scurrying around with handheld devices that
• The theory that fat and cholesterol cause heart disease became widely accepted despite
have the computation power of IBM’s Big Blue, into the emergency room.
much evidence to the contrary, evidence which continues to accumulate. The case is
And in walks a doctor with a tongue depressor.
thankfully being reopened.
She spends about five minutes with you. She tells you to say “ah,” puts a flashlight in your eye,
• Many doctors did not agree—and do not agree—with the cholesterol myth and correctly
listens to your heart with a device that’s essentially the medical version of two tin cans and string,
question the science upon which it was based.
pronounces your diagnosis, writes you a script, and sends you home.
• The adoption of the cholesterol myth by mainstream organizations and the government was
Pretty crazy, right?
not supported by science and had a strong political component to it.
42 THE GREAT CHOLESTEROL MYTH 43

truth. He valued those things far more than he did his out nutritional history (i.e., the villainous caricature of
own ‘beliefs.’ Publish the data—my father would have Ancel Keys). The problem goes much deeper than any
wanted you to.” individual researcher or pet theory. It’s rooted in our CHAPTER 4
So he did. And here’s what Ramsden said when very relationship with science itself—the way we use
he published it in the British Medical Journal: (and abuse) observational findings; the way the media
“Available evidence from randomized controlled trials and policymakers alike confuse correlation for causa-
shows that replacement of saturated fat with linoleic
acid effectively lowers serum cholesterol—but does
tion; the way the public’s dearth of scientific literacy
keeps us vulnerable to misleading information. THE REAL DEAL
ON CHOLESTEROL
not support the hypothesis that this translates to a There’s nothing wrong, per se, with epidemiology.
lower risk of death from coronary heart disease” We simply need to understand where observational
(emphasis ours). In fact, Ramsden pointed out, the studies land in the hierarchy of scientific research
best clinical trials we have reached the exact opposite (spoiler alert: pretty low down on the totem pole). We
conclusion. also need to take the necessary steps to determine
causation. Sure, conducting controlled trials might be WHEN WE WERE KIDS, DOCTORS STILL MADE HOUSE CALLS.
SO, WHAT DO WE TAKE AWAY slower, more expensive, and trickier to pull off than One of us—Jonny—vividly remembers “Dr. Leo” coming to the house, always dressed in a suit and
FROM ALL THIS? running a bunch of food frequency questionnaire tie, with black satchel at the ready. He’d take out his trusty tongue depressor, tell you to say “ah,” put
As Esther Perel once said, “Human beings have a answers through a statistical model—but isn’t our a flashlight in your eye and a stethoscope on your chest and voilà, he’d pronounce his verdict—a flu, a
tendency to search for truth in the places where it is health worth it? bug, strep throat. He’d dash off an unreadable prescription and within a day or two the “bug” would
easiest to look rather than where it is likely to be We need to be much more critical readers of be gone.
18
found.” We might all do well to be less attached to media messages about health. Don’t take them at Now imagine, if you will, that instead of being a boy of ten you are a grown person, age forty-
our beliefs and more devoted to the truth. face value. Dig deeper. Do your own research and lis- seven, living in Southern California. You have a strange pain, dizziness, and a wicked headache. You
Our current state of cholesterol confusion isn’t ten to competing views. The headlines are almost definitely don’t feel “right.” You wonder if you’re having a stroke, or possibly a heart attack. You call
simply due to “bad guys doing bad things” through- never the whole story. an ambulance and they take you to Cedars Sinai in Los Angeles, one of the best-equipped and most
highly rated hospitals in the country.
They wheel you in past the gleaming high-tech machines that can take a picture of virtually any
 WHAT YOU NEED TO KNOW organ in your body, past the electron microscopes that can measure virtually any metabolic process at
the subcellular level, past the Harvard-trained physicians scurrying around with handheld devices that
• The theory that fat and cholesterol cause heart disease became widely accepted despite
have the computation power of IBM’s Big Blue, into the emergency room.
much evidence to the contrary, evidence which continues to accumulate. The case is
And in walks a doctor with a tongue depressor.
thankfully being reopened.
She spends about five minutes with you. She tells you to say “ah,” puts a flashlight in your eye,
• Many doctors did not agree—and do not agree—with the cholesterol myth and correctly
listens to your heart with a device that’s essentially the medical version of two tin cans and string,
question the science upon which it was based.
pronounces your diagnosis, writes you a script, and sends you home.
• The adoption of the cholesterol myth by mainstream organizations and the government was
Pretty crazy, right?
not supported by science and had a strong political component to it.

Well, the “good” versus “bad” cholesterol test is
the tongue depressor of diagnostic tests. It’s equiva-
Cholesterol can’t travel in the blood because it is
hydrophobic (hydro=water, phobic=avoiding). Trying to
Remember this: Cholesterol is the cargo and the lipoprotein
lent to trying to make meaningful decisions about get cholesterol to get from point A to point B in the is the boat. This is important because what matters
a person’s health based on which of two categories
of height they fall into—short or tall. In an age when
bloodstream without putting it in some kind of protec-
tive container would be like pouring oil in a lake and
is the boats—not the cargo!
we have access to the entire human genome wouldn’t expecting it to make it to the other side of the lake
it be pretty ridiculous to diagnose based on “short intact. Lipoprotein Class Protein Cholesterol Triglyceride
and tall”? Yet that’s exactly what we’re doing when Cholesterol always has to be contained in a pro-
VLDL (very low-density) lipoprotein 10% 22% 50%
we prescribe drugs based on “good and bad” tective structure—the protective container that the
cholesterol? body uses to safely transport cholesterol is called a IDL (intermediate density lipoprotein) 18% 29% 50%
At this point in our knowledge of heart disease, lipoprotein (as in “high-density lipoprotein”—HDL—and
LDL (low-density lipoprotein) 25% 46-50% 31%
inflammatory markers, cholesterol fractionization, and “low-density lipoprotein”—LDL.) We colloquially call
genetic markers, the “good” and “bad” cholesterol these lipoproteins “cholesterol” but in fact, choles- HDL (high-density lipoprotein) 33% 30% 4-8%
test is no more useful in predicting outcomes than terol is only a portion of the cargo these lipoprotein
this month’s horoscope. It’s an obsolete test, and I’m “boats” carry around the bloodstream. (For example, Though most people—and most doctors—only terns of lipoprotein distribution (i.e., “Pattern A—
about to explain why. lipoproteins also carry triglycerides and protein.) know about “LDL” and “HDL,” the fact is that scien- mostly large, buoyant particles” versus “Pattern B—
That is why—as you’ll soon see—the single most tists have now been able to identify at least thirteen mostly small, inflammatory particles”). These pat-
CHOLESTEROL 101 important metric to know from any test regarding different subfractions of cholesterol—HDL2a, HDL2b, terns—independent of anything else—are predictive of
This is the real story of what cholesterol is, what it cholesterol is this: How many boats are there in the LDL llla, LDL lllb, Lp(a), oxLDL, just to name a cardiometabolic problems such as diabetes, insulin
does, how it gets into your bloodstream, and what water. How much cholesterol those boats are carrying handful. resistance, and metabolic syndrome.
actually happens once it gets there. Once you see the is really beside the point. If there are too many boats The presence (and preponderance) of different
story in its full Technicolor glory—with all the in the water, the chance of an accident is greater than subfractions have very different meanings when it Why Conventional Tests Are Worthless
subtleties and nuances—you will never again accept a if there are less boats in the water, regardless of the comes to risk. For example: HDL2b consists of the larg- Here’s a great example of the obsolescence of the
prescription for a powerful drug based on nothing cargo (cholesterol, protein, triglycerides) those boats est and most buoyant particles in the HDL “family.” “good” versus “bad” cholesterol test. The following
more than an outdated test for “good” versus “bad” happen to be carrying. And there is a simple, widely Even if your overall “HDL” is “normal,” a breakdown of hypothetical numbers represent what your
cholesterol. In fact, you will understand how baffling it available test to find out how many “boats” are float- the subclasses might reveal that you actually have a conventional doc would call a “great” cholesterol test.
is to still be relying on this test in the early decades ing around in your bloodstream, and it’s called the very low level of large HDL particles, which increases If you had these numbers, your conventional doc
of the twenty-first century. NMR particle test. (Much more on the particle test cardiovascular disease (CVD) risk by 1.8 times. would pronounce your heart in great shape and would
So let’s get started. coming—stay tuned!) Some subfractions are more likely to promote the be unlikely to write you a script for a statin drug.
The first and most important thing you need to If you’re beginning to think, “it’s all about the formation of plaque. These subfractions are smaller,
know about cholesterol is that it cannot travel unac- lipoproteins,” well guess what? You’re right. Here’s a denser, and more susceptible to inflammation and oxi- TOTAL CHOLESTEROL: 137
companied in the bloodstream. The second thing breakdown of the approximate protein/ cholesterol/ dation (see chapter 5). Some subfractions are less LDL: 66
worth knowing is the astonishing fact that most con- triglyceride content of the basic classes of likely to be damaged and to therefore become a prob- HDL: 42
ventional doctors do not know this. lipoproteins: lem. What’s more, researchers can now identify pat- Triglycerides: 146
44 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 45

Well, the “good” versus “bad” cholesterol test is
the tongue depressor of diagnostic tests. It’s equiva-
Cholesterol can’t travel in the blood because it is
hydrophobic (hydro=water, phobic=avoiding). Trying to
Remember this: Cholesterol is the cargo and the lipoprotein
lent to trying to make meaningful decisions about get cholesterol to get from point A to point B in the is the boat. This is important because what matters
a person’s health based on which of two categories
of height they fall into—short or tall. In an age when
bloodstream without putting it in some kind of protec-
tive container would be like pouring oil in a lake and
is the boats—not the cargo!
we have access to the entire human genome wouldn’t expecting it to make it to the other side of the lake
it be pretty ridiculous to diagnose based on “short intact. Lipoprotein Class Protein Cholesterol Triglyceride
and tall”? Yet that’s exactly what we’re doing when Cholesterol always has to be contained in a pro-
VLDL (very low-density) lipoprotein 10% 22% 50%
we prescribe drugs based on “good and bad” tective structure—the protective container that the
cholesterol? body uses to safely transport cholesterol is called a IDL (intermediate density lipoprotein) 18% 29% 50%
At this point in our knowledge of heart disease, lipoprotein (as in “high-density lipoprotein”—HDL—and
LDL (low-density lipoprotein) 25% 46-50% 31%
inflammatory markers, cholesterol fractionization, and “low-density lipoprotein”—LDL.) We colloquially call
genetic markers, the “good” and “bad” cholesterol these lipoproteins “cholesterol” but in fact, choles- HDL (high-density lipoprotein) 33% 30% 4-8%
test is no more useful in predicting outcomes than terol is only a portion of the cargo these lipoprotein
this month’s horoscope. It’s an obsolete test, and I’m “boats” carry around the bloodstream. (For example, Though most people—and most doctors—only terns of lipoprotein distribution (i.e., “Pattern A—
about to explain why. lipoproteins also carry triglycerides and protein.) know about “LDL” and “HDL,” the fact is that scien- mostly large, buoyant particles” versus “Pattern B—
That is why—as you’ll soon see—the single most tists have now been able to identify at least thirteen mostly small, inflammatory particles”). These pat-
CHOLESTEROL 101 important metric to know from any test regarding different subfractions of cholesterol—HDL2a, HDL2b, terns—independent of anything else—are predictive of
This is the real story of what cholesterol is, what it cholesterol is this: How many boats are there in the LDL llla, LDL lllb, Lp(a), oxLDL, just to name a cardiometabolic problems such as diabetes, insulin
does, how it gets into your bloodstream, and what water. How much cholesterol those boats are carrying handful. resistance, and metabolic syndrome.
actually happens once it gets there. Once you see the is really beside the point. If there are too many boats The presence (and preponderance) of different
story in its full Technicolor glory—with all the in the water, the chance of an accident is greater than subfractions have very different meanings when it Why Conventional Tests Are Worthless
subtleties and nuances—you will never again accept a if there are less boats in the water, regardless of the comes to risk. For example: HDL2b consists of the larg- Here’s a great example of the obsolescence of the
prescription for a powerful drug based on nothing cargo (cholesterol, protein, triglycerides) those boats est and most buoyant particles in the HDL “family.” “good” versus “bad” cholesterol test. The following
more than an outdated test for “good” versus “bad” happen to be carrying. And there is a simple, widely Even if your overall “HDL” is “normal,” a breakdown of hypothetical numbers represent what your
cholesterol. In fact, you will understand how baffling it available test to find out how many “boats” are float- the subclasses might reveal that you actually have a conventional doc would call a “great” cholesterol test.
is to still be relying on this test in the early decades ing around in your bloodstream, and it’s called the very low level of large HDL particles, which increases If you had these numbers, your conventional doc
of the twenty-first century. NMR particle test. (Much more on the particle test cardiovascular disease (CVD) risk by 1.8 times. would pronounce your heart in great shape and would
So let’s get started. coming—stay tuned!) Some subfractions are more likely to promote the be unlikely to write you a script for a statin drug.
The first and most important thing you need to If you’re beginning to think, “it’s all about the formation of plaque. These subfractions are smaller,
know about cholesterol is that it cannot travel unac- lipoproteins,” well guess what? You’re right. Here’s a denser, and more susceptible to inflammation and oxi- TOTAL CHOLESTEROL: 137
companied in the bloodstream. The second thing breakdown of the approximate protein/ cholesterol/ dation (see chapter 5). Some subfractions are less LDL: 66
worth knowing is the astonishing fact that most con- triglyceride content of the basic classes of likely to be damaged and to therefore become a prob- HDL: 42
ventional doctors do not know this. lipoproteins: lem. What’s more, researchers can now identify pat- Triglycerides: 146

HOW DOES ATHEROSCLEROSIS
If you’re wondering how to lower your triglycerides, pat on the head, and told that everything is just fine.
But it’s really not. DEVELOP, ANYWAY?
it’s the easiest thing in the world: And we haven’t even started talking about the Arteriosclerosis literally means “hardening of the
They drop like a rock on low-carb diets. number of boats in the water, which is where the real
action is.
arteries.” It’s the process by which an artery goes from
being compliant—able to freely expand and contract to
HDL ratio have a 16x greater risk of heart disease. accommodate blood flow—to being firm and stiff.
Now we should point out that both of us think 1
That’s a 1600 percent increase! You want your Enter Modern Cholesterol Testing Atherosclerosis involves the development of plaque
these test results are problematic, even though con- triglycerides to HDL ratio to be around 2 or less (i.e., So the standard, old-fashioned “good” and “bad” (discussed below) and is the most common cause of
ventional docs don’t. For one thing, a total cholesterol 100 triglycerides, 50 HDL). A ratio of 5 (example: 200: cholesterol test isn’t going to give you much good arteriosclerosis. It’s also the most likely to kill you.
level of 137 is just too darn low—and low cholesterol is 40) increases your risk for cardiovascular events information and, as we saw above, may conceal some And it all starts with an irritant.
associated with a higher risk of death from non-heart significantly. A ratio of 2 (or less) is wonderful. In important facts. And that’s when a more modern Now, this irritant could be a toxin from the air. Or
related issues (like accidents and suicides). And if other words, if your triglycerides were 100 and your cholesterol panel comes in. it could be—and often is—cigarette smoke. It could be a
you’re wondering why the heck low cholesterol might HDL was 50, you’d have the lowest statistical risk for The state-of-the-art test for cholesterol, as of this stray LDL particle (more on that in a moment). Or it
be associated with such random things as accidents a heart attack. writing, is the NMR particle test, also known as the could be the stress of high blood pressure, banging up
and suicides, maybe it’s because cholesterol is needed The triglyceride to HDL ratio in the above test is NMR Lipo-Profile. This test doesn’t just tell you how against the inner walls of the arteries and causing
for proper brain functioning. found by dividing the triglycerides (146) by the HDL much “HDL” and “LDL” you have, it tells you what distress among the layer of cells that lines them, the
Another thing about those “terrific” cholesterol (42) which yields a ratio of 3.47—not terrible, but cer- kind of LDL you have, and, most importantly, how endothelium.
test numbers above: Most functional medicine and tainly not great. But if this person’s triglycerides many boats are in the water carrying around choles- Endothelial cells are the one-celled line of
functional nutrition practitioners (like us) think an dropped to 100, the ratio would go immediately down terol cargo. These boats—the lipoproteins—are techni- defense between what’s floating around in the blood-
optimal triglyceride level is under 100, not under 150. to 2.38 (100:42). That’s a huge improvement in risk, cally called particles, and the NMR test tells you your stream and the actual artery wall—and when those
We would not be overjoyed with a triglyceride level of and one you could make just by dropping your triglyc- total number of them. Now that’s important. endothelial cells become damaged and dysfunctional,
146 even though it’s within the “normal” range for erides even if your HDL cholesterol remained exactly The total number of particles predicts heart dis- the condition is called endothelial dysfunction. (It’s
most labs. the same. ease many times better than simply knowing how like the artery’s version of “leaky gut.”) Many modern
But your doc isn’t looking at any of this; he or much LDL you have. (Remember—the more boats in physicians see endothelial dysfunction as one of the
Triglycerides to HDL Ratio: A Hidden she is looking at a cholesterol test in which all the the water, the more chance of an accident.) The NMR root causes of modern illness. When there’s a break in
Clue to the State of Your Health numbers are “in range” so no problems are assumed. test also identifies how many of those particles are the security of the artery wall—that is, when the endo-
The ratio of triglycerides to HDL is one of the best Your doctor is very happy; you have a very low total small and dense and atherogenic, and how many are thelial layer is damaged—the stage is set for the heart
predictors of both heart disease and insulin resistance cholesterol, and a low LDL, everything else (like tri- big and fluffy and far less damaging. disease version of the Invasion of the Body Snatchers.
(see chapter 9). People with a high triglyceride to glycerides) is “in range” so you’re sent home with a The point is that—given the extraordinary range First, a rogue molecule—most often a rogue LDL—
of measurement tools we now have at our disposal to breaks through the broken and dysfunctional barrier
Cholesterol is an essential molecule without which measure the intricacies of blood lipid levels—it is and parks where it doesn’t belong. Once that LDL par-
there would be no life, so important that virtually head-shakingly baffling that doctors continue to hold
on to a test invented in the 1960s that’s about as
ticle gets into that sub-endothelial space, others fol-
low, like cockroaches in a New York apartment. They
every cell in the body is capable of synthesizing it. accurate as a tongue depressor. become like “squatters,” taking up “illegal residence”

HOW DOES ATHEROSCLEROSIS
If you’re wondering how to lower your triglycerides, pat on the head, and told that everything is just fine.
But it’s really not. DEVELOP, ANYWAY?
it’s the easiest thing in the world: And we haven’t even started talking about the Arteriosclerosis literally means “hardening of the
They drop like a rock on low-carb diets. number of boats in the water, which is where the real
action is.
arteries.” It’s the process by which an artery goes from
being compliant—able to freely expand and contract to
HDL ratio have a 16x greater risk of heart disease. accommodate blood flow—to being firm and stiff.
Now we should point out that both of us think 1
That’s a 1600 percent increase! You want your Enter Modern Cholesterol Testing Atherosclerosis involves the development of plaque
these test results are problematic, even though con- triglycerides to HDL ratio to be around 2 or less (i.e., So the standard, old-fashioned “good” and “bad” (discussed below) and is the most common cause of
ventional docs don’t. For one thing, a total cholesterol 100 triglycerides, 50 HDL). A ratio of 5 (example: 200: cholesterol test isn’t going to give you much good arteriosclerosis. It’s also the most likely to kill you.
level of 137 is just too darn low—and low cholesterol is 40) increases your risk for cardiovascular events information and, as we saw above, may conceal some And it all starts with an irritant.
associated with a higher risk of death from non-heart significantly. A ratio of 2 (or less) is wonderful. In important facts. And that’s when a more modern Now, this irritant could be a toxin from the air. Or
related issues (like accidents and suicides). And if other words, if your triglycerides were 100 and your cholesterol panel comes in. it could be—and often is—cigarette smoke. It could be a
you’re wondering why the heck low cholesterol might HDL was 50, you’d have the lowest statistical risk for The state-of-the-art test for cholesterol, as of this stray LDL particle (more on that in a moment). Or it
be associated with such random things as accidents a heart attack. writing, is the NMR particle test, also known as the could be the stress of high blood pressure, banging up
and suicides, maybe it’s because cholesterol is needed The triglyceride to HDL ratio in the above test is NMR Lipo-Profile. This test doesn’t just tell you how against the inner walls of the arteries and causing
for proper brain functioning. found by dividing the triglycerides (146) by the HDL much “HDL” and “LDL” you have, it tells you what distress among the layer of cells that lines them, the
Another thing about those “terrific” cholesterol (42) which yields a ratio of 3.47—not terrible, but cer- kind of LDL you have, and, most importantly, how endothelium.
test numbers above: Most functional medicine and tainly not great. But if this person’s triglycerides many boats are in the water carrying around choles- Endothelial cells are the one-celled line of
functional nutrition practitioners (like us) think an dropped to 100, the ratio would go immediately down terol cargo. These boats—the lipoproteins—are techni- defense between what’s floating around in the blood-
optimal triglyceride level is under 100, not under 150. to 2.38 (100:42). That’s a huge improvement in risk, cally called particles, and the NMR test tells you your stream and the actual artery wall—and when those
We would not be overjoyed with a triglyceride level of and one you could make just by dropping your triglyc- total number of them. Now that’s important. endothelial cells become damaged and dysfunctional,
146 even though it’s within the “normal” range for erides even if your HDL cholesterol remained exactly The total number of particles predicts heart dis- the condition is called endothelial dysfunction. (It’s
most labs. the same. ease many times better than simply knowing how like the artery’s version of “leaky gut.”) Many modern
But your doc isn’t looking at any of this; he or much LDL you have. (Remember—the more boats in physicians see endothelial dysfunction as one of the
Triglycerides to HDL Ratio: A Hidden she is looking at a cholesterol test in which all the the water, the more chance of an accident.) The NMR root causes of modern illness. When there’s a break in
Clue to the State of Your Health numbers are “in range” so no problems are assumed. test also identifies how many of those particles are the security of the artery wall—that is, when the endo-
The ratio of triglycerides to HDL is one of the best Your doctor is very happy; you have a very low total small and dense and atherogenic, and how many are thelial layer is damaged—the stage is set for the heart
predictors of both heart disease and insulin resistance cholesterol, and a low LDL, everything else (like tri- big and fluffy and far less damaging. disease version of the Invasion of the Body Snatchers.
(see chapter 9). People with a high triglyceride to glycerides) is “in range” so you’re sent home with a The point is that—given the extraordinary range First, a rogue molecule—most often a rogue LDL—
of measurement tools we now have at our disposal to breaks through the broken and dysfunctional barrier
Cholesterol is an essential molecule without which measure the intricacies of blood lipid levels—it is and parks where it doesn’t belong. Once that LDL par-
there would be no life, so important that virtually head-shakingly baffling that doctors continue to hold
on to a test invented in the 1960s that’s about as
ticle gets into that sub-endothelial space, others fol-
low, like cockroaches in a New York apartment. They
every cell in the body is capable of synthesizing it. accurate as a tongue depressor. become like “squatters,” taking up “illegal residence”

in the artery wall. They bind to substances called pro-
teoglycans in the arterial wall and become a magnet
sterol mix that looks like sea foam. This “sea foam”
spreads out like a little lake, but it’s still very much in
LDL particles aren’t the problem—LDL particles winding up in
for oxidative forces. This institutes a full-on inflamma- the artery wall—specifically, the tunica intima, the the wrong place and then getting attacked by oxidative and
tory response. Mayhem ensues.
Remember—this process of inflammation and oxi-
artery wall’s innermost layer.
What happens next is that the smooth muscle cells
inflammatory compounds is the problem.
dation of rogue LDL particles can all be contained in immediately sense that something is amiss, so they
the artery wall and may not even bulge into the lumen, dance a little migration dance over to the tunica intima location, can in turn cause a stroke or a heart attack. The LDL particle only lodges in the wrong place if
the “inner tube” of the artery. As Dr. Peter Attia points and they begin building a fibrous cap on the plaque. There is now a widely available test, called the there’s an irritant or break in the protective arterial
out, this is the reason a person with advanced athero- The fibrous cap—made of proteins like collagen and Lp-PLA2, that can determine your risk for having wall (the endothelium).
sclerosis can still have a normal angiogram! elastin—is like a protective scab on a wound. As one plaque ruptured (see page 203). Guess what—it’s not If there’s a solution to the problem, it has three
As plaque progresses, it can—and usually does— clever instructor from the Kahn Academy referred to it, on the standard cholesterol test. Quelle surprise. We’d essential components: One, we need to reduce our
eventually start to expand or bulge from the artery the resulting structure is like “fat with a cap.” pay a lot more attention to tests like that than we exposure to toxins that create arterial wall injury. Two,
wall into the lumen, narrowing the passageway. This The smooth muscle cells also get confused by all would to LDL tests. we need to keep LDL particles away from where they
compromises the delivery of oxygen to the tissues the dead foam cells and start to think, “maybe we The process of atherosclerosis always involves an don’t belong. And three, we need to prevent or reduce
(ischemia) and can lead to the rupturing of plaque and should lay down some bone here!” so they start errant LDL particle. So maybe you’re thinking that oxidation and inflammation of those LDL particles
even to a full-on myocardial infarction—a heart attack. depositing calcium into the mix. Note to all: Calcium is lowering the total number of LDL particles with statin and their cholesterol content!
The process of atherosclerosis always—100 per- a great nutrient, but you want it deposited in your drugs does kind of make sense after all. Then there As you can see, this is a complex process that
cent of the time—starts with a penetration of the bones, not your arteries. would be less LDL particles around to get into places involves a lot more than the general, gross category
(damaged) artery wall by a rogue lipoprotein. Many Meanwhile, the “fat with a cap” is beginning to they don’t belong. Sure. But that makes as much of “LDL” cholesterol. What’s more, LDL cholesterol
things, such as high blood pressure or cigarette protrude from the tunica intima (the artery wall) into sense as trying to reduce forest fires by getting rid levels in the blood are highly influenced by receptor
smoke, may weaken and damage that artery wall, the artery itself. This creates two conditions. The first of trees. activity. There are normal, healthy LDL receptors on
making it an easy target for penetration. But it’s the is resistance. The radius of the artery has just shrunk
LDL particle that “does the deed” and actually moves a bit to accommodate the intrusion, and that means
into that “no-parking” zone. It takes up residence, and the artery offers more resistance to blood flow, just
thus begins the cascade of plaque formation that can as a hose with a kink is more resistant to water flow.
lead to a lot more serious stuff. The second thing that happens is that the wall of the • Cholesterol travels through the blood in a structure known as a “lipoprotein.”
One of the first things that happens is that the artery itself becomes stiffer, due partially to all the • The lipoproteins are the boats in the water, while cholesterol is one of the passengers.
immune system senses something that doesn’t calcium that’s been laid down near and around the • The total number of lipoproteins in the blood stream is far more predictive of heart disease
belong. It mounts an attack and sends cells called fibrous cap. than the amount of cholesterol cargo.
macrophages—literally “big eater”—to dispose of the Now remember, lots of people have plaque, and • Modern cholesterol testing focuses on the number, size, and patterns of the lipoproteins, not
intruder. The macrophages gobble up the illegally don’t necessarily have problems. What makes plaque the amount of cholesterol they contain.
parked LDL, like little Pac-Men, and in doing so get so a problem is when it ruptures. If it ruptures, you’re in • The triglyceride to HDL ratio is one of the most valuable numbers to know when it comes to
stuffed that they die. Dead macrophages are known trouble. The fibrous cap comes loose and can easily predicting heart disease (and diabetes!).
as foam cells, because they’re stuffed with a fat and cause a blockage of blood flow which, depending on

in the artery wall. They bind to substances called pro-
teoglycans in the arterial wall and become a magnet
sterol mix that looks like sea foam. This “sea foam”
spreads out like a little lake, but it’s still very much in
LDL particles aren’t the problem—LDL particles winding up in
for oxidative forces. This institutes a full-on inflamma- the artery wall—specifically, the tunica intima, the the wrong place and then getting attacked by oxidative and
tory response. Mayhem ensues.
Remember—this process of inflammation and oxi-
artery wall’s innermost layer.
What happens next is that the smooth muscle cells
inflammatory compounds is the problem.
dation of rogue LDL particles can all be contained in immediately sense that something is amiss, so they
the artery wall and may not even bulge into the lumen, dance a little migration dance over to the tunica intima location, can in turn cause a stroke or a heart attack. The LDL particle only lodges in the wrong place if
the “inner tube” of the artery. As Dr. Peter Attia points and they begin building a fibrous cap on the plaque. There is now a widely available test, called the there’s an irritant or break in the protective arterial
out, this is the reason a person with advanced athero- The fibrous cap—made of proteins like collagen and Lp-PLA2, that can determine your risk for having wall (the endothelium).
sclerosis can still have a normal angiogram! elastin—is like a protective scab on a wound. As one plaque ruptured (see page 203). Guess what—it’s not If there’s a solution to the problem, it has three
As plaque progresses, it can—and usually does— clever instructor from the Kahn Academy referred to it, on the standard cholesterol test. Quelle surprise. We’d essential components: One, we need to reduce our
eventually start to expand or bulge from the artery the resulting structure is like “fat with a cap.” pay a lot more attention to tests like that than we exposure to toxins that create arterial wall injury. Two,
wall into the lumen, narrowing the passageway. This The smooth muscle cells also get confused by all would to LDL tests. we need to keep LDL particles away from where they
compromises the delivery of oxygen to the tissues the dead foam cells and start to think, “maybe we The process of atherosclerosis always involves an don’t belong. And three, we need to prevent or reduce
(ischemia) and can lead to the rupturing of plaque and should lay down some bone here!” so they start errant LDL particle. So maybe you’re thinking that oxidation and inflammation of those LDL particles
even to a full-on myocardial infarction—a heart attack. depositing calcium into the mix. Note to all: Calcium is lowering the total number of LDL particles with statin and their cholesterol content!
The process of atherosclerosis always—100 per- a great nutrient, but you want it deposited in your drugs does kind of make sense after all. Then there As you can see, this is a complex process that
cent of the time—starts with a penetration of the bones, not your arteries. would be less LDL particles around to get into places involves a lot more than the general, gross category
(damaged) artery wall by a rogue lipoprotein. Many Meanwhile, the “fat with a cap” is beginning to they don’t belong. Sure. But that makes as much of “LDL” cholesterol. What’s more, LDL cholesterol
things, such as high blood pressure or cigarette protrude from the tunica intima (the artery wall) into sense as trying to reduce forest fires by getting rid levels in the blood are highly influenced by receptor
smoke, may weaken and damage that artery wall, the artery itself. This creates two conditions. The first of trees. activity. There are normal, healthy LDL receptors on
making it an easy target for penetration. But it’s the is resistance. The radius of the artery has just shrunk
LDL particle that “does the deed” and actually moves a bit to accommodate the intrusion, and that means
into that “no-parking” zone. It takes up residence, and the artery offers more resistance to blood flow, just
thus begins the cascade of plaque formation that can as a hose with a kink is more resistant to water flow.
lead to a lot more serious stuff. The second thing that happens is that the wall of the • Cholesterol travels through the blood in a structure known as a “lipoprotein.”
One of the first things that happens is that the artery itself becomes stiffer, due partially to all the • The lipoproteins are the boats in the water, while cholesterol is one of the passengers.
immune system senses something that doesn’t calcium that’s been laid down near and around the • The total number of lipoproteins in the blood stream is far more predictive of heart disease
belong. It mounts an attack and sends cells called fibrous cap. than the amount of cholesterol cargo.
macrophages—literally “big eater”—to dispose of the Now remember, lots of people have plaque, and • Modern cholesterol testing focuses on the number, size, and patterns of the lipoproteins, not
intruder. The macrophages gobble up the illegally don’t necessarily have problems. What makes plaque the amount of cholesterol they contain.
parked LDL, like little Pac-Men, and in doing so get so a problem is when it ruptures. If it ruptures, you’re in • The triglyceride to HDL ratio is one of the most valuable numbers to know when it comes to
stuffed that they die. Dead macrophages are known trouble. The fibrous cap comes loose and can easily predicting heart disease (and diabetes!).
as foam cells, because they’re stuffed with a fat and cause a blockage of blood flow which, depending on

cells that will allow LDLs to “park” on the cell and A new class of medicines—PCSK9 inhibitors—are get-
deliver their cargo in a normal, healthy way. But when ting a lot of attention since they have been shown to
All of which is to say . . . the cholesterol in your diet just doesn’t matter*. And what really
someone has less LDL receptors, there are less “park- lower LDL.
rankles about this—and about the fact that most medical doctors don’t even know it—is that it’s
ing spaces” for the LDL to land in, and hence blood Whether PCKS9 inhibitors wind up saving lives or
been known for decades. For goodness sake, the prime force behind the cholesterol and fat
levels of LDL remain higher, regardless of what you just improving LDL lab values remains to be seen.
hypothesis, Ancel Keys, knew it all along: “(T)he cholesterol content, per se, of all natural diets
eat or how much you exercise. But the very discovery of PCKS9 and the existence of
has no significant effect on either the serum cholesterol level or the development of athero-
There is an enzyme that specifically attacks these PCKS9 inhibitors demonstrates the lack of simplicity
sclerosis in man,” he wrote in 1954.
LDL receptors—it’s called PCSK9 (which stands for in the relationship between cholesterol and heart dis-
Did you hear that? The man who virtually invented the cholesterol theory of heart disease
Proprotein convertase subtilisin/kexin type 9, which is ease. It should argue for the retirement of the stan-
said that the cholesterol you eat doesn’t make a whit of difference. And he said it in 1954.
why everyone simply refers to it as PCSK9!). Some dard “good” and “bad” cholesterol tests and their
We’ll let that sink in for a moment.
people have a lot of PCSK9 activity and therefore less replacement with the much more valuable lab tests
So if everyone knew eating cholesterol didn’t make a whit of difference to blood choles-
functioning LDL receptors and therefore more LDL now available to assess all aspects of blood lipids.
terol—“the cholesterol content of all natural diets has no effect," said Keys—then why on earth
traveling in the bloodstream with nowhere to land.
have we been avoiding egg yolks?
The answer is simple. In the opinion of the dietary dictators, making the distinction
between cholesterol in the blood and cholesterol in the diet was just too heavy a lift for the
EAT THOSE YOLKS! WHY THE CHOLESTEROL YOU EAT general public, so to simplify the issue for public consumption they demonized cholesterol
DOESN’T MAKE A BIT OF DIFFERENCE TO ANYTHING* in general.
For 99.6 perent of the population, here’s the real reason eating cholesterol makes absolutely Better the public should not have to trouble their “pretty little heads” about such compli-
no difference to your blood test cholesterol. cated stuff as the difference between cholesterol on your plate and cholesterol in the blood,
Cholesterol comes in two forms, unattached and attached. Scientists call cholesterol that the establishment seemed to be saying. So they told us to avoid all of it.
has attached itself to another molecule esterfied; unattached cholesterol molecules are either Or at least they did until 2015. And—like a retraction in the newspapers that’s published on
free cholesterol or, if they were once attached and are now single, deesterfied cholesterol. page 32 and that nobody reads—the U.S. government quietly noted in the 2015 guidelines that
The body can only use free, or unesterfied, cholesterol. Most of the cholesterol we eat— “cholesterol is (no longer) a nutrient of concern for over consumption.” (Mention that to your
e.g. in eggs—is esterfied. So in order to be used by the body, we have to first “uncouple” it doctor the next time she tells you not to eat eggs!)
from whatever it’s attached to, a process known as deesterfication. And now that deesterfied
*The exception is for the .04 percent of the population with a genetic condition known as
cholesterol has to compete with the huge amount of ready-to-use unesterfied (unattached)
familial hypercholesterolemia.
cholesterol already being made by your liver and intestines on a daily basis. Which is basically
four-fifths of the cholesterol in your body on any given day. Yes, fully 80 percent of the
cholesterol in your body does in fact come from your own body—the aforementioned liver
being the primary source.

cells that will allow LDLs to “park” on the cell and A new class of medicines—PCSK9 inhibitors—are get-
deliver their cargo in a normal, healthy way. But when ting a lot of attention since they have been shown to
All of which is to say . . . the cholesterol in your diet just doesn’t matter*. And what really
someone has less LDL receptors, there are less “park- lower LDL.
rankles about this—and about the fact that most medical doctors don’t even know it—is that it’s
ing spaces” for the LDL to land in, and hence blood Whether PCKS9 inhibitors wind up saving lives or
been known for decades. For goodness sake, the prime force behind the cholesterol and fat
levels of LDL remain higher, regardless of what you just improving LDL lab values remains to be seen.
hypothesis, Ancel Keys, knew it all along: “(T)he cholesterol content, per se, of all natural diets
eat or how much you exercise. But the very discovery of PCKS9 and the existence of
has no significant effect on either the serum cholesterol level or the development of athero-
There is an enzyme that specifically attacks these PCKS9 inhibitors demonstrates the lack of simplicity
sclerosis in man,” he wrote in 1954.
LDL receptors—it’s called PCSK9 (which stands for in the relationship between cholesterol and heart dis-
Did you hear that? The man who virtually invented the cholesterol theory of heart disease
Proprotein convertase subtilisin/kexin type 9, which is ease. It should argue for the retirement of the stan-
said that the cholesterol you eat doesn’t make a whit of difference. And he said it in 1954.
why everyone simply refers to it as PCSK9!). Some dard “good” and “bad” cholesterol tests and their
We’ll let that sink in for a moment.
people have a lot of PCSK9 activity and therefore less replacement with the much more valuable lab tests
So if everyone knew eating cholesterol didn’t make a whit of difference to blood choles-
functioning LDL receptors and therefore more LDL now available to assess all aspects of blood lipids.
terol—“the cholesterol content of all natural diets has no effect," said Keys—then why on earth
traveling in the bloodstream with nowhere to land.
have we been avoiding egg yolks?
The answer is simple. In the opinion of the dietary dictators, making the distinction
between cholesterol in the blood and cholesterol in the diet was just too heavy a lift for the
EAT THOSE YOLKS! WHY THE CHOLESTEROL YOU EAT general public, so to simplify the issue for public consumption they demonized cholesterol
DOESN’T MAKE A BIT OF DIFFERENCE TO ANYTHING* in general.
For 99.6 perent of the population, here’s the real reason eating cholesterol makes absolutely Better the public should not have to trouble their “pretty little heads” about such compli-
no difference to your blood test cholesterol. cated stuff as the difference between cholesterol on your plate and cholesterol in the blood,
Cholesterol comes in two forms, unattached and attached. Scientists call cholesterol that the establishment seemed to be saying. So they told us to avoid all of it.
has attached itself to another molecule esterfied; unattached cholesterol molecules are either Or at least they did until 2015. And—like a retraction in the newspapers that’s published on
free cholesterol or, if they were once attached and are now single, deesterfied cholesterol. page 32 and that nobody reads—the U.S. government quietly noted in the 2015 guidelines that
The body can only use free, or unesterfied, cholesterol. Most of the cholesterol we eat— “cholesterol is (no longer) a nutrient of concern for over consumption.” (Mention that to your
e.g. in eggs—is esterfied. So in order to be used by the body, we have to first “uncouple” it doctor the next time she tells you not to eat eggs!)
from whatever it’s attached to, a process known as deesterfication. And now that deesterfied
*The exception is for the .04 percent of the population with a genetic condition known as
cholesterol has to compete with the huge amount of ready-to-use unesterfied (unattached)
familial hypercholesterolemia.
cholesterol already being made by your liver and intestines on a daily basis. Which is basically
four-fifths of the cholesterol in your body on any given day. Yes, fully 80 percent of the
cholesterol in your body does in fact come from your own body—the aforementioned liver
being the primary source.

WHY YOU SHOULD CARE ABOUT damage), even if you didn’t know the technical name
CHRONIC INFLAMMATION, NOT for it. You’re also familiar with oxidation if you’ve ever
CHAPTER 5 CHOLESTEROL left apple slices out on a picnic table where they were
Chronic inflammation flies beneath the pain radar. exposed to the air. They turned brown, didn’t they?
Much like high blood pressure, it has no obvious That’s oxidative damage.
symptoms. Yet chronic inflammation is a significant For those of you who don’t remember high school
INFLAMMATION AND component of virtually every single degenerative

condition, including Alzheimer’s, diabetes, obesity,
chemistry (or would understandably prefer to forget
it), electrons travel in pairs and orbit around atoms.
OXIDATION
arthritis, cancer, neurodegenerative diseases, chronic Every so often one of those electrons gets “loose,”
lower respiratory disease, influenza and pneumonia, and pandemonium ensues. The atom with the
chronic liver and kidney diseases, and, most unpaired electron—known as a free radical—starts run-
especially, heart disease. ning around like a headless chicken trying to find its
When chronic inflammation exists unchecked in head. Free radicals are like college sophomores on
the cardiovascular system, it almost always spells big spring break—temporarily free from the constraints of
INFLAMMATION AND OXIDATION are two of the most vicious processes in the human body. This trouble for the heart. dormitory living, they basically go nuts and will
chapter explains why they are so destructive and what we can do to minimize their damage. And inflammation is rarely a local phenomenon. “bond” with anyone! Free radicals “hit” on existing,
Let’s begin with inflammation, which comes in two flavors. We all have experience with acute For instance, women with rheumatoid arthritis, a highly stable pairs of electrons thousands of times a day,
inflammation. It happens every time you stub your toe, bang your knee, or get a splinter in your finger. inflammatory condition that primarily affects the joints, trying to find an electron they can pair-bond with,
When you complain about your aching back, an abscess in your mouth, or a rash on your skin, that’s wind up having double the risk of a heart attack when and meanwhile inflicting enormous damage upon your
acute inflammation. It’s visible and uncomfortable, if not downright painful. compared to women without it. Microbes that cause cells and DNA.
The redness on your skin is a result of blood that’s rushed to the affected area. The swelling you problems in one part of the body can easily migrate to The free radicals that come from oxygen (known,
experience is the result of an army of specialized cells dispatched by the immune system to mend the other areas and cause inflammatory damage there. An not surprisingly, as oxygen free radicals) are the most
injured area. The job of these immune system cells is to surround the site of the injury and neutralize infection that starts in the gums, for example, can eas- deadly and damaging kind. Antioxidants are a class of
nasty invaders such as microbes, preventing the spread of potential infection. The swelling, redness, ily leak bacteria into the bloodstream; bacteria that substances, including certain vitamins, minerals, and
and soreness you experience as a result of acute inflammation are natural accompaniments to the may then find fertile ground in a weakened arterial many plant chemicals, that helps neutralize free radi-
healing process. wall and fan the fires of inflammation there. cals, soaking them up like little sponges, thus limiting
It’s the inflammation you’re less familiar with that’s at the core of heart disease. Acute inflamma- So how exactly does inflammation happen, and, the damage they can do to your body. The reason cut
tion hurts, but chronic inflammation kills. more importantly, what can we do about it? apple slices don’t turn brown so quickly when you
Let us explain. squirt lemon juice on them is because lemon juice
OXIDATION: THE FREQUENT contains vitamin C, a powerful antioxidant.
INITIATOR OF INFLAMMATION Free radicals are so important that in the mid-
One of the prime initiators of inflammation is 1950s a scientist named Denham Harman, M.D., Ph.D.,
oxidation. If you’ve ever seen rust on metal, you’re put forth a theory called the Free Radical Theory of
familiar with oxidation (also known as oxidative Aging that remains popular to this day.1 In it he basi-
52 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 53

WHY YOU SHOULD CARE ABOUT damage), even if you didn’t know the technical name
CHRONIC INFLAMMATION, NOT for it. You’re also familiar with oxidation if you’ve ever
CHAPTER 5 CHOLESTEROL left apple slices out on a picnic table where they were
Chronic inflammation flies beneath the pain radar. exposed to the air. They turned brown, didn’t they?
Much like high blood pressure, it has no obvious That’s oxidative damage.
symptoms. Yet chronic inflammation is a significant For those of you who don’t remember high school
INFLAMMATION AND component of virtually every single degenerative

condition, including Alzheimer’s, diabetes, obesity,
chemistry (or would understandably prefer to forget
it), electrons travel in pairs and orbit around atoms.
OXIDATION
arthritis, cancer, neurodegenerative diseases, chronic Every so often one of those electrons gets “loose,”
lower respiratory disease, influenza and pneumonia, and pandemonium ensues. The atom with the
chronic liver and kidney diseases, and, most unpaired electron—known as a free radical—starts run-
especially, heart disease. ning around like a headless chicken trying to find its
When chronic inflammation exists unchecked in head. Free radicals are like college sophomores on
the cardiovascular system, it almost always spells big spring break—temporarily free from the constraints of
INFLAMMATION AND OXIDATION are two of the most vicious processes in the human body. This trouble for the heart. dormitory living, they basically go nuts and will
chapter explains why they are so destructive and what we can do to minimize their damage. And inflammation is rarely a local phenomenon. “bond” with anyone! Free radicals “hit” on existing,
Let’s begin with inflammation, which comes in two flavors. We all have experience with acute For instance, women with rheumatoid arthritis, a highly stable pairs of electrons thousands of times a day,
inflammation. It happens every time you stub your toe, bang your knee, or get a splinter in your finger. inflammatory condition that primarily affects the joints, trying to find an electron they can pair-bond with,
When you complain about your aching back, an abscess in your mouth, or a rash on your skin, that’s wind up having double the risk of a heart attack when and meanwhile inflicting enormous damage upon your
acute inflammation. It’s visible and uncomfortable, if not downright painful. compared to women without it. Microbes that cause cells and DNA.
The redness on your skin is a result of blood that’s rushed to the affected area. The swelling you problems in one part of the body can easily migrate to The free radicals that come from oxygen (known,
experience is the result of an army of specialized cells dispatched by the immune system to mend the other areas and cause inflammatory damage there. An not surprisingly, as oxygen free radicals) are the most
injured area. The job of these immune system cells is to surround the site of the injury and neutralize infection that starts in the gums, for example, can eas- deadly and damaging kind. Antioxidants are a class of
nasty invaders such as microbes, preventing the spread of potential infection. The swelling, redness, ily leak bacteria into the bloodstream; bacteria that substances, including certain vitamins, minerals, and
and soreness you experience as a result of acute inflammation are natural accompaniments to the may then find fertile ground in a weakened arterial many plant chemicals, that helps neutralize free radi-
healing process. wall and fan the fires of inflammation there. cals, soaking them up like little sponges, thus limiting
It’s the inflammation you’re less familiar with that’s at the core of heart disease. Acute inflamma- So how exactly does inflammation happen, and, the damage they can do to your body. The reason cut
tion hurts, but chronic inflammation kills. more importantly, what can we do about it? apple slices don’t turn brown so quickly when you
Let us explain. squirt lemon juice on them is because lemon juice
OXIDATION: THE FREQUENT contains vitamin C, a powerful antioxidant.
INITIATOR OF INFLAMMATION Free radicals are so important that in the mid-
One of the prime initiators of inflammation is 1950s a scientist named Denham Harman, M.D., Ph.D.,
oxidation. If you’ve ever seen rust on metal, you’re put forth a theory called the Free Radical Theory of
familiar with oxidation (also known as oxidative Aging that remains popular to this day.1 In it he basi-

cally proposes that aging is a kind of “rusting from The Good, the Bad, and the Really, WHEN LDL REALLY IS BAD FOR YOU: Once those rogue particles set up residence,
within,” largely due to the damage caused by oxygen Really Ugly! THE SMOKER’S PARADOX they’re like a molecular “tent city,” creating even
free radicals. As of this writing, new research funded by the British Riddle us this: Why is it that smokers with normal LDL more inflammation and oxidation. Meanwhile,
Now let’s see how inflammation, oxidation, cho- Heart Foundation has uncovered still another subtype (the so-called “bad” cholesterol) levels have a much non-oxidized LDL is pretty much harmless, just
lesterol, and the arterial walls interact in real life, and of LDL cholesterol that is particularly bad. It’s called higher risk of heart disease than nonsmokers with traveling through the bloodstream minding its own
how they work together to create a dangerous situa- the MGmin-low-density lipoprotein, and it’s more elevated LDL levels? business. It’s oxidation—and its partner in crime,
tion for your heart. common in people with type 2 diabetes and in the Sure, we all know how cigarette smoke damages inflammation—that actually initiates the process
elderly. It’s “stickier” than normal LDL, which makes it the lungs, and that cigarette smoking significantly that culminates in atherosclerosis.
GROUND ZERO FOR DAMAGE: much more likely to attach to the walls of the arteries. increases the odds of getting lung cancer. But, really, So now it should be clear exactly why smoking
INTRODUCING THE ENDOTHELIUM This new “ultra-bad” boy is actually created by a what’s the connection between smoking and heart turbo-charges the risk for heart disease. Smoking is
The arterial walls are anything but hard and firm. process called glycation. Glycation happens when disease, or, more specifically, between smoking and equivalent to taking a blowtorch to your LDL. A
They’re composed of smooth muscle that expands there’s too much sugar hanging around in the blood- LDL cholesterol? smoker with a low amount of LDL, most of which has
and contracts like a mini accordion; they respond to stream. The excess sugar starts gumming up the Glad you asked. been damaged by oxidation, is at far greater risk for
the rhythm of the heart and accommodate the works, inserting itself in places where it doesn’t Besides the harsh smoke, cigarettes also gra- heart disease than a nonsmoker with a much higher
pulsing of the blood. These arteries—far from being a belong—in this case, the LDL molecule. (We’ll have a ciously provide your body with myriad toxic chemicals, level of LDL, only a tiny percentage of which has been
static system of tubes and pipes—are a living, lot more to say about sugar and its role in heart dis- all at no extra charge, thank you very much. These damaged. It’s not the LDL that causes the problem—
breathing, very dynamic organ. And the innermost ease later on in chapter 6. Preview: Sugar is way chemicals and toxins both constrict the blood vessels it’s damaged (oxidized) LDL. And nothing reliably
layer of the artery walls—the “interface,” if you will, more of a threat to your heart than fat ever was!) and harm the arterial walls. Specifically, they cause damages your LDL like hot smoke, especially from
between the blood inside the arteries and the walls The point is that there is, indeed, “bad” choles- your LDL to become oxidized—damaged by the free cigarettes, which—besides nicotine—deliver a vast
that contain it—is a central player in our little drama. terol—even “ultra-bad” cholesterol—but we’re not radicals that are found in abundance in cigarette array of damaging and carcinogenic chemicals.
This layer is called the endothelium—and it’s the accomplishing anything by using a shotgun pharma- smoke! (And, by the way, it’s not just cigarette smoke So LDL floats around in the bloodstream, deliver-
starting point for the damage that can ultimately lead ceutical approach that lowers total cholesterol. We that can oxidize LDL. Heavy metals like mercury can ing cholesterol to the cells that need it, and some of
to a heart attack. need to get into the weeds and figure out what do it, as can insecticides, radiation, and all manner of this LDL, the LDL that’s damaged by oxidation, infil-
Big word, endothelium, yes, not often bandied exactly is causing any damage, and we now have toxins in the environment, the air, and the food supply.) trates the endothelium. Once the endothelium
about in cocktail party chatter about heart disease, sophisticated tools to do just that. The old approach And listen carefully now: LDL is not really a prob- becomes infiltrated with this damaged LDL, the pro-
but it’s one of the most important places in the arter- is akin to clipping a hangnail with an axe—and what’s lem in the body until it becomes oxidized. Only oxi- cess of inflammation begins in earnest.
ies for you to know about because that’s where the more, the old approach has significant unwanted side dized (damaged) LDL gets under the arterial walls Remember our earlier discussion about harmless
damage to your arteries starts. Only always. effects, as we will see in chapter 8. starting a whole inflammatory process that ultimately “bad” cholesterol (LDL pattern A) and dangerous
The endothelium is just one cell thick, but it’s It’s also—as we hope you’ll be convinced—an awful winds up creating plaque while causing further “bad” cholesterol (LDL pattern B)? Well, one of the
where a tremendous amount of biochemical activity lot of effort focused on the wrong molecule. As one of inflammation and injury. It’s almost always damaged reasons why pattern B molecules (those BB gun pellet
takes place. There’s even a name for the pathological us (Jonny) said on the Dr. Oz Show after the first edi- little oxidized lipoproteins that manage to slip through types) are so bad is that they are the ones most likely
state in which damage to that innermost layer exists— tion of this book came out, “Trying to prevent heart vulnerable sections of the endothelium, like unruly to be damaged and most likely to be oxidized. On top
it’s called endothelial dysfunction, and it’s a key event disease by lowering cholesterol is like trying to prevent teenagers sneaking through an unguarded gate to get of that, they’re small enough to penetrate the arterial
in the development of heart disease. obesity by taking the lettuce off your whoppers.” into a concert. walls in the first place. The smaller the particles (and

cally proposes that aging is a kind of “rusting from The Good, the Bad, and the Really, WHEN LDL REALLY IS BAD FOR YOU: Once those rogue particles set up residence,
within,” largely due to the damage caused by oxygen Really Ugly! THE SMOKER’S PARADOX they’re like a molecular “tent city,” creating even
free radicals. As of this writing, new research funded by the British Riddle us this: Why is it that smokers with normal LDL more inflammation and oxidation. Meanwhile,
Now let’s see how inflammation, oxidation, cho- Heart Foundation has uncovered still another subtype (the so-called “bad” cholesterol) levels have a much non-oxidized LDL is pretty much harmless, just
lesterol, and the arterial walls interact in real life, and of LDL cholesterol that is particularly bad. It’s called higher risk of heart disease than nonsmokers with traveling through the bloodstream minding its own
how they work together to create a dangerous situa- the MGmin-low-density lipoprotein, and it’s more elevated LDL levels? business. It’s oxidation—and its partner in crime,
tion for your heart. common in people with type 2 diabetes and in the Sure, we all know how cigarette smoke damages inflammation—that actually initiates the process
elderly. It’s “stickier” than normal LDL, which makes it the lungs, and that cigarette smoking significantly that culminates in atherosclerosis.
GROUND ZERO FOR DAMAGE: much more likely to attach to the walls of the arteries. increases the odds of getting lung cancer. But, really, So now it should be clear exactly why smoking
INTRODUCING THE ENDOTHELIUM This new “ultra-bad” boy is actually created by a what’s the connection between smoking and heart turbo-charges the risk for heart disease. Smoking is
The arterial walls are anything but hard and firm. process called glycation. Glycation happens when disease, or, more specifically, between smoking and equivalent to taking a blowtorch to your LDL. A
They’re composed of smooth muscle that expands there’s too much sugar hanging around in the blood- LDL cholesterol? smoker with a low amount of LDL, most of which has
and contracts like a mini accordion; they respond to stream. The excess sugar starts gumming up the Glad you asked. been damaged by oxidation, is at far greater risk for
the rhythm of the heart and accommodate the works, inserting itself in places where it doesn’t Besides the harsh smoke, cigarettes also gra- heart disease than a nonsmoker with a much higher
pulsing of the blood. These arteries—far from being a belong—in this case, the LDL molecule. (We’ll have a ciously provide your body with myriad toxic chemicals, level of LDL, only a tiny percentage of which has been
static system of tubes and pipes—are a living, lot more to say about sugar and its role in heart dis- all at no extra charge, thank you very much. These damaged. It’s not the LDL that causes the problem—
breathing, very dynamic organ. And the innermost ease later on in chapter 6. Preview: Sugar is way chemicals and toxins both constrict the blood vessels it’s damaged (oxidized) LDL. And nothing reliably
layer of the artery walls—the “interface,” if you will, more of a threat to your heart than fat ever was!) and harm the arterial walls. Specifically, they cause damages your LDL like hot smoke, especially from
between the blood inside the arteries and the walls The point is that there is, indeed, “bad” choles- your LDL to become oxidized—damaged by the free cigarettes, which—besides nicotine—deliver a vast
that contain it—is a central player in our little drama. terol—even “ultra-bad” cholesterol—but we’re not radicals that are found in abundance in cigarette array of damaging and carcinogenic chemicals.
This layer is called the endothelium—and it’s the accomplishing anything by using a shotgun pharma- smoke! (And, by the way, it’s not just cigarette smoke So LDL floats around in the bloodstream, deliver-
starting point for the damage that can ultimately lead ceutical approach that lowers total cholesterol. We that can oxidize LDL. Heavy metals like mercury can ing cholesterol to the cells that need it, and some of
to a heart attack. need to get into the weeds and figure out what do it, as can insecticides, radiation, and all manner of this LDL, the LDL that’s damaged by oxidation, infil-
Big word, endothelium, yes, not often bandied exactly is causing any damage, and we now have toxins in the environment, the air, and the food supply.) trates the endothelium. Once the endothelium
about in cocktail party chatter about heart disease, sophisticated tools to do just that. The old approach And listen carefully now: LDL is not really a prob- becomes infiltrated with this damaged LDL, the pro-
but it’s one of the most important places in the arter- is akin to clipping a hangnail with an axe—and what’s lem in the body until it becomes oxidized. Only oxi- cess of inflammation begins in earnest.
ies for you to know about because that’s where the more, the old approach has significant unwanted side dized (damaged) LDL gets under the arterial walls Remember our earlier discussion about harmless
damage to your arteries starts. Only always. effects, as we will see in chapter 8. starting a whole inflammatory process that ultimately “bad” cholesterol (LDL pattern A) and dangerous
The endothelium is just one cell thick, but it’s It’s also—as we hope you’ll be convinced—an awful winds up creating plaque while causing further “bad” cholesterol (LDL pattern B)? Well, one of the
where a tremendous amount of biochemical activity lot of effort focused on the wrong molecule. As one of inflammation and injury. It’s almost always damaged reasons why pattern B molecules (those BB gun pellet
takes place. There’s even a name for the pathological us (Jonny) said on the Dr. Oz Show after the first edi- little oxidized lipoproteins that manage to slip through types) are so bad is that they are the ones most likely
state in which damage to that innermost layer exists— tion of this book came out, “Trying to prevent heart vulnerable sections of the endothelium, like unruly to be damaged and most likely to be oxidized. On top
it’s called endothelial dysfunction, and it’s a key event disease by lowering cholesterol is like trying to prevent teenagers sneaking through an unguarded gate to get of that, they’re small enough to penetrate the arterial
in the development of heart disease. obesity by taking the lettuce off your whoppers.” into a concert. walls in the first place. The smaller the particles (and

pattern B particles are small indeed), the more inflam- eating, consuming oxidized LDL until they literally If the cycle is not stopped, the fatty streak grows So the more inflammation continues, the more
matory they are. Oxidized LDL is like “angry” LDL, choke to death, leaving something called the lipid into what’s known as plaque. (Plaque is basically a big foam cells accumulate. This means more macro-
and the smaller the particle, the angrier it is. So these core of plaque. Once they reach a certain size they old collection of foam cells). Some foam cells will die, phages (Ms. Pac-Man), which in turn means more
nasty little damaged LDL particles stick to the endo- start to look like foam and actually become what and they will release a whole bunch of the accumu- oozy, slimy lipid core. This lipid core gets into the
thelium and begin the process of inflammation. In the pathologists call “foam cells,” living cells that will con- lated fats (lipids), which in turn develop into the bloodstream, where the blood immediately puts out a
presence of oxidative damage—or in the presence of tinue the work of the macrophages, fighting and con- aforementioned lipid core, a soft, yellowy substance signal saying, “What the heck is this? Foreign object!
high blood sugar, which is such an important initiator suming until the “invader” is gone. that resembles melted butter (but isn’t nearly as good Foreign object!” And a blood clot is formed in an
of damage that we’ll examine it separately in chapter But it isn’t an invader that sets them off. It’s just for you). attempt to keep this foreign, gooey substance from
6—this LDL experiences chemical changes that the plain old LDL experiencing chemical changes from Now if you stop the inflammation at this point in spreading.
immune system perceives as dangerous. sugar, starches, or oxidation and thus initiating an time, the artery heals itself with what’s called a fibrous So the blood clot is actually a protective mecha-
Once the immune system notices this damaged inflammatory process that can easily become an out- cap. The fibrous cap is composed of fibrous scar tissue nism. It’s the blood’s—or the body’s, if you prefer—way
(oxidized) LDL, it sends in the heavy artillery. First, of-control “fire” within your arterial walls. As we’ve and will stay nice and stable. (Cardiologists like Steve of saying, “Let’s contain this threat and keep it from
cells known as monocytes rush to the scene of the said, without inflammation, it’s pretty irrelevant what call this “stable plaque.”) Of course, if there’s new spreading!” But though this strategy makes sense, it
action, releasing chemicals called cytokines. Cytokines your cholesterol levels are. inflammation, the cycle begins all over again. has a big downside. That blood clot may block access
are essentially chemical messengers that help regu- If inflammation isn’t halted and if macrophages
late the immune system response, but many of these continue to feast away until they bust, they’ll release
cytokines are themselves highly inflammatory. In the a whole new set of toxins into the walls of the artery.
presence of some of these cytokines, the lining of the “We can see this in surgery as a yellow streak  WHAT YOU NEED TO KNOW
blood vessels (the endothelium) secrete sticky little inside the artery wall,” said Dwight Lundell, M.D., who
• Cholesterol is the parent molecule for sex hormones (estrogen, progesterone, and
molecules called adhesion molecules that act like has performed more than five thousand heart surger-
testosterone) as well as for vitamin D and the bile acids needed for digestion. You need
molecular glue, grabbing on to the monocytes that ies. “It is called the ‘fatty streak,’ and it is the begin-
cholesterol for life.
have rushed to the scene of the crime to help put out ning of significant heart disease.”2
• Atherosclerosis begins when a rogue particle of LDL (low-density lipoprotein) gets through a
the fire. The body tries to contain this fatty streak by
weakened section of the arterial wall and parks itself there, beginning the process of
Heart surgeon Dwight Lundell, M.D., cleverly building a wall to hold it in—scarring is an example.
inflammation.
refers to this as the “Velcro effect.” But the immune system is now on full alert; it sends
• Inflammation is initiated by damage from rogue molecules known as free radicals. This
Monocytes now convert into a type of cell we like more soldiers to the front, and they try valiantly to
damage is also known as oxidation or oxidative stress. Antioxidants help fight this damage.
to call “Little Ms. Pac-Man.” They’re technically called break down the wall (the scar tissue), and the cycle
• Cholesterol is only a problem when it’s damaged by oxidation and inflammation.
macrophages, and their job, much like Ms. Pac-Man in continues—more scarring, more soldiers. Over time, if
• There are at least thirteen subtypes of LDL (“bad”) cholesterol and ten subtypes of HDL
the video game, is to eat up the enemy, in this case the body’s immune system defenses are good enough,
(“good”) cholesterol.2 Total particle number is far more important than “LDL.”
the damaged LDL particles and other molecular junk they will weaken the wall of the artery and literally
• A total cholesterol level of 160 mg/dL or less has been linked to depression, aggression,
that have caused the problem in the first place. (The “chew through” the scar tissue. A rupture will occur,
cerebral hemorrhages, and loss of sex drive. So don’t be “happy” that your cholesterol is
word macrophage literally means “big eater.”) resulting in more inflammation, and the potentially
that low.
The macrophages are like sugar addicts at a pie- deadly cycle continues.
eating contest. They have no off button; they’ll keep Not good news.

pattern B particles are small indeed), the more inflam- eating, consuming oxidized LDL until they literally If the cycle is not stopped, the fatty streak grows So the more inflammation continues, the more
matory they are. Oxidized LDL is like “angry” LDL, choke to death, leaving something called the lipid into what’s known as plaque. (Plaque is basically a big foam cells accumulate. This means more macro-
and the smaller the particle, the angrier it is. So these core of plaque. Once they reach a certain size they old collection of foam cells). Some foam cells will die, phages (Ms. Pac-Man), which in turn means more
nasty little damaged LDL particles stick to the endo- start to look like foam and actually become what and they will release a whole bunch of the accumu- oozy, slimy lipid core. This lipid core gets into the
thelium and begin the process of inflammation. In the pathologists call “foam cells,” living cells that will con- lated fats (lipids), which in turn develop into the bloodstream, where the blood immediately puts out a
presence of oxidative damage—or in the presence of tinue the work of the macrophages, fighting and con- aforementioned lipid core, a soft, yellowy substance signal saying, “What the heck is this? Foreign object!
high blood sugar, which is such an important initiator suming until the “invader” is gone. that resembles melted butter (but isn’t nearly as good Foreign object!” And a blood clot is formed in an
of damage that we’ll examine it separately in chapter But it isn’t an invader that sets them off. It’s just for you). attempt to keep this foreign, gooey substance from
6—this LDL experiences chemical changes that the plain old LDL experiencing chemical changes from Now if you stop the inflammation at this point in spreading.
immune system perceives as dangerous. sugar, starches, or oxidation and thus initiating an time, the artery heals itself with what’s called a fibrous So the blood clot is actually a protective mecha-
Once the immune system notices this damaged inflammatory process that can easily become an out- cap. The fibrous cap is composed of fibrous scar tissue nism. It’s the blood’s—or the body’s, if you prefer—way
(oxidized) LDL, it sends in the heavy artillery. First, of-control “fire” within your arterial walls. As we’ve and will stay nice and stable. (Cardiologists like Steve of saying, “Let’s contain this threat and keep it from
cells known as monocytes rush to the scene of the said, without inflammation, it’s pretty irrelevant what call this “stable plaque.”) Of course, if there’s new spreading!” But though this strategy makes sense, it
action, releasing chemicals called cytokines. Cytokines your cholesterol levels are. inflammation, the cycle begins all over again. has a big downside. That blood clot may block access
are essentially chemical messengers that help regu- If inflammation isn’t halted and if macrophages
late the immune system response, but many of these continue to feast away until they bust, they’ll release
cytokines are themselves highly inflammatory. In the a whole new set of toxins into the walls of the artery.
presence of some of these cytokines, the lining of the “We can see this in surgery as a yellow streak  WHAT YOU NEED TO KNOW
blood vessels (the endothelium) secrete sticky little inside the artery wall,” said Dwight Lundell, M.D., who
• Cholesterol is the parent molecule for sex hormones (estrogen, progesterone, and
molecules called adhesion molecules that act like has performed more than five thousand heart surger-
testosterone) as well as for vitamin D and the bile acids needed for digestion. You need
molecular glue, grabbing on to the monocytes that ies. “It is called the ‘fatty streak,’ and it is the begin-
cholesterol for life.
have rushed to the scene of the crime to help put out ning of significant heart disease.”2
• Atherosclerosis begins when a rogue particle of LDL (low-density lipoprotein) gets through a
the fire. The body tries to contain this fatty streak by
weakened section of the arterial wall and parks itself there, beginning the process of
Heart surgeon Dwight Lundell, M.D., cleverly building a wall to hold it in—scarring is an example.
inflammation.
refers to this as the “Velcro effect.” But the immune system is now on full alert; it sends
• Inflammation is initiated by damage from rogue molecules known as free radicals. This
Monocytes now convert into a type of cell we like more soldiers to the front, and they try valiantly to
damage is also known as oxidation or oxidative stress. Antioxidants help fight this damage.
to call “Little Ms. Pac-Man.” They’re technically called break down the wall (the scar tissue), and the cycle
• Cholesterol is only a problem when it’s damaged by oxidation and inflammation.
macrophages, and their job, much like Ms. Pac-Man in continues—more scarring, more soldiers. Over time, if
• There are at least thirteen subtypes of LDL (“bad”) cholesterol and ten subtypes of HDL
the video game, is to eat up the enemy, in this case the body’s immune system defenses are good enough,
(“good”) cholesterol.2 Total particle number is far more important than “LDL.”
the damaged LDL particles and other molecular junk they will weaken the wall of the artery and literally
• A total cholesterol level of 160 mg/dL or less has been linked to depression, aggression,
that have caused the problem in the first place. (The “chew through” the scar tissue. A rupture will occur,
cerebral hemorrhages, and loss of sex drive. So don’t be “happy” that your cholesterol is
word macrophage literally means “big eater.”) resulting in more inflammation, and the potentially
that low.
The macrophages are like sugar addicts at a pie- deadly cycle continues.
eating contest. They have no off button; they’ll keep Not good news.

to the heart muscle, preventing oxygen from getting ecological purposes, and removing them is hardly tion, elevated blood sugar, and out-of-range blood lip-
through. Anytime you deprive cells of oxygen, the tis- without consequences, both to the environment and ids. Spoiler alert: We’ll also tell you how to catch insu-
FOR MEN ONLY
sue they make begins to die. And when that tissue is to the landscape. lin resistance early, and how easy it is to correct with-
Note to the men reading this: Endothelial
the muscle of the heart, you’re looking at—you Wouldn’t it be better to reduce the conditions out drugs!
dysfunction has the same acronym (ED)
guessed it—a heart attack. under which a fire is likely to break out? That way we But first let’s introduce you to a “food” that is a
as another condition you may be familiar
So overall, LDL can be likened to trees in a for- could have all the wonderful benefits of trees with far, far greater risk to your overall health—and specifi-
with or concerned about: erectile
est. A forest that has tons of trees but gets plenty of none of the side effects of a compromised ecology. cally to your heart—than fat ever was. This “food”—in
dysfunction. They’re not unrelated. Our
rain isn’t likely to be the site of a wildfire, but a for- We hope we’ve convinced you that inflammation, all its many forms—is also one of the biggest causes
friend Mark Houston, M.D., director of the
est with far fewer trees can be a tinder box just wait- and its main initiator, oxidation, are at the core of of insulin resistance, which, as you’ll see in chapter 6,
Hypertension Institute and an associate
ing to ignite if all those trees are dried up (damaged) heart disease. But inflammation and oxidation aren’t is the Godfather of the whole operation. We’re talking
professor of medicine at Vanderbilt
and there’s very little rainfall! Getting rid of the trees the only vicious foot soldiers causing heart disease. about sugar.
University, wryly commented, “I’ve never
is surely one crude way to prevent forest fires, just Now in chapter 9, we’ll lay out the case for why insu-
seen someone with a case of ED (erectile
as lowering cholesterol indiscriminately might theo- lin resistance is often the earliest sign of impending
dysfunction) that didn’t also have ED
retically decrease the risk of a “fire” in your artery heart disease and can be picked up way earlier than
(endothelial dysfunction).”
walls, but at what cost? Those trees serve a lot of late-stage signs like elevated markers of inflamma-
Bottom line: A healthy functioning
endothelium is essential for . . . well, more
things than just the heart!
WHAT THE FRAMINGHAM HEART STUDY FOUND
Want a much better way to tell whether you’re at risk? Look at these two line items on your
blood test: triglycerides and HDL (the so-called “good” cholesterol).
Now if you’re not too freaked out about doing a bit of math, calculate the ratio of your
triglycerides to your HDL. Just divide your triglyceride number by your HDL number. If, for
example, your triglycerides are 150 mg/dL and your HDL is 50 mg/dL, you have a ratio of 3
(150:50). If your triglycerides are 100 mg/dL and your HDL is 50 mg/dL, you have a ratio of 2
(100:50).
(If your triglycerides are smaller than your HDL and you get a ratio of less than one, you
can pretty much stop reading this book right now. Your risk factor is off-the-charts low.
The triglyceride to HDL ratio is a far better predictor of heart disease than cholesterol ever
was. In one study out of Harvard published in Circulation, a journal published by the American
Heart Association, those who had the highest triglyceride to HDL ratios had a whopping
sixteen times the risk of developing heart disease as those with the lowest ratios.3
If you have a ratio of around 2, you should be happy, indeed, regardless of your cholesterol
levels. (A ratio of 5, however, is problematic.)

to the heart muscle, preventing oxygen from getting ecological purposes, and removing them is hardly tion, elevated blood sugar, and out-of-range blood lip-
through. Anytime you deprive cells of oxygen, the tis- without consequences, both to the environment and ids. Spoiler alert: We’ll also tell you how to catch insu-
FOR MEN ONLY
sue they make begins to die. And when that tissue is to the landscape. lin resistance early, and how easy it is to correct with-
Note to the men reading this: Endothelial
the muscle of the heart, you’re looking at—you Wouldn’t it be better to reduce the conditions out drugs!
dysfunction has the same acronym (ED)
guessed it—a heart attack. under which a fire is likely to break out? That way we But first let’s introduce you to a “food” that is a
as another condition you may be familiar
So overall, LDL can be likened to trees in a for- could have all the wonderful benefits of trees with far, far greater risk to your overall health—and specifi-
with or concerned about: erectile
est. A forest that has tons of trees but gets plenty of none of the side effects of a compromised ecology. cally to your heart—than fat ever was. This “food”—in
dysfunction. They’re not unrelated. Our
rain isn’t likely to be the site of a wildfire, but a for- We hope we’ve convinced you that inflammation, all its many forms—is also one of the biggest causes
friend Mark Houston, M.D., director of the
est with far fewer trees can be a tinder box just wait- and its main initiator, oxidation, are at the core of of insulin resistance, which, as you’ll see in chapter 6,
Hypertension Institute and an associate
ing to ignite if all those trees are dried up (damaged) heart disease. But inflammation and oxidation aren’t is the Godfather of the whole operation. We’re talking
professor of medicine at Vanderbilt
and there’s very little rainfall! Getting rid of the trees the only vicious foot soldiers causing heart disease. about sugar.
University, wryly commented, “I’ve never
is surely one crude way to prevent forest fires, just Now in chapter 9, we’ll lay out the case for why insu-
seen someone with a case of ED (erectile
as lowering cholesterol indiscriminately might theo- lin resistance is often the earliest sign of impending
dysfunction) that didn’t also have ED
retically decrease the risk of a “fire” in your artery heart disease and can be picked up way earlier than
(endothelial dysfunction).”
walls, but at what cost? Those trees serve a lot of late-stage signs like elevated markers of inflamma-
Bottom line: A healthy functioning
endothelium is essential for . . . well, more
things than just the heart!
WHAT THE FRAMINGHAM HEART STUDY FOUND
Want a much better way to tell whether you’re at risk? Look at these two line items on your
blood test: triglycerides and HDL (the so-called “good” cholesterol).
Now if you’re not too freaked out about doing a bit of math, calculate the ratio of your
triglycerides to your HDL. Just divide your triglyceride number by your HDL number. If, for
example, your triglycerides are 150 mg/dL and your HDL is 50 mg/dL, you have a ratio of 3
(150:50). If your triglycerides are 100 mg/dL and your HDL is 50 mg/dL, you have a ratio of 2
(100:50).
(If your triglycerides are smaller than your HDL and you get a ratio of less than one, you
can pretty much stop reading this book right now. Your risk factor is off-the-charts low.
The triglyceride to HDL ratio is a far better predictor of heart disease than cholesterol ever
was. In one study out of Harvard published in Circulation, a journal published by the American
Heart Association, those who had the highest triglyceride to HDL ratios had a whopping
sixteen times the risk of developing heart disease as those with the lowest ratios.3
If you have a ratio of around 2, you should be happy, indeed, regardless of your cholesterol
levels. (A ratio of 5, however, is problematic.)

PART TWO
And the thesis of this book is that diabetes is a In chapter 9 of this section, we will lay out the
train stop on the journey to heart disease. Sadly, it’s a case that insulin resistance is the first sign of heart
train most people don’t know they’re on until it’s too disease and that it “shows up” (i.e., is measurable) as
late. You can get off that train before it reaches its much as a decade before you or your doctor notices
inevitable destination, but that means looking care- that anything is “wrong.”
fully for signs that you’re headed in the wrong direc- And speaking of something being wrong, part two
tion. One of the most important signs to look for is also discusses statin drugs, the number one medica-
In part two, we’re going tackle three of the most important players on
insulin resistance. (More on that in a moment.) tion for high cholesterol. We hope that by the time
the heart disease playing field: sugar, fat, and statins. We’re going to make
If you’re wondering why we’re spending so much you finish this section of the book you will be con-
the case that fat—including saturated fat—has been wrongly demonized by
time on sugar and fat, it’s because sugar has a great vinced that treating “high cholesterol” is very differ-
the dietary dictators, while sugar—largely due to the superb efforts of the
press agent. We all love it, accept it as part of the ent from treating heart disease. And that the trend to
sugar lobby—has been given a pass. Beginning on page 62 we’ll show you
American experience, associated with wonderful prescribe statins for large swathes of the population
compelling evidence from neuroscience that confirm what you may have
things like holidays and birthdays and breakfast cere- who are unlikely to benefit from them is a foolish
suspected all along—sugar is indeed addictive. Meanwhile, as we will also
als and cookies, and it’s going to take a lot of work to strategy that will benefit no one but stockholders in
show you, that addictive substance is the driving force behind diabetes.
break through those associations and see the real toll Big Pharma.
it’s taken on our health. Similarly, we’ve demonized Let’s begin our story by discussing a substance
fat for so long that we can barely utter the term “sat- that—as of this writing—we consume to the tune of an
urated fat” without prefacing it with “artery-clogging.” eye-popping 152 pounds of a year, per person.1 That
Deconstructing the mythology about fats is no small innocent-looking white powder known as sugar.
task, and it’s why we tried to make the case we did as
meticulously as possible.
Which brings us back to insulin resistance. Once
you demystify fat and sugar you can see their actual
roles in metabolic dysfunction. Insulin resistance is
most frequently the result of too many carbs, specifi-
cally sugar and processed grains. It’s not the result of
too much fat. And insulin resistance nearly always
leads to pre-diabetes, which leads to diabetes, which
leads—as you’ll see in chapter 9—to heart disease.

PART TWO
And the thesis of this book is that diabetes is a In chapter 9 of this section, we will lay out the
train stop on the journey to heart disease. Sadly, it’s a case that insulin resistance is the first sign of heart
train most people don’t know they’re on until it’s too disease and that it “shows up” (i.e., is measurable) as
late. You can get off that train before it reaches its much as a decade before you or your doctor notices
inevitable destination, but that means looking care- that anything is “wrong.”
fully for signs that you’re headed in the wrong direc- And speaking of something being wrong, part two
tion. One of the most important signs to look for is also discusses statin drugs, the number one medica-
In part two, we’re going tackle three of the most important players on
insulin resistance. (More on that in a moment.) tion for high cholesterol. We hope that by the time
the heart disease playing field: sugar, fat, and statins. We’re going to make
If you’re wondering why we’re spending so much you finish this section of the book you will be con-
the case that fat—including saturated fat—has been wrongly demonized by
time on sugar and fat, it’s because sugar has a great vinced that treating “high cholesterol” is very differ-
the dietary dictators, while sugar—largely due to the superb efforts of the
press agent. We all love it, accept it as part of the ent from treating heart disease. And that the trend to
sugar lobby—has been given a pass. Beginning on page 62 we’ll show you
American experience, associated with wonderful prescribe statins for large swathes of the population
compelling evidence from neuroscience that confirm what you may have
things like holidays and birthdays and breakfast cere- who are unlikely to benefit from them is a foolish
suspected all along—sugar is indeed addictive. Meanwhile, as we will also
als and cookies, and it’s going to take a lot of work to strategy that will benefit no one but stockholders in
show you, that addictive substance is the driving force behind diabetes.
break through those associations and see the real toll Big Pharma.
it’s taken on our health. Similarly, we’ve demonized Let’s begin our story by discussing a substance
fat for so long that we can barely utter the term “sat- that—as of this writing—we consume to the tune of an
urated fat” without prefacing it with “artery-clogging.” eye-popping 152 pounds of a year, per person.1 That
Deconstructing the mythology about fats is no small innocent-looking white powder known as sugar.
task, and it’s why we tried to make the case we did as
meticulously as possible.
Which brings us back to insulin resistance. Once
you demystify fat and sugar you can see their actual
roles in metabolic dysfunction. Insulin resistance is
most frequently the result of too many carbs, specifi-
cally sugar and processed grains. It’s not the result of
too much fat. And insulin resistance nearly always
leads to pre-diabetes, which leads to diabetes, which
leads—as you’ll see in chapter 9—to heart disease.

But you don’t have to be a slave to those hor- storing hormone also has some serious consequences
mones; you just have to understand them. Because for the heart.
CHAPTER 6 your lifestyle choices have a profound effect on the The name of that fat-storing hormone? Insulin.
secretion of important hormones, and lifestyle choices
are under your control (see chapter 12). Nonetheless, INSULIN: WHAT IT IS AND WHY IT
at the end of the day, your hormones drive a big part MATTERS
SUGAR: THE REAL of your behavior. (And almost 100 percent of your
cravings!)
Insulin, a hormone first discovered in 1921, is the star
actor in our little hormonal play. It is an anabolic
DEMON IN THE DIET

Food—along with several key lifestyle factors such hormone, which means it is responsible for building
as stress—is the trigger that stimulates hormones. things up—putting compounds like glucose (sugar and
Those hormones direct the body to store or burn fat, amino acids) inside storage units (such as cells). Its
just as they direct the body to perform a gazillion sister hormone, glucagon, is responsible for breaking
other metabolic operations. Meanwhile, our brain’s things down—opening those storage units and
reward centers—complex neural systems that tell us releasing their contents as needed. Insulin is
SUGAR—ESPECIALLY IN THE CONTEXT OF THE MODERN INDUSTRIALIZED DIET—is a far greater to keep doing things that feel good and to stop doing responsible for saving; glucagon is responsible for
danger to your heart than fat ever was. things that feel bad—dictate what it is we even want spending.
In this chapter, we are going to venture into the labyrinth-like worlds of endocrinology and neuro- to eat. And certain foods can make those systems Together their main job is to maintain blood
science. But relax! We promise not to make your eyes glaze over. And we promise that by the time you go haywire—sugar being one of the most notorious sugar levels within the tightly regulated range it
finish this chapter you will know more than many doctors do about the common link among heart offenders. We’ll return to this stuff a bit later. needs to be to keep your metabolic machinery run-
disease, diabetes, obesity, and hypertension—serious conditions that are of interest to most readers. “Food may be the most powerful drug you will ning smoothly.
And we believe you’ll come to the same conclusion we have: The smoking gun points at the hyper- ever encounter because it causes dramatic changes in Insulin is at the hub of a significant number of
processed, sugar-laden foods that dominate our modern diets’—foods that manipulate our hormones your hormones that are hundreds of times more pow- diseases of civilization. When you control insulin, you
and trick our delicate brains. It’s not a conspiracy theory. It’s not a Twilight Zone episode. It’s science, erful than any pharmaceutical,” said Barry Sears, Ph.D., reduce the risk for heart disease and the risk for
plain and simple. the author of The Zone Diet. Hormones are the air hypertension, diabetes, polycystic ovary syndrome,
traffic controllers that determine the fate of whatever inflammatory diseases, and even, possibly, cancer.
ENDOCRINOLOGY 101: THE HORMONAL EFFECT OF FOOD flies in (or in our case, “slides” in through the gullet!). Did that get your attention? We hope so.
Our journey starts with a simple premise: Hormones control almost every metabolic event that goes This fact has been conveniently ignored by many Both insulin and glucagon are essential to health.
on in your body. And you control some of the most critical hormones through your lifestyle. mainstream dietitians and doctors. The standard mes- It’s almost impossible to overstate the importance of
sage to overweight people at increased risk for heart this. Without insulin, blood sugar would skyrocket, and
disease is to simply reduce calories and saturated fat. the result would be coma and death: the fate of virtu-
But in the real world, it’s not so simple. Some foods ally every type 1 diabetic in the early part of the
influence our body’s metabolic systems in ways that twentieth century before the discovery of insulin.
override our hunger signals and boost levels of hor- However, without glucagon, blood sugar would plum-
mones that store fat. Not coincidentally, our main fat- met, and the result would be brain dysfunction, coma,
62 THE GREAT CHOLESTEROL MYTH SUGAR: THE REAL DEMON IN THE DIET 63
But you don’t have to be a slave to those hor- storing hormone also has some serious consequences
mones; you just have to understand them. Because for the heart.
CHAPTER 6 your lifestyle choices have a profound effect on the The name of that fat-storing hormone? Insulin.
secretion of important hormones, and lifestyle choices
are under your control (see chapter 12). Nonetheless, INSULIN: WHAT IT IS AND WHY IT
at the end of the day, your hormones drive a big part MATTERS
SUGAR: THE REAL of your behavior. (And almost 100 percent of your
cravings!)
Insulin, a hormone first discovered in 1921, is the star
actor in our little hormonal play. It is an anabolic
DEMON IN THE DIET

Food—along with several key lifestyle factors such hormone, which means it is responsible for building
as stress—is the trigger that stimulates hormones. things up—putting compounds like glucose (sugar and
Those hormones direct the body to store or burn fat, amino acids) inside storage units (such as cells). Its
just as they direct the body to perform a gazillion sister hormone, glucagon, is responsible for breaking
other metabolic operations. Meanwhile, our brain’s things down—opening those storage units and
reward centers—complex neural systems that tell us releasing their contents as needed. Insulin is
SUGAR—ESPECIALLY IN THE CONTEXT OF THE MODERN INDUSTRIALIZED DIET—is a far greater to keep doing things that feel good and to stop doing responsible for saving; glucagon is responsible for
danger to your heart than fat ever was. things that feel bad—dictate what it is we even want spending.
In this chapter, we are going to venture into the labyrinth-like worlds of endocrinology and neuro- to eat. And certain foods can make those systems Together their main job is to maintain blood
science. But relax! We promise not to make your eyes glaze over. And we promise that by the time you go haywire—sugar being one of the most notorious sugar levels within the tightly regulated range it
finish this chapter you will know more than many doctors do about the common link among heart offenders. We’ll return to this stuff a bit later. needs to be to keep your metabolic machinery run-
disease, diabetes, obesity, and hypertension—serious conditions that are of interest to most readers. “Food may be the most powerful drug you will ning smoothly.
And we believe you’ll come to the same conclusion we have: The smoking gun points at the hyper- ever encounter because it causes dramatic changes in Insulin is at the hub of a significant number of
processed, sugar-laden foods that dominate our modern diets’—foods that manipulate our hormones your hormones that are hundreds of times more pow- diseases of civilization. When you control insulin, you
and trick our delicate brains. It’s not a conspiracy theory. It’s not a Twilight Zone episode. It’s science, erful than any pharmaceutical,” said Barry Sears, Ph.D., reduce the risk for heart disease and the risk for
plain and simple. the author of The Zone Diet. Hormones are the air hypertension, diabetes, polycystic ovary syndrome,
traffic controllers that determine the fate of whatever inflammatory diseases, and even, possibly, cancer.
ENDOCRINOLOGY 101: THE HORMONAL EFFECT OF FOOD flies in (or in our case, “slides” in through the gullet!). Did that get your attention? We hope so.
Our journey starts with a simple premise: Hormones control almost every metabolic event that goes This fact has been conveniently ignored by many Both insulin and glucagon are essential to health.
on in your body. And you control some of the most critical hormones through your lifestyle. mainstream dietitians and doctors. The standard mes- It’s almost impossible to overstate the importance of
sage to overweight people at increased risk for heart this. Without insulin, blood sugar would skyrocket, and
disease is to simply reduce calories and saturated fat. the result would be coma and death: the fate of virtu-
But in the real world, it’s not so simple. Some foods ally every type 1 diabetic in the early part of the
influence our body’s metabolic systems in ways that twentieth century before the discovery of insulin.
override our hunger signals and boost levels of hor- However, without glucagon, blood sugar would plum-
mones that store fat. Not coincidentally, our main fat- met, and the result would be brain dysfunction, coma,
and death. But there’s an even more insidious way in which manufacturing machinery in your body. This enzyme— on the body, such as being anti-inflammatory,” says
So the body knows what it’s doing. This little insulin raises blood pressure. with the unwieldy name of HMG-CoA reductase—is the Jeff Volek, Ph.D., R.D., one of the top researchers in
dance between the force that keeps blood sugar from It talks to the kidneys. very same enzyme that’s shut down by cholesterol- the field of diet and health.5 “But if you’re insulin
soaring too high (insulin) and the forces that prevent Insulin’s message to the kidneys is this: Hold on lowering drugs! You could probably lower your resistant, chronically high insulin levels have the
it from going too low (glucagon, for one) is essential to salt. Insulin makes the kidneys do this even if the cholesterol—if you still care about that—by simply opposite effect. They actually promote inflammation
for survival. It’s interesting to note that although insu- kidneys would much prefer not to. Because the body lowering your insulin levels. And doing so would have and cardiovascular problems. That’s not generally
lin is the only hormone responsible for preventing controls sodium within a tight range, as it does sugar, none of the side effects of cholesterol-lowering appreciated yet; what is well accepted is that high
blood sugar from rising too high, there are several the kidneys figure, “Listen, if we have to hold on to all medication, unless you call a longer life span and glucose (blood sugar) will cause problems over time.”6
other hormones besides glucagon—cortisol, adrena- this salt, we’d better bring on more water to dilute it better health side effects! So insulin is anti-inflammatory in people with nor-
line, noradrenaline, and human growth hormone—that so that it stays in the safe range.” And that’s exactly By the way, we’re not kidding about the “longer mal insulin sensitivity, but it is highly inflammatory in
prevent it from going too low. You could say that insu- what they do. Increased sodium retention results in life span and better health” part. A classic 1992 study those with insulin resistance. Which is more than 50
lin is such a powerful hormone that it needs five increased water retention. More water means more examined the blood work of healthy centenarians in percent of the population, and that’s a conservative
other hormones just to counterbalance its effects! blood volume, and more blood volume means higher an effort to find out whether there were any com- estimate based on crude measurements. We suspect
In fact, as you’ll see a bit later on in the book, blood pressure. Fully 70 percent of people with hyper- monalities among the members of this unusually that if insulin resistance was measured in a state-of-
1
when insulin metabolism is off the rails—a condition tension (high blood pressure) have insulin resistance. long-lived demographic. It found three: low triglycer- the-art way, such as with LabCorp’s LP-IR test, the
known as insulin resistance—it’s an early warning sign And this is not just theoretical. Research from ides, high HDL cholesterol, and—wait for it—low fasting number would be significantly higher.
2 4
that something is going very, very wrong. In chapter Wake Forest Baptist Medical Center demonstrates insulin. Your diet affects two of these blood mea-
9, we’ll explore in great detail the relationship of insu- that insulin resistance is directly related to high blood sures—triglycerides and fasting insulin—and both mea- Insulin Resistance and Heart Disease
lin resistance to heart disease. Spoiler alert: We’re pressure. “We found you can predict who’s at higher sures will fall like a rock when you reduce or eliminate Having insulin resistance is a tsunami when it comes
going to make the case that insulin resistance is one risk for developing high blood pressure based on their sugar and processed carbs in your diet. to developing heart disease. Insulin resistance makes
of the most important—and earliest—signs of coming insulin resistance,” said lead researcher David Goff Jr., Remember—the body makes triglycerides out of it more likely you’ll have hypertension, puts you at
heart disease. Ph.D., M.D. “The one-third of participants [in our excess calories from carbohydrates. It’s not important significantly greater risk for diabetes, is almost
Let’s begin by looking at the stunning example of study] with the highest levels of insulin resistance had to know how the biochemistry of this works; it’s just certainly correlated with elevated triglycerides, and is
how insulin influences the cardiovascular system: rates of hypertension that were 35 percent higher important to know that too much sugar equals high heavily correlated with obesity—all major risk factors
blood pressure. than the one-third with the least resistance. These triglycerides (not to mention high fasting insulin). for cardiovascular disease. But to add insult to injury,
findings point out that reducing the body’s resistance It’s hard to change your HDL, but you can signifi- that excess insulin has an inflammatory effect on
Insulin Resistance and High Blood to insulin may help prevent hypertension and cardio- cantly improve two out of three measures of longev- your system as well. As we’ve seen, inflammation is a
Pressure 3
vascular disease” (emphasis ours). ity—triglycerides and insulin—just by reducing carbs! major player in the development of plaque, and a far
High levels of insulin will increase your blood pressure In our opinion, lowering triglycerides is one of the more important risk factor for heart disease than
in a couple of ways. For one thing, insulin can narrow The Insulin–Cholesterol Connection major health benefits of a diet lower in sugar, as high cholesterol is.
the artery walls. Narrower walls translate into higher Interesting factoid: Insulin has a profound effect on triglycerides are far more of a danger sign for heart If you have any degree of insulin resistance, con-
blood pressure because a harder pumping action is cholesterol as well. It turns up the cholesterol-making disease than high cholesterol is. trolling your insulin by dietary means may be one of
required to get the blood through the narrower machinery by turbocharging the activity of the Beginning to connect the dots? the most effective strategies for reducing the risk of
passageways. enzyme that actually controls the cholesterol- “Normally, insulin has some fairly positive effects coronary disease. It certainly beats the fairly irrele-
and death. But there’s an even more insidious way in which manufacturing machinery in your body. This enzyme— on the body, such as being anti-inflammatory,” says
So the body knows what it’s doing. This little insulin raises blood pressure. with the unwieldy name of HMG-CoA reductase—is the Jeff Volek, Ph.D., R.D., one of the top researchers in
dance between the force that keeps blood sugar from It talks to the kidneys. very same enzyme that’s shut down by cholesterol- the field of diet and health.5 “But if you’re insulin
soaring too high (insulin) and the forces that prevent Insulin’s message to the kidneys is this: Hold on lowering drugs! You could probably lower your resistant, chronically high insulin levels have the
it from going too low (glucagon, for one) is essential to salt. Insulin makes the kidneys do this even if the cholesterol—if you still care about that—by simply opposite effect. They actually promote inflammation
for survival. It’s interesting to note that although insu- kidneys would much prefer not to. Because the body lowering your insulin levels. And doing so would have and cardiovascular problems. That’s not generally
lin is the only hormone responsible for preventing controls sodium within a tight range, as it does sugar, none of the side effects of cholesterol-lowering appreciated yet; what is well accepted is that high
blood sugar from rising too high, there are several the kidneys figure, “Listen, if we have to hold on to all medication, unless you call a longer life span and glucose (blood sugar) will cause problems over time.”6
other hormones besides glucagon—cortisol, adrena- this salt, we’d better bring on more water to dilute it better health side effects! So insulin is anti-inflammatory in people with nor-
line, noradrenaline, and human growth hormone—that so that it stays in the safe range.” And that’s exactly By the way, we’re not kidding about the “longer mal insulin sensitivity, but it is highly inflammatory in
prevent it from going too low. You could say that insu- what they do. Increased sodium retention results in life span and better health” part. A classic 1992 study those with insulin resistance. Which is more than 50
lin is such a powerful hormone that it needs five increased water retention. More water means more examined the blood work of healthy centenarians in percent of the population, and that’s a conservative
other hormones just to counterbalance its effects! blood volume, and more blood volume means higher an effort to find out whether there were any com- estimate based on crude measurements. We suspect
In fact, as you’ll see a bit later on in the book, blood pressure. Fully 70 percent of people with hyper- monalities among the members of this unusually that if insulin resistance was measured in a state-of-
1
when insulin metabolism is off the rails—a condition tension (high blood pressure) have insulin resistance. long-lived demographic. It found three: low triglycer- the-art way, such as with LabCorp’s LP-IR test, the
known as insulin resistance—it’s an early warning sign And this is not just theoretical. Research from ides, high HDL cholesterol, and—wait for it—low fasting number would be significantly higher.
2 4
that something is going very, very wrong. In chapter Wake Forest Baptist Medical Center demonstrates insulin. Your diet affects two of these blood mea-
9, we’ll explore in great detail the relationship of insu- that insulin resistance is directly related to high blood sures—triglycerides and fasting insulin—and both mea- Insulin Resistance and Heart Disease
lin resistance to heart disease. Spoiler alert: We’re pressure. “We found you can predict who’s at higher sures will fall like a rock when you reduce or eliminate Having insulin resistance is a tsunami when it comes
going to make the case that insulin resistance is one risk for developing high blood pressure based on their sugar and processed carbs in your diet. to developing heart disease. Insulin resistance makes
of the most important—and earliest—signs of coming insulin resistance,” said lead researcher David Goff Jr., Remember—the body makes triglycerides out of it more likely you’ll have hypertension, puts you at
heart disease. Ph.D., M.D. “The one-third of participants [in our excess calories from carbohydrates. It’s not important significantly greater risk for diabetes, is almost
Let’s begin by looking at the stunning example of study] with the highest levels of insulin resistance had to know how the biochemistry of this works; it’s just certainly correlated with elevated triglycerides, and is
how insulin influences the cardiovascular system: rates of hypertension that were 35 percent higher important to know that too much sugar equals high heavily correlated with obesity—all major risk factors
blood pressure. than the one-third with the least resistance. These triglycerides (not to mention high fasting insulin). for cardiovascular disease. But to add insult to injury,
findings point out that reducing the body’s resistance It’s hard to change your HDL, but you can signifi- that excess insulin has an inflammatory effect on
Insulin Resistance and High Blood to insulin may help prevent hypertension and cardio- cantly improve two out of three measures of longev- your system as well. As we’ve seen, inflammation is a
Pressure 3
vascular disease” (emphasis ours). ity—triglycerides and insulin—just by reducing carbs! major player in the development of plaque, and a far
High levels of insulin will increase your blood pressure In our opinion, lowering triglycerides is one of the more important risk factor for heart disease than
in a couple of ways. For one thing, insulin can narrow The Insulin–Cholesterol Connection major health benefits of a diet lower in sugar, as high cholesterol is.
the artery walls. Narrower walls translate into higher Interesting factoid: Insulin has a profound effect on triglycerides are far more of a danger sign for heart If you have any degree of insulin resistance, con-
blood pressure because a harder pumping action is cholesterol as well. It turns up the cholesterol-making disease than high cholesterol is. trolling your insulin by dietary means may be one of
required to get the blood through the narrower machinery by turbocharging the activity of the Beginning to connect the dots? the most effective strategies for reducing the risk of
passageways. enzyme that actually controls the cholesterol- “Normally, insulin has some fairly positive effects coronary disease. It certainly beats the fairly irrele-
The collection of diseases strongly influenced by insulin resistance
has been given the acronym CHAOS: coronary disease, Stand in front of a wall and walk toward it.
hypertension, adult onset diabetes, obesity, and stroke. They’re all If your belly touches the wall before the rest of your body,
related, and what they have in common is insulin resistance. there’s an excellent chance that you’re insulin resistant.
vant strategy of lowering cholesterol! tance has skyrocketed 61 percent in the past decade cent of the population had flawless glucose metabo- The higher your triglycerides, the greater the
“[H]aving chronically elevated insulin levels has alone, according to Daniel Einhorn, M.D., medical lism, the rest of us—up to 75 percent of the popula- chance that you’re insulin resistant. This in turn
harmful effects of its own—heart disease for one,” director of the Scripps Whittier Diabetes Institute in tion—had some degree of insulin resistance! Also, means that insulin is contributing mightily to the very
7 8
Gary Taubes wrote in the New York Times. Elevated California. The prevalence of insulin resistance has Reaven used young, healthy adults as subjects, and inflammation that damages LDL cholesterol in the
insulin increases triglycerides, raises blood pressure, probably been underestimated from the beginning. their numbers were definitely not representative of first place and starts the whole cycle of plaque forma-
and lowers HDL cholesterol—all making insulin resis- The late great scientist Gerald Reaven of Stanford the population as a whole—the fact is, sensitivity to tion. The take-home point: Reduce your triglycerides
tance even worse and substantially upping the risk for University—whom you’ll be learning more about in insulin actually decreases (and insulin resistance (and raise your HDL), and you reduce your risk of
heart disease. chapter 9—did the original work on insulin resistance increases) as you get older. heart disease.
At this point you may be wondering, “How do I in the 1980s. Here’s how he approximated the number The take-home point: Insulin resistance isn’t just Lowering your sugar intake probably won’t affect
know if I have insulin resistance?” An excellent ques- of people who were insulin resistant. He divided his something that happens to other people. The your HDL level, but it will dramatically affect triglycer-
tion. Though there are blood measures to determine test population—nondiabetic, healthy adults—into quar- American Association of Clinical Endocrinologists has ides and fasting insulin. And both of these will cer-
this—and we’ll discuss those later on—there’s also a tiles and tested their ability to metabolize sugar and estimated that one in three Americans is insulin resis- tainly drop when you lower the amount of sugar and
9
nice, simple, low-tech way to do it. Stand in front of a carbohydrates. He found that while the top 25 per- tant, and a fair amount of emerging research indi- processed carbs you’re eating (or drinking).
wall and walk toward it. If your belly touches the wall cent of the population could handle sugar just fine, cates that the number is quite a bit higher, as you’ll The bottom line here is that changing your diet
before the rest of your body, there’s an excellent the bottom 25 percent could not—they had insulin see later in the book. can really change your life. No kidding. This is not just
chance that you’re insulin resistant. Men with waist resistance (or, in the parlance of researchers, impaired Back in chapter 4 we mentioned that calculating theoretical or pie-in-the-sky. A change in diet and a
sizes of 40 inches or more are almost certainly insu- glucose metabolism). So for a long time, it was your ratio of triglycerides to HDL cholesterol is a much few important lifestyle changes—as outlined in part
lin resistant, as are women with waist sizes of 35 thought that the number of people with insulin resis- better way to predict heart disease than by assessing three of this book—can make the difference between a
inches or more. tance was one in four (25 percent). cholesterol levels. (Just so you don’t have to go back life of energy, vigor, and health, and a life of constant
Although there are, indeed, people with insulin But there’s a problem. and look it up: You calculate your ratio by simply look- doctor appointments, weight problems, and diabetes
resistance who are rail thin, the vast majority of people What happened to the 50 percent of people ing at two line items on your blood test—triglycerides medications.
with insulin resistance are not. We’ll talk about other between those two extremes? It turns out they had and HDL cholesterol. If, for example, your triglycerides
ways to measure insulin resistance through scientifi- neither the terrific glucose metabolism of the top 25 are 150 mg/dL and your HDL cholesterol is 30 mg/dL, THE TWINKIE PARADOX
cally validated blood tests later on in this book, but the percent nor the full-blown insulin resistance of the your ratio is 150 divided by 30, or five.) As it turns out, In 2010, Mark Haub—a nutrition professor from Kansas
“walk-into-the-wall” way is a good stand-in for now. bottom 25 percent; instead, they fell somewhere in this same ratio is an excellent predictor of insulin resis- State University—made headlines with what seemed
Insulin resistance is reversible. And it’s hardly a between. tance. In one study, a ratio of three or greater was a like a kamikaze diet experiment: He spent ten weeks
10
rare phenomenon. The prevalence of insulin resis- One could easily argue that because only 25 per- reliable predictor of insulin resistance. eating a steady stream of Twinkies—one every three
The collection of diseases strongly influenced by insulin resistance
has been given the acronym CHAOS: coronary disease, Stand in front of a wall and walk toward it.
hypertension, adult onset diabetes, obesity, and stroke. They’re all If your belly touches the wall before the rest of your body,
related, and what they have in common is insulin resistance. there’s an excellent chance that you’re insulin resistant.
vant strategy of lowering cholesterol! tance has skyrocketed 61 percent in the past decade cent of the population had flawless glucose metabo- The higher your triglycerides, the greater the
“[H]aving chronically elevated insulin levels has alone, according to Daniel Einhorn, M.D., medical lism, the rest of us—up to 75 percent of the popula- chance that you’re insulin resistant. This in turn
harmful effects of its own—heart disease for one,” director of the Scripps Whittier Diabetes Institute in tion—had some degree of insulin resistance! Also, means that insulin is contributing mightily to the very
7 8
Gary Taubes wrote in the New York Times. Elevated California. The prevalence of insulin resistance has Reaven used young, healthy adults as subjects, and inflammation that damages LDL cholesterol in the
insulin increases triglycerides, raises blood pressure, probably been underestimated from the beginning. their numbers were definitely not representative of first place and starts the whole cycle of plaque forma-
and lowers HDL cholesterol—all making insulin resis- The late great scientist Gerald Reaven of Stanford the population as a whole—the fact is, sensitivity to tion. The take-home point: Reduce your triglycerides
tance even worse and substantially upping the risk for University—whom you’ll be learning more about in insulin actually decreases (and insulin resistance (and raise your HDL), and you reduce your risk of
heart disease. chapter 9—did the original work on insulin resistance increases) as you get older. heart disease.
At this point you may be wondering, “How do I in the 1980s. Here’s how he approximated the number The take-home point: Insulin resistance isn’t just Lowering your sugar intake probably won’t affect
know if I have insulin resistance?” An excellent ques- of people who were insulin resistant. He divided his something that happens to other people. The your HDL level, but it will dramatically affect triglycer-
tion. Though there are blood measures to determine test population—nondiabetic, healthy adults—into quar- American Association of Clinical Endocrinologists has ides and fasting insulin. And both of these will cer-
this—and we’ll discuss those later on—there’s also a tiles and tested their ability to metabolize sugar and estimated that one in three Americans is insulin resis- tainly drop when you lower the amount of sugar and
9
nice, simple, low-tech way to do it. Stand in front of a carbohydrates. He found that while the top 25 per- tant, and a fair amount of emerging research indi- processed carbs you’re eating (or drinking).
wall and walk toward it. If your belly touches the wall cent of the population could handle sugar just fine, cates that the number is quite a bit higher, as you’ll The bottom line here is that changing your diet
before the rest of your body, there’s an excellent the bottom 25 percent could not—they had insulin see later in the book. can really change your life. No kidding. This is not just
chance that you’re insulin resistant. Men with waist resistance (or, in the parlance of researchers, impaired Back in chapter 4 we mentioned that calculating theoretical or pie-in-the-sky. A change in diet and a
sizes of 40 inches or more are almost certainly insu- glucose metabolism). So for a long time, it was your ratio of triglycerides to HDL cholesterol is a much few important lifestyle changes—as outlined in part
lin resistant, as are women with waist sizes of 35 thought that the number of people with insulin resis- better way to predict heart disease than by assessing three of this book—can make the difference between a
inches or more. tance was one in four (25 percent). cholesterol levels. (Just so you don’t have to go back life of energy, vigor, and health, and a life of constant
Although there are, indeed, people with insulin But there’s a problem. and look it up: You calculate your ratio by simply look- doctor appointments, weight problems, and diabetes
resistance who are rail thin, the vast majority of people What happened to the 50 percent of people ing at two line items on your blood test—triglycerides medications.
with insulin resistance are not. We’ll talk about other between those two extremes? It turns out they had and HDL cholesterol. If, for example, your triglycerides
ways to measure insulin resistance through scientifi- neither the terrific glucose metabolism of the top 25 are 150 mg/dL and your HDL cholesterol is 30 mg/dL, THE TWINKIE PARADOX
cally validated blood tests later on in this book, but the percent nor the full-blown insulin resistance of the your ratio is 150 divided by 30, or five.) As it turns out, In 2010, Mark Haub—a nutrition professor from Kansas
“walk-into-the-wall” way is a good stand-in for now. bottom 25 percent; instead, they fell somewhere in this same ratio is an excellent predictor of insulin resis- State University—made headlines with what seemed
Insulin resistance is reversible. And it’s hardly a between. tance. In one study, a ratio of three or greater was a like a kamikaze diet experiment: He spent ten weeks
10
rare phenomenon. The prevalence of insulin resis- One could easily argue that because only 25 per- reliable predictor of insulin resistance. eating a steady stream of Twinkies—one every three
hours, to be exact—along with Oreos, Doritos, sugary cates of the “energy balance” theory. regardless of what we’re eating. (and better yet, are losing weight at the same time),
cereals, and a variety of Little Debbie’s snack cakes. But is that really the case? And that means we can’t trust weight-loss studies but sugar also makes it just about impossible to actu-
To make the diet somewhat less death defying, he This brings us to one of the biggest problems to tell us about the effects of sugar during non- ally do that. And the reason has to do with what’s
also threw in a multivitamin supplement, a daily with weight-loss studies of any sort—especially ones weight-loss situations. Indeed, the real issue is what going on in your noggin.
protein shake, and the odd can of green beans or that simultaneously try to assess the effects of sugar. happens when we stop dropping pounds and try to
celery stalks. For most people, shedding pounds alone is enough to maintain what we’ve got. If Haub kept up his Twinkie MEANWHILE, UP IN THE BRAIN . . .
The only stipulation was a cap on his calorie improve their blood lipids. And the reasons for that diet after he was done losing weight, the results, most We’ve covered plenty on the endocrinology front so
intake—1800 a day. are plentiful. For one, losing weight inevitably causes assuredly, would have been much different. far. (Hopefully we kept our promise and your eyes
Given what you’ve learned in this book so far, some fat loss from the organs—and once enough fat An aside: One of us—Jonny—was a personal didn’t glaze over.) But sugar’s effects don’t end with
you might suspect the results were disastrous. Surely slurps out of the pancreas and liver, insulin sensitivity trainer on staff at Equinox Fitness Clubs for many its effect on hormones. The flip side of sugar’s impact
his triglycerides shot through the stratosphere. And improves and a whole host of benefits quickly follow. years during the 1990s. During that time, he saw a lot on our hormones is its impact on our brain.
if he somehow didn’t gain weight, he certainly didn’t A fascinating study from 2015 found that losing of people lose weight successfully on what trainers If you’ll recall, our bodies come equipped with a
lose any. That tidal wave of sugar probably exhausted less than one gram of fat from the pancreas was then privately referred to as “the model’s diet: reward system—a feedback network that tells us what
11
his pancreas and turned him insulin resistant in enough to reverse type 2 diabetes. On top of that, cocaine, coffee, and an occasional salad.” Weight loss we do or don’t like. As far as survival is concerned,
record speed! staying in a negative energy balance—that is, consum- in the short term is not a good measure of overall this reward system does us all sorts of favors: It tells
But that’s not what happened. ing fewer calories than you burn each day—ensures health, and certainly isn’t a good predictor of long- us to seek out food (because eating feels good), to
In what came to be known as the “Twinkie diet,” liver and glycogen stores get a chance to empty out, term success, or else everyone would just eat reproduce (because sex feels good), to form connec-
Haub dropped 27 pounds, raised his HDL by 20 per- which also boosts insulin sensitivity. Twinkies for a month like Haub did and be just fine. tions in our community (because socializing feels
cent, slashed his LDL by 20 percent, lowered his tri- If you’re starting to sense a theme here, you’re Jonny had an exercise physiology professor in gradu- good), and so on.
glycerides by 39 percent, and reduced his body fat right. Spoiler alert: Notice that just about everything ate school who used to say: “Losing weight by itself is The problem is that our modern environment—
from over 33 percent to just shy of 25 percent. that reduces risk for cardiovascular events also reduces easy. I can take any client in the world and put them especially our modern food environment—exposes us
In other words, he seemed—on paper—to have got- insulin resistance, and anything that increases risk for in a closet for a month with just a tube for water. I to all sorts of stuff our delicate reward centers aren’t
ten healthier. cardiovascular events also seems to increase insulin guarantee they’ll lose weight. But so what?” equipped to handle. This includes many substances
Eating a diet literally made of sugary junk food. resistance. We’ll look at this connection—possibly the That said, some folks—especially those in the unanimously deemed addictive—tobacco and opiates,
The very stuff we’ve been telling you to avoid like most important take-home point in the book—in much “everything in moderation” camp—have argued that if for example—but research is increasingly showing that
the plague. greater detail when we get to chapter 9. we just keep a tight lockdown on our calories, then it also includes certain foods. And guess what? Of all
In attempt to explain these shocking results, dieti- Researchers have also discovered that weight sugary foods can be a harmless addition to a “well- the “foods” with addictive potential, sugar is number
cians near and far chimed in. “A calorie is a calorie!” loss significantly raises our circulating levels of adipo- balanced diet.” Such proponents often point to exam- one with a bullet.
roared the conventional wisdom devotees. The take- nectin—a protein hormone that helps regulate our ples like Mr. Haub and his Twinkies as evidence that
home message, many believed, was that it’s all about blood sugar and improves lipid metabolism, which can all calories are more or less equal; we can just count Hyperpalatability: When Food
calories in versus calories out. Whether your calories improve the numbers on our blood test and our abil- them and be on our merry way. Becomes a Drug
come from a grilled chicken salad or a cream-filled ity to handle high-carb foods. But there’s a problem here. You see, the whole You’ve probably heard the phrase “let food be thy
pastry doesn’t matter, as long as you’re burning off In other words, weight loss—when we have some thing’s a perverse Catch-22: Sugar might be some- medicine,” credited to our ancient Greek friend
more than you eat each day, or so claim the advo- to lose—can improve a number of health markers, what less harmful if we strictly moderate our intake Hippocrates—but what about “let food be thy
hours, to be exact—along with Oreos, Doritos, sugary cates of the “energy balance” theory. regardless of what we’re eating. (and better yet, are losing weight at the same time),
cereals, and a variety of Little Debbie’s snack cakes. But is that really the case? And that means we can’t trust weight-loss studies but sugar also makes it just about impossible to actu-
To make the diet somewhat less death defying, he This brings us to one of the biggest problems to tell us about the effects of sugar during non- ally do that. And the reason has to do with what’s
also threw in a multivitamin supplement, a daily with weight-loss studies of any sort—especially ones weight-loss situations. Indeed, the real issue is what going on in your noggin.
protein shake, and the odd can of green beans or that simultaneously try to assess the effects of sugar. happens when we stop dropping pounds and try to
celery stalks. For most people, shedding pounds alone is enough to maintain what we’ve got. If Haub kept up his Twinkie MEANWHILE, UP IN THE BRAIN . . .
The only stipulation was a cap on his calorie improve their blood lipids. And the reasons for that diet after he was done losing weight, the results, most We’ve covered plenty on the endocrinology front so
intake—1800 a day. are plentiful. For one, losing weight inevitably causes assuredly, would have been much different. far. (Hopefully we kept our promise and your eyes
Given what you’ve learned in this book so far, some fat loss from the organs—and once enough fat An aside: One of us—Jonny—was a personal didn’t glaze over.) But sugar’s effects don’t end with
you might suspect the results were disastrous. Surely slurps out of the pancreas and liver, insulin sensitivity trainer on staff at Equinox Fitness Clubs for many its effect on hormones. The flip side of sugar’s impact
his triglycerides shot through the stratosphere. And improves and a whole host of benefits quickly follow. years during the 1990s. During that time, he saw a lot on our hormones is its impact on our brain.
if he somehow didn’t gain weight, he certainly didn’t A fascinating study from 2015 found that losing of people lose weight successfully on what trainers If you’ll recall, our bodies come equipped with a
lose any. That tidal wave of sugar probably exhausted less than one gram of fat from the pancreas was then privately referred to as “the model’s diet: reward system—a feedback network that tells us what
11
his pancreas and turned him insulin resistant in enough to reverse type 2 diabetes. On top of that, cocaine, coffee, and an occasional salad.” Weight loss we do or don’t like. As far as survival is concerned,
record speed! staying in a negative energy balance—that is, consum- in the short term is not a good measure of overall this reward system does us all sorts of favors: It tells
But that’s not what happened. ing fewer calories than you burn each day—ensures health, and certainly isn’t a good predictor of long- us to seek out food (because eating feels good), to
In what came to be known as the “Twinkie diet,” liver and glycogen stores get a chance to empty out, term success, or else everyone would just eat reproduce (because sex feels good), to form connec-
Haub dropped 27 pounds, raised his HDL by 20 per- which also boosts insulin sensitivity. Twinkies for a month like Haub did and be just fine. tions in our community (because socializing feels
cent, slashed his LDL by 20 percent, lowered his tri- If you’re starting to sense a theme here, you’re Jonny had an exercise physiology professor in gradu- good), and so on.
glycerides by 39 percent, and reduced his body fat right. Spoiler alert: Notice that just about everything ate school who used to say: “Losing weight by itself is The problem is that our modern environment—
from over 33 percent to just shy of 25 percent. that reduces risk for cardiovascular events also reduces easy. I can take any client in the world and put them especially our modern food environment—exposes us
In other words, he seemed—on paper—to have got- insulin resistance, and anything that increases risk for in a closet for a month with just a tube for water. I to all sorts of stuff our delicate reward centers aren’t
ten healthier. cardiovascular events also seems to increase insulin guarantee they’ll lose weight. But so what?” equipped to handle. This includes many substances
Eating a diet literally made of sugary junk food. resistance. We’ll look at this connection—possibly the That said, some folks—especially those in the unanimously deemed addictive—tobacco and opiates,
The very stuff we’ve been telling you to avoid like most important take-home point in the book—in much “everything in moderation” camp—have argued that if for example—but research is increasingly showing that
the plague. greater detail when we get to chapter 9. we just keep a tight lockdown on our calories, then it also includes certain foods. And guess what? Of all
In attempt to explain these shocking results, dieti- Researchers have also discovered that weight sugary foods can be a harmless addition to a “well- the “foods” with addictive potential, sugar is number
cians near and far chimed in. “A calorie is a calorie!” loss significantly raises our circulating levels of adipo- balanced diet.” Such proponents often point to exam- one with a bullet.
roared the conventional wisdom devotees. The take- nectin—a protein hormone that helps regulate our ples like Mr. Haub and his Twinkies as evidence that
home message, many believed, was that it’s all about blood sugar and improves lipid metabolism, which can all calories are more or less equal; we can just count Hyperpalatability: When Food
calories in versus calories out. Whether your calories improve the numbers on our blood test and our abil- them and be on our merry way. Becomes a Drug
come from a grilled chicken salad or a cream-filled ity to handle high-carb foods. But there’s a problem here. You see, the whole You’ve probably heard the phrase “let food be thy
pastry doesn’t matter, as long as you’re burning off In other words, weight loss—when we have some thing’s a perverse Catch-22: Sugar might be some- medicine,” credited to our ancient Greek friend
more than you eat each day, or so claim the advo- to lose—can improve a number of health markers, what less harmful if we strictly moderate our intake Hippocrates—but what about “let food be thy
hopelessly addictive drug”? mixtures results in behaviors resembling that of drug Glycated proteins are too big and sticky to get
It turns out, that second phrase isn’t far from the addiction—binging, withdrawal (including anxiety and SUGAR: CAUGHT AT THE SCENE OF through small blood vessels and capillaries, including
truth. At least when it comes to stuff chemically depression), and cravings. 12
THE CRIME the small vessels in the kidneys, eyes, and feet, which
designed to get us hooked. For decades, food industry Recently, scientists have discovered that our We’re pretty sure that if you asked a random sampling is why so many diabetics are at risk for kidney dis-
scientists have been engineering foods to be “hyper- reward systems contain glucose-sensing neurons that of ordinary people what part of their diet is most ease, vision problems, and amputations of toes, feet,
palatable”—that is, they’ve been purposefully designed respond to sugar intake. While a naturally sweet food, dangerous to their heart, the majority of them would and even legs. The sugar-coated proteins become
to trigger your brain’s reward centers in ways that like an apple or melon, creates a healthy level of say “fat.” toxic and make the cell machinery run less efficiently.
surpass anything a peach, an egg, or chuck roast “reward” stimulation, foods with hyper-condensed They’d be wrong. They damage the body and exhaust the immune sys-
could ever accomplish. (For a superb and detailed sweetness—say, a piece of candy—send our reward path- A far more powerful contributor to heart disease is tem. Scientists have given these sticky proteins the
explanation of how the food industry accomplishes ways into a tizzy, triggering biological compensations sugar. (And, of course, the insulin resistance that can acronym AGEs—which stands for advanced glycation
this, read Pulitzer Prize-winning journalist Michael that, over time, result in tolerance. Eventually, we need results from eating too much of it!) Diets that are lower end products—partially because these proteins are so
13
Moss’s excellent book, Salt Sugar Fat: How the Food to eat more just to feel the same level of pleasure. in sugar and processed carbs will reduce inflammation, involved in aging the body.
Giants Hooked Us.) Here’s where it gets even more fascinating. On its blood sugar, insulin, insulin resistance, and triglycerides. What does this have to do with cholesterol and
By mixing together more salt, more fat, more fla- own, sugar isn’t a particularly “rewarding” food. Think And lowering triglycerides automatically improves that heart disease? Actually, everything. Remember LDL
vorings, and—importantly—more sugar than any food about it: When was the last time you ripped opened a all-important ratio of triglycerides to HDL. (If your tri- cholesterol is a far greater problem once it becomes
in nature could possibly produce, they’ve created bag of pure sugar and went to town with nothing glycerides were 150 mg/dL and your HDL was 50 mg/ damaged. And one primary way in which LDL choles-
products that virtually light up the dopamine and opi- other than a spoon and your appetite? Unless you dL, you’d have a ratio of three, but if you brought your terol gets damaged is through oxidative stress gener-
oid pathways in our brain. Those are the very same lost a bet, you’ve probably never even been tempted. triglycerides down to 100 mg/dL, the ratio would auto- ated by free radicals.
pathways activated by recreational drugs. Indeed, Part of the confusion surrounding sugar’s addictive matically drop to two, or 100:50. Neat, huh?) Can you guess the other way it gets damaged?
some research has shown that sugary foods have an properties is the fact that it’s a much different animal Sugar is directly responsible for one of the most Glycation.
even more intense effect on the brain’s reward path- when it’s flying solo than it is when it’s hanging out damaging processes in the body, something called So now you have sugar at the scene of several
ways than cocaine. with the wrong crowd. Straight out of the bag—sans glycation. Here’s how it works. Glycation is what hap- crimes, all related to heart disease. “High blood sugar
Certain combinations of ingredients signal our flavorings, fat, starches, or salt—sugar doesn’t trip our pens when sticky sugar molecules glom onto struc- causes the lining cells of the arteries to be inflamed,
brains to eat, and eat, and eat some more. This isn’t reward pathways as intensely as when we add it to tures and get stuck where they don’t belong, essen- changes LDL cholesterol, and causes sugar to be
the same as a food being delicious and flavorful, by something else. But once we mix it with other tasty tially gumming up the works. attached to a variety of proteins, which changes their
the way: you can feel compelled to overeat on foods items—fat and salt, for example—all bets are off. You see, sugar is sticky—think cotton candy and normal function,” says Dwight Lundell, M.D., author of
you don’t even like all that much, but be perfectly As a result, sugar has long been the food indus- maple syrup. Proteins, on the other hand, are smooth The Cure for Heart Disease. High sugar intake, as we
content in moderating foods you love. That’s why you try’s secret weapon for getting us hooked. and slippery—think egg whites, which are pure protein. saw, also trains our brain’s reward centers to make us
can relish a perfectly seasoned salmon filet and stop Bottom line? Don’t let anyone trick you into think- The slippery nature of proteins lets them slide around eat more and more of it—leading to a buildup of fat
when you’re full, but might find yourself unwrapping ing sugar is fine as long as you don’t eat too much. easily in the cells and do their jobs effectively. But around the pancreas and subsequently insulin resis-
bar after bar of cheap Halloween candy until you “Just a little sugar” might not do as much damage as when you’ve got a lot of excess sugar in your system, tance, the central player in every condition we’ve
have a stomachache. eating a ton of it—but the caveat is, most of us can’t it keeps bumping into proteins, ultimately getting examined that is intimately connected to heart dis-
Reams of studies have confirmed the addictive ever stop at “just a little.” And for that, we have our stuck onto the protein molecules. Such proteins are ease: diabetes, obesity, high blood pressure, and met-
nature of sugar. In animals, sporadic access to sugary brains to thank. now said to have become glycated. abolic syndrome.
hopelessly addictive drug”? mixtures results in behaviors resembling that of drug Glycated proteins are too big and sticky to get
It turns out, that second phrase isn’t far from the addiction—binging, withdrawal (including anxiety and SUGAR: CAUGHT AT THE SCENE OF through small blood vessels and capillaries, including
truth. At least when it comes to stuff chemically depression), and cravings. 12
THE CRIME the small vessels in the kidneys, eyes, and feet, which
designed to get us hooked. For decades, food industry Recently, scientists have discovered that our We’re pretty sure that if you asked a random sampling is why so many diabetics are at risk for kidney dis-
scientists have been engineering foods to be “hyper- reward systems contain glucose-sensing neurons that of ordinary people what part of their diet is most ease, vision problems, and amputations of toes, feet,
palatable”—that is, they’ve been purposefully designed respond to sugar intake. While a naturally sweet food, dangerous to their heart, the majority of them would and even legs. The sugar-coated proteins become
to trigger your brain’s reward centers in ways that like an apple or melon, creates a healthy level of say “fat.” toxic and make the cell machinery run less efficiently.
surpass anything a peach, an egg, or chuck roast “reward” stimulation, foods with hyper-condensed They’d be wrong. They damage the body and exhaust the immune sys-
could ever accomplish. (For a superb and detailed sweetness—say, a piece of candy—send our reward path- A far more powerful contributor to heart disease is tem. Scientists have given these sticky proteins the
explanation of how the food industry accomplishes ways into a tizzy, triggering biological compensations sugar. (And, of course, the insulin resistance that can acronym AGEs—which stands for advanced glycation
this, read Pulitzer Prize-winning journalist Michael that, over time, result in tolerance. Eventually, we need results from eating too much of it!) Diets that are lower end products—partially because these proteins are so
13
Moss’s excellent book, Salt Sugar Fat: How the Food to eat more just to feel the same level of pleasure. in sugar and processed carbs will reduce inflammation, involved in aging the body.
Giants Hooked Us.) Here’s where it gets even more fascinating. On its blood sugar, insulin, insulin resistance, and triglycerides. What does this have to do with cholesterol and
By mixing together more salt, more fat, more fla- own, sugar isn’t a particularly “rewarding” food. Think And lowering triglycerides automatically improves that heart disease? Actually, everything. Remember LDL
vorings, and—importantly—more sugar than any food about it: When was the last time you ripped opened a all-important ratio of triglycerides to HDL. (If your tri- cholesterol is a far greater problem once it becomes
in nature could possibly produce, they’ve created bag of pure sugar and went to town with nothing glycerides were 150 mg/dL and your HDL was 50 mg/ damaged. And one primary way in which LDL choles-
products that virtually light up the dopamine and opi- other than a spoon and your appetite? Unless you dL, you’d have a ratio of three, but if you brought your terol gets damaged is through oxidative stress gener-
oid pathways in our brain. Those are the very same lost a bet, you’ve probably never even been tempted. triglycerides down to 100 mg/dL, the ratio would auto- ated by free radicals.
pathways activated by recreational drugs. Indeed, Part of the confusion surrounding sugar’s addictive matically drop to two, or 100:50. Neat, huh?) Can you guess the other way it gets damaged?
some research has shown that sugary foods have an properties is the fact that it’s a much different animal Sugar is directly responsible for one of the most Glycation.
even more intense effect on the brain’s reward path- when it’s flying solo than it is when it’s hanging out damaging processes in the body, something called So now you have sugar at the scene of several
ways than cocaine. with the wrong crowd. Straight out of the bag—sans glycation. Here’s how it works. Glycation is what hap- crimes, all related to heart disease. “High blood sugar
Certain combinations of ingredients signal our flavorings, fat, starches, or salt—sugar doesn’t trip our pens when sticky sugar molecules glom onto struc- causes the lining cells of the arteries to be inflamed,
brains to eat, and eat, and eat some more. This isn’t reward pathways as intensely as when we add it to tures and get stuck where they don’t belong, essen- changes LDL cholesterol, and causes sugar to be
the same as a food being delicious and flavorful, by something else. But once we mix it with other tasty tially gumming up the works. attached to a variety of proteins, which changes their
the way: you can feel compelled to overeat on foods items—fat and salt, for example—all bets are off. You see, sugar is sticky—think cotton candy and normal function,” says Dwight Lundell, M.D., author of
you don’t even like all that much, but be perfectly As a result, sugar has long been the food indus- maple syrup. Proteins, on the other hand, are smooth The Cure for Heart Disease. High sugar intake, as we
content in moderating foods you love. That’s why you try’s secret weapon for getting us hooked. and slippery—think egg whites, which are pure protein. saw, also trains our brain’s reward centers to make us
can relish a perfectly seasoned salmon filet and stop Bottom line? Don’t let anyone trick you into think- The slippery nature of proteins lets them slide around eat more and more of it—leading to a buildup of fat
when you’re full, but might find yourself unwrapping ing sugar is fine as long as you don’t eat too much. easily in the cells and do their jobs effectively. But around the pancreas and subsequently insulin resis-
bar after bar of cheap Halloween candy until you “Just a little sugar” might not do as much damage as when you’ve got a lot of excess sugar in your system, tance, the central player in every condition we’ve
have a stomachache. eating a ton of it—but the caveat is, most of us can’t it keeps bumping into proteins, ultimately getting examined that is intimately connected to heart dis-
Reams of studies have confirmed the addictive ever stop at “just a little.” And for that, we have our stuck onto the protein molecules. Such proteins are ease: diabetes, obesity, high blood pressure, and met-
nature of sugar. In animals, sporadic access to sugary brains to thank. now said to have become glycated. abolic syndrome.
Is it any surprise that we think reducing sugar is Journal of Clinical Nutrition, and Nature. of scientists and doctors to study the evidence that fat dietary fat caused heart disease actually support the
far more important than reducing fat or cholesterol? Yudkin was typically portrayed by his detractors as and cholesterol cause heart disease, a concept he later sugar theory as well,” Taubes wrote. “During the
15
And by the way, we’re hardly the first people to say so. a wild-eyed fanatic who blamed sugar as the cause of called “the greatest health scam of the century.” Korean War, pathologists doing autopsies on American
heart disease, but in fact he was nothing of the sort. In Though Yudkin did not write a low-carb diet book soldiers killed in battle noticed that many had signifi-
The Voice of Dissent: Introducing his 1972 book, Sweet and Dangerous, he was the per se, he was one of the most influential voices of cant plaques in their arteries, even those who were
John Yudkin embodiment of reason when he called for a reexamina- the time to put forth the position that sugar was still teenagers, while the Koreans killed in battle did
By 1970, Ancel Keys’s research indicting saturated fat tion of the data—which he considered highly flawed— responsible for far more health problems than fat not. The atherosclerotic plaques in the Americans
in heart disease had been published and was being that led to the hypothesis that fat causes heart dis- was. His book called attention to countries in which were attributed to the fact that they ate high-fat diets
picked up by the media; the low- or no-cholesterol ease. (He’s since been proven right—many times!) the correlation between heart disease and sugar and the Koreans ate low-fat. But the Americans were
brigade was gearing up for an assault on the In the 1960s, Yudkin did a series of animal experi- intake was far more striking than the correlation also eating high-sugar diets, while the Koreans, like
consciousness of the American public. Then in 1972, ments in which he fed sugar and starch to a variety of between heart disease and fat. And he pointed to a the Japanese, were not.”
Robert Atkins published Diet Revolution, which became critters, including chickens, rabbits, pigs, and college number of studies—most dramatically of the Masai in As Yudkin put it, “It may turn out that [many fac-
the de facto poster child for the low-carb movement students. Invariably he found that the levels of triglyc- Kenya and Tanzania—in which people consumed copi- tors, including sugar] ultimately have the same effect
two decades later. Atkins advocated an approach erides in all these subjects were raised. (Remember, ous amounts of milk and fat and yet had virtually no on metabolism and so produce coronary disease by
completely opposite to the one promoted by Keys: He high triglycerides are a major risk factor for heart dis- heart disease. Interestingly, these people also con- the same mechanism.” What is that mechanism?
16
said that insulin and carbohydrates, not fat and ease, and triglycerides rise like an air balloon when sumed almost no sugar. Fingers are beginning to point suspiciously to an
cholesterol, were the problem in the American diet. you eat a lot of sugar and starch.) In Yudkin’s experi- overload of insulin as a common culprit at the root of
Because his high-fat, high-protein, low-carb diet ments, sugar also raised insulin, linking sugar to type The Sweetening of America at least some of these metabolic and negative health
went so dramatically against the conventional wisdom 2 diabetes, which, as you now know, is intimately To be clear, Yudkin never said that sugar causes the effects, such as heart disease.
14
of the times, Atkins was attacked mercilessly in the related to heart disease as well. diseases of modern civilization, just that a case could As you will soon see, there are now compelling
press and vilified by the medical mainstream, which Yudkin was one of the many who pointed out that easily be made that it deserved attention and study, reasons to believe that there is a causal relationship
turned him into a pariah in the medical community. statistics for heart disease and fat consumption certainly as much as, if not more than, fat between insulin resistance and heart disease, and,
But in the same year that Atkins published his book, existed for many more countries than those referred consumption. Heart disease is associated with a since insulin resistance is eminently treatable, that
an English doctor named John Yudkin was making to by Keys, and that these other figures didn’t fit into number of indicators, including fat consumption, early testing for insulin resistance could prevent a
waves by politely and reasonably suggesting to the the “more fat, more heart disease” relationship that being overweight, cigarette smoking, a sedentary significant number of heart attacks from ever hap-
medical establishment that perhaps its emperor, while was evident when only the seven selected countries lifestyle, television viewing, and a high intake of sugar. pening in the first place. We’ll outline that case in
indeed cholesterol-free and low-fat, was nonetheless were considered. He pointed out that there was a bet- Yudkin himself did several interesting studies on chapter 9.
naked as a jaybird. ter and truer relationship between sugar consumption sugar consumption and coronary heart disease. In Controlling insulin was the main purpose of the
A professor of nutrition at Queen Elizabeth and heart disease, and he said that “there is a sizable one he found that the median sugar intake of a group original Atkins diet and has become the raison d’être
College, University of London, Yudkin was a highly minority—of which I am one—that believes that coro- of coronary patients was 147 g, twice as much as it of the low-carb approach to living. Though the Atkins
respected scientist and nutritionist who had dozens of nary disease is not largely due to fat in the diet.” was in two different groups of control subjects that diet is certainly not the only way to control insulin,
published papers in such renowned peer-reviewed Three decades later, Dr. George Mann, an associate didn’t have coronary disease; these groups consumed Atkins—who was after all a cardiologist—is to be com-
17
journals as The Lancet, the British Medical Journal, director of the Framingham Heart Study, arrived at the only 67 g and 74 g, respectively. mended for being prescient when it comes to identify-
the Archives of Internal Medicine, the American same conclusion and assembled a distinguished group “Many of the key observations cited to argue that ing carbohydrates and insulin resistance as causative
Is it any surprise that we think reducing sugar is Journal of Clinical Nutrition, and Nature. of scientists and doctors to study the evidence that fat dietary fat caused heart disease actually support the
far more important than reducing fat or cholesterol? Yudkin was typically portrayed by his detractors as and cholesterol cause heart disease, a concept he later sugar theory as well,” Taubes wrote. “During the
15
And by the way, we’re hardly the first people to say so. a wild-eyed fanatic who blamed sugar as the cause of called “the greatest health scam of the century.” Korean War, pathologists doing autopsies on American
heart disease, but in fact he was nothing of the sort. In Though Yudkin did not write a low-carb diet book soldiers killed in battle noticed that many had signifi-
The Voice of Dissent: Introducing his 1972 book, Sweet and Dangerous, he was the per se, he was one of the most influential voices of cant plaques in their arteries, even those who were
John Yudkin embodiment of reason when he called for a reexamina- the time to put forth the position that sugar was still teenagers, while the Koreans killed in battle did
By 1970, Ancel Keys’s research indicting saturated fat tion of the data—which he considered highly flawed— responsible for far more health problems than fat not. The atherosclerotic plaques in the Americans
in heart disease had been published and was being that led to the hypothesis that fat causes heart dis- was. His book called attention to countries in which were attributed to the fact that they ate high-fat diets
picked up by the media; the low- or no-cholesterol ease. (He’s since been proven right—many times!) the correlation between heart disease and sugar and the Koreans ate low-fat. But the Americans were
brigade was gearing up for an assault on the In the 1960s, Yudkin did a series of animal experi- intake was far more striking than the correlation also eating high-sugar diets, while the Koreans, like
consciousness of the American public. Then in 1972, ments in which he fed sugar and starch to a variety of between heart disease and fat. And he pointed to a the Japanese, were not.”
Robert Atkins published Diet Revolution, which became critters, including chickens, rabbits, pigs, and college number of studies—most dramatically of the Masai in As Yudkin put it, “It may turn out that [many fac-
the de facto poster child for the low-carb movement students. Invariably he found that the levels of triglyc- Kenya and Tanzania—in which people consumed copi- tors, including sugar] ultimately have the same effect
two decades later. Atkins advocated an approach erides in all these subjects were raised. (Remember, ous amounts of milk and fat and yet had virtually no on metabolism and so produce coronary disease by
completely opposite to the one promoted by Keys: He high triglycerides are a major risk factor for heart dis- heart disease. Interestingly, these people also con- the same mechanism.” What is that mechanism?
16
said that insulin and carbohydrates, not fat and ease, and triglycerides rise like an air balloon when sumed almost no sugar. Fingers are beginning to point suspiciously to an
cholesterol, were the problem in the American diet. you eat a lot of sugar and starch.) In Yudkin’s experi- overload of insulin as a common culprit at the root of
Because his high-fat, high-protein, low-carb diet ments, sugar also raised insulin, linking sugar to type The Sweetening of America at least some of these metabolic and negative health
went so dramatically against the conventional wisdom 2 diabetes, which, as you now know, is intimately To be clear, Yudkin never said that sugar causes the effects, such as heart disease.
14
of the times, Atkins was attacked mercilessly in the related to heart disease as well. diseases of modern civilization, just that a case could As you will soon see, there are now compelling
press and vilified by the medical mainstream, which Yudkin was one of the many who pointed out that easily be made that it deserved attention and study, reasons to believe that there is a causal relationship
turned him into a pariah in the medical community. statistics for heart disease and fat consumption certainly as much as, if not more than, fat between insulin resistance and heart disease, and,
But in the same year that Atkins published his book, existed for many more countries than those referred consumption. Heart disease is associated with a since insulin resistance is eminently treatable, that
an English doctor named John Yudkin was making to by Keys, and that these other figures didn’t fit into number of indicators, including fat consumption, early testing for insulin resistance could prevent a
waves by politely and reasonably suggesting to the the “more fat, more heart disease” relationship that being overweight, cigarette smoking, a sedentary significant number of heart attacks from ever hap-
medical establishment that perhaps its emperor, while was evident when only the seven selected countries lifestyle, television viewing, and a high intake of sugar. pening in the first place. We’ll outline that case in
indeed cholesterol-free and low-fat, was nonetheless were considered. He pointed out that there was a bet- Yudkin himself did several interesting studies on chapter 9.
naked as a jaybird. ter and truer relationship between sugar consumption sugar consumption and coronary heart disease. In Controlling insulin was the main purpose of the
A professor of nutrition at Queen Elizabeth and heart disease, and he said that “there is a sizable one he found that the median sugar intake of a group original Atkins diet and has become the raison d’être
College, University of London, Yudkin was a highly minority—of which I am one—that believes that coro- of coronary patients was 147 g, twice as much as it of the low-carb approach to living. Though the Atkins
respected scientist and nutritionist who had dozens of nary disease is not largely due to fat in the diet.” was in two different groups of control subjects that diet is certainly not the only way to control insulin,
published papers in such renowned peer-reviewed Three decades later, Dr. George Mann, an associate didn’t have coronary disease; these groups consumed Atkins—who was after all a cardiologist—is to be com-
17
journals as The Lancet, the British Medical Journal, director of the Framingham Heart Study, arrived at the only 67 g and 74 g, respectively. mended for being prescient when it comes to identify-
the Archives of Internal Medicine, the American same conclusion and assembled a distinguished group “Many of the key observations cited to argue that ing carbohydrates and insulin resistance as causative
factors in diabetes, obesity, hypertension, and, you vegetarian, high-fiber diet with 10 percent of the supposedly heart-healthy low-fat diet. Not only do you the WHO,” reported Juliet Eilperin in the Washington
guessed it, heart disease. calories coming from fat. raise one important independent risk factor for heart Post.21 The Post quoted an April 14, 2003, letter from
When Ornish’s study showed some reversal of disease (triglycerides) while at the same time lower- the Sugar Association’s president, Andrew Briscoe, to
Cholesterol Insanity atherosclerosis and fewer cardiac events in the ing one protective measure (HDL cholesterol), but you the general director of WHO in which he stated, “We
Yudkin’s warnings against sugar and Atkins’s early twenty men who completed the five-year study, the also change the all-important ratio of triglycerides to will exercise every avenue available to expose the
low-carb approach to weight loss were mere whispers public perception—reinforced by Ornish himself—was HDL cholesterol in the worst way possible. A higher dubious nature of the Diet, Nutrition and the
lost in the roar of anti-fat mania. By the mid-1980s, that the results largely stemmed from the low-fat triglycerides number and a lower HDL cholesterol Prevention of Chronic Diseases report.”
fat had been utterly and completely demonized, and diet. This conclusion is an incredible leap that is in no number mean a much higher ratio of triglycerides to Two senators wrote a letter to then Health and
fat phobia was in full bloom, with hundreds of way supported by his research. The fact is that there’s HDL. As we’ve seen, you want your ratio to be low, Human Services Secretary Tommy G. Thompson, urg-
cholesterol-free foods being foisted on a gullible no way to know whether the results were because of not high; low-fat, high-carbohydrate diets make the ing him to squelch the report. Soon afterward, the
18
public. In November 1985, the National Heart, Lung, the low-fat diet portion of the experiment (highly ratio higher. U.S. Department of Health and Human Services sub-
and Blood Institute launched the National Cholesterol unlikely in our view), the high fiber, the whole foods, mitted comments on the report, stating that “evi-
Education Program with the stated goal of “reducing the lack of sugar, or some combination of the inter- THE SUGAR LOBBY IN ACTION dence that soft drinks are associated with obesity is
illness and death from coronary heart disease in the ventions. It is entirely possible that Ornish would have So how did fat get demonized while sugar got a “get not compelling.”
United States by reducing the percent of Americans gotten the same or better results with a program of out of jail free” card? Oh, really? Shades of the tobacco industry’s
19
with high blood cholesterol [italics ours].” exercise, stress management, smoking cessation, and Well, there’s no political lobby for “fat,” but defense of cigarettes.
In 1976, Nathan Pritikin opened his Pritikin group therapy plus a whole foods diet high in protein there’s a powerful one for sugar. But our story doesn’t end there. In fact, the sugar
Longevity Center in Santa Barbara, California, and for and fiber and low in sugar. In 2003, the World Health Organization (WHO)— industry’s backlash against the 2003 WHO report was
the next decade preached the super-low-fat dogma to Yet low-fat eating managed to remain the dietary not exactly a bunch of wide-eyed radicals—published a far from its first rodeo, as far as manipulating public
all who would listen, which included most of the coun- prescription of every major mainstream health organi- conservative, eminently reasonable report called Diet, perception goes. In fact, it’s been playing that game
20
try. Pritikin died in 1985, but his mantle was quickly zation. This recommendation was built on a founda- Nutrition and the Prevention of Chronic Diseases. In for longer than some readers have been alive.
taken up by Dr. Dean Ornish. Ornish’s reputation—and tion of two basic beliefs: that low-fat diets will reduce it, the WHO made the unremarkable statement that it Want proof of the fix? In 2016, the smoking gun
much of the public’s faith in the low-fat diet cholesterol, and that reducing cholesterol will actually would be a good idea for people to derive no more we’d all been waiting for fell from the sky and landed in
approach—was fueled by his famous five-year inter- reduce heart disease and extend life. than 10 percent of their daily calories from added the pages of JAMA Internal Medicine.22 No, it wasn’t a
vention study, the Lifestyle Heart Trial, which demon- Although some studies have shown that low-fat sugars. The report suggested that people could lower brand new study. In fact, the fuss was over a very old
strated that intensive lifestyle changes may lead to diets do reduce overall cholesterol, many—most, in their risk of obesity, diabetes, and heart disease sim- one. Back in 1967, Harvard scientists had conducted a
regression of coronary heart disease. Ornish took fact—have shown nothing of the sort. When you ply by curbing some of the sugar they were consum- massive review of all the sugar and heart disease stud-
forty-eight middle-aged white men with moderate-to- replace fat in the diet with carbohydrates, which is ing. A completely mainstream, noncontroversial, ies available at the time. (One of those researchers was
severe coronary heart disease and assigned them to exactly what low-fat diets do, you wind up with higher “vanilla” recommendation if ever there was one. Who none other than Mark Hegsted, better known for his
two groups. One group received “usual care,” and the triglycerides and lower HDL cholesterol. could possibly object, you might think? role in drafting the 1977 Dietary Goals for the United
other group received a special, intensive, five-part Bad news indeed. Higher triglycerides are an Well, the U.S. sugar industry, for one. States—the committee report that helped shape
lifestyle intervention consisting of (1) aerobic exercise, independent risk factor for heart disease—and raising “Hoping to block the report . . . the Sugar America’s catastrophic nutritional guidelines.)
(2) stress-management training, (3) smoking cessa- them while lowering HDL cholesterol at the same time Association threatened to lobby Congress to cut off After assessing study after study in humans and
tion, (4) group psychological support, and (5) a strict is a double whammy, a really bad “side effect” of the the $406 million the United States gives annually to animals alike, Hegsted et al. published a paper in the
factors in diabetes, obesity, hypertension, and, you vegetarian, high-fiber diet with 10 percent of the supposedly heart-healthy low-fat diet. Not only do you the WHO,” reported Juliet Eilperin in the Washington
guessed it, heart disease. calories coming from fat. raise one important independent risk factor for heart Post.21 The Post quoted an April 14, 2003, letter from
When Ornish’s study showed some reversal of disease (triglycerides) while at the same time lower- the Sugar Association’s president, Andrew Briscoe, to
Cholesterol Insanity atherosclerosis and fewer cardiac events in the ing one protective measure (HDL cholesterol), but you the general director of WHO in which he stated, “We
Yudkin’s warnings against sugar and Atkins’s early twenty men who completed the five-year study, the also change the all-important ratio of triglycerides to will exercise every avenue available to expose the
low-carb approach to weight loss were mere whispers public perception—reinforced by Ornish himself—was HDL cholesterol in the worst way possible. A higher dubious nature of the Diet, Nutrition and the
lost in the roar of anti-fat mania. By the mid-1980s, that the results largely stemmed from the low-fat triglycerides number and a lower HDL cholesterol Prevention of Chronic Diseases report.”
fat had been utterly and completely demonized, and diet. This conclusion is an incredible leap that is in no number mean a much higher ratio of triglycerides to Two senators wrote a letter to then Health and
fat phobia was in full bloom, with hundreds of way supported by his research. The fact is that there’s HDL. As we’ve seen, you want your ratio to be low, Human Services Secretary Tommy G. Thompson, urg-
cholesterol-free foods being foisted on a gullible no way to know whether the results were because of not high; low-fat, high-carbohydrate diets make the ing him to squelch the report. Soon afterward, the
18
public. In November 1985, the National Heart, Lung, the low-fat diet portion of the experiment (highly ratio higher. U.S. Department of Health and Human Services sub-
and Blood Institute launched the National Cholesterol unlikely in our view), the high fiber, the whole foods, mitted comments on the report, stating that “evi-
Education Program with the stated goal of “reducing the lack of sugar, or some combination of the inter- THE SUGAR LOBBY IN ACTION dence that soft drinks are associated with obesity is
illness and death from coronary heart disease in the ventions. It is entirely possible that Ornish would have So how did fat get demonized while sugar got a “get not compelling.”
United States by reducing the percent of Americans gotten the same or better results with a program of out of jail free” card? Oh, really? Shades of the tobacco industry’s
19
with high blood cholesterol [italics ours].” exercise, stress management, smoking cessation, and Well, there’s no political lobby for “fat,” but defense of cigarettes.
In 1976, Nathan Pritikin opened his Pritikin group therapy plus a whole foods diet high in protein there’s a powerful one for sugar. But our story doesn’t end there. In fact, the sugar
Longevity Center in Santa Barbara, California, and for and fiber and low in sugar. In 2003, the World Health Organization (WHO)— industry’s backlash against the 2003 WHO report was
the next decade preached the super-low-fat dogma to Yet low-fat eating managed to remain the dietary not exactly a bunch of wide-eyed radicals—published a far from its first rodeo, as far as manipulating public
all who would listen, which included most of the coun- prescription of every major mainstream health organi- conservative, eminently reasonable report called Diet, perception goes. In fact, it’s been playing that game
20
try. Pritikin died in 1985, but his mantle was quickly zation. This recommendation was built on a founda- Nutrition and the Prevention of Chronic Diseases. In for longer than some readers have been alive.
taken up by Dr. Dean Ornish. Ornish’s reputation—and tion of two basic beliefs: that low-fat diets will reduce it, the WHO made the unremarkable statement that it Want proof of the fix? In 2016, the smoking gun
much of the public’s faith in the low-fat diet cholesterol, and that reducing cholesterol will actually would be a good idea for people to derive no more we’d all been waiting for fell from the sky and landed in
approach—was fueled by his famous five-year inter- reduce heart disease and extend life. than 10 percent of their daily calories from added the pages of JAMA Internal Medicine.22 No, it wasn’t a
vention study, the Lifestyle Heart Trial, which demon- Although some studies have shown that low-fat sugars. The report suggested that people could lower brand new study. In fact, the fuss was over a very old
strated that intensive lifestyle changes may lead to diets do reduce overall cholesterol, many—most, in their risk of obesity, diabetes, and heart disease sim- one. Back in 1967, Harvard scientists had conducted a
regression of coronary heart disease. Ornish took fact—have shown nothing of the sort. When you ply by curbing some of the sugar they were consum- massive review of all the sugar and heart disease stud-
forty-eight middle-aged white men with moderate-to- replace fat in the diet with carbohydrates, which is ing. A completely mainstream, noncontroversial, ies available at the time. (One of those researchers was
severe coronary heart disease and assigned them to exactly what low-fat diets do, you wind up with higher “vanilla” recommendation if ever there was one. Who none other than Mark Hegsted, better known for his
two groups. One group received “usual care,” and the triglycerides and lower HDL cholesterol. could possibly object, you might think? role in drafting the 1977 Dietary Goals for the United
other group received a special, intensive, five-part Bad news indeed. Higher triglycerides are an Well, the U.S. sugar industry, for one. States—the committee report that helped shape
lifestyle intervention consisting of (1) aerobic exercise, independent risk factor for heart disease—and raising “Hoping to block the report . . . the Sugar America’s catastrophic nutritional guidelines.)
(2) stress-management training, (3) smoking cessa- them while lowering HDL cholesterol at the same time Association threatened to lobby Congress to cut off After assessing study after study in humans and
tion, (4) group psychological support, and (5) a strict is a double whammy, a really bad “side effect” of the the $406 million the United States gives annually to animals alike, Hegsted et al. published a paper in the
prestigious New England Journal of Medicine claiming who’d served on the Sugar Research Foundation’s sci- play a “slightly significant role” in regulating blood lip- of Medicine, the authors acknowledged that there was
that sugar didn’t play any convincing role in heart dis- entific advisory board. Those papers encompassed ids, and that “these effects are somewhat more pro- a ton of evidence suggesting that sugar consumption
ease. The evidence, the paper claimed, showed there over a decade of correspondence—spanning 1959 to nounced when diets low in fat are consumed.” But the could increase the risk of heart disease and diabetes—
was “only one avenue” by which diet could influence 1971—between Adams and the foundation, totaling a researchers then threw us a logical curve ball: “Since and that it could even raise LDL (“bad”) cholesterol.
heart disease: that avenue was blood lipids, and the whopping 1551 pages from 319 different documents. diets low in fat and high in sugar are rarely taken, we The problem was they couldn’t say that the research
only dietary players of import were fat and choles- What Kearns found in that treasure trove was conclude that the practical significance of differences was definitive. “There was enough ambiguity, they con-
22
terol. Any benefits of reducing sugar, the research- shocking. For one, it turned out that in 1965—right after in dietary carbohydrate is minimal in comparison to cluded, that they couldn’t even set an upper limit on
24
ers concluded, were so puny compared to those of the Annals of Internal Medicine had published some those related to dietary fat and cholesterol.” how much sugar constitutes too much,” Taubes wrote.
reducing fat that “in our opinion they have no practi- articles linking sugar to heart disease—the Sugar Did you hear that noise? That was the sound of a This dovetailed nicely with the last assessment of
23
cal importance.” Research Foundation had struck a deal with Harvard thousand “someone’s pulling a fast one on us” alarm sugar by the Food and Drug Administration (FDA)
At a time when diet and heart disease research researchers Mark Hegsted and Robert McGandy, paying bells going off. Even in a review paper designed to back in 1986 that basically said “no conclusive evi-
was in its fledgling stage, a single well-respected them $6,500 (the equivalent of over $50,000 today) pardon sugar, researchers couldn’t get around the dence on sugars demonstrates a hazard to the gen-
review could shape consensus and steer the direction to do some damage control: The foundation asked fact that sugar behaved especially bad when it came eral public when sugars are consumed at the levels
of future research. And that’s exactly what this paper them to write a review article of “several papers which to low-fat diets. And tragically, the “low in fat, high in that are now current.”
did. With sugar declared innocent (by fancy Harvard find some special metabolic peril in sucrose,” with the sugar” diet the researchers cited as problematic was “This is another way of saying that the evidence
scientists, no less), anti-fat-and-cholesterol research implication that sugar needed to look good—or at least, the very one they helped steer Americans toward. by no means refuted the [charges against sugar], just
took center stage, dominating the scientific discourse not look bad. Those internal documents showed ongo- How’s that for a cruel twist of fate? that it wasn’t definitive or unambiguous,” Taubes said.
for decades to come. Meanwhile, sugar research dwin- ing back-and-forths between Hegsted and the founda- The implications of Kearns’s sugar industry find- It’s also worth noting that at the time, we were con-
dled to near oblivion. Why would anyone waste grant tion’s vice president throughout the whole review pro- ings can’t be overstated. Not only did Big Sugar try to suming approximately 40 pounds per year of “added
money chasing a sugar and heart disease hypothesis cess, concluding with a word of praise from the VP that control the public and scientific narrative about its sugars,” meaning sugar beyond what we might natu-
that had been confirmed DOA? the article—with its anti-fat, sugar-neutral conclusion— product, but it actually succeeded. Scientists stopped rally obtain from fruits and vegetables. (That comes
There was just one problem. was up to snuff: “Let me assure you this is quite what pouring their time and brainpower into potentially to about two hundred extra sugar calories a day,
Unbeknownst to anyone other than industry we had in mind and we look forward to its appearance life-saving sugar research, instead turning their focus about a can and a half of Coke.)
insiders, the review had been secretly funded, in print,” he wrote to Hegsted. squarely on fat and cholesterol. As Kearns wrote in a That doesn’t sound so bad, really, and if that were
designed, and directed by the Sugar Research When the review was finally published, there 2012 Mother Jones article she co-authored with Gary all the sugar we were consuming, most nutritionists in
Foundation—a Washington, D.C.-based trade group wasn’t a peep about the Sugar Research Foundation’s Taubes, “Research on the suspected links between America would be pretty happy. The problem was it
dedicated to defending sugar’s honor. And no one involvement—despite declarations of other industry sugar and chronic disease largely ground to a halt by wasn’t 40 pounds a year. Even back then the
would’ve been the wiser if not for the sleuthing work funding. the late 1980s, and scientists came to view such pur- Department of Agriculture said we were consuming
25
of Cristin Kearns, a former dentist from Colorado who Now, let’s jump back to what that 1967 New suits as a career dead end.” 75 pounds a year, and by the early 2000s it was up to
cracked the case herself. England Journal of Medicine review actually found. If What’s more, Kearns and Taubes continued, “So 90 pounds. As of late 2011, we were up to 156 pounds
Years earlier, Kearns had stumbled upon what we look closely, we can see how painstakingly the effective were the Sugar Association’s efforts that, to a year. That’s the equivalent of thirty-one 5-pound
turned out to be the find of a lifetime. Tucked away in researchers tried to downplay sugar’s harmful effects, this day, no consensus exists about sugar’s potential bags for every man, woman, and child in America.26
the University of Illinois archives were reams of papers which were hard to ignore even then. For example, the dangers.” Now, back to our story. It turned out there was
from Roger Adams—an organic chemistry professor paper conceded that sugar versus complex carbs could And it was true. In a 2005 report by the Institute more—much more—in Kearns’s food industry exposé.
prestigious New England Journal of Medicine claiming who’d served on the Sugar Research Foundation’s sci- play a “slightly significant role” in regulating blood lip- of Medicine, the authors acknowledged that there was
that sugar didn’t play any convincing role in heart dis- entific advisory board. Those papers encompassed ids, and that “these effects are somewhat more pro- a ton of evidence suggesting that sugar consumption
ease. The evidence, the paper claimed, showed there over a decade of correspondence—spanning 1959 to nounced when diets low in fat are consumed.” But the could increase the risk of heart disease and diabetes—
was “only one avenue” by which diet could influence 1971—between Adams and the foundation, totaling a researchers then threw us a logical curve ball: “Since and that it could even raise LDL (“bad”) cholesterol.
heart disease: that avenue was blood lipids, and the whopping 1551 pages from 319 different documents. diets low in fat and high in sugar are rarely taken, we The problem was they couldn’t say that the research
only dietary players of import were fat and choles- What Kearns found in that treasure trove was conclude that the practical significance of differences was definitive. “There was enough ambiguity, they con-
22
terol. Any benefits of reducing sugar, the research- shocking. For one, it turned out that in 1965—right after in dietary carbohydrate is minimal in comparison to cluded, that they couldn’t even set an upper limit on
24
ers concluded, were so puny compared to those of the Annals of Internal Medicine had published some those related to dietary fat and cholesterol.” how much sugar constitutes too much,” Taubes wrote.
reducing fat that “in our opinion they have no practi- articles linking sugar to heart disease—the Sugar Did you hear that noise? That was the sound of a This dovetailed nicely with the last assessment of
23
cal importance.” Research Foundation had struck a deal with Harvard thousand “someone’s pulling a fast one on us” alarm sugar by the Food and Drug Administration (FDA)
At a time when diet and heart disease research researchers Mark Hegsted and Robert McGandy, paying bells going off. Even in a review paper designed to back in 1986 that basically said “no conclusive evi-
was in its fledgling stage, a single well-respected them $6,500 (the equivalent of over $50,000 today) pardon sugar, researchers couldn’t get around the dence on sugars demonstrates a hazard to the gen-
review could shape consensus and steer the direction to do some damage control: The foundation asked fact that sugar behaved especially bad when it came eral public when sugars are consumed at the levels
of future research. And that’s exactly what this paper them to write a review article of “several papers which to low-fat diets. And tragically, the “low in fat, high in that are now current.”
did. With sugar declared innocent (by fancy Harvard find some special metabolic peril in sucrose,” with the sugar” diet the researchers cited as problematic was “This is another way of saying that the evidence
scientists, no less), anti-fat-and-cholesterol research implication that sugar needed to look good—or at least, the very one they helped steer Americans toward. by no means refuted the [charges against sugar], just
took center stage, dominating the scientific discourse not look bad. Those internal documents showed ongo- How’s that for a cruel twist of fate? that it wasn’t definitive or unambiguous,” Taubes said.
for decades to come. Meanwhile, sugar research dwin- ing back-and-forths between Hegsted and the founda- The implications of Kearns’s sugar industry find- It’s also worth noting that at the time, we were con-
dled to near oblivion. Why would anyone waste grant tion’s vice president throughout the whole review pro- ings can’t be overstated. Not only did Big Sugar try to suming approximately 40 pounds per year of “added
money chasing a sugar and heart disease hypothesis cess, concluding with a word of praise from the VP that control the public and scientific narrative about its sugars,” meaning sugar beyond what we might natu-
that had been confirmed DOA? the article—with its anti-fat, sugar-neutral conclusion— product, but it actually succeeded. Scientists stopped rally obtain from fruits and vegetables. (That comes
There was just one problem. was up to snuff: “Let me assure you this is quite what pouring their time and brainpower into potentially to about two hundred extra sugar calories a day,
Unbeknownst to anyone other than industry we had in mind and we look forward to its appearance life-saving sugar research, instead turning their focus about a can and a half of Coke.)
insiders, the review had been secretly funded, in print,” he wrote to Hegsted. squarely on fat and cholesterol. As Kearns wrote in a That doesn’t sound so bad, really, and if that were
designed, and directed by the Sugar Research When the review was finally published, there 2012 Mother Jones article she co-authored with Gary all the sugar we were consuming, most nutritionists in
Foundation—a Washington, D.C.-based trade group wasn’t a peep about the Sugar Research Foundation’s Taubes, “Research on the suspected links between America would be pretty happy. The problem was it
dedicated to defending sugar’s honor. And no one involvement—despite declarations of other industry sugar and chronic disease largely ground to a halt by wasn’t 40 pounds a year. Even back then the
would’ve been the wiser if not for the sleuthing work funding. the late 1980s, and scientists came to view such pur- Department of Agriculture said we were consuming
25
of Cristin Kearns, a former dentist from Colorado who Now, let’s jump back to what that 1967 New suits as a career dead end.” 75 pounds a year, and by the early 2000s it was up to
cracked the case herself. England Journal of Medicine review actually found. If What’s more, Kearns and Taubes continued, “So 90 pounds. As of late 2011, we were up to 156 pounds
Years earlier, Kearns had stumbled upon what we look closely, we can see how painstakingly the effective were the Sugar Association’s efforts that, to a year. That’s the equivalent of thirty-one 5-pound
turned out to be the find of a lifetime. Tucked away in researchers tried to downplay sugar’s harmful effects, this day, no consensus exists about sugar’s potential bags for every man, woman, and child in America.26
the University of Illinois archives were reams of papers which were hard to ignore even then. For example, the dangers.” Now, back to our story. It turned out there was
from Roger Adams—an organic chemistry professor paper conceded that sugar versus complex carbs could And it was true. In a 2005 report by the Institute more—much more—in Kearns’s food industry exposé.
From 1967 to 1971, the Sugar Research Foundation the National Institute of Dental Research, and devel- In fact, in terms of metabolic and heart health, • High-fructose corn syrup is 55 percent fructose
funded a series of animal experiments—officially titled oping questionable vaccines against tooth decay (we the notion that “a calorie is just a calorie” is . . . well, and 45 percent glucose, a difference that just
28
“Project 259: Dietary Carbohydrate and Blood Lipids in couldn’t make this stuff up if we tried). fake news. But it’s a wonderful cover story for the doesn’t matter very much.
Germ-Free Rats”—designed to evaluate the effects of And the list goes on. Buried amidst those industry sugar-soaked industry known as processed food. So sugar and high-fructose corn syrup are essen-
sugar on heart disease risk. The results were both fas- documents was a copy of a 1954 speech from the In case there was any doubt that the sugar indus- tially the same thing.
cinating and disturbing: There was evidence that gut Sugar Research Foundation’s president, discussing a try not only knew about the perils of sugar, but Because high-fructose corn syrup has gotten so
bacteria could influence how sugar affected triglycer- strategic opportunity to get Americans to eat more actively tried to suppress that knowledge from public much heat in the press, some food manufacturers
ides. Not only that, but compared to starch, sugar sugar by pushing a low-fat diet—thanks to preliminary awareness, this should kick that to the curb. The now proudly advertise that their products contain
seemed to promote high levels of beta-glucuronidase— research at the time linking fat and cholesterol to Sugar Research Foundation papers not only con- none of it and are instead sweetened with “natural”
an enzyme known, even back then, to be associated heart problems. Another document, an internal memo firmed what we’ve all suspected, but made it clear sugar (meaning ordinary sucrose). Meanwhile, the
with bladder cancer and potentially atherosclerosis. from the group’s vice president in 1964, proposed that that the rabbit hole went much deeper than anyone Corn Refiners Association has claimed that high-
That’s right: A study from half a century ago was the foundation should start funding research to “refute could’ve guessed. fructose corn syrup is being unjustly targeted and
already incriminating sugar as a heart-harmer and our detractors,” as well as embark on a deliberate pro- And now, with that depressing history in mind, is no worse than “regular” sugar.
potential carcinogen. gram to counteract “negative attitudes toward sugar”— let’s return to our chapter’s science lesson: the nitty Sadly, the association is technically right. Fructose
29
If you’re wondering why you haven’t heard about including the ideas presented by John Yudkin. gritty of sugar’s effects on our bodies. is the damaging part of sugar, and whether you get
this before, the reason is simple: Project 259 never saw And if you’re tempted to think, “but all that hap- that fructose from regular sugar or from HFCS doesn’t
the peer-reviewed light of day. The Sugar Research pened a million years ago,” please don’t. It was pre- What’s So Bad about a Little Sugar? make a whit of difference. That doesn’t absolve HFCS
Foundation made sure of it. Instead of publishing what cisely this subterranean effort—funded by deep-pock- The way in which sugar damages the heart is directly at all; it just means that “regular” sugar is virtually just
would have been game-changing information for the eted lobbyist groups. Aided and abetted by sympa- related to insulin resistance. Ordinary table sugar, as bad as HFCS. It’s the fructose in each of them that’s
nutrition field (and human health at large), the founda- thetic researchers who, for a price, were willing to known technically as sucrose, is actually composed causing the damage, and here’s why.
tion axed the project and buried its findings deep produce scientific cover for the sugar industry and of equal parts glucose and fructose, two mono- Fructose and glucose are metabolized in the body
underground—quietly letting the scientific community “manufacture doubt”—they produced the food envi- saccharides (simple sugars) that are anything but in completely different ways. They are not identical.
27
continue its misguided witch-hunt against fat. ronment in which we live today. (For a fascinating metabolically equal. Glucose can be used by any cell Glucose goes right into the bloodstream and then into
The sugar industry, it turned out, also tried to account of how industry “buys” science to create a in the body. Fructose, on the other hand, is metabolic the cells, but fructose goes right to the liver. Research
distract the public from sugar’s link with tooth decay. narrative that supports their financial interests, read poison—at least at the levels in which it’s currently has shown that fructose is seven times more likely to
An analysis of the Roger Adams papers showed that Merchants of Doubt by historians Naomi Oreskes and consumed. It’s the fructose in our sweetened foods— form the previously mentioned artery-damaging AGEs
the sugar industry was well aware that sugar caused Erik Conway, or watch the 2014 film based on it.) usually in the form of high-fructose corn syrup—that (advanced glycation end products). Fructose is metab-
cavities—the scientific evidence, even then, was over- The narrative set in motion by the sugar industry we should fear the most. olized by the body like fat, and it turns into fat (tri-
whelming. But instead of informing the public they back in the day continues to this very day. Fat and But before you point the finger of blame exclu- glycerides) almost immediately. “When you consume
should eat less sugar, the Sugar Research Foundation cholesterol are demonized in mainstream medicine sively at high-fructose corn syrup (HFCS), an additive fructose, you’re not consuming carbs,” says Robert
decided to spend its dollars promoting health inter- while sugar gets a handy-dandy "get out of jail" card. that’s made it into virtually every processed food on Lustig, M.D., professor of pediatrics at the University
ventions that would reduce sugar’s harmful effects— That narrative fits well with the philosophy “a calorie the market, consider the following: of California, San Francisco. “You’re consuming fat.”
including funding research on enzymes to break up is just a calorie,” implying that the only problem with • Regular sugar (sucrose) is 50 percent glucose Fructose is the major cause of fat accumulation
dental plaque, getting chummy with scientists from sugar is empty calories. and 50 percent fructose. in the liver, a condition known technically as hepatic
From 1967 to 1971, the Sugar Research Foundation the National Institute of Dental Research, and devel- In fact, in terms of metabolic and heart health, • High-fructose corn syrup is 55 percent fructose
funded a series of animal experiments—officially titled oping questionable vaccines against tooth decay (we the notion that “a calorie is just a calorie” is . . . well, and 45 percent glucose, a difference that just
28
“Project 259: Dietary Carbohydrate and Blood Lipids in couldn’t make this stuff up if we tried). fake news. But it’s a wonderful cover story for the doesn’t matter very much.
Germ-Free Rats”—designed to evaluate the effects of And the list goes on. Buried amidst those industry sugar-soaked industry known as processed food. So sugar and high-fructose corn syrup are essen-
sugar on heart disease risk. The results were both fas- documents was a copy of a 1954 speech from the In case there was any doubt that the sugar indus- tially the same thing.
cinating and disturbing: There was evidence that gut Sugar Research Foundation’s president, discussing a try not only knew about the perils of sugar, but Because high-fructose corn syrup has gotten so
bacteria could influence how sugar affected triglycer- strategic opportunity to get Americans to eat more actively tried to suppress that knowledge from public much heat in the press, some food manufacturers
ides. Not only that, but compared to starch, sugar sugar by pushing a low-fat diet—thanks to preliminary awareness, this should kick that to the curb. The now proudly advertise that their products contain
seemed to promote high levels of beta-glucuronidase— research at the time linking fat and cholesterol to Sugar Research Foundation papers not only con- none of it and are instead sweetened with “natural”
an enzyme known, even back then, to be associated heart problems. Another document, an internal memo firmed what we’ve all suspected, but made it clear sugar (meaning ordinary sucrose). Meanwhile, the
with bladder cancer and potentially atherosclerosis. from the group’s vice president in 1964, proposed that that the rabbit hole went much deeper than anyone Corn Refiners Association has claimed that high-
That’s right: A study from half a century ago was the foundation should start funding research to “refute could’ve guessed. fructose corn syrup is being unjustly targeted and
already incriminating sugar as a heart-harmer and our detractors,” as well as embark on a deliberate pro- And now, with that depressing history in mind, is no worse than “regular” sugar.
potential carcinogen. gram to counteract “negative attitudes toward sugar”— let’s return to our chapter’s science lesson: the nitty Sadly, the association is technically right. Fructose
29
If you’re wondering why you haven’t heard about including the ideas presented by John Yudkin. gritty of sugar’s effects on our bodies. is the damaging part of sugar, and whether you get
this before, the reason is simple: Project 259 never saw And if you’re tempted to think, “but all that hap- that fructose from regular sugar or from HFCS doesn’t
the peer-reviewed light of day. The Sugar Research pened a million years ago,” please don’t. It was pre- What’s So Bad about a Little Sugar? make a whit of difference. That doesn’t absolve HFCS
Foundation made sure of it. Instead of publishing what cisely this subterranean effort—funded by deep-pock- The way in which sugar damages the heart is directly at all; it just means that “regular” sugar is virtually just
would have been game-changing information for the eted lobbyist groups. Aided and abetted by sympa- related to insulin resistance. Ordinary table sugar, as bad as HFCS. It’s the fructose in each of them that’s
nutrition field (and human health at large), the founda- thetic researchers who, for a price, were willing to known technically as sucrose, is actually composed causing the damage, and here’s why.
tion axed the project and buried its findings deep produce scientific cover for the sugar industry and of equal parts glucose and fructose, two mono- Fructose and glucose are metabolized in the body
underground—quietly letting the scientific community “manufacture doubt”—they produced the food envi- saccharides (simple sugars) that are anything but in completely different ways. They are not identical.
27
continue its misguided witch-hunt against fat. ronment in which we live today. (For a fascinating metabolically equal. Glucose can be used by any cell Glucose goes right into the bloodstream and then into
The sugar industry, it turned out, also tried to account of how industry “buys” science to create a in the body. Fructose, on the other hand, is metabolic the cells, but fructose goes right to the liver. Research
distract the public from sugar’s link with tooth decay. narrative that supports their financial interests, read poison—at least at the levels in which it’s currently has shown that fructose is seven times more likely to
An analysis of the Roger Adams papers showed that Merchants of Doubt by historians Naomi Oreskes and consumed. It’s the fructose in our sweetened foods— form the previously mentioned artery-damaging AGEs
the sugar industry was well aware that sugar caused Erik Conway, or watch the 2014 film based on it.) usually in the form of high-fructose corn syrup—that (advanced glycation end products). Fructose is metab-
cavities—the scientific evidence, even then, was over- The narrative set in motion by the sugar industry we should fear the most. olized by the body like fat, and it turns into fat (tri-
whelming. But instead of informing the public they back in the day continues to this very day. Fat and But before you point the finger of blame exclu- glycerides) almost immediately. “When you consume
should eat less sugar, the Sugar Research Foundation cholesterol are demonized in mainstream medicine sively at high-fructose corn syrup (HFCS), an additive fructose, you’re not consuming carbs,” says Robert
decided to spend its dollars promoting health inter- while sugar gets a handy-dandy "get out of jail" card. that’s made it into virtually every processed food on Lustig, M.D., professor of pediatrics at the University
ventions that would reduce sugar’s harmful effects— That narrative fits well with the philosophy “a calorie the market, consider the following: of California, San Francisco. “You’re consuming fat.”
including funding research on enzymes to break up is just a calorie,” implying that the only problem with • Regular sugar (sucrose) is 50 percent glucose Fructose is the major cause of fat accumulation
dental plaque, getting chummy with scientists from sugar is empty calories. and 50 percent fructose. in the liver, a condition known technically as hepatic
steatosis but which most of us know as fatty liver. High-fructose corn syrup was first invented in know that it also predicts future obesity and high a high level of consumption of soft drinks.”34
And there is a direct link between fatty liver and our Japan in the 1960s and made it into the American blood pressure? All told, the case for fructose being a major con-
old friend, insulin resistance. food supply around the mid-1970s. It had two advan- Fructose and glucose behave very differently in tributor to heart disease is way stronger than the
A top researcher in the field of insulin resistance, tages over regular sugar, from the point of view of the brain as well, as research from Johns Hopkins has case against fat. In fact, it’s not even close. It’s also
Varman Samuel of the Yale School of Medicine, told food manufacturers. Number one, it was sweeter, so suggested. Glucose decreases food intake while fruc- worth pointing out that every single bad thing that
the New York Times that the correlation between fat theoretically you could use less of it. Number two, it tose increases it. If your appetite increases, you eat fructose does to increase our risk for heart disease—
in the liver (fatty liver) and insulin resistance is was much cheaper than sugar. Low-fat products could more, thus making obesity, and an increased risk for and it does a lot—has virtually nothing to do with ele-
remarkably strong. “When you deposit fat in the liver, be made “palatable” by the addition of HFCS, and heart disease, far more likely. “Take a kid to vated cholesterol.
30
that’s when you become insulin resistant,” he said. before long, manufacturers were adding the stuff to McDonald’s and give him a Coke,” Lustig said. “Does The fact is that sugar is far more damaging to
And all together now, class: What causes fat to everything. (Doubt us? Take a field trip to your local he eat less? Or does he eat more?” the heart than either fat or cholesterol. But that has
accumulate in the liver? Fructose. supermarket and start reading labels. See if you can M. Daniel Lane, Ph.D., of the Johns Hopkins never stopped the diet establishment from continuing
If you want to watch a bunch of lab animals find any processed foods that don’t contain it.) University School of Medicine stated, “We feel that [the to stick to its number one talking point: Fat and cho-
become insulin resistant, all you have to do is feed The result is that our fructose consumption has findings on fructose and appetite] may have particular lesterol are what we ought to be worried about.
them fructose. Feed them enough fructose and, sure skyrocketed. Twenty-five percent of adolescents today relevance to the massive increase in the use of high- As the old journalistic maxim goes, “Never let the
enough, the liver converts it to fat, which then accu- consume 15 percent of their calories from fructose fructose sweeteners (both high-fructose corn syrup facts get in the way of a good story.” Unfortunately,
mulates in the liver—with insulin resistance right alone! As Robert Lustig points out in a brilliant lecture, and table sugar) in virtually all sweetened foods, most this story is long past its expiration date. Sticking to it
behind it. This can take place in as little as a week if “Sugar: The Bitter Truth” (available on YouTube), the notably soft drinks. The per capita consumption of in the face of all evidence continues to make many
the animals are fed enough fructose, whereas it might percentage of calories from fat in the American diet these sweeteners in the USA is about 145 lbs./year and people very sick indeed.
take a few months at the levels we humans normally has gone down at the same time that fructose con- is probably much higher in teenagers/youth that have
consume. Studies conducted by Luc Tappy, M.D., in sumption has skyrocketed, along with heart disease,
Switzerland revealed that feeding human subjects a diabetes, obesity, and hypertension. Coincidence?
daily dose of fructose equal to the amount found in Lustig doesn’t think so, and neither do we.
eight to ten cans of soda produced insulin resistance Remember our mention of metabolic syndrome?  WHAT YOU NEED TO KNOW
and elevated triglycerides within a few days.31 It’s a collection of symptoms—high triglycerides, • Sugar is the missing link among diabetes, obesity, and heart disease. It overrides our body’s
Fructose found in whole foods such as fruits, abdominal fat, hypertension, and insulin resistance— natural hunger regulation, making it very easy to overeat. It is also a major contributor to
however, is a different story. There’s not all that much that seriously increases the risk for heart disease. inflammation in the artery walls.
fructose in, for example, an apple, and the apple Well, rodents consuming large amounts of fructose • Hypertension, high triglycerides, and a high ratio of triglycerides to HDL are all better
32
comes with a hefty dose of fiber, which slows the rate rapidly develop it. In humans, a high-fructose diet predictors of heart disease than cholesterol. Sugar, or more specifically fructose, raises every
of carbohydrate absorption and reduces insulin raises triglycerides almost instantly; the rest of the single one them.
response. But fructose extracted from fruit, concen- symptoms associated with metabolic syndrome take • High levels of both sugar and insulin damage LDL particles in the blood, making them far
trated into a syrup, and then inserted into practically a little longer to develop in humans than they do in more likely to end up incorporated into arterial plaque.
33
every food we buy at the supermarket—from bread rats, but develop they do. Fructose also raises uric • When sugar in the bloodstream sticks to proteins, it creates damaging and toxic molecules
and hamburger buns to pretzels and cereals—well, acid levels in the bloodstream. Excess uric acid is well called advanced glycation end products, or AGEs.
that’s a whole different animal. known as the defining feature of gout, but did you
steatosis but which most of us know as fatty liver. High-fructose corn syrup was first invented in know that it also predicts future obesity and high a high level of consumption of soft drinks.”34
And there is a direct link between fatty liver and our Japan in the 1960s and made it into the American blood pressure? All told, the case for fructose being a major con-
old friend, insulin resistance. food supply around the mid-1970s. It had two advan- Fructose and glucose behave very differently in tributor to heart disease is way stronger than the
A top researcher in the field of insulin resistance, tages over regular sugar, from the point of view of the brain as well, as research from Johns Hopkins has case against fat. In fact, it’s not even close. It’s also
Varman Samuel of the Yale School of Medicine, told food manufacturers. Number one, it was sweeter, so suggested. Glucose decreases food intake while fruc- worth pointing out that every single bad thing that
the New York Times that the correlation between fat theoretically you could use less of it. Number two, it tose increases it. If your appetite increases, you eat fructose does to increase our risk for heart disease—
in the liver (fatty liver) and insulin resistance is was much cheaper than sugar. Low-fat products could more, thus making obesity, and an increased risk for and it does a lot—has virtually nothing to do with ele-
remarkably strong. “When you deposit fat in the liver, be made “palatable” by the addition of HFCS, and heart disease, far more likely. “Take a kid to vated cholesterol.
30
that’s when you become insulin resistant,” he said. before long, manufacturers were adding the stuff to McDonald’s and give him a Coke,” Lustig said. “Does The fact is that sugar is far more damaging to
And all together now, class: What causes fat to everything. (Doubt us? Take a field trip to your local he eat less? Or does he eat more?” the heart than either fat or cholesterol. But that has
accumulate in the liver? Fructose. supermarket and start reading labels. See if you can M. Daniel Lane, Ph.D., of the Johns Hopkins never stopped the diet establishment from continuing
If you want to watch a bunch of lab animals find any processed foods that don’t contain it.) University School of Medicine stated, “We feel that [the to stick to its number one talking point: Fat and cho-
become insulin resistant, all you have to do is feed The result is that our fructose consumption has findings on fructose and appetite] may have particular lesterol are what we ought to be worried about.
them fructose. Feed them enough fructose and, sure skyrocketed. Twenty-five percent of adolescents today relevance to the massive increase in the use of high- As the old journalistic maxim goes, “Never let the
enough, the liver converts it to fat, which then accu- consume 15 percent of their calories from fructose fructose sweeteners (both high-fructose corn syrup facts get in the way of a good story.” Unfortunately,
mulates in the liver—with insulin resistance right alone! As Robert Lustig points out in a brilliant lecture, and table sugar) in virtually all sweetened foods, most this story is long past its expiration date. Sticking to it
behind it. This can take place in as little as a week if “Sugar: The Bitter Truth” (available on YouTube), the notably soft drinks. The per capita consumption of in the face of all evidence continues to make many
the animals are fed enough fructose, whereas it might percentage of calories from fat in the American diet these sweeteners in the USA is about 145 lbs./year and people very sick indeed.
take a few months at the levels we humans normally has gone down at the same time that fructose con- is probably much higher in teenagers/youth that have
consume. Studies conducted by Luc Tappy, M.D., in sumption has skyrocketed, along with heart disease,
Switzerland revealed that feeding human subjects a diabetes, obesity, and hypertension. Coincidence?
daily dose of fructose equal to the amount found in Lustig doesn’t think so, and neither do we.
eight to ten cans of soda produced insulin resistance Remember our mention of metabolic syndrome?  WHAT YOU NEED TO KNOW
and elevated triglycerides within a few days.31 It’s a collection of symptoms—high triglycerides, • Sugar is the missing link among diabetes, obesity, and heart disease. It overrides our body’s
Fructose found in whole foods such as fruits, abdominal fat, hypertension, and insulin resistance— natural hunger regulation, making it very easy to overeat. It is also a major contributor to
however, is a different story. There’s not all that much that seriously increases the risk for heart disease. inflammation in the artery walls.
fructose in, for example, an apple, and the apple Well, rodents consuming large amounts of fructose • Hypertension, high triglycerides, and a high ratio of triglycerides to HDL are all better
32
comes with a hefty dose of fiber, which slows the rate rapidly develop it. In humans, a high-fructose diet predictors of heart disease than cholesterol. Sugar, or more specifically fructose, raises every
of carbohydrate absorption and reduces insulin raises triglycerides almost instantly; the rest of the single one them.
response. But fructose extracted from fruit, concen- symptoms associated with metabolic syndrome take • High levels of both sugar and insulin damage LDL particles in the blood, making them far
trated into a syrup, and then inserted into practically a little longer to develop in humans than they do in more likely to end up incorporated into arterial plaque.
33
every food we buy at the supermarket—from bread rats, but develop they do. Fructose also raises uric • When sugar in the bloodstream sticks to proteins, it creates damaging and toxic molecules
and hamburger buns to pretzels and cereals—well, acid levels in the bloodstream. Excess uric acid is well called advanced glycation end products, or AGEs.
that’s a whole different animal. known as the defining feature of gout, but did you
WHAT EXACTLY IS FAT, ANYWAY? omega-3 fatty acids and omega-6 fatty acids. They’re
Fat is the collective shorthand name given to any big of special importance, and we’ll be talking about them
CHAPTER 7 collection of smaller units called fatty acids. You can in depth later on.
think of “fat” and “fatty acids” as analogous to paper Now a word of complete candor from your
money and a bunch of coins. The dollar bill is the authors. We wrote this book for our families. We
“fat” and the coins are the “fatty acids.” Just as a wanted the average intelligent person who didn’t have
THE TRUTH ABOUT FAT: dollar can comprise different combinations of coins—
one hundred pennies, four quarters, ten dimes, twenty
a background in science to be able to follow the basic
arguments and have a clear sense of the takeaway
IT'S NOT WHAT

nickels, and so forth—a “fat” comprises different messages. We wanted the discussions within the book
combinations of fatty acids. to be simple enough that they could be easily grasped
YOU THINK
There are more fatty acids in a stick of butter by nonmedical people. And, frankly, fat is complicated.
than there are in a spoonful of butter, just as there So this is the part of the book where we could
are more coins in $5 than there are in $1. But whether easily slip into a short course on the biochemistry of
you’re dealing with a splash of olive oil, a tub of lard, fats. It’s interesting to write about, it fills a lot of
YOU CAN’T TALK ABOUT CHOLESTEROL WITHOUT ALSO TALKING ABOUT FAT, which is conve- or a tablespoon of fish oil, all fat on earth is com- pages—and it’s deadly dull for readers. Don’t worry,
nient, because it’s exactly what we’re going to discuss in this chapter. posed of fatty acids. The only difference between the we’re not going to write sprawling essays about the
When you’re done reading it, you may have an entirely different perspective on fat and a much fat in olive oil and the fat in lard is that if you looked chemical structure of fat and give you a pop quiz at
more accurate notion of what the terms “good fat” and “bad fat” mean. And no, we’re not just going at them under a microscope, you’d see that each is the end. And as much as we enjoy talking about this
to tell you the stuff you’ve heard a million times, such as “fat from fish is good” (completely true) and made up of a different mix of fatty acids (i.e., nickels, stuff and would be happy to chat about it if you met
“saturated fat is bad” (very far from always true). dimes, quarters, etc.). us at a cocktail party, the truth is it causes many peo-
But let’s not get ahead of ourselves. There are three families of fatty acids: saturated ple’s eyes to glaze over pretty quickly.
According to conventional wisdom, fat and cholesterol are the twin demons of heart disease, fatty acids, monounsaturated fatty acids, and polyun- So if you’re interested in reading the Full Monty
linked together in our minds as firmly as Hell and Damnation or Bonnie and Clyde. We’ve been admon- saturated fatty acids. (There’s actually a fourth class about how double bonds, saturation, chain length, and
ished to lower our cholesterol and stop eating saturated fat. These two mandates are the basis of the of fatty acids called trans fats, a kind of “Franken-fat,” other cool biochemical stuff affects us at a molecular
diet-heart hypothesis, which has guided national health policy on healthy eating for decades and basi- but we’ll address that later.) The difference between level, please, by all means, be our guest! That infor-
cally holds that fat and cholesterol in the diet are a direct and significant cause of heart disease. all these fat types has to do with the number of mation is widely available. It’s not controversial, it’s
Okay, so fat and cholesterol (whether they show up in your diet or in your bloodstream) are pretty chemical double bonds that exist in the fatty acid’s not debated, and it’s not really germane to our story.
much kissing cousins. molecular chain. Monounsaturated fats have one dou- So, mercifully, we’ve decided to minimize the “in the
We’ve discussed cholesterol in the previous chapters, so let’s clear up some misconceptions about ble bond, polyunsaturated fats have more than one, weeds” lectures here and instead give you the essen-
fat—what it is, what it does, what it doesn’t do—and why all this matters in the first place. Once we’ve and saturated fats have none. tials—what you really need to know about saturated,
done that, we’ll be able to look at the relationship among heart disease, fat in the diet, and cholesterol In this section we’ll concentrate primarily on satu- polyunsaturated, and monounsaturated fats. The tech-
in the blood with completely new eyes. rated fat, but keep a place on your dance card for two nical bits we’ll cover are only there because they’re
Let’s get to work! members of the polyunsaturated family called really, really important.
82 THE GREAT CHOLESTEROL MYTH THE TRUTH ABOUT FAT: IT'S NOT WHAT YOU THINK 83
WHAT EXACTLY IS FAT, ANYWAY? omega-3 fatty acids and omega-6 fatty acids. They’re
Fat is the collective shorthand name given to any big of special importance, and we’ll be talking about them
CHAPTER 7 collection of smaller units called fatty acids. You can in depth later on.
think of “fat” and “fatty acids” as analogous to paper Now a word of complete candor from your
money and a bunch of coins. The dollar bill is the authors. We wrote this book for our families. We
“fat” and the coins are the “fatty acids.” Just as a wanted the average intelligent person who didn’t have
THE TRUTH ABOUT FAT: dollar can comprise different combinations of coins—
one hundred pennies, four quarters, ten dimes, twenty
a background in science to be able to follow the basic
arguments and have a clear sense of the takeaway
IT'S NOT WHAT

nickels, and so forth—a “fat” comprises different messages. We wanted the discussions within the book
combinations of fatty acids. to be simple enough that they could be easily grasped
YOU THINK
There are more fatty acids in a stick of butter by nonmedical people. And, frankly, fat is complicated.
than there are in a spoonful of butter, just as there So this is the part of the book where we could
are more coins in $5 than there are in $1. But whether easily slip into a short course on the biochemistry of
you’re dealing with a splash of olive oil, a tub of lard, fats. It’s interesting to write about, it fills a lot of
YOU CAN’T TALK ABOUT CHOLESTEROL WITHOUT ALSO TALKING ABOUT FAT, which is conve- or a tablespoon of fish oil, all fat on earth is com- pages—and it’s deadly dull for readers. Don’t worry,
nient, because it’s exactly what we’re going to discuss in this chapter. posed of fatty acids. The only difference between the we’re not going to write sprawling essays about the
When you’re done reading it, you may have an entirely different perspective on fat and a much fat in olive oil and the fat in lard is that if you looked chemical structure of fat and give you a pop quiz at
more accurate notion of what the terms “good fat” and “bad fat” mean. And no, we’re not just going at them under a microscope, you’d see that each is the end. And as much as we enjoy talking about this
to tell you the stuff you’ve heard a million times, such as “fat from fish is good” (completely true) and made up of a different mix of fatty acids (i.e., nickels, stuff and would be happy to chat about it if you met
“saturated fat is bad” (very far from always true). dimes, quarters, etc.). us at a cocktail party, the truth is it causes many peo-
But let’s not get ahead of ourselves. There are three families of fatty acids: saturated ple’s eyes to glaze over pretty quickly.
According to conventional wisdom, fat and cholesterol are the twin demons of heart disease, fatty acids, monounsaturated fatty acids, and polyun- So if you’re interested in reading the Full Monty
linked together in our minds as firmly as Hell and Damnation or Bonnie and Clyde. We’ve been admon- saturated fatty acids. (There’s actually a fourth class about how double bonds, saturation, chain length, and
ished to lower our cholesterol and stop eating saturated fat. These two mandates are the basis of the of fatty acids called trans fats, a kind of “Franken-fat,” other cool biochemical stuff affects us at a molecular
diet-heart hypothesis, which has guided national health policy on healthy eating for decades and basi- but we’ll address that later.) The difference between level, please, by all means, be our guest! That infor-
cally holds that fat and cholesterol in the diet are a direct and significant cause of heart disease. all these fat types has to do with the number of mation is widely available. It’s not controversial, it’s
Okay, so fat and cholesterol (whether they show up in your diet or in your bloodstream) are pretty chemical double bonds that exist in the fatty acid’s not debated, and it’s not really germane to our story.
much kissing cousins. molecular chain. Monounsaturated fats have one dou- So, mercifully, we’ve decided to minimize the “in the
We’ve discussed cholesterol in the previous chapters, so let’s clear up some misconceptions about ble bond, polyunsaturated fats have more than one, weeds” lectures here and instead give you the essen-
fat—what it is, what it does, what it doesn’t do—and why all this matters in the first place. Once we’ve and saturated fats have none. tials—what you really need to know about saturated,
done that, we’ll be able to look at the relationship among heart disease, fat in the diet, and cholesterol In this section we’ll concentrate primarily on satu- polyunsaturated, and monounsaturated fats. The tech-
in the blood with completely new eyes. rated fat, but keep a place on your dance card for two nical bits we’ll cover are only there because they’re
Let’s get to work! members of the polyunsaturated family called really, really important.
Saturated Fat 101: Everything We centration of saturated fatty acids) is actually a better
Learned Was Wrong! choice for frying than the cheap, processed, polyun-
DR. JONNY
Saturated fats are primarily found in animal foods saturated vegetable oils that gradually replaced it as
When I was in fifth grade back in Queens, New York, there was a kid named A.J. who was always,
(meat, cheese, butter, eggs) and, less often, in certain restaurants tried to be more “health” conscious.
and I mean always, getting in trouble. But it was for the most minor stuff: coming in a couple of
plant foods, such as coconut, coconut oil, cocoa The problem with vegetable oils is that they’re
minutes late from recess, whispering in class, or, worst case scenario, throwing a spitball. There
butter, and palm oil. They tend to be solid at room nowhere near as resistant to damage as saturated
could be five other kids doing the same thing, but A.J. would always be the one to get caught.
temperature (think butter) and soften when warm. fats are. When you heat and reheat them for frying,
Singled out, reprimanded, parents called in to school, the whole humiliating deal.
Here’s the part they don’t tell you. Just as poly- as virtually every restaurant in America does, it
But there were a couple of other kids in the class who were real pieces of work. One kid,
unsaturated fats aren’t a singular entity—they include causes the formation of all sorts of noxious com-
Gilbert, compulsively lit firecrackers, scaring everyone to death, and then disappeared before
both omega-3 and omega-6 fats, which have wildly pounds, including carcinogens. Those multiple double
he could be caught at the scene of the crime. Another kid named Howie took delight in
different health effects—saturated fat, too, is actually bonds we mentioned earlier? They’re woefully vulner-
breaking people’s windows with rocks. A third one, Corky, was a bully. And yet none of them
a collection of different fatty acids. And those differ- able to chemical attack. Compared to saturated fat,
ever managed to get caught. Rarely did any of these kids even get a stern talking–to. The role
ent saturated fatty acids have diverse effects on your the unsaturated fatty acids in vegetable oils are much
of the “bad kid” in the class was played by A.J., who would have to serve detention, sit in the
cholesterol levels, metabolism, and overall health. more easily damaged by high heat and more suscepti-
corner, and be yelled at in front of the class, all for fairly meaningless infractions, while the
That’s why, when we talk about “saturated fat,” ble to oxidation and the production of free radicals.
kids who were doing all the really bad stuff got off scot-free.
we also have to ask: Which saturated fat? And it’s also Those vegetable oils transform into all sorts of
Now it’s not that old A.J. didn’t do anything wrong. But unlike the other kids, he never beat
why we can’t use a study on coconut oil to tell us mutant molecules under the stress of high heat and
anyone up, he never did anything mean, he never destroyed anyone’s property—and yet
about the health effects of cheese, or a study on egg reheating, but when high heat is applied to saturated
whenever there was trouble, he was always the scapegoat.
yolks to tell us about the health effects of steak—even fat, it behaves like the strong, silent uncle at the fam-
I think saturated fat is like that kid A.J. It’s not that it’s perfect. It’s just that it’s far less
when scientists wave their magical statistical wands ily gathering; everyone else is going nuts, but he’s
important than the stuff we ignore—such as high intakes of omega-6 fatty acids, low intakes of
trying to predict such things. Saturated fat isn’t a sin- calm and serene!
omega-3s, and obscene intakes of sugar and processed carbs.
gular entity, and neither are the foods that contain it. Even when heat isn’t in the picture, polyunsatu-
Is saturated fat so wonderful that we should all resolve to melt a ton of butter and add it to
Importantly, no matter which saturated fat we’re rated fats are fragile flowers, so to speak. Mere expo-
our smoothies right this minute? No, of course not. Saturated fat has some negatives. It is
talking about, the news is not as bad as we’ve been sure to oxygen and sunlight will cause an open bottle
mildly inflammatory. It may contribute to insulin resistance.
told—full stop. What’s more, certain saturated fats are of soybean oil to go rancid on the counter, while an
If the dietary dictocrats are going to warn us against inflammatory food components, why
uniquely beneficial, as has been born out in study open jar of coconut oil will sit there for eons without
choose saturated fat, a relatively minor factor in inflammation compared to the omega-6 to
after study. How’s that for some juicy fine print to the oxidizing. (We’ll talk about some of the other prob-
omega-3 ratio? If they’re going to warn us about saturated fat because of its purported
“saturated fat is bad” hoo-ha? lems with the overuse of vegetable oils in our diet
connection to insulin resistance, why do they continue to promote ridiculously high
They also have a few other characteristics worth later on.)
carbohydrate intakes, which are demonstrably worse?
mentioning. Saturated fats are very stable. They’re Now let us ask you a question, and please answer
Saturated fat is a lot like A.J. Not perfect, but it doesn’t deserve to get beat up. And the
tough—when exposed to high heat they don’t honestly: Did you shudder in horror when we implied a
irony is that while everyone’s pushing him around and blaming him for everything bad that
“mutate” or “damage” as easily as their more delicate few sentences ago that using lard for cooking might
happens, the real culprits are getting away.
cousins, the unsaturated (especially polyunsaturated) actually be a good idea? You probably thought to your-
fats do. That’s one reason why lard (with its high con- self, “Now they’ve gone too far. Did they really say lard
Saturated Fat 101: Everything We centration of saturated fatty acids) is actually a better
Learned Was Wrong! choice for frying than the cheap, processed, polyun-
DR. JONNY
Saturated fats are primarily found in animal foods saturated vegetable oils that gradually replaced it as
When I was in fifth grade back in Queens, New York, there was a kid named A.J. who was always,
(meat, cheese, butter, eggs) and, less often, in certain restaurants tried to be more “health” conscious.
and I mean always, getting in trouble. But it was for the most minor stuff: coming in a couple of
plant foods, such as coconut, coconut oil, cocoa The problem with vegetable oils is that they’re
minutes late from recess, whispering in class, or, worst case scenario, throwing a spitball. There
butter, and palm oil. They tend to be solid at room nowhere near as resistant to damage as saturated
could be five other kids doing the same thing, but A.J. would always be the one to get caught.
temperature (think butter) and soften when warm. fats are. When you heat and reheat them for frying,
Singled out, reprimanded, parents called in to school, the whole humiliating deal.
Here’s the part they don’t tell you. Just as poly- as virtually every restaurant in America does, it
But there were a couple of other kids in the class who were real pieces of work. One kid,
unsaturated fats aren’t a singular entity—they include causes the formation of all sorts of noxious com-
Gilbert, compulsively lit firecrackers, scaring everyone to death, and then disappeared before
both omega-3 and omega-6 fats, which have wildly pounds, including carcinogens. Those multiple double
he could be caught at the scene of the crime. Another kid named Howie took delight in
different health effects—saturated fat, too, is actually bonds we mentioned earlier? They’re woefully vulner-
breaking people’s windows with rocks. A third one, Corky, was a bully. And yet none of them
a collection of different fatty acids. And those differ- able to chemical attack. Compared to saturated fat,
ever managed to get caught. Rarely did any of these kids even get a stern talking–to. The role
ent saturated fatty acids have diverse effects on your the unsaturated fatty acids in vegetable oils are much
of the “bad kid” in the class was played by A.J., who would have to serve detention, sit in the
cholesterol levels, metabolism, and overall health. more easily damaged by high heat and more suscepti-
corner, and be yelled at in front of the class, all for fairly meaningless infractions, while the
That’s why, when we talk about “saturated fat,” ble to oxidation and the production of free radicals.
kids who were doing all the really bad stuff got off scot-free.
we also have to ask: Which saturated fat? And it’s also Those vegetable oils transform into all sorts of
Now it’s not that old A.J. didn’t do anything wrong. But unlike the other kids, he never beat
why we can’t use a study on coconut oil to tell us mutant molecules under the stress of high heat and
anyone up, he never did anything mean, he never destroyed anyone’s property—and yet
about the health effects of cheese, or a study on egg reheating, but when high heat is applied to saturated
whenever there was trouble, he was always the scapegoat.
yolks to tell us about the health effects of steak—even fat, it behaves like the strong, silent uncle at the fam-
I think saturated fat is like that kid A.J. It’s not that it’s perfect. It’s just that it’s far less
when scientists wave their magical statistical wands ily gathering; everyone else is going nuts, but he’s
important than the stuff we ignore—such as high intakes of omega-6 fatty acids, low intakes of
trying to predict such things. Saturated fat isn’t a sin- calm and serene!
omega-3s, and obscene intakes of sugar and processed carbs.
gular entity, and neither are the foods that contain it. Even when heat isn’t in the picture, polyunsatu-
Is saturated fat so wonderful that we should all resolve to melt a ton of butter and add it to
Importantly, no matter which saturated fat we’re rated fats are fragile flowers, so to speak. Mere expo-
our smoothies right this minute? No, of course not. Saturated fat has some negatives. It is
talking about, the news is not as bad as we’ve been sure to oxygen and sunlight will cause an open bottle
mildly inflammatory. It may contribute to insulin resistance.
told—full stop. What’s more, certain saturated fats are of soybean oil to go rancid on the counter, while an
If the dietary dictocrats are going to warn us against inflammatory food components, why
uniquely beneficial, as has been born out in study open jar of coconut oil will sit there for eons without
choose saturated fat, a relatively minor factor in inflammation compared to the omega-6 to
after study. How’s that for some juicy fine print to the oxidizing. (We’ll talk about some of the other prob-
omega-3 ratio? If they’re going to warn us about saturated fat because of its purported
“saturated fat is bad” hoo-ha? lems with the overuse of vegetable oils in our diet
connection to insulin resistance, why do they continue to promote ridiculously high
They also have a few other characteristics worth later on.)
carbohydrate intakes, which are demonstrably worse?
mentioning. Saturated fats are very stable. They’re Now let us ask you a question, and please answer
Saturated fat is a lot like A.J. Not perfect, but it doesn’t deserve to get beat up. And the
tough—when exposed to high heat they don’t honestly: Did you shudder in horror when we implied a
irony is that while everyone’s pushing him around and blaming him for everything bad that
“mutate” or “damage” as easily as their more delicate few sentences ago that using lard for cooking might
happens, the real culprits are getting away.
cousins, the unsaturated (especially polyunsaturated) actually be a good idea? You probably thought to your-
fats do. That’s one reason why lard (with its high con- self, “Now they’ve gone too far. Did they really say lard
is better to fry with than canola oil? That’s nuts!” has been the prevailing dogma about saturated fat, sionals, researchers, scientists, doctors, and nutrition- SATURATED FAT AND HEART
We’d be surprised if you didn’t recoil in horror. cholesterol, and heart disease for decades. By now ists are beginning to reexamine the case against satu- DISEASE: WHERE’S THE EVIDENCE?
Most people would do just that—and it’s because most you’re more than familiar with this notion, known as rated fat, and they’re finding that it’s based on very Look, there is no shortage of studies pointing to an
people have totally bought into the idea that satu- the diet-heart hypothesis—it’s the mantra that has little solid evidence (and a lot of guilt by association). association between increased saturated fat intake
rated fat is the worst thing on the planet. guided public policy on diet and heart disease for vir- Not only that, but different types of saturated fat— and cardiovascular risk, but there are a few things to
The idea that lard—with its high content of satu- tually every major governmental and mainstream from different dietary sources—have such diverse know about those studies.
rated fat—could ever be a better choice than those health organization, such as the American Heart impacts on our health, it’s hard to make blanket state- Number one, the associations are far weaker than
high omega-6 vegetable oils that are continually Association. ments about saturated fat on the whole. As we’ll see, one might suspect, given how entrenched the belief is
pushed on us is in direct opposition to fat theology, There’s only one problem. It isn’t true. some saturated fatty acids are not only non-harmful, that saturated fat clogs your arteries. In many of
the deeply held belief that saturated fat and choles- Despite its horrible reputation, saturated fat is far but we might be better off eating more of them these studies, the major “risk” examined was choles-
terol are the root of all heart disease evil. That notion from a dietary demon. More and more health profes- rather than less. terol, so we wind up with a circular argument in which
A WORD ABOUT META-ANALYSES AND WHY THEY’RE IMPORTANT measures used, the populations studied, and even the definition of terms. (Is a “smoker”
A little backstory about meta-analyses and why people do them. Say you want to learn about defined as anyone who has even one cigarette a week? Or is a “smoker” defined as someone
the sex habits of college students. There are probably a couple dozen relevant studies you who smokes at least half a pack a day?)
could look at, but as with any other area of research, there’s no guarantee that all the studies Which brings us, finally, back to meta-analysis.
will reach the same conclusions. In fact, it’s almost certain that they won’t. One study might Sometimes researchers gather up a whole bunch of these individual studies whose results
find, for example, that college kids are having more sex, while another study might find that are clustered all over the place like pins on CNN’s election maps. Then they’ll ask, “What do
they’re actually having less. (A critical look at these two studies might uncover the fact that these studies, taken together as a whole, really tell us about what’s going on?” They’ll gather
researchers in the two studies used slightly different definitions of the term “sex” when they up all the studies on, say, smoking and cancer, college students and sex, or saturated fat and
surveyed the students, something that might account for the difference in results.) heart disease. They’ll examine them scrupulously, tossing out any studies whose methods,
Sometimes researchers overlook an obvious variable that could skew the results. designs, or data don’t meet the highest standards of research excellence. (Meta-analyses
Although researchers always try to control for these variables (such as age, sex, and typically exclude small pilot studies, unblinded studies, studies with too few participants, or
smoking) and generally “match” subjects by the most important criteria, they don’t—they studies that do not collect data on something the researchers consider important.)
can’t—always control for every variable that might make a difference (and this is particularly Once the “best-of-the-best” studies are selected for inclusion (and lesser studies are
true in diet research). The point is, if you look at anything worth studying you’re going to eliminated), the researchers go to work and apply every statistical manipulation you can
find a whole bunch of research on it, and among those research studies you’re almost imagine to tease out the real relationships from the mass of accumulated data. They look at
guaranteed to encounter conflicting findings and areas of disagreement about how to the findings of the individual studies and compare them. They pool the subjects from all the
interpret those findings. studies. They look for trends, directions, statistical significance, and hidden relationships. And
Even something that now seems as clearly connected as the link between smoking and though meta-analyses themselves are not infallible, they’re a great way to look at the big
cancer started out as a hypothesis and had to be tested in all sorts of populations under all picture to gauge what’s really going on.
sorts of conditions. Studies can and do reach different conclusions depending on the statistical
is better to fry with than canola oil? That’s nuts!” has been the prevailing dogma about saturated fat, sionals, researchers, scientists, doctors, and nutrition- SATURATED FAT AND HEART
We’d be surprised if you didn’t recoil in horror. cholesterol, and heart disease for decades. By now ists are beginning to reexamine the case against satu- DISEASE: WHERE’S THE EVIDENCE?
Most people would do just that—and it’s because most you’re more than familiar with this notion, known as rated fat, and they’re finding that it’s based on very Look, there is no shortage of studies pointing to an
people have totally bought into the idea that satu- the diet-heart hypothesis—it’s the mantra that has little solid evidence (and a lot of guilt by association). association between increased saturated fat intake
rated fat is the worst thing on the planet. guided public policy on diet and heart disease for vir- Not only that, but different types of saturated fat— and cardiovascular risk, but there are a few things to
The idea that lard—with its high content of satu- tually every major governmental and mainstream from different dietary sources—have such diverse know about those studies.
rated fat—could ever be a better choice than those health organization, such as the American Heart impacts on our health, it’s hard to make blanket state- Number one, the associations are far weaker than
high omega-6 vegetable oils that are continually Association. ments about saturated fat on the whole. As we’ll see, one might suspect, given how entrenched the belief is
pushed on us is in direct opposition to fat theology, There’s only one problem. It isn’t true. some saturated fatty acids are not only non-harmful, that saturated fat clogs your arteries. In many of
the deeply held belief that saturated fat and choles- Despite its horrible reputation, saturated fat is far but we might be better off eating more of them these studies, the major “risk” examined was choles-
terol are the root of all heart disease evil. That notion from a dietary demon. More and more health profes- rather than less. terol, so we wind up with a circular argument in which
A WORD ABOUT META-ANALYSES AND WHY THEY’RE IMPORTANT measures used, the populations studied, and even the definition of terms. (Is a “smoker”
A little backstory about meta-analyses and why people do them. Say you want to learn about defined as anyone who has even one cigarette a week? Or is a “smoker” defined as someone
the sex habits of college students. There are probably a couple dozen relevant studies you who smokes at least half a pack a day?)
could look at, but as with any other area of research, there’s no guarantee that all the studies Which brings us, finally, back to meta-analysis.
will reach the same conclusions. In fact, it’s almost certain that they won’t. One study might Sometimes researchers gather up a whole bunch of these individual studies whose results
find, for example, that college kids are having more sex, while another study might find that are clustered all over the place like pins on CNN’s election maps. Then they’ll ask, “What do
they’re actually having less. (A critical look at these two studies might uncover the fact that these studies, taken together as a whole, really tell us about what’s going on?” They’ll gather
researchers in the two studies used slightly different definitions of the term “sex” when they up all the studies on, say, smoking and cancer, college students and sex, or saturated fat and
surveyed the students, something that might account for the difference in results.) heart disease. They’ll examine them scrupulously, tossing out any studies whose methods,
Sometimes researchers overlook an obvious variable that could skew the results. designs, or data don’t meet the highest standards of research excellence. (Meta-analyses
Although researchers always try to control for these variables (such as age, sex, and typically exclude small pilot studies, unblinded studies, studies with too few participants, or
smoking) and generally “match” subjects by the most important criteria, they don’t—they studies that do not collect data on something the researchers consider important.)
can’t—always control for every variable that might make a difference (and this is particularly Once the “best-of-the-best” studies are selected for inclusion (and lesser studies are
true in diet research). The point is, if you look at anything worth studying you’re going to eliminated), the researchers go to work and apply every statistical manipulation you can
find a whole bunch of research on it, and among those research studies you’re almost imagine to tease out the real relationships from the mass of accumulated data. They look at
guaranteed to encounter conflicting findings and areas of disagreement about how to the findings of the individual studies and compare them. They pool the subjects from all the
interpret those findings. studies. They look for trends, directions, statistical significance, and hidden relationships. And
Even something that now seems as clearly connected as the link between smoking and though meta-analyses themselves are not infallible, they’re a great way to look at the big
cancer started out as a hypothesis and had to be tested in all sorts of populations under all picture to gauge what’s really going on.
sorts of conditions. Studies can and do reach different conclusions depending on the statistical
higher saturated fat intake increases the risk for saturated fat increases the risk of heart disease. In stroke, or CVD. Even when the researchers factored in intake of saturated fatty acids is associated with a
heart disease, but only if you accept the use of cho- the scientific literature, this issue is as far from being age, sex, and study quality, it didn’t change the modest increase in serum total cholesterol, but not
lesterol levels as a stand-in for heart disease. Studies settled as you might think from listening to CNN. In results. Saturated fat did bupkis—it didn’t increase or associated with cardiovascular disease [italics ours].”2
that measure the effect of saturated fat on heart dis- 2012, Patty Siri-Tarino, Ph.D., and Ronald Krauss, M.D., decrease risk in any meaningful way. Period. And it doesn’t end there. In 2014, another wave-
ease and mortality directly—rather than indirectly by of the Children’s Hospital Oakland Research Institute “There is no significant evidence for concluding making study was published in the Annals of Internal
measuring its effect on cholesterol—are few and far together with Frank B. Hu, M.D., Ph.D., of Harvard, that dietary saturated fat is associated with an Medicine examining the associations between various
between. But there are some important ones, which decided to do a meta-analysis—a study of studies. In increased risk of CHD or CVD,” the researchers dietary, circulating, and supplementary fatty acids and
1
we’ll discuss in a moment. this case, they looked at all previously published stud- concluded. subsequent heart disease risk.3 This meta-analysis
Number two, as scientists have looked more care- ies whose purpose was to investigate the relationship Now—and this is a very important point—it’s not included thirty-two studies of fatty acid intake from
fully at the association between saturated fat in the of saturated fat to coronary heart disease (CHD), that there’s no evidence that saturated fat doesn’t people’s diets, seventeen studies of fatty acid level
diet and levels of cholesterol in the blood, they are stroke, or cardiovascular disease (CVD). Note that this raise cholesterol. There is, and we’ll examine that biomarkers (standing in as indicators of dietary
beginning to see that even here the relationship is is one of those hard-to-find studies we mentioned more in a moment. But the above meta-analysis didn’t intake), and twenty-seven randomized, controlled tri-
murky. As we’ll explain shortly, not all saturated fatty earlier: a study of the direct effect of saturated fat on just look at cholesterol levels; it looked at what we als of fatty acids consumed as supplements. In con-
acids have the same impact on your cholesterol health. The researchers weren’t just interested in the really care about—heart disease and dying. So never trast to the entrenched “saturated fat causes heart
levels—making it hard to make any single, overarching effect saturated fat had on cholesterol—they wanted mind whether saturated fat raises my cholesterol disease” dogma, the results showed no increased risk
blanket statements about saturated fat as a whole. to know the effect saturated fat had on heart disease. level. What I really want to know is, does eating satu- of heart disease from eating saturated fat—as well as
What’s more, the stuff saturated fat seems to do (Remember, they are not the same thing!) rated fat increase my chances of getting a heart no association with saturated fat biomarkers. (What’s
depends a whole lot on what we’re comparing it to Twenty-one studies qualified for inclusion in their attack or not? The meta-analysis looked at exactly more, increasing polyunsaturated fat intake, the long-
(unsaturated fats? Carbs? Protein?), who’s eating it meta-analysis, meaning these studies met the criteria that real-life endpoint we truly care about, and on standing battle cry of mainstream nutrition, didn’t
(a lean twenty-something, or an obese middle-ager for being well designed and reliable. All in all, the that all-important metric, the verdict was clear. show any clear benefit for heart health.)
with diabetes?), the overall dietary context (an energy- twenty-one studies included 347,747 subjects who Saturated fat in the diet has virtually no effect on In the researchers’ own words: “Current evidence
surplus Standard Western Diet, or a ketogenic weight- were followed for between five and twenty-three your risk of dying from a heart attack. does not clearly support cardiovascular guidelines that
loss diet?), among plenty of other factors that add years. Over this period of time, 11,006 of the subjects That meta-analysis is hardly the only study that encourage high consumption of polyunsaturated fatty
nuance and caveats to the saturated fat story. developed coronary heart disease (CHD) or stroke. has found saturated fat innocent of any direct acids and low consumption of total saturated fats.”
And the kicker: Even when all saturated fats are Ready for the findings? How much saturated fat involvement in cardiovascular disease. In the fall of Still not convinced? A 2015 meta-analysis pub-
lumped together in studies (which is most of the time), people ate predicted absolutely nothing about their 2011, a new study came out in the Netherlands lished in the British Medical Journal found that
the collective effect is still more positive than negative. risk for cardiovascular disease. In the researchers’ Journal of Medicine titled “Saturated Fat, “Saturated fats are not associated with all-cause
Even those who still believe in the conventional division own words, “Intake of saturated fat was not associ- Carbohydrates, and Cardiovascular Disease.” Like the mortality CVD, CHD, ischemic stroke, or type 2 dia-
of cholesterol into “good and bad” cholesterol division ated with an increased risk of coronary heart disease above-discussed meta-analysis, its purpose was to betes.” All-cause mortality means dying from any-
have to face the (well-documented) fact that saturated (CHD) or stroke, nor was it associated with an examine the current scientific data on the effects of thing—accidents to cancer. Another way to say it
fat usually causes HDL (“good” cholesterol) to go up increased risk of cardiovascular disease (CVD).” Those saturated fat, looking at all the controversies as well is “total deaths from anything you can think of.”4
more than LDL (“bad” cholesterol). Even by conven- folks consuming the highest amount of saturated fat as the potential mechanisms for the role of saturated A 2016 re-evaluation of Minnesota Coronary
tional standards that’s a net gain. were statistically identical to those consuming the fat in cardiovascular disease. Experiment data found that “replacement of
One of the basic tenets of fat theology is that least amount when it came to the probability of CHD, Here’s what the researchers wrote: “The dietary saturated fat in the diet with linoleic acid effectively
higher saturated fat intake increases the risk for saturated fat increases the risk of heart disease. In stroke, or CVD. Even when the researchers factored in intake of saturated fatty acids is associated with a
heart disease, but only if you accept the use of cho- the scientific literature, this issue is as far from being age, sex, and study quality, it didn’t change the modest increase in serum total cholesterol, but not
lesterol levels as a stand-in for heart disease. Studies settled as you might think from listening to CNN. In results. Saturated fat did bupkis—it didn’t increase or associated with cardiovascular disease [italics ours].”2
that measure the effect of saturated fat on heart dis- 2012, Patty Siri-Tarino, Ph.D., and Ronald Krauss, M.D., decrease risk in any meaningful way. Period. And it doesn’t end there. In 2014, another wave-
ease and mortality directly—rather than indirectly by of the Children’s Hospital Oakland Research Institute “There is no significant evidence for concluding making study was published in the Annals of Internal
measuring its effect on cholesterol—are few and far together with Frank B. Hu, M.D., Ph.D., of Harvard, that dietary saturated fat is associated with an Medicine examining the associations between various
between. But there are some important ones, which decided to do a meta-analysis—a study of studies. In increased risk of CHD or CVD,” the researchers dietary, circulating, and supplementary fatty acids and
1
we’ll discuss in a moment. this case, they looked at all previously published stud- concluded. subsequent heart disease risk.3 This meta-analysis
Number two, as scientists have looked more care- ies whose purpose was to investigate the relationship Now—and this is a very important point—it’s not included thirty-two studies of fatty acid intake from
fully at the association between saturated fat in the of saturated fat to coronary heart disease (CHD), that there’s no evidence that saturated fat doesn’t people’s diets, seventeen studies of fatty acid level
diet and levels of cholesterol in the blood, they are stroke, or cardiovascular disease (CVD). Note that this raise cholesterol. There is, and we’ll examine that biomarkers (standing in as indicators of dietary
beginning to see that even here the relationship is is one of those hard-to-find studies we mentioned more in a moment. But the above meta-analysis didn’t intake), and twenty-seven randomized, controlled tri-
murky. As we’ll explain shortly, not all saturated fatty earlier: a study of the direct effect of saturated fat on just look at cholesterol levels; it looked at what we als of fatty acids consumed as supplements. In con-
acids have the same impact on your cholesterol health. The researchers weren’t just interested in the really care about—heart disease and dying. So never trast to the entrenched “saturated fat causes heart
levels—making it hard to make any single, overarching effect saturated fat had on cholesterol—they wanted mind whether saturated fat raises my cholesterol disease” dogma, the results showed no increased risk
blanket statements about saturated fat as a whole. to know the effect saturated fat had on heart disease. level. What I really want to know is, does eating satu- of heart disease from eating saturated fat—as well as
What’s more, the stuff saturated fat seems to do (Remember, they are not the same thing!) rated fat increase my chances of getting a heart no association with saturated fat biomarkers. (What’s
depends a whole lot on what we’re comparing it to Twenty-one studies qualified for inclusion in their attack or not? The meta-analysis looked at exactly more, increasing polyunsaturated fat intake, the long-
(unsaturated fats? Carbs? Protein?), who’s eating it meta-analysis, meaning these studies met the criteria that real-life endpoint we truly care about, and on standing battle cry of mainstream nutrition, didn’t
(a lean twenty-something, or an obese middle-ager for being well designed and reliable. All in all, the that all-important metric, the verdict was clear. show any clear benefit for heart health.)
with diabetes?), the overall dietary context (an energy- twenty-one studies included 347,747 subjects who Saturated fat in the diet has virtually no effect on In the researchers’ own words: “Current evidence
surplus Standard Western Diet, or a ketogenic weight- were followed for between five and twenty-three your risk of dying from a heart attack. does not clearly support cardiovascular guidelines that
loss diet?), among plenty of other factors that add years. Over this period of time, 11,006 of the subjects That meta-analysis is hardly the only study that encourage high consumption of polyunsaturated fatty
nuance and caveats to the saturated fat story. developed coronary heart disease (CHD) or stroke. has found saturated fat innocent of any direct acids and low consumption of total saturated fats.”
And the kicker: Even when all saturated fats are Ready for the findings? How much saturated fat involvement in cardiovascular disease. In the fall of Still not convinced? A 2015 meta-analysis pub-
lumped together in studies (which is most of the time), people ate predicted absolutely nothing about their 2011, a new study came out in the Netherlands lished in the British Medical Journal found that
the collective effect is still more positive than negative. risk for cardiovascular disease. In the researchers’ Journal of Medicine titled “Saturated Fat, “Saturated fats are not associated with all-cause
Even those who still believe in the conventional division own words, “Intake of saturated fat was not associ- Carbohydrates, and Cardiovascular Disease.” Like the mortality CVD, CHD, ischemic stroke, or type 2 dia-
of cholesterol into “good and bad” cholesterol division ated with an increased risk of coronary heart disease above-discussed meta-analysis, its purpose was to betes.” All-cause mortality means dying from any-
have to face the (well-documented) fact that saturated (CHD) or stroke, nor was it associated with an examine the current scientific data on the effects of thing—accidents to cancer. Another way to say it
fat usually causes HDL (“good” cholesterol) to go up increased risk of cardiovascular disease (CVD).” Those saturated fat, looking at all the controversies as well is “total deaths from anything you can think of.”4
more than LDL (“bad” cholesterol). Even by conven- folks consuming the highest amount of saturated fat as the potential mechanisms for the role of saturated A 2016 re-evaluation of Minnesota Coronary
tional standards that’s a net gain. were statistically identical to those consuming the fat in cardiovascular disease. Experiment data found that “replacement of
One of the basic tenets of fat theology is that least amount when it came to the probability of CHD, Here’s what the researchers wrote: “The dietary saturated fat in the diet with linoleic acid effectively
lowers serum cholesterol,” but that evidence from FAT THEOLOGY: TWO MAIN TENETS In fact, the group with the lowest cholesterol lev- called the Isehara Study.9 The Isehara Study was based
available trials “does not support the hypothesis DEBUNKED els died at the highest rate. on data collected from annual checkups of residents in
that this translates to a lower risk of death from cor- Researchers in Japan examined the first of those In scientific terms, the risk for dying from any Isehara, a smallish city (population: 100,000) located in
5
onary heart disease or all causes.” And a 2017 beliefs—that cholesterol is a good predictor of heart cause whatsoever (called “all-cause mortality”) was the central Kanagawa Prefecture in Japan. A database
meta-analysis of randomized controlled trials deter- disease—with another meta-analysis. They searched highest in the group with low cholesterol. Compared of 8,340 men (average age sixty-four) and 13,591
mined that “Available evidence from adequately con- for all studies that had examined the relationship of with the reference group (160 to 199 mg/dL), the risk women (average age sixty-one) was mined for choles-
trolled randomized controlled trials suggest replac- cholesterol to mortality, excluding any done before of dying from any cause whatsoever was significantly terol readings, and the 21,931 people were divided into
ing SFA with mostly n-6 PUFA is unlikely to reduce 1995 and any that had fewer than five thousand decreased in the group having “borderline high” cho- seven groups ranked from lowest to highest LDL cho-
CHD events, CHD mortality or total mortality”—and subjects. Nine studies met the criteria, but four had lesterol of 200 to 239 mg/dL and even further lesterol levels (in mg/dL): <80, 80 to 99, 100 to 119, 120
what’s more, the whole reason very early meta-anal- incomplete data and so were excluded. The decreased in the group having “high” (greater than to 139 (reference group), 140 to 159, 160 to 179, and
yses seemed to incriminate saturated fat was researchers then performed a meta-analysis on the 240 mg/dL) cholesterol. In contrast, your risk of dying >180. In both men and women, overall mortality was
6
because they included poorly controlled trials. And remaining five studies, which together involved more from any cause was the highest of all if your choles- significantly higher in the group with the lowest LDL
7
most recently, a meta-analysis of cohort studies, than 150,000 people followed for approximately five terol was under 160 mg/dL! cholesterol levels (under 80 mg/dL).
conducted by researchers in China, found that—when years. So high cholesterol is associated with a reduced Although it’s true that in this study mortality
comparing the lowest levels intake to the highest The researchers placed everyone into one of four risk of death? Not exactly what you might expect but from heart disease was greater in the group with the
ones—there was no increased risk of cardiovascular groups depending on their cholesterol levels: less exactly what the study found. Total cholesterol is so highest LDL levels (over 180 mg/dL), this was only
disease from eating saturated fat. than 160 mg/dL, 160 to 199 mg/dL, 200 to 239 mg/dL, irrelevant as a metric that in 2007 the Japan true in men. In women the opposite was so—fewer
The picture should be pretty clear by now. and higher than 240 mg/dL. (These categories mirror Atherosclerosis Society stopped using it in any tables women died of heart disease in the group with the
As we’ve been saying throughout this book, cho- the American Heart Association guidelines, which related to the diagnosis or treatment criteria in its highest LDL levels. In any case, this increase in heart
8
lesterol is only used as a marker. (In other words, it’s state that 200 mg/dL or lower is “desirable,” 200 to guidelines. It’s not that the society abandoned the disease in the high LDL group of men was apparently
a stand-in answer for what we really want to know— 239 mg/dL is “borderline high,” and higher than cholesterol theory, mind you. It just now relies more than offset by the increase in deaths from other
namely, what is the likelihood of developing heart dis- 240 mg/dL is bad news indeed.) entirely on LDL levels to determine who should be causes.
ease?) But if you’re looking for a metric to predict Which group do you think would have the worst classified as having “high cholesterol,” reasoning that Okay, hopefully this information will get you, and
who is and isn’t going to get heart disease, choles- possible outcomes? According to everything we’ve if total cholesterol is high simply because you’ve got a your doctor, to at least question the notion that cho-
terol—as we’ve seen in this book—is a lousy choice for heard from the cholesterol zealots, the answer is sim- terrifically high HDL level, that shouldn’t be counted lesterol is an important marker or predictor of heart
a marker. If cholesterol really predicted heart disease ple: Those whose cholesterol readings were the high- as a bad thing. Many American doctors—even the disease. But let’s say for the sake of argument that
(wrong belief number one), and if saturated fat really est (240 mg/dL and over), and even those with cho- most conservative ones—would probably agree that you, or your doctor, is not quite willing to throw out
did terrible things to your cholesterol (wrong belief lesterol readings in the “borderline” category (200 to the LDL number is the important one, even if they the cholesterol theory. Fine, no problem. After all,
number two), then that might be reason to eliminate 239 mg/dL), should be expected to die at a higher don’t fully embrace the notion that it is the type of you, like most of us, have been indoctrinated with the
saturated fat from your diet. rate than those with a cholesterol level of 160 to LDL—not the LDL number—that matters the most. idea that anything that raises your cholesterol is bad
But it turns out neither of those two things is 199 mg/dL. And those in the under 160 mg/dL cate- But is the LDL level a better predicator of heart news, and that’s a hard thing to let go of, especially
true. Let’s take those two notions one by one, gory should live longest of all! disease or mortality than the total cholesterol level? when you’ve been hearing it for your entire adult life.
because they are the bedrock beliefs of fat theology. That is precisely and exactly what did not happen. Once again, let’s go to the video. Researchers in But before you go back to demonizing saturated
Japan set out to answer this question in something fat, let’s examine the second belief that constitutes
lowers serum cholesterol,” but that evidence from FAT THEOLOGY: TWO MAIN TENETS In fact, the group with the lowest cholesterol lev- called the Isehara Study.9 The Isehara Study was based
available trials “does not support the hypothesis DEBUNKED els died at the highest rate. on data collected from annual checkups of residents in
that this translates to a lower risk of death from cor- Researchers in Japan examined the first of those In scientific terms, the risk for dying from any Isehara, a smallish city (population: 100,000) located in
5
onary heart disease or all causes.” And a 2017 beliefs—that cholesterol is a good predictor of heart cause whatsoever (called “all-cause mortality”) was the central Kanagawa Prefecture in Japan. A database
meta-analysis of randomized controlled trials deter- disease—with another meta-analysis. They searched highest in the group with low cholesterol. Compared of 8,340 men (average age sixty-four) and 13,591
mined that “Available evidence from adequately con- for all studies that had examined the relationship of with the reference group (160 to 199 mg/dL), the risk women (average age sixty-one) was mined for choles-
trolled randomized controlled trials suggest replac- cholesterol to mortality, excluding any done before of dying from any cause whatsoever was significantly terol readings, and the 21,931 people were divided into
ing SFA with mostly n-6 PUFA is unlikely to reduce 1995 and any that had fewer than five thousand decreased in the group having “borderline high” cho- seven groups ranked from lowest to highest LDL cho-
CHD events, CHD mortality or total mortality”—and subjects. Nine studies met the criteria, but four had lesterol of 200 to 239 mg/dL and even further lesterol levels (in mg/dL): <80, 80 to 99, 100 to 119, 120
what’s more, the whole reason very early meta-anal- incomplete data and so were excluded. The decreased in the group having “high” (greater than to 139 (reference group), 140 to 159, 160 to 179, and
yses seemed to incriminate saturated fat was researchers then performed a meta-analysis on the 240 mg/dL) cholesterol. In contrast, your risk of dying >180. In both men and women, overall mortality was
6
because they included poorly controlled trials. And remaining five studies, which together involved more from any cause was the highest of all if your choles- significantly higher in the group with the lowest LDL
7
most recently, a meta-analysis of cohort studies, than 150,000 people followed for approximately five terol was under 160 mg/dL! cholesterol levels (under 80 mg/dL).
conducted by researchers in China, found that—when years. So high cholesterol is associated with a reduced Although it’s true that in this study mortality
comparing the lowest levels intake to the highest The researchers placed everyone into one of four risk of death? Not exactly what you might expect but from heart disease was greater in the group with the
ones—there was no increased risk of cardiovascular groups depending on their cholesterol levels: less exactly what the study found. Total cholesterol is so highest LDL levels (over 180 mg/dL), this was only
disease from eating saturated fat. than 160 mg/dL, 160 to 199 mg/dL, 200 to 239 mg/dL, irrelevant as a metric that in 2007 the Japan true in men. In women the opposite was so—fewer
The picture should be pretty clear by now. and higher than 240 mg/dL. (These categories mirror Atherosclerosis Society stopped using it in any tables women died of heart disease in the group with the
As we’ve been saying throughout this book, cho- the American Heart Association guidelines, which related to the diagnosis or treatment criteria in its highest LDL levels. In any case, this increase in heart
8
lesterol is only used as a marker. (In other words, it’s state that 200 mg/dL or lower is “desirable,” 200 to guidelines. It’s not that the society abandoned the disease in the high LDL group of men was apparently
a stand-in answer for what we really want to know— 239 mg/dL is “borderline high,” and higher than cholesterol theory, mind you. It just now relies more than offset by the increase in deaths from other
namely, what is the likelihood of developing heart dis- 240 mg/dL is bad news indeed.) entirely on LDL levels to determine who should be causes.
ease?) But if you’re looking for a metric to predict Which group do you think would have the worst classified as having “high cholesterol,” reasoning that Okay, hopefully this information will get you, and
who is and isn’t going to get heart disease, choles- possible outcomes? According to everything we’ve if total cholesterol is high simply because you’ve got a your doctor, to at least question the notion that cho-
terol—as we’ve seen in this book—is a lousy choice for heard from the cholesterol zealots, the answer is sim- terrifically high HDL level, that shouldn’t be counted lesterol is an important marker or predictor of heart
a marker. If cholesterol really predicted heart disease ple: Those whose cholesterol readings were the high- as a bad thing. Many American doctors—even the disease. But let’s say for the sake of argument that
(wrong belief number one), and if saturated fat really est (240 mg/dL and over), and even those with cho- most conservative ones—would probably agree that you, or your doctor, is not quite willing to throw out
did terrible things to your cholesterol (wrong belief lesterol readings in the “borderline” category (200 to the LDL number is the important one, even if they the cholesterol theory. Fine, no problem. After all,
number two), then that might be reason to eliminate 239 mg/dL), should be expected to die at a higher don’t fully embrace the notion that it is the type of you, like most of us, have been indoctrinated with the
saturated fat from your diet. rate than those with a cholesterol level of 160 to LDL—not the LDL number—that matters the most. idea that anything that raises your cholesterol is bad
But it turns out neither of those two things is 199 mg/dL. And those in the under 160 mg/dL cate- But is the LDL level a better predicator of heart news, and that’s a hard thing to let go of, especially
true. Let’s take those two notions one by one, gory should live longest of all! disease or mortality than the total cholesterol level? when you’ve been hearing it for your entire adult life.
because they are the bedrock beliefs of fat theology. That is precisely and exactly what did not happen. Once again, let’s go to the video. Researchers in But before you go back to demonizing saturated
Japan set out to answer this question in something fat, let’s examine the second belief that constitutes
the bedrock of fat theology, the idea that saturated acids have less than six carbon atoms. though long-chain saturated fats were (bearing in colon cells, helps protect against colon cancer, fights
11
fat does really bad things to your cholesterol. That wasn’t too painful, right? mind, yet again, that correlation isn’t causation). oxidative stress, and reduces inflammation.
When cholesterol was assessed in the old-fashioned As few studies as there are looking directly at the Medium-chain saturated fats deserve some spe- In sum, although the research isn’t totally consis-
way—“total,” “good,” and “bad”—this idea might have effects of saturated on heart disease, even fewer cial mention here. Although mainstream nutrition still tent—and it rarely is in the field of nutrition—here’s
made sense, because a number of studies show that break down those effects by saturated fat subtype. gives it the side-eye, coconut oil rose to superfood what the science typically shows when it comes to
saturated fat does raise total cholesterol and LDL So, until the research world conspires in our favor to status due to its high concentration of these special individual saturated fatty acids:
cholesterol. And if you bought into the theory that answer our most pressing questions (hint: they’re not fats—in particular, lauric acid, a twelve-carbon fatty • Stearic acid (long-chain): Mainly found in beef,
cholesterol is a big cause of heart disease, this would usually the same questions grant money goes to acid—which have benefits far beyond the realm of butter, lard, mutton, coconut, palm kernel oil, and
be a good enough reason to give up the butter. fund), here’s what we have to work with: a bunch of heart health. Their shorter length allows them to cocoa butter. It has a neutral effect on LDL in
But this where it stops being so simple. You see, studies looking at individual saturated fatty acids and head straight to the liver for energy, reducing the general, and compared to other saturated fats,
saturated fat isn’t one single nutrient. Literally dozens blood cholesterol. It’s not perfect, but the findings—as potential for fat storage. Possibly even more exciting, slightly lowers LDL. Your body can also convert a
of unique saturated fatty acids exist—and, the kicker, we’ll see next—are enough to make it abundantly clear these fats have been shown to benefit a number of small amount of stearic acid into oleic acid—the
they all have different effects on your cholesterol and that talking about “saturated fat” as a single nutrient neurological conditions, including epilepsy, Alz- same monounsaturated fat abundant in olive oil.
health. Some raise LDL; some don’t. Some raise HDL; is like talking about “Africa” as a travel destination. heimer’s disease, and autism, while also having anti- • Palmitic acid (long-chain): The most common
some don’t. Some are associated with heart disease Just as Cape Town is a far cry from the Sahara microbial properties. And while coconut oil alone sup- form of saturated fat in most people’s diets. It’s
in observational studies; some are statistically inno- Desert, short- and medium-chain saturated fats are a plies plenty of medium-chain fats, an even more con- extremely abundant in palm oil, but is also found
cent. Given all the fuss made—and rightfully so—about whole different beast than their long-chain brethren. centrated source—MCT oil—has recently hit the scene in red meat, dairy, salmon, and egg yolks. It can
the differences between omega-3 and omega-6 poly- In a 2018 systematic review and meta-analysis, as a popular supplement. MCT oil is typically significantly raise LDL levels without impacting
unsaturated fats, it’s curious the Dietary Powers That Australian researchers set out to investigate how extracted from coconut oil, and may have an even HDL.
Be are so tight-lipped when it comes to differentiating medium-chain saturated fats versus long-chain satu- greater capacity than its parent oil to raise HDL with- • Myristic acid (long-chain): Found in coconut oil,
10
between various saturated fats. It’s kind of a big deal. rated fats affected people’s cholesterol levels. (For out impacting (or even lowering) LDL. dairy products, palm oil, and palm kernel oil. This
Let’s look at why. reference: Medium-chain fats—also known as medium- In one 16-week trial comparing high intakes of form of saturated fat has the greatest LDL-
chain triglycerides or MCTs—are, as of this writing, MCT oil to olive oil, MCT oil-consuming participants raising effect out of all the saturated fats, with-
THE DEVIL’S IN THE DETAILS: wildly popular as a supplement. MCTs are abundant in actually saw a significant drop in their LDL levels. 12
out raising HDL.
THE DIFFERENT TYPES OF coconut oil, while long-chain saturated fats are abun- Short-chain saturated fats have also been studied • Lauric acid (medium-chain): Highest in coconut oil
SATURATED FAT dant in dairy fat, tallow, and lard.) After identifying a for their unusual health benefits. This group of fats— and palm kernel oil, making up almost half the fat
Here’s the stuff you won’t read in media headlines. Far dozen eligible trials in humans, the researchers found the tiniest of the bunch—are produced when bacteria in each of those oils. It has a small LDL-raising
from being one “thing,” saturated fatty acids can be that diets enriched with medium-chain fatty acids sig- in your colon ferment certain fibers, and that’s where effect, but raises HDL significantly—in fact, it’s the
grouped into three categories, all based on the number nificantly raised HDL levels, without impacting LDL. we get the majority of them. But here’s where dairy most powerful HDL-raiser out of any saturated fat!
of carbon atoms in their chain (don’t worry—this is as But while medium-chain saturated fats raised HDL, earns its stripes: Butter, especially the grass-fed vari- • Capric acid, caprylic acid, and caproic acid (all
technical as we’ll get!). Long-chain saturated fats are, long-chain saturated fats had almost no effect on ety, is one of our few dietary sources of butyric acid— medium-chain): Found in coconut oil, palm kernel
no surprise, long: They have fourteen to twenty carbon HDL. Even the famed Nurses’ Health Study found that one of the most beneficial short-chain saturated fats oil, and the now-popular MCT oil. Due to their
atoms. Medium-chain saturated fats have between six medium-chain or short-chain saturated fats were not out there. Butyric acid not only independently short length, they’re rapidly broken down and
and thirteen carbon atoms. Short-chain saturated fatty associated with increased heart disease risk, even reduces cholesterol levels, it also serves as food for absorbed rapidly, getting directly transported to
the bedrock of fat theology, the idea that saturated acids have less than six carbon atoms. though long-chain saturated fats were (bearing in colon cells, helps protect against colon cancer, fights
11
fat does really bad things to your cholesterol. That wasn’t too painful, right? mind, yet again, that correlation isn’t causation). oxidative stress, and reduces inflammation.
When cholesterol was assessed in the old-fashioned As few studies as there are looking directly at the Medium-chain saturated fats deserve some spe- In sum, although the research isn’t totally consis-
way—“total,” “good,” and “bad”—this idea might have effects of saturated on heart disease, even fewer cial mention here. Although mainstream nutrition still tent—and it rarely is in the field of nutrition—here’s
made sense, because a number of studies show that break down those effects by saturated fat subtype. gives it the side-eye, coconut oil rose to superfood what the science typically shows when it comes to
saturated fat does raise total cholesterol and LDL So, until the research world conspires in our favor to status due to its high concentration of these special individual saturated fatty acids:
cholesterol. And if you bought into the theory that answer our most pressing questions (hint: they’re not fats—in particular, lauric acid, a twelve-carbon fatty • Stearic acid (long-chain): Mainly found in beef,
cholesterol is a big cause of heart disease, this would usually the same questions grant money goes to acid—which have benefits far beyond the realm of butter, lard, mutton, coconut, palm kernel oil, and
be a good enough reason to give up the butter. fund), here’s what we have to work with: a bunch of heart health. Their shorter length allows them to cocoa butter. It has a neutral effect on LDL in
But this where it stops being so simple. You see, studies looking at individual saturated fatty acids and head straight to the liver for energy, reducing the general, and compared to other saturated fats,
saturated fat isn’t one single nutrient. Literally dozens blood cholesterol. It’s not perfect, but the findings—as potential for fat storage. Possibly even more exciting, slightly lowers LDL. Your body can also convert a
of unique saturated fatty acids exist—and, the kicker, we’ll see next—are enough to make it abundantly clear these fats have been shown to benefit a number of small amount of stearic acid into oleic acid—the
they all have different effects on your cholesterol and that talking about “saturated fat” as a single nutrient neurological conditions, including epilepsy, Alz- same monounsaturated fat abundant in olive oil.
health. Some raise LDL; some don’t. Some raise HDL; is like talking about “Africa” as a travel destination. heimer’s disease, and autism, while also having anti- • Palmitic acid (long-chain): The most common
some don’t. Some are associated with heart disease Just as Cape Town is a far cry from the Sahara microbial properties. And while coconut oil alone sup- form of saturated fat in most people’s diets. It’s
in observational studies; some are statistically inno- Desert, short- and medium-chain saturated fats are a plies plenty of medium-chain fats, an even more con- extremely abundant in palm oil, but is also found
cent. Given all the fuss made—and rightfully so—about whole different beast than their long-chain brethren. centrated source—MCT oil—has recently hit the scene in red meat, dairy, salmon, and egg yolks. It can
the differences between omega-3 and omega-6 poly- In a 2018 systematic review and meta-analysis, as a popular supplement. MCT oil is typically significantly raise LDL levels without impacting
unsaturated fats, it’s curious the Dietary Powers That Australian researchers set out to investigate how extracted from coconut oil, and may have an even HDL.
Be are so tight-lipped when it comes to differentiating medium-chain saturated fats versus long-chain satu- greater capacity than its parent oil to raise HDL with- • Myristic acid (long-chain): Found in coconut oil,
10
between various saturated fats. It’s kind of a big deal. rated fats affected people’s cholesterol levels. (For out impacting (or even lowering) LDL. dairy products, palm oil, and palm kernel oil. This
Let’s look at why. reference: Medium-chain fats—also known as medium- In one 16-week trial comparing high intakes of form of saturated fat has the greatest LDL-
chain triglycerides or MCTs—are, as of this writing, MCT oil to olive oil, MCT oil-consuming participants raising effect out of all the saturated fats, with-
THE DEVIL’S IN THE DETAILS: wildly popular as a supplement. MCTs are abundant in actually saw a significant drop in their LDL levels. 12
out raising HDL.
THE DIFFERENT TYPES OF coconut oil, while long-chain saturated fats are abun- Short-chain saturated fats have also been studied • Lauric acid (medium-chain): Highest in coconut oil
SATURATED FAT dant in dairy fat, tallow, and lard.) After identifying a for their unusual health benefits. This group of fats— and palm kernel oil, making up almost half the fat
Here’s the stuff you won’t read in media headlines. Far dozen eligible trials in humans, the researchers found the tiniest of the bunch—are produced when bacteria in each of those oils. It has a small LDL-raising
from being one “thing,” saturated fatty acids can be that diets enriched with medium-chain fatty acids sig- in your colon ferment certain fibers, and that’s where effect, but raises HDL significantly—in fact, it’s the
grouped into three categories, all based on the number nificantly raised HDL levels, without impacting LDL. we get the majority of them. But here’s where dairy most powerful HDL-raiser out of any saturated fat!
of carbon atoms in their chain (don’t worry—this is as But while medium-chain saturated fats raised HDL, earns its stripes: Butter, especially the grass-fed vari- • Capric acid, caprylic acid, and caproic acid (all
technical as we’ll get!). Long-chain saturated fats are, long-chain saturated fats had almost no effect on ety, is one of our few dietary sources of butyric acid— medium-chain): Found in coconut oil, palm kernel
no surprise, long: They have fourteen to twenty carbon HDL. Even the famed Nurses’ Health Study found that one of the most beneficial short-chain saturated fats oil, and the now-popular MCT oil. Due to their
atoms. Medium-chain saturated fats have between six medium-chain or short-chain saturated fats were not out there. Butyric acid not only independently short length, they’re rapidly broken down and
and thirteen carbon atoms. Short-chain saturated fatty associated with increased heart disease risk, even reduces cholesterol levels, it also serves as food for absorbed rapidly, getting directly transported to
the liver for energy. They tend to raise HDL cho- didn’t touch their LDL. Meanwhile, butter had a small globule membrane. Most milk fat comes in the form of milk fat, the two diets produced wildly different
lesterol and lower triglycerides. HDL-raising effect while dramatically raising LDL. (In tiny droplets surrounded by a thin membrane made results. Whereas the diet with butter oil increased
• Butyric acid (short-chain): Highest in butter, and case you’re wondering, the olive oil raised HDL about of lipids, proteins, and enzymes, and that membrane total and LDL cholesterol, the diet containing milk fat
also produced in the colon when bacteria ferment as much as butter and didn’t impact LDL one way or happens to be chock-full of compounds that affect globule membrane didn’t alter the participants’ lipid
certain fibers. Butyrate can help suppress choles- the other.) everything from brain function to gut health to profiles. The researchers suspected this was due to
terol synthesis in the body and lower LDL levels— Amusingly, the researchers called the results immune defense, and even gene expression. milk fat globule protein suppressing the expression of
on top of improving insulin sensitivity and blood “somewhat surprising,” due to coconut oil’s high con- In dairy products made from less processed milk— certain genes related to cholesterol metabolism.
sugar control, which (as you’ll see in chapter 9 or tent of saturated fat—which, in their words, “is gener- think cream and cheese—milk fat globule membrane When it comes to dairy, of course, the important
as you saw in chapter6), may be one of the most ally held to have an adverse effect on blood lipids by remains intact. During processing methods like homog- question isn’t how it impacts cholesterol levels, but
important factors in the development of heart increasing blood LDL-C concentrations.” The different enization, though, fat globules get broken down and how it impacts actual disease and mortality outcomes.
disease. composition of these fats—rather than their overall the structure of their membrane gets altered, losing its Even here, the scientific literature isn’t totally clear. A
Looking at this list, you might notice a bit of a saturated fat content—was responsible for their spe- bioactive properties. This could be why studies tend to review of eighteen observational studies found that
problem. Most of the foods here contain more than cific effects on blood cholesterol. be inconsistent when looking at high-fat dairy prod- milk, cheese, and yogurt tended to be negatively
one type of saturated fat. And sometimes—like in the Does this mean we should swap out butter for ucts: Less refined, fat globule membrane-containing associated with cardiovascular disease, whereas but-
case of coconut oil, those different saturated fats coconut oil to fill our culinary needs? Not so fast! Even items like cheese, cream, and yogurt tend to have a ter had mixed results—raising the risk in some studies,
have seemingly opposite effects on cholesterol. In if we go out on that long, ever-weakening limb that negligible impact on LDL, while butter—which has much and having a neutral effect in others.15
coconut oil, for example, one of the fats—lauric acid— asserts our blood cholesterol directly and significantly lower levels of milk fat globule membrane, as a result
raises HDL cholesterol. Another—stearic acid—has no raises heart disease risk, recall that butter is one of of the churning process transferring the membrane to THE CARBOHYDRATE SWAP
impact at all on cholesterol. What happens when both our only dietary sources of butyric acid—that special lit- the buttermilk fraction—tends to raise LDL significantly. For decades, most health professionals have told us
of those saturated fatty acids join forces within one tle fat with a whole slew of health benefits. Butter Studying high-fat dairy products as a whole misses this that we’d be doing ourselves a huge favor if we just
food? Does one clearly dominate? Do their effects might raise LDL more so than it does HDL, but it does important nuance! cut out saturated fat and replaced it with carbo-
cancel out? Do they play “rock, paper, scissors” to fig- so alongside some pretty impressive health perks. In 2015, a fascinating randomized trial was pub- hydrates. And that’s exactly what most people did.
ure out a winner? Can you see why trying to study the effects of lished in the American Journal of Clinical Nutrition After all, this idea fit nicely with the prevailing ethos:
Often, the only way to tell is by studying each saturated fat as a single, all-encompassing category is looking at the impact of milk fat globule membrane Saturated fat is bad, and “complex” carbohydrates are
14
food directly. For an example of how this pans out in an exercise in futility? on blood lipids and cholesterol metabolism. In it, good. If we just swap ’em, everyone will go home
the real world, we can look at a recent randomized Swedish researchers placed fifty-seven overweight happy, and all will be right with the world.
trial testing the blood lipid effects of eating different A Word on Dairy adults on one of two diets, each with the same num- So, as our old friend Dr. Phil might’ve said, “How’s
fats—two saturated, and one monounsaturated. In this Dairy: Is it good for your bones? Bad for your heart? ber of calories, for eight weeks total: one diet contain- that working for you?”
study, ninety-four healthy men and women were Is butter an artery-clogging killer, or falsely accused? ing 40 g per day of milk fat as whipping cream (con- The answer is, “Not so well.”
assigned to consume 50 grams daily of extra-virgin And what about the French—with their historically low taining milk fat globule membrane), and the other One important study shed light on the whole
coconut oil, butter, or extra-virgin olive oil for a total heart disease rates and famously cheese-rich cuisine? containing the same amount of milk fat, but in the “carbs for saturated fat” swap but raised a lot of
13
of four weeks. It turns out, there’s a reason the science is so form of butter oil (without intact milk fat globule eyebrows because of its unexpected results. The
The results? Compared to baseline, the coconut confusing (and often contradictory) when it comes to membrane). study, titled “Dietary Fats, Carbohydrate, and
oil significantly raised participants’ HDL levels, but dairy—and it has to do with something called milk fat Despite containing the exact same amount of the Progression of Coronary Atherosclerosis in
the liver for energy. They tend to raise HDL cho- didn’t touch their LDL. Meanwhile, butter had a small globule membrane. Most milk fat comes in the form of milk fat, the two diets produced wildly different
lesterol and lower triglycerides. HDL-raising effect while dramatically raising LDL. (In tiny droplets surrounded by a thin membrane made results. Whereas the diet with butter oil increased
• Butyric acid (short-chain): Highest in butter, and case you’re wondering, the olive oil raised HDL about of lipids, proteins, and enzymes, and that membrane total and LDL cholesterol, the diet containing milk fat
also produced in the colon when bacteria ferment as much as butter and didn’t impact LDL one way or happens to be chock-full of compounds that affect globule membrane didn’t alter the participants’ lipid
certain fibers. Butyrate can help suppress choles- the other.) everything from brain function to gut health to profiles. The researchers suspected this was due to
terol synthesis in the body and lower LDL levels— Amusingly, the researchers called the results immune defense, and even gene expression. milk fat globule protein suppressing the expression of
on top of improving insulin sensitivity and blood “somewhat surprising,” due to coconut oil’s high con- In dairy products made from less processed milk— certain genes related to cholesterol metabolism.
sugar control, which (as you’ll see in chapter 9 or tent of saturated fat—which, in their words, “is gener- think cream and cheese—milk fat globule membrane When it comes to dairy, of course, the important
as you saw in chapter6), may be one of the most ally held to have an adverse effect on blood lipids by remains intact. During processing methods like homog- question isn’t how it impacts cholesterol levels, but
important factors in the development of heart increasing blood LDL-C concentrations.” The different enization, though, fat globules get broken down and how it impacts actual disease and mortality outcomes.
disease. composition of these fats—rather than their overall the structure of their membrane gets altered, losing its Even here, the scientific literature isn’t totally clear. A
Looking at this list, you might notice a bit of a saturated fat content—was responsible for their spe- bioactive properties. This could be why studies tend to review of eighteen observational studies found that
problem. Most of the foods here contain more than cific effects on blood cholesterol. be inconsistent when looking at high-fat dairy prod- milk, cheese, and yogurt tended to be negatively
one type of saturated fat. And sometimes—like in the Does this mean we should swap out butter for ucts: Less refined, fat globule membrane-containing associated with cardiovascular disease, whereas but-
case of coconut oil, those different saturated fats coconut oil to fill our culinary needs? Not so fast! Even items like cheese, cream, and yogurt tend to have a ter had mixed results—raising the risk in some studies,
have seemingly opposite effects on cholesterol. In if we go out on that long, ever-weakening limb that negligible impact on LDL, while butter—which has much and having a neutral effect in others.15
coconut oil, for example, one of the fats—lauric acid— asserts our blood cholesterol directly and significantly lower levels of milk fat globule membrane, as a result
raises HDL cholesterol. Another—stearic acid—has no raises heart disease risk, recall that butter is one of of the churning process transferring the membrane to THE CARBOHYDRATE SWAP
impact at all on cholesterol. What happens when both our only dietary sources of butyric acid—that special lit- the buttermilk fraction—tends to raise LDL significantly. For decades, most health professionals have told us
of those saturated fatty acids join forces within one tle fat with a whole slew of health benefits. Butter Studying high-fat dairy products as a whole misses this that we’d be doing ourselves a huge favor if we just
food? Does one clearly dominate? Do their effects might raise LDL more so than it does HDL, but it does important nuance! cut out saturated fat and replaced it with carbo-
cancel out? Do they play “rock, paper, scissors” to fig- so alongside some pretty impressive health perks. In 2015, a fascinating randomized trial was pub- hydrates. And that’s exactly what most people did.
ure out a winner? Can you see why trying to study the effects of lished in the American Journal of Clinical Nutrition After all, this idea fit nicely with the prevailing ethos:
Often, the only way to tell is by studying each saturated fat as a single, all-encompassing category is looking at the impact of milk fat globule membrane Saturated fat is bad, and “complex” carbohydrates are
14
food directly. For an example of how this pans out in an exercise in futility? on blood lipids and cholesterol metabolism. In it, good. If we just swap ’em, everyone will go home
the real world, we can look at a recent randomized Swedish researchers placed fifty-seven overweight happy, and all will be right with the world.
trial testing the blood lipid effects of eating different A Word on Dairy adults on one of two diets, each with the same num- So, as our old friend Dr. Phil might’ve said, “How’s
fats—two saturated, and one monounsaturated. In this Dairy: Is it good for your bones? Bad for your heart? ber of calories, for eight weeks total: one diet contain- that working for you?”
study, ninety-four healthy men and women were Is butter an artery-clogging killer, or falsely accused? ing 40 g per day of milk fat as whipping cream (con- The answer is, “Not so well.”
assigned to consume 50 grams daily of extra-virgin And what about the French—with their historically low taining milk fat globule membrane), and the other One important study shed light on the whole
coconut oil, butter, or extra-virgin olive oil for a total heart disease rates and famously cheese-rich cuisine? containing the same amount of milk fat, but in the “carbs for saturated fat” swap but raised a lot of
13
of four weeks. It turns out, there’s a reason the science is so form of butter oil (without intact milk fat globule eyebrows because of its unexpected results. The
The results? Compared to baseline, the coconut confusing (and often contradictory) when it comes to membrane). study, titled “Dietary Fats, Carbohydrate, and
oil significantly raised participants’ HDL levels, but dairy—and it has to do with something called milk fat Despite containing the exact same amount of the Progression of Coronary Atherosclerosis in
DR. SINATRA: THE CASE AGAINST CANOLA OIL DR. JONNY: GOOD CARBS, BAD CARBS
Back in 1997, I wrote an article for Connecticut Medicine about oxidized LDL and free radicals. Whenever I give a talk about healthy eating and I mention that a diet very high in carbohydrates
I was very gung ho about canola oil at the time—as were most of my colleagues—and I was is problematic for most people, I’m very careful to add the caveat: “I’m not talking about fruits
emphatic in my recommendation of it. and vegetables!” So here’s a quick cheat sheet on “good” versus “bad” carbs.
But the paper was rejected. Good carbs include the following foods:
A Yale professor of medicine who was on the peer-review board—a biochemist, in fact— • Fruits
reviewed the paper and nixed it for publication. But he was kind enough to suggest some • Vegetables
review articles on canola oil in the literature. • Beans and legumes
I read them. Bad carbs, which cover almost all carbs that come in a box with a bar code*, include:
My reaction: “What have I been smoking all these years?” • Cereals • Pastries
The success of canola oil and its reputation as the healthiest of oils is a triumph of • White rice • Snack foods
marketing over science. It’s a terrible oil. It’s typically extracted and refined using very high • Pasta • Sodas
heat and petroleum solvents (such as hexane). Then it undergoes a process of refining, • Breads • Juice drinks
degumming, bleaching, and—because it stinks—deodorization using even more chemicals. The • Cookies • Crackers
only kind of canola oil that could possibly be okay is organic, cold-pressed, unrefined canola
* There are exceptions in the categories of cereal and bread, but they are few and far between.
oil, and hardly anyone is using that.
Oatmeal is one example (but not the instant kind). Ezekiel 4:9 bread is another. But by and
Our friend Fred Pescatore, M.D., best-selling author of The Hamptons Diet and former
large if you stay away from most of the foods on the above list—or keep them to an absolute
medical director of the Atkins Center, is something of a cooking oil expert. Here’s what he had
minimum—you’ll be much better off.
to say about canola oil: “I would never use this stuff!”
If you’d like to read more about the dark side of canola oil, check out the definitive paper
by lipid biochemist Mary Enig and Weston A. Price Foundation president Sally Fallon. Widely
should substantially reduce your risk for heart disease. hardly the dietary demon it’s been made out to be.
available online, it’s called, tellingly, “The Great Con-Ola.”
Except that it didn’t. “Greater saturated fat intake And if this were not a knockout punch by itself,
As for my 1997 paper, I revised it, removing the recommendation to use canola oil.
is associated with less progression of coronary ath- consider what was associated with a greater progres-
The paper was accepted and published.
erosclerosis, whereas carbohydrate intake is associ- sion of coronary atherosclerosis.
ated with a greater progression [italics ours],” the Are you sitting down? Carbohydrates.
Post-menopausal Women,” was conducted by the dis- ate a relatively low-fat diet. Noting that standard authors concluded. “Women with higher saturated fat Especially the high-glycemic, processed variety of
tinguished researcher Dariush Mozaffarian and his dietary advice has always been to eat less saturated intakes had less progression of coronary carbohydrates, which is exactly what we tend to eat
16
associates from Harvard Medical School. fat, the researchers wondered exactly what terrific atherosclerosis.” when we replace saturated fat in the diet with so-
As the study title suggests, Mozaffarian set out to things would happen if you replaced terrible saturated Greater saturated fat intake was also associated called “complex” carbs such as breads, pasta, rice,
investigate how various fats—saturated, polyunsatu- fat with other food substances. According to the stan- with higher HDL levels, higher HDL-2 cholesterol levels, and cereal.
rated, and monounsaturated—influenced the progres- dard advice, replacing saturated fat with good stuff lower triglycerides, and an improved total cholesterol “The findings also suggest,” wrote the re-
sion of heart disease in postmenopausal women who (e.g., carbs or “good fats” such as vegetable oils) to HDL ratio. Saturated fat, at least in this study, was searchers, “that carbohydrate intake may increase
DR. SINATRA: THE CASE AGAINST CANOLA OIL DR. JONNY: GOOD CARBS, BAD CARBS
Back in 1997, I wrote an article for Connecticut Medicine about oxidized LDL and free radicals. Whenever I give a talk about healthy eating and I mention that a diet very high in carbohydrates
I was very gung ho about canola oil at the time—as were most of my colleagues—and I was is problematic for most people, I’m very careful to add the caveat: “I’m not talking about fruits
emphatic in my recommendation of it. and vegetables!” So here’s a quick cheat sheet on “good” versus “bad” carbs.
But the paper was rejected. Good carbs include the following foods:
A Yale professor of medicine who was on the peer-review board—a biochemist, in fact— • Fruits
reviewed the paper and nixed it for publication. But he was kind enough to suggest some • Vegetables
review articles on canola oil in the literature. • Beans and legumes
I read them. Bad carbs, which cover almost all carbs that come in a box with a bar code*, include:
My reaction: “What have I been smoking all these years?” • Cereals • Pastries
The success of canola oil and its reputation as the healthiest of oils is a triumph of • White rice • Snack foods
marketing over science. It’s a terrible oil. It’s typically extracted and refined using very high • Pasta • Sodas
heat and petroleum solvents (such as hexane). Then it undergoes a process of refining, • Breads • Juice drinks
degumming, bleaching, and—because it stinks—deodorization using even more chemicals. The • Cookies • Crackers
only kind of canola oil that could possibly be okay is organic, cold-pressed, unrefined canola
* There are exceptions in the categories of cereal and bread, but they are few and far between.
oil, and hardly anyone is using that.
Oatmeal is one example (but not the instant kind). Ezekiel 4:9 bread is another. But by and
Our friend Fred Pescatore, M.D., best-selling author of The Hamptons Diet and former
large if you stay away from most of the foods on the above list—or keep them to an absolute
medical director of the Atkins Center, is something of a cooking oil expert. Here’s what he had
minimum—you’ll be much better off.
to say about canola oil: “I would never use this stuff!”
If you’d like to read more about the dark side of canola oil, check out the definitive paper
by lipid biochemist Mary Enig and Weston A. Price Foundation president Sally Fallon. Widely
should substantially reduce your risk for heart disease. hardly the dietary demon it’s been made out to be.
available online, it’s called, tellingly, “The Great Con-Ola.”
Except that it didn’t. “Greater saturated fat intake And if this were not a knockout punch by itself,
As for my 1997 paper, I revised it, removing the recommendation to use canola oil.
is associated with less progression of coronary ath- consider what was associated with a greater progres-
The paper was accepted and published.
erosclerosis, whereas carbohydrate intake is associ- sion of coronary atherosclerosis.
ated with a greater progression [italics ours],” the Are you sitting down? Carbohydrates.
Post-menopausal Women,” was conducted by the dis- ate a relatively low-fat diet. Noting that standard authors concluded. “Women with higher saturated fat Especially the high-glycemic, processed variety of
tinguished researcher Dariush Mozaffarian and his dietary advice has always been to eat less saturated intakes had less progression of coronary carbohydrates, which is exactly what we tend to eat
16
associates from Harvard Medical School. fat, the researchers wondered exactly what terrific atherosclerosis.” when we replace saturated fat in the diet with so-
As the study title suggests, Mozaffarian set out to things would happen if you replaced terrible saturated Greater saturated fat intake was also associated called “complex” carbs such as breads, pasta, rice,
investigate how various fats—saturated, polyunsatu- fat with other food substances. According to the stan- with higher HDL levels, higher HDL-2 cholesterol levels, and cereal.
rated, and monounsaturated—influenced the progres- dard advice, replacing saturated fat with good stuff lower triglycerides, and an improved total cholesterol “The findings also suggest,” wrote the re-
sion of heart disease in postmenopausal women who (e.g., carbs or “good fats” such as vegetable oils) to HDL ratio. Saturated fat, at least in this study, was searchers, “that carbohydrate intake may increase
atherosclerotic progression, especially when refined replaced with polyunsaturated fat there was no drates, such as Brussels sprouts or kale, no one would
carbohydrates replace saturated or monounsaturated change in atherosclerotic progression—in terms of complain. Substituting saturated fat with low-glycemic
GLYCEMIC INDEX AND
fats.” heart disease risk, it was a wash. But when saturated carbs such as vegetables doesn’t increase the risk of
GLYCEMIC LOAD
“Wait a minute,” you might well say. “When I take fat was replaced with polyunsaturated fat, there was a heart attacks at all, but substitution of saturated fat
Glycemic index is a measure of how
the saturated fat out of my diet and replace it with big change—but not in the expected direction. with high-glycemic carbs does—by a fair amount, actu-
quickly a given amount of food raises
high-glycemic carbohydrates I’m actually increasing Replacing saturated fat with polyunsaturated fat actually. A study in the American Journal of Clinical
your blood sugar (and keeps it elevated).
my risk for heart disease?” ally led to an increase in the progression of coronary Nutrition found that replacing saturated fats with
Glycemic load is a related (and more
Um, yes. atherosclerosis!17 high-glycemic index carbs was associated with a 33
accurate) measure of the same thing.
By the way, Mozaffarian and his research team (This seemingly crazy finding will make a lot more percent increase in heart attack risk.21 Because most
High-glycemic foods—such as most white
didn’t just look at cholesterol. They looked at actual sense when we discuss those special classes of poly- people replace saturated fat with exactly these kinds
breads, white rice, and cereals—are
clinical events, such as heart attacks and deaths, from unsaturated fat mentioned earlier in the chapter, of processed, high-glycemic (high-sugar) carbs (e.g.,
simply those that send your blood sugar
any type of cardiovascular disease. They also looked omega-3s and omega-6s. Stay tuned.) breads, cereals, and pasta), the conventional wisdom
on a roller–coaster ride. Low-glycemic
at lesser known metrics that only your doctor will If you’re confused by these findings, you’re hardly to cut out saturated fat and consume lots of carbs
foods include most fruits and vegetables
appreciate (such as coronary revascularization and alone. The American Journal of Clinical Nutrition instead is starting to look like an increasingly bone-
as well as beans and legumes.
unstable angina). devoted an entire editorial to the findings titled headed notion.
Bottom line: Greater saturated fat intake didn’t “Saturated Fat Prevents Coronary Artery Disease? An Although it’s not perfect, saturated fat does a
18
increase the risk for any of them. American Paradox.” But it’s only a paradox if we number of good things in the body. Its wholesale
refuse to question the bedrock belief of fat theology replacement by the worst kind of carbohydrates is the ones you’re eating, and your liver is creating even
VEGETABLE OILS: MYTHS AND that saturated fat consumption increases the risk for turning out to be a cure far worse than the disease. 22
more of them, fueled by the carbs you’re consuming.
MYTH-CONCEPTIONS heart disease. The research is showing that it does not. A recent Dutch study added to the list of accumulat- Because large amounts of saturated fat can lessen
The researchers also tested what happens when you We worry deeply about the wholesale, unqualified ing research showing that when you substitute high- the anti-inflammatory actions of HDL cholesterol,24
replace saturated fat with polyunsaturated fat (such recommendation to reduce saturated fat at all costs, glycemic carbohydrates for saturated fat you actually this isn’t a good situation.
23
as vegetable oils), the conventional dietary advice because it invariably means that people will replace it increase cardiovascular risk. But the Dutch research- However, the Dutch researchers correctly noted
given by just about every major health organization. with processed carbohydrates. That switcheroo is just ers had an interesting take on this, one that appreci- that cutting saturated fat out of the diet is not the
Maybe high-sugar carbs aren’t so good for us after about guaranteed to both reduce HDLs and increase ates that an accumulation of saturated fat in the body most effective way to combat the accumulation of
all, but what about the much-touted vegetable oils, triglycerides, and if you’re trying to prevent heart dis- is not necessarily the best thing in the world. saturated fatty acids in the body. It’s far better, they
19
which contain the “healthy fat” our doctors keep ease, those are very bad outcomes indeed. In the They pointed out that eating a high amount of suggested, to reduce dietary carbohydrates. This way,
telling us about? Swapping saturated fat for a nice Nurses’ Health Study, for example, refined carbohy- carbs causes your body to hold on to the saturated your body makes fewer saturated fatty acids, and its
helping of healthy vegetable fat has got to be just the drates and their high glycemic load were indepen- fatty acids that you’re also consuming—and those sat- tendency to hold on to those you do eat is reduced.
ticket to heart health, right? dently shown to be associated with an increased risk urated fats get preserved, stored in your body rather “Attention should be shifted from the harmful effects
20
So the researchers looked at the effect of replac- for coronary heart disease. than burned for energy. Meanwhile, all those extra of dietary saturated fat per se to the prevention of
ing saturated fat with polyunsaturated fat. Just for Now don’t misunderstand us. If you wanted to carbs you’re eating get converted into more saturated the accumulation of saturated fatty acids (in the
fun, they also took a look at what happens when you swap some saturated fat out of your diet and trade it fatty acids in the liver. Now you’ve got a serious body),” the authors wrote. “This shift would empha-
swap carbs for polyunsaturated fat. When carbs were for some low-sugar, high-fiber, nutrient-rich carbohy- excess of saturated fatty acids—you’re holding on to size the importance of reducing dietary carbs, espe-
atherosclerotic progression, especially when refined replaced with polyunsaturated fat there was no drates, such as Brussels sprouts or kale, no one would
carbohydrates replace saturated or monounsaturated change in atherosclerotic progression—in terms of complain. Substituting saturated fat with low-glycemic
GLYCEMIC INDEX AND
fats.” heart disease risk, it was a wash. But when saturated carbs such as vegetables doesn’t increase the risk of
GLYCEMIC LOAD
“Wait a minute,” you might well say. “When I take fat was replaced with polyunsaturated fat, there was a heart attacks at all, but substitution of saturated fat
Glycemic index is a measure of how
the saturated fat out of my diet and replace it with big change—but not in the expected direction. with high-glycemic carbs does—by a fair amount, actu-
quickly a given amount of food raises
high-glycemic carbohydrates I’m actually increasing Replacing saturated fat with polyunsaturated fat actually. A study in the American Journal of Clinical
your blood sugar (and keeps it elevated).
my risk for heart disease?” ally led to an increase in the progression of coronary Nutrition found that replacing saturated fats with
Glycemic load is a related (and more
Um, yes. atherosclerosis!17 high-glycemic index carbs was associated with a 33
accurate) measure of the same thing.
By the way, Mozaffarian and his research team (This seemingly crazy finding will make a lot more percent increase in heart attack risk.21 Because most
High-glycemic foods—such as most white
didn’t just look at cholesterol. They looked at actual sense when we discuss those special classes of poly- people replace saturated fat with exactly these kinds
breads, white rice, and cereals—are
clinical events, such as heart attacks and deaths, from unsaturated fat mentioned earlier in the chapter, of processed, high-glycemic (high-sugar) carbs (e.g.,
simply those that send your blood sugar
any type of cardiovascular disease. They also looked omega-3s and omega-6s. Stay tuned.) breads, cereals, and pasta), the conventional wisdom
on a roller–coaster ride. Low-glycemic
at lesser known metrics that only your doctor will If you’re confused by these findings, you’re hardly to cut out saturated fat and consume lots of carbs
foods include most fruits and vegetables
appreciate (such as coronary revascularization and alone. The American Journal of Clinical Nutrition instead is starting to look like an increasingly bone-
as well as beans and legumes.
unstable angina). devoted an entire editorial to the findings titled headed notion.
Bottom line: Greater saturated fat intake didn’t “Saturated Fat Prevents Coronary Artery Disease? An Although it’s not perfect, saturated fat does a
18
increase the risk for any of them. American Paradox.” But it’s only a paradox if we number of good things in the body. Its wholesale
refuse to question the bedrock belief of fat theology replacement by the worst kind of carbohydrates is the ones you’re eating, and your liver is creating even
VEGETABLE OILS: MYTHS AND that saturated fat consumption increases the risk for turning out to be a cure far worse than the disease. 22
more of them, fueled by the carbs you’re consuming.
MYTH-CONCEPTIONS heart disease. The research is showing that it does not. A recent Dutch study added to the list of accumulat- Because large amounts of saturated fat can lessen
The researchers also tested what happens when you We worry deeply about the wholesale, unqualified ing research showing that when you substitute high- the anti-inflammatory actions of HDL cholesterol,24
replace saturated fat with polyunsaturated fat (such recommendation to reduce saturated fat at all costs, glycemic carbohydrates for saturated fat you actually this isn’t a good situation.
23
as vegetable oils), the conventional dietary advice because it invariably means that people will replace it increase cardiovascular risk. But the Dutch research- However, the Dutch researchers correctly noted
given by just about every major health organization. with processed carbohydrates. That switcheroo is just ers had an interesting take on this, one that appreci- that cutting saturated fat out of the diet is not the
Maybe high-sugar carbs aren’t so good for us after about guaranteed to both reduce HDLs and increase ates that an accumulation of saturated fat in the body most effective way to combat the accumulation of
all, but what about the much-touted vegetable oils, triglycerides, and if you’re trying to prevent heart dis- is not necessarily the best thing in the world. saturated fatty acids in the body. It’s far better, they
19
which contain the “healthy fat” our doctors keep ease, those are very bad outcomes indeed. In the They pointed out that eating a high amount of suggested, to reduce dietary carbohydrates. This way,
telling us about? Swapping saturated fat for a nice Nurses’ Health Study, for example, refined carbohy- carbs causes your body to hold on to the saturated your body makes fewer saturated fatty acids, and its
helping of healthy vegetable fat has got to be just the drates and their high glycemic load were indepen- fatty acids that you’re also consuming—and those sat- tendency to hold on to those you do eat is reduced.
ticket to heart health, right? dently shown to be associated with an increased risk urated fats get preserved, stored in your body rather “Attention should be shifted from the harmful effects
20
So the researchers looked at the effect of replac- for coronary heart disease. than burned for energy. Meanwhile, all those extra of dietary saturated fat per se to the prevention of
ing saturated fat with polyunsaturated fat. Just for Now don’t misunderstand us. If you wanted to carbs you’re eating get converted into more saturated the accumulation of saturated fatty acids (in the
fun, they also took a look at what happens when you swap some saturated fat out of your diet and trade it fatty acids in the liver. Now you’ve got a serious body),” the authors wrote. “This shift would empha-
swap carbs for polyunsaturated fat. When carbs were for some low-sugar, high-fiber, nutrient-rich carbohy- excess of saturated fatty acids—you’re holding on to size the importance of reducing dietary carbs, espe-
cially carbs with a high glycemic index, rather than trans fat–laden Crisco, the most popular vegetable Omega-6s are the precursors to the inflammatory is ALA, which is found in green, leafy vegetables and
25
reducing dietary saturated fat.” shortening of its time.) Even now, most people believe compounds in our body—they’re the building blocks in flaxseeds, chia seeds, perilla seeds, and walnuts.
that substituting vegetable oil for animal fats is uni- the body uses to make these inflammatory hormones That doesn’t mean the other two aren’t important. In
FAT IN THE DIET: OUR PERSPECTIVE versally a good thing. (specifically series 2 prostaglandins). And omega-3s terms of their overall effects on human health, the
We want to propose a different way of looking at fat But is it always? have the opposite function: The body uses omega-3s other two are probably more important than ALA. The
intake. We think what we are about to suggest goes a Let’s, as they say, go to the video. as building blocks for the anti-inflammatory com- reason the other two—EPA and DHA—aren’t considered
long way toward explaining the contradictory findings, Polyunsaturated fats as a whole are divided into two pounds (known as series 1 prostaglandins and series 3 “essential” is that scientists use the word essential in
or apparently contradictory findings, on saturated fat, subcategories: omega-3 fatty acids and omega-6 fatty prostaglandins). a different way than regular people use it in ordinary
diet, fat reduction, and cardiovascular disease. acids. (For those who’ve always wondered what the A ton of research has established that the ideal conversation. In this context, essential simply means
To do this, we have to briefly introduce the other heck an “omega” is anyway, you can think of the ratio of omega-6s to omega-3s in the human diet is that it’s something the body can’t make, so you have
two categories of fats besides saturated: monounsatu- terms omega-6 and omega-3 as real estate terms; somewhere between 1:1 and 4:1. This seems to be the to get it from your diet. Your body can make EPA and
rated fats and polyunsaturated fats. (Remember, all they’re simply descriptions of the location of certain best balance to keep inflammation in check and DHA, so technically they’re not classed as “essential.”
fatty acids fall into one of these three broad chemical structures—called double bonds—within the everything running smoothly. It’s the ratio found in Because the body can’t make ALA, however, it’s con-
categories.)* fatty acid. An omega-3 has its first double bond at the the diets of both hunter-gatherers and healthy indige- sidered an “essential” omega-3.
26
Monounsaturated fat is the fat that’s predominant third carbon atom in the chain, while omega-6 has its nous societies where heart disease is rare. But the fact that the body can make EPA and
in olive oil (as well as in nuts, avocados, and nut oils, first double bond at the sixth carbon atom in the But the ratio of omega-6s to omega-3s in Western DHA from ALA doesn’t mean it does a particularly
such as macadamia nut oil). Its health benefits have chain. Now, for our purposes, you can promptly forget diets is anywhere from an astonishing 15:1 to an even good job of it. It converts the ALA from the diet into
27
been well documented and are noncontroversial. all that and just concentrate on what these two types more astonishing 20:1 in favor of omega-6s. If you EPA and DHA using enzymes and a complicated series
Monounsaturated fat is the primary fat consumed in of fatty acids—omega-3s and omega-6s—actually do in think of the inflammatory and anti-inflammatory hor- of operations known as elongation and desaturation,
the highly touted Mediterranean diet, and it’s gener- the body.) mones as two armies that work together to create bal- the success of which is influenced by many different
ally accepted that this kind of fat is perfectly healthy. Omega-6s, as mentioned, are found primarily in ance in the body, that means we’re overfunding the factors, including the amount of inflammatory
For that reason, we won’t spend much time on it, vegetable oils and some plant foods. Omega-3s are inflammation army by 1,500 to 2,000 percent! omega-6’s in the diet. Even under the best of circum-
because it is pretty irrelevant at this point to the case found primarily in fish, such as salmon, and certain stances, only a small amount of ALA successfully gets
we’re about to make. animal foods, such as grass-fed beef, as well as in THE LAW OF UNINTENDED converted into the very critical EPA and DHA.
The real action is with polyunsaturated fats. some plant foods, such as flax and flaxseed oil. So far, CONSEQUENCES Omega-6s and omega-3s compete for the same
Remember, polyunsaturated fats, which are primarily so good. Our extraordinarily high intake of vegetable oil has enzymes, and when omega-6 intake is very high, it
found in vegetable oils, are the very ones we’ve been Here’s where it gets tricky. another unintended consequence, and one that may wins the competition by default. A high intake of
admonished to include more of in our diets. When Both inflammatory and anti-inflammatory hor- have a profound effect on cardiovascular health. To omega-6 reduces the conversion of ALA into EPA and
lard was slammed back in the early part of the twenti- mones, known as eicosanoids, are made in the body understand it, though, you have to take a short excur- DHA, which might be another reason why high
eth century, the health dictocrats started their cheer- from polyunsaturated fats. (And to answer the inevi- sion into the world of omega-3 fatty acids. (Trust us, omega-6 diets contribute to heart disease.28 So not
leading effort for vegetable fats. (The first major ben- table question, yes, we actually need both. Inflam- it’s a short and easy trip.) You see, there are actually only are those omega-6 fatty acids pro-inflammatory
eficiary of this all-out campaign to make vegetable matory compounds are a necessary part of the three omega-3 fatty acids—ALA (alpha-linolenic acid), on their own, but they also reduce the body’s ability
fats synonymous with “healthy” fat was actually the immune system and play a big part in the healing pro- EPA (eicosapentaenoic acid), and DHA (docosahexae- to produce two of the most anti-inflammatory sub-
* Trans fats are a special category. cess when you have a wound or other type of injury.) noic acid). The only one that is “essential” in the diet stances on the planet: the omega-3s EPA and DHA.
cially carbs with a high glycemic index, rather than trans fat–laden Crisco, the most popular vegetable Omega-6s are the precursors to the inflammatory is ALA, which is found in green, leafy vegetables and
25
reducing dietary saturated fat.” shortening of its time.) Even now, most people believe compounds in our body—they’re the building blocks in flaxseeds, chia seeds, perilla seeds, and walnuts.
that substituting vegetable oil for animal fats is uni- the body uses to make these inflammatory hormones That doesn’t mean the other two aren’t important. In
FAT IN THE DIET: OUR PERSPECTIVE versally a good thing. (specifically series 2 prostaglandins). And omega-3s terms of their overall effects on human health, the
We want to propose a different way of looking at fat But is it always? have the opposite function: The body uses omega-3s other two are probably more important than ALA. The
intake. We think what we are about to suggest goes a Let’s, as they say, go to the video. as building blocks for the anti-inflammatory com- reason the other two—EPA and DHA—aren’t considered
long way toward explaining the contradictory findings, Polyunsaturated fats as a whole are divided into two pounds (known as series 1 prostaglandins and series 3 “essential” is that scientists use the word essential in
or apparently contradictory findings, on saturated fat, subcategories: omega-3 fatty acids and omega-6 fatty prostaglandins). a different way than regular people use it in ordinary
diet, fat reduction, and cardiovascular disease. acids. (For those who’ve always wondered what the A ton of research has established that the ideal conversation. In this context, essential simply means
To do this, we have to briefly introduce the other heck an “omega” is anyway, you can think of the ratio of omega-6s to omega-3s in the human diet is that it’s something the body can’t make, so you have
two categories of fats besides saturated: monounsatu- terms omega-6 and omega-3 as real estate terms; somewhere between 1:1 and 4:1. This seems to be the to get it from your diet. Your body can make EPA and
rated fats and polyunsaturated fats. (Remember, all they’re simply descriptions of the location of certain best balance to keep inflammation in check and DHA, so technically they’re not classed as “essential.”
fatty acids fall into one of these three broad chemical structures—called double bonds—within the everything running smoothly. It’s the ratio found in Because the body can’t make ALA, however, it’s con-
categories.)* fatty acid. An omega-3 has its first double bond at the the diets of both hunter-gatherers and healthy indige- sidered an “essential” omega-3.
26
Monounsaturated fat is the fat that’s predominant third carbon atom in the chain, while omega-6 has its nous societies where heart disease is rare. But the fact that the body can make EPA and
in olive oil (as well as in nuts, avocados, and nut oils, first double bond at the sixth carbon atom in the But the ratio of omega-6s to omega-3s in Western DHA from ALA doesn’t mean it does a particularly
such as macadamia nut oil). Its health benefits have chain. Now, for our purposes, you can promptly forget diets is anywhere from an astonishing 15:1 to an even good job of it. It converts the ALA from the diet into
27
been well documented and are noncontroversial. all that and just concentrate on what these two types more astonishing 20:1 in favor of omega-6s. If you EPA and DHA using enzymes and a complicated series
Monounsaturated fat is the primary fat consumed in of fatty acids—omega-3s and omega-6s—actually do in think of the inflammatory and anti-inflammatory hor- of operations known as elongation and desaturation,
the highly touted Mediterranean diet, and it’s gener- the body.) mones as two armies that work together to create bal- the success of which is influenced by many different
ally accepted that this kind of fat is perfectly healthy. Omega-6s, as mentioned, are found primarily in ance in the body, that means we’re overfunding the factors, including the amount of inflammatory
For that reason, we won’t spend much time on it, vegetable oils and some plant foods. Omega-3s are inflammation army by 1,500 to 2,000 percent! omega-6’s in the diet. Even under the best of circum-
because it is pretty irrelevant at this point to the case found primarily in fish, such as salmon, and certain stances, only a small amount of ALA successfully gets
we’re about to make. animal foods, such as grass-fed beef, as well as in THE LAW OF UNINTENDED converted into the very critical EPA and DHA.
The real action is with polyunsaturated fats. some plant foods, such as flax and flaxseed oil. So far, CONSEQUENCES Omega-6s and omega-3s compete for the same
Remember, polyunsaturated fats, which are primarily so good. Our extraordinarily high intake of vegetable oil has enzymes, and when omega-6 intake is very high, it
found in vegetable oils, are the very ones we’ve been Here’s where it gets tricky. another unintended consequence, and one that may wins the competition by default. A high intake of
admonished to include more of in our diets. When Both inflammatory and anti-inflammatory hor- have a profound effect on cardiovascular health. To omega-6 reduces the conversion of ALA into EPA and
lard was slammed back in the early part of the twenti- mones, known as eicosanoids, are made in the body understand it, though, you have to take a short excur- DHA, which might be another reason why high
eth century, the health dictocrats started their cheer- from polyunsaturated fats. (And to answer the inevi- sion into the world of omega-3 fatty acids. (Trust us, omega-6 diets contribute to heart disease.28 So not
leading effort for vegetable fats. (The first major ben- table question, yes, we actually need both. Inflam- it’s a short and easy trip.) You see, there are actually only are those omega-6 fatty acids pro-inflammatory
eficiary of this all-out campaign to make vegetable matory compounds are a necessary part of the three omega-3 fatty acids—ALA (alpha-linolenic acid), on their own, but they also reduce the body’s ability
fats synonymous with “healthy” fat was actually the immune system and play a big part in the healing pro- EPA (eicosapentaenoic acid), and DHA (docosahexae- to produce two of the most anti-inflammatory sub-
* Trans fats are a special category. cess when you have a wound or other type of injury.) noic acid). The only one that is “essential” in the diet stances on the planet: the omega-3s EPA and DHA.
It’s a double whammy, and your heart is the loser. THE PARADOX OF THE We suspect that when very low-fat, high-carb with 231 scientific references) that was published in
No, the omega-6s that have been the darling of ULTRA-LOW-FAT DIET diets work at all—and they frequently don’t—they work the scientific journal Progress in Lipid Research.
the high-carb, low-fat movement, the vegetable oils At this point you may well be wondering why low-fat, because of these four dietary factors: fewer inflamma- Here’s what Lands had to say about saturated fat
we’ve been told to use instead of animal fats—the very high-carb diets work at all when they do work. If tory omega-6s, fewer high-glycemic carbs, more and heart disease:
vegetable oils that “saturate” (no pun intended) our saturated fat is not the bad guy we thought it was, dietary fiber, and much less fructose or sugar. We “Advice to replace saturated fat with unsaturated
diet through their incorporation into virtually every and if carbohydrates aren’t always the good guys, why believe that whatever benefits might sometimes fat stimulated my early experiments in lipid research.
baked, fried, and processed food available in the is it that some of these high-carb, super-low-fat accrue from extremely low-fat, high-carb diets could It made me ask by what mechanisms could saturated
supermarket, the very vegetable oils that restaurants programs seem to work sometimes? be easily achieved by simply reducing sugar and pro- fats be ‘bad’ and unsaturated fats ‘good’ . . . Fifty
proudly boast of using because they’re so “healthy”— Glad you asked, because we have a theory about cessed carbs, eliminating trans fats, increasing years later, I still cannot cite a definite mechanism or
are actually turning out to be as bad as, or worse that. omega-3s, and decreasing omega-6s. Reducing satu- mediator by which saturated fat is shown to kill peo-
than, the original saturated fats (such as lard) that Although many people may believe that rated fat and dietary cholesterol intakes has virtually ple . . . The current advice to the public needs to iden-
they replaced, just as margarine turned out to be far extremely low-fat diets work because they cut out nothing to do with it. tify logical causal mechanisms and mediators so we
worse than butter. saturated fat, we suspect a bigger benefit comes from Besides, what is the mechanism by which satu- can focus logically on what food choices to avoid.”34
For example, the primary omega-6 fatty acid— reducing omega-6s. Omega-6 is the predominant fat rated fat could cause heart disease? In 2008, the dis- When it comes to the theory that saturated fat
linoleic acid—has been shown to increase the oxida- we consume, and as we’ve seen, we consume way too tinguished biochemist Bill Lands attempted to answer kills people, Lands was essentially challenging his
tion of LDL cholesterol, thus increasing the severity much of it. When we follow a very low-fat diet we con- this and other related questions about conventional researcher colleagues to “prove it.”
29
of coronary atherosclerosis. One research study sume less of it, which automatically lowers the pro- dietary advice in a closely argued review (complete And they haven’t.
showed that a diet enriched with linoleic acid inflammatory to anti-inflammatory ratio. The fact that
increased the oxidation of the small, nasty LDL parti- saturated fat is lowered is actually incidental.
cles, precisely the cholesterol particles that are most In addition, those famous low-fat, high-carb diets,
dangerous and most involved in the formation of such as those promoted by McDougall, Ornish, and
arterial plaque.30 Omega-6s even inhibit your body’s Esselstyn, are remarkably low in sugar. The carb con- • “Saturated fat” actually refers to a family of fatty acids, each with different health effects—
ability to fully incorporate the EPA you get from fish tent may be high, but they’re not the carbs most peo- some good, some bad, some neutral. It isn’t a single nutrient—it’s a family containing many
or fish oil supplements into the cell membranes, ple are gorging on. The carbs in these high-carb diets different fatty acids, each with different health effects.
which is meaningful because EPA is the omega-3 that tend to be vegetables, fruits, and minimally processed • Saturated fat has been wrongfully demonized. Several recent studies have shown that
has the most profound effect on the heart.31 starches, such as beans and brown rice. And although saturated fat is not associated with a greater risk of heart disease.35
Published values for omega-6 intake closely track some of the starches may be high-glycemic (such as • The balance between dietary intake of omega-6 and omega-3 is far more important than
observed coronary heart disease death rates for all potatoes), they’re high in fiber (a boon for gut health dietary intake of saturated fat.
sorts of populations worldwide.32 And in the famous and short-chain fatty acid production in the colon)
MRFIT study, subjects with the lowest ratio of and they don’t contain a ton of fructose (as do most
omega-6 to omega-3 (i.e., those with the lowest processed carbs and virtually all packaged goods).
intakes of omega-6 relative to their omega-3 intakes) Fructose is the most metabolically dangerous of the
33
had the lowest death rate. sugars, and it is a very minor player in any of the low-
fat, high-carb diets that are successful.
It’s a double whammy, and your heart is the loser. THE PARADOX OF THE We suspect that when very low-fat, high-carb with 231 scientific references) that was published in
No, the omega-6s that have been the darling of ULTRA-LOW-FAT DIET diets work at all—and they frequently don’t—they work the scientific journal Progress in Lipid Research.
the high-carb, low-fat movement, the vegetable oils At this point you may well be wondering why low-fat, because of these four dietary factors: fewer inflamma- Here’s what Lands had to say about saturated fat
we’ve been told to use instead of animal fats—the very high-carb diets work at all when they do work. If tory omega-6s, fewer high-glycemic carbs, more and heart disease:
vegetable oils that “saturate” (no pun intended) our saturated fat is not the bad guy we thought it was, dietary fiber, and much less fructose or sugar. We “Advice to replace saturated fat with unsaturated
diet through their incorporation into virtually every and if carbohydrates aren’t always the good guys, why believe that whatever benefits might sometimes fat stimulated my early experiments in lipid research.
baked, fried, and processed food available in the is it that some of these high-carb, super-low-fat accrue from extremely low-fat, high-carb diets could It made me ask by what mechanisms could saturated
supermarket, the very vegetable oils that restaurants programs seem to work sometimes? be easily achieved by simply reducing sugar and pro- fats be ‘bad’ and unsaturated fats ‘good’ . . . Fifty
proudly boast of using because they’re so “healthy”— Glad you asked, because we have a theory about cessed carbs, eliminating trans fats, increasing years later, I still cannot cite a definite mechanism or
are actually turning out to be as bad as, or worse that. omega-3s, and decreasing omega-6s. Reducing satu- mediator by which saturated fat is shown to kill peo-
than, the original saturated fats (such as lard) that Although many people may believe that rated fat and dietary cholesterol intakes has virtually ple . . . The current advice to the public needs to iden-
they replaced, just as margarine turned out to be far extremely low-fat diets work because they cut out nothing to do with it. tify logical causal mechanisms and mediators so we
worse than butter. saturated fat, we suspect a bigger benefit comes from Besides, what is the mechanism by which satu- can focus logically on what food choices to avoid.”34
For example, the primary omega-6 fatty acid— reducing omega-6s. Omega-6 is the predominant fat rated fat could cause heart disease? In 2008, the dis- When it comes to the theory that saturated fat
linoleic acid—has been shown to increase the oxida- we consume, and as we’ve seen, we consume way too tinguished biochemist Bill Lands attempted to answer kills people, Lands was essentially challenging his
tion of LDL cholesterol, thus increasing the severity much of it. When we follow a very low-fat diet we con- this and other related questions about conventional researcher colleagues to “prove it.”
29
of coronary atherosclerosis. One research study sume less of it, which automatically lowers the pro- dietary advice in a closely argued review (complete And they haven’t.
showed that a diet enriched with linoleic acid inflammatory to anti-inflammatory ratio. The fact that
increased the oxidation of the small, nasty LDL parti- saturated fat is lowered is actually incidental.
cles, precisely the cholesterol particles that are most In addition, those famous low-fat, high-carb diets,
dangerous and most involved in the formation of such as those promoted by McDougall, Ornish, and
arterial plaque.30 Omega-6s even inhibit your body’s Esselstyn, are remarkably low in sugar. The carb con- • “Saturated fat” actually refers to a family of fatty acids, each with different health effects—
ability to fully incorporate the EPA you get from fish tent may be high, but they’re not the carbs most peo- some good, some bad, some neutral. It isn’t a single nutrient—it’s a family containing many
or fish oil supplements into the cell membranes, ple are gorging on. The carbs in these high-carb diets different fatty acids, each with different health effects.
which is meaningful because EPA is the omega-3 that tend to be vegetables, fruits, and minimally processed • Saturated fat has been wrongfully demonized. Several recent studies have shown that
has the most profound effect on the heart.31 starches, such as beans and brown rice. And although saturated fat is not associated with a greater risk of heart disease.35
Published values for omega-6 intake closely track some of the starches may be high-glycemic (such as • The balance between dietary intake of omega-6 and omega-3 is far more important than
observed coronary heart disease death rates for all potatoes), they’re high in fiber (a boon for gut health dietary intake of saturated fat.
sorts of populations worldwide.32 And in the famous and short-chain fatty acid production in the colon)
MRFIT study, subjects with the lowest ratio of and they don’t contain a ton of fructose (as do most
omega-6 to omega-3 (i.e., those with the lowest processed carbs and virtually all packaged goods).
intakes of omega-6 relative to their omega-3 intakes) Fructose is the most metabolically dangerous of the
33
had the lowest death rate. sugars, and it is a very minor player in any of the low-
fat, high-carb diets that are successful.
But she didn’t quit MIT. “In those days,” she told methodologically precise skills as a researcher to the
us, “you could get a job as a programmer with no task at hand and proceeded to try to learn everything
CHAPTER 8 prior experience. I got a job at MIT Lincoln there was to learn about cholesterol, heart disease,
Laboratory, where I lucked into a group of pioneers in and statin drugs. Understand, now, that she had not
the fledging field of computer speech processing.” spent four years in medical school being subtly influ-
Voilà. Seneff found a home, a perfect blend of enced by the drug companies, had not been a consul-
THE STATIN her two great interests—biology and computer dia-

logue systems. She went on to earn a Ph.D. in electri-
tant to the pharmaceutical industry, had not been vis-
ited daily by a charming crew of pharmaceutical reps
DECEPTION
cal engineering from MIT, ultimately publishing more spinning industry-funded studies touting the benefits
than 170 papers and becoming one of the world’s of their products. And she had not been paid hefty
leading experts in blending biological systems with fees by those same pharmaceutical companies (the
computer intelligence. (It was her pioneering work in way Dr. Sinatra had been) to give “educational” lec-
the field of voice recognition and computer systems tures on behalf of their products (lectures that are lit-
that led to commercial applications such as SIRI, the tle more than marketing tools disguised as
STEPHANIE SENEFF ALWAYS WANTED TO BE A BIOLOGIST. virtual assistant built into the iPhone.) scholarship).
For as long as she can remember, she has been fascinated by how things work, particularly Then something happened: Seneff’s husband was She had no agenda—other than to help her hus-
how living things work. She wanted to know how frogs jump, how grasshoppers breathe, how cells diagnosed with heart disease. band get well. Basically, she wasn’t bought or influ-
communicate, how the heart talks to the brain, all of which scientists study in detail, frequently by His doctor put him on a high-dose statin—four enced by or beholden to anyone in the heart disease–
spending hours a day peering into a microscope. She was interested in systems, and to her the human times the usual dose—and told him it was imperative cholesterol–statin drug establishment. She had no
body was the most fascinating system of all. So she was more than a little delighted when, after high that he stay on it. “If you go off this, or even reduce preconceived ideas, either positive or negative, about
school, she was accepted into the biology program at MIT. the dosage, I can no longer be your doctor,” his physi- what she’d find. Her research was motivated only by a
After completing her B.S. in biophysics, she entered the MIT Ph.D. program and spent a year cian told him. desire to get her husband well, and by her lifelong
working under Professor Harvey Lodish in the laboratory headed by future Nobel Prize winner David Almost immediately, the side effects started. He interest in biology and nutrition.
Baltimore. developed debilitating shoulder problems; muscle And let’s remember that we’re talking about
But there was a problem. After a year in Baltimore’s lab, Seneff realized two things. One, she aches and weakness (he could no longer open drawers someone who has a world-class ability to understand
wasn’t really cut out for the isolation required by a life in the lab, and two, she wanted to start a or jars); cognitive and memory problems; and depres- systems, theory, statistics, interpretation, experimen-
family. So she quit the Ph.D. program. sion, something he had never experienced before. tal bias, confounding variables, and all the rest of the
We all know what we do when we first get a diag- esoterica associated with evaluating studies.
nosis, or are prescribed a medication we’re not famil- Here’s what Seneff told us about statin drugs
iar with, or begin having a bunch of unexplained when we contacted her for this book: “Statin drugs
symptoms or side effects: We ask Dr. Google, which is are toxic. I liken them to arsenic, which will slowly poi-
exactly what Seneff did. son you over time.” (P.S.: Seneff’s husband terminated
Except Seneff, as you can probably imagine, is no his statin therapy, and all of his symptoms disap-
ordinary Googler. She applied her not inconsiderable, peared. Needless to say, he also changed doctors.)
104 THE GREAT CHOLESTEROL MYTH THE STATIN DECEPTION 105

But she didn’t quit MIT. “In those days,” she told methodologically precise skills as a researcher to the
us, “you could get a job as a programmer with no task at hand and proceeded to try to learn everything
CHAPTER 8 prior experience. I got a job at MIT Lincoln there was to learn about cholesterol, heart disease,
Laboratory, where I lucked into a group of pioneers in and statin drugs. Understand, now, that she had not
the fledging field of computer speech processing.” spent four years in medical school being subtly influ-
Voilà. Seneff found a home, a perfect blend of enced by the drug companies, had not been a consul-
THE STATIN her two great interests—biology and computer dia-

logue systems. She went on to earn a Ph.D. in electri-
tant to the pharmaceutical industry, had not been vis-
ited daily by a charming crew of pharmaceutical reps
DECEPTION
cal engineering from MIT, ultimately publishing more spinning industry-funded studies touting the benefits
than 170 papers and becoming one of the world’s of their products. And she had not been paid hefty
leading experts in blending biological systems with fees by those same pharmaceutical companies (the
computer intelligence. (It was her pioneering work in way Dr. Sinatra had been) to give “educational” lec-
the field of voice recognition and computer systems tures on behalf of their products (lectures that are lit-
that led to commercial applications such as SIRI, the tle more than marketing tools disguised as
STEPHANIE SENEFF ALWAYS WANTED TO BE A BIOLOGIST. virtual assistant built into the iPhone.) scholarship).
For as long as she can remember, she has been fascinated by how things work, particularly Then something happened: Seneff’s husband was She had no agenda—other than to help her hus-
how living things work. She wanted to know how frogs jump, how grasshoppers breathe, how cells diagnosed with heart disease. band get well. Basically, she wasn’t bought or influ-
communicate, how the heart talks to the brain, all of which scientists study in detail, frequently by His doctor put him on a high-dose statin—four enced by or beholden to anyone in the heart disease–
spending hours a day peering into a microscope. She was interested in systems, and to her the human times the usual dose—and told him it was imperative cholesterol–statin drug establishment. She had no
body was the most fascinating system of all. So she was more than a little delighted when, after high that he stay on it. “If you go off this, or even reduce preconceived ideas, either positive or negative, about
school, she was accepted into the biology program at MIT. the dosage, I can no longer be your doctor,” his physi- what she’d find. Her research was motivated only by a
After completing her B.S. in biophysics, she entered the MIT Ph.D. program and spent a year cian told him. desire to get her husband well, and by her lifelong
working under Professor Harvey Lodish in the laboratory headed by future Nobel Prize winner David Almost immediately, the side effects started. He interest in biology and nutrition.
Baltimore. developed debilitating shoulder problems; muscle And let’s remember that we’re talking about
But there was a problem. After a year in Baltimore’s lab, Seneff realized two things. One, she aches and weakness (he could no longer open drawers someone who has a world-class ability to understand
wasn’t really cut out for the isolation required by a life in the lab, and two, she wanted to start a or jars); cognitive and memory problems; and depres- systems, theory, statistics, interpretation, experimen-
family. So she quit the Ph.D. program. sion, something he had never experienced before. tal bias, confounding variables, and all the rest of the
We all know what we do when we first get a diag- esoterica associated with evaluating studies.
nosis, or are prescribed a medication we’re not famil- Here’s what Seneff told us about statin drugs
iar with, or begin having a bunch of unexplained when we contacted her for this book: “Statin drugs
symptoms or side effects: We ask Dr. Google, which is are toxic. I liken them to arsenic, which will slowly poi-
exactly what Seneff did. son you over time.” (P.S.: Seneff’s husband terminated
Except Seneff, as you can probably imagine, is no his statin therapy, and all of his symptoms disap-
ordinary Googler. She applied her not inconsiderable, peared. Needless to say, he also changed doctors.)

THE NEXT MEDICAL TRAGEDY? ingless ability to lower cholesterol. In fact, that’s why “DYING WITH CORRECTED was no difference in the number of deaths between
Seneff has become one of the most respected and statins occasionally show up as beneficial for condi- CHOLESTEROL IS NOT A the group that lowered its cholesterol and the group
outspoken critics of the cholesterol hypothesis, and tions that have absolutely nothing to do with choles- SUCCESSFUL OUTCOME” that didn’t. In fact, in a few cases, more people died in
1 2
she is quite vocal about her opposition to statin terol—including gum disease and sepsis, a complex Back in the late 1980s, Russell Smith, Ph.D., an the group that lowered its cholesterol.
drugs, which she believes are the next medical inflammatory syndrome. American experimental psychologist with a strong Okay, so we’ve talked about ten out of those
tragedy waiting to happen. (When you finish reading this section, you may background in physiology, math, and engineering, twelve cholesterol-lowering trials—pretty dismal
Let’s be clear: Although Seneff and other indepen- find that you agree with a growing number of health decided to write the most comprehensive and critical results. But what about the remaining two trials?
dent researchers are pretty unequivocal in their nega- professionals who think that statin drugs would be review of the diet-heart disease literature yet seen. In these two trials, there were fewer deaths in the
tive appraisal of statin drugs, we are not—we’re a little even more effective if they didn’t lower cholesterol. Published in two volumes that spanned more than group treated with cholesterol-lowering drugs than in
more moderate. Neither of us believes that statin But we digress.) 600 pages and contained 3,000 references, it was the control group. These two studies, accounting for
drugs are all bad. As mentioned earlier, Steve still pre- If you still doubt that the cholesterol-lowering titled Diet, Blood Cholesterol, and Coronary Heart only a sixth of the total number of drug studies con-
scribes them very occasionally, in certain limited cir- effect of statins is the least important thing they do, Disease: A Critical Review of the Literature. ducted, were exactly the ones the cholesterol estab-
cumstances (i.e. to middle-aged men who have had a put on your detective thinking hat for a moment, do a In the vast majority of studies reviewed, there lishment seized on as “proof” of the link between
previous heart attack and are at high risk for a sec- thought exercise with us, and consider the following: was no difference in the number of deaths between cholesterol and heart disease. “However,” reported
ond). Even Duane Graveline, M.D., perhaps the most Before the introduction of statin drugs in the 1990s, the group that lowered its cholesterol and the group Smith and Pinckney, “one of these trials was con-
outspoken critic of statins on the planet and author of there were a number of studies done in which choles- that didn’t. ducted by a pharmaceutical company, which evalu-
Lipitor: Thief of Memory, lists low-dose statin therapy terol was successfully lowered by other drugs, notably Then in 1991, together with Edward Pinckney, ated its own cholesterol-lowering drug.3 The second
as one possible option for “high-risk” people. the class of drugs known as fibrates, the go-to treat- M.D., an editor of four medical journals and former trial involved an estrogen drug that produced more
Statin drugs do some good in some circum- ment for high cholesterol before the near-universal co-editor of the Journal of the American Medical harm than good in three other trials.4 Therefore, both
stances, but their benefits, and the circumstances in switch to statins in the last decade of the twentieth Association, Smith published a summary of this mas- of these trials are suspect.”
which they are appropriate, are much more limited century.** These drugs actually lowered cholesterol sive work in a book called The Cholesterol Conspiracy. Scorecard: Out of twelve studies, ten showed no
than the pharmaceutical companies—and the doctors quite well, thank you very much. If lowering choles- Among many other things, Smith and Pinckney benefit; the two that did were both somewhat
who buy into their talking points—would have us terol does in fact prevent heart attacks or strokes, reviewed all of the cholesterol-lowering trials that had questionable.
believe. Furthermore, any good they may accomplish then we should see a significant reduction in heart been done before 1991. The studies found that using Choosing one or two studies that show a positive
has almost nothing to do with cholesterol lowering, as attacks and strokes anytime we successfully lower it, drugs to lower cholesterol was quite effective—at low- result and burying the ones that don’t is a well- docu-
you will soon see. regardless of the particular drug (or diet) used to ering cholesterol. The problem was that they weren’t mented tactic of the pharmaceutical industry. It’s akin
Here’s what’s good about statin drugs. One, accomplish this. much good for anything else—for example, saving to finding two white checkers in a bucket of black
they’re mildly anti-inflammatory. They lower But investigations of the cholesterol-lowering lives. If cholesterol lowering was in fact the holy grail ones and then holding up the white ones claiming
C-reactive protein (a protein in the blood that’s an studies before the mainstream use of statin drugs of preventing heart disease and death, then we would that’s proof that all checkers are white.
excellent measure of systemic inflammation). And showed quite the opposite. And there’s proof, all cata- expect the research to show a reduction in heart So let’s review. Before the introduction of statin
two, they decrease blood viscosity (making the blood loged, collected, and assembled in one place, thanks attacks, strokes, and deaths when cholesterol was drugs, it was overwhelmingly clear that lowering cho-
less like ketchup and more like red wine). Any of the to a man named Russell Smith. effectively lowered, wouldn’t we? lesterol by itself did virtually nothing to prevent a sin-
benefits seen with statins are almost surely related to ** Mevacor, a statin drug, was actually introduced in Here’s what Smith and Pinckney concluded: gle death or even to affect coronary heart disease in
these other actions of the drug, not to its fairly mean- 1987, but statins didn’t become popular until the 1990s. In the vast majority of the studies reviewed, there any meaningful way. Zip, nada, zilch. Therefore, if any

THE NEXT MEDICAL TRAGEDY? ingless ability to lower cholesterol. In fact, that’s why “DYING WITH CORRECTED was no difference in the number of deaths between
Seneff has become one of the most respected and statins occasionally show up as beneficial for condi- CHOLESTEROL IS NOT A the group that lowered its cholesterol and the group
outspoken critics of the cholesterol hypothesis, and tions that have absolutely nothing to do with choles- SUCCESSFUL OUTCOME” that didn’t. In fact, in a few cases, more people died in
1 2
she is quite vocal about her opposition to statin terol—including gum disease and sepsis, a complex Back in the late 1980s, Russell Smith, Ph.D., an the group that lowered its cholesterol.
drugs, which she believes are the next medical inflammatory syndrome. American experimental psychologist with a strong Okay, so we’ve talked about ten out of those
tragedy waiting to happen. (When you finish reading this section, you may background in physiology, math, and engineering, twelve cholesterol-lowering trials—pretty dismal
Let’s be clear: Although Seneff and other indepen- find that you agree with a growing number of health decided to write the most comprehensive and critical results. But what about the remaining two trials?
dent researchers are pretty unequivocal in their nega- professionals who think that statin drugs would be review of the diet-heart disease literature yet seen. In these two trials, there were fewer deaths in the
tive appraisal of statin drugs, we are not—we’re a little even more effective if they didn’t lower cholesterol. Published in two volumes that spanned more than group treated with cholesterol-lowering drugs than in
more moderate. Neither of us believes that statin But we digress.) 600 pages and contained 3,000 references, it was the control group. These two studies, accounting for
drugs are all bad. As mentioned earlier, Steve still pre- If you still doubt that the cholesterol-lowering titled Diet, Blood Cholesterol, and Coronary Heart only a sixth of the total number of drug studies con-
scribes them very occasionally, in certain limited cir- effect of statins is the least important thing they do, Disease: A Critical Review of the Literature. ducted, were exactly the ones the cholesterol estab-
cumstances (i.e. to middle-aged men who have had a put on your detective thinking hat for a moment, do a In the vast majority of studies reviewed, there lishment seized on as “proof” of the link between
previous heart attack and are at high risk for a sec- thought exercise with us, and consider the following: was no difference in the number of deaths between cholesterol and heart disease. “However,” reported
ond). Even Duane Graveline, M.D., perhaps the most Before the introduction of statin drugs in the 1990s, the group that lowered its cholesterol and the group Smith and Pinckney, “one of these trials was con-
outspoken critic of statins on the planet and author of there were a number of studies done in which choles- that didn’t. ducted by a pharmaceutical company, which evalu-
Lipitor: Thief of Memory, lists low-dose statin therapy terol was successfully lowered by other drugs, notably Then in 1991, together with Edward Pinckney, ated its own cholesterol-lowering drug.3 The second
as one possible option for “high-risk” people. the class of drugs known as fibrates, the go-to treat- M.D., an editor of four medical journals and former trial involved an estrogen drug that produced more
Statin drugs do some good in some circum- ment for high cholesterol before the near-universal co-editor of the Journal of the American Medical harm than good in three other trials.4 Therefore, both
stances, but their benefits, and the circumstances in switch to statins in the last decade of the twentieth Association, Smith published a summary of this mas- of these trials are suspect.”
which they are appropriate, are much more limited century.** These drugs actually lowered cholesterol sive work in a book called The Cholesterol Conspiracy. Scorecard: Out of twelve studies, ten showed no
than the pharmaceutical companies—and the doctors quite well, thank you very much. If lowering choles- Among many other things, Smith and Pinckney benefit; the two that did were both somewhat
who buy into their talking points—would have us terol does in fact prevent heart attacks or strokes, reviewed all of the cholesterol-lowering trials that had questionable.
believe. Furthermore, any good they may accomplish then we should see a significant reduction in heart been done before 1991. The studies found that using Choosing one or two studies that show a positive
has almost nothing to do with cholesterol lowering, as attacks and strokes anytime we successfully lower it, drugs to lower cholesterol was quite effective—at low- result and burying the ones that don’t is a well- docu-
you will soon see. regardless of the particular drug (or diet) used to ering cholesterol. The problem was that they weren’t mented tactic of the pharmaceutical industry. It’s akin
Here’s what’s good about statin drugs. One, accomplish this. much good for anything else—for example, saving to finding two white checkers in a bucket of black
they’re mildly anti-inflammatory. They lower But investigations of the cholesterol-lowering lives. If cholesterol lowering was in fact the holy grail ones and then holding up the white ones claiming
C-reactive protein (a protein in the blood that’s an studies before the mainstream use of statin drugs of preventing heart disease and death, then we would that’s proof that all checkers are white.
excellent measure of systemic inflammation). And showed quite the opposite. And there’s proof, all cata- expect the research to show a reduction in heart So let’s review. Before the introduction of statin
two, they decrease blood viscosity (making the blood loged, collected, and assembled in one place, thanks attacks, strokes, and deaths when cholesterol was drugs, it was overwhelmingly clear that lowering cho-
less like ketchup and more like red wine). Any of the to a man named Russell Smith. effectively lowered, wouldn’t we? lesterol by itself did virtually nothing to prevent a sin-
benefits seen with statins are almost surely related to ** Mevacor, a statin drug, was actually introduced in Here’s what Smith and Pinckney concluded: gle death or even to affect coronary heart disease in
these other actions of the drug, not to its fairly mean- 1987, but statins didn’t become popular until the 1990s. In the vast majority of the studies reviewed, there any meaningful way. Zip, nada, zilch. Therefore, if any

positive effects were to be seen in statin drug studies,
these beneficial effects couldn’t possibly be due to
With that in mind, let’s take a look at the side
effects of statin drugs you probably don’t know about.
Note to parents: The fact that some groups are currently
lowered cholesterol. (No surprise—this is not exactly data that manufactur- advocating statin drugs for children, whose brains
As Smith and Pinckney conclusively demonstrate,
all thirty or so studies completed before 1990 showed
ers of these drugs are dying to publicize.)
aren’t even fully developed until they’re twenty-five,
that you could lower cholesterol to your heart’s con- The Dark Side of Statin Drugs should be as utterly frightening to you as it is to us.
tent without adding a single day to your life. John Besides being far less effective than you’ve been led
Abramson, M.D., a professor of medicine at Harvard to believe, statins have myriad unpleasant, and in statin drugs don’t stop at just lowering cholesterol in cholesterol was put back in.
Medical School and the author of Overdosed America, some cases acute—or even fatal—side effects, such as the blood—they also lower it in the brain. And that’s Cholesterol increased protein function fivefold.
summed up the problem perfectly in the medical many of those Seneff’s husband experienced. These not good news. “Our study shows there is a direct link between cho-
journal The Lancet: “You can lower cholesterol with include muscle pain, weakness, fatigue, memory and Why? Because the brain absolutely depends on lesterol and neurotransmitter release,” said Shin.
a drug, yet provide no health benefits whatsoever. cognition problems, and—for a large number of cholesterol to function at its best. Although the brain “Cholesterol changes the shape of the protein to
And dying with corrected cholesterol is not a suc- people—very serious problems with sexual functioning. makes up only about 2 percent of the total weight of stimulate thinking and memory.”5 In other words—how
cessful outcome.” Statin drugs cut off cholesterol production in the the body, it contains 25 percent of the body’s choles- smart you are and how well you remember things.6
body. That’s pretty obvious, right? But to understand terol. Cholesterol is a vital part of cell membranes in Adults should be no less sanguine. Speaking at a
STATIN DRUGS: RISKS VERSUS why the side effects of this seemingly “innocent” the brain, and it plays a critical role in the transmis- luncheon discussion put on by Project A.L.S.—a non-
BENEFITS action are so severe and troubling, you have to under- sion of neurotransmitters. Without cholesterol, brain profit dedicated to raising money for brain research
Let’s review: Lowering cholesterol, as the thirty-some stand exactly how statin drugs cut down on the body’s cells can’t effectively “talk” to each other, cellular and the understanding of Lou Gehrig’s disease—the
odd studies before 1990 showed, accomplished production of cholesterol. When you do, you’ll see that communication is impaired, and cognition and mem- vice chairman of medicine at New York Presbyterian
nothing (except, of course, to lower cholesterol). So if cutting off cholesterol production in the way that ory are significantly affected, usually not in a good Hospital, Orli Eingin, M.D., had this to say regarding
there’s a benefit to statin drugs at all, that benefit statin drugs do is like trying to kill a branch at the top way! (See the sidebar, “SpaceDoc: The Strange Case the number-one-selling statin drug in the world,
has to be coming from something other than their of a tree by starving the roots. The “side effect” of of the Missing Memory," on page 112.) Lipitor: “This drug makes women stupid.”7
ability to lower cholesterol. starving the roots is that you don’t just kill the branch, Cognitive and memory problems are one of the
Now, one might reasonably argue, so what? you destroy the tree. And the irony is that there was most dramatic and frequent side effects of statin STATIN DRUGS AND YOUR ENERGY
Suppose you’re right that the ability of statin drugs to no need to remove the branch in the first place. drugs, and a 2009 study from Iowa State University Here is one noncontroversial and incontrovertible
lower cholesterol is irrelevant, but suppose they do a Besides being far less effective than you’ve been demonstrates why. Yeon-Kyun Shin, Ph.D., a biophys- fact: Statin drugs significantly deplete your body’s
lot of good anyway? Why not just use them for their led to believe, statins have myriad unpleasant, and in ics professor in the department of biochemistry, bio- stores of coenzyme Q10 (CoQ10).
other benefits? some cases acute—or even fatal—side effects. physics, and molecular biology at Iowa State, tested If you don’t already know what CoQ10 is, this
Good question. But to answer it, we need to know Let us explain. the whole neurotransmitter machinery of brain cells would be a great time to become familiar with it.
two things: One, just how great a benefit are we actu- in a novel experiment. (Neurotransmitters affect data- Once you understand the importance of CoQ10 to
ally talking about? And two, what are the side effects? Statin Drugs and Your Brain: Memory, processing and memory functions in the brain.) He human health, you’ll immediately appreciate why the
In simple terms, we’d want to know the same Thinking, and Alzheimer’s measured how the system released neurotransmitters depletion of CoQ10 by statin drugs is such a big deal.
things we’d want to know about a financial investment: There are a number of unintended consequences of when cholesterol was removed from the cells and The depletion of CoQ10 is one of the most important
What are we risking versus what are we getting? statin drugs you ought to know about. For one thing, compared that with how the system functioned when negative effects of statins, and the one that is pretty

positive effects were to be seen in statin drug studies,
these beneficial effects couldn’t possibly be due to
With that in mind, let’s take a look at the side
effects of statin drugs you probably don’t know about.
Note to parents: The fact that some groups are currently
lowered cholesterol. (No surprise—this is not exactly data that manufactur- advocating statin drugs for children, whose brains
As Smith and Pinckney conclusively demonstrate,
all thirty or so studies completed before 1990 showed
ers of these drugs are dying to publicize.)
aren’t even fully developed until they’re twenty-five,
that you could lower cholesterol to your heart’s con- The Dark Side of Statin Drugs should be as utterly frightening to you as it is to us.
tent without adding a single day to your life. John Besides being far less effective than you’ve been led
Abramson, M.D., a professor of medicine at Harvard to believe, statins have myriad unpleasant, and in statin drugs don’t stop at just lowering cholesterol in cholesterol was put back in.
Medical School and the author of Overdosed America, some cases acute—or even fatal—side effects, such as the blood—they also lower it in the brain. And that’s Cholesterol increased protein function fivefold.
summed up the problem perfectly in the medical many of those Seneff’s husband experienced. These not good news. “Our study shows there is a direct link between cho-
journal The Lancet: “You can lower cholesterol with include muscle pain, weakness, fatigue, memory and Why? Because the brain absolutely depends on lesterol and neurotransmitter release,” said Shin.
a drug, yet provide no health benefits whatsoever. cognition problems, and—for a large number of cholesterol to function at its best. Although the brain “Cholesterol changes the shape of the protein to
And dying with corrected cholesterol is not a suc- people—very serious problems with sexual functioning. makes up only about 2 percent of the total weight of stimulate thinking and memory.”5 In other words—how
cessful outcome.” Statin drugs cut off cholesterol production in the the body, it contains 25 percent of the body’s choles- smart you are and how well you remember things.6
body. That’s pretty obvious, right? But to understand terol. Cholesterol is a vital part of cell membranes in Adults should be no less sanguine. Speaking at a
STATIN DRUGS: RISKS VERSUS why the side effects of this seemingly “innocent” the brain, and it plays a critical role in the transmis- luncheon discussion put on by Project A.L.S.—a non-
BENEFITS action are so severe and troubling, you have to under- sion of neurotransmitters. Without cholesterol, brain profit dedicated to raising money for brain research
Let’s review: Lowering cholesterol, as the thirty-some stand exactly how statin drugs cut down on the body’s cells can’t effectively “talk” to each other, cellular and the understanding of Lou Gehrig’s disease—the
odd studies before 1990 showed, accomplished production of cholesterol. When you do, you’ll see that communication is impaired, and cognition and mem- vice chairman of medicine at New York Presbyterian
nothing (except, of course, to lower cholesterol). So if cutting off cholesterol production in the way that ory are significantly affected, usually not in a good Hospital, Orli Eingin, M.D., had this to say regarding
there’s a benefit to statin drugs at all, that benefit statin drugs do is like trying to kill a branch at the top way! (See the sidebar, “SpaceDoc: The Strange Case the number-one-selling statin drug in the world,
has to be coming from something other than their of a tree by starving the roots. The “side effect” of of the Missing Memory," on page 112.) Lipitor: “This drug makes women stupid.”7
ability to lower cholesterol. starving the roots is that you don’t just kill the branch, Cognitive and memory problems are one of the
Now, one might reasonably argue, so what? you destroy the tree. And the irony is that there was most dramatic and frequent side effects of statin STATIN DRUGS AND YOUR ENERGY
Suppose you’re right that the ability of statin drugs to no need to remove the branch in the first place. drugs, and a 2009 study from Iowa State University Here is one noncontroversial and incontrovertible
lower cholesterol is irrelevant, but suppose they do a Besides being far less effective than you’ve been demonstrates why. Yeon-Kyun Shin, Ph.D., a biophys- fact: Statin drugs significantly deplete your body’s
lot of good anyway? Why not just use them for their led to believe, statins have myriad unpleasant, and in ics professor in the department of biochemistry, bio- stores of coenzyme Q10 (CoQ10).
other benefits? some cases acute—or even fatal—side effects. physics, and molecular biology at Iowa State, tested If you don’t already know what CoQ10 is, this
Good question. But to answer it, we need to know Let us explain. the whole neurotransmitter machinery of brain cells would be a great time to become familiar with it.
two things: One, just how great a benefit are we actu- in a novel experiment. (Neurotransmitters affect data- Once you understand the importance of CoQ10 to
ally talking about? And two, what are the side effects? Statin Drugs and Your Brain: Memory, processing and memory functions in the brain.) He human health, you’ll immediately appreciate why the
In simple terms, we’d want to know the same Thinking, and Alzheimer’s measured how the system released neurotransmitters depletion of CoQ10 by statin drugs is such a big deal.
things we’d want to know about a financial investment: There are a number of unintended consequences of when cholesterol was removed from the cells and The depletion of CoQ10 is one of the most important
What are we risking versus what are we getting? statin drugs you ought to know about. For one thing, compared that with how the system functioned when negative effects of statins, and the one that is pretty

much responsible for a host of common side effects alerting the public to the CoQ10 problem and then call “cholesterol madness.” Desulfovibrio, often associated with inflammatory
involving muscle pain, weakness, and loss of energy. “solving” it with a combo drug. No one else was doing If you are on a statin drug and need to remain on bowel disease.10
CoQ10 is a vitamin-like compound found in virtu- it, so why should Merck bother? one for whatever reason, don’t spend one more day Although research on the effects of statins and
ally every cell in the human body, and when your As we age, we make less CoQ10, so keeping what without supplementing with CoQ10. Run, don’t walk, to gut bacteria in humans is still in its infancy, we
CoQ10 levels fall, so does your general health. CoQ10 is we have is even more important during our middle-age your nearest pharmacy or health food store and pick suspect future findings will confirm that impaired
used in the energy-producing metabolic pathways of and older years, when statin drugs are prescribed the some up. We recommend a minimum of 100 mg twice or dysfunctional gut health is yet another causality
every cell. It’s a powerful antioxidant, combating oxi- most. Lower CoQ10 means less energy production for a day of a highly bioavailable ubiquinone, or you can of statin drugs.
dative damage from free radicals and protecting your the heart and muscles. Stephanie Seneff and her asso- use the ubiquinol varietal.
cell membranes, proteins, and DNA. In a previous ciates at MIT collected a large number of subjective STATIN DRUGS AND IMMUNITY
book, Dr. Sinatra has referred to CoQ10 as “the spark reports by patients on various drugs. They gathered STATIN DRUGS AND YOUR GUT BUGS (NF-KB)
of life,” and Dr. Jonny has written about it at length in more than 8,400 online reviews by patients on statin We’ve long known that antibiotics alter our gut As mentioned earlier, one of the good things about
The Most Effective Natural Cures on Earth. drugs and compared them for mentions of side effects microbiome (the massive, and incredibly important, statin drugs is that they are anti-inflammatory. This
Without CoQ10, our bodies simply can’t survive. with the same number of age-matched reviews ran- collection of microbes inhabiting our colon)—hence is important and probably one of the main reasons
The production of CoQ10 happens in one of the domly sampled from a broad spectrum of other drugs. the age-old advice to eat live-cultured yogurt or take statins show any of the benefit they sometimes do.
branches of the mevalonate pathway tree that is To this day, many doctors are completely clueless acidophilus tablets after a course of antibiotics. More Inflammation, as you learned in chapter 5, is one of
blocked by the action of statin drugs. When choles- about the CoQ10 connection and are unaware of its sig- recently, though, researchers have started exploring four major contributors to heart disease.
terol production is interfered with in this way, so is nificance. One of us, Dr. Jonny, played tennis for years the effects of other drugs on our gut critters. One of We want our anti-inflammatory arsenal to be as
the production of CoQ10. Interestingly, the most impor- with a terrific eighty-year-old named Marty. Although those drugs is statins. So far, the news isn’t good. powerful as possible, because inflammation is a major
tant muscle in the body—the heart—contains the great- in great shape, Marty was always winded, had trouble The reason? Cholesterol is a precursor for bile component of every degenerative disease known to
est concentration of CoQ10. The severe reduction in catching his breath, and frequently experienced mus- acid production in our bodies, and taking statins is a humankind. Anti-inflammatory foods, supplements,
CoQ10 caused by statin drugs damages not only the cle pain and fatigue, which he (and his doc) attributed sure-fire way to alter the size and composition of our drugs? Bring ’em on!
heart but also the skeletal muscles that rely on CoQ10 to “getting older.” It turns out that Marty’s doctor had bile acid pool. And it just so happens that bile acids So the fact that statins are anti-inflammatory is
for energy production. How ironic that a drug given to put him on a statin drug for his cholesterol; his symp- play a big role in shaping the gut microbiome. In mice, a good thing. But the way they accomplish this anti-
prevent heart disease—which it barely does, and then toms marked a classic case of CoQ10 depletion. When twelve weeks of treatment with either pravastatin inflammatory action may not be without problems.
only in extremely limited circumstances—substantially Dr. Jonny pointed this out to him and suggested he (Pravachol) or atorvastatin (Lipitor) significantly They suppress chemicals in the body (such as NF-kB)
weakens the very organ it’s meant to protect! immediately start supplementing with CoQ10, Marty changed the animals’ bile acid levels and reduced based on the idea that these chemicals are bad
The fact that statin drugs cause depletion of said, “I’ll ask my doctor about that!” their diversity of gut bacteria (an indicator of dis- actors that are associated with inflammation. (The
CoQ10 levels has been known for decades. Merck, the The doctor barely knew what CoQ10 was, was ease), reduced levels of butyrate (a short-chain fatty thinking seems to be “let’s round those suckers up
manufacturer of Zocor (one of the best-selling statin utterly clueless about its importance, and was com- acid produced by fiber fermentation in the gut, and and march ‘em the heck outta here.”) But the prob-
drugs), has had a patent on a combination statin- pletely unaware of this critically important side effect which plays a vital role in protecting against colon lem is that those chemicals aren’t always bad! Like
CoQ10 drug since around 1990 but never manufac- of the drug he had prescribed—a drug that was espe- cancer), and overall changed the gut microbiome to most of the humans we know, chemicals like NF-kB
tured it. Although no one knows for sure why, it’s cially unnecessary in Marty’s case, because high cho- resemble patterns similar to what we see with diet- have bad sides and good sides. NF-kB, for example,
9
widely believed that Merck never produced this drug lesterol is actually protective for older people. induced obesity. In another study, treatment with helps protect against salmonella and e Coli. That’s a
because there was no real economic incentive to This, folks, is just one example of what we like to Lipitor raised levels of the harmful microbe neat little benefit you don’t want to lose just to get a

much responsible for a host of common side effects alerting the public to the CoQ10 problem and then call “cholesterol madness.” Desulfovibrio, often associated with inflammatory
involving muscle pain, weakness, and loss of energy. “solving” it with a combo drug. No one else was doing If you are on a statin drug and need to remain on bowel disease.10
CoQ10 is a vitamin-like compound found in virtu- it, so why should Merck bother? one for whatever reason, don’t spend one more day Although research on the effects of statins and
ally every cell in the human body, and when your As we age, we make less CoQ10, so keeping what without supplementing with CoQ10. Run, don’t walk, to gut bacteria in humans is still in its infancy, we
CoQ10 levels fall, so does your general health. CoQ10 is we have is even more important during our middle-age your nearest pharmacy or health food store and pick suspect future findings will confirm that impaired
used in the energy-producing metabolic pathways of and older years, when statin drugs are prescribed the some up. We recommend a minimum of 100 mg twice or dysfunctional gut health is yet another causality
every cell. It’s a powerful antioxidant, combating oxi- most. Lower CoQ10 means less energy production for a day of a highly bioavailable ubiquinone, or you can of statin drugs.
dative damage from free radicals and protecting your the heart and muscles. Stephanie Seneff and her asso- use the ubiquinol varietal.
cell membranes, proteins, and DNA. In a previous ciates at MIT collected a large number of subjective STATIN DRUGS AND IMMUNITY
book, Dr. Sinatra has referred to CoQ10 as “the spark reports by patients on various drugs. They gathered STATIN DRUGS AND YOUR GUT BUGS (NF-KB)
of life,” and Dr. Jonny has written about it at length in more than 8,400 online reviews by patients on statin We’ve long known that antibiotics alter our gut As mentioned earlier, one of the good things about
The Most Effective Natural Cures on Earth. drugs and compared them for mentions of side effects microbiome (the massive, and incredibly important, statin drugs is that they are anti-inflammatory. This
Without CoQ10, our bodies simply can’t survive. with the same number of age-matched reviews ran- collection of microbes inhabiting our colon)—hence is important and probably one of the main reasons
The production of CoQ10 happens in one of the domly sampled from a broad spectrum of other drugs. the age-old advice to eat live-cultured yogurt or take statins show any of the benefit they sometimes do.
branches of the mevalonate pathway tree that is To this day, many doctors are completely clueless acidophilus tablets after a course of antibiotics. More Inflammation, as you learned in chapter 5, is one of
blocked by the action of statin drugs. When choles- about the CoQ10 connection and are unaware of its sig- recently, though, researchers have started exploring four major contributors to heart disease.
terol production is interfered with in this way, so is nificance. One of us, Dr. Jonny, played tennis for years the effects of other drugs on our gut critters. One of We want our anti-inflammatory arsenal to be as
the production of CoQ10. Interestingly, the most impor- with a terrific eighty-year-old named Marty. Although those drugs is statins. So far, the news isn’t good. powerful as possible, because inflammation is a major
tant muscle in the body—the heart—contains the great- in great shape, Marty was always winded, had trouble The reason? Cholesterol is a precursor for bile component of every degenerative disease known to
est concentration of CoQ10. The severe reduction in catching his breath, and frequently experienced mus- acid production in our bodies, and taking statins is a humankind. Anti-inflammatory foods, supplements,
CoQ10 caused by statin drugs damages not only the cle pain and fatigue, which he (and his doc) attributed sure-fire way to alter the size and composition of our drugs? Bring ’em on!
heart but also the skeletal muscles that rely on CoQ10 to “getting older.” It turns out that Marty’s doctor had bile acid pool. And it just so happens that bile acids So the fact that statins are anti-inflammatory is
for energy production. How ironic that a drug given to put him on a statin drug for his cholesterol; his symp- play a big role in shaping the gut microbiome. In mice, a good thing. But the way they accomplish this anti-
prevent heart disease—which it barely does, and then toms marked a classic case of CoQ10 depletion. When twelve weeks of treatment with either pravastatin inflammatory action may not be without problems.
only in extremely limited circumstances—substantially Dr. Jonny pointed this out to him and suggested he (Pravachol) or atorvastatin (Lipitor) significantly They suppress chemicals in the body (such as NF-kB)
weakens the very organ it’s meant to protect! immediately start supplementing with CoQ10, Marty changed the animals’ bile acid levels and reduced based on the idea that these chemicals are bad
The fact that statin drugs cause depletion of said, “I’ll ask my doctor about that!” their diversity of gut bacteria (an indicator of dis- actors that are associated with inflammation. (The
CoQ10 levels has been known for decades. Merck, the The doctor barely knew what CoQ10 was, was ease), reduced levels of butyrate (a short-chain fatty thinking seems to be “let’s round those suckers up
manufacturer of Zocor (one of the best-selling statin utterly clueless about its importance, and was com- acid produced by fiber fermentation in the gut, and and march ‘em the heck outta here.”) But the prob-
drugs), has had a patent on a combination statin- pletely unaware of this critically important side effect which plays a vital role in protecting against colon lem is that those chemicals aren’t always bad! Like
CoQ10 drug since around 1990 but never manufac- of the drug he had prescribed—a drug that was espe- cancer), and overall changed the gut microbiome to most of the humans we know, chemicals like NF-kB
tured it. Although no one knows for sure why, it’s cially unnecessary in Marty’s case, because high cho- resemble patterns similar to what we see with diet- have bad sides and good sides. NF-kB, for example,
9
widely believed that Merck never produced this drug lesterol is actually protective for older people. induced obesity. In another study, treatment with helps protect against salmonella and e Coli. That’s a
because there was no real economic incentive to This, folks, is just one example of what we like to Lipitor raised levels of the harmful microbe neat little benefit you don’t want to lose just to get a

SPACEDOC: THE STRANGE CASE OF THE MISSING MEMORY later, he was persuaded to restart the statin at half the previous dose. Two months after doing
In 2006, magician and performance artist David Blaine decided to do a stunt in which he was so, he experienced another episode of TGA. This time it lasted for twelve hours. His awareness
immersed in water for seven days. To prepare for this grueling event, he decided to train with was tossed back fifty-six years to when he was thirteen years old—he knew the names of every
a man named Duane Graveline. teacher and kid in his classes, but he had no memory of his subsequent life. He didn’t even
Graveline has a particularly interesting resume: He’s both an M.D. and an astronaut, one of recognize his wife, who was with him when the incident occurred. Decades had been erased
six scientists selected by NASA for the Apollo program. He’s also a renowned expert in the from his mind as if they had never happened.
field of zero gravity deconditioning research. The reason Blaine chose him as a consultant was Fortunately, the amnesia lifted, and his memory reverted back to normal. He stopped taking
because Graveline himself had once spent seven days immersed in water as part of his own the statin again, too—this time for good.
zero gravity conditioning program. Graveline began his own personal search for the facts about statins, and what he found was
Ask Graveline how terrifying it was to be immersed in water for seven days, and he’d more than a little disturbing. He learned that TGA had befallen hundreds of other patients
probably tell you it was a walk in the park compared to what he went through when he taking statin drugs. He also discovered that the side effects of statin drugs in general were
suddenly lost his memory. both potentially serious and vastly underreported—they included elevated liver enzymes,
Graveline’s story began in 1999, when he took his annual astronaut physical. The doctors muscle wasting, sexual dysfunction, and fatigue. He began digging a little deeper into the
said his cholesterol was too high and prescribed Lipitor, the biggest selling drug in the history whole issue of statin drugs and heart disease. He started questioning some of the accepted
of medicine. But shortly after starting the medication, Graveline experienced a six-hour notions about cholesterol, ideas he himself had once embraced wholeheartedly: for example,
episode of transient global amnesia (TGA). TGA is the medical term for a rare phenomenon the idea that cholesterol causes heart disease and the idea that lowering cholesterol is one of
that can last anywhere from fifteen minutes to twelve hours. TGA sufferers suddenly lose the the most important things you can do to protect your heart.
ability to retain new memory and often fail to recognize familiar surroundings. Often they can’t “I came to realize that cholesterol was in no way the heinous foe we had been led to believe
even identify members of their own family, and they frequently become confused and it was,” he wrote. “Instead, I realized that cholesterol was the most important substance within
disoriented. People experiencing TGA will literally regress in time—hours, days, weeks, or even our bodies, a substance without which life as we know it would simply cease to exist. That
years—and not have any memory of their life after the time they’ve regressed to. billions of dollars have been spent in an all-out war on a substance that is so fundamentally
Following the episode, Graveline discontinued the statin. But during his next physical a year important to our health is undoubtedly one of the great scientific travesties of our era.”8
mild anti-inflammatory effect that you could probably bacterial products.11 Not only is this a common side effect of choles- We’ve already seen how lowering cholesterol can have
easily achieve by other methods (like taking fish oil, terol lowering, but it’s also vastly underreported. And serious consequences for memory, thinking, and
for example). STATIN DRUGS AND YOUR SEX LIFE worst of all, many people who experience sexual dys- mood. Just as the brain needs cholesterol for neu-
And the impact of dramatically lowering choles- And now for the part that no one is talking about. The function, especially men, have no idea that it might rotransmitters to properly function, the gonads need
terol on the immune system is hardly limited to dirty little secret about statin drugs. Please don’t very well be related to the drug they’re taking to it to produce the hormonal fuel to keep our sex lives
NF-kB. Research has shown that human LDL itself shoot the messengers. Ready? lower their cholesterol. humming. All the major sex hormones—testosterone,
(the so-called “bad” cholesterol) is able to inactivate Statin drugs have an uncanny ability to com- Erectile dysfunction affects more than half of all progesterone, and estrogen—come from cholesterol.
13
more than 90 percent of the worst and most toxic pletely mess up your sex life. No kidding. men between the ages of forty and seventy years. It’s utterly preposterous to assume that lowering cho-

SPACEDOC: THE STRANGE CASE OF THE MISSING MEMORY later, he was persuaded to restart the statin at half the previous dose. Two months after doing
In 2006, magician and performance artist David Blaine decided to do a stunt in which he was so, he experienced another episode of TGA. This time it lasted for twelve hours. His awareness
immersed in water for seven days. To prepare for this grueling event, he decided to train with was tossed back fifty-six years to when he was thirteen years old—he knew the names of every
a man named Duane Graveline. teacher and kid in his classes, but he had no memory of his subsequent life. He didn’t even
Graveline has a particularly interesting resume: He’s both an M.D. and an astronaut, one of recognize his wife, who was with him when the incident occurred. Decades had been erased
six scientists selected by NASA for the Apollo program. He’s also a renowned expert in the from his mind as if they had never happened.
field of zero gravity deconditioning research. The reason Blaine chose him as a consultant was Fortunately, the amnesia lifted, and his memory reverted back to normal. He stopped taking
because Graveline himself had once spent seven days immersed in water as part of his own the statin again, too—this time for good.
zero gravity conditioning program. Graveline began his own personal search for the facts about statins, and what he found was
Ask Graveline how terrifying it was to be immersed in water for seven days, and he’d more than a little disturbing. He learned that TGA had befallen hundreds of other patients
probably tell you it was a walk in the park compared to what he went through when he taking statin drugs. He also discovered that the side effects of statin drugs in general were
suddenly lost his memory. both potentially serious and vastly underreported—they included elevated liver enzymes,
Graveline’s story began in 1999, when he took his annual astronaut physical. The doctors muscle wasting, sexual dysfunction, and fatigue. He began digging a little deeper into the
said his cholesterol was too high and prescribed Lipitor, the biggest selling drug in the history whole issue of statin drugs and heart disease. He started questioning some of the accepted
of medicine. But shortly after starting the medication, Graveline experienced a six-hour notions about cholesterol, ideas he himself had once embraced wholeheartedly: for example,
episode of transient global amnesia (TGA). TGA is the medical term for a rare phenomenon the idea that cholesterol causes heart disease and the idea that lowering cholesterol is one of
that can last anywhere from fifteen minutes to twelve hours. TGA sufferers suddenly lose the the most important things you can do to protect your heart.
ability to retain new memory and often fail to recognize familiar surroundings. Often they can’t “I came to realize that cholesterol was in no way the heinous foe we had been led to believe
even identify members of their own family, and they frequently become confused and it was,” he wrote. “Instead, I realized that cholesterol was the most important substance within
disoriented. People experiencing TGA will literally regress in time—hours, days, weeks, or even our bodies, a substance without which life as we know it would simply cease to exist. That
years—and not have any memory of their life after the time they’ve regressed to. billions of dollars have been spent in an all-out war on a substance that is so fundamentally
Following the episode, Graveline discontinued the statin. But during his next physical a year important to our health is undoubtedly one of the great scientific travesties of our era.”8
mild anti-inflammatory effect that you could probably bacterial products.11 Not only is this a common side effect of choles- We’ve already seen how lowering cholesterol can have
easily achieve by other methods (like taking fish oil, terol lowering, but it’s also vastly underreported. And serious consequences for memory, thinking, and
for example). STATIN DRUGS AND YOUR SEX LIFE worst of all, many people who experience sexual dys- mood. Just as the brain needs cholesterol for neu-
And the impact of dramatically lowering choles- And now for the part that no one is talking about. The function, especially men, have no idea that it might rotransmitters to properly function, the gonads need
terol on the immune system is hardly limited to dirty little secret about statin drugs. Please don’t very well be related to the drug they’re taking to it to produce the hormonal fuel to keep our sex lives
NF-kB. Research has shown that human LDL itself shoot the messengers. Ready? lower their cholesterol. humming. All the major sex hormones—testosterone,
(the so-called “bad” cholesterol) is able to inactivate Statin drugs have an uncanny ability to com- Erectile dysfunction affects more than half of all progesterone, and estrogen—come from cholesterol.
13
more than 90 percent of the worst and most toxic pletely mess up your sex life. No kidding. men between the ages of forty and seventy years. It’s utterly preposterous to assume that lowering cho-

We know for sure that low cholesterol is linked to oxytocin. (Males also make oxytocin, just a lot less of
low testosterone in women from studies conducted on it than females do.) Researchers love to study male
STATINS FOR CHILDREN?
women with a condition known as polycystic ovary prairie voles because they are a rare exception to the
Dr. Sinatra will frequently prescribe a low-dose statin drug for people in this specific
syndrome (PCOS). Women with PCOS suffer from an male–female oxytocin dichotomy; male prairie voles,
population: middle-aged men who have already had a heart attack or have documented
abnormal increase in their testosterone levels, but unlike males of most species, make a ton of the stuff.
coronary artery disease. Both of us believe there is no other good use for statin drugs*.
when you lower their cholesterol their testosterone Male prairie voles are also a rare example of monog-
There is virtually no good evidence to support their use in women,12 they do not need to be
plummets, leaving little doubt about the anti-hormone amy in the animal kingdom, and this has long been
prescribed for people who have not had a heart attack, and they definitely—emphatically, 15
effect of statin drugs. The effect on men is pretty attributed to their oxytocin production, resulting in
positively—should not be prescribed for children.
easy to document, and many studies have done just fairly permanent “pair-bondings.” The bottom line is
We want to clarify this position once again, partly to help counteract the enormous lobbying
that. One study showed that Crestor, one of the most that oxytocin, which helps you feel good and bond
efforts of the pharmaceutical companies, which, as of this writing, are working tirelessly to
popular statin drugs, increased the risk of erectile with another person (or another prairie vole!), is an
expand the market for statin drugs to include children, one of the worst ideas in history. In 16
dysfunction at least two and up to seven times! important part of human sexual desire, expression,
The End of Illness, author David Agus, M.D., recommends that everyone in the country be on a
If libido and sexual health were the only things and satisfaction.
statin drug. Agus is well-meaning but completely wrong. His idea, if accepted, may be the next
disturbed by diminishing levels of testosterone, that So what does oxytocin have to do with
medical disaster just waiting to happen.
would be reason enough to be deeply concerned. But cholesterol?
So a middle-aged man who has already had a first heart attack may indeed find that a
low testosterone has a much more global influence on Unlike testosterone, oxytocin is not made from
statin drug, along with coenzyme Q10 and fish oil, fits into his overall treatment plan.
overall health. Low testosterone is associated with cholesterol. But oxytocin gets into its target organs
Remember, the antioxidant and blood-thinning effects of a low-dose statin may afford some
decreased life expectancy, as well as increased risk of via cell receptors, and those cell receptors are highly
degree of protection in extremely vulnerable men who have had a previous heart attack or 17
mortality from cardiovascular disease. And for those dependent on cholesterol-rich membranes. Critically
moderate-to-severe coronary disease.
who have diminished testosterone levels, the risk is important parts of the membranes known as lipid
For anyone else, proceed with caution!
doubled! (Men: If you’re over fifty, it’s a good idea to rafts don’t work well without cholesterol, meaning
* Recently, a case has been made for low-dose statin therapy in cases of extremely elevated have your testosterone levels assessed by a physician that lowering cholesterol interferes with the ability of
particle number familiar with age-management medicine, such as the hormones such as oxytocin to reach their destination
Cenegenics Medical Institute.) and work their magic. (As we’ve seen, this also hap-
pens with neurotransmitters in the brain that depend
lesterol, which is tantamount to downsizing your problem—women also make testosterone (albeit much The Hormone of Love on cholesterol-rich membranes for cellular
body’s own sex hormone factory, is not going to have less of it), and it’s increasingly clear that even this As important as it is, testosterone certainly isn’t the communication.)
a profound effect on sexual functioning. small amount of testosterone strongly influences only driver of sex and desire in either males or Finally, statins also interfere with serotonin recep-
Of course it is. And it does. women’s sexual desire. (Most anti-aging clinics now females. Another important hormone—known as the tors in the brain.
Several studies have shown beyond any doubt routinely prescribe small, physiologic doses of testos- “hormone of love”—is oxytocin. In case you’re not familiar with serotonin, it’s one
that statin drugs lead to a reduction in sex hormones, terone to postmenopausal women to treat sagging Oxytocin is produced in the brain, and levels are of the critical neurotransmitters involved in mood.
14
most notably testosterone. And this is a very big libido levels and improve general well-being. Even very high during childbirth and nursing because one The most commonly used antidepressants, including
deal indeed. though women have less of it than men do, testoster- of its functions is to help the mother bond with the the blockbuster drugs Prozac, Zoloft, Lexapro, and the
Remember, low testosterone is not just a male one is vitally important to both sexes!) child. When you cuddle after sex, you’re flooded with like, are known as selective serotonin reuptake inhibi-

We know for sure that low cholesterol is linked to oxytocin. (Males also make oxytocin, just a lot less of
low testosterone in women from studies conducted on it than females do.) Researchers love to study male
STATINS FOR CHILDREN?
women with a condition known as polycystic ovary prairie voles because they are a rare exception to the
Dr. Sinatra will frequently prescribe a low-dose statin drug for people in this specific
syndrome (PCOS). Women with PCOS suffer from an male–female oxytocin dichotomy; male prairie voles,
population: middle-aged men who have already had a heart attack or have documented
abnormal increase in their testosterone levels, but unlike males of most species, make a ton of the stuff.
coronary artery disease. Both of us believe there is no other good use for statin drugs*.
when you lower their cholesterol their testosterone Male prairie voles are also a rare example of monog-
There is virtually no good evidence to support their use in women,12 they do not need to be
plummets, leaving little doubt about the anti-hormone amy in the animal kingdom, and this has long been
prescribed for people who have not had a heart attack, and they definitely—emphatically, 15
effect of statin drugs. The effect on men is pretty attributed to their oxytocin production, resulting in
positively—should not be prescribed for children.
easy to document, and many studies have done just fairly permanent “pair-bondings.” The bottom line is
We want to clarify this position once again, partly to help counteract the enormous lobbying
that. One study showed that Crestor, one of the most that oxytocin, which helps you feel good and bond
efforts of the pharmaceutical companies, which, as of this writing, are working tirelessly to
popular statin drugs, increased the risk of erectile with another person (or another prairie vole!), is an
expand the market for statin drugs to include children, one of the worst ideas in history. In 16
dysfunction at least two and up to seven times! important part of human sexual desire, expression,
The End of Illness, author David Agus, M.D., recommends that everyone in the country be on a
If libido and sexual health were the only things and satisfaction.
statin drug. Agus is well-meaning but completely wrong. His idea, if accepted, may be the next
disturbed by diminishing levels of testosterone, that So what does oxytocin have to do with
medical disaster just waiting to happen.
would be reason enough to be deeply concerned. But cholesterol?
So a middle-aged man who has already had a first heart attack may indeed find that a
low testosterone has a much more global influence on Unlike testosterone, oxytocin is not made from
statin drug, along with coenzyme Q10 and fish oil, fits into his overall treatment plan.
overall health. Low testosterone is associated with cholesterol. But oxytocin gets into its target organs
Remember, the antioxidant and blood-thinning effects of a low-dose statin may afford some
decreased life expectancy, as well as increased risk of via cell receptors, and those cell receptors are highly
degree of protection in extremely vulnerable men who have had a previous heart attack or 17
mortality from cardiovascular disease. And for those dependent on cholesterol-rich membranes. Critically
moderate-to-severe coronary disease.
who have diminished testosterone levels, the risk is important parts of the membranes known as lipid
For anyone else, proceed with caution!
doubled! (Men: If you’re over fifty, it’s a good idea to rafts don’t work well without cholesterol, meaning
* Recently, a case has been made for low-dose statin therapy in cases of extremely elevated have your testosterone levels assessed by a physician that lowering cholesterol interferes with the ability of
particle number familiar with age-management medicine, such as the hormones such as oxytocin to reach their destination
Cenegenics Medical Institute.) and work their magic. (As we’ve seen, this also hap-
pens with neurotransmitters in the brain that depend
lesterol, which is tantamount to downsizing your problem—women also make testosterone (albeit much The Hormone of Love on cholesterol-rich membranes for cellular
body’s own sex hormone factory, is not going to have less of it), and it’s increasingly clear that even this As important as it is, testosterone certainly isn’t the communication.)
a profound effect on sexual functioning. small amount of testosterone strongly influences only driver of sex and desire in either males or Finally, statins also interfere with serotonin recep-
Of course it is. And it does. women’s sexual desire. (Most anti-aging clinics now females. Another important hormone—known as the tors in the brain.
Several studies have shown beyond any doubt routinely prescribe small, physiologic doses of testos- “hormone of love”—is oxytocin. In case you’re not familiar with serotonin, it’s one
that statin drugs lead to a reduction in sex hormones, terone to postmenopausal women to treat sagging Oxytocin is produced in the brain, and levels are of the critical neurotransmitters involved in mood.
14
most notably testosterone. And this is a very big libido levels and improve general well-being. Even very high during childbirth and nursing because one The most commonly used antidepressants, including
deal indeed. though women have less of it than men do, testoster- of its functions is to help the mother bond with the the blockbuster drugs Prozac, Zoloft, Lexapro, and the
Remember, low testosterone is not just a male one is vitally important to both sexes!) child. When you cuddle after sex, you’re flooded with like, are known as selective serotonin reuptake inhibi-

tors (SSRIs) because they act mainly to keep sero- causes, so the overall net “gain” in terms of lives tumor cells); two, through increases in endothelial study, the more consistently the participants took
tonin hanging around the brain longer. Serotonin has saved was a big fat zero. progenitor cells in the bone marrow (which are their statins, the greater their risk of developing dia-
a great deal to do with our feelings of relaxation, well- But many studies show even more troubling associated with invasive breast cancer and lymphoma, betes: The researchers wrote, “In a real-world setting,
being, and satisfaction. results. For example, a study in the Journal of Cardiac and can potentially feed tumors by supporting new the risk of new-onset diabetes rises as adherence
So how exactly do statins act on the physiology Failure showed that low cholesterol was actually associ- blood vessel growth); and three, by increasing the with statin therapy increases.”23 In fact, compared to
of serotonin? ated with a marked increase in mortality in heart fail- numbers and functionality of regulatory T-cells (which patients with very low adherence to the drug, those
19
Simple. Much like oxytocin (discussed above), ure cases. And the Italian Longitudinal Study on can impair the body’s immune response against who took the drug religiously had a 32 percent
serotonin depends on cell receptors to get into the Aging, published in the Journal of the American tumors and decrease the effectiveness of cancer greater risk of becoming diabetic.
22
cells. Serotonin receptors—just like oxytocin recep- Geriatric Society, found that those with cholesterol lev- immunotherapy). And dose matters. Higher-potency statins were
tors—are anchored into the cholesterol-rich lipid rafts els lower than 189 were far more likely to die than Even more disturbing, some individual statin trials associated with an even greater risk of diabetes in
in the cell membrane. If you lower cholesterol you’re those with the highest cholesterol levels. The research- have confirmed a potential cancer risk increase from one major Canadian study. Those who underwent
going to interfere with serotonin getting into the cells. ers concluded, “Subjects with low total cholesterol lev- statin therapy. In the Prospective Study of Pravastatin “high-dose” statin therapy in a meta-analysis of five
It’s that simple. In fact, research has convincingly els are at higher risk of dying even when many related in the Elderly at Risk (PROSPER)—one of the only statin studies were found to have a significantly
demonstrated that serotonin receptors can be ren- factors have been taken into account,” adding that statin trials designed for elderly subjects—overall can- increased risk of diabetes.24 In another study,
dered dysfunctional by statin drugs.18 “. . . physicians may want to regard very low levels of cer incidence was significantly higher for participants researchers found that statin use increased the risk
The noted French researcher Michel de Lorgeril, cholesterol as potential warning signs of occult disease taking pravastatin compared to a placebo. In fact, can- of diabetes by a whopping 46 percent. Let us point
20
M.D. (lead author on the Lyon Diet Heart Study), is so or as signals of rapidly declining health.” cer rates went up so much that they cancelled out the out that as recently as 2018, Dr. Jennifer Ashton went
strongly convinced that statins are screwing up our reduction in heart disease deaths, leaving overall on Good Morning America to defend the American
sex lives that he devoted an entire book to the sub- STATINS, CANCER, AND DIABETES mortality unchanged. (For a deeper discussion of the Heart Association’s astonishing recommendation that
ject. His only book in English, it offers a brilliant argu- There are also troubling indications that statin drugs PROSPER study see appendix A.) Likewise, in the people take whatever high dose of statins is neces-
ment supported by ninety-two references from peer- may be associated with a higher risk for cancer and Long-Term Intervention with Pravastatin in Ischaemic sary to bring their LDL down to 70 or less.25
reviewed journals and textbooks. The name of the diabetes. Researchers from the Department of Disease (LIPID) study, the elderly subgroup (ages Let that sink in for a minute. The American Heart
book—A Near-Perfect Sexual Crime: Statins Against Medicine at Tufts Medical Center and Tufts University sixty-five to seventy-five) taking pravastatin had sig- Association and its apologists literally recommend
Cholesterol—pretty much tells you what de Lorgeril School of Medicine examined twenty-three statin nificantly higher cancer incidence than the placebo that you take however high a dose you need of a drug
thinks about statins and our sex lives. trials looking for any connection between cholesterol group. Collectively, this suggests that elderly statin known to cause diabetes for the sole purpose of
levels and cancer. They concluded that “the risk of users might be especially susceptible to the cancer- bringing down a number (“LDL”) that no longer mat-
STATINS AND ALL-CAUSE cancer is significantly associated with lower achieved promoting properties of these drugs. ters. It would be funny if it weren’t so sad.
MORTALITY LDL-cholesterol levels,” adding that “the cardio- When it comes to diabetes, statins are also look- Considering that statins have been shown to
Earlier, we discussed how the majority of cholesterol- vascular benefits of low achieved levels of LDL- ing increasingly suspect. In a study published in reduce glucose tolerance, induce hyperglycemia,
lowering studies didn’t show any difference in death cholesterol may in part be offset by an increased risk Diabetes Care in 2014, a cohort of over 115,000 Italian induce hyperinsulinemia, and change insulin secretion
21
rates between patients who took cholesterol-lowering of cancer.” Statins can potentially promote cancer residents—all freshly treated with statins during 2003 patterns in the pancreas, it probably shouldn’t come
meds and patients who didn’t. In some of these cases, through a variety of mechanisms: one, through and 2004—were followed for about seven years, with as a surprise that for some people, the end result is
a slight reduction in heart disease deaths was clearly reductions in natural killer cell cytotoxicity (which, researchers tracking any subsequent diabetes diagno- full-blown diabetes.26 As we’ve noted in chapter 1, dia-
offset by a slight increase in deaths from other over time, decrease the body’s immune response to ses or treatment they received. By the end of the betes should really be considered “pre-heart disease.”

tors (SSRIs) because they act mainly to keep sero- causes, so the overall net “gain” in terms of lives tumor cells); two, through increases in endothelial study, the more consistently the participants took
tonin hanging around the brain longer. Serotonin has saved was a big fat zero. progenitor cells in the bone marrow (which are their statins, the greater their risk of developing dia-
a great deal to do with our feelings of relaxation, well- But many studies show even more troubling associated with invasive breast cancer and lymphoma, betes: The researchers wrote, “In a real-world setting,
being, and satisfaction. results. For example, a study in the Journal of Cardiac and can potentially feed tumors by supporting new the risk of new-onset diabetes rises as adherence
So how exactly do statins act on the physiology Failure showed that low cholesterol was actually associ- blood vessel growth); and three, by increasing the with statin therapy increases.”23 In fact, compared to
of serotonin? ated with a marked increase in mortality in heart fail- numbers and functionality of regulatory T-cells (which patients with very low adherence to the drug, those
19
Simple. Much like oxytocin (discussed above), ure cases. And the Italian Longitudinal Study on can impair the body’s immune response against who took the drug religiously had a 32 percent
serotonin depends on cell receptors to get into the Aging, published in the Journal of the American tumors and decrease the effectiveness of cancer greater risk of becoming diabetic.
22
cells. Serotonin receptors—just like oxytocin recep- Geriatric Society, found that those with cholesterol lev- immunotherapy). And dose matters. Higher-potency statins were
tors—are anchored into the cholesterol-rich lipid rafts els lower than 189 were far more likely to die than Even more disturbing, some individual statin trials associated with an even greater risk of diabetes in
in the cell membrane. If you lower cholesterol you’re those with the highest cholesterol levels. The research- have confirmed a potential cancer risk increase from one major Canadian study. Those who underwent
going to interfere with serotonin getting into the cells. ers concluded, “Subjects with low total cholesterol lev- statin therapy. In the Prospective Study of Pravastatin “high-dose” statin therapy in a meta-analysis of five
It’s that simple. In fact, research has convincingly els are at higher risk of dying even when many related in the Elderly at Risk (PROSPER)—one of the only statin studies were found to have a significantly
demonstrated that serotonin receptors can be ren- factors have been taken into account,” adding that statin trials designed for elderly subjects—overall can- increased risk of diabetes.24 In another study,
dered dysfunctional by statin drugs.18 “. . . physicians may want to regard very low levels of cer incidence was significantly higher for participants researchers found that statin use increased the risk
The noted French researcher Michel de Lorgeril, cholesterol as potential warning signs of occult disease taking pravastatin compared to a placebo. In fact, can- of diabetes by a whopping 46 percent. Let us point
20
M.D. (lead author on the Lyon Diet Heart Study), is so or as signals of rapidly declining health.” cer rates went up so much that they cancelled out the out that as recently as 2018, Dr. Jennifer Ashton went
strongly convinced that statins are screwing up our reduction in heart disease deaths, leaving overall on Good Morning America to defend the American
sex lives that he devoted an entire book to the sub- STATINS, CANCER, AND DIABETES mortality unchanged. (For a deeper discussion of the Heart Association’s astonishing recommendation that
ject. His only book in English, it offers a brilliant argu- There are also troubling indications that statin drugs PROSPER study see appendix A.) Likewise, in the people take whatever high dose of statins is neces-
ment supported by ninety-two references from peer- may be associated with a higher risk for cancer and Long-Term Intervention with Pravastatin in Ischaemic sary to bring their LDL down to 70 or less.25
reviewed journals and textbooks. The name of the diabetes. Researchers from the Department of Disease (LIPID) study, the elderly subgroup (ages Let that sink in for a minute. The American Heart
book—A Near-Perfect Sexual Crime: Statins Against Medicine at Tufts Medical Center and Tufts University sixty-five to seventy-five) taking pravastatin had sig- Association and its apologists literally recommend
Cholesterol—pretty much tells you what de Lorgeril School of Medicine examined twenty-three statin nificantly higher cancer incidence than the placebo that you take however high a dose you need of a drug
thinks about statins and our sex lives. trials looking for any connection between cholesterol group. Collectively, this suggests that elderly statin known to cause diabetes for the sole purpose of
levels and cancer. They concluded that “the risk of users might be especially susceptible to the cancer- bringing down a number (“LDL”) that no longer mat-
STATINS AND ALL-CAUSE cancer is significantly associated with lower achieved promoting properties of these drugs. ters. It would be funny if it weren’t so sad.
MORTALITY LDL-cholesterol levels,” adding that “the cardio- When it comes to diabetes, statins are also look- Considering that statins have been shown to
Earlier, we discussed how the majority of cholesterol- vascular benefits of low achieved levels of LDL- ing increasingly suspect. In a study published in reduce glucose tolerance, induce hyperglycemia,
lowering studies didn’t show any difference in death cholesterol may in part be offset by an increased risk Diabetes Care in 2014, a cohort of over 115,000 Italian induce hyperinsulinemia, and change insulin secretion
21
rates between patients who took cholesterol-lowering of cancer.” Statins can potentially promote cancer residents—all freshly treated with statins during 2003 patterns in the pancreas, it probably shouldn’t come
meds and patients who didn’t. In some of these cases, through a variety of mechanisms: one, through and 2004—were followed for about seven years, with as a surprise that for some people, the end result is
a slight reduction in heart disease deaths was clearly reductions in natural killer cell cytotoxicity (which, researchers tracking any subsequent diabetes diagno- full-blown diabetes.26 As we’ve noted in chapter 1, dia-
offset by a slight increase in deaths from other over time, decrease the body’s immune response to ses or treatment they received. By the end of the betes should really be considered “pre-heart disease.”

Okay, so it’s pretty clear that statin drug side have to know how much money we’re talking about to actually see at the end of the day, or the number of in trouble also!
effects are hardly uncommon. But if so many people know if you made the right choice. After all, I’d rather patients who you’ll actually help. Percentages are And when the folks with the highest cholesterol
have so many symptoms as a result of taking statin have one percent of Warren Buffet’s bank account wildly misleading. were compared to the folks with the lowest? Those
drugs, why, you might well ask, have you not heard than 90 percent of the average American’s. with levels greater than 290 mg/dL were at a 400
about them? Don’t doctors know about this stuff? So this is where drug companies get sleazy. Let’s A NEUROSCIENTIST TAKES ON percent increased relative risk of keeling over from a
Okay, we’ve answered the first question in our say a drug company advertises that their drug was THE STATIN DATA heart attack.
inquiry—”What are the risks?” Now it’s time to take a shown to produce a “40 percent reduction in risk!” Let’s look at one of the most stunning real-life The researchers proclaimed their study proved
look at the second question: “What are the benefits?” for a heart attack. Let’s use some real numbers to examples of how relative risk tricked us into fearing that cholesterol “powerfully affects risk for the great
Only then can we make an intelligent decision about show how misleading that can be, even though it cholesterol. This one’s brought to us by David majority of middle-aged American men.”
the risk-benefit ratio and decide whether it really sounds really good. As of this writing, Russia has the Diamond, a brilliant neuroscientist whose interest in If that doesn’t make your doc whip out the pre-
makes sense to take (or stay) on a statin drug. greatest rate of heart attacks of any country, 1,752 cholesterol began after he was diagnosed with familial scription pad, we’re not sure what will. Not surpris-
Let’s take a look at the evidence. people for every 100,000. That means any given per- hypertriglyceridemia—a genetic condition that leads to ingly, the paper had a formidable impact on the
son has a 1.752 percent chance of getting a heart dangerously high triglyceride levels. nation’s beliefs about cholesterol. Surely a study fol-
THE “BENEFITS” OF STATIN DRUGS: attack in any given year. Now let’s assume you didn’t In his quest to get to the bottom of the heart dis- lowing that many people couldn’t lead us astray. High
NOT EXACTLY WHAT WE’VE BEEN know that, but you’re scared to death of a heart ease and cholesterol confusion, Diamond decided to cholesterol sure seemed like a bad actor. The logical
LED TO BELIEVE attack because there’s heart disease in your family. take a deeper dive into the research. He started with conclusion from the study became “the lower, the
29
To understand how you may have been misled about You’re offered a drug that has a lot of potential side a highly influential study known as the MRFIT study better” where cholesterol was concerned—an assump-
the benefits of statin drugs, it’ll be useful to first effects but your doctor, repeating the drug company’s which is often used as evidence in favor of the con- tion that still lingers today, fueling doctors’ aggressive
understand something about how it’s possible to talking points, explains that this drug will reduce your ventional view on cholesterol and heart disease. (The attempts to push patients’ levels as far down as phar-
mislead by using percentages. (Spoiler alert: If you risk of a heart attack by 25 percent. That’s no small MRFIT study followed a whopping near 360,000 men— maceutically possible (and, incidentally, making the
want to make something sound better than it is—for potatoes, and many of us would take a chance on side at the time, the largest cohort of its kind—tracking the shareholders of Big Pharma crack open the bubbly).
example, the success rates for a drug—percentages effects in order to reduce our risk of a heart attack subjects’ cholesterol levels and risk of heart attack And that’s why David Diamond wanted to see
are the way to go. We’ll explain.) by such a large percentage. But when you do the over the years.) whether the study’s alarmism stood on solid ground.
Let’s say you’re on a game show and you can math and look at the actual numbers, here’s what you The paper’s claims were bold, alarming, and Given how important we know cholesterol is for our
choose between two prizes, both of which are a big get. Without the drug, you’ve got roughly a 1.75 per- enough to send anyone with even normal cholesterol body’s basic survival—and, what’s more, how flimsy
pile of money (but you don’t know how much). Here’s cent chance of getting a heart attack. With the drug, levels into a panic. The analysis seemed to show that the cholesterol hypothesis of heart disease has
the choice: You can have 10 percent of all the money your chance drops to . . . wait for it . . . 1.31 percent virtually any increase in blood cholesterol above 150 proven to be—something seemed fishy about such
behind door number one, or you can have 90 percent chance. Presented with the opportunity to take a drug mg/dL was associated with an incrementally greater dramatic findings. So instead of trusting the relative
of all the money behind door number two. with a lot of side effects in order to reduce your risk of death from heart disease. For every mere 1 risk that the researchers reported, Diamond wanted
Which one do you choose? actual odds of getting a heart attack by less than a percent increase in blood cholesterol, in fact, heart to know the absolute risk—how many people actually
It’s impossible to know what’s the better deal half a percent, many people might understandably disease risk rose by 2 percent. got heart attacks and died during the study.
without knowing the absolute number of dollars say, “No thanks, doc.” In other words, it wasn’t just folks with very high Which is exactly what you really want to know.
behind each door. Sure, all things being equal, 90 The point is—you always want to know the actual cholesterol that needed to worry: pretty everyone So Diamond takes a fresh look at the MRFIT
percent sounds a lot better than 10 percent, but you’d numbers, whether it’s the number of dollars you’ll else who had a cholesterol over the “ideal” level was study and crunches the numbers—and the results

Okay, so it’s pretty clear that statin drug side have to know how much money we’re talking about to actually see at the end of the day, or the number of in trouble also!
effects are hardly uncommon. But if so many people know if you made the right choice. After all, I’d rather patients who you’ll actually help. Percentages are And when the folks with the highest cholesterol
have so many symptoms as a result of taking statin have one percent of Warren Buffet’s bank account wildly misleading. were compared to the folks with the lowest? Those
drugs, why, you might well ask, have you not heard than 90 percent of the average American’s. with levels greater than 290 mg/dL were at a 400
about them? Don’t doctors know about this stuff? So this is where drug companies get sleazy. Let’s A NEUROSCIENTIST TAKES ON percent increased relative risk of keeling over from a
Okay, we’ve answered the first question in our say a drug company advertises that their drug was THE STATIN DATA heart attack.
inquiry—”What are the risks?” Now it’s time to take a shown to produce a “40 percent reduction in risk!” Let’s look at one of the most stunning real-life The researchers proclaimed their study proved
look at the second question: “What are the benefits?” for a heart attack. Let’s use some real numbers to examples of how relative risk tricked us into fearing that cholesterol “powerfully affects risk for the great
Only then can we make an intelligent decision about show how misleading that can be, even though it cholesterol. This one’s brought to us by David majority of middle-aged American men.”
the risk-benefit ratio and decide whether it really sounds really good. As of this writing, Russia has the Diamond, a brilliant neuroscientist whose interest in If that doesn’t make your doc whip out the pre-
makes sense to take (or stay) on a statin drug. greatest rate of heart attacks of any country, 1,752 cholesterol began after he was diagnosed with familial scription pad, we’re not sure what will. Not surpris-
Let’s take a look at the evidence. people for every 100,000. That means any given per- hypertriglyceridemia—a genetic condition that leads to ingly, the paper had a formidable impact on the
son has a 1.752 percent chance of getting a heart dangerously high triglyceride levels. nation’s beliefs about cholesterol. Surely a study fol-
THE “BENEFITS” OF STATIN DRUGS: attack in any given year. Now let’s assume you didn’t In his quest to get to the bottom of the heart dis- lowing that many people couldn’t lead us astray. High
NOT EXACTLY WHAT WE’VE BEEN know that, but you’re scared to death of a heart ease and cholesterol confusion, Diamond decided to cholesterol sure seemed like a bad actor. The logical
LED TO BELIEVE attack because there’s heart disease in your family. take a deeper dive into the research. He started with conclusion from the study became “the lower, the
29
To understand how you may have been misled about You’re offered a drug that has a lot of potential side a highly influential study known as the MRFIT study better” where cholesterol was concerned—an assump-
the benefits of statin drugs, it’ll be useful to first effects but your doctor, repeating the drug company’s which is often used as evidence in favor of the con- tion that still lingers today, fueling doctors’ aggressive
understand something about how it’s possible to talking points, explains that this drug will reduce your ventional view on cholesterol and heart disease. (The attempts to push patients’ levels as far down as phar-
mislead by using percentages. (Spoiler alert: If you risk of a heart attack by 25 percent. That’s no small MRFIT study followed a whopping near 360,000 men— maceutically possible (and, incidentally, making the
want to make something sound better than it is—for potatoes, and many of us would take a chance on side at the time, the largest cohort of its kind—tracking the shareholders of Big Pharma crack open the bubbly).
example, the success rates for a drug—percentages effects in order to reduce our risk of a heart attack subjects’ cholesterol levels and risk of heart attack And that’s why David Diamond wanted to see
are the way to go. We’ll explain.) by such a large percentage. But when you do the over the years.) whether the study’s alarmism stood on solid ground.
Let’s say you’re on a game show and you can math and look at the actual numbers, here’s what you The paper’s claims were bold, alarming, and Given how important we know cholesterol is for our
choose between two prizes, both of which are a big get. Without the drug, you’ve got roughly a 1.75 per- enough to send anyone with even normal cholesterol body’s basic survival—and, what’s more, how flimsy
pile of money (but you don’t know how much). Here’s cent chance of getting a heart attack. With the drug, levels into a panic. The analysis seemed to show that the cholesterol hypothesis of heart disease has
the choice: You can have 10 percent of all the money your chance drops to . . . wait for it . . . 1.31 percent virtually any increase in blood cholesterol above 150 proven to be—something seemed fishy about such
behind door number one, or you can have 90 percent chance. Presented with the opportunity to take a drug mg/dL was associated with an incrementally greater dramatic findings. So instead of trusting the relative
of all the money behind door number two. with a lot of side effects in order to reduce your risk of death from heart disease. For every mere 1 risk that the researchers reported, Diamond wanted
Which one do you choose? actual odds of getting a heart attack by less than a percent increase in blood cholesterol, in fact, heart to know the absolute risk—how many people actually
It’s impossible to know what’s the better deal half a percent, many people might understandably disease risk rose by 2 percent. got heart attacks and died during the study.
without knowing the absolute number of dollars say, “No thanks, doc.” In other words, it wasn’t just folks with very high Which is exactly what you really want to know.
behind each door. Sure, all things being equal, 90 The point is—you always want to know the actual cholesterol that needed to worry: pretty everyone So Diamond takes a fresh look at the MRFIT
percent sounds a lot better than 10 percent, but you’d numbers, whether it’s the number of dollars you’ll else who had a cholesterol over the “ideal” level was study and crunches the numbers—and the results

speak for themselves. In an impressive re-analysis of with really high cholesterol levels—290 mg/dL and increased risk of death from heart disease” for peo- their drugs.
30
the actual numbers (which he’s presented in a number over, the kind of numbers that would drive a conven- ple with the highest cholesterol. The makers of Lipitor, for example, famously
of recorded lectures some of which are available on tional doctor to drink. In the super-high cholesterol See why this stuff is so tricky? The original advertised a 36 percent reduction in heart attack risk
YouTube), Diamond showed that in each cholesterol group, fully 98.7 percent didn’t die of heart disease paper’s relative risk wasn’t dishonest, per se—but it in their magazine ads. But read the fine print. It’s a
bracket, the number of people who didn’t develop (and a very slightly higher 1.3 percent did). certainly wasn’t the kind of reporting that tells us the relative number. Here’s how they compute it.
heart disease and the number of people who did was That’s right. The real, absolute difference in risk full story. And if it weren’t for relentlessly investiga- Let’s say you have a hundred randomly chosen
nearly identical. between those with very low cholesterol and those tive minds like Diamond’s, we’d be none the wiser. men who are not taking medication; and let’s say that
Consider this: Among folks with rock-bottom cho- with very high cholesterol was a mere 1 percent (the All that being said, the MRFIT paper in question out of that hundred, it’s statistically likely that three
lesterol levels (150 mg/dL), the kind of numbers most difference between .3 and 1.3). A lousy 1 percent dif- was published in 1986—a great many decades ago. Has of them would be expected to experience a heart
conventional docs would be delighted to see, 99.7 ference in absolute risk across the entire range of its findings, as ultimately unimpressive as they are, attack at some point over the course of five years—in
percent didn’t die of heart disease (and 0.3 percent cholesterol is what got everyone’s knickers in a knot. held up over time? Is having very low cholesterol lev- other words, 3 percent of the total number of men
did). Okay, sounds like really low cholesterol is a Through the wizardry of statistics, the researchers els really even a tiny boon for heart disease mortality? (one hundred) would be normally expected to have a
great goal. But compare those numbers to the group were able to present those numbers as “400 percent The answer appears to be a resounding “no.” In heart attack over the course of sixty months. (The
2016, an even bigger analysis published in the actual numbers in the study were slightly different,
Relationship Between Serum Cholesterol and Risk of Premature American Heart Association’s journal Circulation—this resulting in the “36 percent” claim, but for purposes
Death from Coronary Heart Disease Continuous and Graded? time following more than 1,250,00 statins-free veter- of clarity, let’s just round it out to 33 percent.)
Findings in 354.22 Primary Screenees of the Multiple Risk Factor Intervention Trial (MRFIT) ans between the years 2002 and 2007—successfully Now, if you had put those same men on Lipitor
Jeremiah Stamler, MD; Deborah Wentworth, MPH, James D. Neaton, PhD called MRFIT’s bluff. While folks with the highest cho- over the course of the same five years, it turns out
99.7% JAMA 1986 98.7% lesterol levels still had a higher risk for heart disease, that instead of three men having a heart attack, only
did not did not
this study found that folks with low cholesterol were two would (2 percent of the total number of men). A
die of die of
CHD CHD in trouble, too: Those with cholesterol under 180 mg/ reduction from three heart attacks to two heart
4.5 - - 100 dL had more deaths from heart disease than those attacks is in fact a 331⁄3 percent reduction in relative
4.0 - with cholesterol all the way up to 240 mg/dL. risk—“1” is obviously 1⁄3 of the number 3—but so what?,
3.5 - - 80 Imagine if, way back in the 1980s, we’d been told The real, absolute number of heart attacks prevented
3.0 - that low cholesterol was just as bad as high choles- is only one. One heart attack among a hundred men
- 60 terol. And that having “normal” cholesterol of, say, over the course of five years. The real absolute reduc-
2.5 -
175 mg/dL actually put you at a greater heart disease tion in risk is 1 percent (the difference between the 3
2.0 -
- 40 risk than having a “high” cholesterol of 235 mg/dL. percent in the no-drug group who would have had a
1.5 -
Unfortunately, that’s not what happened. heart attack and the 2 percent in the Lipitor group).
1.0 - - 20 The “33 percent reduction” figure is, again, a relative
0.5 - FUZZY MATH, ANYONE? number, and because it’s way more impressive than
0.0 - -0 Now let’s see how the drug companies use the same the much more truthful “1 percent” (the absolute
150 175 187 198 208 215 226 238 243 > 290
deceptive “relative” numbers (percentages rather number), researchers frequently choose to use rela-
Serum Cholesterol (mg/dl) than patients) to mislead you about the effects of tive risk instead of absolute risk when they report

speak for themselves. In an impressive re-analysis of with really high cholesterol levels—290 mg/dL and increased risk of death from heart disease” for peo- their drugs.
30
the actual numbers (which he’s presented in a number over, the kind of numbers that would drive a conven- ple with the highest cholesterol. The makers of Lipitor, for example, famously
of recorded lectures some of which are available on tional doctor to drink. In the super-high cholesterol See why this stuff is so tricky? The original advertised a 36 percent reduction in heart attack risk
YouTube), Diamond showed that in each cholesterol group, fully 98.7 percent didn’t die of heart disease paper’s relative risk wasn’t dishonest, per se—but it in their magazine ads. But read the fine print. It’s a
bracket, the number of people who didn’t develop (and a very slightly higher 1.3 percent did). certainly wasn’t the kind of reporting that tells us the relative number. Here’s how they compute it.
heart disease and the number of people who did was That’s right. The real, absolute difference in risk full story. And if it weren’t for relentlessly investiga- Let’s say you have a hundred randomly chosen
nearly identical. between those with very low cholesterol and those tive minds like Diamond’s, we’d be none the wiser. men who are not taking medication; and let’s say that
Consider this: Among folks with rock-bottom cho- with very high cholesterol was a mere 1 percent (the All that being said, the MRFIT paper in question out of that hundred, it’s statistically likely that three
lesterol levels (150 mg/dL), the kind of numbers most difference between .3 and 1.3). A lousy 1 percent dif- was published in 1986—a great many decades ago. Has of them would be expected to experience a heart
conventional docs would be delighted to see, 99.7 ference in absolute risk across the entire range of its findings, as ultimately unimpressive as they are, attack at some point over the course of five years—in
percent didn’t die of heart disease (and 0.3 percent cholesterol is what got everyone’s knickers in a knot. held up over time? Is having very low cholesterol lev- other words, 3 percent of the total number of men
did). Okay, sounds like really low cholesterol is a Through the wizardry of statistics, the researchers els really even a tiny boon for heart disease mortality? (one hundred) would be normally expected to have a
great goal. But compare those numbers to the group were able to present those numbers as “400 percent The answer appears to be a resounding “no.” In heart attack over the course of sixty months. (The
2016, an even bigger analysis published in the actual numbers in the study were slightly different,
Relationship Between Serum Cholesterol and Risk of Premature American Heart Association’s journal Circulation—this resulting in the “36 percent” claim, but for purposes
Death from Coronary Heart Disease Continuous and Graded? time following more than 1,250,00 statins-free veter- of clarity, let’s just round it out to 33 percent.)
Findings in 354.22 Primary Screenees of the Multiple Risk Factor Intervention Trial (MRFIT) ans between the years 2002 and 2007—successfully Now, if you had put those same men on Lipitor
Jeremiah Stamler, MD; Deborah Wentworth, MPH, James D. Neaton, PhD called MRFIT’s bluff. While folks with the highest cho- over the course of the same five years, it turns out
99.7% JAMA 1986 98.7% lesterol levels still had a higher risk for heart disease, that instead of three men having a heart attack, only
did not did not
this study found that folks with low cholesterol were two would (2 percent of the total number of men). A
die of die of
CHD CHD in trouble, too: Those with cholesterol under 180 mg/ reduction from three heart attacks to two heart
4.5 - - 100 dL had more deaths from heart disease than those attacks is in fact a 331⁄3 percent reduction in relative
4.0 - with cholesterol all the way up to 240 mg/dL. risk—“1” is obviously 1⁄3 of the number 3—but so what?,
3.5 - - 80 Imagine if, way back in the 1980s, we’d been told The real, absolute number of heart attacks prevented
3.0 - that low cholesterol was just as bad as high choles- is only one. One heart attack among a hundred men
- 60 terol. And that having “normal” cholesterol of, say, over the course of five years. The real absolute reduc-
2.5 -
175 mg/dL actually put you at a greater heart disease tion in risk is 1 percent (the difference between the 3
2.0 -
- 40 risk than having a “high” cholesterol of 235 mg/dL. percent in the no-drug group who would have had a
1.5 -
Unfortunately, that’s not what happened. heart attack and the 2 percent in the Lipitor group).
1.0 - - 20 The “33 percent reduction” figure is, again, a relative
0.5 - FUZZY MATH, ANYONE? number, and because it’s way more impressive than
0.0 - -0 Now let’s see how the drug companies use the same the much more truthful “1 percent” (the absolute
150 175 187 198 208 215 226 238 243 > 290
deceptive “relative” numbers (percentages rather number), researchers frequently choose to use rela-
Serum Cholesterol (mg/dl) than patients) to mislead you about the effects of tive risk instead of absolute risk when they report

results! (Would you take a drug for five years with all Lipitor study. He created a graph to show the differ- Keep this in mind when you read our review of addition to lowering the risk for heart disease the
the potential side effects reported above if you knew ence between the people treated with Lipitor and the some of the studies used to promote the idea that drug increased the risk for diabetes—a finding that’s
that it would reduce your chance of a heart attack by people who got a placebo. On the graph you’ll see two statins save lives. shown up in a couple of statin drug studies—the con-
just 1 percent? Probably not, right? Which is exactly large bars, one in gray, one in black, that—if you There’s a second concept that would be helpful to nection to diabetes might easily be buried in the text
why the advertisements would tout “ ⁄3 reduction in
1
squint—look like they are the exact same height. understand before we venture into the studies them- where only the most determined investigators would
heart attacks” or “33 percent less risk.” The drug And that’s because, for all intents and purposes, selves, and that’s the distinction between primary pre- be likely to uncover it.
companies may be avaricious, but they’re not stupid!) they are. vention and secondary prevention. Primary prevention At this point, in the first edition of this book, we
Worth noting: The fine print in that famous The bars show the percentage of people in the refers to treating people who have not had a heart went on a bit of a rampage, taking apart the sacred
Lipitor ad did indeed admit that what really happened study that did not get a heart attack. They show that attack for the purpose of preventing one. Secondary cow studies of the cholesterol establishment while
was heart attacks went from 3 percent to 2 percent. in the placebo group, 97 percent of the people did not prevention refers to treating people who’ve already bringing to light many of the studies that refute their
(You can see the original ad online—complete with get one, while in the Lipitor group, 98.1 percent did had a heart attack for the purpose of preventing conclusions. The “positive” studies—those showing a
fine print—by checking Google images for “Lipitor not. When you see these bars side by side, it shows another. As you’ll soon see, the effect of statins on statistical benefit—are used by the drug companies to
reduces heart attack risk by 36 percent.) how truly minor the effect was. Lipitor basically these two populations is quite different. support the idea that statin drugs prevent heart
By the way—the aforementioned neuroscientist, reduced the percentage of people getting heart Before we get to that, there’s something else you attacks (sometimes, they claim, by as much as 36%!)
Dr. David Diamond, worked his wizardry on that same attacks by 1.1 percent. should know about study interpretation in general that and that statin drugs save lives.
may help you make more sense of some of the statin In the original book we went over these studies—
propaganda. Studies usually produce a mass of data including the ALLHAT study, the ASCOT-LLA trial, the
Prevention of coronary and stroke events with atorvastatin in hypertensive patients that can be spun in a number of ways. Let’s take one Japanese Lipid Intervention Trial, the PROSPER trial
who have average or lower-than-average cholesterol concentrations,
common substance we’re all familiar with: alcohol. and the infamous JUPITER study—in great detail,
in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA):
There are no shortages of studies demonstrating that exposing faulty methodology and unjustified conclu-
a multicenter randomized controlled trial
moderate alcohol consumption is associated with a sions whenever they occurred (and they occurred
Placebo slightly lower risk of heart disease. So far, so good. But frequently).
Atorvastatin those same studies have also teased out a troubling But that was ten years ago, and detail that might
100 - connection—alcohol consumption increases the risk for seem mind-numbing and tedious today was needed
-
breast cancer! Both facts—that alcohol helps your then to expose the real flaws in the cholesterol
% of 80 -
Subjects heart and that alcohol increases the risk for breast hypothesis. We’ve decided to take a different
-
Without 60 - cancer—are absolutely true, but if you’re a manufac- approach in this edition, largely to save those who
an Event - turer of alcoholic beverages you’re going to be talking don’t really care about the methodological minutiae
40 - up the reduction in heart disease risk and not calling and statistical details and would rather just get to the
-
attention to the association with breast cancer. conclusions. We feel you.
20 -
In much the same way, a drug company–spon- But for those of you who are interested in the
-
0.0 - sored study might indeed find a beneficial effect on details of the how’s and why’s of misleading statistics,
Absence of No CVD No Coronary Survival No CVD Survival
Nonfatal MI Events Events Death
heart disease associated with a particular drug, a we’ve included the detailed analyses of all these stud-
+ Fatal CHD beneficial effect similar to that of alcohol. But if in ies in appendix A. Those who want to can nerd out on

results! (Would you take a drug for five years with all Lipitor study. He created a graph to show the differ- Keep this in mind when you read our review of addition to lowering the risk for heart disease the
the potential side effects reported above if you knew ence between the people treated with Lipitor and the some of the studies used to promote the idea that drug increased the risk for diabetes—a finding that’s
that it would reduce your chance of a heart attack by people who got a placebo. On the graph you’ll see two statins save lives. shown up in a couple of statin drug studies—the con-
just 1 percent? Probably not, right? Which is exactly large bars, one in gray, one in black, that—if you There’s a second concept that would be helpful to nection to diabetes might easily be buried in the text
why the advertisements would tout “ ⁄3 reduction in
1
squint—look like they are the exact same height. understand before we venture into the studies them- where only the most determined investigators would
heart attacks” or “33 percent less risk.” The drug And that’s because, for all intents and purposes, selves, and that’s the distinction between primary pre- be likely to uncover it.
companies may be avaricious, but they’re not stupid!) they are. vention and secondary prevention. Primary prevention At this point, in the first edition of this book, we
Worth noting: The fine print in that famous The bars show the percentage of people in the refers to treating people who have not had a heart went on a bit of a rampage, taking apart the sacred
Lipitor ad did indeed admit that what really happened study that did not get a heart attack. They show that attack for the purpose of preventing one. Secondary cow studies of the cholesterol establishment while
was heart attacks went from 3 percent to 2 percent. in the placebo group, 97 percent of the people did not prevention refers to treating people who’ve already bringing to light many of the studies that refute their
(You can see the original ad online—complete with get one, while in the Lipitor group, 98.1 percent did had a heart attack for the purpose of preventing conclusions. The “positive” studies—those showing a
fine print—by checking Google images for “Lipitor not. When you see these bars side by side, it shows another. As you’ll soon see, the effect of statins on statistical benefit—are used by the drug companies to
reduces heart attack risk by 36 percent.) how truly minor the effect was. Lipitor basically these two populations is quite different. support the idea that statin drugs prevent heart
By the way—the aforementioned neuroscientist, reduced the percentage of people getting heart Before we get to that, there’s something else you attacks (sometimes, they claim, by as much as 36%!)
Dr. David Diamond, worked his wizardry on that same attacks by 1.1 percent. should know about study interpretation in general that and that statin drugs save lives.
may help you make more sense of some of the statin In the original book we went over these studies—
propaganda. Studies usually produce a mass of data including the ALLHAT study, the ASCOT-LLA trial, the
Prevention of coronary and stroke events with atorvastatin in hypertensive patients that can be spun in a number of ways. Let’s take one Japanese Lipid Intervention Trial, the PROSPER trial
who have average or lower-than-average cholesterol concentrations,
common substance we’re all familiar with: alcohol. and the infamous JUPITER study—in great detail,
in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA):
There are no shortages of studies demonstrating that exposing faulty methodology and unjustified conclu-
a multicenter randomized controlled trial
moderate alcohol consumption is associated with a sions whenever they occurred (and they occurred
Placebo slightly lower risk of heart disease. So far, so good. But frequently).
Atorvastatin those same studies have also teased out a troubling But that was ten years ago, and detail that might
100 - connection—alcohol consumption increases the risk for seem mind-numbing and tedious today was needed
-
breast cancer! Both facts—that alcohol helps your then to expose the real flaws in the cholesterol
% of 80 -
Subjects heart and that alcohol increases the risk for breast hypothesis. We’ve decided to take a different
-
Without 60 - cancer—are absolutely true, but if you’re a manufac- approach in this edition, largely to save those who
an Event - turer of alcoholic beverages you’re going to be talking don’t really care about the methodological minutiae
40 - up the reduction in heart disease risk and not calling and statistical details and would rather just get to the
-
attention to the association with breast cancer. conclusions. We feel you.
20 -
In much the same way, a drug company–spon- But for those of you who are interested in the
-
0.0 - sored study might indeed find a beneficial effect on details of the how’s and why’s of misleading statistics,
Absence of No CVD No Coronary Survival No CVD Survival
Nonfatal MI Events Events Death
heart disease associated with a particular drug, a we’ve included the detailed analyses of all these stud-
+ Fatal CHD beneficial effect similar to that of alcohol. But if in ies in appendix A. Those who want to can nerd out on

the numbers all they like, and the “cut-to-the-chase” CHOLESTEROL LOWERING
crowd can break out the kazoos and keep reading, Now, if you’re still on the cholesterol-lowering/statin
WHAT ABOUT PLAQUE?
because here’s the executive, “what-you-need-to- bandwagon, you might be forgiven for trying to look
Okay, so maybe statin drugs don’t cut the risk of dying, except possibly in middle-aged men
know” summary of the “case” for statin drugs. on the bright side. “Look,” we can almost hear you
with previous histories of heart disease (and even then the effect is modest). But what about
In the ALLHAT study, there was ultimately no dif- saying, “maybe you guys are right. Maybe lowering
plaque? Doesn’t aggressive lowering of LDL cholesterol at least reduce plaque?
ference in the death rate from heart attacks between cholesterol doesn’t matter all that much. But clearly
Well, no.
the statin-treated group and the no-statin group. Not there are some good things statins do besides lower
A study published in the American Journal of Cardiology in 2003 used electron beam
a single life was saved by statins. The ASCOT-LLA cholesterol, as you yourselves have pointed out.
tomography to evaluate plaque in 182 patients after 1.2 years of treatment with either statins
study was the one that allowed Lipitor to claim that They’re anti-inflammatory, they’re powerful
alone or statins in conjunction with niacin.32 And yes, just like in many other studies,
their drug lowered the risk of heart disease by 36 antioxidants, and they thin the blood. So what’s the
cholesterol did indeed go down in those patients treated with cholesterol-lowering medication.
percent but for all the bragging, 100 mil was spent on harm if people take them?”
But plaque?
the study and not a single life was saved. What’s Fair enough. For some people, especially middle-
Sorry.
more, critics of the study pointed out a trend toward aged men who’ve already had a first heart attack,
The authors wrote, “Despite the greater improvement in [cholesterol numbers] . . . there
higher rates of heart failure, diabetes, and kidney the good statins do may indeed outweigh the risks.
were no differences in calcified plaque progression.” In fact, subjects in both groups had—on
impairment in the Lipitor-treated group. The problem is twofold: One, statins are being pre-
average—a 9.2 percent increase in plaque buildup. “[W]ith respect to LDL cholesterol lowering,
The Heart Protection Study—which claimed “mas- scribed left and right to people who have absolutely
‘lower is better’ is not supported by changes in calcified plaque progression,” concluded
sive” benefits for a statin drug—actually produced a no business being on them, and to populations for
the authors.
1.8% difference in five-year survival rates between the which they have shown no real benefit. Two, the
statin and non-statin group, and that benefit was risks are significant, serious, varied, and highly
completely independent of LDL cholesterol (meaning underpublicized.
lowering cholesterol had nothing to do with it). The Before we get to our evaluation of the risks and side effects!) egg). Clearly, the body thinks you need that
PROSPER study showed a slight reduction in heart benefits of statin drugs, let’s review exactly what it is Cholesterol is used by the body to synthesize cholesterol.
attacks and strokes, but a slight increase in cancer. that cholesterol does in the first place. Understanding bile acids. Bile acids are vitally important for the Cholesterol is an essential component of all
And again, no change in overall mortality. the functions of this much maligned molecule will help digestion of fat. The acids are synthesized from cho- the cell membranes in the body. It’s especially
Finally, in the famous JUPITER trial that pro- you understand why so many things can go wrong lesterol and then secreted into the bile. Bile acids are important in the membranes of the brain, the nervous
claimed a “50 percent reduction in risk of heart when we pursue lower and lower cholesterol numbers. so important to the body that the body holds on to system, the spinal cord, and the peripheral nerves. It’s
attacks,” the actual risk went from 1.8% in the pla- Cholesterol is a hormone factory. Cholesterol most of them. It keeps them from being lost in the incorporated into the myelin sheath, a kind of insula-
cebo group to .9 percent in the statin group and the is actually the parent molecule for the whole family feces by causing them to be reabsorbed from the tion or “cover” for the nerve fibers that facilitates
statin group had higher rates of diabetes. (For those of hormones known as steroid hormones. These hor- lower intestine, put into a kind of “metabolic recy- nerve impulse transmission. And, as we’ve already
who want more details, please go to the appendix.) mones include cortisol (known as the fight-or-flight cling” container, and taken back to the liver. Still, even seen, cholesterol is an integral part of the lipid raft,
The bottom line is that the body of “evidence” for the hormone) and the entire family of sex steroids, with its best efforts, the body loses some bile acids. essentially allowing for cellular communication.
overwhelming benefit of statins is . . . well, under- including estrogens, progesterones, and testoster- To make up for this, the liver synthesizes approxi- (That’s why there are so many cognitive problems
whelming at best. one. (No wonder statins produce such serious sexual mately 1,500 to 2,000 mg of new cholesterol a day associated with aggressive cholesterol lowering.)
THE DARKER SIDE OF (that’s about seven to ten times the amount in a large Cholesterol is also important for stabilizing cells

the numbers all they like, and the “cut-to-the-chase” CHOLESTEROL LOWERING
crowd can break out the kazoos and keep reading, Now, if you’re still on the cholesterol-lowering/statin
WHAT ABOUT PLAQUE?
because here’s the executive, “what-you-need-to- bandwagon, you might be forgiven for trying to look
Okay, so maybe statin drugs don’t cut the risk of dying, except possibly in middle-aged men
know” summary of the “case” for statin drugs. on the bright side. “Look,” we can almost hear you
with previous histories of heart disease (and even then the effect is modest). But what about
In the ALLHAT study, there was ultimately no dif- saying, “maybe you guys are right. Maybe lowering
plaque? Doesn’t aggressive lowering of LDL cholesterol at least reduce plaque?
ference in the death rate from heart attacks between cholesterol doesn’t matter all that much. But clearly
Well, no.
the statin-treated group and the no-statin group. Not there are some good things statins do besides lower
A study published in the American Journal of Cardiology in 2003 used electron beam
a single life was saved by statins. The ASCOT-LLA cholesterol, as you yourselves have pointed out.
tomography to evaluate plaque in 182 patients after 1.2 years of treatment with either statins
study was the one that allowed Lipitor to claim that They’re anti-inflammatory, they’re powerful
alone or statins in conjunction with niacin.32 And yes, just like in many other studies,
their drug lowered the risk of heart disease by 36 antioxidants, and they thin the blood. So what’s the
cholesterol did indeed go down in those patients treated with cholesterol-lowering medication.
percent but for all the bragging, 100 mil was spent on harm if people take them?”
But plaque?
the study and not a single life was saved. What’s Fair enough. For some people, especially middle-
Sorry.
more, critics of the study pointed out a trend toward aged men who’ve already had a first heart attack,
The authors wrote, “Despite the greater improvement in [cholesterol numbers] . . . there
higher rates of heart failure, diabetes, and kidney the good statins do may indeed outweigh the risks.
were no differences in calcified plaque progression.” In fact, subjects in both groups had—on
impairment in the Lipitor-treated group. The problem is twofold: One, statins are being pre-
average—a 9.2 percent increase in plaque buildup. “[W]ith respect to LDL cholesterol lowering,
The Heart Protection Study—which claimed “mas- scribed left and right to people who have absolutely
‘lower is better’ is not supported by changes in calcified plaque progression,” concluded
sive” benefits for a statin drug—actually produced a no business being on them, and to populations for
the authors.
1.8% difference in five-year survival rates between the which they have shown no real benefit. Two, the
statin and non-statin group, and that benefit was risks are significant, serious, varied, and highly
completely independent of LDL cholesterol (meaning underpublicized.
lowering cholesterol had nothing to do with it). The Before we get to our evaluation of the risks and side effects!) egg). Clearly, the body thinks you need that
PROSPER study showed a slight reduction in heart benefits of statin drugs, let’s review exactly what it is Cholesterol is used by the body to synthesize cholesterol.
attacks and strokes, but a slight increase in cancer. that cholesterol does in the first place. Understanding bile acids. Bile acids are vitally important for the Cholesterol is an essential component of all
And again, no change in overall mortality. the functions of this much maligned molecule will help digestion of fat. The acids are synthesized from cho- the cell membranes in the body. It’s especially
Finally, in the famous JUPITER trial that pro- you understand why so many things can go wrong lesterol and then secreted into the bile. Bile acids are important in the membranes of the brain, the nervous
claimed a “50 percent reduction in risk of heart when we pursue lower and lower cholesterol numbers. so important to the body that the body holds on to system, the spinal cord, and the peripheral nerves. It’s
attacks,” the actual risk went from 1.8% in the pla- Cholesterol is a hormone factory. Cholesterol most of them. It keeps them from being lost in the incorporated into the myelin sheath, a kind of insula-
cebo group to .9 percent in the statin group and the is actually the parent molecule for the whole family feces by causing them to be reabsorbed from the tion or “cover” for the nerve fibers that facilitates
statin group had higher rates of diabetes. (For those of hormones known as steroid hormones. These hor- lower intestine, put into a kind of “metabolic recy- nerve impulse transmission. And, as we’ve already
who want more details, please go to the appendix.) mones include cortisol (known as the fight-or-flight cling” container, and taken back to the liver. Still, even seen, cholesterol is an integral part of the lipid raft,
The bottom line is that the body of “evidence” for the hormone) and the entire family of sex steroids, with its best efforts, the body loses some bile acids. essentially allowing for cellular communication.
overwhelming benefit of statins is . . . well, under- including estrogens, progesterones, and testoster- To make up for this, the liver synthesizes approxi- (That’s why there are so many cognitive problems
whelming at best. one. (No wonder statins produce such serious sexual mately 1,500 to 2,000 mg of new cholesterol a day associated with aggressive cholesterol lowering.)
THE DARKER SIDE OF (that’s about seven to ten times the amount in a large Cholesterol is also important for stabilizing cells

against temperature changes. in the United States (and probably the world) have ciencies are showing up all over the place at the same NOTE
Cholesterol is important for the immune sys- less than optimal vitamin D levels. According to the time that 11 million to 30 million Americans are on Millions of Americans will be taking statin drugs for
tem. Cholesterol has an important connection to the Centers for Disease Control and Prevention, “only” 33 statin drugs, the purpose of which is to lower the very decades, as recommended by the National Cholesterol
immune system. Research has shown that human LDL percent of the U.S. population is at risk for either molecule that gives “birth” to this vitally important Education Program’s (NCEP) guidelines, and long-term
37
(the so-called “bad” cholesterol) is able to inactivate vitamin D “inadequacy” or vitamin D “deficiency,” nutrient? side effects will become apparent, creating a whole
more than 90 percent of the worst and most toxic but the levels considered “sufficient” are still being host of pathologic situations.
bacterial products. 33
debated, and “sufficient” is hardly “optimal.” AN OVERALL HEALTH BENEFIT What does all this confusion and controversy
A number of studies have linked low cholesterol In 2010, the Life Extension Foundation conducted OF ZERO mean to practicing physicians and the patients for
to a greater risk of infections. One review of nine- a survey of its members—a self-selected sample of peo- A few years ago, John Abramson, M.D., author of whom they care? Dietary factors and therapeutic life-
teen large, peer-reviewed studies of more than ple who really care about these things and pay particu- Overdosed America, analyzed eight randomized trials style changes have no side effects. They should be
68,000 deaths found that low cholesterol predicted lar attention to their health, blood tests, and supple- that compared statin drugs with placebos. His findings considered the first line of defense in preventive
an increased risk of dying from respiratory and gas- mentation—and found that even in this highly health- and conclusions were published in a column in The cardiology.
trointestinal diseases, which frequently have an conscious population, a whopping 85 percent had Lancet. Here’s what he wrote: “Our analysis suggests Look, there’s not much doubt that statin therapy
34
infectious origin. Another study that followed more blood tests with vitamin D levels below 50 ng/mL, con- that . . . statins should not be prescribed for true can reduce the incidence of coronary morbidity and
38
than 100,000 healthy individuals in San Francisco sidered the low end of “optimal” (50 to 80 ng/mL). primary prevention in women of any age or for men mortality for those who are at great risk of develop-
40
found that those who had low cholesterol at the Why does this matter? Because there is compel- older than 69 years" ing coronary artery disease.42 But as research contin-
beginning of the fifteen-year study were far more ling research that links less than optimal levels of Dr. Abramson’s conclusions echo the findings and ues to implicate inflammation as the major coronary
likely to be admitted to the hospital because of an vitamin D with heart disease, poor physical perfor- recommendations of the researchers at Therapeutics risk factor, cholesterol recommendations by groups
35
infectious disease. And an interesting finding from mance, osteoporosis, depression, cancer, difficulty in Initiative, a kind of “consumer reports” on drug-indus- such as the NCEP need to be modified. We’re chasing
the MRFIT study showed that sixteen years after losing weight, and even all-cause mortality. Vitamin D try studies that was started in 1994 at the University the wrong villain, as you’ll see in the coming chapters.
their cholesterol was first checked, the group of men is so important that Dr. Gregory Plotnikoff, medical of British Columbia. Therapeutics Initiative, which is Ultimately, hopefully, the attention paid to cholesterol
whose cholesterol level was 160 mg/dL or lower was director of the Penny George Institute for Health and wholly independent of government and Big Pharma, will wind up being proportional to its importance as a
four times more likely to die from AIDS than the Healing, Abbott Northwestern Hospital in Minneapolis, evaluated five of the major statin trials (including causative factor in heart disease, which is to say, not
group of men whose cholesterol was higher than recently commented, “Because vitamin D is so cheap some we talk about in the appendix) and concluded much.
36
240 mg/dL! and so clearly reduces all-cause mortality, I can say that total mortality—i.e., the number of people who Rather than selecting treatment options as a
We make vitamin D from cholesterol. It’s almost this with great certainty: Vitamin D represents the actually died—was not impacted by statin therapy, and technician or a computer would do and targeting cho-
impossible to overstate how important the choles- single most cost-effective medical intervention in the that “statins have not been shown to provide an over- lesterol numbers alone, doctors owe it to their
39 41
terol–vitamin D connection is. Vitamin D, which is United States.” all health benefit in primary prevention trials” patients—and patients owe it to themselves!—to look
actually a hormone, not a vitamin, is made from cho- Undoubtedly, there are multiple reasons why so (emphasis ours). further into these controversial issues before embrac-
lesterol in the body. If you lower cholesterol indiscrim- many people are walking around with suboptimal lev- ing potent drugs that might not truly serve the needs
inately, it stands to reason that you may negatively els of vitamin D, not the least of which is that we are STATINS: A FINAL CAUTIONARY of the people for whom they’re being prescribed.
affect vitamin D levels. And that’s hardly insignificant. so darn sun-phobic that we now slather SPF ninety on Although the use of statins in high-risk coronary
Virtually every health practitioner worth his or our skin just to go to the grocery store. But is it a
her salt will tell you that massive numbers of people coincidence that vitamin D deficiencies and insuffi-

against temperature changes. in the United States (and probably the world) have ciencies are showing up all over the place at the same NOTE
Cholesterol is important for the immune sys- less than optimal vitamin D levels. According to the time that 11 million to 30 million Americans are on Millions of Americans will be taking statin drugs for
tem. Cholesterol has an important connection to the Centers for Disease Control and Prevention, “only” 33 statin drugs, the purpose of which is to lower the very decades, as recommended by the National Cholesterol
immune system. Research has shown that human LDL percent of the U.S. population is at risk for either molecule that gives “birth” to this vitally important Education Program’s (NCEP) guidelines, and long-term
37
(the so-called “bad” cholesterol) is able to inactivate vitamin D “inadequacy” or vitamin D “deficiency,” nutrient? side effects will become apparent, creating a whole
more than 90 percent of the worst and most toxic but the levels considered “sufficient” are still being host of pathologic situations.
bacterial products. 33
debated, and “sufficient” is hardly “optimal.” AN OVERALL HEALTH BENEFIT What does all this confusion and controversy
A number of studies have linked low cholesterol In 2010, the Life Extension Foundation conducted OF ZERO mean to practicing physicians and the patients for
to a greater risk of infections. One review of nine- a survey of its members—a self-selected sample of peo- A few years ago, John Abramson, M.D., author of whom they care? Dietary factors and therapeutic life-
teen large, peer-reviewed studies of more than ple who really care about these things and pay particu- Overdosed America, analyzed eight randomized trials style changes have no side effects. They should be
68,000 deaths found that low cholesterol predicted lar attention to their health, blood tests, and supple- that compared statin drugs with placebos. His findings considered the first line of defense in preventive
an increased risk of dying from respiratory and gas- mentation—and found that even in this highly health- and conclusions were published in a column in The cardiology.
trointestinal diseases, which frequently have an conscious population, a whopping 85 percent had Lancet. Here’s what he wrote: “Our analysis suggests Look, there’s not much doubt that statin therapy
34
infectious origin. Another study that followed more blood tests with vitamin D levels below 50 ng/mL, con- that . . . statins should not be prescribed for true can reduce the incidence of coronary morbidity and
38
than 100,000 healthy individuals in San Francisco sidered the low end of “optimal” (50 to 80 ng/mL). primary prevention in women of any age or for men mortality for those who are at great risk of develop-
40
found that those who had low cholesterol at the Why does this matter? Because there is compel- older than 69 years" ing coronary artery disease.42 But as research contin-
beginning of the fifteen-year study were far more ling research that links less than optimal levels of Dr. Abramson’s conclusions echo the findings and ues to implicate inflammation as the major coronary
likely to be admitted to the hospital because of an vitamin D with heart disease, poor physical perfor- recommendations of the researchers at Therapeutics risk factor, cholesterol recommendations by groups
35
infectious disease. And an interesting finding from mance, osteoporosis, depression, cancer, difficulty in Initiative, a kind of “consumer reports” on drug-indus- such as the NCEP need to be modified. We’re chasing
the MRFIT study showed that sixteen years after losing weight, and even all-cause mortality. Vitamin D try studies that was started in 1994 at the University the wrong villain, as you’ll see in the coming chapters.
their cholesterol was first checked, the group of men is so important that Dr. Gregory Plotnikoff, medical of British Columbia. Therapeutics Initiative, which is Ultimately, hopefully, the attention paid to cholesterol
whose cholesterol level was 160 mg/dL or lower was director of the Penny George Institute for Health and wholly independent of government and Big Pharma, will wind up being proportional to its importance as a
four times more likely to die from AIDS than the Healing, Abbott Northwestern Hospital in Minneapolis, evaluated five of the major statin trials (including causative factor in heart disease, which is to say, not
group of men whose cholesterol was higher than recently commented, “Because vitamin D is so cheap some we talk about in the appendix) and concluded much.
36
240 mg/dL! and so clearly reduces all-cause mortality, I can say that total mortality—i.e., the number of people who Rather than selecting treatment options as a
We make vitamin D from cholesterol. It’s almost this with great certainty: Vitamin D represents the actually died—was not impacted by statin therapy, and technician or a computer would do and targeting cho-
impossible to overstate how important the choles- single most cost-effective medical intervention in the that “statins have not been shown to provide an over- lesterol numbers alone, doctors owe it to their
39 41
terol–vitamin D connection is. Vitamin D, which is United States.” all health benefit in primary prevention trials” patients—and patients owe it to themselves!—to look
actually a hormone, not a vitamin, is made from cho- Undoubtedly, there are multiple reasons why so (emphasis ours). further into these controversial issues before embrac-
lesterol in the body. If you lower cholesterol indiscrim- many people are walking around with suboptimal lev- ing potent drugs that might not truly serve the needs
inately, it stands to reason that you may negatively els of vitamin D, not the least of which is that we are STATINS: A FINAL CAUTIONARY of the people for whom they’re being prescribed.
affect vitamin D levels. And that’s hardly insignificant. so darn sun-phobic that we now slather SPF ninety on Although the use of statins in high-risk coronary
Virtually every health practitioner worth his or our skin just to go to the grocery store. But is it a
her salt will tell you that massive numbers of people coincidence that vitamin D deficiencies and insuffi-

patients—especially those with inflammatory markers—
might be good medicine right now, overuse of these
potent pharmacologic agents (that have both known CHAPTER 9
and unknown side effects) for long-term use in other-
wise healthy people is simply not justifiable.
THE REAL CAUSE

• The benefits of statin drugs have been widely exaggerated, and any benefit of these drugs
OF HEART DISEASE
has little to do with their ability to lower cholesterol.
• Statin drugs deplete coenzyme Q10, one of the most important nutrients for the heart.
Depletion of CoQ10 can cause muscle pain, weakness, and fatigue.
• Statin drugs lead to a reduction in sex hormones, as shown by several studies. Sexual WE’VE ALL HEARD ABOUT THE APPARENTLY HEALTHY PERSON with no history of heart
dysfunction is a common (but underreported) side effect of statin drugs. disease and no known risk factors who suddenly drops dead of a heart attack at age forty-seven while
• There are troubling indicators that statin drugs may be associated with a higher risk for running in the park.
cancer and diabetes. Everybody clucks their tongue, expresses shock and disbelief, and says some version of, “But he
• Statins should not be prescribed for the elderly or for the vast majority of women, and they was so healthy!”
should never be prescribed for children. Well, he wasn’t.
The signs and symptoms were there, probably for many years. And they were hiding in plain sight.
The problem is, no one was looking for them. Because the warning signs for heart disease—the ones
we should be paying close attention to, the ones that often show up years before an actual event—
have very little to do with total cholesterol or LDL.
But they have everything to do with diabetes.
And to understand why, you first need to understand a condition that is at the root of not just dia-
betes, but—according to some compelling research—is at the root of most of the degenerative diseases
of aging. It’s called insulin resistance.

patients—especially those with inflammatory markers—
might be good medicine right now, overuse of these
potent pharmacologic agents (that have both known CHAPTER 9
and unknown side effects) for long-term use in other-
wise healthy people is simply not justifiable.
THE REAL CAUSE

• The benefits of statin drugs have been widely exaggerated, and any benefit of these drugs
OF HEART DISEASE
has little to do with their ability to lower cholesterol.
• Statin drugs deplete coenzyme Q10, one of the most important nutrients for the heart.
Depletion of CoQ10 can cause muscle pain, weakness, and fatigue.
• Statin drugs lead to a reduction in sex hormones, as shown by several studies. Sexual WE’VE ALL HEARD ABOUT THE APPARENTLY HEALTHY PERSON with no history of heart
dysfunction is a common (but underreported) side effect of statin drugs. disease and no known risk factors who suddenly drops dead of a heart attack at age forty-seven while
• There are troubling indicators that statin drugs may be associated with a higher risk for running in the park.
cancer and diabetes. Everybody clucks their tongue, expresses shock and disbelief, and says some version of, “But he
• Statins should not be prescribed for the elderly or for the vast majority of women, and they was so healthy!”
should never be prescribed for children. Well, he wasn’t.
The signs and symptoms were there, probably for many years. And they were hiding in plain sight.
The problem is, no one was looking for them. Because the warning signs for heart disease—the ones
we should be paying close attention to, the ones that often show up years before an actual event—
have very little to do with total cholesterol or LDL.
But they have everything to do with diabetes.
And to understand why, you first need to understand a condition that is at the root of not just dia-
betes, but—according to some compelling research—is at the root of most of the degenerative diseases
of aging. It’s called insulin resistance.

Get to know insulin—it’s more important to your health and
Insulin resistance is to heart disease
your heart than you can imagine, and way more important
what smoking is to lung disease.
than your doctor has probably told you.
Insulin resistance doesn’t account for 100 percent vided by the apple. And that’s just dandy—he goes The pancreas says, “Code Red! Send out the big like it or not. Indeed, they welcome in all that excess
of heart disease any more than smoking accounts for home, his blood sugar is slightly lower than normal guns! This dude just ate the equivalent of ten packs of sugar, and for a while your blood sugar levels may
100 percent of lung cancer. But it tracks with and pre- because all the sugar has gone to powering his mus- Ding Dongs!” The pancreas produces a bucketful of even be in the normal range, as the pancreas valiantly
dicts cardiovascular disease better than any other cles. Now he’s hungry, he eats a healthy dinner, and insulin in a desperate attempt to get all that sugar tries to pump out enough insulin to keep up with the
variable yet studied. We’ll show you the proof a little all is right with the world. out of the bloodstream and deliver it to the muscles. sugar influx.
later on—and don’t worry, there’s quite a bit of it. But That’s how insulin—and metabolism—is supposed Problem is the muscle cells aren’t having it. But don’t be fooled. If insulin is frequently ele-
first we have to explain exactly what insulin resis- to work. In theory. In fact, it does not work that way “What do we need all this sugar for?” they seem vated beyond what it should be, that’s a good clue
tance is, and why it’s so critically important to your in at least 50 percent—or more—of the population. A to be asking. “The only ‘exercise’ this guy’s gonna get that it’s having to work awfully hard to keep sugar at
health. 2015 study showed that when you combine patients all day is pushing a computer mouse, and when he manageable levels. Your blood sugar may still be
with “pre-diabetes” with patients who have already goes home, he’s going to sit on the couch and play hanging on in the “normal” range, but the high levels
INSULIN RESISTANCE IS been diagnosed with diabetes, and, just for good mea- with the TV clicker. The last thing we need here is of insulin—which your doc may not be testing for—are
ESSENTIALLY AN ERROR OF sure, throw in historically-based estimates of the large more fuel.” a clue that the whole thing is about to come tumbling
METABOLISM number of people who are walking around with undi- So the muscle cells begin to resist the effects of down. You can think of chronically elevated insulin as
To understand how a healthy metabolism is supposed agnosed diabetes, you’re left with the disturbing con- insulin. Like residents of New York apartments, they the pancreas’s way of shouting “Help!”
to work, imagine an eight-year-old kid back in the clusion that between 49 to 52 percent of the popula- get so used to the “noise” that they barely notice it. Eventually, insulin will no longer be able to keep
1
days before the internet and play dates. He has a tion has some form of diabetes. And that figure is They say to insulin, “Thank you but no thank you. blood sugar in the “normal” range, and blood sugar
healthy, undamaged metabolism. The kid comes home probably a low estimate. We’ll get into all that in a Don’t need it. Go somewhere else. We gave at the will start to rise past “normal.” Now your blood
from third grade and eats a small snack—say an apple. moment. office. Buh-bye.” And insulin has no choice but to take sugar is high—as it’s got nowhere left to go! Your
His blood sugar goes up a little—it always goes up Now back to our story about the kid with a its sugar payload to another location, and guess insulin is high, and you’re thisclose to a diagnosis of
when you eat food—and so his pancreas releases a healthy metabolism. Let’s fast-forward thirty years or where that is? full-blown diabetes.
little shot of a hormone called insulin. so. That same “kid”—now thirty-eight—wakes up late, The fat cells. Which happily welcome the sugar in.
One of insulin’s main jobs is to round up that stress hormones coursing through his body. Stress And that’s not a good thing for all sorts of reasons, CAUTION: HEART DISEASE AHEAD!
sugar in the bloodstream and deliver it into the mus- hormones send a message to his brain to fuel up for starting with the fact that fat cells don’t just sit there “Emerging evidence shows that insulin resistance is
cle cells where it can be “burned” for energy. This is an anticipated emergency (read: stock up on sugar!). on your waist, butt, and thighs—they are actually the most important predictor of cardiovascular
just fine for our eight-year-old kid, because he’s going He runs out the door and stop at the local coffee endocrine organs, and they secrete a ton of inflam- disease and type 2 diabetes,” says Robert Lustig,
2
to be climbing on the monkey bars, riding his bike, emporium for a pumpkin spice latte (380 calories, 49 matory chemicals. And inflammation is one of the M.D., the pediatric endocrinologist and professor in
and playing tag. Eventually, his blood sugar goes grams of sugar) and a nice, “low-fat” blueberry muffin major causes and promoters of heart disease. Making the Department of Endocrinology at University of
3
down, and even drops a little from baseline because (350 calories, 55 grams of carbs, 29 grams of sugar). your fat cells bigger only creates more inflammation. Southern California, San Francisco.4
his muscles have eagerly used up all the sugar pro- His blood sugar takes off like the Challenger. But the fat cells get bigger anyway, whether you The fact that insulin resistance is the most impor-
130 THE GREAT CHOLESTEROL MYTH THE REAL CAUSE OF HEART DISEASE 131
Get to know insulin—it’s more important to your health and
Insulin resistance is to heart disease
your heart than you can imagine, and way more important
what smoking is to lung disease.
than your doctor has probably told you.
Insulin resistance doesn’t account for 100 percent vided by the apple. And that’s just dandy—he goes The pancreas says, “Code Red! Send out the big like it or not. Indeed, they welcome in all that excess
of heart disease any more than smoking accounts for home, his blood sugar is slightly lower than normal guns! This dude just ate the equivalent of ten packs of sugar, and for a while your blood sugar levels may
100 percent of lung cancer. But it tracks with and pre- because all the sugar has gone to powering his mus- Ding Dongs!” The pancreas produces a bucketful of even be in the normal range, as the pancreas valiantly
dicts cardiovascular disease better than any other cles. Now he’s hungry, he eats a healthy dinner, and insulin in a desperate attempt to get all that sugar tries to pump out enough insulin to keep up with the
variable yet studied. We’ll show you the proof a little all is right with the world. out of the bloodstream and deliver it to the muscles. sugar influx.
later on—and don’t worry, there’s quite a bit of it. But That’s how insulin—and metabolism—is supposed Problem is the muscle cells aren’t having it. But don’t be fooled. If insulin is frequently ele-
first we have to explain exactly what insulin resis- to work. In theory. In fact, it does not work that way “What do we need all this sugar for?” they seem vated beyond what it should be, that’s a good clue
tance is, and why it’s so critically important to your in at least 50 percent—or more—of the population. A to be asking. “The only ‘exercise’ this guy’s gonna get that it’s having to work awfully hard to keep sugar at
health. 2015 study showed that when you combine patients all day is pushing a computer mouse, and when he manageable levels. Your blood sugar may still be
with “pre-diabetes” with patients who have already goes home, he’s going to sit on the couch and play hanging on in the “normal” range, but the high levels
INSULIN RESISTANCE IS been diagnosed with diabetes, and, just for good mea- with the TV clicker. The last thing we need here is of insulin—which your doc may not be testing for—are
ESSENTIALLY AN ERROR OF sure, throw in historically-based estimates of the large more fuel.” a clue that the whole thing is about to come tumbling
METABOLISM number of people who are walking around with undi- So the muscle cells begin to resist the effects of down. You can think of chronically elevated insulin as
To understand how a healthy metabolism is supposed agnosed diabetes, you’re left with the disturbing con- insulin. Like residents of New York apartments, they the pancreas’s way of shouting “Help!”
to work, imagine an eight-year-old kid back in the clusion that between 49 to 52 percent of the popula- get so used to the “noise” that they barely notice it. Eventually, insulin will no longer be able to keep
1
days before the internet and play dates. He has a tion has some form of diabetes. And that figure is They say to insulin, “Thank you but no thank you. blood sugar in the “normal” range, and blood sugar
healthy, undamaged metabolism. The kid comes home probably a low estimate. We’ll get into all that in a Don’t need it. Go somewhere else. We gave at the will start to rise past “normal.” Now your blood
from third grade and eats a small snack—say an apple. moment. office. Buh-bye.” And insulin has no choice but to take sugar is high—as it’s got nowhere left to go! Your
His blood sugar goes up a little—it always goes up Now back to our story about the kid with a its sugar payload to another location, and guess insulin is high, and you’re thisclose to a diagnosis of
when you eat food—and so his pancreas releases a healthy metabolism. Let’s fast-forward thirty years or where that is? full-blown diabetes.
little shot of a hormone called insulin. so. That same “kid”—now thirty-eight—wakes up late, The fat cells. Which happily welcome the sugar in.
One of insulin’s main jobs is to round up that stress hormones coursing through his body. Stress And that’s not a good thing for all sorts of reasons, CAUTION: HEART DISEASE AHEAD!
sugar in the bloodstream and deliver it into the mus- hormones send a message to his brain to fuel up for starting with the fact that fat cells don’t just sit there “Emerging evidence shows that insulin resistance is
cle cells where it can be “burned” for energy. This is an anticipated emergency (read: stock up on sugar!). on your waist, butt, and thighs—they are actually the most important predictor of cardiovascular
just fine for our eight-year-old kid, because he’s going He runs out the door and stop at the local coffee endocrine organs, and they secrete a ton of inflam- disease and type 2 diabetes,” says Robert Lustig,
2
to be climbing on the monkey bars, riding his bike, emporium for a pumpkin spice latte (380 calories, 49 matory chemicals. And inflammation is one of the M.D., the pediatric endocrinologist and professor in
and playing tag. Eventually, his blood sugar goes grams of sugar) and a nice, “low-fat” blueberry muffin major causes and promoters of heart disease. Making the Department of Endocrinology at University of
3
down, and even drops a little from baseline because (350 calories, 55 grams of carbs, 29 grams of sugar). your fat cells bigger only creates more inflammation. Southern California, San Francisco.4
his muscles have eagerly used up all the sugar pro- His blood sugar takes off like the Challenger. But the fat cells get bigger anyway, whether you The fact that insulin resistance is the most impor-
THE ENGINEER AND THE EMPEROR’S NEW CLOTHES: allowed to take that product to market.”
THE STRANGE CASE OF IVOR CUMMINS He took the knowledge he had gained from his rigorous systems-analysis of metabolism and
Many folks—including both of us—would never have heard of Dr. Joseph R. Kraft (see page 134) began giving seminars to other engineers.
had it not been for an Irish engineer named Ivor Cummins. In 2013, Ivor Cummins got some Eventually those seminars—many of them as complex and detailed as any medical school
problematic blood tests back from his doctor, and wanted to figure out exactly what they lecture—wound up on YouTube. Where they created quite a sensation and remain wildly
meant in terms of risk. He had five kids and was a relatively young guy. What did these tests popular (and highly recommended: Start with “Wanna Know How To Collapse Your Heart
mean in terms of mortality? It was an odd assortment of out-of-range tests and Cummins Disease Risk? Well, then.”).5
wanted to know their significance. People started sending him their blood work and asking for advice. Doctors—notably
The problem was that his doctor didn’t really know. It was, after all, a strange trio of functional medicine doctor Jeffrey Gerber, M.D.—reached out to collaborate. (Gerber and
seemingly unrelated anomalies. Two doctors Cummins consulted for second and third opinions Cummins eventually wrote a terrific—and heavily referenced—book called Eat Rich Live Long—
weren’t much help either. highly recommended.) Cummins became the director of the Irish Heart Disease Association.
Since nothing looked particularly life threatening, many folks might have been tempted to Andreas Eenfelt, M.D., the highly regarded low-carbohydrate advocate, posted a video interview
just forget about it and see if anything weird showed up on the blood test next time around. with Cummings titled, “The engineer who knows more than your doctor.”6
But Cummins wasn’t—isn’t—an “ordinary folks” type of guy. Cummins made his living as a Cummins now blogs and tweets @thefatemperor. The name derives from the Hans Christian
master strategist, a problem-solver who led teams of other brainiac engineers in problem- Anderson fable, and suggests an outsider telling truth to power, particularly on the subject of
solving for complex, multifactorial systems. Not content with an “I don’t know” answer, he fat and cholesterol, and what Cummins calls “the bad science we’ve had on this for the last
began to apply his considerable abilities in systems-analysis to metabolism and the human body. fifty years.” He considers the cholesterol focus in heart disease “a farce” and—like Kraft,
It didn’t take him long to get at what he thought was the root of his problem. In all cases, Reaven, and so many since—sees insulin resistance as what his engineering team would call a
his elevated readings could be linked back to a high intake of carbohydrates. “root cause.”7
A liver enzyme that was elevated turned out to be a marker for fatty liver, which is linked to Is he right? Is insulin resistance a “root cause” of chronic disease? Many researchers are
diabetes. A high level of serum ferritin turned out to be a sixth marker for metabolic syndrome coming to that conclusion. The title of one study recently published captures a growing
(“pre-diabetes”). What did they have in common? “They all tracked back to the metabolic sentiment: Hyperinsulinemia: A unifying theory of chronic disease?8 As this book was being
syndrome and insulin resistance,” says Cummins.5 written, a new study was published in the journal Aging Cell.9 It said that a combination drug
Cummins changed his diet—not based on any diet book he read but based on the published cocktail that included a drug called Metformin had, in a small pilot study, been found to
peer-review research he carefully reviewed—and within a short time lost 30 pounds. All his reverse biological aging by 1.5 years. Not stop aging—reverse it.
weird blood tests returned to normal. Including the troublesome cholesterol numbers. Metformin has also undergone studies at the National Institutes of Health10 for its anti-aging
He started to research cholesterol—and fairly quickly arrived at the conclusion that the effects, and was the subject of a 60 Minutes piece.
research supporting the cholesterol-causes-heart disease hypothesis, when examined Metformin is a drug used to fight diabetes and insulin resistance.
rigorously from a systems biology point of view, turned out to be . . . extremely thin. (In one of Let that sink in for a minute. As Bob Dylan said, many, many moons ago, “You don’t have to
his many lectures available on YouTube he said, and we’re paraphrasing, “If my safety data on be a weatherman to know which way the wind blows.”
a product was as weak as the data on cholesterol causing heart disease, I wouldn’t even be
THE ENGINEER AND THE EMPEROR’S NEW CLOTHES: allowed to take that product to market.”
THE STRANGE CASE OF IVOR CUMMINS He took the knowledge he had gained from his rigorous systems-analysis of metabolism and
Many folks—including both of us—would never have heard of Dr. Joseph R. Kraft (see page 134) began giving seminars to other engineers.
had it not been for an Irish engineer named Ivor Cummins. In 2013, Ivor Cummins got some Eventually those seminars—many of them as complex and detailed as any medical school
problematic blood tests back from his doctor, and wanted to figure out exactly what they lecture—wound up on YouTube. Where they created quite a sensation and remain wildly
meant in terms of risk. He had five kids and was a relatively young guy. What did these tests popular (and highly recommended: Start with “Wanna Know How To Collapse Your Heart
mean in terms of mortality? It was an odd assortment of out-of-range tests and Cummins Disease Risk? Well, then.”).5
wanted to know their significance. People started sending him their blood work and asking for advice. Doctors—notably
The problem was that his doctor didn’t really know. It was, after all, a strange trio of functional medicine doctor Jeffrey Gerber, M.D.—reached out to collaborate. (Gerber and
seemingly unrelated anomalies. Two doctors Cummins consulted for second and third opinions Cummins eventually wrote a terrific—and heavily referenced—book called Eat Rich Live Long—
weren’t much help either. highly recommended.) Cummins became the director of the Irish Heart Disease Association.
Since nothing looked particularly life threatening, many folks might have been tempted to Andreas Eenfelt, M.D., the highly regarded low-carbohydrate advocate, posted a video interview
just forget about it and see if anything weird showed up on the blood test next time around. with Cummings titled, “The engineer who knows more than your doctor.”6
But Cummins wasn’t—isn’t—an “ordinary folks” type of guy. Cummins made his living as a Cummins now blogs and tweets @thefatemperor. The name derives from the Hans Christian
master strategist, a problem-solver who led teams of other brainiac engineers in problem- Anderson fable, and suggests an outsider telling truth to power, particularly on the subject of
solving for complex, multifactorial systems. Not content with an “I don’t know” answer, he fat and cholesterol, and what Cummins calls “the bad science we’ve had on this for the last
began to apply his considerable abilities in systems-analysis to metabolism and the human body. fifty years.” He considers the cholesterol focus in heart disease “a farce” and—like Kraft,
It didn’t take him long to get at what he thought was the root of his problem. In all cases, Reaven, and so many since—sees insulin resistance as what his engineering team would call a
his elevated readings could be linked back to a high intake of carbohydrates. “root cause.”7
A liver enzyme that was elevated turned out to be a marker for fatty liver, which is linked to Is he right? Is insulin resistance a “root cause” of chronic disease? Many researchers are
diabetes. A high level of serum ferritin turned out to be a sixth marker for metabolic syndrome coming to that conclusion. The title of one study recently published captures a growing
(“pre-diabetes”). What did they have in common? “They all tracked back to the metabolic sentiment: Hyperinsulinemia: A unifying theory of chronic disease?8 As this book was being
syndrome and insulin resistance,” says Cummins.5 written, a new study was published in the journal Aging Cell.9 It said that a combination drug
Cummins changed his diet—not based on any diet book he read but based on the published cocktail that included a drug called Metformin had, in a small pilot study, been found to
peer-review research he carefully reviewed—and within a short time lost 30 pounds. All his reverse biological aging by 1.5 years. Not stop aging—reverse it.
weird blood tests returned to normal. Including the troublesome cholesterol numbers. Metformin has also undergone studies at the National Institutes of Health10 for its anti-aging
He started to research cholesterol—and fairly quickly arrived at the conclusion that the effects, and was the subject of a 60 Minutes piece.
research supporting the cholesterol-causes-heart disease hypothesis, when examined Metformin is a drug used to fight diabetes and insulin resistance.
rigorously from a systems biology point of view, turned out to be . . . extremely thin. (In one of Let that sink in for a minute. As Bob Dylan said, many, many moons ago, “You don’t have to
his many lectures available on YouTube he said, and we’re paraphrasing, “If my safety data on be a weatherman to know which way the wind blows.”
a product was as weak as the data on cholesterol causing heart disease, I wouldn’t even be
tant predictor of diabetes might not surprise you. But what happened to them, this is what he concluded: triglycerides. Any of those conditions alone is a risk During follow-up, Reaven’s team observed forty
the fact that it’s the single most important predictor “Those with cardiovascular disease not identified (as factor for heart disease, but together—with insulin “clinical events” (i.e., the appearance of hypertension,
of cardiovascular disease may come as a shock. Let diabetics) . . . are simply undiagnosed.” resistance at the core—they were even more ominous. coronary heart disease, stroke, cancer, and type 2 dia-
us show you why that’s true, and why diabetic The insulin assay is in use to this day, albeit mod- Reaven named this dangerous collection of symp- betes) in thirty-seven people. Several people in the
dysfunction (aka insulin resistance syndrome) is ified a bit with modern technology. Labs like Meridian toms Syndrome X, but not long afterwards it became study had multiple “events.” Twenty-five of the thirty-
indeed the most potent risk factor and the best pre- Valley now offer what they call the Kraft Prediabetes known as metabolic syndrome, and later, as pre-diabe- seven who experienced events had scored “high” on
12
dictor of heart disease on the planet. Profile, based on Kraft’s seminal work. In 2013, tes. Many researchers are now calling this syndrome— insulin resistance syndrome. The other twelve had
researchers found that the Kraft patterns predicted correctly in our view—insulin resistance syndrome. scored “moderate.”
Introducing the Insulin Assay the risk of type 2 diabetes in Japanese Americans. 13
Over half of U.S. adults have it. And yes, you should No one in the insulin sensitive group got sick.
A good place to start is with Dr. Joseph R. Kraft, one Then, in 2015, researchers led by Catherine Crofts be worried. To be crystal clear, the subjects with a healthy
of the most important researchers that almost no one published an important paper whose title says it all: “During insulin resistance, several metabolic alter- insulin response (i.e., those who had no measurable
had ever heard of, at least until fairly recently. Dr. Hyperinsulinemia: A Unified Field Theory of Chronic ations induce the development of cardiovascular dis- level of insulin resistance) suffered zero deaths or
14
Kraft was Chairman of the Department of Clinical Disease? ease,” said a 2018 article in the journal Cardiovascular “events” of any kind over the next seven years of fol-
16
Pathology and Nuclear Medicine at St. Joseph In 2017, Crofts team published another paper Diabetology. The authors point to many of the down- low-up. And that’s pretty unusual for a large sample
Hospital in Chicago for thirty-five years and, upon citing research showing that high levels of insulin stream by-products of insulin resistance—oxidative of sixty-one-year-olds. The odds of getting those
retirement, was appointed Chairman Emeritus. (hyperinsulinemia) had been shown to be causal in stress, inflammatory responses, endothelial dysfunc- results by chance are about .00001.
Dr. Kraft invented something called the insulin hypertension, obesity, atherosclerosis, microvascular tion, hyperglycemia, and cell damage. They noted that It’s important to know that Reaven’s tests for
assay, a then state-of-the-art test requiring glucose disease, neurodegenerative disorders, idiopathic insulin resistance leads to the well-known lipid triad: insulin resistance were phenomenally sophisticated—
15
and insulin monitoring over anywhere from three to peripheral neuropathy, and certain cancers. They (1) high levels of triglycerides, (2) low levels of HDL far more than just measuring blood glucose, and even
five hours. It goes far beyond the “fasting blood titled their paper, “Postprandial insulin assay as the and (3) small, dense LDL particles. more accurate than fasting insulin. Reaven’s results
sugar” test and, by monitoring insulin levels, looks at earliest biomarker for diagnosing pre-diabetes, type Reaven himself already knew that insulin resis- were no accident. And the fact that both Kraft’s tests
how the body handles a given load of sugar over sev- 2 diabetes, and increased cardiovascular risk” tance put you on the fast track to diabetes. Next, he and Reaven’s show almost the exact same thing
eral hours. It was the most accurate test for insulin (emphasis ours). wanted to find out if it put you on the fast track to should give us pause.
resistance ever devised. anything else. The truth is insulin resistance is a bear of a pre-
In virtually every study Kraft did, very few folks Insulin Resistance Syndrome It did. dictor. Reaven’s studies demonstrated that if a person
with healthy insulin response got sick, while a disturb- Kraft may have been the first to actually demonstrate Reaven and his team performed sophisticated has a high degree of insulin resistance then he or she
ingly high percentage of those with insulin resistance the connection of insulin resistance to heart disease, statistical tests to answer the question, “Does insulin has a 40x increase in his risk for heart disease (and,
did. Kraft wrote a book—still in print—summarizing all but he was hardly the last. In 1988, a brilliant resistance predict bad stuff happening?” They took frankly, other chronic diseases as well). But not just
of the studies he did over the course of his career, all Stanford University medical professor and researcher 208 apparently healthy and non-obese individuals, an “increase in risk” that’s a doggone force multiplier.
11
pointing to the same conclusion. named Gerald Reaven noticed that insulin resistance average age sixty-one, and measured their insulin To make matters worse, insulin resistance is also
Kraft summed up his life’s work succinctly and was almost always at the center of a cluster of resistance and related variables. He followed them up linked to obesity, which, in turn, is associated with a
beautifully. After rigorously testing more than 14,000 conditions that, together, greatly increased the risk for a period of four to eleven years, looking for inci- higher risk of cardiovascular disease (CVD).17
people for insulin resistance over his 30-something for cardiovascular disease: high blood pressure, dence of hypertension, coronary heart disease, stroke, Insulin resistance doesn’t just put its thumb on
year career, and following them up for years to track abdominal obesity, low HDL cholesterol, and high type 2 diabetes, and—just for good measure—cancer. the scale that measures your heart disease risk, it
tant predictor of diabetes might not surprise you. But what happened to them, this is what he concluded: triglycerides. Any of those conditions alone is a risk During follow-up, Reaven’s team observed forty
the fact that it’s the single most important predictor “Those with cardiovascular disease not identified (as factor for heart disease, but together—with insulin “clinical events” (i.e., the appearance of hypertension,
of cardiovascular disease may come as a shock. Let diabetics) . . . are simply undiagnosed.” resistance at the core—they were even more ominous. coronary heart disease, stroke, cancer, and type 2 dia-
us show you why that’s true, and why diabetic The insulin assay is in use to this day, albeit mod- Reaven named this dangerous collection of symp- betes) in thirty-seven people. Several people in the
dysfunction (aka insulin resistance syndrome) is ified a bit with modern technology. Labs like Meridian toms Syndrome X, but not long afterwards it became study had multiple “events.” Twenty-five of the thirty-
indeed the most potent risk factor and the best pre- Valley now offer what they call the Kraft Prediabetes known as metabolic syndrome, and later, as pre-diabe- seven who experienced events had scored “high” on
12
dictor of heart disease on the planet. Profile, based on Kraft’s seminal work. In 2013, tes. Many researchers are now calling this syndrome— insulin resistance syndrome. The other twelve had
researchers found that the Kraft patterns predicted correctly in our view—insulin resistance syndrome. scored “moderate.”
Introducing the Insulin Assay the risk of type 2 diabetes in Japanese Americans. 13
Over half of U.S. adults have it. And yes, you should No one in the insulin sensitive group got sick.
A good place to start is with Dr. Joseph R. Kraft, one Then, in 2015, researchers led by Catherine Crofts be worried. To be crystal clear, the subjects with a healthy
of the most important researchers that almost no one published an important paper whose title says it all: “During insulin resistance, several metabolic alter- insulin response (i.e., those who had no measurable
had ever heard of, at least until fairly recently. Dr. Hyperinsulinemia: A Unified Field Theory of Chronic ations induce the development of cardiovascular dis- level of insulin resistance) suffered zero deaths or
14
Kraft was Chairman of the Department of Clinical Disease? ease,” said a 2018 article in the journal Cardiovascular “events” of any kind over the next seven years of fol-
16
Pathology and Nuclear Medicine at St. Joseph In 2017, Crofts team published another paper Diabetology. The authors point to many of the down- low-up. And that’s pretty unusual for a large sample
Hospital in Chicago for thirty-five years and, upon citing research showing that high levels of insulin stream by-products of insulin resistance—oxidative of sixty-one-year-olds. The odds of getting those
retirement, was appointed Chairman Emeritus. (hyperinsulinemia) had been shown to be causal in stress, inflammatory responses, endothelial dysfunc- results by chance are about .00001.
Dr. Kraft invented something called the insulin hypertension, obesity, atherosclerosis, microvascular tion, hyperglycemia, and cell damage. They noted that It’s important to know that Reaven’s tests for
assay, a then state-of-the-art test requiring glucose disease, neurodegenerative disorders, idiopathic insulin resistance leads to the well-known lipid triad: insulin resistance were phenomenally sophisticated—
15
and insulin monitoring over anywhere from three to peripheral neuropathy, and certain cancers. They (1) high levels of triglycerides, (2) low levels of HDL far more than just measuring blood glucose, and even
five hours. It goes far beyond the “fasting blood titled their paper, “Postprandial insulin assay as the and (3) small, dense LDL particles. more accurate than fasting insulin. Reaven’s results
sugar” test and, by monitoring insulin levels, looks at earliest biomarker for diagnosing pre-diabetes, type Reaven himself already knew that insulin resis- were no accident. And the fact that both Kraft’s tests
how the body handles a given load of sugar over sev- 2 diabetes, and increased cardiovascular risk” tance put you on the fast track to diabetes. Next, he and Reaven’s show almost the exact same thing
eral hours. It was the most accurate test for insulin (emphasis ours). wanted to find out if it put you on the fast track to should give us pause.
resistance ever devised. anything else. The truth is insulin resistance is a bear of a pre-
In virtually every study Kraft did, very few folks Insulin Resistance Syndrome It did. dictor. Reaven’s studies demonstrated that if a person
with healthy insulin response got sick, while a disturb- Kraft may have been the first to actually demonstrate Reaven and his team performed sophisticated has a high degree of insulin resistance then he or she
ingly high percentage of those with insulin resistance the connection of insulin resistance to heart disease, statistical tests to answer the question, “Does insulin has a 40x increase in his risk for heart disease (and,
did. Kraft wrote a book—still in print—summarizing all but he was hardly the last. In 1988, a brilliant resistance predict bad stuff happening?” They took frankly, other chronic diseases as well). But not just
of the studies he did over the course of his career, all Stanford University medical professor and researcher 208 apparently healthy and non-obese individuals, an “increase in risk” that’s a doggone force multiplier.
11
pointing to the same conclusion. named Gerald Reaven noticed that insulin resistance average age sixty-one, and measured their insulin To make matters worse, insulin resistance is also
Kraft summed up his life’s work succinctly and was almost always at the center of a cluster of resistance and related variables. He followed them up linked to obesity, which, in turn, is associated with a
beautifully. After rigorously testing more than 14,000 conditions that, together, greatly increased the risk for a period of four to eleven years, looking for inci- higher risk of cardiovascular disease (CVD).17
people for insulin resistance over his 30-something for cardiovascular disease: high blood pressure, dence of hypertension, coronary heart disease, stroke, Insulin resistance doesn’t just put its thumb on
year career, and following them up for years to track abdominal obesity, low HDL cholesterol, and high type 2 diabetes, and—just for good measure—cancer. the scale that measures your heart disease risk, it
puts its whole hand on it. Researchers in the famed the raw data to figure out what factors were real and goes, there were a total of twelve studies included in had survived a heart attack, so the study aimed to
Insulin Resistance Atherosclerosis Study (IRAS) what factors were spurious. They did the standard the review, four studies on atherosclerosis, and eight follow up with these patients for many years and to
showed a direct relation between insulin resistance multivariate analysis—which simply tells you what more for cardiovascular disease in general. One hun- discover which risk factors were the most powerful
and atherosclerosis. And subsequent studies have factors are dependent on what other factors, what dred percent of the studies on people with cardiovas- predictors of a second event.20
consistently found insulin resistance to be an impor- factors are “noise,” and what factors are “signal.” cular disease reported significant elevation in insulin The researchers initially separated the patient
tant risk factor and an excellent predictor for CVD. (For example, sometimes “low education” shows up levels. That’s an astonishing twelve out of twelve population into two groups—those with cardiovascular
A mathematical analysis of the relationship of as a risk factor for heart disease, but it’s really a studies on heart disease showing significant hyperin- disease and diabetes, and those with cardiovascular
insulin resistance (and other measures of diabetic stand-in for “low income,” which is itself is a stand-in sulinemia in heart disease patients. disease without diabetes. One third of the initial
physiology) to coronary artery disease in young non- for a diet of cheap, processed food.) This kind of patient population were full-blown, diagnosed diabet-
diabetic adults concluded that preventing insulin analysis teases out what factors are really responsible HIDDEN DIABETES AND THE ics. The other two thirds were classified as having
resistance could avoid approximately 42 percent of for the observed results. HIDDEN RISK OF HEART DISEASE “cardiovascular disease without diabetes.” And here’s
18
myocardial infarctions in the next sixty years. When all the analysis was done, only one factor According to the data about 65 percent of U.S. where it got interesting—and scary.
Think about that for a minute—over 40 percent of remained standing as a “significant predictor for new adults over forty-five are pre-diabetic or diabetic— On closer examination, a third of the “non-diabet-
heart attacks could be prevented just by reversing or cardiovascular events”—insulin. The authors concluded and many suspect that’s an understatement. After ics” in EUROASPIRE were anything but. They were
preventing insulin resistance! that high levels of insulin were by far the most impor- all, those conclusions are based on blood sugar actually full-blown diabetics, which when you think
Here’s another great example of careful research tant factor related to the occurrence of new cardio- readings, not direct measures of insulin, nor of about it is not all that surprising, because in the U.S.
that clearly exposed the central role of insulin resis- vascular disease. Insulin was a jaw-dropping 6.7x mul- insulin resistance. Unfortunately, high blood sugar is alone, about one third of full-blown diabetics are
tance in heart attacks. And it was research done for a tiplier of risk. By contrast, the association between a late sign of problems. The pancreas can be walking around undiagnosed and as of 2015, more
very practical reason. You see, in Columbia—as in LDL and a second heart attack was non-significant, so furiously producing a truckload of insulin in a gallant than 81 million adults in the U.S. had pre-diabetes.21
many parts of the world—heart attacks are the num- LDL was essentially a “zero multiplier” of risk. attempt to keep blood sugar “normal,” which it may We can be pretty sure that the percentage of
ber one cause of mortality and disability. So Now to be fair, there are studies that show a well be for a while, leading your conventional doc to those “non-diabetics” that were actually diabetic
Columbian researchers set out to discover what they slightly higher than zero correlation between LDL and say “everything’s fine.” would have been considerably higher if measure-
could do to prevent second heart attacks in their peo- second heart attacks, but even the most touted stud- But it isn’t. ments of insulin were available on the patient popula-
ple who had already had one attack, a question that ies don’t show much better than a 1.5x correlation. Like a volcano on an island that looks peaceful to tion. Even using the imperfect measurement of blood
probably has great relevance to more than a few peo- And in many cases, a “bad” cholesterol test may only a tourist, your metabolism has hidden signs of a sugar, we’re still left with the conclusion that practi-
19
ple reading this book. be a symptom of the real problem: insulin resistance. forthcoming eruption, and in the case of heart dis- cally three quarters of heart disease patients studied
The researchers gathered up 295 Columbians One group of researchers reviewed seventy stud- ease, the most important “hidden” sign is insulin are actually, to some important degree, diabetic.
who had survived a first heart attack. The initial anal- ies that had accurately documented the insulin levels resistance. And it’s actually not hidden at all—you just Here’s a good time to make mention of what’s
ysis found that there were eleven factors (including of patients in the studies. The jaw-dropping results have to know how to look for it. called diabetes in situ—which basically means hidden
age, low income, lack of education, hypertension, and showed that out of 7seventy studies on patients with And often, as we said earlier, the overwhelming diabetes. Because that is exactly what these folks—
insulin over 10 IU/ml) that were initially associated chronic disease, sixty-seven of the studies showed importance of insulin resistance is hiding in plain and so many others reading this book—are walking
with new cardiovascular events. All of those would be that subjects in the “sick” categories had significantly sight. Take, for example, the famous EUROASPIRE around with.
considered “risk factors.” elevated levels of insulin compared to subjects in the study, which identified risk factors in patients with See, we’re all familiar with the metabolically
But then they did what all researchers do—look at “healthy” categories. As far as heart disease itself cardiovascular disease. All the patients in the study obese unhealthy person with the collection of risk
puts its whole hand on it. Researchers in the famed the raw data to figure out what factors were real and goes, there were a total of twelve studies included in had survived a heart attack, so the study aimed to
Insulin Resistance Atherosclerosis Study (IRAS) what factors were spurious. They did the standard the review, four studies on atherosclerosis, and eight follow up with these patients for many years and to
showed a direct relation between insulin resistance multivariate analysis—which simply tells you what more for cardiovascular disease in general. One hun- discover which risk factors were the most powerful
and atherosclerosis. And subsequent studies have factors are dependent on what other factors, what dred percent of the studies on people with cardiovas- predictors of a second event.20
consistently found insulin resistance to be an impor- factors are “noise,” and what factors are “signal.” cular disease reported significant elevation in insulin The researchers initially separated the patient
tant risk factor and an excellent predictor for CVD. (For example, sometimes “low education” shows up levels. That’s an astonishing twelve out of twelve population into two groups—those with cardiovascular
A mathematical analysis of the relationship of as a risk factor for heart disease, but it’s really a studies on heart disease showing significant hyperin- disease and diabetes, and those with cardiovascular
insulin resistance (and other measures of diabetic stand-in for “low income,” which is itself is a stand-in sulinemia in heart disease patients. disease without diabetes. One third of the initial
physiology) to coronary artery disease in young non- for a diet of cheap, processed food.) This kind of patient population were full-blown, diagnosed diabet-
diabetic adults concluded that preventing insulin analysis teases out what factors are really responsible HIDDEN DIABETES AND THE ics. The other two thirds were classified as having
resistance could avoid approximately 42 percent of for the observed results. HIDDEN RISK OF HEART DISEASE “cardiovascular disease without diabetes.” And here’s
18
myocardial infarctions in the next sixty years. When all the analysis was done, only one factor According to the data about 65 percent of U.S. where it got interesting—and scary.
Think about that for a minute—over 40 percent of remained standing as a “significant predictor for new adults over forty-five are pre-diabetic or diabetic— On closer examination, a third of the “non-diabet-
heart attacks could be prevented just by reversing or cardiovascular events”—insulin. The authors concluded and many suspect that’s an understatement. After ics” in EUROASPIRE were anything but. They were
preventing insulin resistance! that high levels of insulin were by far the most impor- all, those conclusions are based on blood sugar actually full-blown diabetics, which when you think
Here’s another great example of careful research tant factor related to the occurrence of new cardio- readings, not direct measures of insulin, nor of about it is not all that surprising, because in the U.S.
that clearly exposed the central role of insulin resis- vascular disease. Insulin was a jaw-dropping 6.7x mul- insulin resistance. Unfortunately, high blood sugar is alone, about one third of full-blown diabetics are
tance in heart attacks. And it was research done for a tiplier of risk. By contrast, the association between a late sign of problems. The pancreas can be walking around undiagnosed and as of 2015, more
very practical reason. You see, in Columbia—as in LDL and a second heart attack was non-significant, so furiously producing a truckload of insulin in a gallant than 81 million adults in the U.S. had pre-diabetes.21
many parts of the world—heart attacks are the num- LDL was essentially a “zero multiplier” of risk. attempt to keep blood sugar “normal,” which it may We can be pretty sure that the percentage of
ber one cause of mortality and disability. So Now to be fair, there are studies that show a well be for a while, leading your conventional doc to those “non-diabetics” that were actually diabetic
Columbian researchers set out to discover what they slightly higher than zero correlation between LDL and say “everything’s fine.” would have been considerably higher if measure-
could do to prevent second heart attacks in their peo- second heart attacks, but even the most touted stud- But it isn’t. ments of insulin were available on the patient popula-
ple who had already had one attack, a question that ies don’t show much better than a 1.5x correlation. Like a volcano on an island that looks peaceful to tion. Even using the imperfect measurement of blood
probably has great relevance to more than a few peo- And in many cases, a “bad” cholesterol test may only a tourist, your metabolism has hidden signs of a sugar, we’re still left with the conclusion that practi-
19
ple reading this book. be a symptom of the real problem: insulin resistance. forthcoming eruption, and in the case of heart dis- cally three quarters of heart disease patients studied
The researchers gathered up 295 Columbians One group of researchers reviewed seventy stud- ease, the most important “hidden” sign is insulin are actually, to some important degree, diabetic.
who had survived a first heart attack. The initial anal- ies that had accurately documented the insulin levels resistance. And it’s actually not hidden at all—you just Here’s a good time to make mention of what’s
ysis found that there were eleven factors (including of patients in the studies. The jaw-dropping results have to know how to look for it. called diabetes in situ—which basically means hidden
age, low income, lack of education, hypertension, and showed that out of 7seventy studies on patients with And often, as we said earlier, the overwhelming diabetes. Because that is exactly what these folks—
insulin over 10 IU/ml) that were initially associated chronic disease, sixty-seven of the studies showed importance of insulin resistance is hiding in plain and so many others reading this book—are walking
with new cardiovascular events. All of those would be that subjects in the “sick” categories had significantly sight. Take, for example, the famous EUROASPIRE around with.
considered “risk factors.” elevated levels of insulin compared to subjects in the study, which identified risk factors in patients with See, we’re all familiar with the metabolically
But then they did what all researchers do—look at “healthy” categories. As far as heart disease itself cardiovascular disease. All the patients in the study obese unhealthy person with the collection of risk
factors—including, of course, insulin resistance and
hyperinsulinemia. There’s nothing hidden about their
sage to your brain that you’re full. Processed carbs do
the opposite, and often create cravings for more.
Stop worrying so much about LDL cholesterol and start
health problems, whether diabetes, obesity, or heart Never was there a truer marketing saying than, looking at where you are on the insulin resistance scale.
disease. We’re sad when folks like this get heart dis- “Betcha can’t eat just one!”
ease, but we’re not really surprised. They’re over- And this isn’t just theoretical. Studies have dem- times more omega-6 than omega-3 and some Take those two numbers—fasting insulin and blood
24
weight, they have high blood pressure, they eat a bad onstrated that Paleo-type diets constructed from pro- researchers think that estimate is conservative. glucose—then go online and look for a HOMA-2 calcu-
diet, and they don’t exercise. We almost expect they tein and plenty of fibrous vegetables send satiety hor- Inflammation is a key—if not the key—factor in the lator, such as the Blood Code Insulin Resistance calcu-
will get heart disease at some point in their lives. mones sailing upward, while conventional “food pyra- development of heart disease. lator. HOMA stands for homeostatic model of insulin
But what we’re always surprised by is heart dis- mid” diets drive up the very hormones that raise insu- resistance. HOMA-2 is a very good surrogate for insu-
ease in a person of normal weight who seems to be 22
lin and fat storage. SO WHY AREN’T WE TALKING lin resistance and incredibly easy to obtain. Plug
doing everything right. He’s not overweight, he doesn’t And remember, it’s not just the food itself—it’s ABOUT THIS? those two numbers into the calculator, just as you
smoke, he’s not downing a dozen cans of sweetened how it’s processed. Brown rice and white rice produce Conventional medicine continues to focus on LDL plug your weight and height into an online body mass
sodas . . . but yet under the hood, he’s aging rapidly slightly different insulin response curves, neither of cholesterol—but the correlations between insulin index (BMI) calculator. If you have healthy insulin sen-
due, largely, to undiagnosed insulin resistance and the them great, but the brown rice is slightly better. Grind resistance and heart disease had been known since sitivity, your HOMA number will be between .5 and 1.4.
metabolic damage it leaves in its wake. them up and the difference disappears. The insulin the 1970s. What gives? If it’s more than 1.9, you have early insulin resistance.
response curve for both forms of rice goes through Well, for one thing, insulin resistance remains a Over 2.9 and it’s significant insulin resistance. In
How Does Insulin Resistance Happen the roof—the brown/white distinction goes away. 23
much more complicated thing to measure properly either case, it’s time to change your diet.
in a Person of Normal Weight? Processing matters! than LDL. When LDL measurement became accepted If you’d like something even more accurate, and
Let’s start with refined carbohydrates. Remember the as the gold standard of heart disease prevention, it your doctor is open-minded to the information in this
gut is the largest endocrine organ in your body—it’s LET’S ALL SWITCH TO was a very different time. And if there is one message book, consider the LP-IR test, available through
one of the immune system organs, like your skin, that VEGETABLE OIL! NOT. from this book that you take home with you it should LabCorp.26 This is the most accurate test currently
helps protect you from the outside world. This gut Coming up right behind refined carbs as a culprit in be this: Stop worrying so much about LDL cholesterol available and is actually based upon data from the
talks to practically everything in your body: your this insulin resistance syndrome mess is the entire and start looking at where you are on the insulin NMR particle test, which itself is a test we have long
brain, your pancreas, your liver, your fat tissue. That’s category of refined vegetable oils, or more properly, resistance scale. And if your doctor balks at ordering recommended as the gold standard for cholesterol
what Dr. Barry Sears means when he says, “food is refined seed oils (e.g., corn, soybean, sunflower, an insulin resistance test, you have options. testing. The LP-IR (the IR stands for insulin resis-
information.” rapeseed, safflower, and other highly processed tance) test takes the data from the NMR particle test,
Carbs—most especially processed carbs—drive up petrochemical-extracted oils). These oils are all very How to Test for Insulin Resistance adds extremely sensitive inflammatory marker tests
insulin. And anything filled with refined carbs doesn’t high in omega-6 fats, which, while necessary for The easiest option is to get yourself a fasting insulin like GlycA—an excellent measure of systemic inflam-
provide that feeling of fullness that comes with the human health, are very much pro-inflammatory. test. These tests are now available online for as little mation—and uses a sophisticated and validated algo-
release of satiety hormones. That’s precisely why it’s For optimal health, they need to be consumed in as $28 and they don’t always require an outside rithm to calculate an IR score.
25
so easy to eat six bowls of sugared cereal while balance with their anti-inflammatory relatives, the doctor’s prescription. Once you have your fasting
you’re watching reruns of Seinfeld, and why it’s omega-3 fats. insulin level, go to any recent blood test you’ve had Critically Important: Your Triglyceride
almost impossible to eat six servings of buttered But nothing of the sort is happening in the with your doctor, and note the number next to to HDL Ratio
broccoli and steak. Broccoli and steak get the mes- Western diet. We currently consume about sixteen “fasting glucose” (blood sugar). There are two numbers already available on just
factors—including, of course, insulin resistance and
hyperinsulinemia. There’s nothing hidden about their
sage to your brain that you’re full. Processed carbs do
the opposite, and often create cravings for more.
Stop worrying so much about LDL cholesterol and start
health problems, whether diabetes, obesity, or heart Never was there a truer marketing saying than, looking at where you are on the insulin resistance scale.
disease. We’re sad when folks like this get heart dis- “Betcha can’t eat just one!”
ease, but we’re not really surprised. They’re over- And this isn’t just theoretical. Studies have dem- times more omega-6 than omega-3 and some Take those two numbers—fasting insulin and blood
24
weight, they have high blood pressure, they eat a bad onstrated that Paleo-type diets constructed from pro- researchers think that estimate is conservative. glucose—then go online and look for a HOMA-2 calcu-
diet, and they don’t exercise. We almost expect they tein and plenty of fibrous vegetables send satiety hor- Inflammation is a key—if not the key—factor in the lator, such as the Blood Code Insulin Resistance calcu-
will get heart disease at some point in their lives. mones sailing upward, while conventional “food pyra- development of heart disease. lator. HOMA stands for homeostatic model of insulin
But what we’re always surprised by is heart dis- mid” diets drive up the very hormones that raise insu- resistance. HOMA-2 is a very good surrogate for insu-
ease in a person of normal weight who seems to be 22
lin and fat storage. SO WHY AREN’T WE TALKING lin resistance and incredibly easy to obtain. Plug
doing everything right. He’s not overweight, he doesn’t And remember, it’s not just the food itself—it’s ABOUT THIS? those two numbers into the calculator, just as you
smoke, he’s not downing a dozen cans of sweetened how it’s processed. Brown rice and white rice produce Conventional medicine continues to focus on LDL plug your weight and height into an online body mass
sodas . . . but yet under the hood, he’s aging rapidly slightly different insulin response curves, neither of cholesterol—but the correlations between insulin index (BMI) calculator. If you have healthy insulin sen-
due, largely, to undiagnosed insulin resistance and the them great, but the brown rice is slightly better. Grind resistance and heart disease had been known since sitivity, your HOMA number will be between .5 and 1.4.
metabolic damage it leaves in its wake. them up and the difference disappears. The insulin the 1970s. What gives? If it’s more than 1.9, you have early insulin resistance.
response curve for both forms of rice goes through Well, for one thing, insulin resistance remains a Over 2.9 and it’s significant insulin resistance. In
How Does Insulin Resistance Happen the roof—the brown/white distinction goes away. 23
much more complicated thing to measure properly either case, it’s time to change your diet.
in a Person of Normal Weight? Processing matters! than LDL. When LDL measurement became accepted If you’d like something even more accurate, and
Let’s start with refined carbohydrates. Remember the as the gold standard of heart disease prevention, it your doctor is open-minded to the information in this
gut is the largest endocrine organ in your body—it’s LET’S ALL SWITCH TO was a very different time. And if there is one message book, consider the LP-IR test, available through
one of the immune system organs, like your skin, that VEGETABLE OIL! NOT. from this book that you take home with you it should LabCorp.26 This is the most accurate test currently
helps protect you from the outside world. This gut Coming up right behind refined carbs as a culprit in be this: Stop worrying so much about LDL cholesterol available and is actually based upon data from the
talks to practically everything in your body: your this insulin resistance syndrome mess is the entire and start looking at where you are on the insulin NMR particle test, which itself is a test we have long
brain, your pancreas, your liver, your fat tissue. That’s category of refined vegetable oils, or more properly, resistance scale. And if your doctor balks at ordering recommended as the gold standard for cholesterol
what Dr. Barry Sears means when he says, “food is refined seed oils (e.g., corn, soybean, sunflower, an insulin resistance test, you have options. testing. The LP-IR (the IR stands for insulin resis-
information.” rapeseed, safflower, and other highly processed tance) test takes the data from the NMR particle test,
Carbs—most especially processed carbs—drive up petrochemical-extracted oils). These oils are all very How to Test for Insulin Resistance adds extremely sensitive inflammatory marker tests
insulin. And anything filled with refined carbs doesn’t high in omega-6 fats, which, while necessary for The easiest option is to get yourself a fasting insulin like GlycA—an excellent measure of systemic inflam-
provide that feeling of fullness that comes with the human health, are very much pro-inflammatory. test. These tests are now available online for as little mation—and uses a sophisticated and validated algo-
release of satiety hormones. That’s precisely why it’s For optimal health, they need to be consumed in as $28 and they don’t always require an outside rithm to calculate an IR score.
25
so easy to eat six bowls of sugared cereal while balance with their anti-inflammatory relatives, the doctor’s prescription. Once you have your fasting
you’re watching reruns of Seinfeld, and why it’s omega-3 fats. insulin level, go to any recent blood test you’ve had Critically Important: Your Triglyceride
almost impossible to eat six servings of buttered But nothing of the sort is happening in the with your doctor, and note the number next to to HDL Ratio
broccoli and steak. Broccoli and steak get the mes- Western diet. We currently consume about sixteen “fasting glucose” (blood sugar). There are two numbers already available on just
about any blood test you’ve ever taken that can tell ratio will be less than 1.0!)
you a lot about your risk for both insulin resistance We can’t overemphasize how important the tri-
and heart disease: your triglycerides and your HDL. glyceride to HDL ratio is.
(Interestingly, these are the same two numbers that It’s a good surrogate for an insulin resistance
PART THREE
both Kraft and Reaven identified as red flags for test. If your ratio is more than 2, pay attention, and if
cardiometabolic problems.) In the vast majority of it’s over 5 change your diet immediately.
cases, your triglycerides will be the larger number of It’s hard to improve your ratio by raising your
the two. Divide your triglycerides by your HDL and HDL since changing your HDL levels isn’t easy.,
the result is your triglycerides to HDL ratio. The ideal Lowering your triglycerides, however, is the easiest
ratio—the one associated with the least risk for heart thing in the world to do, and will have the same effect
disease—is two or under. on your ratio as bringing your HDL up. How do you
Both of us cut our teeth in the era when something known as “functional
Let’s say, for example, that your triglycerides are lower triglycerides? Simple. With a low-carb diet.
medicine” was just beginning to gain traction among integrative medicine
100 and your HDL is 50. You take 100 and divide by Triglycerides drop like a rock 99 percent of the time
practitioners. (It is now a fully recognized way of practicing medicine,
50 giving you a ratio of 2, which is excellent. (If you on a low-carb diet, such as the higher-fat version of
complete with its own conferences and certifications.) Functional medicine
are an outlier, and your HDL is higher than your tri- the Mediterranean diet we talk about in chapter 10.
approaches the body as a working group of components in which every
glycerides, you’re in even better shape because your
part influences the performance of the whole. It is essentially “root cause
medicine.” Functional medicine practitioners understand that what affects
the heart affects the brain (and vice versa), what affects the adrenals
 WHAT YOU NEED TO KNOW affects the thyroid (ditto), and what affects the gut affects . . . well, just
about everything. The motto of functional medicine might as well be
• Insulin resistance—pre-diabetes—is one of the strongest and most consistent predictors of
“it’s all connected.”
heart disease.
• Insulin resistance happens when the body is no longer able to effectively manage your
intake of sugar and starch.
• Studies going back to the 1970s show clearly that insulin resistance substantially increases
the risk for many degenerative diseases and is an early warning sign for heart disease.
• You can have insulin resistance as much as a decade before the other, more “conventional”
signs of heart disease show up, making it all the more important to test for insulin
resistance.
• Preventing, reversing, or treating insulin resistance may be one of the most effective ways
yet discovered to prevent heart disease.

about any blood test you’ve ever taken that can tell ratio will be less than 1.0!)
you a lot about your risk for both insulin resistance We can’t overemphasize how important the tri-
and heart disease: your triglycerides and your HDL. glyceride to HDL ratio is.
(Interestingly, these are the same two numbers that It’s a good surrogate for an insulin resistance
PART THREE
both Kraft and Reaven identified as red flags for test. If your ratio is more than 2, pay attention, and if
cardiometabolic problems.) In the vast majority of it’s over 5 change your diet immediately.
cases, your triglycerides will be the larger number of It’s hard to improve your ratio by raising your
the two. Divide your triglycerides by your HDL and HDL since changing your HDL levels isn’t easy.,
the result is your triglycerides to HDL ratio. The ideal Lowering your triglycerides, however, is the easiest
ratio—the one associated with the least risk for heart thing in the world to do, and will have the same effect
disease—is two or under. on your ratio as bringing your HDL up. How do you
Both of us cut our teeth in the era when something known as “functional
Let’s say, for example, that your triglycerides are lower triglycerides? Simple. With a low-carb diet.
medicine” was just beginning to gain traction among integrative medicine
100 and your HDL is 50. You take 100 and divide by Triglycerides drop like a rock 99 percent of the time
practitioners. (It is now a fully recognized way of practicing medicine,
50 giving you a ratio of 2, which is excellent. (If you on a low-carb diet, such as the higher-fat version of
complete with its own conferences and certifications.) Functional medicine
are an outlier, and your HDL is higher than your tri- the Mediterranean diet we talk about in chapter 10.
approaches the body as a working group of components in which every
glycerides, you’re in even better shape because your
part influences the performance of the whole. It is essentially “root cause
medicine.” Functional medicine practitioners understand that what affects
the heart affects the brain (and vice versa), what affects the adrenals
 WHAT YOU NEED TO KNOW affects the thyroid (ditto), and what affects the gut affects . . . well, just
about everything. The motto of functional medicine might as well be
• Insulin resistance—pre-diabetes—is one of the strongest and most consistent predictors of
“it’s all connected.”
heart disease.
• Insulin resistance happens when the body is no longer able to effectively manage your
intake of sugar and starch.
• Studies going back to the 1970s show clearly that insulin resistance substantially increases
the risk for many degenerative diseases and is an early warning sign for heart disease.
• You can have insulin resistance as much as a decade before the other, more “conventional”
signs of heart disease show up, making it all the more important to test for insulin
resistance.
• Preventing, reversing, or treating insulin resistance may be one of the most effective ways
yet discovered to prevent heart disease.

In this spirit, we introduce part three of this book, There is even an entire science known as psychoneu-
the part we’ve affectionately referred to as our “Eat. roimmunology, which studies how what we think
Play. Love” section. In it we discuss three main issues: about affects our immune system. Thoughts are pow- CHAPTER 10
Food, Supplements, and what we might call erful. So are feelings. They can strengthen—or
Everything Else. weaken—the heart, and as such, deserve a discussion
While the sections on what to eat and what sup- in any book on heart health.
plements to take may seem pretty straightforward,
the “Everything Else” section needs a few words of
So in this section—in addition to learning about
food and supplements—you’ll also find some sugges- BEYOND THE
MEDITERRANEAN DIET:
explanation. Maybe because each of us—at one point tions for self-care in general. That includes such
in our respective careers—studied psychology and psy- things as deep breathing, meditation, walks in the
chotherapy, we are acutely aware of the impact our park, and Epson salt baths. Think stuff like that
brain (not to mention anything more ethereal like our
“soul” or “spirit”) has on the health of our heart. For
doesn’t affect your heart? Think again. Relaxing and
relating are two of the most potent medicines in the
WHAT DO I EAT?
proof, look no further than the physiology of stress. playbook for heart disease treatment and prevention.
Worry and anxiety and stress all cause the release of If either of us were presented with a choice NEARLY EVERY HEALTH ORGANIZATION ON THE PLANET routinely recommends the
powerful hormones that have significant impact on between two prescriptions for preventing heart dis- Mediterranean Diet, as do most doctors and dietitians. But the definition of what exactly the
everything in our body from sex drive to hunger to ease—the first for a statin drug, the second for a daily Mediterranean Diet is remains far more elusive than you might think. First of all, there are twenty-one
blood pressure to brain wave patterns to immune sys- dose of laughter, cuddling, joy, healthy food, supple- countries bordering the Mediterranean Sea—Montenegro, Spain, Albania, Greece, Turkey, Monaco, Italy,
tem function. ments, and a good night’s sleep—neither of us would Malta, Slovenia, Cyprus, France, Croatia, Bosnia and Herzegovina, Syria, Lebanon, Israel, Egypt, Libya,
Stress may originate in your head, but it ends up hesitate before choosing the second. Tunisia, Algeria, and Morocco. And guess what—they don’t all eat the same foods.
influencing virtually every system in the human body. Not even for a second. Most of what we think we know about the “Mediterranean Diet” actually came from Ancel Keys’s
personal observations during his trips to Naples and Nicoteria in 1957,1 based on which he launched
the infamous Seven Countries Study, about which controversy has been ranging for at least a decade.
What’s more, there’s emerging evidence that the fabled Mediterranean Diet may have included a lot
more meat than is commonly believed.

In this spirit, we introduce part three of this book, There is even an entire science known as psychoneu-
the part we’ve affectionately referred to as our “Eat. roimmunology, which studies how what we think
Play. Love” section. In it we discuss three main issues: about affects our immune system. Thoughts are pow- CHAPTER 10
Food, Supplements, and what we might call erful. So are feelings. They can strengthen—or
Everything Else. weaken—the heart, and as such, deserve a discussion
While the sections on what to eat and what sup- in any book on heart health.
plements to take may seem pretty straightforward,
the “Everything Else” section needs a few words of
So in this section—in addition to learning about
food and supplements—you’ll also find some sugges- BEYOND THE
MEDITERRANEAN DIET:
explanation. Maybe because each of us—at one point tions for self-care in general. That includes such
in our respective careers—studied psychology and psy- things as deep breathing, meditation, walks in the
chotherapy, we are acutely aware of the impact our park, and Epson salt baths. Think stuff like that
brain (not to mention anything more ethereal like our
“soul” or “spirit”) has on the health of our heart. For
doesn’t affect your heart? Think again. Relaxing and
relating are two of the most potent medicines in the
WHAT DO I EAT?
proof, look no further than the physiology of stress. playbook for heart disease treatment and prevention.
Worry and anxiety and stress all cause the release of If either of us were presented with a choice NEARLY EVERY HEALTH ORGANIZATION ON THE PLANET routinely recommends the
powerful hormones that have significant impact on between two prescriptions for preventing heart dis- Mediterranean Diet, as do most doctors and dietitians. But the definition of what exactly the
everything in our body from sex drive to hunger to ease—the first for a statin drug, the second for a daily Mediterranean Diet is remains far more elusive than you might think. First of all, there are twenty-one
blood pressure to brain wave patterns to immune sys- dose of laughter, cuddling, joy, healthy food, supple- countries bordering the Mediterranean Sea—Montenegro, Spain, Albania, Greece, Turkey, Monaco, Italy,
tem function. ments, and a good night’s sleep—neither of us would Malta, Slovenia, Cyprus, France, Croatia, Bosnia and Herzegovina, Syria, Lebanon, Israel, Egypt, Libya,
Stress may originate in your head, but it ends up hesitate before choosing the second. Tunisia, Algeria, and Morocco. And guess what—they don’t all eat the same foods.
influencing virtually every system in the human body. Not even for a second. Most of what we think we know about the “Mediterranean Diet” actually came from Ancel Keys’s
personal observations during his trips to Naples and Nicoteria in 1957,1 based on which he launched
the infamous Seven Countries Study, about which controversy has been ranging for at least a decade.
What’s more, there’s emerging evidence that the fabled Mediterranean Diet may have included a lot
more meat than is commonly believed.

Sardinia is a perfect example. Not only is it in benefits to the meat-supplemented diet when com- suggest that no more than 25 percent of your Internal Medicine demonstrated that women who ate
5
Italy—the virtual birthplace of the concept of pared to the “traditional” Mediterranean diet. calories should come from added sugars, but we think the highest amount of carbohydrates had a
“Mediterranean Diet”—but it’s also one of the “Blue The point, we feel, is not to be slavish to a diet, that’s a ridiculously high amount. (The American significantly greater risk of coronary heart disease
Zones,” those five areas around the world that have but rather to be conscious about what foods you eat Heart Association recommends no more than 5 than those who ate the lowest amount, and that
the greatest number of healthy centenarians and are in general. Which is what this section is about. percent.) Research by Kimber Stanhope, Ph.D., at the carbohydrates from high-glycemic carbs were
constantly touted as having the healthiest lifestyles University of California, Davis, has shown that when particularly associated with significantly greater risk
on the planet. So Sardinia is kind of the poster-child BEYOND DIET—WAY BEYOND people consume 25 percent of their calories from for heart disease.7 (This association was not
example of a country with a much-envied diet. And But food is not the only thing experts mean when fructose or high-fructose corn syrup, several factors confirmed for men in this particular study, but we
that diet is hardly meat-free. they say “Mediterranean Diet.” With that diet— associated with an increased risk for heart disease— suspect that future studies will discover that it’s true
On the “Sardinia Unlimited” website, the third however ill-defined it is—goes an entire lifestyle that including triglycerides and a nasty little substance for both sexes.)
6
most popular traditional Sardinian dish is roast suck- is, frankly, quite different than ours, in ways it would called apolipoprotein-B—escalate. There’s no two ways about it—high-glycemic car-
2
ling pig. And a look at the Italian cookbooks of famed benefit us to understand. Remember, it’s the fructose in sugar that’s the bohydrates are inflammatory. As researchers from
3
food writer Elizabeth David or at the menu of any Men share their emotional lives much more freely problem. High-fructose corn syrup is 55 percent fruc- Harvard Medical School and the Harvard School of
fine Sardinian restaurant will reveal—along with the there than they do here. There is much activity in the tose, and regular sugar is 50 percent fructose, so for Public Health noted, quickly digested and absorbed
vegetables—plenty of bacon, pork, chops, veal, and public square. People take naps. They have their big all intents and purposes, they have the same bad carbs (i.e., those with a high glycemic load) are asso-
4
ribs. So rather than echoing the standard fare about meal during the day. They spend time in the sun. If effect on your heart and your health. ciated with an increased risk of heart disease.8
following the ill-defined “Mediterranean Diet” we’d we should be talking about anything Mediterranean, it Fast Action Plan: Cut out soda. Soda is probably Full disclosure: We don’t much buy into the argu-
rather talk about the best things in the Mediterranean should be the Mediterranean Lifestyle—at least as the worst offender in this category, but not by much. ment that “whole grains” eliminate all the problems
pattern of eating and about the best things in the much as the food itself. Fruit juices are loaded with sugar and only marginally associated with processed carbs, and here’s why:
Mediterranean pattern of living. But now it’s time to focus on food. The rest of better than soda. “Energy drinks” aren’t any better. Number one, most commercial products that are
Great foods that are part of a “Mediterranean this section is divided into two parts—what to eat and Most are loaded with sugar, and the sugar-free ver- made with whole grains don’t contain all that much of
Diet”—such as walnuts and olive oil and fish—can be what not to eat for optimal heart health. Fortunately, sions are loaded with chemicals. Many processed them. Number two, whole grains raise blood sugar
beneficial to anyone, following any eating plan. Many the list of what not to eat is fairly short, so let’s get carbs (see below) are also full of sugar, and virtually almost as much as processed grains do. Number
of the things we like about the Mediterranean diet that one out of the way first. We call it the “Dump It!” all cakes, candies, pastries, doughnuts, and other three, whole grains still contain gluten, which can be
can actually be compatible with any number of list and provide you with specific “fast action plans” sources of empty calories are also sugar very inflammatory for people who are gluten-sensi-
healthy diets. (You could even do a keto diet using to help you remove these nutritionally empty, heart- heavyweights. tive. That said, real whole-grain products (Ezekiel 4:9
primarily extra-virgin olive oil as your fat, or a low- unfriendly foods from your diet. The second part of breads, for example) are way better than their pro-
carb diet using traditional Mediterranean foods with- this section is called “Eat This!” and reveals some of Dump It: Processed Carbohydrates cessed counterparts. But be a careful consumer—just
out the grains. And even keto diets can incorporate the healthiest foods on the planet. Processed carbs include almost any carbohydrate because a label says “wheat” instead of “white,” don’t
nuts and green vegetables!) food that comes in a package: cereals, pasta, bread, assume it’s good for you.
Researchers writing in the American Journal of Dump It: Sugar minute rice, you name it. These foods are almost Fast Action Plan: Reduce (or eliminate) con-
Clinical Nutrition recently tested a “Mediterranean- As we’ve said throughout this book (see chapter 6), always high-glycemic, meaning they quickly and sumption of processed carbohydrates. At the same
type” diet supplemented with unprocessed red meat sugar is a far worse threat to your heart than fat ever dramatically raise your blood sugar, which is exactly time, increase non-processed carbohydrates such as
on overweight or obese adults. They found significant was. The 2010 Dietary Guidelines for Americans what you do not want. A study in the Archives of vegetables and low-sugar fruits. Replace your bagel
144 THE GREAT CHOLESTEROL MYTH BEYOND THE MEDITERRANEAN DIET: WHAT DO I EAT? 145
Sardinia is a perfect example. Not only is it in benefits to the meat-supplemented diet when com- suggest that no more than 25 percent of your Internal Medicine demonstrated that women who ate
5
Italy—the virtual birthplace of the concept of pared to the “traditional” Mediterranean diet. calories should come from added sugars, but we think the highest amount of carbohydrates had a
“Mediterranean Diet”—but it’s also one of the “Blue The point, we feel, is not to be slavish to a diet, that’s a ridiculously high amount. (The American significantly greater risk of coronary heart disease
Zones,” those five areas around the world that have but rather to be conscious about what foods you eat Heart Association recommends no more than 5 than those who ate the lowest amount, and that
the greatest number of healthy centenarians and are in general. Which is what this section is about. percent.) Research by Kimber Stanhope, Ph.D., at the carbohydrates from high-glycemic carbs were
constantly touted as having the healthiest lifestyles University of California, Davis, has shown that when particularly associated with significantly greater risk
on the planet. So Sardinia is kind of the poster-child BEYOND DIET—WAY BEYOND people consume 25 percent of their calories from for heart disease.7 (This association was not
example of a country with a much-envied diet. And But food is not the only thing experts mean when fructose or high-fructose corn syrup, several factors confirmed for men in this particular study, but we
that diet is hardly meat-free. they say “Mediterranean Diet.” With that diet— associated with an increased risk for heart disease— suspect that future studies will discover that it’s true
On the “Sardinia Unlimited” website, the third however ill-defined it is—goes an entire lifestyle that including triglycerides and a nasty little substance for both sexes.)
6
most popular traditional Sardinian dish is roast suck- is, frankly, quite different than ours, in ways it would called apolipoprotein-B—escalate. There’s no two ways about it—high-glycemic car-
2
ling pig. And a look at the Italian cookbooks of famed benefit us to understand. Remember, it’s the fructose in sugar that’s the bohydrates are inflammatory. As researchers from
3
food writer Elizabeth David or at the menu of any Men share their emotional lives much more freely problem. High-fructose corn syrup is 55 percent fruc- Harvard Medical School and the Harvard School of
fine Sardinian restaurant will reveal—along with the there than they do here. There is much activity in the tose, and regular sugar is 50 percent fructose, so for Public Health noted, quickly digested and absorbed
vegetables—plenty of bacon, pork, chops, veal, and public square. People take naps. They have their big all intents and purposes, they have the same bad carbs (i.e., those with a high glycemic load) are asso-
4
ribs. So rather than echoing the standard fare about meal during the day. They spend time in the sun. If effect on your heart and your health. ciated with an increased risk of heart disease.8
following the ill-defined “Mediterranean Diet” we’d we should be talking about anything Mediterranean, it Fast Action Plan: Cut out soda. Soda is probably Full disclosure: We don’t much buy into the argu-
rather talk about the best things in the Mediterranean should be the Mediterranean Lifestyle—at least as the worst offender in this category, but not by much. ment that “whole grains” eliminate all the problems
pattern of eating and about the best things in the much as the food itself. Fruit juices are loaded with sugar and only marginally associated with processed carbs, and here’s why:
Mediterranean pattern of living. But now it’s time to focus on food. The rest of better than soda. “Energy drinks” aren’t any better. Number one, most commercial products that are
Great foods that are part of a “Mediterranean this section is divided into two parts—what to eat and Most are loaded with sugar, and the sugar-free ver- made with whole grains don’t contain all that much of
Diet”—such as walnuts and olive oil and fish—can be what not to eat for optimal heart health. Fortunately, sions are loaded with chemicals. Many processed them. Number two, whole grains raise blood sugar
beneficial to anyone, following any eating plan. Many the list of what not to eat is fairly short, so let’s get carbs (see below) are also full of sugar, and virtually almost as much as processed grains do. Number
of the things we like about the Mediterranean diet that one out of the way first. We call it the “Dump It!” all cakes, candies, pastries, doughnuts, and other three, whole grains still contain gluten, which can be
can actually be compatible with any number of list and provide you with specific “fast action plans” sources of empty calories are also sugar very inflammatory for people who are gluten-sensi-
healthy diets. (You could even do a keto diet using to help you remove these nutritionally empty, heart- heavyweights. tive. That said, real whole-grain products (Ezekiel 4:9
primarily extra-virgin olive oil as your fat, or a low- unfriendly foods from your diet. The second part of breads, for example) are way better than their pro-
carb diet using traditional Mediterranean foods with- this section is called “Eat This!” and reveals some of Dump It: Processed Carbohydrates cessed counterparts. But be a careful consumer—just
out the grains. And even keto diets can incorporate the healthiest foods on the planet. Processed carbs include almost any carbohydrate because a label says “wheat” instead of “white,” don’t
nuts and green vegetables!) food that comes in a package: cereals, pasta, bread, assume it’s good for you.
Researchers writing in the American Journal of Dump It: Sugar minute rice, you name it. These foods are almost Fast Action Plan: Reduce (or eliminate) con-
Clinical Nutrition recently tested a “Mediterranean- As we’ve said throughout this book (see chapter 6), always high-glycemic, meaning they quickly and sumption of processed carbohydrates. At the same
type” diet supplemented with unprocessed red meat sugar is a far worse threat to your heart than fat ever dramatically raise your blood sugar, which is exactly time, increase non-processed carbohydrates such as
on overweight or obese adults. They found significant was. The 2010 Dietary Guidelines for Americans what you do not want. A study in the Archives of vegetables and low-sugar fruits. Replace your bagel
CORNFLAKES A GREAT BREAKFAST? THINK AGAIN! statistically significant positive association between dietary glycemic load and [blood levels of]
If any of you out there still think cornflakes are a great, wholesome breakfast, read on. A CRP.”10 And that’s putting it mildly.
landmark research study conducted by Michael Shechter, M.D., of Tel Aviv University’s Sackler Women whose diets were highest in glycemic load had almost twice the amount of CRP in
School of Medicine and the Heart Institute of Sheba Medical Center, with collaboration from their blood as women whose diets were lowest in glycemic load (3.7 for high-glycemic load
the Endocrinology Institute, shows exactly how high-carbohydrate foods increase the risk for ladies, 1.9 for low-glycemic load ladies). The difference in inflammation levels was even more
heart problems. 9 pronounced for overweight women. Among women with a body mass index (BMI) greater than
Researchers looked at four groups of volunteers who were given different breakfasts. The 25, those whose diets were lowest in glycemic load, had an average CRP reading of 1.6, but
first group was given a cornflake mush mixed with milk, not unlike the typical American those whose diets were highest in glycemic load had a CRP reading more than three times
breakfast. The second group was given a pure sugar mixture. The third group was given bran that amount (average measurement: 5.0 mg/L).11
flakes. And the fourth group was given a placebo (water).
Over four weeks, Shechter applied a test that allows researchers to visualize how the
arteries are functioning. It’s called brachial reactive testing, and it uses a cuff on the arm
and orange juice with some eggs, veggies, and a slice cups, virtually all packaged baked goods (e.g.,
(similar to those used for measuring blood pressure) that can visualize arterial function in
of avocado. Have berries for dessert. When eating Twinkies, chips, and crackers), doughnuts, many
real time.
out, say “no” to the breadbasket. breakfast cereals, “energy” bars, cookies, and defi-
The results were dramatic. Before any of the patients ate, their arterial function was
nitely fast food. (Just for example, a medium order of
basically the same. After eating, all had reduced functioning except for the patients in the
Dump It: Trans Fats fries contains an incredible 14.5 g of trans fat, and a
water-drinking placebo group. Enormous peaks indicating arterial stress were found in the high
According to findings presented at the annual Kentucky Fried Chicken Original Recipe chicken dinner
GI groups: the cornflakes and sugar groups.
meeting of the American Heart Association in 2006, has 7 g. The ideal intake for humans is 0 g.)
“We knew high glycemic foods were bad for the heart. Now we have a mechanism that
women who ate the most trans fats were more than Worth knowing: There is one exception to the
shows how,” Shechter wrote. “Foods like cornflakes, white bread, French fries, and sweetened
three times as likely to develop heart disease as don’t-eat-trans-fats rule, and that’s something called
soda all put undue stress on our arteries. We’ve explained for the first time how high-glycemic 12
women who ate the least. Harvard researcher conjugated linoleic acid, or CLA. CLA is a trans fat
carbs can affect the progression of heart disease.” During the consumption of foods high in
Charlene Hu examined data from the long-running that’s not man-made; rather, it’s made naturally in the
sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the
Nurses’ Health Study, which has followed 120,000 bodies of ruminants (cows). Factory-farmed meat
arteries. Endothelial health can be traced back to almost every disorder and disease in the
female nurses for more than thirty years. His research doesn’t have any, but grass-fed meat—and products
body. According to Shechter, it is the “riskiest of the risk factors.”
shows that for each 2 percent increase in trans fat that come from pasture-raised animals—do. CLA has
Shechter recommended sticking to foods such as oatmeal, fruits and vegetables, and
calories consumed, the risk for coronary heart both anticancer and antiobesity properties. CLA is
legumes and nuts, which all have a low glycemic index. Exercising every day for at least thirty 13
disease roughly doubles! Trans fats raise LDL good for you, unlike man-made trans fats —which are
minutes, he added, is an extra heart-smart action to take.
cholesterol levels, which doesn’t mean very much by definitely not good for you.
These same researchers examined the diets of 244 apparently healthy women to evaluate
itself, but at high intakes they also reduce HDL levels, Fast Action Plan: Stop eating fast food. On all
the association between glycemic load and blood levels of CRP (C-reactive protein, the 14
which definitely isn’t good. packaged foods from the supermarket, check the
systemic measure of inflammation discussed earlier in this chapter). They found “a strong and
The worst offenders include nondairy “creamers,” ingredients list for “partially hydrogenated” oils. If
most margarines, cake mixes, ramen noodles, soup you see it in the ingredients list, don’t eat it. Look in
CORNFLAKES A GREAT BREAKFAST? THINK AGAIN! statistically significant positive association between dietary glycemic load and [blood levels of]
If any of you out there still think cornflakes are a great, wholesome breakfast, read on. A CRP.”10 And that’s putting it mildly.
landmark research study conducted by Michael Shechter, M.D., of Tel Aviv University’s Sackler Women whose diets were highest in glycemic load had almost twice the amount of CRP in
School of Medicine and the Heart Institute of Sheba Medical Center, with collaboration from their blood as women whose diets were lowest in glycemic load (3.7 for high-glycemic load
the Endocrinology Institute, shows exactly how high-carbohydrate foods increase the risk for ladies, 1.9 for low-glycemic load ladies). The difference in inflammation levels was even more
heart problems. 9 pronounced for overweight women. Among women with a body mass index (BMI) greater than
Researchers looked at four groups of volunteers who were given different breakfasts. The 25, those whose diets were lowest in glycemic load, had an average CRP reading of 1.6, but
first group was given a cornflake mush mixed with milk, not unlike the typical American those whose diets were highest in glycemic load had a CRP reading more than three times
breakfast. The second group was given a pure sugar mixture. The third group was given bran that amount (average measurement: 5.0 mg/L).11
flakes. And the fourth group was given a placebo (water).
Over four weeks, Shechter applied a test that allows researchers to visualize how the
arteries are functioning. It’s called brachial reactive testing, and it uses a cuff on the arm
and orange juice with some eggs, veggies, and a slice cups, virtually all packaged baked goods (e.g.,
(similar to those used for measuring blood pressure) that can visualize arterial function in
of avocado. Have berries for dessert. When eating Twinkies, chips, and crackers), doughnuts, many
real time.
out, say “no” to the breadbasket. breakfast cereals, “energy” bars, cookies, and defi-
The results were dramatic. Before any of the patients ate, their arterial function was
nitely fast food. (Just for example, a medium order of
basically the same. After eating, all had reduced functioning except for the patients in the
Dump It: Trans Fats fries contains an incredible 14.5 g of trans fat, and a
water-drinking placebo group. Enormous peaks indicating arterial stress were found in the high
According to findings presented at the annual Kentucky Fried Chicken Original Recipe chicken dinner
GI groups: the cornflakes and sugar groups.
meeting of the American Heart Association in 2006, has 7 g. The ideal intake for humans is 0 g.)
“We knew high glycemic foods were bad for the heart. Now we have a mechanism that
women who ate the most trans fats were more than Worth knowing: There is one exception to the
shows how,” Shechter wrote. “Foods like cornflakes, white bread, French fries, and sweetened
three times as likely to develop heart disease as don’t-eat-trans-fats rule, and that’s something called
soda all put undue stress on our arteries. We’ve explained for the first time how high-glycemic 12
women who ate the least. Harvard researcher conjugated linoleic acid, or CLA. CLA is a trans fat
carbs can affect the progression of heart disease.” During the consumption of foods high in
Charlene Hu examined data from the long-running that’s not man-made; rather, it’s made naturally in the
sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the
Nurses’ Health Study, which has followed 120,000 bodies of ruminants (cows). Factory-farmed meat
arteries. Endothelial health can be traced back to almost every disorder and disease in the
female nurses for more than thirty years. His research doesn’t have any, but grass-fed meat—and products
body. According to Shechter, it is the “riskiest of the risk factors.”
shows that for each 2 percent increase in trans fat that come from pasture-raised animals—do. CLA has
Shechter recommended sticking to foods such as oatmeal, fruits and vegetables, and
calories consumed, the risk for coronary heart both anticancer and antiobesity properties. CLA is
legumes and nuts, which all have a low glycemic index. Exercising every day for at least thirty 13
disease roughly doubles! Trans fats raise LDL good for you, unlike man-made trans fats —which are
minutes, he added, is an extra heart-smart action to take.
cholesterol levels, which doesn’t mean very much by definitely not good for you.
These same researchers examined the diets of 244 apparently healthy women to evaluate
itself, but at high intakes they also reduce HDL levels, Fast Action Plan: Stop eating fast food. On all
the association between glycemic load and blood levels of CRP (C-reactive protein, the 14
which definitely isn’t good. packaged foods from the supermarket, check the
systemic measure of inflammation discussed earlier in this chapter). They found “a strong and
The worst offenders include nondairy “creamers,” ingredients list for “partially hydrogenated” oils. If
most margarines, cake mixes, ramen noodles, soup you see it in the ingredients list, don’t eat it. Look in
Although the study didn’t identify which specific higher than 4:1, and many believe the ideal ratio is 1:1.
ingredients in processed meat could be responsible In the average Westernized diet, the ratio is anywhere
THE “NO TRANS-FATS!” SCAM
for the association, many health professionals believe between 15:1 and 25:1, which creates a highly inflam-
When the government mandated that trans fats be listed on the nutrition facts label of food,
that the high levels of sodium and nitrates might be matory state in the body. Because heart disease is
big food lobbyists sprang into action. They somehow created a loophole that lets
responsible. “When we looked at average nutrients in primarily a disease of inflammation, such a state
manufacturers use trans fats while legally claiming “no trans fats!” on their packaging.
unprocessed red and processed meats eaten in the should be avoided as much as humanly possible.
Here’s how:
United States, we found that they contained similar And by the way, it’s not just the oils you use for
Manufacturers can claim “no trans fats” as long as there is less than half a gram of the
average amounts of saturated fat and cholesterol. In cooking that tip the scales into inflammation land.
stuff per serving. Sounds reasonable, until you remember how clever and ruthless Big Food
contrast, processed meats contained, on average, four Omega-6 fats are everywhere in the food supply—you
can be. By making “serving sizes” ridiculously small, and by keeping trans fats to just under
times more sodium and 50 percent more nitrate pre- can’t swing a rope without hitting a food product
half a gram per “serving,” they were able to technically comply with the rules. But the end
servatives,” said Renata Micha, a research fellow in loaded with omega-6s. Nearly all processed foods
result is that if each artificially small “serving” contains, say 0.4 g of trans fats, you could
the department of epidemiology at the Harvard contain them. They’re used almost exclusively in res-
quite easily consume a gram or two of the stuff just by eating what most people would
School of Public Health and lead author of the study. taurants, for frying, sautéing, and baking, so virtually
consider a “normal” serving size. Do that a few times a day and before you know it you’ve
“This suggests that differences in salt and preserva- anything you order from the menu has got a ton of
raised your heart disease risk by quite a few percentage points.
tives, rather than fats, might explain the higher risk of omega-6 fats.
What to do? Simple. Ignore the “no trans fats!” legend on the front of the package and read
heart disease and diabetes seen with processed So choose your omega-6 fats carefully and use
the ingredients list instead. No matter what the label says, if the list of ingredients contains 16
meats, but not with unprocessed red meats.” them sparingly. (The best choices are cold-pressed,
partially hydrogenated oil or hydrogenated oil, the product has trans fats. Period. (Typically,
Fast Action Plan: Cut out processed (e.g., deli) unrefined oils—sesame oil is a particularly good
you’ll see partially hydrogenated soybean oil in the ingredients list, but it could be any type of
meats. choice.) Use highly processed supermarket oils (such
oil at all. What you’re looking for are the keywords hydrogenated and partially hydrogenated.)
as corn oil) infrequently or not at all. When you
Dump It: Excessive Omega-6 Fats sauté food, try substituting monounsaturated fats
Vegetable oils (corn, canola, and soybean) are mostly such as olive oil and macadamia nut oil for high
particular at margarines, cookies, cakes, pastries, (Previous studies had rarely separated processed made up of pro-inflammatory omega-6 fats, and you omega-6 oils such as canola or soybean. And, above
doughnuts, and, as mentioned, fast food. meat from unprocessed meat when investigating the should reduce (not necessarily eliminate) your all, increase your intake of omega-3 fats to help bal-
relationship between disease and meat eating.) The consumption of them while increasing your ance your intake of omega-6s (see the “Eat This!”
Dump It: Processed Meats researchers analyzed twenty studies that included a consumption of anti-inflammatory omega-3 fats. section on page 150).
Processed meats contribute to both inflammation in total of 1,218,380 people from ten countries on four This is the one recommendation that comes with Fast Action Plan: Never use generic processed
general and heart disease specifically. Harvard continents (North America, Europe, Asia, and an asterisk. Omega-6 fats, the ones that are most oils such as Wesson or Crisco. Cut down on corn oil,
researchers investigated the effect of eating Australia). They found that each 1.8-ounce daily prevalent in vegetable oils, are not in and of them- safflower oil, soybean oil, and canola oil (see Dr.
processed meat versus unprocessed meat. Processed serving of processed meat (about one hot dog or a selves “bad.” But they are pro-inflammatory, and they Sinatra’s personal story on canola oil in chapter 7).
meat was defined as any meat preserved by curing, couple slices of deli meat) was associated with a 42 need to be balanced by an equal (or near-equal) Whenever possible, use olive oil, sesame oil, or maca-
salting, smoking, or with the addition of chemical percent higher risk of developing heart disease. (In intake of anti-inflammatory omega-3s. (You can damia oil. And pay attention to the “Eat This!” section
preservatives, such as those found in salami, contrast, no relationship was found between heart review this information in chapter 7.) The optimal in this chapter on omega-3s.
15
sausages, hot dogs, luncheon meats, and bacon. disease and nonprocessed red meat.) ratio of omega-6 to omega-3 in the human diet is no
Although the study didn’t identify which specific higher than 4:1, and many believe the ideal ratio is 1:1.
ingredients in processed meat could be responsible In the average Westernized diet, the ratio is anywhere
THE “NO TRANS-FATS!” SCAM
for the association, many health professionals believe between 15:1 and 25:1, which creates a highly inflam-
When the government mandated that trans fats be listed on the nutrition facts label of food,
that the high levels of sodium and nitrates might be matory state in the body. Because heart disease is
big food lobbyists sprang into action. They somehow created a loophole that lets
responsible. “When we looked at average nutrients in primarily a disease of inflammation, such a state
manufacturers use trans fats while legally claiming “no trans fats!” on their packaging.
unprocessed red and processed meats eaten in the should be avoided as much as humanly possible.
Here’s how:
United States, we found that they contained similar And by the way, it’s not just the oils you use for
Manufacturers can claim “no trans fats” as long as there is less than half a gram of the
average amounts of saturated fat and cholesterol. In cooking that tip the scales into inflammation land.
stuff per serving. Sounds reasonable, until you remember how clever and ruthless Big Food
contrast, processed meats contained, on average, four Omega-6 fats are everywhere in the food supply—you
can be. By making “serving sizes” ridiculously small, and by keeping trans fats to just under
times more sodium and 50 percent more nitrate pre- can’t swing a rope without hitting a food product
half a gram per “serving,” they were able to technically comply with the rules. But the end
servatives,” said Renata Micha, a research fellow in loaded with omega-6s. Nearly all processed foods
result is that if each artificially small “serving” contains, say 0.4 g of trans fats, you could
the department of epidemiology at the Harvard contain them. They’re used almost exclusively in res-
quite easily consume a gram or two of the stuff just by eating what most people would
School of Public Health and lead author of the study. taurants, for frying, sautéing, and baking, so virtually
consider a “normal” serving size. Do that a few times a day and before you know it you’ve
“This suggests that differences in salt and preserva- anything you order from the menu has got a ton of
raised your heart disease risk by quite a few percentage points.
tives, rather than fats, might explain the higher risk of omega-6 fats.
What to do? Simple. Ignore the “no trans fats!” legend on the front of the package and read
heart disease and diabetes seen with processed So choose your omega-6 fats carefully and use
the ingredients list instead. No matter what the label says, if the list of ingredients contains 16
meats, but not with unprocessed red meats.” them sparingly. (The best choices are cold-pressed,
partially hydrogenated oil or hydrogenated oil, the product has trans fats. Period. (Typically,
Fast Action Plan: Cut out processed (e.g., deli) unrefined oils—sesame oil is a particularly good
you’ll see partially hydrogenated soybean oil in the ingredients list, but it could be any type of
meats. choice.) Use highly processed supermarket oils (such
oil at all. What you’re looking for are the keywords hydrogenated and partially hydrogenated.)
as corn oil) infrequently or not at all. When you
Dump It: Excessive Omega-6 Fats sauté food, try substituting monounsaturated fats
Vegetable oils (corn, canola, and soybean) are mostly such as olive oil and macadamia nut oil for high
particular at margarines, cookies, cakes, pastries, (Previous studies had rarely separated processed made up of pro-inflammatory omega-6 fats, and you omega-6 oils such as canola or soybean. And, above
doughnuts, and, as mentioned, fast food. meat from unprocessed meat when investigating the should reduce (not necessarily eliminate) your all, increase your intake of omega-3 fats to help bal-
relationship between disease and meat eating.) The consumption of them while increasing your ance your intake of omega-6s (see the “Eat This!”
Dump It: Processed Meats researchers analyzed twenty studies that included a consumption of anti-inflammatory omega-3 fats. section on page 150).
Processed meats contribute to both inflammation in total of 1,218,380 people from ten countries on four This is the one recommendation that comes with Fast Action Plan: Never use generic processed
general and heart disease specifically. Harvard continents (North America, Europe, Asia, and an asterisk. Omega-6 fats, the ones that are most oils such as Wesson or Crisco. Cut down on corn oil,
researchers investigated the effect of eating Australia). They found that each 1.8-ounce daily prevalent in vegetable oils, are not in and of them- safflower oil, soybean oil, and canola oil (see Dr.
processed meat versus unprocessed meat. Processed serving of processed meat (about one hot dog or a selves “bad.” But they are pro-inflammatory, and they Sinatra’s personal story on canola oil in chapter 7).
meat was defined as any meat preserved by curing, couple slices of deli meat) was associated with a 42 need to be balanced by an equal (or near-equal) Whenever possible, use olive oil, sesame oil, or maca-
salting, smoking, or with the addition of chemical percent higher risk of developing heart disease. (In intake of anti-inflammatory omega-3s. (You can damia oil. And pay attention to the “Eat This!” section
preservatives, such as those found in salami, contrast, no relationship was found between heart review this information in chapter 7.) The optimal in this chapter on omega-3s.
15
sausages, hot dogs, luncheon meats, and bacon. disease and nonprocessed red meat.) ratio of omega-6 to omega-3 in the human diet is no
THE “EAT THIS!” LIST able fishing and equally scrupulous about testing while leaving the non-inflammatory COX-1 alone. Eat This: Vegetables (and Some Fruit)
Both of us are frequently interviewed about the best their fish thoroughly for contaminants and metals. Unfortunately, there were some really unpleasant side No matter what kind of diet you’re on—from vegan to
foods for health. Virtually every reporter either of us They ship in dry ice, and they have the best fish we’ve effects associated with Vioxx, and it was taken off the Atkins—you can probably benefit from eating more
has ever spoken with winds up asking, “How much of ever tasted. market. But anthocyanins produce a similar effect vegetables than you already do. The entire vegetable
this food do you need to eat to get its benefits?” It’s Fast Action Plan: Eat wild salmon twice a week. with none of the problems of such drugs. Cherries kingdom is loaded with natural anti-inflammatories,
a reasonable question, but there’s almost never a (along with raspberries) have the highest yields of antioxidants, and other plant compounds, such as
perfect answer. We know of no study, for example, Eat This: Berries pure anthocyanins. In one study, the COX inhibitory flavonoids, that are good for your heart.
that has systematically tested the effects of eating All berries are loaded with natural anti-inflammatory activity of anthocyanins from cherries was compara- In two long-running Harvard-based research proj-
five portions of blueberries a week as opposed to properties and natural antioxidants. They’re also very ble to that of ibuprofen and naproxen. Researchers ects, the Nurses’ Health Study and the Health
three, or compared eating two portions of salmon per low in sugar. Blueberries contain a beneficial feel that in addition to helping with pain and inflam- Professionals Follow-up Study, the higher the average
week with eating it daily. Our recommendation is to compound called pterostilbene, which helps prevent mation, consuming anthocyanins on a regular basis daily consumption of vegetables and fruits, the lower
put these foods in heavy rotation in your diet, the deposit of plaque in the arteries and also helps may help lower heart attack and stroke risk. the chances of developing cardiovascular disease.
enjoying them as frequently as you like. prevent some of the damage caused by oxidized Fast Action Plan: Eat cherries two (or more) Compared with those in the lowest category of fruit
18
Here are the foods you want to include in your cholesterol. Raspberries and strawberries contain times a week. and vegetable intake (fewer than one and a half serv-
diet on a regular basis. another substance, ellagic acid, which offers similar ings daily), those averaging eight or more servings
19
protection against oxidized LDL. And all berries— Eat This: Grass-Fed Beef per day were a whopping 30 percent less likely to
Eat This: Wild Alaskan Salmon blueberries, raspberries, strawberries, and others— We’re not anti-meat guys, but we are very much have had a heart attack or stroke.20
Salmon is one of the best sources of anti- contain anthocyanins, plant compounds that help against factory-farmed meat. The majority of the Although all vegetables and fruits probably con-
inflammatory omega-3s. But not all salmon is created lower inflammation (see “Cherries” below). meat we consume, unfortunately, is feedlot-raised tributed to this stunning effect, the researchers felt
equal. Wild Alaskan salmon is far superior to the Fast Action Plan: Eat berries three (or more) meat from factory farms. It’s loaded with antibiotics, that the most outstanding contributors were the
farm-raised variety. (According to independent lab times a week. steroids, and hormones; it’s very high in inflammatory green, leafy veggies (such as spinach and Swiss
tests by the Environmental Working Group, seven out omega-6 fats; and it contains virtually no anti- chard) and the cruciferous ones (broccoli, Brussels
of ten farmed salmon purchased at grocery stores Eat This: Cherries inflammatory omega-3s. sprouts, kale, cabbage, and cauliflower). (In the fruit
were contaminated with polychlorinated biphenyls Cherries and cherry juice have long been known to be Grass-fed meat is a whole different “animal.” department, citrus fruits such as oranges, lemons,
[PCBs] at levels high enough to raise health effective against the pain of gout, and scientists (Okay, bad pun, sorry, we couldn’t resist.) Raised on limes, and grapefruit were particularly protective.21)
concerns.) Wild salmon is far cleaner, and it has the believe that the compounds in cherries responsible pasture, it contains less omega-6s plus a fair amount When researchers took the Harvard studies men-
added benefit of containing one of the most powerful for this are anthocyanins. Anthocyanins act like of omega-3s, resulting in a much better omega- tioned above and combined them with several other
antioxidants on the planet, astaxanthin. A 4-ounce natural COX-2 inhibitors. “COX” stands for 6:omega-3 ratio. Grass-fed meat is almost always long-term studies both in Europe and the United
serving also contains 462 mg of heart-healthy cyclooxygenase, which is produced in the body in two raised organically, and, in any case, it never has hor- States, they found a similar protective effect.
17
potassium, the same amount in a medium banana. forms called COX-1 and COX-2. COX-2 is used for mones, steroids, or antibiotics. If you eat meat, grass- Individuals who ate more than five servings a day of
Both of us have been buying our salmon from a signaling pain and inflammation. fed is the only way to go. vegetables and fruits had a roughly 20 percent lower
wonderful company called Vital Choice for many The popularity of arthritis drugs such as Vioxx Fast Action Plan: Eat only grass-fed meat when risk of coronary heart disease,22 and a similar reduc-
years. Vital Choice is run by third-generation Alaskan and Celebrex was based on their unique ability to you eat meat. tion in the risk of stroke.23
fishermen who are scrupulous about using sustain- block the pain and inflammation messages of COX-2
THE “EAT THIS!” LIST able fishing and equally scrupulous about testing while leaving the non-inflammatory COX-1 alone. Eat This: Vegetables (and Some Fruit)
Both of us are frequently interviewed about the best their fish thoroughly for contaminants and metals. Unfortunately, there were some really unpleasant side No matter what kind of diet you’re on—from vegan to
foods for health. Virtually every reporter either of us They ship in dry ice, and they have the best fish we’ve effects associated with Vioxx, and it was taken off the Atkins—you can probably benefit from eating more
has ever spoken with winds up asking, “How much of ever tasted. market. But anthocyanins produce a similar effect vegetables than you already do. The entire vegetable
this food do you need to eat to get its benefits?” It’s Fast Action Plan: Eat wild salmon twice a week. with none of the problems of such drugs. Cherries kingdom is loaded with natural anti-inflammatories,
a reasonable question, but there’s almost never a (along with raspberries) have the highest yields of antioxidants, and other plant compounds, such as
perfect answer. We know of no study, for example, Eat This: Berries pure anthocyanins. In one study, the COX inhibitory flavonoids, that are good for your heart.
that has systematically tested the effects of eating All berries are loaded with natural anti-inflammatory activity of anthocyanins from cherries was compara- In two long-running Harvard-based research proj-
five portions of blueberries a week as opposed to properties and natural antioxidants. They’re also very ble to that of ibuprofen and naproxen. Researchers ects, the Nurses’ Health Study and the Health
three, or compared eating two portions of salmon per low in sugar. Blueberries contain a beneficial feel that in addition to helping with pain and inflam- Professionals Follow-up Study, the higher the average
week with eating it daily. Our recommendation is to compound called pterostilbene, which helps prevent mation, consuming anthocyanins on a regular basis daily consumption of vegetables and fruits, the lower
put these foods in heavy rotation in your diet, the deposit of plaque in the arteries and also helps may help lower heart attack and stroke risk. the chances of developing cardiovascular disease.
enjoying them as frequently as you like. prevent some of the damage caused by oxidized Fast Action Plan: Eat cherries two (or more) Compared with those in the lowest category of fruit
18
Here are the foods you want to include in your cholesterol. Raspberries and strawberries contain times a week. and vegetable intake (fewer than one and a half serv-
diet on a regular basis. another substance, ellagic acid, which offers similar ings daily), those averaging eight or more servings
19
protection against oxidized LDL. And all berries— Eat This: Grass-Fed Beef per day were a whopping 30 percent less likely to
Eat This: Wild Alaskan Salmon blueberries, raspberries, strawberries, and others— We’re not anti-meat guys, but we are very much have had a heart attack or stroke.20
Salmon is one of the best sources of anti- contain anthocyanins, plant compounds that help against factory-farmed meat. The majority of the Although all vegetables and fruits probably con-
inflammatory omega-3s. But not all salmon is created lower inflammation (see “Cherries” below). meat we consume, unfortunately, is feedlot-raised tributed to this stunning effect, the researchers felt
equal. Wild Alaskan salmon is far superior to the Fast Action Plan: Eat berries three (or more) meat from factory farms. It’s loaded with antibiotics, that the most outstanding contributors were the
farm-raised variety. (According to independent lab times a week. steroids, and hormones; it’s very high in inflammatory green, leafy veggies (such as spinach and Swiss
tests by the Environmental Working Group, seven out omega-6 fats; and it contains virtually no anti- chard) and the cruciferous ones (broccoli, Brussels
of ten farmed salmon purchased at grocery stores Eat This: Cherries inflammatory omega-3s. sprouts, kale, cabbage, and cauliflower). (In the fruit
were contaminated with polychlorinated biphenyls Cherries and cherry juice have long been known to be Grass-fed meat is a whole different “animal.” department, citrus fruits such as oranges, lemons,
[PCBs] at levels high enough to raise health effective against the pain of gout, and scientists (Okay, bad pun, sorry, we couldn’t resist.) Raised on limes, and grapefruit were particularly protective.21)
concerns.) Wild salmon is far cleaner, and it has the believe that the compounds in cherries responsible pasture, it contains less omega-6s plus a fair amount When researchers took the Harvard studies men-
added benefit of containing one of the most powerful for this are anthocyanins. Anthocyanins act like of omega-3s, resulting in a much better omega- tioned above and combined them with several other
antioxidants on the planet, astaxanthin. A 4-ounce natural COX-2 inhibitors. “COX” stands for 6:omega-3 ratio. Grass-fed meat is almost always long-term studies both in Europe and the United
serving also contains 462 mg of heart-healthy cyclooxygenase, which is produced in the body in two raised organically, and, in any case, it never has hor- States, they found a similar protective effect.
17
potassium, the same amount in a medium banana. forms called COX-1 and COX-2. COX-2 is used for mones, steroids, or antibiotics. If you eat meat, grass- Individuals who ate more than five servings a day of
Both of us have been buying our salmon from a signaling pain and inflammation. fed is the only way to go. vegetables and fruits had a roughly 20 percent lower
wonderful company called Vital Choice for many The popularity of arthritis drugs such as Vioxx Fast Action Plan: Eat only grass-fed meat when risk of coronary heart disease,22 and a similar reduc-
years. Vital Choice is run by third-generation Alaskan and Celebrex was based on their unique ability to you eat meat. tion in the risk of stroke.23
fishermen who are scrupulous about using sustain- block the pain and inflammation messages of COX-2
Study (22,000 men) and the Adventist Health Study beans as having the highest antioxidant capacity per
(more than 40,000 people), have demonstrated a link serving size of any food tested. In fact, of the four
FIGHT HEART DISEASE WITH FOOD 27
between nut eating and a reduction in heart disease. top-scoring foods, three were beans (red beans, red
In a fascinating and much-discussed article that appeared in the December 16, 2004, issue of
Just keep portions reasonable—an ounce or so a day kidney beans, and pinto beans). Many bean varieties
the British Medical Journal, researchers put forth an idea called the polymeal. They examined
is great. have a lot of folic acid (especially adzuki beans, len-
all of the research on foods and health to see whether they could put together the ideal meal
Fast Action Plan: Eat 1 ounce of nuts five times tils, black-eyed peas, and pinto beans). Folic acid is
(the polymeal) that, if you ate it every day, would significantly reduce your risk for
a week. one of the key players in bringing down the inflamma-
cardiovascular disease. They came up with a theoretical meal that, eaten daily, would reduce
tory compound homocysteine, itself a risk factor for
cardiovascular risk by a staggering 75 percent (there’s not a pill in the world that can do that!).
Eat This: Beans heart disease.
The ingredients of the polymeal? Wine, fish, almonds, garlic, fruits, vegetables, and dark
Fact number one: Fiber is good. (High-fiber diets have Fast Action Plan: Eat a serving of beans or len-
chocolate.
been associated with lower rates of a host of tils at least four times a week. (One serving is 1⁄2 cup
One of the many reasons for the protective effect of nuts may be an amino acid named
diseases, including heart disease.) Fact number two: to 1 cup cooked beans.)
arginine. Remember our earlier discussion about the endothelium (the inner lining of the
We don’t get enough of it. (Most health organizations
arterial walls)? Arginine has a role in protecting this inner lining, making the arterial walls
recommend a daily intake of 25 to 38 g daily; the Eat This: Dark Chocolate
more pliable and less susceptible to atherogenesis. Arginine is needed to make an important
average American gets 11 g.) Fact number three: Study after study is confirming that plant chemicals
molecule called nitric oxide, which helps relax constricted blood vessels and ease blood flow.25
Beans are a fiber heavyweight. Case closed. in cocoa-rich dark chocolate called flavanols can lower
Regarding heart disease, the big selling point of blood pressure and reduce inflammation. A 2011 study
28
beans used to be that they lowered cholesterol. in the British Medical Journal found that high levels
The reason we’re not as over-the-top enthusiastic heart attacks or die from heart disease than those That’s definitely true, but, as you’ve learned, it’s not of chocolate consumption are associated with a one-
about fruit is that despite its terrific benefits, it still who don’t. Five large studies—the Adventist Health nearly as important as whether they actually lower third reduction in the risk of developing heart disease.
contains sugar, which can be a problem for many Study, the Iowa Women’s Health Study, the Nurses’ heart disease. And they do. One study found that one The highest levels of chocolate consumption were
folks. For the large number of people whose blood Health Study, the Physicians’ Health Study, and the serving of beans on a daily basis lowered the risk of a associated with a 37 percent reduction in
29
sugar rises when they merely look at a candy bar, CARE Study—have all found a consistent 30 to 50 heart attack by an eyebrow-raising 38 percent! cardiovascular disease and a 29 percent reduction in
unlimited fruit is a bad idea. Low-sugar fruits (such as percent lower risk of heart attacks or heart disease Another study found that individuals eating beans stroke when compared to the lowest levels.31
apples, grapefruit, cherries, berries, and oranges) are associated with eating nuts several times a week.24 and legumes at least four times a week had a 22 per- Flavanol-rich cocoa lowers blood pressure.32 And
fine in moderation. Vegetables, on the other hand, In addition, nuts are a great source of numerous cent lower risk of heart disease than individuals con- the Zutphen Elderly Study of 470 elderly men found
30
can be virtually unlimited. phytonutrients—bioactive chemicals found in plants. suming beans/legumes less than once a week. that those who ate the most cocoa had literally half
Fast Action Plan: Eat five to nine half-cup serv- These compounds have powerful health benefits, not One study found that one serving of beans on the risk of dying from heart disease than men who
ings of vegetables and fruit a day. the least of which is their antioxidant activity, which a daily basis lowered the risk of a heart attack by ate the least.33
is linked to the prevention of coronary heart disease. 38 percent. Now the thing about chocolate is that all the
Eat This: Nuts And if you’re worried about calories, consider this: In Their high fiber content alone would make beans good stuff is found in the cocoa that it’s made from,
Although an apple a day may indeed keep the doctor the Nurses’ Health Study out of Harvard, nut con- a top food for the heart, but beans offer a lot more so you really want high-cocoa chocolate. We’re not
26
away, the same can also be said of a handful of nuts. sumption was inversely related to weight gain. than fiber. The U.S. Department of Agriculture ranking talking about the candy bars you get at the 7-Eleven
People who eat nuts regularly are less likely to have Several large studies, including the Physicians’ Health of foods by antioxidant capacity lists small red dried here; we’re talking about a cocoa-rich chocolate that
Study (22,000 men) and the Adventist Health Study beans as having the highest antioxidant capacity per
(more than 40,000 people), have demonstrated a link serving size of any food tested. In fact, of the four
FIGHT HEART DISEASE WITH FOOD 27
between nut eating and a reduction in heart disease. top-scoring foods, three were beans (red beans, red
In a fascinating and much-discussed article that appeared in the December 16, 2004, issue of
Just keep portions reasonable—an ounce or so a day kidney beans, and pinto beans). Many bean varieties
the British Medical Journal, researchers put forth an idea called the polymeal. They examined
is great. have a lot of folic acid (especially adzuki beans, len-
all of the research on foods and health to see whether they could put together the ideal meal
Fast Action Plan: Eat 1 ounce of nuts five times tils, black-eyed peas, and pinto beans). Folic acid is
(the polymeal) that, if you ate it every day, would significantly reduce your risk for
a week. one of the key players in bringing down the inflamma-
cardiovascular disease. They came up with a theoretical meal that, eaten daily, would reduce
tory compound homocysteine, itself a risk factor for
cardiovascular risk by a staggering 75 percent (there’s not a pill in the world that can do that!).
Eat This: Beans heart disease.
The ingredients of the polymeal? Wine, fish, almonds, garlic, fruits, vegetables, and dark
Fact number one: Fiber is good. (High-fiber diets have Fast Action Plan: Eat a serving of beans or len-
chocolate.
been associated with lower rates of a host of tils at least four times a week. (One serving is 1⁄2 cup
One of the many reasons for the protective effect of nuts may be an amino acid named
diseases, including heart disease.) Fact number two: to 1 cup cooked beans.)
arginine. Remember our earlier discussion about the endothelium (the inner lining of the
We don’t get enough of it. (Most health organizations
arterial walls)? Arginine has a role in protecting this inner lining, making the arterial walls
recommend a daily intake of 25 to 38 g daily; the Eat This: Dark Chocolate
more pliable and less susceptible to atherogenesis. Arginine is needed to make an important
average American gets 11 g.) Fact number three: Study after study is confirming that plant chemicals
molecule called nitric oxide, which helps relax constricted blood vessels and ease blood flow.25
Beans are a fiber heavyweight. Case closed. in cocoa-rich dark chocolate called flavanols can lower
Regarding heart disease, the big selling point of blood pressure and reduce inflammation. A 2011 study
28
beans used to be that they lowered cholesterol. in the British Medical Journal found that high levels
The reason we’re not as over-the-top enthusiastic heart attacks or die from heart disease than those That’s definitely true, but, as you’ve learned, it’s not of chocolate consumption are associated with a one-
about fruit is that despite its terrific benefits, it still who don’t. Five large studies—the Adventist Health nearly as important as whether they actually lower third reduction in the risk of developing heart disease.
contains sugar, which can be a problem for many Study, the Iowa Women’s Health Study, the Nurses’ heart disease. And they do. One study found that one The highest levels of chocolate consumption were
folks. For the large number of people whose blood Health Study, the Physicians’ Health Study, and the serving of beans on a daily basis lowered the risk of a associated with a 37 percent reduction in
29
sugar rises when they merely look at a candy bar, CARE Study—have all found a consistent 30 to 50 heart attack by an eyebrow-raising 38 percent! cardiovascular disease and a 29 percent reduction in
unlimited fruit is a bad idea. Low-sugar fruits (such as percent lower risk of heart attacks or heart disease Another study found that individuals eating beans stroke when compared to the lowest levels.31
apples, grapefruit, cherries, berries, and oranges) are associated with eating nuts several times a week.24 and legumes at least four times a week had a 22 per- Flavanol-rich cocoa lowers blood pressure.32 And
fine in moderation. Vegetables, on the other hand, In addition, nuts are a great source of numerous cent lower risk of heart disease than individuals con- the Zutphen Elderly Study of 470 elderly men found
30
can be virtually unlimited. phytonutrients—bioactive chemicals found in plants. suming beans/legumes less than once a week. that those who ate the most cocoa had literally half
Fast Action Plan: Eat five to nine half-cup serv- These compounds have powerful health benefits, not One study found that one serving of beans on the risk of dying from heart disease than men who
ings of vegetables and fruit a day. the least of which is their antioxidant activity, which a daily basis lowered the risk of a heart attack by ate the least.33
is linked to the prevention of coronary heart disease. 38 percent. Now the thing about chocolate is that all the
Eat This: Nuts And if you’re worried about calories, consider this: In Their high fiber content alone would make beans good stuff is found in the cocoa that it’s made from,
Although an apple a day may indeed keep the doctor the Nurses’ Health Study out of Harvard, nut con- a top food for the heart, but beans offer a lot more so you really want high-cocoa chocolate. We’re not
26
away, the same can also be said of a handful of nuts. sumption was inversely related to weight gain. than fiber. The U.S. Department of Agriculture ranking talking about the candy bars you get at the 7-Eleven
People who eat nuts regularly are less likely to have Several large studies, including the Physicians’ Health of foods by antioxidant capacity lists small red dried here; we’re talking about a cocoa-rich chocolate that
contains all the flavanols that have been found to be Eat This: Pomegranate Juice Eat This: Red Wine quently forgotten that they also have the highest
so healthy. White chocolate and milk chocolate have Pomegranate juice is one of the few “trendy” health For years, it was believed that the reason the French rates of liver cirrhosis!) The key to enjoying wine’s
hardly any flavanols to speak of, so it’s got to be dark. foods that actually lives up to its hype. Researchers at could “get away” with eating high-fat foods—while beneficial effects is moderate consumption, defined
Many dark chocolate bars will now tell you their cocoa the Technion-Israel Institute of Technology in Haifa still having remarkably lower rates of heart disease as about two glasses a day for men and about one a
content in percentage form—look for at least 60 per- suggest that long-term consumption of pomegranate than Americans—was because of their regular day for women, about three to four times a week.
cent cocoa. (The higher the cocoa content, the less juice may help slow aging and protect against heart consumption of red wine, which contains numerous Also worth mentioning is that alcohol increases the
sweet the bar.) disease. compounds that protect the heart. Chief among risk for breast cancer in women who aren’t consum-
You’ll also find that this kind of chocolate is easy In a study published in the American Journal of these is resveratrol, a polyphenol (plant compound) ing enough folic acid, so make sure you’re getting at
to eat in small quantities—it’s not so sweet that it Cardiology, forty-five patients with heart disease that’s found in the skins of dark grapes and is highly least 400 mg of folic acid a day through food or
causes you to crave more and more of it, and it’s easy drank either 8 ounces of pomegranate juice or 8 concentrated in red wine. Resveratrol is a potent supplementation.
to be satisfied with just a square or two, which is all ounces of a placebo drink for three months. The antioxidant that can prevent harmful elements in the Fast Action Plan: If you are a drinker, have a
you need for the health benefits. pomegranate juice drinkers had significantly less oxy- body from attacking healthy cells. Red wine has glass of red wine with dinner. (If you’re not, don’t
Fast Action Plan: Eat one to two squares of dark gen deficiency to the heart during exercise, suggest- been shown to be cardio-protective in quite a start!)
37
chocolate four to six days a week. ing that they had increased blood flow to the heart. number of studies.
Pomegranate juice has the ability to inhibit the And resveratrol isn’t the only reason. Other com- Eat This: Green Tea
Eat This: Turmeric oxidation of LDL cholesterol. 34
(Remember that LDL pounds in red wine such as flavonoids inhibit the oxi- Apart from water, tea is probably the most consumed
Turmeric is the spice that makes curries yellow. It cholesterol is only a problem when it’s oxidized!) And dation of LDL cholesterol, which is pretty darn beverage in the world, and it’s also one of the
occupies a place of distinction in both Ayurvedic and an impressive number of studies have demonstrated a important because oxidized LDL cholesterol initiates healthiest. That’s because it’s absolutely loaded with
38
Chinese medicine, largely because of its phenomenal beneficial effect of pomegranate juice on cardiovascu- and intensifies the inflammatory process. Red wine protective plant-based chemicals known as
anti-inflammatory properties. (It also has anticancer lar health, including one that showed 30 percent also limits the tendency of compounds in the blood polyphenols. Green tea in particular has gotten a ton
35 39
activity and is very helpful for the liver.) The active reduced arterial plaque. Pomegranate juice also to clot and increases HDL cholesterol to boot. of attention in the media, largely for the anticancer
ingredients in turmeric are a group of plant enhances the activity of nitric oxide, a molecule Interestingly, in one study, moderate consumption of action of one of its compounds, epigallocatechin
36
compounds called curcuminoids (collectively known as essential for cardiovascular health. red wine was associated with lower levels of three gallate (EGCG).
curcumin). In addition to being anti-inflammatory, One caution: Avoid “juice blends” and “juice cock- markers we told you about earlier: CRP, fibrinogen, But green tea also contributes to cardiovascular
curcumin is a powerful antioxidant. Because oxidized tails,” because these have much less pomegranate and interleukin-6.50 It’s hard to think of a more health. Although much has been written about its
LDL is a big player in the cascade that leads to juice in them and much more sugar. We like pure heart-healthy drink. cholesterol-lowering effect, we find it much more
inflammation and heart disease, turmeric’s pomegranate juices such as Just Pomegranate, which Worth noting: The dark side of alcohol is well interesting that green tea lowers fibrinogen, a sub-
antioxidant properties are a big benefit. are admittedly expensive but contain absolutely noth- known, and we don’t have to recount it here. If you’re stance in the body that can cause clots and strokes.
Fast Action Plan: Put turmeric at the front of ing but pure pomegranate juice. Another popular not a drinker, please don’t start because of the bene- In an article in the journal Circulation titled “Effects
your spice cabinet and use it often. It goes well on brand we like a lot is Pom Wonderful. fits of red wine. Not everyone can handle alcohol, and of Green Tea Intake on the Development of Coronary
veggies, eggs, sautéed dishes, meats, fish, and Fast Action Plan: Put pomegranate juice in if you suspect you’re someone who doesn’t do well Artery Disease,” researchers from the department of
poultry. “heavy rotation” on your menu: 4 to 8 ounces a day, with it, for goodness’ sake, don’t drink it! (With all the medicine at Chiba Hokusoh Hospital, Nippon Medical
or as often as you like. talk about how the wine-drinking French have the low- School, Chiba, Japan, concluded that “the more green
est rates of heart disease in Western Europe, it’s fre- tea patients consume, the less likely they are to have
contains all the flavanols that have been found to be Eat This: Pomegranate Juice Eat This: Red Wine quently forgotten that they also have the highest
so healthy. White chocolate and milk chocolate have Pomegranate juice is one of the few “trendy” health For years, it was believed that the reason the French rates of liver cirrhosis!) The key to enjoying wine’s
hardly any flavanols to speak of, so it’s got to be dark. foods that actually lives up to its hype. Researchers at could “get away” with eating high-fat foods—while beneficial effects is moderate consumption, defined
Many dark chocolate bars will now tell you their cocoa the Technion-Israel Institute of Technology in Haifa still having remarkably lower rates of heart disease as about two glasses a day for men and about one a
content in percentage form—look for at least 60 per- suggest that long-term consumption of pomegranate than Americans—was because of their regular day for women, about three to four times a week.
cent cocoa. (The higher the cocoa content, the less juice may help slow aging and protect against heart consumption of red wine, which contains numerous Also worth mentioning is that alcohol increases the
sweet the bar.) disease. compounds that protect the heart. Chief among risk for breast cancer in women who aren’t consum-
You’ll also find that this kind of chocolate is easy In a study published in the American Journal of these is resveratrol, a polyphenol (plant compound) ing enough folic acid, so make sure you’re getting at
to eat in small quantities—it’s not so sweet that it Cardiology, forty-five patients with heart disease that’s found in the skins of dark grapes and is highly least 400 mg of folic acid a day through food or
causes you to crave more and more of it, and it’s easy drank either 8 ounces of pomegranate juice or 8 concentrated in red wine. Resveratrol is a potent supplementation.
to be satisfied with just a square or two, which is all ounces of a placebo drink for three months. The antioxidant that can prevent harmful elements in the Fast Action Plan: If you are a drinker, have a
you need for the health benefits. pomegranate juice drinkers had significantly less oxy- body from attacking healthy cells. Red wine has glass of red wine with dinner. (If you’re not, don’t
Fast Action Plan: Eat one to two squares of dark gen deficiency to the heart during exercise, suggest- been shown to be cardio-protective in quite a start!)
37
chocolate four to six days a week. ing that they had increased blood flow to the heart. number of studies.
Pomegranate juice has the ability to inhibit the And resveratrol isn’t the only reason. Other com- Eat This: Green Tea
Eat This: Turmeric oxidation of LDL cholesterol. 34
(Remember that LDL pounds in red wine such as flavonoids inhibit the oxi- Apart from water, tea is probably the most consumed
Turmeric is the spice that makes curries yellow. It cholesterol is only a problem when it’s oxidized!) And dation of LDL cholesterol, which is pretty darn beverage in the world, and it’s also one of the
occupies a place of distinction in both Ayurvedic and an impressive number of studies have demonstrated a important because oxidized LDL cholesterol initiates healthiest. That’s because it’s absolutely loaded with
38
Chinese medicine, largely because of its phenomenal beneficial effect of pomegranate juice on cardiovascu- and intensifies the inflammatory process. Red wine protective plant-based chemicals known as
anti-inflammatory properties. (It also has anticancer lar health, including one that showed 30 percent also limits the tendency of compounds in the blood polyphenols. Green tea in particular has gotten a ton
35 39
activity and is very helpful for the liver.) The active reduced arterial plaque. Pomegranate juice also to clot and increases HDL cholesterol to boot. of attention in the media, largely for the anticancer
ingredients in turmeric are a group of plant enhances the activity of nitric oxide, a molecule Interestingly, in one study, moderate consumption of action of one of its compounds, epigallocatechin
36
compounds called curcuminoids (collectively known as essential for cardiovascular health. red wine was associated with lower levels of three gallate (EGCG).
curcumin). In addition to being anti-inflammatory, One caution: Avoid “juice blends” and “juice cock- markers we told you about earlier: CRP, fibrinogen, But green tea also contributes to cardiovascular
curcumin is a powerful antioxidant. Because oxidized tails,” because these have much less pomegranate and interleukin-6.50 It’s hard to think of a more health. Although much has been written about its
LDL is a big player in the cascade that leads to juice in them and much more sugar. We like pure heart-healthy drink. cholesterol-lowering effect, we find it much more
inflammation and heart disease, turmeric’s pomegranate juices such as Just Pomegranate, which Worth noting: The dark side of alcohol is well interesting that green tea lowers fibrinogen, a sub-
antioxidant properties are a big benefit. are admittedly expensive but contain absolutely noth- known, and we don’t have to recount it here. If you’re stance in the body that can cause clots and strokes.
Fast Action Plan: Put turmeric at the front of ing but pure pomegranate juice. Another popular not a drinker, please don’t start because of the bene- In an article in the journal Circulation titled “Effects
your spice cabinet and use it often. It goes well on brand we like a lot is Pom Wonderful. fits of red wine. Not everyone can handle alcohol, and of Green Tea Intake on the Development of Coronary
veggies, eggs, sautéed dishes, meats, fish, and Fast Action Plan: Put pomegranate juice in if you suspect you’re someone who doesn’t do well Artery Disease,” researchers from the department of
poultry. “heavy rotation” on your menu: 4 to 8 ounces a day, with it, for goodness’ sake, don’t drink it! (With all the medicine at Chiba Hokusoh Hospital, Nippon Medical
or as often as you like. talk about how the wine-drinking French have the low- School, Chiba, Japan, concluded that “the more green
est rates of heart disease in Western Europe, it’s fre- tea patients consume, the less likely they are to have
coronary artery disease.”40 as one of the healthiest fats for the heart. refined and have questionable benefits. That’s why antimicrobial, and antiviral properties. Garlic has
Worth knowing: Just because green tea gets the Research in the Archives of Internal Medicine you want “extra-virgin” olive oil, which is the least been shown to lower triglyceride levels. It can also
lion’s share of attention from health writers doesn’t concluded that greater adherence to the traditional processed, the most like what you’d get if you walked reduce plaque, making it a powerful agent for
mean there’s not great stuff in other teas, such as Mediterranean Diet (including plenty of olive oil and around barefoot in barrels of olives. It’s made without cardiovascular health.
black, oolong, white, and yerba matte. At Boston other monounsaturated fats such as nuts and avoca- the use of heat, hot water, or solvents, and it is left In one study, subjects receiving 900 mg of garlic
University’s School of Medicine, Joseph Vita, M.D., dos) was associated with significant reduction in mor- unfiltered. The first pressing produces the best stuff, powder for four years in a randomized, double-
conducted a study in which sixty-six men either drank tality among people who had been diagnosed with known as “extra-virgin," but virgin isn’t bad either. blinded, placebo-controlled study had a regression in
43
four cups of black tea a day or took a placebo. The heart disease. Once you begin machine harvesting and process- their plaque volume of 2.6 percent; meanwhile, a
researchers showed that drinking black tea can help Another study in the same journal compared two ing with very high heat, you start damaging the deli- matched group of subjects given a placebo (an inert
44
reverse an abnormal functioning of blood vessels that groups of people with high blood pressure. One cate compounds in olive oil responsible for all those substance) saw their plaque increase over the same
can contribute to stroke or heart attack. Best of all, group was given sunflower oil, a typical high omega-6 great health benefits. The antioxidant and anti-inflam- time period by 15.6 percent!46
improvement in the functioning of the blood vessels oil used in Western diets, and one group was given matory polyphenols are water soluble and can be One of the active ingredients in garlic—allicin—also
was visible within two hours of drinking just one cup the good stuff: extra-virgin olive oil. The olive oil washed away with factory processing. That’s one rea- has significant antiplatelet activity. That means it
41
of black tea! decreased the second group’s blood pressure by a sig- son that factory-produced olive oil has a shorter shelf helps prevent platelets in the blood from sticking
“What we found was that if you take a group of nificant amount; it also decreased their need for life—no antioxidants to protect it. Real olive oil—the together. To understand just how important that is,
people with heart disease who have abnormal blood blood pressure meds by a whopping 48 percent. As extra-virgin kind, made with care and love and the consider that many heart attacks and strokes are
vessel function to begin with and asked them to drink the English might say, “Not too shabby.” absence of high heat and harsh chemicals—lasts for caused by spontaneous clots in the blood vessels.
42
tea, their blood vessels improved,” said Vita. Like red wine and green tea, olive oil contains years. Dr. Sinatra feels so strongly about the healing The anticoagulant effect of garlic is an important
Fast Action Plan: Remember, any form of tea polyphenols that are anti-inflammatory and act as powers of olive oil that he invested in a company that health benefit.
contains caffeine, so drink in moderation. Make a big powerful antioxidants. (Researchers have isolated one makes superb, authentic (and delicious) extra-virgin Worth knowing: The preparation of garlic is criti-
pitcher of green tea and keep it in the fridge. Drink it in particular, oleocanthal, which acts similarly to ibu- olive oil. It’s called Vervana. Vervana is true extra- cal for it to release its health-providing benefits. If for
45
in the earlier part of the day, up to two glasses. profen. ) Because so many of these polyphenols have virgin olive oil—not a blend, like many imposters—and is any reason you had the impulse to swallow a garlic
significant health benefits, some people believe that one of the finest (and best-tasting) olive oils either of clove whole, not much would happen. The garlic clove
Eat This: Olive Oil the fat in olive oil may not be the only reason olive oil us has ever had! You can find links to the company on has to be crushed or chopped—the more finely the
Olive oil is the primary fat used in the Mediterranean is so darn healthy. They think that the main health both our websites. And it’s reasonably priced to boot! better—for the compounds in it to mix together to cre-
area and the one most associated with what’s been benefits of olive oil come from the fact that it is a Fast Action Plan: Switch to extra-virgin olive oil. ate allicin, the active ingredient responsible for the
called the Mediterranean Diet. (As we said earlier, delivery system for these powerful polyphenols. Use it for salad dressing, low-heat stir-fries, and sautées. health benefits. Allicin starts degrading immediately
there’s no single “Mediterranean Diet,” but all Either way, the stuff is great, and you should make it after it’s produced, so the fresher it is when you use
variations of it contain high amounts of fish, fruits, a part of your heart-healthy diet. Eat This: Garlic it, the better. (Microwaving destroys it completely.)
vegetables, nuts, wine, and olive oil.) There are Worth knowing: All olive oil is not created equal. Garlic is a global remedy. More than 1,200 (and Garlic experts advise crushing a little raw garlic and
countless studies on the Mediterranean Diet and Unfortunately, commercial manufacturers, trying to counting) pharmacological studies have been done combining it with cooked food. If you add it to food
heart health and virtually all of them show enormous ride the health hype on olive oil, have rushed to mar- on garlic, and the findings are pretty impressive. In you’re sautéing, do it toward the end so the allicin
benefits for the heart and the brain. These studies ket all kinds of imitation and inferior products that addition to lowering lipids and preventing blood is freshest.
have left olive oil with an unimpeachable reputation say “olive oil” on them but are highly processed and coagulation, it has antihypertensive, antioxidant, Fast Action Plan: Start cooking with garlic.
coronary artery disease.”40 as one of the healthiest fats for the heart. refined and have questionable benefits. That’s why antimicrobial, and antiviral properties. Garlic has
Worth knowing: Just because green tea gets the Research in the Archives of Internal Medicine you want “extra-virgin” olive oil, which is the least been shown to lower triglyceride levels. It can also
lion’s share of attention from health writers doesn’t concluded that greater adherence to the traditional processed, the most like what you’d get if you walked reduce plaque, making it a powerful agent for
mean there’s not great stuff in other teas, such as Mediterranean Diet (including plenty of olive oil and around barefoot in barrels of olives. It’s made without cardiovascular health.
black, oolong, white, and yerba matte. At Boston other monounsaturated fats such as nuts and avoca- the use of heat, hot water, or solvents, and it is left In one study, subjects receiving 900 mg of garlic
University’s School of Medicine, Joseph Vita, M.D., dos) was associated with significant reduction in mor- unfiltered. The first pressing produces the best stuff, powder for four years in a randomized, double-
conducted a study in which sixty-six men either drank tality among people who had been diagnosed with known as “extra-virgin," but virgin isn’t bad either. blinded, placebo-controlled study had a regression in
43
four cups of black tea a day or took a placebo. The heart disease. Once you begin machine harvesting and process- their plaque volume of 2.6 percent; meanwhile, a
researchers showed that drinking black tea can help Another study in the same journal compared two ing with very high heat, you start damaging the deli- matched group of subjects given a placebo (an inert
44
reverse an abnormal functioning of blood vessels that groups of people with high blood pressure. One cate compounds in olive oil responsible for all those substance) saw their plaque increase over the same
can contribute to stroke or heart attack. Best of all, group was given sunflower oil, a typical high omega-6 great health benefits. The antioxidant and anti-inflam- time period by 15.6 percent!46
improvement in the functioning of the blood vessels oil used in Western diets, and one group was given matory polyphenols are water soluble and can be One of the active ingredients in garlic—allicin—also
was visible within two hours of drinking just one cup the good stuff: extra-virgin olive oil. The olive oil washed away with factory processing. That’s one rea- has significant antiplatelet activity. That means it
41
of black tea! decreased the second group’s blood pressure by a sig- son that factory-produced olive oil has a shorter shelf helps prevent platelets in the blood from sticking
“What we found was that if you take a group of nificant amount; it also decreased their need for life—no antioxidants to protect it. Real olive oil—the together. To understand just how important that is,
people with heart disease who have abnormal blood blood pressure meds by a whopping 48 percent. As extra-virgin kind, made with care and love and the consider that many heart attacks and strokes are
vessel function to begin with and asked them to drink the English might say, “Not too shabby.” absence of high heat and harsh chemicals—lasts for caused by spontaneous clots in the blood vessels.
42
tea, their blood vessels improved,” said Vita. Like red wine and green tea, olive oil contains years. Dr. Sinatra feels so strongly about the healing The anticoagulant effect of garlic is an important
Fast Action Plan: Remember, any form of tea polyphenols that are anti-inflammatory and act as powers of olive oil that he invested in a company that health benefit.
contains caffeine, so drink in moderation. Make a big powerful antioxidants. (Researchers have isolated one makes superb, authentic (and delicious) extra-virgin Worth knowing: The preparation of garlic is criti-
pitcher of green tea and keep it in the fridge. Drink it in particular, oleocanthal, which acts similarly to ibu- olive oil. It’s called Vervana. Vervana is true extra- cal for it to release its health-providing benefits. If for
45
in the earlier part of the day, up to two glasses. profen. ) Because so many of these polyphenols have virgin olive oil—not a blend, like many imposters—and is any reason you had the impulse to swallow a garlic
significant health benefits, some people believe that one of the finest (and best-tasting) olive oils either of clove whole, not much would happen. The garlic clove
Eat This: Olive Oil the fat in olive oil may not be the only reason olive oil us has ever had! You can find links to the company on has to be crushed or chopped—the more finely the
Olive oil is the primary fat used in the Mediterranean is so darn healthy. They think that the main health both our websites. And it’s reasonably priced to boot! better—for the compounds in it to mix together to cre-
area and the one most associated with what’s been benefits of olive oil come from the fact that it is a Fast Action Plan: Switch to extra-virgin olive oil. ate allicin, the active ingredient responsible for the
called the Mediterranean Diet. (As we said earlier, delivery system for these powerful polyphenols. Use it for salad dressing, low-heat stir-fries, and sautées. health benefits. Allicin starts degrading immediately
there’s no single “Mediterranean Diet,” but all Either way, the stuff is great, and you should make it after it’s produced, so the fresher it is when you use
variations of it contain high amounts of fish, fruits, a part of your heart-healthy diet. Eat This: Garlic it, the better. (Microwaving destroys it completely.)
vegetables, nuts, wine, and olive oil.) There are Worth knowing: All olive oil is not created equal. Garlic is a global remedy. More than 1,200 (and Garlic experts advise crushing a little raw garlic and
countless studies on the Mediterranean Diet and Unfortunately, commercial manufacturers, trying to counting) pharmacological studies have been done combining it with cooked food. If you add it to food
heart health and virtually all of them show enormous ride the health hype on olive oil, have rushed to mar- on garlic, and the findings are pretty impressive. In you’re sautéing, do it toward the end so the allicin
benefits for the heart and the brain. These studies ket all kinds of imitation and inferior products that addition to lowering lipids and preventing blood is freshest.
have left olive oil with an unimpeachable reputation say “olive oil” on them but are highly processed and coagulation, it has antihypertensive, antioxidant, Fast Action Plan: Start cooking with garlic.
 WHAT YOU NEED TO KNOW CHAPTER 11
Eat Less of These
• Sugar
• Soda
HELP YOUR HEART WITH

• Processed carbs
• Trans fats
• Processed meats
• Excess vegetable oils THESE SUPPLEMENTS
Eat More of These
• Wild salmon
• Berries and cherries
• Grass-fed meat ASK YOUR TYPICAL DOCTOR ABOUT NUTRITIONAL SUPPLEMENTS and the first thing you’re
• Vegetables likely to hear is this: “There’s no good research showing they work.” Both of us have heard this refrain
• Nuts time and time again when we discuss nutritional medicine with our more conservative colleagues.
• Beans It’s not true.
• Dark chocolate You or your doctor can go online to the National Institute of Medicine’s library (www.pubmed.
• Garlic and turmeric com), enter into the search box the name of virtually any vitamin or herb you can think of, and,
• Pomegranate juice, green tea, depending on what you choose, hundreds to thousands of citations will pop up. So the problem isn’t
and red wine an absence of research.
• Extra-virgin olive oil The problem is twofold. One, the conventional training of medical doctors in this country is highly
biased toward pharmaceuticals. From the time they enter med school, doctors are courted by the
pharmaceutical companies in myriad ways, some subtle, some not so subtle. Free lunches, sympo-
siums, honorariums, consulting and lecturing contracts, vacations, perky pharmaceutical reps showing
up at offices with the latest studies that show their products in a favorable light, free samples, and
pens and prescription pads bearing the company’s name—all create a culture in which pharmaceuticals
are the first choice in any treatment plan. (Most docs will tell you these practices have no influence on
them or what they choose to prescribe, but the research tells a very different story.1)

 WHAT YOU NEED TO KNOW CHAPTER 11
Eat Less of These
• Sugar
• Soda
HELP YOUR HEART WITH

• Processed carbs
• Trans fats
• Processed meats
• Excess vegetable oils THESE SUPPLEMENTS
Eat More of These
• Wild salmon
• Berries and cherries
• Grass-fed meat ASK YOUR TYPICAL DOCTOR ABOUT NUTRITIONAL SUPPLEMENTS and the first thing you’re
• Vegetables likely to hear is this: “There’s no good research showing they work.” Both of us have heard this refrain
• Nuts time and time again when we discuss nutritional medicine with our more conservative colleagues.
• Beans It’s not true.
• Dark chocolate You or your doctor can go online to the National Institute of Medicine’s library (www.pubmed.
• Garlic and turmeric com), enter into the search box the name of virtually any vitamin or herb you can think of, and,
• Pomegranate juice, green tea, depending on what you choose, hundreds to thousands of citations will pop up. So the problem isn’t
and red wine an absence of research.
• Extra-virgin olive oil The problem is twofold. One, the conventional training of medical doctors in this country is highly
biased toward pharmaceuticals. From the time they enter med school, doctors are courted by the
pharmaceutical companies in myriad ways, some subtle, some not so subtle. Free lunches, sympo-
siums, honorariums, consulting and lecturing contracts, vacations, perky pharmaceutical reps showing
up at offices with the latest studies that show their products in a favorable light, free samples, and
pens and prescription pads bearing the company’s name—all create a culture in which pharmaceuticals
are the first choice in any treatment plan. (Most docs will tell you these practices have no influence on
them or what they choose to prescribe, but the research tells a very different story.1)

The second part of the problem is that much of The study concluded that they did not. The study was The supplements listed in this chapter are some COENZYME Q10: THE SPARK OF LIFE
the research on vitamins flies beneath the radar. Your widely reported, and the notion that omega-3s were of the superstars for heart health that Dr. Sinatra Coenzyme Q10 is a vitamin-like substance found
overworked doctor barely has time to scan the helpful for heart disease even wound up on the New uses in his practice (as he has for decades) and that throughout the body and made in every cell. Among
3
abstracts of the New England Journal of Medicine York Times list of “medical myths.” Dr. Jonny has recommended to clients and written the many important things it does, CoQ10 helps create
every month, let alone dig deeply into the hundreds But the study tested extremely sick people with about extensively in his books and columns. Neither energy from fuel (food) in the human body, just as a
of studies that are published every year on vitamins multiple risk factors for heart disease, and they used of us is saying you should just throw out your pre- spark plug creates energy from fuel (gasoline) in a car.
and nutrients in journals like the American Journal of a dose of omega-3 that no functional medicine doctor scriptions and start randomly taking vitamins. But we A CoQ10 deficiency affects your heart as pro-
Clinical Nutrition. The vast majority of doctors in this on earth would expect to do a damn thing for any but are saying that natural substances such as vitamins, foundly as a calcium deficiency would affect your
country get no training whatsoever in nutrition, and the healthiest people in the world. They used 1000 antioxidants, omega-3 fats, and many of the thou- bones. We create less of it as we age, making it all
those who do receive only the most rudimentary and mg of “fish oil” and didn’t specify how much of that sands of compounds found in foods may affect the the more important to supplement with CoQ10 as we
superficial introduction to the subject. Put this oil was EPA and DHA, the two omega-3s that you take health of the heart in an even more profound way grow older.
together with the built-in medical school bias in favor fish oil for in the first place. So the subjects likely got than many of the medicines routinely prescribed as Here’s how it works: Your body uses a molecule
of patent medicines, and it’s easy to see why doctors less than a gram of combined EPA and DHA, which is the first order of business. called adenosine triphosphate, or ATP, as a source of
often fail to think of natural substances as legitimate about ⁄3– ⁄2 the recommended dose. And the “pla-
1 1
Even if you’re already on medication, nutritional energy (which is why ATP is nicknamed “the energy
tools that can help keep people healthy. cebo” was olive oil, which has anti-inflammatory prop- supplements can still improve your health. In the case molecule”). Much like gasoline is the fuel that allows
The third part of the problem is that the proto- erties of its own and is hardly an inert substance—just of coenzyme Q10 (CoQ10), for example, supplementa- you to actually drive a car to any of a million destina-
cols that are suitable for testing pharmaceuticals are ask the PREDIMED investigators who reported that tion is an absolute must if you’re on a statin drug tions, ATP is the fuel that allows your body to per-
not always suited for vitamins and nutraceuticals. olive oil had remarkable medicinal and therapeutic (more on that in a moment). Magnesium is often used form any of a million activities, ranging from cellular
Many compounds—like flavonoids in apples—work syn- effects. (To our way of thinking, olive oil is the secret in conjunction with blood sugar drugs such as metabolism to doing bench presses to dancing the
ergistically and support and augment the impact of sauce in Mediterranean-type diets—it’s anything but a Metformin (Glucophage) or blood pressure medica- tango. The body makes ATP by stripping electrons—
the vitamins found in that food (like vitamin C in the “placebo.”) tions such as beta blockers. And virtually everyone tiny subatomic particles that carry a negative electri-
apple). An isolated nutrient rarely shows up in the Let’s be clear. Conventional medicine is simply needs a little help in reducing oxidation and inflam- cal charge—from food and then delivering those elec-
natural world, so testing isolated nutrients—separated terrific at keeping people alive in emergencies. Both mation, two of the most important drivers in the trons to oxygen, which is an electron receptor. CoQ10
from the nutrients they are normally found with in of us know that if we were to be in a car accident, we development of heart disease. Omega-3 fatty acids, is one of the carriers of these electrons, so it essen-
nature—may not reveal what these nutrients actually wouldn’t want the ambulance rushing us to the near- for example, can be used by just about anyone, tially helps the cells use oxygen and create more
can accomplish. est herbalist’s office. We’d want to go to the emer- whether he or she is on medication or not (check with energy. Bottom line: CoQ10 has the ability to increase
And the fourth problem is that medical research- gency room of the best hospital we could find. But as your doctor for any possible contraindications, such the body’s production of the energy molecule ATP,
ers are often so removed from the world of nutrition, good as conventional medicine is at treating people in as right before going into surgery). and this is a very good thing indeed.
or so biased against it, that they test nutrients in acute situations, it’s astonishingly bad at overall pre- The following list is far from exhaustive, but it will Just as a gasoline engine can’t work without
doses that no nutritionist would expect to “work.” In ventive care. It’s great at keeping your heart beating give you a good idea of how you can use supplements spark plugs, the human body can’t work without
the period between editions of this book, a highly if you’ve just had a heart attack. It’s not nearly as to keep your heart healthy, either alone or, in some CoQ10. It’s an essential component of the mitochon-
publicized randomized placebo-control trial was pub- good at keeping your heart healthy for the long run cases, as an adjunct to conventional therapy. dria, which is command central for the production of
lished in a reputable medical journal that purportedly and keeping you, the heart’s owner, out of the hospi- cellular energy (ATP). Not coincidentally, the heart is
2
“tested” the effect of omega-3s on heart disease. tal in the first place. one of the major organs where the most CoQ10 is
160 THE GREAT CHOLESTEROL MYTH HELP YOUR HEART WITH THESE SUPPLEMENTS 161
The second part of the problem is that much of The study concluded that they did not. The study was The supplements listed in this chapter are some COENZYME Q10: THE SPARK OF LIFE
the research on vitamins flies beneath the radar. Your widely reported, and the notion that omega-3s were of the superstars for heart health that Dr. Sinatra Coenzyme Q10 is a vitamin-like substance found
overworked doctor barely has time to scan the helpful for heart disease even wound up on the New uses in his practice (as he has for decades) and that throughout the body and made in every cell. Among
3
abstracts of the New England Journal of Medicine York Times list of “medical myths.” Dr. Jonny has recommended to clients and written the many important things it does, CoQ10 helps create
every month, let alone dig deeply into the hundreds But the study tested extremely sick people with about extensively in his books and columns. Neither energy from fuel (food) in the human body, just as a
of studies that are published every year on vitamins multiple risk factors for heart disease, and they used of us is saying you should just throw out your pre- spark plug creates energy from fuel (gasoline) in a car.
and nutrients in journals like the American Journal of a dose of omega-3 that no functional medicine doctor scriptions and start randomly taking vitamins. But we A CoQ10 deficiency affects your heart as pro-
Clinical Nutrition. The vast majority of doctors in this on earth would expect to do a damn thing for any but are saying that natural substances such as vitamins, foundly as a calcium deficiency would affect your
country get no training whatsoever in nutrition, and the healthiest people in the world. They used 1000 antioxidants, omega-3 fats, and many of the thou- bones. We create less of it as we age, making it all
those who do receive only the most rudimentary and mg of “fish oil” and didn’t specify how much of that sands of compounds found in foods may affect the the more important to supplement with CoQ10 as we
superficial introduction to the subject. Put this oil was EPA and DHA, the two omega-3s that you take health of the heart in an even more profound way grow older.
together with the built-in medical school bias in favor fish oil for in the first place. So the subjects likely got than many of the medicines routinely prescribed as Here’s how it works: Your body uses a molecule
of patent medicines, and it’s easy to see why doctors less than a gram of combined EPA and DHA, which is the first order of business. called adenosine triphosphate, or ATP, as a source of
often fail to think of natural substances as legitimate about ⁄3– ⁄2 the recommended dose. And the “pla-
1 1
Even if you’re already on medication, nutritional energy (which is why ATP is nicknamed “the energy
tools that can help keep people healthy. cebo” was olive oil, which has anti-inflammatory prop- supplements can still improve your health. In the case molecule”). Much like gasoline is the fuel that allows
The third part of the problem is that the proto- erties of its own and is hardly an inert substance—just of coenzyme Q10 (CoQ10), for example, supplementa- you to actually drive a car to any of a million destina-
cols that are suitable for testing pharmaceuticals are ask the PREDIMED investigators who reported that tion is an absolute must if you’re on a statin drug tions, ATP is the fuel that allows your body to per-
not always suited for vitamins and nutraceuticals. olive oil had remarkable medicinal and therapeutic (more on that in a moment). Magnesium is often used form any of a million activities, ranging from cellular
Many compounds—like flavonoids in apples—work syn- effects. (To our way of thinking, olive oil is the secret in conjunction with blood sugar drugs such as metabolism to doing bench presses to dancing the
ergistically and support and augment the impact of sauce in Mediterranean-type diets—it’s anything but a Metformin (Glucophage) or blood pressure medica- tango. The body makes ATP by stripping electrons—
the vitamins found in that food (like vitamin C in the “placebo.”) tions such as beta blockers. And virtually everyone tiny subatomic particles that carry a negative electri-
apple). An isolated nutrient rarely shows up in the Let’s be clear. Conventional medicine is simply needs a little help in reducing oxidation and inflam- cal charge—from food and then delivering those elec-
natural world, so testing isolated nutrients—separated terrific at keeping people alive in emergencies. Both mation, two of the most important drivers in the trons to oxygen, which is an electron receptor. CoQ10
from the nutrients they are normally found with in of us know that if we were to be in a car accident, we development of heart disease. Omega-3 fatty acids, is one of the carriers of these electrons, so it essen-
nature—may not reveal what these nutrients actually wouldn’t want the ambulance rushing us to the near- for example, can be used by just about anyone, tially helps the cells use oxygen and create more
can accomplish. est herbalist’s office. We’d want to go to the emer- whether he or she is on medication or not (check with energy. Bottom line: CoQ10 has the ability to increase
And the fourth problem is that medical research- gency room of the best hospital we could find. But as your doctor for any possible contraindications, such the body’s production of the energy molecule ATP,
ers are often so removed from the world of nutrition, good as conventional medicine is at treating people in as right before going into surgery). and this is a very good thing indeed.
or so biased against it, that they test nutrients in acute situations, it’s astonishingly bad at overall pre- The following list is far from exhaustive, but it will Just as a gasoline engine can’t work without
doses that no nutritionist would expect to “work.” In ventive care. It’s great at keeping your heart beating give you a good idea of how you can use supplements spark plugs, the human body can’t work without
the period between editions of this book, a highly if you’ve just had a heart attack. It’s not nearly as to keep your heart healthy, either alone or, in some CoQ10. It’s an essential component of the mitochon-
publicized randomized placebo-control trial was pub- good at keeping your heart healthy for the long run cases, as an adjunct to conventional therapy. dria, which is command central for the production of
lished in a reputable medical journal that purportedly and keeping you, the heart’s owner, out of the hospi- cellular energy (ATP). Not coincidentally, the heart is
2
“tested” the effect of omega-3s on heart disease. tal in the first place. one of the major organs where the most CoQ10 is
concentrated (the others, being the liver and kidney). CoQ10 has been approved in Japan as a prescrip- erance. “CoQ10 is safe and effective long-term therapy thus damaged and sticky in the first place than to use
The heart never sleeps, and it never takes a vacation. tion drug for congestive heart failure since 1974. And for cardiomyopathy,” the study authors concluded. a sledgehammer pharmaceutical to reduce LDL as
It beats more than one hundred thousand times a even in the United States, the benefits of CoQ10 for CoQ10 also has the ability to reduce blood pres- much as possible!
day, making it one of the most metabolically active the heart have been well known since at least the sure. A recent meta-analysis of CoQ10 in the treatment Coenzyme Q10 and vitamin E have a strange,
tissues in the body, so it’s very dependent on the mid-1980s. A study published in the Proceedings of of high blood pressure reviewed twelve different clini- almost symbiotic relationship. In rats given supple-
energy-generating power of CoQ10. the National Academy of Sciences of the United States cal trials and found that across the board, patients mental vitamin E, increases in blood levels of CoQ10
A CoQ10 deficiency affects your heart as proof America in 1985 gave either CoQ10 or a placebo to who received CoQ10 supplementation had significant were observed; in baboons given supplemental CoQ10,
foundly as a calcium deficiency would affect your two groups of patients having class III or class IV car- reductions in blood pressure compared to control sub- the anti-inflammatory effects of vitamin E were
7
bones. We create less of it as we age, making it all the diomyopathy according to the definitions put forth by jects who didn’t receive supplemention. It’s no won- increased; and in one study, CoQ10 plus vitamin E
4
more important to supplement with CoQ10 as we grow the New York Heart Association (NYHA). These are der that several studies have demonstrated a strong actually lowered C-reactive protein (CRP), a systemic
older. Although it’s present in food, the only foods seriously ill folks. Class III patients have marked limi- correlation between severity of heart disease and measure of inflammation. We think it’s wise to make
8
that have any CoQ10 to speak of are organ meats such tation in activity because of symptoms and can basi- severity of CoQ10 deficiency. sure you’re getting about 100 to 200 IUs or so of vita-
as heart and liver. Beef has some carnitine but—other cally only be comfortable at rest or with minimal Since the publication of the first edition of this min E a day (from mixed tocopherols) in addition to
than organ meats—the best source of carnitine in the activity; class IV patients have severe limitations and book, there has been an explosion in the medical liter- your CoQ10 supplement. (But read the section on vita-
entire animal kingdom is young lamb. Note: CoQ10 is experience symptoms even while resting. (Most class ature on the cardiovascular merits of CoQ10. We now min E, “The Good, the Bad, and the Ugly,” on page 171
easily destroyed by too much heat or overcooking. IV patients are bedbound.) know that CoQ10 reduces Lp(a) (see page 170), first!)
As we’ve said, one of the biggest problems with So what happened when these very sick patients improves endothelial function, decreases cholesterol/
statin drugs is that they significantly deplete CoQ10 were given CoQ10? Here’s how the researchers them- triglyceride levels, increases HDL, decreases fasting D-RIBOSE: THE MISSING LINK
levels. You may recall from the previous chapter on selves summarized the results: “These patients, blood sugar, decreases Hba1c, and—just for good mea- D-ribose, a five-carbon sugar, is one of the
statins that the same pathway that produces choles- steadily worsening and expected to die within two sure—reduces LDL oxidation. components of ATP, the energy molecule the body
terol (the mevalonate pathway) also produces CoQ10, years under conventional therapy, generally showed You might recall that oxidative damage (oxida- uses to power all activities. Without D-ribose, there
so when you block that pathway at its virtual starting an extraordinary clinical improvement, indicating that tion) is one of the four major culprits in heart disease, would be no ATP; without ATP, there would be no
gate (as statin drugs do), you not only reduce the CoQ10 therapy might extend the lives of such patients. and you might also remember that cholesterol in the energy.
body’s ability to make cholesterol but you also inter- This improvement could be due to correction of a body is never a problem until it becomes oxidized. It’s Both CoQ10 and the nutritional supplement
fere with its ability to make CoQ10. myocardial deficiency of CoQ10 and to enhanced syn- only this oxidized cholesterol—specifically, pattern B L-carnitine help facilitate the process by which the
5
We’ve said this before, but in case you missed it thesis of CoQ10-requiring enzymes.” LDL cholesterol—that is a problem, because pattern B body manufactures ATP. Metaphorically speaking,
the first time, it’s important enough to repeat: If you Another study that lasted six years and was pub- LDL molecules are the ones that adhere to the cell they act like little elves, shuttling the material needed
are on a statin drug you must, repeat must, supple- lished in 1990 looked at 143 patients, 98 percent of walls and initiate or accelerate the process of to make ATP to the factories where it’s made, result-
ment with CoQ10. We recommend at least 100 mg whom were in the same two classes as the patients in inflammation. ing in more efficient production of this important
6
twice a day. the 1985 study. The participants were given 100 mg Why do we mention that here? Simple. CoQ10 is a energy molecule. CoQ10 and L-carnitine can be said to
But CoQ10 isn’t just essential for those on statin of CoQ10 (orally), in addition to being treated in their powerful antioxidant, inhibiting oxidative damage to function like very efficient trucks transporting build-
drugs. We believe it’s essential for everyone else as conventional medical program. Eighty-five percent of LDL cholesterol and thus helping to prevent choles- ing materials to the factories where stuff actually
well, and especially for anyone at risk for heart the patients improved by one or two NYHA classes, terol from becoming a “problem” in the first place. It’s gets built, but D-ribose is one of the actual building
disease. and there was no positive evidence of toxicity or intol- far smarter to prevent LDL from getting oxidized and materials. A shortage of D-ribose means a shortage
concentrated (the others, being the liver and kidney). CoQ10 has been approved in Japan as a prescrip- erance. “CoQ10 is safe and effective long-term therapy thus damaged and sticky in the first place than to use
The heart never sleeps, and it never takes a vacation. tion drug for congestive heart failure since 1974. And for cardiomyopathy,” the study authors concluded. a sledgehammer pharmaceutical to reduce LDL as
It beats more than one hundred thousand times a even in the United States, the benefits of CoQ10 for CoQ10 also has the ability to reduce blood pres- much as possible!
day, making it one of the most metabolically active the heart have been well known since at least the sure. A recent meta-analysis of CoQ10 in the treatment Coenzyme Q10 and vitamin E have a strange,
tissues in the body, so it’s very dependent on the mid-1980s. A study published in the Proceedings of of high blood pressure reviewed twelve different clini- almost symbiotic relationship. In rats given supple-
energy-generating power of CoQ10. the National Academy of Sciences of the United States cal trials and found that across the board, patients mental vitamin E, increases in blood levels of CoQ10
A CoQ10 deficiency affects your heart as proof America in 1985 gave either CoQ10 or a placebo to who received CoQ10 supplementation had significant were observed; in baboons given supplemental CoQ10,
foundly as a calcium deficiency would affect your two groups of patients having class III or class IV car- reductions in blood pressure compared to control sub- the anti-inflammatory effects of vitamin E were
7
bones. We create less of it as we age, making it all the diomyopathy according to the definitions put forth by jects who didn’t receive supplemention. It’s no won- increased; and in one study, CoQ10 plus vitamin E
4
more important to supplement with CoQ10 as we grow the New York Heart Association (NYHA). These are der that several studies have demonstrated a strong actually lowered C-reactive protein (CRP), a systemic
older. Although it’s present in food, the only foods seriously ill folks. Class III patients have marked limi- correlation between severity of heart disease and measure of inflammation. We think it’s wise to make
8
that have any CoQ10 to speak of are organ meats such tation in activity because of symptoms and can basi- severity of CoQ10 deficiency. sure you’re getting about 100 to 200 IUs or so of vita-
as heart and liver. Beef has some carnitine but—other cally only be comfortable at rest or with minimal Since the publication of the first edition of this min E a day (from mixed tocopherols) in addition to
than organ meats—the best source of carnitine in the activity; class IV patients have severe limitations and book, there has been an explosion in the medical liter- your CoQ10 supplement. (But read the section on vita-
entire animal kingdom is young lamb. Note: CoQ10 is experience symptoms even while resting. (Most class ature on the cardiovascular merits of CoQ10. We now min E, “The Good, the Bad, and the Ugly,” on page 171
easily destroyed by too much heat or overcooking. IV patients are bedbound.) know that CoQ10 reduces Lp(a) (see page 170), first!)
As we’ve said, one of the biggest problems with So what happened when these very sick patients improves endothelial function, decreases cholesterol/
statin drugs is that they significantly deplete CoQ10 were given CoQ10? Here’s how the researchers them- triglyceride levels, increases HDL, decreases fasting D-RIBOSE: THE MISSING LINK
levels. You may recall from the previous chapter on selves summarized the results: “These patients, blood sugar, decreases Hba1c, and—just for good mea- D-ribose, a five-carbon sugar, is one of the
statins that the same pathway that produces choles- steadily worsening and expected to die within two sure—reduces LDL oxidation. components of ATP, the energy molecule the body
terol (the mevalonate pathway) also produces CoQ10, years under conventional therapy, generally showed You might recall that oxidative damage (oxida- uses to power all activities. Without D-ribose, there
so when you block that pathway at its virtual starting an extraordinary clinical improvement, indicating that tion) is one of the four major culprits in heart disease, would be no ATP; without ATP, there would be no
gate (as statin drugs do), you not only reduce the CoQ10 therapy might extend the lives of such patients. and you might also remember that cholesterol in the energy.
body’s ability to make cholesterol but you also inter- This improvement could be due to correction of a body is never a problem until it becomes oxidized. It’s Both CoQ10 and the nutritional supplement
fere with its ability to make CoQ10. myocardial deficiency of CoQ10 and to enhanced syn- only this oxidized cholesterol—specifically, pattern B L-carnitine help facilitate the process by which the
5
We’ve said this before, but in case you missed it thesis of CoQ10-requiring enzymes.” LDL cholesterol—that is a problem, because pattern B body manufactures ATP. Metaphorically speaking,
the first time, it’s important enough to repeat: If you Another study that lasted six years and was pub- LDL molecules are the ones that adhere to the cell they act like little elves, shuttling the material needed
are on a statin drug you must, repeat must, supple- lished in 1990 looked at 143 patients, 98 percent of walls and initiate or accelerate the process of to make ATP to the factories where it’s made, result-
ment with CoQ10. We recommend at least 100 mg whom were in the same two classes as the patients in inflammation. ing in more efficient production of this important
6
twice a day. the 1985 study. The participants were given 100 mg Why do we mention that here? Simple. CoQ10 is a energy molecule. CoQ10 and L-carnitine can be said to
But CoQ10 isn’t just essential for those on statin of CoQ10 (orally), in addition to being treated in their powerful antioxidant, inhibiting oxidative damage to function like very efficient trucks transporting build-
drugs. We believe it’s essential for everyone else as conventional medical program. Eighty-five percent of LDL cholesterol and thus helping to prevent choles- ing materials to the factories where stuff actually
well, and especially for anyone at risk for heart the patients improved by one or two NYHA classes, terol from becoming a “problem” in the first place. It’s gets built, but D-ribose is one of the actual building
disease. and there was no positive evidence of toxicity or intol- far smarter to prevent LDL from getting oxidized and materials. A shortage of D-ribose means a shortage
of ATP, and a shortage of ATP, especially in the heart, nary artery disease increased their ability to do exer- L-carnitine and CoQ10. In just a few short days, Louis angina; for individuals awaiting heart transplant;
is bad news indeed. cise and delayed the onset of moderate angina (chest showed remarkable improvement. His son-in-law, a and for individuals with severe fibromyalgia,
D-ribose is synthesized in every cell in the body, pain). Since then, the benefits of D-ribose have been dentist, called me a few days later and reported, “You muscle cramps, or neuromuscular disease
but only slowly and to varying degrees depending on reported for heart failure, cardiac surgery recovery, fixed Louis!” Reported side effects are minimal and infrequent,
the tissue. Tissues such as the liver, adrenal cortex, restoration of energy to stressed skeletal muscles, An adequate dose of D-ribose usually results in and there are no known adverse drug or nutritional
and adipose tissue make plenty of D-ribose because and control of free radical formation in tissues that symptom improvement very quickly, sometimes within interactions associated with D-ribose use. The toxicol-
they produce chemical compounds used to synthesize have been deprived of oxygen. days, as in Louis’s case. If initial response is poor, the ogy and safety of D-ribose have been exhaustively
fatty acids and steroids, which are in turn used to Here’s one dramatic story from Dr. Sinatra’s prac- dose should be increased to 5 g (1 teaspoon) three studied, and the supplement is 100 percent safe when
make hormones. tice that illustrates the almost miraculous power of times a day. Logically, those who are the sickest and taken as directed. (Thousands of patients have taken
But molecules of D-ribose made by these tissues D-ribose supplementation to improve the quality of the most energy depleted will notice the most D-ribose with minimal, if any, side effects.)
have to be used right then and there and can’t be life of cardiac patients: improvement in the quickest time. However, even though there are no known contra-
“transferred” to other tissues that might need them, Despite accumulating scientific evidence of the indications for supplementation with D-ribose, we rec-
such as the heart. The heart, as well as the skeletal Dr. Sinatra: The Case of Louis and benefit of D-ribose, very few physicians in the United ommend that pregnant women, nursing mothers, and
muscles and brain, can only make enough ribose for D-Ribose States have even heard of it outside of their first-year very young children refrain from taking D-ribose in
their day-to-day needs. They have no D-ribose saving Louis came to my office suffering from severe med school biochemistry class. Fewer still recommend the absence of congestive heart failure simply
account. When the cells of the heart, for example, coronary artery disease. He had been previously it to their patients. Those who are familiar with it because there is not enough research in these
encounter a stressor such as oxygen deprivation, they treated by having a stent placed in a major coronary have the wonderful gratification of seeing it help populations.
lack the metabolic machinery needed to quickly whip artery, but he still had severe blockage in a small patients on a regular basis.
up some badly needed D-ribose. Tissues that are arterial branch that was difficult to dilate with a stent Although the optimal level of D-ribose supple- L-CARNITINE: THE SHUTTLE BUS
stressed because they don’t get enough blood flow or and next to impossible to bypass with surgery. He had mentation will differ depending on the person and the FOR FATTY ACIDS
oxygen can’t make enough D-ribose to replace lost what’s called refractory angina, which means he particular condition, here are some good recom- As previously stated, the best way to conceptualize
energy quickly. And when oxygen or blood flow defi- experienced chest pain even with normal activities mended starting points for supplementation: L-carnitine is to think of it as a transportation system.
cits are chronic—as in heart disease—tissues can never such as walking across a room. He’d also feel chest • 5 g daily for cardiovascular prevention, for ath- It acts as a kind of shuttle bus, loading up fatty acids
make enough D-ribose, and cellular energy levels are pain anytime he had even mild emotional stress. Louis letes on maintenance, and for healthy people who and transporting them into tiny structures within
constantly depleted. had visited a number of cardiologists for his heart engage in strenuous activities or hard-core each cell called mitochondria, where they can be
The D-ribose connection to cardiac function was problem and had been placed on a number of workouts burned for energy. Because the heart gets 60 percent
first discovered by the physiologist Heinz-Gerd common heart drugs, but his problems persisted. • 10 to 15 g daily for most patients with heart fail- of its energy from fat, it’s very important that the
Zimmer at the University of Munich. Zimmer’s When Louis came to my office I noticed high lev- ure, ischemic cardiovascular disease, or periph- body has enough L-carnitine to shuttle the fatty acids
research found that D-ribose plays an enormous part els of uric acid in his blood, indicating faulty ATP eral vascular disease; for individuals recovering into the heart’s muscle cells.
in both energy restoration and the return of normal metabolism. At the time, he was already taking from heart attacks or heart surgery; for treat- Studies of patients being treated for various
diastolic cardiac function. (Diastolic dysfunction is L-carnitine and CoQ10 at “maintenance doses.” ment of stable angina; and for athletes who forms of cardiovascular disease provide the strongest
basically a kind of heart failure.) One 1992 clinical Realizing that it would help him enormously if he engage in chronic bouts of high-intensity exercise evidence for the benefit of L-carnitine supplementa-
study from Zimmer’s group showed that administer- could build up his ATP stores, I immediately recom- • 15 to 20 g daily for patients with advanced heart tion. One study showed that people who took
ing D-ribose to patients with severe but stable coro- mended D-ribose as well as increased doses of failure, dilated cardiomyopathy, or frequent L-carnitine supplements after suffering heart attacks
of ATP, and a shortage of ATP, especially in the heart, nary artery disease increased their ability to do exer- L-carnitine and CoQ10. In just a few short days, Louis angina; for individuals awaiting heart transplant;
is bad news indeed. cise and delayed the onset of moderate angina (chest showed remarkable improvement. His son-in-law, a and for individuals with severe fibromyalgia,
D-ribose is synthesized in every cell in the body, pain). Since then, the benefits of D-ribose have been dentist, called me a few days later and reported, “You muscle cramps, or neuromuscular disease
but only slowly and to varying degrees depending on reported for heart failure, cardiac surgery recovery, fixed Louis!” Reported side effects are minimal and infrequent,
the tissue. Tissues such as the liver, adrenal cortex, restoration of energy to stressed skeletal muscles, An adequate dose of D-ribose usually results in and there are no known adverse drug or nutritional
and adipose tissue make plenty of D-ribose because and control of free radical formation in tissues that symptom improvement very quickly, sometimes within interactions associated with D-ribose use. The toxicol-
they produce chemical compounds used to synthesize have been deprived of oxygen. days, as in Louis’s case. If initial response is poor, the ogy and safety of D-ribose have been exhaustively
fatty acids and steroids, which are in turn used to Here’s one dramatic story from Dr. Sinatra’s prac- dose should be increased to 5 g (1 teaspoon) three studied, and the supplement is 100 percent safe when
make hormones. tice that illustrates the almost miraculous power of times a day. Logically, those who are the sickest and taken as directed. (Thousands of patients have taken
But molecules of D-ribose made by these tissues D-ribose supplementation to improve the quality of the most energy depleted will notice the most D-ribose with minimal, if any, side effects.)
have to be used right then and there and can’t be life of cardiac patients: improvement in the quickest time. However, even though there are no known contra-
“transferred” to other tissues that might need them, Despite accumulating scientific evidence of the indications for supplementation with D-ribose, we rec-
such as the heart. The heart, as well as the skeletal Dr. Sinatra: The Case of Louis and benefit of D-ribose, very few physicians in the United ommend that pregnant women, nursing mothers, and
muscles and brain, can only make enough ribose for D-Ribose States have even heard of it outside of their first-year very young children refrain from taking D-ribose in
their day-to-day needs. They have no D-ribose saving Louis came to my office suffering from severe med school biochemistry class. Fewer still recommend the absence of congestive heart failure simply
account. When the cells of the heart, for example, coronary artery disease. He had been previously it to their patients. Those who are familiar with it because there is not enough research in these
encounter a stressor such as oxygen deprivation, they treated by having a stent placed in a major coronary have the wonderful gratification of seeing it help populations.
lack the metabolic machinery needed to quickly whip artery, but he still had severe blockage in a small patients on a regular basis.
up some badly needed D-ribose. Tissues that are arterial branch that was difficult to dilate with a stent Although the optimal level of D-ribose supple- L-CARNITINE: THE SHUTTLE BUS
stressed because they don’t get enough blood flow or and next to impossible to bypass with surgery. He had mentation will differ depending on the person and the FOR FATTY ACIDS
oxygen can’t make enough D-ribose to replace lost what’s called refractory angina, which means he particular condition, here are some good recom- As previously stated, the best way to conceptualize
energy quickly. And when oxygen or blood flow defi- experienced chest pain even with normal activities mended starting points for supplementation: L-carnitine is to think of it as a transportation system.
cits are chronic—as in heart disease—tissues can never such as walking across a room. He’d also feel chest • 5 g daily for cardiovascular prevention, for ath- It acts as a kind of shuttle bus, loading up fatty acids
make enough D-ribose, and cellular energy levels are pain anytime he had even mild emotional stress. Louis letes on maintenance, and for healthy people who and transporting them into tiny structures within
constantly depleted. had visited a number of cardiologists for his heart engage in strenuous activities or hard-core each cell called mitochondria, where they can be
The D-ribose connection to cardiac function was problem and had been placed on a number of workouts burned for energy. Because the heart gets 60 percent
first discovered by the physiologist Heinz-Gerd common heart drugs, but his problems persisted. • 10 to 15 g daily for most patients with heart fail- of its energy from fat, it’s very important that the
Zimmer at the University of Munich. Zimmer’s When Louis came to my office I noticed high lev- ure, ischemic cardiovascular disease, or periph- body has enough L-carnitine to shuttle the fatty acids
research found that D-ribose plays an enormous part els of uric acid in his blood, indicating faulty ATP eral vascular disease; for individuals recovering into the heart’s muscle cells.
in both energy restoration and the return of normal metabolism. At the time, he was already taking from heart attacks or heart surgery; for treat- Studies of patients being treated for various
diastolic cardiac function. (Diastolic dysfunction is L-carnitine and CoQ10 at “maintenance doses.” ment of stable angina; and for athletes who forms of cardiovascular disease provide the strongest
basically a kind of heart failure.) One 1992 clinical Realizing that it would help him enormously if he engage in chronic bouts of high-intensity exercise evidence for the benefit of L-carnitine supplementa-
study from Zimmer’s group showed that administer- could build up his ATP stores, I immediately recom- • 15 to 20 g daily for patients with advanced heart tion. One study showed that people who took
ing D-ribose to patients with severe but stable coro- mended D-ribose as well as increased doses of failure, dilated cardiomyopathy, or frequent L-carnitine supplements after suffering heart attacks
had significantly lower mortality rates compared to that this action of L-carnitine “would be expected to ized. There were improvements in cellular energy significant increase in the risk of cardiovascular dis-
those of a control group (1.2 percent of the L-carnitine protect from oxidative stress related to cardiovascular metabolism and stabilization of heart cell membranes, ease—an increase, they noted, that might well trans-
12
takers died versus 12.5 percent of the subjects in the and myocardial damage.” which resulted in not only the reduction of ventricular late into “a large burden of disease in the population.”
9
control group). One randomized, placebo-controlled arrhythmias and angina symptoms but a significant The authors called for a reassessment of the role of
study divided eighty heart failure patients into two Dr. Sinatra: L-Carnitine and CoQ10 reduction in death as well. calcium supplements in the management of
groups. One group received 2 g of L-carnitine a day, Eighty-five percent of my patients with congestive The bottom line is that the heart is the most met- osteoporosis.13
and the other group received a placebo. There was a heart failure have improved significantly on CoQ10. But abolically active tissue in the body, and thus it A second study had a different purpose, one par-
significantly higher three-year survival rate in the I was concerned about the 15 percent who, despite requires a huge and constant amount of energy mole- ticularly relevant to our story.14 The researchers began
group receiving L-carnitine.10 supplementation with CoQ10, still had symptoms that cules, or ATPs. with the premise that statins reduce cardiovascular
L-carnitine improves the ability of those with severely compromised their quality Remember, the heart has to pump sixty to one risk and slow the progression of coronary artery cal-
11
angina to exercise without chest pain. In one study, of life. hundred times a minute, twenty-four hours a day, for cium. The purpose of the study, then, was to deter-
the walking capacity of patients with intermittent These folks were supplementing with CoQ10 and years and years with no time off for good behavior! mine whether lowering LDL cholesterol (as statins do)
claudication—a painful cramping sensation in the mus- had excellent blood levels to show for it, typically Cardiac muscle cells burn fats for fuel, so the heart is is in some way complementary to slowing the pro-
cles of the legs because of a decreased oxygen sup- 3.5 ug/mL or higher (the normal level of CoQ10 is 0.5 especially vulnerable to even subtle deficiencies in gression of coronary artery calcium. The researchers
ply—improved significantly when they were given oral to 1.5 ug/mL.) Nonetheless, these folks seemed to be the factors contributing to ATP supply: coenzyme Q10, basically wanted to illuminate the relationship of
L-carnitine. In another study, patients with peripheral unable to utilize what was in their own bodies. D-ribose, and L-carnitine. these two phenomena as they relate to heart disease.
arterial disease of the legs were able to increase their As I read more about L-carnitine, I came to see These nutrients make up three of what I call the Here’s what they did. They measured the change
walking distance by 98 meters when they supple- that it might work in synergy with coenzyme Q10, stok- “Awesome Foursome” in metabolic cardiology. Now in coronary artery calcium in 495 patients who were
mented with L-carnitine; they were able to walk ing the fire in the ATP production phase of the Krebs let’s introduce the fourth. basically symptom-free at the beginning of the study.
almost twice as far as those who were given a pla- cycle (a sequence of reactions by which living cells They did this by using a method known as electron
cebo. Further, congestive heart failure patients have generate energy). I finally got comfortable enough to MAGNESIUM: THE GREAT RELAXER beam tomography scanning. Right after their first
experienced an increase in exercise endurance on recommend to some of my worrisome patients that Dr. Robert Atkins once referred to magnesium as a scan, the patients were started on statin drugs, and
only 900 mg of L-carnitine a day. they give it a try in combination with CoQ10, and wow, “natural calcium channel blocker,” and he was 100 they were followed for an average of 3.2 years, during
And if that were not enough to establish what a difference! percent correct. A few paragraphs from now, you’ll which time their cholesterol was checked and they
L-carnitine’s bona fides, it has been shown to be a These treatment-resistant folks came in with bet- understand just why magnesium’s ability to block the were scanned on a regular basis. Over the course of
powerful cardio-protective antioxidant. One paper ter color, breathed easier, and walked around the channels by which calcium gets into the cells is so the 3.2-year follow-up period, forty-one of the
published in the International Journal of Cardiology office with minimal difficulty. I was genuinely amazed. important for the health of your heart. patients had heart attacks.
found that L-carnitine had a direct stimulatory effect It was as if the L-carnitine provided a battery, working Recent research strongly suggests that calcium in On average, the 454 patients who did not suffer
on two important oxidative stress–related compounds perfectly with the coenzyme Q10. The medical litera- the heart can be a huge problem. One meta-analysis heart attacks saw their arterial calcium go up by
(HO-1 and ecNOS). Both of these markers have antiox- ture is also a testimony on carnitine’s benefits. In the examined fifteen eligible trials with the objective of approximately 17 percent every year. But the forty-
idant, antiproliferative (meaning they have an inhibi- Mayo Clinic Proceedings, a meta-analysis of thirteen investigating the relationship between calcium supple- one patients who did experience heart attacks saw a
tory effect on tumor cells), and anti-inflammatory clinical studies on L-carnitine was published in 2013. In ments and cardiovascular disease. The researchers whopping 42 percent increase per year in their arte-
properties, so ratcheting up their activity a notch is a a review of 3,629 patients with heart attack, the sur- concluded that calcium supplements (administered rial calcium. According to the researchers, having a
very good thing indeed. The researchers concluded vival benefits of those taking L-carnitine were real- without vitamin D) were associated with a modest but faster progression of coronary artery calcium gives
had significantly lower mortality rates compared to that this action of L-carnitine “would be expected to ized. There were improvements in cellular energy significant increase in the risk of cardiovascular dis-
those of a control group (1.2 percent of the L-carnitine protect from oxidative stress related to cardiovascular metabolism and stabilization of heart cell membranes, ease—an increase, they noted, that might well trans-
12
takers died versus 12.5 percent of the subjects in the and myocardial damage.” which resulted in not only the reduction of ventricular late into “a large burden of disease in the population.”
9
control group). One randomized, placebo-controlled arrhythmias and angina symptoms but a significant The authors called for a reassessment of the role of
study divided eighty heart failure patients into two Dr. Sinatra: L-Carnitine and CoQ10 reduction in death as well. calcium supplements in the management of
groups. One group received 2 g of L-carnitine a day, Eighty-five percent of my patients with congestive The bottom line is that the heart is the most met- osteoporosis.13
and the other group received a placebo. There was a heart failure have improved significantly on CoQ10. But abolically active tissue in the body, and thus it A second study had a different purpose, one par-
significantly higher three-year survival rate in the I was concerned about the 15 percent who, despite requires a huge and constant amount of energy mole- ticularly relevant to our story.14 The researchers began
group receiving L-carnitine.10 supplementation with CoQ10, still had symptoms that cules, or ATPs. with the premise that statins reduce cardiovascular
L-carnitine improves the ability of those with severely compromised their quality Remember, the heart has to pump sixty to one risk and slow the progression of coronary artery cal-
11
angina to exercise without chest pain. In one study, of life. hundred times a minute, twenty-four hours a day, for cium. The purpose of the study, then, was to deter-
the walking capacity of patients with intermittent These folks were supplementing with CoQ10 and years and years with no time off for good behavior! mine whether lowering LDL cholesterol (as statins do)
claudication—a painful cramping sensation in the mus- had excellent blood levels to show for it, typically Cardiac muscle cells burn fats for fuel, so the heart is is in some way complementary to slowing the pro-
cles of the legs because of a decreased oxygen sup- 3.5 ug/mL or higher (the normal level of CoQ10 is 0.5 especially vulnerable to even subtle deficiencies in gression of coronary artery calcium. The researchers
ply—improved significantly when they were given oral to 1.5 ug/mL.) Nonetheless, these folks seemed to be the factors contributing to ATP supply: coenzyme Q10, basically wanted to illuminate the relationship of
L-carnitine. In another study, patients with peripheral unable to utilize what was in their own bodies. D-ribose, and L-carnitine. these two phenomena as they relate to heart disease.
arterial disease of the legs were able to increase their As I read more about L-carnitine, I came to see These nutrients make up three of what I call the Here’s what they did. They measured the change
walking distance by 98 meters when they supple- that it might work in synergy with coenzyme Q10, stok- “Awesome Foursome” in metabolic cardiology. Now in coronary artery calcium in 495 patients who were
mented with L-carnitine; they were able to walk ing the fire in the ATP production phase of the Krebs let’s introduce the fourth. basically symptom-free at the beginning of the study.
almost twice as far as those who were given a pla- cycle (a sequence of reactions by which living cells They did this by using a method known as electron
cebo. Further, congestive heart failure patients have generate energy). I finally got comfortable enough to MAGNESIUM: THE GREAT RELAXER beam tomography scanning. Right after their first
experienced an increase in exercise endurance on recommend to some of my worrisome patients that Dr. Robert Atkins once referred to magnesium as a scan, the patients were started on statin drugs, and
only 900 mg of L-carnitine a day. they give it a try in combination with CoQ10, and wow, “natural calcium channel blocker,” and he was 100 they were followed for an average of 3.2 years, during
And if that were not enough to establish what a difference! percent correct. A few paragraphs from now, you’ll which time their cholesterol was checked and they
L-carnitine’s bona fides, it has been shown to be a These treatment-resistant folks came in with bet- understand just why magnesium’s ability to block the were scanned on a regular basis. Over the course of
powerful cardio-protective antioxidant. One paper ter color, breathed easier, and walked around the channels by which calcium gets into the cells is so the 3.2-year follow-up period, forty-one of the
published in the International Journal of Cardiology office with minimal difficulty. I was genuinely amazed. important for the health of your heart. patients had heart attacks.
found that L-carnitine had a direct stimulatory effect It was as if the L-carnitine provided a battery, working Recent research strongly suggests that calcium in On average, the 454 patients who did not suffer
on two important oxidative stress–related compounds perfectly with the coenzyme Q10. The medical litera- the heart can be a huge problem. One meta-analysis heart attacks saw their arterial calcium go up by
(HO-1 and ecNOS). Both of these markers have antiox- ture is also a testimony on carnitine’s benefits. In the examined fifteen eligible trials with the objective of approximately 17 percent every year. But the forty-
idant, antiproliferative (meaning they have an inhibi- Mayo Clinic Proceedings, a meta-analysis of thirteen investigating the relationship between calcium supple- one patients who did experience heart attacks saw a
tory effect on tumor cells), and anti-inflammatory clinical studies on L-carnitine was published in 2013. In ments and cardiovascular disease. The researchers whopping 42 percent increase per year in their arte-
properties, so ratcheting up their activity a notch is a a review of 3,629 patients with heart attack, the sur- concluded that calcium supplements (administered rial calcium. According to the researchers, having a
very good thing indeed. The researchers concluded vival benefits of those taking L-carnitine were real- without vitamin D) were associated with a modest but faster progression of coronary artery calcium gives
you an astonishing 17.2-fold increase in your heart Enter magnesium. has a relaxing effect on your arteries. And that’s a with insulin resistance, as opposed to only 5 percent
15
attack risk. Magnesium and calcium have an interesting, sym- very good thing from the perspective of the heart, of those in a control group21
And get this: LDL cholesterol did not differ biotic relationship. When magnesium is depleted, which instead of having to push blood through a nar- Clearly, there’s a strong association between
between the two groups. Ironically, the LDL levels of intracellular calcium rises. Magnesium also inhibits row or constricted vessel (dangerously raising blood magnesium deficiency and insulin resistance. You’ll
the folks who did not suffer heart attacks were slightly platelet aggregation, an important step in the devel- pressure) now has the much easier task of pumping it recall that people with insulin resistance are at great
higher (though not significantly so) than the average opment of clots. Calcium channel blockers widen and through a relaxed, widened vessel that doesn’t put up risk for diabetes, which in turn puts them at great risk
LDL levels of the folks who did suffer heart attacks. relax the blood vessels by affecting the muscle cells so much resistance. Your heart doesn’t have to work for heart disease. Helping to control blood sugar and
So let’s summarize the results. Both groups—the found in the arterial walls, which is exactly what mag- as hard, your blood pressure goes down, and all is insulin is just one more important way in which mag-
forty-one folks who had heart attacks and the 454 nesium does—splendidly, we might add. Magnesium well with the world. nesium is critical for heart health.
folks who didn’t—essentially had the same LDL levels. dilates the arteries, thus reducing blood pressure and There’s another interesting connection between Magnesium is necessary for more than three hun-
(So if you were using patients’ LDL levels to predict making it far easier for the heart to pump blood and magnesium and the heart, and if you’ve followed our dred biochemical reactions in the body, and many of
heart attacks, you’d get no better accuracy than you for the blood to flow freely. argument so far, you’ll love the elegance of how it all these are enzymatic reactions, essential for heart
would by reading their horoscopes!) But if instead of In most of the epidemiologic and clinical trials, a comes full circle. The connection? Sugar. health (or what scientists call myocardial metabo-
LDL levels you looked at the levels of calcium in the high dietary intake of magnesium (at least 500 to You’ll recall from chapter 6 that sugar is one of lism).22 Even borderline deficiencies of magnesium can
arteries, it would be a whole different story. Those 1,000 mg a day) resulted in reduced blood pressure.17 the worst things you can eat if you want to have a negatively affect the heart, and not surprisingly, there
who suffered myocardial infarctions were the most These studies showed an inverse relationship healthy heart. Here’s why: Sugar is highly inflamma- is a considerable amount of evidence associating low
likely to have higher calcium levels in their arteries, between magnesium intake and blood pressure; peo- tory. It also creates dangerous compounds known as levels of magnesium with cardiovascular disease.23
especially when the arteries became totally blocked. ple who consumed more magnesium had lower blood advanced glycation end products, or AGEs, which play Bottom line: Magnesium supplements are a must
19
Coronary artery calcification has long been rec- pressure. One study of sixty hypertensive subjects a pivotal role in atherosclerosis. AGEs play a role of for those who want to protect their hearts. Magne-
ognized as a big risk factor for heart disease, but for who were given magnesium supplementation showed particular importance in type 2 diabetes, which, as sium lowers blood pressure, helps control blood sugar,
some reason we continue to obsessively focus on cho- a significant reduction in blood pressure over an you know, is a condition in which blood sugar and and relaxes the lining of the blood vessels. And
18
lesterol, while few people have heard much about the eight-week period. insulin are essentially at unhealthy levels and have to almost all dietary surveys show that Americans aren’t
calcium connection. So basically, you can think of magnesium as a be brought under control. And diabetes is one way to getting nearly enough.24 We recommend supplement-
Arthur Agatston, M.D., a Florida cardiologist best “relaxer.” One of the most relaxing things you can do fast-track your path to heart disease. ing with at least 400 mg per day.
known as the author of The South Beach Diet, actu- is to bathe in Epsom salts, which is basically a com- One of the very best things magnesium does is NOTE: Magnesium supplementation is not recom-
ally invented a scoring method to determine the pound of magnesium with a little bit of sulfur and help manage blood sugar. In several studies of dia- mended for anyone with renal insufficiency (kidney
severity of calcification in the arteries—it’s known as oxygen. If you’ve ever worked with an integrative betic patients, magnesium supplements of 400 to disease).
the Agatston score. (Research shows that people with medicine practitioner who happens to use vitamin 1,000 mg per day, given for anywhere from three
Agatston scores higher than 400 are at a significantly drips, you might have found that the most amazing weeks to three months, improved a number of mea- NIACIN AND ITS EFFECT ON
increased risk for coronary “events”—myocardial and restful sleep you’ve ever had occurred after get- sures of glycemic (blood sugar) control, including the CHOLESTEROL
infarctions—as well as for most coronary artery proce- ting a magnesium-heavy vitamin push.* Just as requirement for insulin.20 One study measured serum Even if your doctor hasn’t studied nutrition and is
16
dures [bypasses, angioplasty, etc.]. ) magnesium has a relaxing effect on your body, it also concentrations of magnesium in 192 people with insu- skeptical (or worse) when it comes to supplements,
Calcium in the bones? Very good. Calcium in the * A form of vitamin injection administered slowly over lin resistance and found that the prevalence of a low chances are he or she will be familiar with the
arteries? Not so good. the course of ten to fifteen minutes. magnesium level was about 65 percent among those benefits of niacin. It’s been known since 1955 that
you an astonishing 17.2-fold increase in your heart Enter magnesium. has a relaxing effect on your arteries. And that’s a with insulin resistance, as opposed to only 5 percent
15
attack risk. Magnesium and calcium have an interesting, sym- very good thing from the perspective of the heart, of those in a control group21
And get this: LDL cholesterol did not differ biotic relationship. When magnesium is depleted, which instead of having to push blood through a nar- Clearly, there’s a strong association between
between the two groups. Ironically, the LDL levels of intracellular calcium rises. Magnesium also inhibits row or constricted vessel (dangerously raising blood magnesium deficiency and insulin resistance. You’ll
the folks who did not suffer heart attacks were slightly platelet aggregation, an important step in the devel- pressure) now has the much easier task of pumping it recall that people with insulin resistance are at great
higher (though not significantly so) than the average opment of clots. Calcium channel blockers widen and through a relaxed, widened vessel that doesn’t put up risk for diabetes, which in turn puts them at great risk
LDL levels of the folks who did suffer heart attacks. relax the blood vessels by affecting the muscle cells so much resistance. Your heart doesn’t have to work for heart disease. Helping to control blood sugar and
So let’s summarize the results. Both groups—the found in the arterial walls, which is exactly what mag- as hard, your blood pressure goes down, and all is insulin is just one more important way in which mag-
forty-one folks who had heart attacks and the 454 nesium does—splendidly, we might add. Magnesium well with the world. nesium is critical for heart health.
folks who didn’t—essentially had the same LDL levels. dilates the arteries, thus reducing blood pressure and There’s another interesting connection between Magnesium is necessary for more than three hun-
(So if you were using patients’ LDL levels to predict making it far easier for the heart to pump blood and magnesium and the heart, and if you’ve followed our dred biochemical reactions in the body, and many of
heart attacks, you’d get no better accuracy than you for the blood to flow freely. argument so far, you’ll love the elegance of how it all these are enzymatic reactions, essential for heart
would by reading their horoscopes!) But if instead of In most of the epidemiologic and clinical trials, a comes full circle. The connection? Sugar. health (or what scientists call myocardial metabo-
LDL levels you looked at the levels of calcium in the high dietary intake of magnesium (at least 500 to You’ll recall from chapter 6 that sugar is one of lism).22 Even borderline deficiencies of magnesium can
arteries, it would be a whole different story. Those 1,000 mg a day) resulted in reduced blood pressure.17 the worst things you can eat if you want to have a negatively affect the heart, and not surprisingly, there
who suffered myocardial infarctions were the most These studies showed an inverse relationship healthy heart. Here’s why: Sugar is highly inflamma- is a considerable amount of evidence associating low
likely to have higher calcium levels in their arteries, between magnesium intake and blood pressure; peo- tory. It also creates dangerous compounds known as levels of magnesium with cardiovascular disease.23
especially when the arteries became totally blocked. ple who consumed more magnesium had lower blood advanced glycation end products, or AGEs, which play Bottom line: Magnesium supplements are a must
19
Coronary artery calcification has long been rec- pressure. One study of sixty hypertensive subjects a pivotal role in atherosclerosis. AGEs play a role of for those who want to protect their hearts. Magne-
ognized as a big risk factor for heart disease, but for who were given magnesium supplementation showed particular importance in type 2 diabetes, which, as sium lowers blood pressure, helps control blood sugar,
some reason we continue to obsessively focus on cho- a significant reduction in blood pressure over an you know, is a condition in which blood sugar and and relaxes the lining of the blood vessels. And
18
lesterol, while few people have heard much about the eight-week period. insulin are essentially at unhealthy levels and have to almost all dietary surveys show that Americans aren’t
calcium connection. So basically, you can think of magnesium as a be brought under control. And diabetes is one way to getting nearly enough.24 We recommend supplement-
Arthur Agatston, M.D., a Florida cardiologist best “relaxer.” One of the most relaxing things you can do fast-track your path to heart disease. ing with at least 400 mg per day.
known as the author of The South Beach Diet, actu- is to bathe in Epsom salts, which is basically a com- One of the very best things magnesium does is NOTE: Magnesium supplementation is not recom-
ally invented a scoring method to determine the pound of magnesium with a little bit of sulfur and help manage blood sugar. In several studies of dia- mended for anyone with renal insufficiency (kidney
severity of calcification in the arteries—it’s known as oxygen. If you’ve ever worked with an integrative betic patients, magnesium supplements of 400 to disease).
the Agatston score. (Research shows that people with medicine practitioner who happens to use vitamin 1,000 mg per day, given for anywhere from three
Agatston scores higher than 400 are at a significantly drips, you might have found that the most amazing weeks to three months, improved a number of mea- NIACIN AND ITS EFFECT ON
increased risk for coronary “events”—myocardial and restful sleep you’ve ever had occurred after get- sures of glycemic (blood sugar) control, including the CHOLESTEROL
infarctions—as well as for most coronary artery proce- ting a magnesium-heavy vitamin push.* Just as requirement for insulin.20 One study measured serum Even if your doctor hasn’t studied nutrition and is
16
dures [bypasses, angioplasty, etc.]. ) magnesium has a relaxing effect on your body, it also concentrations of magnesium in 192 people with insu- skeptical (or worse) when it comes to supplements,
Calcium in the bones? Very good. Calcium in the * A form of vitamin injection administered slowly over lin resistance and found that the prevalence of a low chances are he or she will be familiar with the
arteries? Not so good. the course of ten to fifteen minutes. magnesium level was about 65 percent among those benefits of niacin. It’s been known since 1955 that
cholesterol can be effectively lowered with doses of called “good” cholesterol family—HDL—once again vitamins, and then, a very short time later while ally to a higher level, in divided doses.
25
1,000 to 4,000 mg of niacin daily. Subsequent demonstrating how obsolete and ridiculous the classi- getting dressed, having the distinct feeling that I was • If the flush is too uncomfortable, take a baby
studies have shown that niacin will lower triglycerides fication of cholesterol into just “good” and “bad” going to die. My skin was flushed, warm to the touch, aspirin before the first meal of the day and then
by 20 to 50 percent and LDL cholesterol by 10 to really is!) and my cheeks (and arms) were pinkish red. It wasn’t take the niacin after the meal. Use the aspirin
26
25 percent. The most clinically important side effect of too painful, but it was deeply unpleasant. only as long as you experience the flush and
Niacin is one of two major forms of vitamin B3— much niacin is that it can be very taxing on the liver My 6 a.m. client happened to be the president of whenever you increase your niacin dosage, which
the other is nicotinamide. Although both forms can be (a condition known as hepatotoxicity), although as Dr. a high-end makeup company whose husband was an will trigger a flush.
used for different things in the body, only the niacin Alan Gaby points out in his exhaustive review of nutri- equally well-known Manhattan dermatologist (as well • You can also try taking an apple pectin supple-
form has an effect on your cholesterol, triglycerides, tional supplements and disease, this is almost never as the only doctor I knew who was likely to be awake ment with the niacin to reduce a flush.
30
and related compounds. And the effect is not just on seen in patients taking 3 g or less per day. at this ungodly hour). I called my client, and she • Niacin may increase the enzyme levels in liver
overall cholesterol. Studies have shown that when Abram Hoffer, M.D., the great pioneer of nutri- immediately put her husband on the line. I described function tests. This does not necessarily mean
LDL cholesterol is reduced with niacin, there is a pref- tional and integrative medicine, stated that his thirty my symptoms, and he asked me if I’d taken or eaten that niacin is causing a liver problem, but have
erential reduction of the really nasty LDL molecules, years of experience with niacin therapy (usually 3 g a anything unusual. “Just my vitamins,” I said, to which your doctor keep an eye on it. He or she may
the hard, small, BB gun pellet–type particles that stick day or more) showed that one out of every two thou- he replied without hesitation, “Oh, it’s just the niacin. suggest stopping the niacin for five days before
to the artery walls, get oxidized, and cause damage. sand patients will develop hepatitis from large doses Nothing to worry about, it’ll pass in a few. I’m going your next liver test to avoid possible confusion.
Niacin also reduces lipoprotein(a), or Lp(a). of this vitamin. However, Hoffer also pointed out that back to bed now.” Be aware, though, that when you resume the nia-
Lipoprotein(a) is basically a special kind of LDL, and in all of his patients who developed hepatotoxicity, So that was my first encounter with the infamous cin you will develop a flush.
it’s a really bad one. This, folks, is the real cholesterol liver function returned to normal after treatment was “niacin flush.” It’s basically a temporary flushing of
story! Lp(a) is an independent risk factor for heart discontinued. 31
the skin, not at all dangerous (especially if you know VITAMIN E: THE GOOD, THE BAD,
disease and for heart attacks, yet it doesn’t get as Sustained-release niacin is actually more hepato- it’s coming!), and it’s actually a result of the dilation AND THE UGLY
much attention as cholesterol does because there toxic than regular niacin, and liver problems may of the blood vessels in the skin (which is why my skin For decades, the nutritional world revered vitamin E
32
aren’t effective drug treatments for lowering it, and occur at lower doses. Nausea may be an early warn- turned pink). Some people experience itching as well as something of a heart savior, a major antioxidant
no one really knows what to do about it. Niacin lowers ing sign of niacin-induced hepatotoxicity; if nausea or even a mild burning sensation. It typically goes that defended against lipid peroxidation, which was
27
Lp(a) levels by a remarkable 10 to 30 percent. occurs, the dose should be reduced, or treatment away within a couple of weeks and can usually be thought to be the cause of cardiovascular disease.
33
Equally terrific, if not more so, is the fact that should be stopped. For folks taking therapeutic counteracted with a baby aspirin taken beforehand. (Lipid simply means fat, and peroxidation is a fancy
niacin raises HDL cholesterol. That alone would be doses of niacin, it’s a good idea to have your doctor NOTE: If you are diabetic or have a liver ailment, way of saying oxidative damage from free radicals.)
worth shouting from the rooftops, because we con- check your liver enzymes periodically using a stan- be sure to check with your doctor before supplement- During the 1990s the adulation for vitamin E even
sider HDL cholesterol to be a much undervalued dard liver function test. ing with niacin. extended to mainstream medicine, going as far as the
player in the heart disease story. (We’ll delve into this American Heart Association. In 1996, for instance,
topic later on in the book.) Niacin raises HDL levels by Dr. Jonny: Niacin Flush Dr. Sinatra’s Niacin Know-How vitamin E was celebrated in a well-publicized study for
28
10 to 30 percent. But even better is the fact that it The first time I experienced the “niacin flush” I was • Look for straight, non-time-release niacin (also significantly reducing cardiovascular events over the
preferentially increases HDL-2, which is the most ben- working as a personal trainer. It was five o’clock in the known as nicotinic acid). Take after meals at dos- course of one year among some 2,000 patients with
29
eficial of the HDL subclasses. (HDL-3 is actually pro- morning, and I was getting ready for my 6 a.m. client. ages of 500 mg to 3 g daily. documented heart disease.
inflammatory, even though it’s a member of the so- I remember drinking my protein shake, swallowing my • Start slowly at 100 mg. Work your way up gradu- The successes and reputation of vitamin E
cholesterol can be effectively lowered with doses of called “good” cholesterol family—HDL—once again vitamins, and then, a very short time later while ally to a higher level, in divided doses.
25
1,000 to 4,000 mg of niacin daily. Subsequent demonstrating how obsolete and ridiculous the classi- getting dressed, having the distinct feeling that I was • If the flush is too uncomfortable, take a baby
studies have shown that niacin will lower triglycerides fication of cholesterol into just “good” and “bad” going to die. My skin was flushed, warm to the touch, aspirin before the first meal of the day and then
by 20 to 50 percent and LDL cholesterol by 10 to really is!) and my cheeks (and arms) were pinkish red. It wasn’t take the niacin after the meal. Use the aspirin
26
25 percent. The most clinically important side effect of too painful, but it was deeply unpleasant. only as long as you experience the flush and
Niacin is one of two major forms of vitamin B3— much niacin is that it can be very taxing on the liver My 6 a.m. client happened to be the president of whenever you increase your niacin dosage, which
the other is nicotinamide. Although both forms can be (a condition known as hepatotoxicity), although as Dr. a high-end makeup company whose husband was an will trigger a flush.
used for different things in the body, only the niacin Alan Gaby points out in his exhaustive review of nutri- equally well-known Manhattan dermatologist (as well • You can also try taking an apple pectin supple-
form has an effect on your cholesterol, triglycerides, tional supplements and disease, this is almost never as the only doctor I knew who was likely to be awake ment with the niacin to reduce a flush.
30
and related compounds. And the effect is not just on seen in patients taking 3 g or less per day. at this ungodly hour). I called my client, and she • Niacin may increase the enzyme levels in liver
overall cholesterol. Studies have shown that when Abram Hoffer, M.D., the great pioneer of nutri- immediately put her husband on the line. I described function tests. This does not necessarily mean
LDL cholesterol is reduced with niacin, there is a pref- tional and integrative medicine, stated that his thirty my symptoms, and he asked me if I’d taken or eaten that niacin is causing a liver problem, but have
erential reduction of the really nasty LDL molecules, years of experience with niacin therapy (usually 3 g a anything unusual. “Just my vitamins,” I said, to which your doctor keep an eye on it. He or she may
the hard, small, BB gun pellet–type particles that stick day or more) showed that one out of every two thou- he replied without hesitation, “Oh, it’s just the niacin. suggest stopping the niacin for five days before
to the artery walls, get oxidized, and cause damage. sand patients will develop hepatitis from large doses Nothing to worry about, it’ll pass in a few. I’m going your next liver test to avoid possible confusion.
Niacin also reduces lipoprotein(a), or Lp(a). of this vitamin. However, Hoffer also pointed out that back to bed now.” Be aware, though, that when you resume the nia-
Lipoprotein(a) is basically a special kind of LDL, and in all of his patients who developed hepatotoxicity, So that was my first encounter with the infamous cin you will develop a flush.
it’s a really bad one. This, folks, is the real cholesterol liver function returned to normal after treatment was “niacin flush.” It’s basically a temporary flushing of
story! Lp(a) is an independent risk factor for heart discontinued. 31
the skin, not at all dangerous (especially if you know VITAMIN E: THE GOOD, THE BAD,
disease and for heart attacks, yet it doesn’t get as Sustained-release niacin is actually more hepato- it’s coming!), and it’s actually a result of the dilation AND THE UGLY
much attention as cholesterol does because there toxic than regular niacin, and liver problems may of the blood vessels in the skin (which is why my skin For decades, the nutritional world revered vitamin E
32
aren’t effective drug treatments for lowering it, and occur at lower doses. Nausea may be an early warn- turned pink). Some people experience itching as well as something of a heart savior, a major antioxidant
no one really knows what to do about it. Niacin lowers ing sign of niacin-induced hepatotoxicity; if nausea or even a mild burning sensation. It typically goes that defended against lipid peroxidation, which was
27
Lp(a) levels by a remarkable 10 to 30 percent. occurs, the dose should be reduced, or treatment away within a couple of weeks and can usually be thought to be the cause of cardiovascular disease.
33
Equally terrific, if not more so, is the fact that should be stopped. For folks taking therapeutic counteracted with a baby aspirin taken beforehand. (Lipid simply means fat, and peroxidation is a fancy
niacin raises HDL cholesterol. That alone would be doses of niacin, it’s a good idea to have your doctor NOTE: If you are diabetic or have a liver ailment, way of saying oxidative damage from free radicals.)
worth shouting from the rooftops, because we con- check your liver enzymes periodically using a stan- be sure to check with your doctor before supplement- During the 1990s the adulation for vitamin E even
sider HDL cholesterol to be a much undervalued dard liver function test. ing with niacin. extended to mainstream medicine, going as far as the
player in the heart disease story. (We’ll delve into this American Heart Association. In 1996, for instance,
topic later on in the book.) Niacin raises HDL levels by Dr. Jonny: Niacin Flush Dr. Sinatra’s Niacin Know-How vitamin E was celebrated in a well-publicized study for
28
10 to 30 percent. But even better is the fact that it The first time I experienced the “niacin flush” I was • Look for straight, non-time-release niacin (also significantly reducing cardiovascular events over the
preferentially increases HDL-2, which is the most ben- working as a personal trainer. It was five o’clock in the known as nicotinic acid). Take after meals at dos- course of one year among some 2,000 patients with
29
eficial of the HDL subclasses. (HDL-3 is actually pro- morning, and I was getting ready for my 6 a.m. client. ages of 500 mg to 3 g daily. documented heart disease.
inflammatory, even though it’s a member of the so- I remember drinking my protein shake, swallowing my • Start slowly at 100 mg. Work your way up gradu- The successes and reputation of vitamin E
prompted many to believe that if a little vitamin E was erol alone and not getting enough gamma-tocopherol with LDL removal.35 Tocotrienols provide significant More than thirty years ago, scientists began to
good, then more would be even better! Critical studies in their diets, or in their supplements, could run the lipid-lowering effects in experimental animals, and notice very low rates of cardiovascular disease among
that followed, however, began demonstrating that risk of experiencing a pro-oxidant effect from vitamin most prospective studies have demonstrated the Greenland Eskimos compared to age- and sex-
36
daily doses of vitamin E at 400 IUs and above didn’t E. Moreover, large doses of alpha-tocopherol could same thing in humans. matched Danish control subjects. Shortly afterward,
necessarily generate beneficial results, and, in fact, also deplete the body’s existing gamma-tocopherol If you take vitamin E, we recommend that you they were able to link these low rates of heart disease
might be detrimental to health. (As early as 2003, Dr. stores. always get it from a supplement labeled “mixed to high consumption of omega-3s in the Greenland
Sinatra wrote in his newsletter about his own reluc- A 2011 study provided an even sharper image of tocopherols” in order to avoid the problems that can diet.38 This discovery triggered an enormous amount
tance to back high-dose vitamin E because the emerg- the two faces of vitamin E. In laboratory experiments, occur with pure alpha-tocopherol supplementation. of research on the role of fish oil in preventing heart
ing research indicated possible pro-oxidant effects.) researchers in Belfast found that vitamin E (alpha- A vitamin E supplement that is 100 percent alpha- disease. (As of this writing—January 2020—a National
That said, both of us found ourselves puzzled by and gamma-tocopherol) protects very low-density tocopherol is less effective and may even be prob- Library Medicine [pubmed.gov] search for “omega-3
the negative study results that have popped up since lipoprotein (VLDL) and LDL cholesterol against oxida- lematic in high doses. Virtually all the studies show- cardiovascular benefit” produced 378 peer-review
then. Sure, problems could come from using the syn- tion. That’s a good thing! Yet they found a “surprising negative results used the alpha-tocopherol form journal articles.)
thetic form of vitamin E (designated dl-alpha-tocoph- ing” pro-oxidant effect on HDL (high-density lipopro- or, worse, the synthetic dl-alpha-tocopherol form. One recent review of omega-3s and cardiovascu-
erol) instead of the “natural” form (designatedd- tein), the cholesterol particle that acts like a garbage (The dl-alpha-tocopherol form should be left on the lar disease by Dariush Mozaffarian, M.D., of the
alpha-tocopherol). But a pro-oxidant effect from natu- truck, picking up harmful oxidized LDL and transport- shelf to rot!) Harvard School of Public Health, concluded that
ral vitamin E, considered one of the powerhouses in ing it back to the liver for removal. Anything that can If you add 100 to 200 IUs of mixed tocopherols omega-3 consumption “lowers plasma triglycerides,
the antioxidant armamentarium? How could that be? hinder HDL is of real concern. and gamma vitamin E to a regimen that also includes resting heart rate, and blood pressure and might also
Sharp-eyed readers may have noticed that we put Worth noting is that the researchers referenced a vitamin C and CoQ10, you should be fine! We also like improve myocardial filling and efficiency, lower inflam-
quotation marks around the word natural when refer- previous study in which taking a small amount of vita- the tocotrienols and especially delta tocotrienol as mation, and improve vascular function.”39 Mozaffarian
ring to natural vitamin E in the above paragraph. min C along with your alpha-tocopherol helped pre- the research clearly demonstrates the remarkable also noted that the benefits of omega-3s seem most
That’s because d-alpha-tocopherol by itself is only one vent the negative, pro-oxidant effect of vitamin E on benefits of these compounds. consistent for coronary heart disease mortality and
part of natural vitamin E. Vitamin E is actually a col- HDL. That wouldn’t be the first time one nutrient sudden cardiac death.
lection of eight related compounds that are divided helped another one out. We already know that CoQ10 OMEGA-3: THE ULTIMATE WELLNESS In case your eyes were beginning to glaze over
into two classes: tocopherols and tocotrienols. The helps protect vitamin E in the body and gives it a MOLECULE from all the medical journal speak, let’s sum it up in
tocopherols come in four forms: alpha, delta, beta, hand by recycling it back to an active form after it’s If you’ve read this book sequentially, you’re already plain English: There is reliable and consistent research
and gamma. Of these four forms, the best known is been oxidized in biochemical reactions. (We are big familiar with omega-3 fatty acids from our extensive evidence demonstrating that omega-3 fats, mainly
alpha. When you purchase a “natural” vitamin E sup- fans of the synergistic effects of nutrients.) discussion of them in chapter 10, so here we’ll from fish, lower the death rate from heart disease
plement, most of the time it is 100 percent The other half of the vitamin E story concerns highlight just a few of the many studies and lower the risk of sudden cardiac death. This is
alpha-tocopherol. the four components known as the tocotrienols. demonstrating the value of omega-3 fats for the hard-core evidence that fish oil saves lives.
And therein lies the problem. Tocotrienols are turning out to be the real heavy lift- heart. (We should also point out that there is equally One of the landmark clinical studies of omega-3
Gamma-tocopherol is turning out to be the most ers in the vitamin E family, at least when it comes to compelling research documenting the positive effect supplementation in a high-risk population was pub-
37
potent of the four tocopherols, and the one most benefits for the heart. They have more potent antioxi- of omega-3s on the brain as well, but because this is lished in 1999 and was known as the GISSI-
34
responsible for vitamin E’s positive effects as an anti- dant activity than tocopherols do. They also a book on cholesterol and cardiovascular disease, Prevenzione trial.40 More than 11,000 patients who
oxidant. Thus, people taking high-dose alpha-tocoph- increase the number of LDL receptors, which helps we’ll focus on the heart.) had suffered a heart attack within the past three
prompted many to believe that if a little vitamin E was erol alone and not getting enough gamma-tocopherol with LDL removal.35 Tocotrienols provide significant More than thirty years ago, scientists began to
good, then more would be even better! Critical studies in their diets, or in their supplements, could run the lipid-lowering effects in experimental animals, and notice very low rates of cardiovascular disease among
that followed, however, began demonstrating that risk of experiencing a pro-oxidant effect from vitamin most prospective studies have demonstrated the Greenland Eskimos compared to age- and sex-
36
daily doses of vitamin E at 400 IUs and above didn’t E. Moreover, large doses of alpha-tocopherol could same thing in humans. matched Danish control subjects. Shortly afterward,
necessarily generate beneficial results, and, in fact, also deplete the body’s existing gamma-tocopherol If you take vitamin E, we recommend that you they were able to link these low rates of heart disease
might be detrimental to health. (As early as 2003, Dr. stores. always get it from a supplement labeled “mixed to high consumption of omega-3s in the Greenland
Sinatra wrote in his newsletter about his own reluc- A 2011 study provided an even sharper image of tocopherols” in order to avoid the problems that can diet.38 This discovery triggered an enormous amount
tance to back high-dose vitamin E because the emerg- the two faces of vitamin E. In laboratory experiments, occur with pure alpha-tocopherol supplementation. of research on the role of fish oil in preventing heart
ing research indicated possible pro-oxidant effects.) researchers in Belfast found that vitamin E (alpha- A vitamin E supplement that is 100 percent alpha- disease. (As of this writing—January 2020—a National
That said, both of us found ourselves puzzled by and gamma-tocopherol) protects very low-density tocopherol is less effective and may even be prob- Library Medicine [pubmed.gov] search for “omega-3
the negative study results that have popped up since lipoprotein (VLDL) and LDL cholesterol against oxida- lematic in high doses. Virtually all the studies show- cardiovascular benefit” produced 378 peer-review
then. Sure, problems could come from using the syn- tion. That’s a good thing! Yet they found a “surprising negative results used the alpha-tocopherol form journal articles.)
thetic form of vitamin E (designated dl-alpha-tocoph- ing” pro-oxidant effect on HDL (high-density lipopro- or, worse, the synthetic dl-alpha-tocopherol form. One recent review of omega-3s and cardiovascu-
erol) instead of the “natural” form (designatedd- tein), the cholesterol particle that acts like a garbage (The dl-alpha-tocopherol form should be left on the lar disease by Dariush Mozaffarian, M.D., of the
alpha-tocopherol). But a pro-oxidant effect from natu- truck, picking up harmful oxidized LDL and transport- shelf to rot!) Harvard School of Public Health, concluded that
ral vitamin E, considered one of the powerhouses in ing it back to the liver for removal. Anything that can If you add 100 to 200 IUs of mixed tocopherols omega-3 consumption “lowers plasma triglycerides,
the antioxidant armamentarium? How could that be? hinder HDL is of real concern. and gamma vitamin E to a regimen that also includes resting heart rate, and blood pressure and might also
Sharp-eyed readers may have noticed that we put Worth noting is that the researchers referenced a vitamin C and CoQ10, you should be fine! We also like improve myocardial filling and efficiency, lower inflam-
quotation marks around the word natural when refer- previous study in which taking a small amount of vita- the tocotrienols and especially delta tocotrienol as mation, and improve vascular function.”39 Mozaffarian
ring to natural vitamin E in the above paragraph. min C along with your alpha-tocopherol helped pre- the research clearly demonstrates the remarkable also noted that the benefits of omega-3s seem most
That’s because d-alpha-tocopherol by itself is only one vent the negative, pro-oxidant effect of vitamin E on benefits of these compounds. consistent for coronary heart disease mortality and
part of natural vitamin E. Vitamin E is actually a col- HDL. That wouldn’t be the first time one nutrient sudden cardiac death.
lection of eight related compounds that are divided helped another one out. We already know that CoQ10 OMEGA-3: THE ULTIMATE WELLNESS In case your eyes were beginning to glaze over
into two classes: tocopherols and tocotrienols. The helps protect vitamin E in the body and gives it a MOLECULE from all the medical journal speak, let’s sum it up in
tocopherols come in four forms: alpha, delta, beta, hand by recycling it back to an active form after it’s If you’ve read this book sequentially, you’re already plain English: There is reliable and consistent research
and gamma. Of these four forms, the best known is been oxidized in biochemical reactions. (We are big familiar with omega-3 fatty acids from our extensive evidence demonstrating that omega-3 fats, mainly
alpha. When you purchase a “natural” vitamin E sup- fans of the synergistic effects of nutrients.) discussion of them in chapter 10, so here we’ll from fish, lower the death rate from heart disease
plement, most of the time it is 100 percent The other half of the vitamin E story concerns highlight just a few of the many studies and lower the risk of sudden cardiac death. This is
alpha-tocopherol. the four components known as the tocotrienols. demonstrating the value of omega-3 fats for the hard-core evidence that fish oil saves lives.
And therein lies the problem. Tocotrienols are turning out to be the real heavy lift- heart. (We should also point out that there is equally One of the landmark clinical studies of omega-3
Gamma-tocopherol is turning out to be the most ers in the vitamin E family, at least when it comes to compelling research documenting the positive effect supplementation in a high-risk population was pub-
37
potent of the four tocopherols, and the one most benefits for the heart. They have more potent antioxi- of omega-3s on the brain as well, but because this is lished in 1999 and was known as the GISSI-
34
responsible for vitamin E’s positive effects as an anti- dant activity than tocopherols do. They also a book on cholesterol and cardiovascular disease, Prevenzione trial.40 More than 11,000 patients who
oxidant. Thus, people taking high-dose alpha-tocoph- increase the number of LDL receptors, which helps we’ll focus on the heart.) had suffered a heart attack within the past three
months were randomly assigned to receive either 1 g tistically significant 19 percent reduction in major coro- at least 2 g daily of combined EPA and DHA. (Jonny is 900 mg of pantethine divided into three daily doses
45
a day of omega-3s, 300 mg of vitamin E, both, or nei- nary events compared to the control group. a fan of even higher doses—3 to 4 g a day of com- of 300 mg each.
ther, in addition to whatever standard therapy they Omega-3 fats, particularly from healthy, wild fish, bined EPA and DHA.
were receiving. Vitamin E had no effect, but omega-3s are your heart’s best friend, whether you’re recover- GLUCOSAMINE SULFATE
were associated with a 20 percent reduction in mor- ing from a heart attack or hoping to prevent one. PANTETHINE: YOUR SECRET If you’re familiar with glucosamine sulfate, you might
tality and a whopping 45 percent reduction in the risk They lower triglycerides. And they lower blood pres- WEAPON be surprised to find it listed here as a potential
of sudden death. These effects were apparent within sure. And best of all, omega-3s are among the most Pantethine is a metabolically active (and somewhat supplement for heart health. Actually, we were also
41
a mere three months of therapy. anti-inflammatory compounds on the planet, meaning more expensive) form of vitamin B5 (pantothenic surprised. For decades, glucosamine—together with a
International guidelines recommend 1 g of they have a beneficial effect on the root causes of acid). The blood tests of patients with dyslipidemia—a synergistic nutrient called chondrotrin sulfate—have
omega-3 fats daily for all people who’ve already had a heart disease. fancy way of saying that their blood levels of been known as supplements for joint health.
heart attack or for patients with elevated triglycer- We recommend that you take 2 to 3 g of fish oil cholesterol are too high—significantly improve with Indeed, almost all the research on glucosamine—a
42
ides. Experts believe these guidelines will soon be daily. Since the publication of the first edition, recom- pantethine supplementation. And although this can’t natural component of cartilage—has been done on
43
extended to patients with heart failure as well. mendations by functional medicine doctors in the be seen on a blood test, pantethine also reduces the arthritis patients. And the results, though generally
46
It’s worth mentioning that the overwhelming know tend to run closer to 3 to 4 g a day, and that’s oxidation of LDL. positive, have not always been conclusive. Sometimes
majority of research on omega-3s and heart disease of combined EPA and DHA (see below for explana- No fewer than twenty-eight clinical trials in it works for knee arthritis, but not for hip arthritis.
was done using the two omega-3s that are found in tion), We also recommend that you eat cold water fish humans have shown that pantethine produces signifi- (Why? Who knows?) Sometimes it works for people
fish, EPA and DHA. But other studies have also found (such as wild salmon) as often as you can. We both cant positive changes in triglycerides, LDL cholesterol, with moderate-to-severe arthritic pain, but not for
47
that ALA—the omega-3 found in plant foods such as recommend Vital Choice, an impeccable source of wild and VLDL, along with increases in HDL cholesterol. mild pain. But overall, it’s a very researched supple-
flax and flaxseed oil—has benefits for the heart as salmon from pristine Alaskan waters that is reason- In all of these trials, virtually no adverse effects were ment that has generally helped people with pain
well. One review of the literature pointed out that ably priced and shipped in dry ice directly to your noted. The mean dose of pantethine in these studies related to joints, and those who use it swear by it.
both in vitro (test-tube) studies and animal studies door. Like many health professionals, we buy nearly was 900 mg per day given as 300 mg three times (Full disclosure: One of us—Jonny—has severe
have shown that ALA can prevent ventricular fibrilla- all of our fish—and 100 percent of our salmon—from daily. This appears to be the optimal dosage, and it is arthritis of the shoulder and is a competitive tennis
tion, the chief mechanism of cardiac death, and that Vital Choice. You can find links to this terrific com- the one we recommend. player. Jonny takes a daily dose of 1500 mg of glucos-
it might be even more efficient at preventing this pany on our websites. According to a review of the literature on pante- amine sulfate—together with 1250 mg of chondroitin—
than EPA and DHA are. The review also noted that When you supplement with fish oil, remember thine published in Progress in Cardiovascular as part of his joint supplement routine, and has found
ALA was effective at lowering platelet aggregation, that the total amount of omega-3s is not what’s Diseases, Mark Houston, M.D., noted that in most it. together with CBD, fish oil, and a few other things,
which is an important step in thrombosis (a stroke or important. Bargain-basement omega-3 supplements studies, at the end of four months pantethine reduced to be extremely helpful.)
44
nonfatal heart attack). often tout on their labels how much omega-3 they total cholesterol by 15.1 percent, LDL by 20.1 percent, So why is glucosamine making a surprise appear-
Even if you’re already on a statin drug and have contain. This number by itself is meaningless. You and triglycerides by 32.9 percent, with an increase in ance in the heart supplement section of this book?
48
decided to remain on one, fish oil can still help you. want to know specifically how much EPA and DHA are HDL of 8.4 percent. Houston also noted that in stud- Well, one thing we know about glucosamine is
One study found that among more than 3,600 people contained within each capsule. These are the gold ies of longer duration, there appeared to be continued that it’s anti-inflammatory. Another thing we know is
with a history of cardiovascular disease—many of whom nuggets in the prospector’s tin—you don’t care about improvement. (The only adverse reactions were mild that glucosamine works even better when it’s com-
were on antiplatelet drugs, antihypertensive agents, the total amount of stones in that pan, you care gastrointestinal side effects in less than 4 percent of bined with fish oil, the combo providing a double
and nitrates—daily fish oil supplementation led to a sta- about the gold. EPA and DHA are the gold. Try to get the subjects.) As previously stated, we recommend whammy of anti-inflammatory power.49
months were randomly assigned to receive either 1 g tistically significant 19 percent reduction in major coro- at least 2 g daily of combined EPA and DHA. (Jonny is 900 mg of pantethine divided into three daily doses
45
a day of omega-3s, 300 mg of vitamin E, both, or nei- nary events compared to the control group. a fan of even higher doses—3 to 4 g a day of com- of 300 mg each.
ther, in addition to whatever standard therapy they Omega-3 fats, particularly from healthy, wild fish, bined EPA and DHA.
were receiving. Vitamin E had no effect, but omega-3s are your heart’s best friend, whether you’re recover- GLUCOSAMINE SULFATE
were associated with a 20 percent reduction in mor- ing from a heart attack or hoping to prevent one. PANTETHINE: YOUR SECRET If you’re familiar with glucosamine sulfate, you might
tality and a whopping 45 percent reduction in the risk They lower triglycerides. And they lower blood pres- WEAPON be surprised to find it listed here as a potential
of sudden death. These effects were apparent within sure. And best of all, omega-3s are among the most Pantethine is a metabolically active (and somewhat supplement for heart health. Actually, we were also
41
a mere three months of therapy. anti-inflammatory compounds on the planet, meaning more expensive) form of vitamin B5 (pantothenic surprised. For decades, glucosamine—together with a
International guidelines recommend 1 g of they have a beneficial effect on the root causes of acid). The blood tests of patients with dyslipidemia—a synergistic nutrient called chondrotrin sulfate—have
omega-3 fats daily for all people who’ve already had a heart disease. fancy way of saying that their blood levels of been known as supplements for joint health.
heart attack or for patients with elevated triglycer- We recommend that you take 2 to 3 g of fish oil cholesterol are too high—significantly improve with Indeed, almost all the research on glucosamine—a
42
ides. Experts believe these guidelines will soon be daily. Since the publication of the first edition, recom- pantethine supplementation. And although this can’t natural component of cartilage—has been done on
43
extended to patients with heart failure as well. mendations by functional medicine doctors in the be seen on a blood test, pantethine also reduces the arthritis patients. And the results, though generally
46
It’s worth mentioning that the overwhelming know tend to run closer to 3 to 4 g a day, and that’s oxidation of LDL. positive, have not always been conclusive. Sometimes
majority of research on omega-3s and heart disease of combined EPA and DHA (see below for explana- No fewer than twenty-eight clinical trials in it works for knee arthritis, but not for hip arthritis.
was done using the two omega-3s that are found in tion), We also recommend that you eat cold water fish humans have shown that pantethine produces signifi- (Why? Who knows?) Sometimes it works for people
fish, EPA and DHA. But other studies have also found (such as wild salmon) as often as you can. We both cant positive changes in triglycerides, LDL cholesterol, with moderate-to-severe arthritic pain, but not for
47
that ALA—the omega-3 found in plant foods such as recommend Vital Choice, an impeccable source of wild and VLDL, along with increases in HDL cholesterol. mild pain. But overall, it’s a very researched supple-
flax and flaxseed oil—has benefits for the heart as salmon from pristine Alaskan waters that is reason- In all of these trials, virtually no adverse effects were ment that has generally helped people with pain
well. One review of the literature pointed out that ably priced and shipped in dry ice directly to your noted. The mean dose of pantethine in these studies related to joints, and those who use it swear by it.
both in vitro (test-tube) studies and animal studies door. Like many health professionals, we buy nearly was 900 mg per day given as 300 mg three times (Full disclosure: One of us—Jonny—has severe
have shown that ALA can prevent ventricular fibrilla- all of our fish—and 100 percent of our salmon—from daily. This appears to be the optimal dosage, and it is arthritis of the shoulder and is a competitive tennis
tion, the chief mechanism of cardiac death, and that Vital Choice. You can find links to this terrific com- the one we recommend. player. Jonny takes a daily dose of 1500 mg of glucos-
it might be even more efficient at preventing this pany on our websites. According to a review of the literature on pante- amine sulfate—together with 1250 mg of chondroitin—
than EPA and DHA are. The review also noted that When you supplement with fish oil, remember thine published in Progress in Cardiovascular as part of his joint supplement routine, and has found
ALA was effective at lowering platelet aggregation, that the total amount of omega-3s is not what’s Diseases, Mark Houston, M.D., noted that in most it. together with CBD, fish oil, and a few other things,
which is an important step in thrombosis (a stroke or important. Bargain-basement omega-3 supplements studies, at the end of four months pantethine reduced to be extremely helpful.)
44
nonfatal heart attack). often tout on their labels how much omega-3 they total cholesterol by 15.1 percent, LDL by 20.1 percent, So why is glucosamine making a surprise appear-
Even if you’re already on a statin drug and have contain. This number by itself is meaningless. You and triglycerides by 32.9 percent, with an increase in ance in the heart supplement section of this book?
48
decided to remain on one, fish oil can still help you. want to know specifically how much EPA and DHA are HDL of 8.4 percent. Houston also noted that in stud- Well, one thing we know about glucosamine is
One study found that among more than 3,600 people contained within each capsule. These are the gold ies of longer duration, there appeared to be continued that it’s anti-inflammatory. Another thing we know is
with a history of cardiovascular disease—many of whom nuggets in the prospector’s tin—you don’t care about improvement. (The only adverse reactions were mild that glucosamine works even better when it’s com-
were on antiplatelet drugs, antihypertensive agents, the total amount of stones in that pan, you care gastrointestinal side effects in less than 4 percent of bined with fish oil, the combo providing a double
and nitrates—daily fish oil supplementation led to a sta- about the gold. EPA and DHA are the gold. Try to get the subjects.) As previously stated, we recommend whammy of anti-inflammatory power.49
Given its anti-inflammatory actions, it really dent—it was not a huge effect. Glucosamine use was lin resistance, it’s not entirely surprising that omega- ideal, is well within the “average risk” range for
shouldn’t be all that remarkable that glucosamine associated with a 15 percent lower risk of total CVD 7s also helps with breaking down fat and increasing inflammation-induced cardiovascular disease.
might have a place in a supplement program designed (cardiovascular disease) events, 22 percent lower risk the enzymes that are needed for fat burning in the This study—having been done at one of the most
53
to protect the heart. And in fact, that’s exactly what a of CVD death, 18 percent lower risk of coronary heart first place. prestigious medical centers in the world, and produc-
recent study in the British Medical Journal found. disease (slightly different from cardiovascular dis- Fat cells produce inflammatory cytokines, as well ing such a significant result—is why we think omega-7
51
Researchers led by Dr. Lu Qi at the Tulane ease), and a 9 percent lower risk for stroke. as other bad actors. They release molecules called may well have a place in the treatment and preven-
University Obesity Research Center in New Orleans Still. That’s not nothing. adipokines that can change the metabolic activity of tion of cardiometabolic disease. One company—
did a lifestyle survey involving more than 466,000 Glucosamine sulfate wouldn’t be our first choice tissues and ultimately produce higher levels of Barlean’s—makes a product with the exact dose used
54
men and women, none of whom had been diagnosed for a heart supplement. But it definitely is one you inflammation. That’s why reducing excess body fat in the study, 210 mg. It’s called Heart Remedy. (Full
with heart disease when survey polling began. They should consider adding to your heart supplement is always a good idea if you’re trying to prevent heart disclosure: Barlean’s also makes a 440 mg dose of
were tracked for an average of seven years. Those routine. disease. Remember, heart disease is in large measure the same omega-7 in a product called Joint Relief. We
taking the supplement had a 15 percent lower risk for an inflammatory disease, and anything that reduces see no reason not to take the higher dose, but either
heart disease. Glucosamine was also associated with a OMEGA-7 inflammation—like losing weight—is a net gain for will provide high quality omega-7.)
significant drop in the experience of coronary heart By now you’ve heard us talk about inflammation quite your heart.
disease, stroke, or death from heart-disease related a bit. That’s because there is no disease either of us Which brings us to the remarkable study on OTHER SUPPLEMENTATION YOU
issues. can think of that doesn’t involve inflammation, and omega-7 performed at the Cleveland Clinic. 55
SHOULD CONSIDER
Dr. Qi, commenting on his own findings, said, “I that’s especially true with heart disease. Therefore, The first randomized control trial of omega-7 sup- Picking the “top” supplements for treating any health
am a bit surprised but not very much, because previ- anything that can be demonstrated to reduce plements in humans was done at the Cleveland Clinic issue is always difficult. In trying to keep the list from
ous studies from humans or animals have shown that systemic inflammation gets our attention. Wellness Institute. Overweight or obese adults with being too overwhelming, you’re always going to leave
glucosamine may have protective effects on inflam- Enter Omega-7. evidence of inflammation—defined as CRP levels a few good things out. There’s also the very real issue
mation, which is a risk factor for cardiovascular dis- Most people have never heard of omega-7, but it’s between 2 mg/L and 5 mg/L—were randomly assigned of compliance. Most people don’t like to take a lot of
ease.” Dr. Qi added. “In addition, glucosamine use may proving to be incredibly important. The main omega-7 to two groups. One group got 220 mg of purified pills, even if the pills in question are natural sub-
mimic effects of a low-carbohydrate diet, which has fat in the body is called palmitoleic acid, and it’s been omega-7 supplementation, one group got a placebo. stances that will boost or protect their health. We
50
been also related to lower CVD risk.” shown to work on the cycle of events we refer to as The “outcome” measure was CRP score (see page consider the following supplements important, and
Now let’s be clear about two things. One, this is “diabetic physiology” (see chapter 9)—high blood 198), which, you may remember stands for C-reactive we suggest that you read about what they do and
an observational/association study. Association does sugar, elevated lipids (fats), excessive body fat, and, protein and is a blood measure for systemic consider using them in addition to the key
not prove causality; it simply shows that two things inevitably, insulin resistance. It’s this cycle—nearly inflammation. supplements discussed above.
are consistently found together, more so than they always triggered by too much sugar and starch—that The average baseline C-reactive protein (CRP) Vitamin C. Vitamin C is one of the most powerful
would be by chance. So while there’s now evidence we believe is the number one set of risk factors for level for all subjects in the study was 4.3 ml/DL, con- antioxidants in the world, and because heart disease
that taking glucosamine is related to a reduction in heart disease. (You’ll see why in Chapter 12.) sidered “high risk” for cardiovascular disease. But is initiated by oxidative damage (damage caused by
the risk for heart disease, we don’t know for sure that Omega-7 actually enhances insulin sensitivity (the after only thirty days, there was a 44 percent reduc- free radicals), any help you can get in the antioxidant
52
one caused the other. exact opposite of the dreaded insulin resistance!). tion in CRP levels in the omega-7 group compared to department is a good thing. And the evidence is not
Two, the effect was small. Though it was statisti- Since insulin resistance and fat accumulation tend to the placebo group. Those who took the supplement just theoretical: A large 2011 study published in the
cally significant—unlikely to have been found by acci- go hand in hand, and since omega-7 helps fight insu- wound up with an average CRP of 2.1, which, while not American Heart Journal found that the lower the
Given its anti-inflammatory actions, it really dent—it was not a huge effect. Glucosamine use was lin resistance, it’s not entirely surprising that omega- ideal, is well within the “average risk” range for
shouldn’t be all that remarkable that glucosamine associated with a 15 percent lower risk of total CVD 7s also helps with breaking down fat and increasing inflammation-induced cardiovascular disease.
might have a place in a supplement program designed (cardiovascular disease) events, 22 percent lower risk the enzymes that are needed for fat burning in the This study—having been done at one of the most
53
to protect the heart. And in fact, that’s exactly what a of CVD death, 18 percent lower risk of coronary heart first place. prestigious medical centers in the world, and produc-
recent study in the British Medical Journal found. disease (slightly different from cardiovascular dis- Fat cells produce inflammatory cytokines, as well ing such a significant result—is why we think omega-7
51
Researchers led by Dr. Lu Qi at the Tulane ease), and a 9 percent lower risk for stroke. as other bad actors. They release molecules called may well have a place in the treatment and preven-
University Obesity Research Center in New Orleans Still. That’s not nothing. adipokines that can change the metabolic activity of tion of cardiometabolic disease. One company—
did a lifestyle survey involving more than 466,000 Glucosamine sulfate wouldn’t be our first choice tissues and ultimately produce higher levels of Barlean’s—makes a product with the exact dose used
54
men and women, none of whom had been diagnosed for a heart supplement. But it definitely is one you inflammation. That’s why reducing excess body fat in the study, 210 mg. It’s called Heart Remedy. (Full
with heart disease when survey polling began. They should consider adding to your heart supplement is always a good idea if you’re trying to prevent heart disclosure: Barlean’s also makes a 440 mg dose of
were tracked for an average of seven years. Those routine. disease. Remember, heart disease is in large measure the same omega-7 in a product called Joint Relief. We
taking the supplement had a 15 percent lower risk for an inflammatory disease, and anything that reduces see no reason not to take the higher dose, but either
heart disease. Glucosamine was also associated with a OMEGA-7 inflammation—like losing weight—is a net gain for will provide high quality omega-7.)
significant drop in the experience of coronary heart By now you’ve heard us talk about inflammation quite your heart.
disease, stroke, or death from heart-disease related a bit. That’s because there is no disease either of us Which brings us to the remarkable study on OTHER SUPPLEMENTATION YOU
issues. can think of that doesn’t involve inflammation, and omega-7 performed at the Cleveland Clinic. 55
SHOULD CONSIDER
Dr. Qi, commenting on his own findings, said, “I that’s especially true with heart disease. Therefore, The first randomized control trial of omega-7 sup- Picking the “top” supplements for treating any health
am a bit surprised but not very much, because previ- anything that can be demonstrated to reduce plements in humans was done at the Cleveland Clinic issue is always difficult. In trying to keep the list from
ous studies from humans or animals have shown that systemic inflammation gets our attention. Wellness Institute. Overweight or obese adults with being too overwhelming, you’re always going to leave
glucosamine may have protective effects on inflam- Enter Omega-7. evidence of inflammation—defined as CRP levels a few good things out. There’s also the very real issue
mation, which is a risk factor for cardiovascular dis- Most people have never heard of omega-7, but it’s between 2 mg/L and 5 mg/L—were randomly assigned of compliance. Most people don’t like to take a lot of
ease.” Dr. Qi added. “In addition, glucosamine use may proving to be incredibly important. The main omega-7 to two groups. One group got 220 mg of purified pills, even if the pills in question are natural sub-
mimic effects of a low-carbohydrate diet, which has fat in the body is called palmitoleic acid, and it’s been omega-7 supplementation, one group got a placebo. stances that will boost or protect their health. We
50
been also related to lower CVD risk.” shown to work on the cycle of events we refer to as The “outcome” measure was CRP score (see page consider the following supplements important, and
Now let’s be clear about two things. One, this is “diabetic physiology” (see chapter 9)—high blood 198), which, you may remember stands for C-reactive we suggest that you read about what they do and
an observational/association study. Association does sugar, elevated lipids (fats), excessive body fat, and, protein and is a blood measure for systemic consider using them in addition to the key
not prove causality; it simply shows that two things inevitably, insulin resistance. It’s this cycle—nearly inflammation. supplements discussed above.
are consistently found together, more so than they always triggered by too much sugar and starch—that The average baseline C-reactive protein (CRP) Vitamin C. Vitamin C is one of the most powerful
would be by chance. So while there’s now evidence we believe is the number one set of risk factors for level for all subjects in the study was 4.3 ml/DL, con- antioxidants in the world, and because heart disease
that taking glucosamine is related to a reduction in heart disease. (You’ll see why in Chapter 12.) sidered “high risk” for cardiovascular disease. But is initiated by oxidative damage (damage caused by
the risk for heart disease, we don’t know for sure that Omega-7 actually enhances insulin sensitivity (the after only thirty days, there was a 44 percent reduc- free radicals), any help you can get in the antioxidant
52
one caused the other. exact opposite of the dreaded insulin resistance!). tion in CRP levels in the omega-7 group compared to department is a good thing. And the evidence is not
Two, the effect was small. Though it was statisti- Since insulin resistance and fat accumulation tend to the placebo group. Those who took the supplement just theoretical: A large 2011 study published in the
cally significant—unlikely to have been found by acci- go hand in hand, and since omega-7 helps fight insu- wound up with an average CRP of 2.1, which, while not American Heart Journal found that the lower the
level of vitamin C in the blood, the higher the risk for nent of resveratrol. Read labels carefully to see what
56
heart failure. Take 1,000 to 2,000 mg a day. percentage of the capsule is actually the “trans” vari-
NATURAL CLOT BUSTERS: NATTOKINASE AND LUMBROKINASE
Worth knowing: Vitamin C is extremely safe, and ety, because that’s the only kind that counts.
Hyperviscosity refers to sticky, or sludgy, blood. When blood thickens, it bogs down as it moves
side effects are rare because the body can’t store the Citrus Bergamot. Citrus bergamot is a fruit
through the blood vessels, causing platelets to stick together and clump. Blood vessels become
vitamin. (In some cases, doses exceeding 2,000 mg a that’s endemic to the Calabrian region in Southern
more rigid, less elastic, and frequently calcified. The danger lies in the tendency to form clots
day can lead to a little harmless stomach upset and Italy and if it lives up to its promise—which it seems to
that can block vessels leading to vital organs.
diarrhea.) The bigger danger is the fact that vitamin be doing—it may turn out to be one of the most
Nattokinase is extracted from the traditional fermented soy food natto, believed by many
C increases the amount of iron absorbed from foods. important supplements for the prevention of meta-
researchers to contribute to the low incidence of coronary heart disease in Japan. It provides
People with hemochromatosis, an inherited condition bolic syndrome (aka insulin resistance syndrome or
a unique, powerful, and safe way to eliminate clots, or reduce the tendency to form clots, and
in which too much iron builds up in the bloodstream, pre-diabetes). Metabolic syndrome, you’ll remember, is
thus decrease the risk of heart attack and stroke.64
should not take more than 100 mg of supplemental a collection of symptoms (high blood sugar, high tri-
Lumbrokinase, developed in both Japan and China, comes from an extract of earthworm, a
vitamin C. glycerides, high blood pressure, abdominal fat, etc.)
traditional source of healing in Asian medicine. These two separate products of dynamic Asian
Curcumin. This extract from the Indian spice tur- that greatly increases the risk for heart disease.
research share a powerful and common property of great interest to anyone who wants to
meric has multiple benefits, not the least of which is Citrus bergamot lowers blood sugar. It lowers tri-
protect their cardiovascular system: They are natural clot eaters.
that it’s highly anti-inflammatory. Scientific research glycerides. And it lowers blood pressure. Dr. Sinatra
Here’s how it works: Your body naturally produces fibrin, a fibrous protein formed from
has demonstrated its anti-inflammatory, antioxidant, calls this, “ a trifecta of cardiovascular health.”
fibrinogen. (A fibrinogen test is one of the blood tests we recommend—see appendix B—
anti-thrombotic, and cardiovascular protective As with all of the other supplements, but espe-
because it is a good marker of how much fibrin you’re making.) Fibrin is both good and bad. Its 57
effects. Curcumin also reduces oxidized LDL choles- cially with resveratrol, curcumin, and fish oil, you
clot-forming action is immediately activated when bleeding occurs, so that’s a good thing. But 58
terol. In animal studies, it was shown to protect the need to pay attention to the label and the amount of
excess fibrin activity can produce consistently thick blood, and that’s a big problem.
lining of the artery walls from damage caused by active ingredients. Look for bergamot products with
To offset the danger—and to create thinner blood—the body produces another substance 59
homocysteine. The synergistic relationship of cur- a high percentage of polyphenols (at least 30 per-
called plasmin, an enzyme whose job is to break down excess fibrin. A nice system of checks
cumin with resveratrol is especially important. cent if not more). Citrus bergamot extract of 38
and balances. But if plasmin, the natural anticlotting agent, becomes overwhelmed and can’t
Resveratrol. Resveratrol is the ingredient in red percent polyphenols has been demonstrated to sup-
keep up with the job, there’s trouble in River City. And that’s where nattokinase and
wine that’s best known for its “anti-aging” activity. It press inflammation, inhibit plaque formation, and
lumbrokinase come in. If blood clots in an already narrowed blood vessel, you’re basically
helps protect the arteries by improving their elastic- improve arterial responsiveness, thus contributing
screwed. So if you can dissolve the clotted material, you can open arteries and improve blood
ity, inhibits blood clots, and lowers both oxidized LDL mightily to cardiovascular health.62
flow. If you reduce the clot even just a tiny bit, you get a significant blood flow boost.
and blood pressure.60 Not a bad resume! It’s both a Berberine. Berberine is an active biological com-
Nattokinase and lumbrokinase are natural blood thinners. They can literally turn your blood
strong antioxidant and a strong anti-inflammatory, pound that can be extracted from a number of plants,
from the consistency of ketchup to the consistency of red wine! Best of all, they work pretty
inhibiting a number of inflammatory enzymes that notably shrubs. Although it has a long history of use
quickly, within minutes to hours.
can contribute to heart disease. It also inhibits the in traditional Chinese medicine, it’s now earning a
If you take these supplements preventively, you may not form clots in the first place.
ability of certain molecules to stick to the arterial reputation among modern day health practitioners in
walls, where they can take up residence and contrib- the west as an effective adjunct treatment for a num-
61
ute to inflammation. The recommended daily dose is ber of cardiometabolic issues.
30 to 200 mg of trans-resveratrol, the active compo- It is a powerful antioxidant and anti-inflammatory
level of vitamin C in the blood, the higher the risk for nent of resveratrol. Read labels carefully to see what
56
heart failure. Take 1,000 to 2,000 mg a day. percentage of the capsule is actually the “trans” vari-
NATURAL CLOT BUSTERS: NATTOKINASE AND LUMBROKINASE
Worth knowing: Vitamin C is extremely safe, and ety, because that’s the only kind that counts.
Hyperviscosity refers to sticky, or sludgy, blood. When blood thickens, it bogs down as it moves
side effects are rare because the body can’t store the Citrus Bergamot. Citrus bergamot is a fruit
through the blood vessels, causing platelets to stick together and clump. Blood vessels become
vitamin. (In some cases, doses exceeding 2,000 mg a that’s endemic to the Calabrian region in Southern
more rigid, less elastic, and frequently calcified. The danger lies in the tendency to form clots
day can lead to a little harmless stomach upset and Italy and if it lives up to its promise—which it seems to
that can block vessels leading to vital organs.
diarrhea.) The bigger danger is the fact that vitamin be doing—it may turn out to be one of the most
Nattokinase is extracted from the traditional fermented soy food natto, believed by many
C increases the amount of iron absorbed from foods. important supplements for the prevention of meta-
researchers to contribute to the low incidence of coronary heart disease in Japan. It provides
People with hemochromatosis, an inherited condition bolic syndrome (aka insulin resistance syndrome or
a unique, powerful, and safe way to eliminate clots, or reduce the tendency to form clots, and
in which too much iron builds up in the bloodstream, pre-diabetes). Metabolic syndrome, you’ll remember, is
thus decrease the risk of heart attack and stroke.64
should not take more than 100 mg of supplemental a collection of symptoms (high blood sugar, high tri-
Lumbrokinase, developed in both Japan and China, comes from an extract of earthworm, a
vitamin C. glycerides, high blood pressure, abdominal fat, etc.)
traditional source of healing in Asian medicine. These two separate products of dynamic Asian
Curcumin. This extract from the Indian spice tur- that greatly increases the risk for heart disease.
research share a powerful and common property of great interest to anyone who wants to
meric has multiple benefits, not the least of which is Citrus bergamot lowers blood sugar. It lowers tri-
protect their cardiovascular system: They are natural clot eaters.
that it’s highly anti-inflammatory. Scientific research glycerides. And it lowers blood pressure. Dr. Sinatra
Here’s how it works: Your body naturally produces fibrin, a fibrous protein formed from
has demonstrated its anti-inflammatory, antioxidant, calls this, “ a trifecta of cardiovascular health.”
fibrinogen. (A fibrinogen test is one of the blood tests we recommend—see appendix B—
anti-thrombotic, and cardiovascular protective As with all of the other supplements, but espe-
because it is a good marker of how much fibrin you’re making.) Fibrin is both good and bad. Its 57
effects. Curcumin also reduces oxidized LDL choles- cially with resveratrol, curcumin, and fish oil, you
clot-forming action is immediately activated when bleeding occurs, so that’s a good thing. But 58
terol. In animal studies, it was shown to protect the need to pay attention to the label and the amount of
excess fibrin activity can produce consistently thick blood, and that’s a big problem.
lining of the artery walls from damage caused by active ingredients. Look for bergamot products with
To offset the danger—and to create thinner blood—the body produces another substance 59
homocysteine. The synergistic relationship of cur- a high percentage of polyphenols (at least 30 per-
called plasmin, an enzyme whose job is to break down excess fibrin. A nice system of checks
cumin with resveratrol is especially important. cent if not more). Citrus bergamot extract of 38
and balances. But if plasmin, the natural anticlotting agent, becomes overwhelmed and can’t
Resveratrol. Resveratrol is the ingredient in red percent polyphenols has been demonstrated to sup-
keep up with the job, there’s trouble in River City. And that’s where nattokinase and
wine that’s best known for its “anti-aging” activity. It press inflammation, inhibit plaque formation, and
lumbrokinase come in. If blood clots in an already narrowed blood vessel, you’re basically
helps protect the arteries by improving their elastic- improve arterial responsiveness, thus contributing
screwed. So if you can dissolve the clotted material, you can open arteries and improve blood
ity, inhibits blood clots, and lowers both oxidized LDL mightily to cardiovascular health.62
flow. If you reduce the clot even just a tiny bit, you get a significant blood flow boost.
and blood pressure.60 Not a bad resume! It’s both a Berberine. Berberine is an active biological com-
Nattokinase and lumbrokinase are natural blood thinners. They can literally turn your blood
strong antioxidant and a strong anti-inflammatory, pound that can be extracted from a number of plants,
from the consistency of ketchup to the consistency of red wine! Best of all, they work pretty
inhibiting a number of inflammatory enzymes that notably shrubs. Although it has a long history of use
quickly, within minutes to hours.
can contribute to heart disease. It also inhibits the in traditional Chinese medicine, it’s now earning a
If you take these supplements preventively, you may not form clots in the first place.
ability of certain molecules to stick to the arterial reputation among modern day health practitioners in
walls, where they can take up residence and contrib- the west as an effective adjunct treatment for a num-
61
ute to inflammation. The recommended daily dose is ber of cardiometabolic issues.
30 to 200 mg of trans-resveratrol, the active compo- It is a powerful antioxidant and anti-inflammatory
that also decreases triglycerides and blood sugar. And color to salmon, shrimp, lobster, and crab to mention
some research shows it may increase insulin recep- a few. It has more antioxidant power than vitamin C
tors (which would increase insulin sensitivity and and even pycnogenol. He was so enthusiastic about  WHAT YOU NEED TO KNOW
reduce insulin resistance). It also increases nitrous what he heard that he started to incorporate astaxan- • Coenzyme Q10 (CoQ10) is a kind of “energy fuel” for the heart. Statins deplete CoQ10;
oxide. thin into his Omega Vitalisea product at Healthy supplementation is an absolute necessity if you’re on a statin drug, and it is a very good idea
A meta-analysis of sixteen berberine studies done Directions. even if you’re not.
in 2018 showed significant improvements in conven- Over the last few years, there have been more • L-carnitine supplementation after a heart attack increases survival rate and makes it less
tional measures of cardiovascular risk, including, by than 1,400 publications in the medical literature likely you’ll suffer a second heart attack.
the way, a reduction in triglycerides of 25 mg/dl. And regarding the powerful antioxidant and anti-aging • Magnesium relaxes the artery walls, reduces blood pressure, and makes it easier for the
another meta-analysis—this one looking at reductions aspects of astaxanthin. These improvements have not heart to pump blood and for the blood to flow freely.
in blood sugar—concluded that “(b)ased on the exist- only been seen in heart and brain function, but also • Niacin will lower both triglycerides and the “bad” kind of LDL cholesterol. It also reduces a
ing evidence reviewed, berberine has beneficial effects in eye and skin health as well. Astaxanthin from algae toxic substance called lipoprotein(a)—Lp(a) for short—and raises HDL. Don’t use the time-
on blood glucose control in the treatment of type 2 is a unique potent carotenoid that is a terrific free- release kind.
diabetic patients and exhibits efficacy comparable radical fighter supporting the brain, eye, heart, and • Omega-3s—especially from fish—lower the death rate from heart disease. They also lower
with that of conventional oral hypoglycaemics.” In skin. Both of us believe this powerful antioxidant triglycerides, resting heart rate, and blood pressure. Omega-3s are highly anti-inflammatory.
other words, berberine’s blood sugar lowering capac- should be incorporated in one’s supplemental pro- • Other supplements worth considering include vitamin C, curcumin, resveratrol, citrus
ity was found to be comparable to several well-estab- gram on a daily basis. (One very good food source bergamot, berberine, and cocoa flavanols.
lished pharmaceutical medicines.63 of astaxanthin is wild-caught salmon and krill!)
Cocoa flavanols. Plant chemicals in cocoa known
as flavanols help the body synthesize a compound CONVINCING YOUR DOCTOR
called nitric oxide, which is critical for healthy blood If you show this chapter to your doctor, and he or she
flow and healthy blood pressure. Nitric oxide also is still skeptical, we suggest you direct him or her to
improves platelet function, meaning it makes your the superb review paper on nonpharmacological
blood less sticky. It also makes the lining of the arter- treatment for dyslipidemia written by Mark Houston,
ies less attractive for white blood cells to attach to M.D., and published in Progress in Cardiovascular
and stick around. Researchers in Germany followed Diseases.66 This paper has 421 citations and should go
more than 19,000 people for a minimum of ten years a long way toward reassuring him or her that there is
and found that those who ate the most flavanol-rich plenty of research to support the use of these natural,
dark chocolate had lower blood pressure and a 39 non-toxic substances.
percent lower risk of having a heart attack or stroke
compared to those who ate almost no chocolate.65
Astaxanthin. Dr. Sinatra first got acquainted with
astaxanthin at a Japanese symposium on CoQ10 over a
decade ago. Astaxanthin is what gives the orange-red
that also decreases triglycerides and blood sugar. And color to salmon, shrimp, lobster, and crab to mention
some research shows it may increase insulin recep- a few. It has more antioxidant power than vitamin C
tors (which would increase insulin sensitivity and and even pycnogenol. He was so enthusiastic about  WHAT YOU NEED TO KNOW
reduce insulin resistance). It also increases nitrous what he heard that he started to incorporate astaxan- • Coenzyme Q10 (CoQ10) is a kind of “energy fuel” for the heart. Statins deplete CoQ10;
oxide. thin into his Omega Vitalisea product at Healthy supplementation is an absolute necessity if you’re on a statin drug, and it is a very good idea
A meta-analysis of sixteen berberine studies done Directions. even if you’re not.
in 2018 showed significant improvements in conven- Over the last few years, there have been more • L-carnitine supplementation after a heart attack increases survival rate and makes it less
tional measures of cardiovascular risk, including, by than 1,400 publications in the medical literature likely you’ll suffer a second heart attack.
the way, a reduction in triglycerides of 25 mg/dl. And regarding the powerful antioxidant and anti-aging • Magnesium relaxes the artery walls, reduces blood pressure, and makes it easier for the
another meta-analysis—this one looking at reductions aspects of astaxanthin. These improvements have not heart to pump blood and for the blood to flow freely.
in blood sugar—concluded that “(b)ased on the exist- only been seen in heart and brain function, but also • Niacin will lower both triglycerides and the “bad” kind of LDL cholesterol. It also reduces a
ing evidence reviewed, berberine has beneficial effects in eye and skin health as well. Astaxanthin from algae toxic substance called lipoprotein(a)—Lp(a) for short—and raises HDL. Don’t use the time-
on blood glucose control in the treatment of type 2 is a unique potent carotenoid that is a terrific free- release kind.
diabetic patients and exhibits efficacy comparable radical fighter supporting the brain, eye, heart, and • Omega-3s—especially from fish—lower the death rate from heart disease. They also lower
with that of conventional oral hypoglycaemics.” In skin. Both of us believe this powerful antioxidant triglycerides, resting heart rate, and blood pressure. Omega-3s are highly anti-inflammatory.
other words, berberine’s blood sugar lowering capac- should be incorporated in one’s supplemental pro- • Other supplements worth considering include vitamin C, curcumin, resveratrol, citrus
ity was found to be comparable to several well-estab- gram on a daily basis. (One very good food source bergamot, berberine, and cocoa flavanols.
lished pharmaceutical medicines.63 of astaxanthin is wild-caught salmon and krill!)
Cocoa flavanols. Plant chemicals in cocoa known
as flavanols help the body synthesize a compound CONVINCING YOUR DOCTOR
called nitric oxide, which is critical for healthy blood If you show this chapter to your doctor, and he or she
flow and healthy blood pressure. Nitric oxide also is still skeptical, we suggest you direct him or her to
improves platelet function, meaning it makes your the superb review paper on nonpharmacological
blood less sticky. It also makes the lining of the arter- treatment for dyslipidemia written by Mark Houston,
ies less attractive for white blood cells to attach to M.D., and published in Progress in Cardiovascular
and stick around. Researchers in Germany followed Diseases.66 This paper has 421 citations and should go
more than 19,000 people for a minimum of ten years a long way toward reassuring him or her that there is
and found that those who ate the most flavanol-rich plenty of research to support the use of these natural,
dark chocolate had lower blood pressure and a 39 non-toxic substances.
percent lower risk of having a heart attack or stroke
compared to those who ate almost no chocolate.65
Astaxanthin. Dr. Sinatra first got acquainted with
astaxanthin at a Japanese symposium on CoQ10 over a
decade ago. Astaxanthin is what gives the orange-red
Here’s a perfect example: stress. Now, textbooks And it can even bring on a heart attack.
have been written detailing exactly how excessive lev- Virtually every one of the recommended activi-
CHAPTER 12 els of stress hormones—known as chronic stress—do ties below lowers stress hormones. We can’t overstate
long-term metabolic damage. And as fascinating as the importance of this. You can test to your heart’s
that story is, it will take us way too far afield to detail content, eat all the right foods, and even exercise reg-
here. So we’re going to ask you, for the purposes of ularly, but if you’re not managing your stress hor-
THE SCIENCE this book, to accept our conclusion based on decades

of study and a close reading of the research: Chronic
mones, you’re draining your health bank account, and
eventually, it will catch up with you.
OF HEALTHY LIVING:
stress is either a promoter, contributor, accompani- And this is not just speculation. Dozens of studies
ment, multiplier, or proximate cause of just about have now shown that what you think about pro-
every disease on the planet. foundly affects your physiology, your immune system,
EAT, LAUGH, PLAY, LOVE It’s also, by the way, a major instigator of inflam-
mation. And weight gain (particularly around the mid-
your blood pressure, your stress hormones, and
everything that’s affected by them. We can simply no
dle). And elevated blood pressure. longer treat “heart disease” like it’s a solely physical
BOTH OF US, DURING OUR GRADUATE SCHOOL YEARS, trained in psychology. Jonny earned a The term “chronic stress” has become an all too phenomenon.
master’s in psychology from the New School for Social Research, and Steve trained for two years in familiar accompaniment to daily life. And here’s what Opening your heart to your feelings and learning
gestalt therapy and then followed up with a six-year certification in bioenergetic psychotherapy. chronic stress does: It damages and weakens your how to express them in a healthy way will do far more
Perhaps that’s why both of us, throughout our careers, have been keenly aware of the role that heart (and your immune system). It weakens your for your heart and your overall health than you might
attitude, thought, feeling, emotion, and the subconscious play in our physical health. We have both resistance to bad stuff. It lowers your resilience. imagine. This final section offers some specific tech-
seen the collapse of the old-fashioned way of thinking about “mind” and “body” as two separate areas
of study. Today, every scientist worth his weight in Bunsen burners understands that “mind” and
“body” are not two discrete entities, but two completely entwined and interrelated parts of a whole Everyone reading this book needs to know this: Diet, exercise,
that operate together and are impossible to disentangle. and/or nutritional supplements are important tools that help
In fact there’s an entire field of legitimate scientific study that actually studies how mind and body
influence each other. It’s called psychoneuroimmunology, or sometimes psychoneuroendocrinology, prevent and even heal heart disease. But they are only a part
and it’s been around since 1975.1 It specifically studies how what we think about (psychoneuro) affects of the picture. The many hidden emotional and psychological
our immune system (immunology) or our hormones (endocrinology). The findings are profound and
incontrovertible—what we think about affects virtually all of our physiology, including (if not especially) risk factors that are hardly ever addressed by conventional
the cardiometabolic ones.2 medicine are equally important—and sometimes even
more so. They include suppressed anger, rage, the loss of love
(what Dr. Sinatra calls “heartbreak”), and the emotional
isolation that results from lack of intimacy with other people.
182 THE GREAT CHOLESTEROL MYTH THE SCIENCE OF HEALTHY LIVING: EAT, LAUGH, PLAY, LOVE 183
Here’s a perfect example: stress. Now, textbooks And it can even bring on a heart attack.
have been written detailing exactly how excessive lev- Virtually every one of the recommended activi-
CHAPTER 12 els of stress hormones—known as chronic stress—do ties below lowers stress hormones. We can’t overstate
long-term metabolic damage. And as fascinating as the importance of this. You can test to your heart’s
that story is, it will take us way too far afield to detail content, eat all the right foods, and even exercise reg-
here. So we’re going to ask you, for the purposes of ularly, but if you’re not managing your stress hor-
THE SCIENCE this book, to accept our conclusion based on decades

of study and a close reading of the research: Chronic
mones, you’re draining your health bank account, and
eventually, it will catch up with you.
OF HEALTHY LIVING:
stress is either a promoter, contributor, accompani- And this is not just speculation. Dozens of studies
ment, multiplier, or proximate cause of just about have now shown that what you think about pro-
every disease on the planet. foundly affects your physiology, your immune system,
EAT, LAUGH, PLAY, LOVE It’s also, by the way, a major instigator of inflam-
mation. And weight gain (particularly around the mid-
your blood pressure, your stress hormones, and
everything that’s affected by them. We can simply no
dle). And elevated blood pressure. longer treat “heart disease” like it’s a solely physical
BOTH OF US, DURING OUR GRADUATE SCHOOL YEARS, trained in psychology. Jonny earned a The term “chronic stress” has become an all too phenomenon.
master’s in psychology from the New School for Social Research, and Steve trained for two years in familiar accompaniment to daily life. And here’s what Opening your heart to your feelings and learning
gestalt therapy and then followed up with a six-year certification in bioenergetic psychotherapy. chronic stress does: It damages and weakens your how to express them in a healthy way will do far more
Perhaps that’s why both of us, throughout our careers, have been keenly aware of the role that heart (and your immune system). It weakens your for your heart and your overall health than you might
attitude, thought, feeling, emotion, and the subconscious play in our physical health. We have both resistance to bad stuff. It lowers your resilience. imagine. This final section offers some specific tech-
seen the collapse of the old-fashioned way of thinking about “mind” and “body” as two separate areas
of study. Today, every scientist worth his weight in Bunsen burners understands that “mind” and
“body” are not two discrete entities, but two completely entwined and interrelated parts of a whole Everyone reading this book needs to know this: Diet, exercise,
that operate together and are impossible to disentangle. and/or nutritional supplements are important tools that help
In fact there’s an entire field of legitimate scientific study that actually studies how mind and body
influence each other. It’s called psychoneuroimmunology, or sometimes psychoneuroendocrinology, prevent and even heal heart disease. But they are only a part
and it’s been around since 1975.1 It specifically studies how what we think about (psychoneuro) affects of the picture. The many hidden emotional and psychological
our immune system (immunology) or our hormones (endocrinology). The findings are profound and
incontrovertible—what we think about affects virtually all of our physiology, including (if not especially) risk factors that are hardly ever addressed by conventional
the cardiometabolic ones.2 medicine are equally important—and sometimes even
more so. They include suppressed anger, rage, the loss of love
(what Dr. Sinatra calls “heartbreak”), and the emotional
isolation that results from lack of intimacy with other people.
niques you can use to accomplish this. relaxes the muscles. It also increases levels of nitric
oxide—a molecule that’s important for circulation and
HOW TO DO “THE RELAXATION RESPONSE”
BREATHE DEEPLY improved blood flow. Tai chi, meditation, yoga, and
Allow ten to twenty minutes to try this simple technique:
When people are subjected to chronic stress, they mindfulness are all able to elicit the relaxation
• Sit quietly in a comfortable position.
oftentimes become tense and rigid. They take shallow response.
• Close your eyes.
breaths. High chest breathing can, over the course of According to the Benson-Henry Institute, between
• Deeply relax all your muscles beginning at your feet and progressing up to your face. Keep
time, result in actual physical changes in the body, 60 and 90 percent of all doctor visits are for com-
them relaxed.
such as a more rigid upper body, including the chest plaints related to, or affected by, stress. “Scores of
• Breathe through your nose. Become aware of your breathing. As you breathe out, say the
and shoulders. Slow, rhythmic, deep abdominal diseases and conditions are either caused or made
word "one" silently to yourself. For example, breathe in…out, (“one”), in…out (“one”), etc.
breathing, however, is physiologically more suited to worse by stress,” Benson has said. “These include
Breathe easily and naturally.
the body and has the added benefit of allowing a anxiety, mild or moderate depression, anger, hostility,
• Continue for ten to twenty minutes.
greater intake of oxygen. hot flashes of menopause, infertility, PMS, high blood
• You may open your eyes to check the time, but don’t use an alarm. When you finish, sit
Proper breathing has been the subject of many pressure, and heart attacks. Every one can be caused
quietly for several minutes at first with your eyes closed and later with your eyes open. Don’t
stress-management programs. It’s the first place you by stress or exacerbated by it. And to the extent that
stand for a few minutes.
start when you learn to meditate, and it’s a principle that’s the case, the relaxation response is helpful.”3
focus of yoga. In Gestalt psychotherapy, deep breath-
“Don’t worry about whether you are successful in achieving a deep level of relaxation.
ing is used as a vehicle to loosen up the energy of the HOW CRYING AND LAUGHING
Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting
chest and to free emotions. CAN HELP
thoughts occur, try to ignore them by not dwelling upon them and return to repeating one.”
A more prolonged form of deep breathing is med- Next to love, crying is perhaps the most healing
—From The Relaxation Response by Herbert Benson, M.D., used with permission
itation, which has an impressive amount of research activity for the heart. It frees the heart of muscular
showing that it lowers blood pressure effectively. tension and rigidity. Sobbing enhances oxygen
Cardiologist Herbert Benson, M.D., has been doing delivery. Man is the only primate able to weep for NOTE: Try not to do this within a couple hours of eating. According to Benson, the digestive process
pioneering research on meditation and deep breath- emotional reasons. Weeping is nature’s way of seems to interfere with eliciting the relaxation response.
ing for decades. An associate professor of medicine at releasing the pain of heartbreak and preventing
Harvard Medical School and founder of the Benson- death. Any expression of feeling will help to heal your
Henry Institute for Mind Body Medicine at heart. Despite what we’re taught, it’s not weak to
Massachusetts General Hospital, he coined the term show your feelings. In fact, it’s far healthier than potential to be extremely therapeutic. chronic inflammation along the axial skeleton. At one
“the Relaxation Response” to refer to a physical state “stuffing” your feelings and seething silently. point, doctors gave him little hope of surviving. He
of deep rest that changes the physical and emotional Laughing is a way of experiencing strong feelings, Laughing Your Way to Health ignored their doomsaying and developed his own
responses to stress. And it’s all based on deep breath- just as crying is. (In fact, strenuous laughter often Over the course of his lifetime, Norman Cousins, the program for recovery that involved love, hope, faith,
ing and calming the mind. turns into tears.) When you laugh fully, breathing legendary journalist and editor of the Saturday and, courtesy of the Marx Brothers films he loved to
Benson was able to show time and again that the increases, freeing up the rigidity in the chest, dia- Evening Post, suffered from a number of serious watch, an awful lot of laughter.
relaxation response decreases the heart rate, lowers phragm, and even deep down in the psoas muscles. medical conditions, including heart disease and Although he eventually died of heart failure at
blood pressure, slows the rate of breathing, and As a spontaneous release of energy, laughter has the ankylosing spondylitis, a disease characterized by age seventy-five, Cousins lived far longer than his
niques you can use to accomplish this. relaxes the muscles. It also increases levels of nitric
oxide—a molecule that’s important for circulation and
HOW TO DO “THE RELAXATION RESPONSE”
BREATHE DEEPLY improved blood flow. Tai chi, meditation, yoga, and
Allow ten to twenty minutes to try this simple technique:
When people are subjected to chronic stress, they mindfulness are all able to elicit the relaxation
• Sit quietly in a comfortable position.
oftentimes become tense and rigid. They take shallow response.
• Close your eyes.
breaths. High chest breathing can, over the course of According to the Benson-Henry Institute, between
• Deeply relax all your muscles beginning at your feet and progressing up to your face. Keep
time, result in actual physical changes in the body, 60 and 90 percent of all doctor visits are for com-
them relaxed.
such as a more rigid upper body, including the chest plaints related to, or affected by, stress. “Scores of
• Breathe through your nose. Become aware of your breathing. As you breathe out, say the
and shoulders. Slow, rhythmic, deep abdominal diseases and conditions are either caused or made
word "one" silently to yourself. For example, breathe in…out, (“one”), in…out (“one”), etc.
breathing, however, is physiologically more suited to worse by stress,” Benson has said. “These include
Breathe easily and naturally.
the body and has the added benefit of allowing a anxiety, mild or moderate depression, anger, hostility,
• Continue for ten to twenty minutes.
greater intake of oxygen. hot flashes of menopause, infertility, PMS, high blood
• You may open your eyes to check the time, but don’t use an alarm. When you finish, sit
Proper breathing has been the subject of many pressure, and heart attacks. Every one can be caused
quietly for several minutes at first with your eyes closed and later with your eyes open. Don’t
stress-management programs. It’s the first place you by stress or exacerbated by it. And to the extent that
stand for a few minutes.
start when you learn to meditate, and it’s a principle that’s the case, the relaxation response is helpful.”3
focus of yoga. In Gestalt psychotherapy, deep breath-
“Don’t worry about whether you are successful in achieving a deep level of relaxation.
ing is used as a vehicle to loosen up the energy of the HOW CRYING AND LAUGHING
Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting
chest and to free emotions. CAN HELP
thoughts occur, try to ignore them by not dwelling upon them and return to repeating one.”
A more prolonged form of deep breathing is med- Next to love, crying is perhaps the most healing
—From The Relaxation Response by Herbert Benson, M.D., used with permission
itation, which has an impressive amount of research activity for the heart. It frees the heart of muscular
showing that it lowers blood pressure effectively. tension and rigidity. Sobbing enhances oxygen
Cardiologist Herbert Benson, M.D., has been doing delivery. Man is the only primate able to weep for NOTE: Try not to do this within a couple hours of eating. According to Benson, the digestive process
pioneering research on meditation and deep breath- emotional reasons. Weeping is nature’s way of seems to interfere with eliciting the relaxation response.
ing for decades. An associate professor of medicine at releasing the pain of heartbreak and preventing
Harvard Medical School and founder of the Benson- death. Any expression of feeling will help to heal your
Henry Institute for Mind Body Medicine at heart. Despite what we’re taught, it’s not weak to
Massachusetts General Hospital, he coined the term show your feelings. In fact, it’s far healthier than potential to be extremely therapeutic. chronic inflammation along the axial skeleton. At one
“the Relaxation Response” to refer to a physical state “stuffing” your feelings and seething silently. point, doctors gave him little hope of surviving. He
of deep rest that changes the physical and emotional Laughing is a way of experiencing strong feelings, Laughing Your Way to Health ignored their doomsaying and developed his own
responses to stress. And it’s all based on deep breath- just as crying is. (In fact, strenuous laughter often Over the course of his lifetime, Norman Cousins, the program for recovery that involved love, hope, faith,
ing and calming the mind. turns into tears.) When you laugh fully, breathing legendary journalist and editor of the Saturday and, courtesy of the Marx Brothers films he loved to
Benson was able to show time and again that the increases, freeing up the rigidity in the chest, dia- Evening Post, suffered from a number of serious watch, an awful lot of laughter.
relaxation response decreases the heart rate, lowers phragm, and even deep down in the psoas muscles. medical conditions, including heart disease and Although he eventually died of heart failure at
blood pressure, slows the rate of breathing, and As a spontaneous release of energy, laughter has the ankylosing spondylitis, a disease characterized by age seventy-five, Cousins lived far longer than his
doctors predicted, a full thirty-six years after first THE POWER OF TOUCH paint drips and blobs and runs, the way the colors
being diagnosed with heart disease. (Cousins also did AND MASSAGE mix, and how closely they can match the picture with
EXPRESSING EMOTIONS
research on the biochemistry of human emotions at Touch therapy or massage appears to be associated the image in their minds. Being carried away by their
(ESPECIALLY FOR MEN!)
the School of Medicine at the University of California, with a decreased heart rate, decreased blood imaginations and getting their inspirations down on
Showing and expressing feelings can be a
Los Angeles, and wrote two important books on emo- pressure, and increased endorphin release, resulting paper is, for a short time, the single most important
huge challenge for some people,
tion, healing, and illness—Anatomy of an Illness and in an increased sense of relaxation and heightened thing in the world to them. Everything else falls
particularly men. But getting in touch
The Healing Heart.) well-being. In humans, massage can be considered a away—worries, fears, wants, needs, hunger—and is
with your feelings doesn’t have to be
tranquilizer with absolutely no side effects! replaced by a sense of total involvement, excitement,
embarrassing at all. You don’t have to get
SEX: THE ADVANTAGES OF Massage activates the parasympathetic system satisfaction, and gratification.
up in front of some encounter group and
INTIMACY and provides a nice, healing balance to the typical If you can play even partially this way, it can com-
spill your guts to strangers. All it may
Have you ever wondered why some elderly people sympathetic overdrive experienced by type-A, coro- pletely cut you free from stress and worry and help
take is a pencil and paper.
look much younger than their stated age while some nary-prone individuals. heal your mind and heart. Because of this nearly
A writing exercise developed by social
younger people look so much older? This observation miraculous benefit of play, we encourage you to play
psychologist James Pennebaker has been
was studied by a Russian gerontologist who examined PLAY like children. If, like most adults, you’ve forgotten how,
tested in dozens of studies in which
15,000 individuals over the age of eighty in provinces Play is one of the most healing things you can do for observe children and see what they do.
subjects were assigned to write about
of the former Soviet Union. He found several common your heart health and your emotional well-being. And Remember, play has no outcome, no goal. You
either mundane activities, such as
denominators or markers for longevity. People who most adults have no idea how to do it. Sure, we talk need to play for play’s sake alone, and, when you play,
running errands, or personal traumas. The
lived the longest reported working outdoors, high about “playing” tennis or golf, but sports are try to bring out the little child inside you. Once you
technique is pure simplicity. You write
levels of physical activity, and a diet high in different—though enjoyable, they’re not healing connect with your inner child—believe us, we all have
your deepest thoughts and emotions
vegetables, fruits, and fresh whole grains. But several because they involve performance, competition, and one—it will bring you to another level of healing.
about any event, situation, person, or
of the common denominators involved relationships, the need to win! (Just ask Dr. Jonny how he feels
even trauma for about fifteen minutes on
intimacy, and sexuality. after losing a tennis match!) HEARTMATH™
four consecutive nights. Pennebaker has
Many of these individuals continued to have an Play is totally different. True play is spontaneous And speaking of another level of healing . . . Bringing
found that people who do this simple,
active sex life well into their eighties and nineties. and has no agenda, rules, or regulations, or even a the heart and brain into balance—also called
private exercise show improvements in
And why not? Aging couples who are committed to desired outcome. When we play, we are totally free. coherence—is an effective way to reduce stress,
immune system functioning, are less likely
one another’s pleasure can adapt sexually to the That is, we do things solely for joy and pleasure. improve overall health (including heart health), and
to visit doctors, get better grades in
aging process. On an emotional level, sexuality pro- When we play, we become totally absorbed in what foster well-being. HeartMath offers an easy-to-do
school, and miss fewer days of work.4
vides a sense of security, connectedness, and emo- we are doing; we are taken out of our heads (and technique to accomplish this.
tional intimacy. When sexuality is an expression of down into our bodies). Coherence—a term used in fields as diverse as
love, the energies of the partners can fuse in har- Time stops for us. quantum physics and social science—always implies a
mony like two tuning forks vibrating with the same Think of how completely absorbed five- or six- harmonious relationship between part of a system.5
frequency. Feelings of warmth, connectedness, and year-olds become when they’re painting a picture. In the case of HeartMath, it refers to a harmonious
emotional intimacy can help open our hearts. Within minutes, nothing else matters to them but the relationship between the heart and the brain.
colors, the feel of the brush on the paper, the way the The Institute of HeartMath—a non-profit organiza-
doctors predicted, a full thirty-six years after first THE POWER OF TOUCH paint drips and blobs and runs, the way the colors
being diagnosed with heart disease. (Cousins also did AND MASSAGE mix, and how closely they can match the picture with
EXPRESSING EMOTIONS
research on the biochemistry of human emotions at Touch therapy or massage appears to be associated the image in their minds. Being carried away by their
(ESPECIALLY FOR MEN!)
the School of Medicine at the University of California, with a decreased heart rate, decreased blood imaginations and getting their inspirations down on
Showing and expressing feelings can be a
Los Angeles, and wrote two important books on emo- pressure, and increased endorphin release, resulting paper is, for a short time, the single most important
huge challenge for some people,
tion, healing, and illness—Anatomy of an Illness and in an increased sense of relaxation and heightened thing in the world to them. Everything else falls
particularly men. But getting in touch
The Healing Heart.) well-being. In humans, massage can be considered a away—worries, fears, wants, needs, hunger—and is
with your feelings doesn’t have to be
tranquilizer with absolutely no side effects! replaced by a sense of total involvement, excitement,
embarrassing at all. You don’t have to get
SEX: THE ADVANTAGES OF Massage activates the parasympathetic system satisfaction, and gratification.
up in front of some encounter group and
INTIMACY and provides a nice, healing balance to the typical If you can play even partially this way, it can com-
spill your guts to strangers. All it may
Have you ever wondered why some elderly people sympathetic overdrive experienced by type-A, coro- pletely cut you free from stress and worry and help
take is a pencil and paper.
look much younger than their stated age while some nary-prone individuals. heal your mind and heart. Because of this nearly
A writing exercise developed by social
younger people look so much older? This observation miraculous benefit of play, we encourage you to play
psychologist James Pennebaker has been
was studied by a Russian gerontologist who examined PLAY like children. If, like most adults, you’ve forgotten how,
tested in dozens of studies in which
15,000 individuals over the age of eighty in provinces Play is one of the most healing things you can do for observe children and see what they do.
subjects were assigned to write about
of the former Soviet Union. He found several common your heart health and your emotional well-being. And Remember, play has no outcome, no goal. You
either mundane activities, such as
denominators or markers for longevity. People who most adults have no idea how to do it. Sure, we talk need to play for play’s sake alone, and, when you play,
running errands, or personal traumas. The
lived the longest reported working outdoors, high about “playing” tennis or golf, but sports are try to bring out the little child inside you. Once you
technique is pure simplicity. You write
levels of physical activity, and a diet high in different—though enjoyable, they’re not healing connect with your inner child—believe us, we all have
your deepest thoughts and emotions
vegetables, fruits, and fresh whole grains. But several because they involve performance, competition, and one—it will bring you to another level of healing.
about any event, situation, person, or
of the common denominators involved relationships, the need to win! (Just ask Dr. Jonny how he feels
even trauma for about fifteen minutes on
intimacy, and sexuality. after losing a tennis match!) HEARTMATH™
four consecutive nights. Pennebaker has
Many of these individuals continued to have an Play is totally different. True play is spontaneous And speaking of another level of healing . . . Bringing
found that people who do this simple,
active sex life well into their eighties and nineties. and has no agenda, rules, or regulations, or even a the heart and brain into balance—also called
private exercise show improvements in
And why not? Aging couples who are committed to desired outcome. When we play, we are totally free. coherence—is an effective way to reduce stress,
immune system functioning, are less likely
one another’s pleasure can adapt sexually to the That is, we do things solely for joy and pleasure. improve overall health (including heart health), and
to visit doctors, get better grades in
aging process. On an emotional level, sexuality pro- When we play, we become totally absorbed in what foster well-being. HeartMath offers an easy-to-do
school, and miss fewer days of work.4
vides a sense of security, connectedness, and emo- we are doing; we are taken out of our heads (and technique to accomplish this.
tional intimacy. When sexuality is an expression of down into our bodies). Coherence—a term used in fields as diverse as
love, the energies of the partners can fuse in har- Time stops for us. quantum physics and social science—always implies a
mony like two tuning forks vibrating with the same Think of how completely absorbed five- or six- harmonious relationship between part of a system.5
frequency. Feelings of warmth, connectedness, and year-olds become when they’re painting a picture. In the case of HeartMath, it refers to a harmonious
emotional intimacy can help open our hearts. Within minutes, nothing else matters to them but the relationship between the heart and the brain.
colors, the feel of the brush on the paper, the way the The Institute of HeartMath—a non-profit organiza-
tion dedicated to researching the principle that the According to Rollin McCraty, Ph.D., director of When you are in convergence—when the heart
heart and the brain are deeply connected—is where research at HeartMath Institute, the heart sends more and brain are on the same metaphorical page—good
much of the research on heart-brain coherence origi- information to the brain and the CNS than the other stuff happens. Remember that appreciation and grati-
6 7
nated. The Institute was founded on the premise that way around. The brain is always interpreting these tude are incompatible with anger and stress. (That’s
the heart has a natural intelligence of its own. signals from the heart to create how we feel. And the why people say to take a deep breath when you’re
Intuitively, we all understand this. Just consider how quality of the informational signals sent from the angry! Deep breathing and anger aren’t good bed-
we speak about the heart—“I knew it in my heart!” is heart to the brain have profound effects on brain mates!) One of the goals of a HeartMath practice is to
just one of countless examples. We seem to “know” function—mental clarity, emotional experience—as well be able to focus on things like gratitude, love, appreci-
that the heart has something to tell us, but as on physical health. The idea is that if you shift the ation, service, peace, and joy—and to know that your
HeartMath goes a bit further and puts that knowledge rhythms of the heart—which you can do using the heart will respond in kind, with all the health benefits
to practical use. Inner Balance app as a biofeedback tool—you can that accrue with that. Since both of us fully subscribe
You see, according to the founders of HeartMath, quickly improve brain function, not to mention overall to the notion that heart, brain, mind, spirit, and physi-
the heart isn’t just a detached organ whose job it is to physical health. cal health are all interconnected, we included
beat regularly like a metronome, passively responding The overall purpose of HeartMath technology is HeartMath as an option for accessing that intercon-
to signals from the central nervous system. It actually to bring the rhythms of the heart into balance with nectedness—and using it to improve your overall
has its own responses to events—which is what the what’s going on in your brain. Which goes a long way health. At the very least, the app helps you get in
HeartMath folks mean when they refer to the heart’s toward reducing stress and all the associated health touch with your own body and what it’s doing—and
native “intelligence.” The way the heart communi- problems that are aggravated or caused by it. that kind of mindfulness is always a positive thing.
cates those responses back out to the rest of the The Inner Balance app—available for both IOS and
body is by varying its rhythms. (Those rhythms— Android and downloadable wherever you get your FINAL WORDS
known as heart rate variability or HRV—can actually apps—works with a little device* that clips onto your Foods can fuel your heart, supplements can support
be measured. You can see the results on an app ear and lets you monitor your own heart rate variabil- it, and exercise can strengthen it. But never neglect
called Inner Balance—more on that in a minute.) The ity in real time, so you can see instantly what it’s the “hidden” emotional and psychological risk factors
variations in heart rhythm are the equivalent of a doing and whether or not it’s congruent with what that contribute to the development of heart disease
kind of Morse code for the rest of the body, and those you’re “thinking” or focused on. If, for example, you as surely as smoking, a high-sugar diet, stress, high
varying rhythms of the heart actually impact your focus on a word like appreciation or gratitude, but blood pressure, and lack of exercise do.
physiology, in a kind of endless feedback loop. your heart rate variability is in the red zone, your Building and maintaining strong emotional con-
Remember when we talked earlier about psycho- heart and brain are not “thinking” the same thing. On nections with other people is one of the best stress-
neuroimmunology, the study of how our thoughts the other hand, if you focus on appreciation or grati- management strategies on the planet. It’s also one of
affect the rest of our body? Well this is similar, only tude and your heart rate variability is in the green the best ways to keep your heart healthy and your
it’s the study of how the heart’s “thoughts”— zone, you are in convergence. Congrats! soul nourished. Next to exercise, it’s the closest thing
expressed through variable rhythms—also affect the * The app is free but there is a charge for the device. we have to a panacea. It also makes life a lot more
rest of our body! Full disclosure: Jonny is a regular user of the Inner rich, a lot more fun, and a lot more gratifying.
Balance app and personally thinks the cost is worth it. Enjoy the journey.
tion dedicated to researching the principle that the According to Rollin McCraty, Ph.D., director of When you are in convergence—when the heart
heart and the brain are deeply connected—is where research at HeartMath Institute, the heart sends more and brain are on the same metaphorical page—good
much of the research on heart-brain coherence origi- information to the brain and the CNS than the other stuff happens. Remember that appreciation and grati-
6 7
nated. The Institute was founded on the premise that way around. The brain is always interpreting these tude are incompatible with anger and stress. (That’s
the heart has a natural intelligence of its own. signals from the heart to create how we feel. And the why people say to take a deep breath when you’re
Intuitively, we all understand this. Just consider how quality of the informational signals sent from the angry! Deep breathing and anger aren’t good bed-
we speak about the heart—“I knew it in my heart!” is heart to the brain have profound effects on brain mates!) One of the goals of a HeartMath practice is to
just one of countless examples. We seem to “know” function—mental clarity, emotional experience—as well be able to focus on things like gratitude, love, appreci-
that the heart has something to tell us, but as on physical health. The idea is that if you shift the ation, service, peace, and joy—and to know that your
HeartMath goes a bit further and puts that knowledge rhythms of the heart—which you can do using the heart will respond in kind, with all the health benefits
to practical use. Inner Balance app as a biofeedback tool—you can that accrue with that. Since both of us fully subscribe
You see, according to the founders of HeartMath, quickly improve brain function, not to mention overall to the notion that heart, brain, mind, spirit, and physi-
the heart isn’t just a detached organ whose job it is to physical health. cal health are all interconnected, we included
beat regularly like a metronome, passively responding The overall purpose of HeartMath technology is HeartMath as an option for accessing that intercon-
to signals from the central nervous system. It actually to bring the rhythms of the heart into balance with nectedness—and using it to improve your overall
has its own responses to events—which is what the what’s going on in your brain. Which goes a long way health. At the very least, the app helps you get in
HeartMath folks mean when they refer to the heart’s toward reducing stress and all the associated health touch with your own body and what it’s doing—and
native “intelligence.” The way the heart communi- problems that are aggravated or caused by it. that kind of mindfulness is always a positive thing.
cates those responses back out to the rest of the The Inner Balance app—available for both IOS and
body is by varying its rhythms. (Those rhythms— Android and downloadable wherever you get your FINAL WORDS
known as heart rate variability or HRV—can actually apps—works with a little device* that clips onto your Foods can fuel your heart, supplements can support
be measured. You can see the results on an app ear and lets you monitor your own heart rate variabil- it, and exercise can strengthen it. But never neglect
called Inner Balance—more on that in a minute.) The ity in real time, so you can see instantly what it’s the “hidden” emotional and psychological risk factors
variations in heart rhythm are the equivalent of a doing and whether or not it’s congruent with what that contribute to the development of heart disease
kind of Morse code for the rest of the body, and those you’re “thinking” or focused on. If, for example, you as surely as smoking, a high-sugar diet, stress, high
varying rhythms of the heart actually impact your focus on a word like appreciation or gratitude, but blood pressure, and lack of exercise do.
physiology, in a kind of endless feedback loop. your heart rate variability is in the red zone, your Building and maintaining strong emotional con-
Remember when we talked earlier about psycho- heart and brain are not “thinking” the same thing. On nections with other people is one of the best stress-
neuroimmunology, the study of how our thoughts the other hand, if you focus on appreciation or grati- management strategies on the planet. It’s also one of
affect the rest of our body? Well this is similar, only tude and your heart rate variability is in the green the best ways to keep your heart healthy and your
it’s the study of how the heart’s “thoughts”— zone, you are in convergence. Congrats! soul nourished. Next to exercise, it’s the closest thing
expressed through variable rhythms—also affect the * The app is free but there is a charge for the device. we have to a panacea. It also makes life a lot more
rest of our body! Full disclosure: Jonny is a regular user of the Inner rich, a lot more fun, and a lot more gratifying.
Balance app and personally thinks the cost is worth it. Enjoy the journey.
cebo group with such fanfare. marketing cholesterol-lowering drugs. That fact alone
Of course, as we’ve pointed out, all these results doesn’t make the results invalid, but it certainly plants
APPENDIX A may be because of the many other things statin drugs
do besides lower cholesterol. And the folks in this
a potential bias among the folks who ran the study.)
In response to the ASCOT-LLA paper, though, a
study certainly had risk factors (e.g., being overweight number of other researchers—especially ones who
and having high blood pressure), so any one of the weren’t on any statin company’s payroll—submitted
The ALLHAT Study: Not a Single The ASCOT-LLA Trial: Not Exactly positive effects of statin drugs—such as its antioxi- commentary that was far less flattering. In one
Life Was Saved a Slam Dunk for Lipitor dant, blood-thinning, or anti-inflammatory qualities— response published in the Lancet, Uffe Ravnskov
The Antihypertensive and Lipid-Lowering Treatment The Anglo-Scandinavian Cardiac Outcomes Trial–Lipid could easily have made a difference. (This is particu- pointed out that in the Lipitor group, there was a
to Prevent Heart Attack Trial (ALLHAT), conducted Lowering Arm (ASCOT-LLA) was a multicenter larly likely given that the participants didn’t have any higher (albeit not quite statistically significant) rate of
between 1994 and 2002, was the largest North randomized controlled trial in which more than ten cholesterol-lowering needs to begin with!) heart failure, diabetes, and kidney impairment com-
American cholesterol study ever undertaken, and as thousand patients with high blood pressure and at Nonetheless, with all those cardiovascular disease pared to the placebo—and what’s more, that the
of 2002, it was the largest study ever done using the least three other cardiovascular risk factors were reductions, it sure looks like a slam dunk for Lipitor, study’s early termination made it hard to assess the
statin drug pravastatin (brand name Pravachol). Ten assigned to one of two groups. Half were given doesn’t it? possible effects of Lipitor on cancer rates.3 Dirk
thousand participants with high LDL cholesterol levels atorvastatin (aka Lipitor), and half were given a Not so fast. Here’s where the story takes a turn Devroey and Leslie Vander Ginst likewise wrote that
were divided into two groups. One group was treated placebo (an inactive substance in a pill form). for the ugly. they “dispute the conclusions” of the ASCOT-LLA’s
with pravastatin, and the other group was simply Remember, too, that all patients in this study were For one, the fine print: After three years, there authors, noting that the benefits of Lipitor weren’t
given the standard advice on “lifestyle changes.” hypertensive. Most were overweight (average BMI was no statistical difference in the number of deaths significant in patients aged sixty or younger, in those
Twenty-eight percent of the pravastatin takers did 28.6), 81 percent were male, and about a third were between the two groups. (In fact, there were actually with diabetes, in those with left-ventricular hypertro-
lower their cholesterol by a small but statistically sig- smokers. And importantly, because it makes this a few more deaths among the women taking Lipitor phy, in those with previous vascular disease, and in
nificant amount (compared to 11 percent who did so in study pretty unique for its time, all the participants than among the women taking the placebo.) So those without renal dysfunction. Likewise—and we
the “lifestyle change” group). This allowed the pravas- had either average or lower than average cholesterol— approximately $100 million was spent, and not a sin- quote—“Among women, placebo even had non-
tatin folks to trumpet a significant reduction in cho- in contrast to the vast majority of statin studies that gle life was saved. significantly better results than atorvastatin.”4
lesterol and declare the trial a success. test their drug on folks with high cholesterol.2 Secondly, a closer examination of the study’s In another reply, physician Peter Trewby high-
Not so fast. First, the good news—at least as far as Lipitor’s findings revealed some serious cracks in the “three lighted the low level of absolute benefit for Lipitor
When the death rates from heart attack were stockholders were concerned: After a mean follow-up cheers for Lipitor” story. Here’s why. When ASCOT- takers—stating “It is not the significance . . . of the
examined, there was no difference between the two time of 3.3 years, those taking Lipitor appeared to LLA’s findings were published in 2003 in the Lancet, reduction in relative risk that causes us concern, but
groups. The statin drug lowered cholesterol in 28 per- benefit. No doubt about it. Risk of heart disease its authors gave the drug an unsurprising thumbs up, whether the reduction in absolute risk with atorvas-
cent of the people taking it, but not a single life was dropped by 36 percent, and on the whole, fatal and stating that “The reductions in major cardiovascular tatin is sufficient for patients to take another drug for
saved. Pravastatin neither significantly reduced “all- nonfatal strokes, total cardiovascular events, and total events with atorvastatin are large, given the short the rest of their lives from which they have under 1%
cause” mortality (death from any reason whatsoever), coronary events were significantly lowered between follow-up time.” (We say “unsurprising,” because all chance per year of benefiting.”5
nor reduced fatal or nonfatal coronary heart disease 21 and 29 percent. Although the study was supposed fourteen of those authors served as consultants to— Speaking of relative versus absolute risk, let’s
1
in the patients who took it. to span five years, it was terminated early—ostensibly and received travel expenses, speaking fees, or dive in to our third and final point: that “36% reduc-
because the Lipitor group was outperforming the pla- research funding from—pharmaceutical companies tion in heart disease risk” wasn’t actually all that
190 THE GREAT CHOLESTEROL MYTH APPENDIX A 191

cebo group with such fanfare. marketing cholesterol-lowering drugs. That fact alone
Of course, as we’ve pointed out, all these results doesn’t make the results invalid, but it certainly plants
APPENDIX A may be because of the many other things statin drugs
do besides lower cholesterol. And the folks in this
a potential bias among the folks who ran the study.)
In response to the ASCOT-LLA paper, though, a
study certainly had risk factors (e.g., being overweight number of other researchers—especially ones who
and having high blood pressure), so any one of the weren’t on any statin company’s payroll—submitted
The ALLHAT Study: Not a Single The ASCOT-LLA Trial: Not Exactly positive effects of statin drugs—such as its antioxi- commentary that was far less flattering. In one
Life Was Saved a Slam Dunk for Lipitor dant, blood-thinning, or anti-inflammatory qualities— response published in the Lancet, Uffe Ravnskov
The Antihypertensive and Lipid-Lowering Treatment The Anglo-Scandinavian Cardiac Outcomes Trial–Lipid could easily have made a difference. (This is particu- pointed out that in the Lipitor group, there was a
to Prevent Heart Attack Trial (ALLHAT), conducted Lowering Arm (ASCOT-LLA) was a multicenter larly likely given that the participants didn’t have any higher (albeit not quite statistically significant) rate of
between 1994 and 2002, was the largest North randomized controlled trial in which more than ten cholesterol-lowering needs to begin with!) heart failure, diabetes, and kidney impairment com-
American cholesterol study ever undertaken, and as thousand patients with high blood pressure and at Nonetheless, with all those cardiovascular disease pared to the placebo—and what’s more, that the
of 2002, it was the largest study ever done using the least three other cardiovascular risk factors were reductions, it sure looks like a slam dunk for Lipitor, study’s early termination made it hard to assess the
statin drug pravastatin (brand name Pravachol). Ten assigned to one of two groups. Half were given doesn’t it? possible effects of Lipitor on cancer rates.3 Dirk
thousand participants with high LDL cholesterol levels atorvastatin (aka Lipitor), and half were given a Not so fast. Here’s where the story takes a turn Devroey and Leslie Vander Ginst likewise wrote that
were divided into two groups. One group was treated placebo (an inactive substance in a pill form). for the ugly. they “dispute the conclusions” of the ASCOT-LLA’s
with pravastatin, and the other group was simply Remember, too, that all patients in this study were For one, the fine print: After three years, there authors, noting that the benefits of Lipitor weren’t
given the standard advice on “lifestyle changes.” hypertensive. Most were overweight (average BMI was no statistical difference in the number of deaths significant in patients aged sixty or younger, in those
Twenty-eight percent of the pravastatin takers did 28.6), 81 percent were male, and about a third were between the two groups. (In fact, there were actually with diabetes, in those with left-ventricular hypertro-
lower their cholesterol by a small but statistically sig- smokers. And importantly, because it makes this a few more deaths among the women taking Lipitor phy, in those with previous vascular disease, and in
nificant amount (compared to 11 percent who did so in study pretty unique for its time, all the participants than among the women taking the placebo.) So those without renal dysfunction. Likewise—and we
the “lifestyle change” group). This allowed the pravas- had either average or lower than average cholesterol— approximately $100 million was spent, and not a sin- quote—“Among women, placebo even had non-
tatin folks to trumpet a significant reduction in cho- in contrast to the vast majority of statin studies that gle life was saved. significantly better results than atorvastatin.”4
lesterol and declare the trial a success. test their drug on folks with high cholesterol.2 Secondly, a closer examination of the study’s In another reply, physician Peter Trewby high-
Not so fast. First, the good news—at least as far as Lipitor’s findings revealed some serious cracks in the “three lighted the low level of absolute benefit for Lipitor
When the death rates from heart attack were stockholders were concerned: After a mean follow-up cheers for Lipitor” story. Here’s why. When ASCOT- takers—stating “It is not the significance . . . of the
examined, there was no difference between the two time of 3.3 years, those taking Lipitor appeared to LLA’s findings were published in 2003 in the Lancet, reduction in relative risk that causes us concern, but
groups. The statin drug lowered cholesterol in 28 per- benefit. No doubt about it. Risk of heart disease its authors gave the drug an unsurprising thumbs up, whether the reduction in absolute risk with atorvas-
cent of the people taking it, but not a single life was dropped by 36 percent, and on the whole, fatal and stating that “The reductions in major cardiovascular tatin is sufficient for patients to take another drug for
saved. Pravastatin neither significantly reduced “all- nonfatal strokes, total cardiovascular events, and total events with atorvastatin are large, given the short the rest of their lives from which they have under 1%
cause” mortality (death from any reason whatsoever), coronary events were significantly lowered between follow-up time.” (We say “unsurprising,” because all chance per year of benefiting.”5
nor reduced fatal or nonfatal coronary heart disease 21 and 29 percent. Although the study was supposed fourteen of those authors served as consultants to— Speaking of relative versus absolute risk, let’s
1
in the patients who took it. to span five years, it was terminated early—ostensibly and received travel expenses, speaking fees, or dive in to our third and final point: that “36% reduc-
because the Lipitor group was outperforming the pla- research funding from—pharmaceutical companies tion in heart disease risk” wasn’t actually all that

impressive once we take off the reality-distorting “rela- As Uffe Ravnskov, M.D., Ph.D., stated in a letter to between LDL levels and death rate in the three The problem? This rosy picture changes when we
tive risk” goggles. Among the Lipitor group, 1.9 percent the editor of the British Medical Journal regarding the groups. In other words, whether your cholesterol had look at what happened with total mortality—or rather,
of the study subjects experienced fatal heart disease Heart Protection Study results, “Tell a patient that his been lowered or not had no correlation to whether or what didn’t happen. By the end of the study, there
or a non-fatal heart attack, compared to 3 percent of chance not to die in five years without statin treat- not you died. Patients with the highest levels of LDL was no significant difference—nada, zilch, goose egg—
the placebo group. That’s an absolute difference of ment is 85.4 percent and that [statin] treatment can died at pretty much the exact same rate as patients in total deaths between the cholestyramine group ver-
only 1.1 percent—the number Trewby deftly cited. increase this to 87.1 percent. With these figures in with the lowest LDL levels (and as patients with LDL sus the placebo group. Despite lowering their choles-
So, slam dunk for Lipitor? More like an air ball. hand I doubt that anyone should accept a treatment levels in between the highest and the lowest). Bottom terol and dying less from heart disease, the cholestyr-
7
whose long-term effects are unknown.” line: Lowering LDL levels didn’t give you even a drop amine group just ended up dying more from other
The Heart Protection Study: Pretty of protection against dying. things—making their total mortality a wash.
Weak Protection Japanese Lipid Intervention Trial: No Not exactly a reason to whip out the bubbly, right?
The Heart Protection Study (HPS) divided more than Relationship between LDL and Dying LRC-CPPT: Escape Heart Disease And that’s not all. LRC-CPPT is another shining
twenty thousand adults with either coronary artery In this trial, more than forty-seven thousand patients So You Can Die from Something Else example of how relative risk can fool us into thinking
disease or diabetes into two groups and gave one received Zocor over the course of six years. There (And Some More Fuzzy Math, a study’s findings are more dramatic than they really
group 40 mg of the statin Zocor daily while the other was quite a variety in their response to this While We’re At It)? are. When we put that “24 percent reduction in heart
6
group received a placebo. It was claimed that treatment. Some folks saw dramatic lowering of their The Lipid Research Clinics Coronary Primary disease death” into absolute terms, the whole house
“massive benefits” were obtained by lowering LDL levels, some saw a moderate fall in their levels, Prevention Trial (LRC-CPPT), published in 1984, is an of cards falls apart: The cholestyramine group’s rate
cholesterol with the statin drug, and indeed fewer and some experienced essentially no reduction in interesting case—one that takes a little digging to see of heart disease death was 1.6 percent, while the pla-
people died in the Zocor group than in the placebo their levels. where we’ve been duped. In this study, researchers cebo group had a microscopically higher rate of 2
group. After five years, the researchers examined the put 3,800 middle-aged men with very high cholesterol percent—a difference of only 0.4 percent.
But let’s look at the absolute numbers. Those in death rate among the participants and cross- on either a cholestyramine resin (which lowers And the number of participants driving that
the Zocor group had an 87.1 percent survival rate referenced these deaths with the patients’ LDL levels. cholesterol by binding to bile acids) or a placebo, with difference? A mere eight men out of 3,800.
after five years, but those in the placebo group had You’d think this would be the perfect study to demon- both groups also following a moderate cholesterol- In other words, another study for the slush pile.
8
an 85.4 percent survival rate, an absolute difference strate a correlation between lower LDL levels and a lowering diet. After an average of 7.4 years, the
of 1.8 percent. Most important, the survival rates were decreased risk for heart disease, right? Clearly, those cholestyramine drug group slashed their total and PROSPER: Some Benefits,
independent of lowering cholesterol. In other words, whose LDL levels had dropped dramatically would LDL cholesterol compared to the placebo—an 8.5 but Only for Certain People
lowering LDL levels made essentially no difference in have been far more likely to live, while those whose percent greater reduction in total cholesterol and 12.6 The Prospective Study of Pravastatin in the Elderly
the risk of death from heart disease. (This is not diffi- cholesterol levels had not dropped at all would have percent greater reduction in LDL, to be exact. More at Risk (PROSPER) was interesting for a number of
cult to understand when you factor in the other been far more likely to die, and those who had low- importantly, the cholestyramine group reduced their reasons. In this study, older patients were divided into
things statins do besides lower cholesterol. If any- ered their cholesterol only a modest amount would rate of death from heart disease by 24 percent and two groups. The first group consisted of patients with
thing, it simply shows that statin drugs may be useful have fallen somewhere in between. their rate of nonfatal heart attacks by 19 percent. no history of heart disease (primary prevention
in certain populations, but if they are, it’s independent We’re sure that’s what the researchers expected It wouldn’t be an exaggeration to call this study group), and the second group consisted of patients
of their ability to lower cholesterol. In fact, it increas- to see. groundbreaking: It was the first trial that actually with current or past cardiovascular disease
ingly looks like lowering cholesterol may be the least But they didn’t. showed people could cut their risk of dying from (secondary prevention group). Half of each group
significant thing statins do.) After five years there was exactly no correlation heart disease by lowering their cholesterol. received Pravachol (a statin drug), while the other

impressive once we take off the reality-distorting “rela- As Uffe Ravnskov, M.D., Ph.D., stated in a letter to between LDL levels and death rate in the three The problem? This rosy picture changes when we
tive risk” goggles. Among the Lipitor group, 1.9 percent the editor of the British Medical Journal regarding the groups. In other words, whether your cholesterol had look at what happened with total mortality—or rather,
of the study subjects experienced fatal heart disease Heart Protection Study results, “Tell a patient that his been lowered or not had no correlation to whether or what didn’t happen. By the end of the study, there
or a non-fatal heart attack, compared to 3 percent of chance not to die in five years without statin treat- not you died. Patients with the highest levels of LDL was no significant difference—nada, zilch, goose egg—
the placebo group. That’s an absolute difference of ment is 85.4 percent and that [statin] treatment can died at pretty much the exact same rate as patients in total deaths between the cholestyramine group ver-
only 1.1 percent—the number Trewby deftly cited. increase this to 87.1 percent. With these figures in with the lowest LDL levels (and as patients with LDL sus the placebo group. Despite lowering their choles-
So, slam dunk for Lipitor? More like an air ball. hand I doubt that anyone should accept a treatment levels in between the highest and the lowest). Bottom terol and dying less from heart disease, the cholestyr-
7
whose long-term effects are unknown.” line: Lowering LDL levels didn’t give you even a drop amine group just ended up dying more from other
The Heart Protection Study: Pretty of protection against dying. things—making their total mortality a wash.
Weak Protection Japanese Lipid Intervention Trial: No Not exactly a reason to whip out the bubbly, right?
The Heart Protection Study (HPS) divided more than Relationship between LDL and Dying LRC-CPPT: Escape Heart Disease And that’s not all. LRC-CPPT is another shining
twenty thousand adults with either coronary artery In this trial, more than forty-seven thousand patients So You Can Die from Something Else example of how relative risk can fool us into thinking
disease or diabetes into two groups and gave one received Zocor over the course of six years. There (And Some More Fuzzy Math, a study’s findings are more dramatic than they really
group 40 mg of the statin Zocor daily while the other was quite a variety in their response to this While We’re At It)? are. When we put that “24 percent reduction in heart
6
group received a placebo. It was claimed that treatment. Some folks saw dramatic lowering of their The Lipid Research Clinics Coronary Primary disease death” into absolute terms, the whole house
“massive benefits” were obtained by lowering LDL levels, some saw a moderate fall in their levels, Prevention Trial (LRC-CPPT), published in 1984, is an of cards falls apart: The cholestyramine group’s rate
cholesterol with the statin drug, and indeed fewer and some experienced essentially no reduction in interesting case—one that takes a little digging to see of heart disease death was 1.6 percent, while the pla-
people died in the Zocor group than in the placebo their levels. where we’ve been duped. In this study, researchers cebo group had a microscopically higher rate of 2
group. After five years, the researchers examined the put 3,800 middle-aged men with very high cholesterol percent—a difference of only 0.4 percent.
But let’s look at the absolute numbers. Those in death rate among the participants and cross- on either a cholestyramine resin (which lowers And the number of participants driving that
the Zocor group had an 87.1 percent survival rate referenced these deaths with the patients’ LDL levels. cholesterol by binding to bile acids) or a placebo, with difference? A mere eight men out of 3,800.
after five years, but those in the placebo group had You’d think this would be the perfect study to demon- both groups also following a moderate cholesterol- In other words, another study for the slush pile.
8
an 85.4 percent survival rate, an absolute difference strate a correlation between lower LDL levels and a lowering diet. After an average of 7.4 years, the
of 1.8 percent. Most important, the survival rates were decreased risk for heart disease, right? Clearly, those cholestyramine drug group slashed their total and PROSPER: Some Benefits,
independent of lowering cholesterol. In other words, whose LDL levels had dropped dramatically would LDL cholesterol compared to the placebo—an 8.5 but Only for Certain People
lowering LDL levels made essentially no difference in have been far more likely to live, while those whose percent greater reduction in total cholesterol and 12.6 The Prospective Study of Pravastatin in the Elderly
the risk of death from heart disease. (This is not diffi- cholesterol levels had not dropped at all would have percent greater reduction in LDL, to be exact. More at Risk (PROSPER) was interesting for a number of
cult to understand when you factor in the other been far more likely to die, and those who had low- importantly, the cholestyramine group reduced their reasons. In this study, older patients were divided into
things statins do besides lower cholesterol. If any- ered their cholesterol only a modest amount would rate of death from heart disease by 24 percent and two groups. The first group consisted of patients with
thing, it simply shows that statin drugs may be useful have fallen somewhere in between. their rate of nonfatal heart attacks by 19 percent. no history of heart disease (primary prevention
in certain populations, but if they are, it’s independent We’re sure that’s what the researchers expected It wouldn’t be an exaggeration to call this study group), and the second group consisted of patients
of their ability to lower cholesterol. In fact, it increas- to see. groundbreaking: It was the first trial that actually with current or past cardiovascular disease
ingly looks like lowering cholesterol may be the least But they didn’t. showed people could cut their risk of dying from (secondary prevention group). Half of each group
significant thing statins do.) After five years there was exactly no correlation heart disease by lowering their cholesterol. received Pravachol (a statin drug), while the other

half received a placebo. The JUPITER Trial: “Flawed” that the group being treated with the drug (Crestor) is particularly concerning because of the strong com-
There was some reduction in heart attacks or We saved this one for last, because it’s the juiciest, experienced half as many deaths, strokes, and heart mercial interest in the study.” They concluded that
strokes, but only in the secondary prevention group most perfect example of utter cholesterol madness, attacks as the control (untreated) group. “[t]he results of the trial do not support the use of
(those who had current heart disease or a history of media hype, behind-the-scenes manipulation, and The JUPITER trial was touted everywhere as statin treatment for primary prevention of cardiovas-
heart disease). There was, however, no reduction in intellectual dishonesty. proof that the cholesterol guidelines needed to be cular diseases.”
heart attacks or strokes in the primary prevention If you read the papers or watched the news in changed. Clearly, the drug manufacturers argued, So how did this study manage to garner head-
group, the group that had no history of heart disease 2009, you probably heard about this study, though people who met or exceeded the existing standards lines like this one: “Heart Attack Risk Lowered More
to begin with. This is pretty much in keeping with the you may not have known what it was called. Its for cholesterol were demonstrably helped by lowering Than 50 Percent by Taking Crestor!”?
findings of the vast majority of other studies. name—JUPITER—stands for the Justification for the their “normal” cholesterol even further, virtually cut- Let’s take a look.
But there were two other interesting findings, one Use of Statins in Primary Prevention: An Intervention ting their risk for all kinds of terrible things in half! The JUPITER trial took 17,800 people—men over
of them quite troubling. Trial Evaluating Rosuvastatin. (Even the title of the Obviously, they argued to anyone who would listen, sixty, women over fifty—and put them into two groups.
When pharmaceutical reps spin the data from the study should give you pause; you don’t do a study to we need to make the recommended “normal” levels One group received 20 mg of Crestor daily, while the
PROSPER study, they concentrate on the single fact justify the use of a drug you’ve already decided to even lower! (Can you imagine the cheers that would other group received a placebo.
that Pravachol reduced heart attacks and strokes use. What if the results of the study indicated the erupt at stockholders’ meetings if your product just Now before we tell you the results, let’s recall the
9
(while downplaying the fact that it did so only in the opposite? An objective scientific study wouldn’t know expanded its market by roughly 11 million people? distinction between relative versus absolute numbers,
group that already had heart disease). Okay, that’s the results in advance.) Why that’s almost as good as expanding an adult mar- a distinction we talked about earlier.
good; the prevention of a few heart attacks and Anyway, on to the study, about which there’s ket by targeting children! Oh, that’s right. Ever since The study went on for 1.9 years, and at the end of
strokes, even in a limited population, is always nice. much to dislike and critique—for example, everything. 2011, that’s exactly what the statin lobbyists were that time it was determined that the risk of having a
But what about other measures of health, disease, The JUPITER trial looked at nearly 18,000 people doing. Never mind.)* heart attack in the placebo group was 1.8 percent,
and well-being besides heart attacks and strokes? whose cholesterol was perfectly normal or even on Well that was then. This is now. while the risk of having a heart attack in the Crestor
To answer this question, researchers decided to the low side. What these folks did have, however, were Nine respected authors, including a Harvard group was 0.9 percent.
look at other measures of total health impact. They elevated levels of C-reactive protein (CRP). As we’ve Medical School faculty member, teamed up to write a So, yes, there was a 50 percent reduction in risk!
looked at “total deaths” and “total serious adverse said, CRP is a general measure of inflammation, and critical reappraisal of the JUPITER trial, a reappraisal Relatively speaking. But let’s do the math on the num-
events” and found that both were completely for the record, it’s a measure we consider important. that was published in 2010 in Archives of Internal ber that really matters, the absolute risk.
unchanged by Pravachol. Once again, a statin drug (You’ll read more about CRP testing in appendix B.) Medicine, one of the most respected, and conserva- The placebo group had a 1.8 percent risk, and the
10
had a beneficial effect on heart attacks and strokes in Now it’s abundantly clear that what the manufactur- tive, medical journals in the world. “The trial was Crestor group had a 0.9 percent risk, so the absolute,
the secondary prevention population but not in the ers of the drug were aiming for here was a demon- flawed,” they wrote. “It was discontinued (according real reduction in risk was 1.8 minus 0.9, or 0.9 per-
primary prevention population, and once again, not a stration that statin drugs help prevent deaths even in to pre-specified rules) after fewer than two years of cent. In absolute numbers, this means that if you took
single life was saved overall. people with normal cholesterol! follow-up, with no differences between the two a group of 100 untreated people, 1.8 of them would
The second finding was more troubling. Both So here’s the party line on the JUPITER trial, the groups on the most objective criteria.” The authors have a heart attack at some point over the course of
groups receiving Pravachol had an increased risk of line that was robotically repeated in virtually every also said, “The possibility that bias entered the trial almost two years. If you took that same group of 100
cancer. Amazingly, the investigators simply dis- news outlet in America: The JUPITER trial was such a * When the results of JUPITER came out, the stock of people and treated them all with Crestor for the same
missed this statistically significant finding as “the resounding success that they had to stop it early AstraZeneca—the company that makes Crestor—shot period, 0.9 of them would have a heart attack.
play of chance.” because it would be “unethical” to continue, given up by double digits. Researchers calculate that this translates into 120

half received a placebo. The JUPITER Trial: “Flawed” that the group being treated with the drug (Crestor) is particularly concerning because of the strong com-
There was some reduction in heart attacks or We saved this one for last, because it’s the juiciest, experienced half as many deaths, strokes, and heart mercial interest in the study.” They concluded that
strokes, but only in the secondary prevention group most perfect example of utter cholesterol madness, attacks as the control (untreated) group. “[t]he results of the trial do not support the use of
(those who had current heart disease or a history of media hype, behind-the-scenes manipulation, and The JUPITER trial was touted everywhere as statin treatment for primary prevention of cardiovas-
heart disease). There was, however, no reduction in intellectual dishonesty. proof that the cholesterol guidelines needed to be cular diseases.”
heart attacks or strokes in the primary prevention If you read the papers or watched the news in changed. Clearly, the drug manufacturers argued, So how did this study manage to garner head-
group, the group that had no history of heart disease 2009, you probably heard about this study, though people who met or exceeded the existing standards lines like this one: “Heart Attack Risk Lowered More
to begin with. This is pretty much in keeping with the you may not have known what it was called. Its for cholesterol were demonstrably helped by lowering Than 50 Percent by Taking Crestor!”?
findings of the vast majority of other studies. name—JUPITER—stands for the Justification for the their “normal” cholesterol even further, virtually cut- Let’s take a look.
But there were two other interesting findings, one Use of Statins in Primary Prevention: An Intervention ting their risk for all kinds of terrible things in half! The JUPITER trial took 17,800 people—men over
of them quite troubling. Trial Evaluating Rosuvastatin. (Even the title of the Obviously, they argued to anyone who would listen, sixty, women over fifty—and put them into two groups.
When pharmaceutical reps spin the data from the study should give you pause; you don’t do a study to we need to make the recommended “normal” levels One group received 20 mg of Crestor daily, while the
PROSPER study, they concentrate on the single fact justify the use of a drug you’ve already decided to even lower! (Can you imagine the cheers that would other group received a placebo.
that Pravachol reduced heart attacks and strokes use. What if the results of the study indicated the erupt at stockholders’ meetings if your product just Now before we tell you the results, let’s recall the
9
(while downplaying the fact that it did so only in the opposite? An objective scientific study wouldn’t know expanded its market by roughly 11 million people? distinction between relative versus absolute numbers,
group that already had heart disease). Okay, that’s the results in advance.) Why that’s almost as good as expanding an adult mar- a distinction we talked about earlier.
good; the prevention of a few heart attacks and Anyway, on to the study, about which there’s ket by targeting children! Oh, that’s right. Ever since The study went on for 1.9 years, and at the end of
strokes, even in a limited population, is always nice. much to dislike and critique—for example, everything. 2011, that’s exactly what the statin lobbyists were that time it was determined that the risk of having a
But what about other measures of health, disease, The JUPITER trial looked at nearly 18,000 people doing. Never mind.)* heart attack in the placebo group was 1.8 percent,
and well-being besides heart attacks and strokes? whose cholesterol was perfectly normal or even on Well that was then. This is now. while the risk of having a heart attack in the Crestor
To answer this question, researchers decided to the low side. What these folks did have, however, were Nine respected authors, including a Harvard group was 0.9 percent.
look at other measures of total health impact. They elevated levels of C-reactive protein (CRP). As we’ve Medical School faculty member, teamed up to write a So, yes, there was a 50 percent reduction in risk!
looked at “total deaths” and “total serious adverse said, CRP is a general measure of inflammation, and critical reappraisal of the JUPITER trial, a reappraisal Relatively speaking. But let’s do the math on the num-
events” and found that both were completely for the record, it’s a measure we consider important. that was published in 2010 in Archives of Internal ber that really matters, the absolute risk.
unchanged by Pravachol. Once again, a statin drug (You’ll read more about CRP testing in appendix B.) Medicine, one of the most respected, and conserva- The placebo group had a 1.8 percent risk, and the
10
had a beneficial effect on heart attacks and strokes in Now it’s abundantly clear that what the manufactur- tive, medical journals in the world. “The trial was Crestor group had a 0.9 percent risk, so the absolute,
the secondary prevention population but not in the ers of the drug were aiming for here was a demon- flawed,” they wrote. “It was discontinued (according real reduction in risk was 1.8 minus 0.9, or 0.9 per-
primary prevention population, and once again, not a stration that statin drugs help prevent deaths even in to pre-specified rules) after fewer than two years of cent. In absolute numbers, this means that if you took
single life was saved overall. people with normal cholesterol! follow-up, with no differences between the two a group of 100 untreated people, 1.8 of them would
The second finding was more troubling. Both So here’s the party line on the JUPITER trial, the groups on the most objective criteria.” The authors have a heart attack at some point over the course of
groups receiving Pravachol had an increased risk of line that was robotically repeated in virtually every also said, “The possibility that bias entered the trial almost two years. If you took that same group of 100
cancer. Amazingly, the investigators simply dis- news outlet in America: The JUPITER trial was such a * When the results of JUPITER came out, the stock of people and treated them all with Crestor for the same
missed this statistically significant finding as “the resounding success that they had to stop it early AstraZeneca—the company that makes Crestor—shot period, 0.9 of them would have a heart attack.
play of chance.” because it would be “unethical” to continue, given up by double digits. Researchers calculate that this translates into 120

people needing treatment for 1.9 years in order to apy, since the absolute benefits of treatment must be
prevent one event. At a cost of well over a quarter of large enough to justify the associated risks and
a million dollars for almost two years’ worth of
Crestor, that’s an awful lot to spend to prevent one
costs.” He added that “[l]ong-term safety is clearly
important in considering committing low-risk subjects
APPENDIX B
event. Especially when there’s a significant chance of without clinical disease to twenty years or more of
experiencing really bad side effects from the medicine
that’s costing you a fortune.
drug treatment.”11
Did we mention that there was a significantly
BEYOND CHOLESTEROL TESTING:
Commenting on the JUPITER study in the New higher incidence of diabetes in the group treated with WHAT TESTS SHOULD I GET?
England Journal of Medicine in November 2008, Mark Crestor?12 (In her studies on statin side effects,
A. Hlatky, M.D., wrote: “[A]bsolute differences in risk Stephanie Seneff also observed a highly significant We hope by now you’re convinced that total behave very differently. Seen under a microscope,
are more clinically important than relative reductions correlation—p = 0.006—between mentions of diabetes cholesterol is a meaningless number and should be some LDL particles are big, fluffy, and much less likely
in risk in deciding whether to recommend drug ther- and statin drug side effect reports.) the basis for absolutely nothing in your treatment to do any damage. Some are small, dense, “angry,”
plan. The old division into “good” (HDL) cholesterol and much more likely to become oxidized and
and “bad” (LDL) cholesterol is out of date and inflamed, slipping through the cells that line the walls
provides only marginally better information than a of the arteries (the endothelium) and beginning the
“total” cholesterol reading. inflammatory cascade that leads to heart disease.
As we’ve said, both good and bad cholesterol Tests are now available that measure LDL particle
have a number of different components (or subtypes) size and total particle number, and that’s the informa-
that behave quite differently, and the twenty-first- tion you really want to have. If you have a pattern A
century version of a cholesterol test should always cholesterol profile, most of your LDL cholesterol is
tell you exactly which subtypes you have and, most the big, fluffy kind; but if you have a pattern B profile,
important, your total number of particles. Anything most of your LDL cholesterol is composed of the
less than this up-to-date test—sometimes called the small, dense, atherogenic particles that cause inflam-
NMR particle test or the NMR Lipo-Profile panel—is mation and ultimately plaque. (Pattern B is much
not particularly useful and should never be the sole more likely to be associated with insulin resistance
basis on which a treatment plan or a statin drug is and metabolic syndrome.)1 (Fortunately, you can
recommended. change the distribution from small to buoyant by fol-
lowing the dietary and supplement recommendations
PARTICLE SIZE TEST in this book.)
(THE NMR LIPO-PROFILE TEST) The LDL particle test is available through a num-
Although LDL cholesterol is known as the “bad” ber of labs. One of the best-known and most estab-
cholesterol, the fact is that it comes in several shapes lished particle tests is known as the NMR Lipo-Profile.
and sizes, as does HDL cholesterol, the so-called Taking a statin drug, or any other medication, based
“good” kind. These different subtypes of cholesterol solely on the standard cholesterol test is a really bad
196 THE GREAT CHOLESTEROL MYTH APPENDIX B 197

people needing treatment for 1.9 years in order to apy, since the absolute benefits of treatment must be
prevent one event. At a cost of well over a quarter of large enough to justify the associated risks and
a million dollars for almost two years’ worth of
Crestor, that’s an awful lot to spend to prevent one
costs.” He added that “[l]ong-term safety is clearly
important in considering committing low-risk subjects
APPENDIX B
event. Especially when there’s a significant chance of without clinical disease to twenty years or more of
experiencing really bad side effects from the medicine
that’s costing you a fortune.
drug treatment.”11
Did we mention that there was a significantly
BEYOND CHOLESTEROL TESTING:
Commenting on the JUPITER study in the New higher incidence of diabetes in the group treated with WHAT TESTS SHOULD I GET?
England Journal of Medicine in November 2008, Mark Crestor?12 (In her studies on statin side effects,
A. Hlatky, M.D., wrote: “[A]bsolute differences in risk Stephanie Seneff also observed a highly significant We hope by now you’re convinced that total behave very differently. Seen under a microscope,
are more clinically important than relative reductions correlation—p = 0.006—between mentions of diabetes cholesterol is a meaningless number and should be some LDL particles are big, fluffy, and much less likely
in risk in deciding whether to recommend drug ther- and statin drug side effect reports.) the basis for absolutely nothing in your treatment to do any damage. Some are small, dense, “angry,”
plan. The old division into “good” (HDL) cholesterol and much more likely to become oxidized and
and “bad” (LDL) cholesterol is out of date and inflamed, slipping through the cells that line the walls
provides only marginally better information than a of the arteries (the endothelium) and beginning the
“total” cholesterol reading. inflammatory cascade that leads to heart disease.
As we’ve said, both good and bad cholesterol Tests are now available that measure LDL particle
have a number of different components (or subtypes) size and total particle number, and that’s the informa-
that behave quite differently, and the twenty-first- tion you really want to have. If you have a pattern A
century version of a cholesterol test should always cholesterol profile, most of your LDL cholesterol is
tell you exactly which subtypes you have and, most the big, fluffy kind; but if you have a pattern B profile,
important, your total number of particles. Anything most of your LDL cholesterol is composed of the
less than this up-to-date test—sometimes called the small, dense, atherogenic particles that cause inflam-
NMR particle test or the NMR Lipo-Profile panel—is mation and ultimately plaque. (Pattern B is much
not particularly useful and should never be the sole more likely to be associated with insulin resistance
basis on which a treatment plan or a statin drug is and metabolic syndrome.)1 (Fortunately, you can
recommended. change the distribution from small to buoyant by fol-
lowing the dietary and supplement recommendations
PARTICLE SIZE TEST in this book.)
(THE NMR LIPO-PROFILE TEST) The LDL particle test is available through a num-
Although LDL cholesterol is known as the “bad” ber of labs. One of the best-known and most estab-
cholesterol, the fact is that it comes in several shapes lished particle tests is known as the NMR Lipo-Profile.
and sizes, as does HDL cholesterol, the so-called Taking a statin drug, or any other medication, based
“good” kind. These different subtypes of cholesterol solely on the standard cholesterol test is a really bad

idea. Ask your doctor for one of the newer particle are between 200 and 400 mg/dL, and they may be this danger always exists for men, it becomes a real LP(A)
tests. If he objects, make sure he has a darn good elevated during any kind of inflammation. risk for women after menopause. Both of us are ada- Lp(a) is a type of cholesterol-carrying molecule that
reason. It’s the only cholesterol test that matters. Fibrinogen has been identified as an independent mant that no one but premenopausal women should contains one LDL (low-density lipoprotein) molecule
risk factor for cardiovascular disease and is associ- ever take vitamins with iron, or supplemental iron of chemically bound to an attachment protein called
C-REACTIVE PROTEIN (CRP) ated with the traditional risk factors as well. In one any kind, unless prescribed by a health practitioner. apolipoprotein(a). In a healthy body, Lp(a) isn’t much
CRP is a marker for inflammation that is directly study, fibrinogen levels were significantly higher Iron overload—technically called hemochromato- of a problem. It circulates and carries out repair and
associated with overall heart and cardiovascular among subjects with cardiovascular disease than sis—can actually contribute to heart disease. restoration work on damaged blood vessels. The
2
health. In multiple studies, CRP has been identified as among those without it. Researchers measure iron in the blood by measuring protein part of it promotes blood clotting. So far,
a potent predictor of future cardiovascular health— If you have a family history of heart concerns, a form of it called ferritin. A 1992 study by Finnish so good.
and, in our opinion, one that is far more reliable than you must check your serum fibrinogen level. Women researchers examined the role of iron in coronary The problem is, the more repair you need on your
elevated cholesterol levels. Biological characteristics who smoke, take oral contraceptives, or are post- artery disease. After studying 1,900 Finnish men arteries, the more Lp(a) is utilized, and that’s when
that are associated with high CRP levels include menopausal usually have higher fibrinogen levels. between the ages of forty-two and sixty for five years, things get ugly. Lp(a) concentrates at the site of dam-
infections, high blood sugar, excess weight, and Worth noting: This test hasn’t caught on with the researchers found that men with excessive levels age, binds with a couple of amino acids within the
hypercoagulability of blood (sticky blood). many doctors because there are no direct treatments of ferritin had an elevated risk of heart attack, and wall of a damaged blood vessel, dumps its LDL cargo,
Fortunately, there is a simple test that your doc- for elevated levels. But supplements such as nattoki- that every 1 percent increase in ferritin translated into and starts to promote the deposition of oxidized LDL
3
tor can conduct to find out how much CRP is in your nase, discussed in chapter 11 on supplements, can a 4 percent increase in heart attack risk. into the wall, leading to more inflammation and ulti-
blood. Just make sure the high-sensitivity test (hs- work well to “thin” the blood and prevent unwanted Those with high levels of ferritin were more than mately to plaque.
CRP) is used. This test doesn’t take much time: clotting. Adding omega-3 fatty acids to your diet may twice as likely to have heart attacks than those with Also, Lp(a) promotes the formation of blood clots
Typically, blood is drawn from a vein located either on also help. lower levels. The authors of this study concluded that on top of the newly formed plaque, which narrows the
your forearm or on the inside of your elbow. The ferritin levels may be an even stronger risk factor for blood vessels further. If the clots are large enough,
blood is then analyzed in several tests to determine SERUM FERRITIN heart disease than high blood pressure or diabetes they can block an artery. (Most heart attacks are due
4
the level of CRP present. (Dr. Sinatra’s recommenda- Ever wonder why so many vitamin manufacturers is. It’s certainly a more important risk factor than to either a large clot developing in vessels with
tion for an optimal CRP level is less than 0.8 mg/dL.) offer multiple vitamins “without iron”? Here’s why: high cholesterol. moderate-to-severe narrowing or a plaque rupture
Iron is one of those weird substances where if you If your ferritin levels are high, consider donating that blocks the artery.)
FIBRINOGEN don’t have enough you can have some real problems blood every so often, or ask your doctor to consider a Elevated Lp(a) is a very serious risk factor. A very
Fibrinogen is a protein that determines the stickiness (e.g., iron-deficiency anemia), but if you have too therapeutic phlebotomy. (Dr. Sinatra’s recommenda- high percentage of heart attacks happen to people
of your blood by enabling your platelets to stick much, look out! Iron is highly susceptible to oxidation. tion for an optimal serum ferritin level is less than with high Lp(a) levels. Dr. Sinatra thinks Lp(a) is one
together. You need adequate fibrinogen levels to stop (Imagine someone leaving a barbell from your gym 80 mg/L for women and less than 90 mg/L for men.) of the most devastating risk factors for heart disease
bleeding when you’ve been injured, but you also want outside in the rain for a couple of days. It’s going to Worth noting: One consideration regarding sup- and one of the hardest to treat.
to balance your fibrinogen levels to support optimal rust like crazy. That’s oxidation.) plemental vitamin C is that it helps the body absorb One reason doctors aren’t running out to test for
blood circulation and prevent unnecessary clotting. Iron levels in the body are cumulative (stored in iron better. If you have a problem with iron levels, Lp(a) all the time is that there are no real pharmaceu-
(In women younger than forty-five, Dr. Sinatra has the muscles and other tissues), and unless iron is lost keep your supplemental vitamin C to less than 100 mg tical interventions that work to lower it. In addition,
seen far more heart attacks caused by improper through menstruation or by donating blood, over the a day. Lp(a) levels are largely genetically determined and
blood clotting than by anything else.) Normal levels years toxic levels can build up in the system. Although not very modifiable by lifestyle choices.

idea. Ask your doctor for one of the newer particle are between 200 and 400 mg/dL, and they may be this danger always exists for men, it becomes a real LP(A)
tests. If he objects, make sure he has a darn good elevated during any kind of inflammation. risk for women after menopause. Both of us are ada- Lp(a) is a type of cholesterol-carrying molecule that
reason. It’s the only cholesterol test that matters. Fibrinogen has been identified as an independent mant that no one but premenopausal women should contains one LDL (low-density lipoprotein) molecule
risk factor for cardiovascular disease and is associ- ever take vitamins with iron, or supplemental iron of chemically bound to an attachment protein called
C-REACTIVE PROTEIN (CRP) ated with the traditional risk factors as well. In one any kind, unless prescribed by a health practitioner. apolipoprotein(a). In a healthy body, Lp(a) isn’t much
CRP is a marker for inflammation that is directly study, fibrinogen levels were significantly higher Iron overload—technically called hemochromato- of a problem. It circulates and carries out repair and
associated with overall heart and cardiovascular among subjects with cardiovascular disease than sis—can actually contribute to heart disease. restoration work on damaged blood vessels. The
2
health. In multiple studies, CRP has been identified as among those without it. Researchers measure iron in the blood by measuring protein part of it promotes blood clotting. So far,
a potent predictor of future cardiovascular health— If you have a family history of heart concerns, a form of it called ferritin. A 1992 study by Finnish so good.
and, in our opinion, one that is far more reliable than you must check your serum fibrinogen level. Women researchers examined the role of iron in coronary The problem is, the more repair you need on your
elevated cholesterol levels. Biological characteristics who smoke, take oral contraceptives, or are post- artery disease. After studying 1,900 Finnish men arteries, the more Lp(a) is utilized, and that’s when
that are associated with high CRP levels include menopausal usually have higher fibrinogen levels. between the ages of forty-two and sixty for five years, things get ugly. Lp(a) concentrates at the site of dam-
infections, high blood sugar, excess weight, and Worth noting: This test hasn’t caught on with the researchers found that men with excessive levels age, binds with a couple of amino acids within the
hypercoagulability of blood (sticky blood). many doctors because there are no direct treatments of ferritin had an elevated risk of heart attack, and wall of a damaged blood vessel, dumps its LDL cargo,
Fortunately, there is a simple test that your doc- for elevated levels. But supplements such as nattoki- that every 1 percent increase in ferritin translated into and starts to promote the deposition of oxidized LDL
3
tor can conduct to find out how much CRP is in your nase, discussed in chapter 11 on supplements, can a 4 percent increase in heart attack risk. into the wall, leading to more inflammation and ulti-
blood. Just make sure the high-sensitivity test (hs- work well to “thin” the blood and prevent unwanted Those with high levels of ferritin were more than mately to plaque.
CRP) is used. This test doesn’t take much time: clotting. Adding omega-3 fatty acids to your diet may twice as likely to have heart attacks than those with Also, Lp(a) promotes the formation of blood clots
Typically, blood is drawn from a vein located either on also help. lower levels. The authors of this study concluded that on top of the newly formed plaque, which narrows the
your forearm or on the inside of your elbow. The ferritin levels may be an even stronger risk factor for blood vessels further. If the clots are large enough,
blood is then analyzed in several tests to determine SERUM FERRITIN heart disease than high blood pressure or diabetes they can block an artery. (Most heart attacks are due
4
the level of CRP present. (Dr. Sinatra’s recommenda- Ever wonder why so many vitamin manufacturers is. It’s certainly a more important risk factor than to either a large clot developing in vessels with
tion for an optimal CRP level is less than 0.8 mg/dL.) offer multiple vitamins “without iron”? Here’s why: high cholesterol. moderate-to-severe narrowing or a plaque rupture
Iron is one of those weird substances where if you If your ferritin levels are high, consider donating that blocks the artery.)
FIBRINOGEN don’t have enough you can have some real problems blood every so often, or ask your doctor to consider a Elevated Lp(a) is a very serious risk factor. A very
Fibrinogen is a protein that determines the stickiness (e.g., iron-deficiency anemia), but if you have too therapeutic phlebotomy. (Dr. Sinatra’s recommenda- high percentage of heart attacks happen to people
of your blood by enabling your platelets to stick much, look out! Iron is highly susceptible to oxidation. tion for an optimal serum ferritin level is less than with high Lp(a) levels. Dr. Sinatra thinks Lp(a) is one
together. You need adequate fibrinogen levels to stop (Imagine someone leaving a barbell from your gym 80 mg/L for women and less than 90 mg/L for men.) of the most devastating risk factors for heart disease
bleeding when you’ve been injured, but you also want outside in the rain for a couple of days. It’s going to Worth noting: One consideration regarding sup- and one of the hardest to treat.
to balance your fibrinogen levels to support optimal rust like crazy. That’s oxidation.) plemental vitamin C is that it helps the body absorb One reason doctors aren’t running out to test for
blood circulation and prevent unnecessary clotting. Iron levels in the body are cumulative (stored in iron better. If you have a problem with iron levels, Lp(a) all the time is that there are no real pharmaceu-
(In women younger than forty-five, Dr. Sinatra has the muscles and other tissues), and unless iron is lost keep your supplemental vitamin C to less than 100 mg tical interventions that work to lower it. In addition,
seen far more heart attacks caused by improper through menstruation or by donating blood, over the a day. Lp(a) levels are largely genetically determined and
blood clotting than by anything else.) Normal levels years toxic levels can build up in the system. Although not very modifiable by lifestyle choices.

However, your Lp(a) level can give you a good more than 3,000 patients with chronic heart disease general mortality in healthy older people. have moderate calcification; those with scores of 100
idea of your real risk for heart disease, and a high and found that a subsequent coronary event was 2.5 Interleukin-6 may be an even better marker for to 400 have increased calcification; and those with
level may serve as a wake-up call to inspire you to times more likely in patients with elevated levels of inflammation than CRP is because these “precursor” scores above 400 have extensive calcification.
work harder to improve your heart health using the homocysteine. What’s more, each 5 μmol/L of homo- levels rise earlier. If you’re concerned about inflamma- It is well established that individuals with
8
strategies, foods, supplements, and lifestyle changes cysteine predicted a 25 percent increase in risk! tion and its effect on your heart, ask your doctor to Agatston scores above 400 have an increased occur-
suggested in this book. That said, Dr. Sinatra feels Fortunately, there’s an easy way to bring down do an interleukin-6 test. (Dr. Sinatra’s recommenda- rence of coronary procedures (bypass, stent place-
that Lp(a) can be lowered with a combination of 1 to homocysteine levels. All you have to do is give the tion for an optimal interleukin-6 level is 0.0 to ment, and angioplasty) and events (myocardial infarc-
2 g of fish oil, 500 to 2,500 mg of niacin (not the body the three main nutrients it needs to metabolize 12.0 pg/mL.) tion and cardiac death) within the two to five years
slow-release kind), and 20 mg of lumbrokinase. homocysteine back into harmless compounds. The following the test. Individuals with very high Agatston
Worth noting: Statin drugs can sometimes raise three nutrients are folic acid, vitamin B12, and vitamin CORONARY CALCIUM SCAN scores (over 1,000) have a 20 percent chance of suf-
Lp(a) levels! This is mentioned on the warning labels B6. All it takes is about 400 to 800 mcg of folic acid, Calcium is great—as long as it stays in the bones and fering a heart attack or cardiac death within a year.
of statin drug ads in the Canadian edition of the New 400 to 1,000 mcg of B12, and 5 to 20 mg of B6. If teeth. One place you don’t want it is in the coronary Even among patients over the age of seventy who fre-
England Journal of Medicine, but such labeling is not you’ve had a heart attack or other cardiovascular arteries. quently have calcification, an Agatston score above
required by the Food and Drug Administration, so you event; if you have a family history of early heart dis- Coronary calcification is one of the major risk 400 was associated with a higher risk of death.11
won’t see it in ads published in the United States.5 ease; or if you have hypothyroidism, lupus, or kidney factors that predicts coronary heart disease and The American Heart Association and the
9
disease, consider asking your doctor to test your future heart attacks. The more calcium present, the American College of Cardiology provide guidelines for
HOMOCYSTEINE homocysteine levels. Finally, if you take drugs that greater the risk of suffering a heart attack. Men coronary calcification testing, available online, www.
Homocysteine is an amino acid by-product that tend to elevate homocysteine—theophylline (for develop calcifications about ten to fifteen years ear- ahajournals.org/misc/sci-stmts_topindex.shtml. These
causes your body to lay down sticky platelets in blood asthma), methotrexate (for cancer or arthritis), or lier than women do. Calcification can be detected in guidelines currently suggest—and we agree—that
vessels. Having some homocysteine is normal, but an L-dopa (for Parkinson’s)—you should be tested. (Dr. the majority of asymptomatic men over fifty-five screening for calcification is of value for an individual
excess might affect your cardiovascular health. Sinatra’s recommendation for an optimal homocyste- years of age and in women over sixty-five. who is considered to be at intermediate ten-year risk,
Evidence shows that homocysteine contributes to ine level is between 7 and 9 μmol/L.) As far back as 1991, cardiologist Stephen Seely, which means that he or she has a 10 to 20 percent
atherosclerosis, reduces the flexibility of blood M.D., published a paper in the International Journal of likelihood of experiencing a cardiac event within the
vessels, and helps make platelets stickier, thus slowing INTERLEUKIN-6 Cardiology titled “Is Calcium Excess in the Western next ten years.12
blood flow. Net result: There’s a direct correlation Interleukin-6 is important because it stimulates the Diet a Major Cause of Arterial Disease?” He pointed
between high homocysteine levels and an increased liver to produce CRP. And we are learning that this out that cholesterol only makes up 3 percent of arte- CARDIAC AND GENETIC MARKERS
10
risk of heart disease and stroke. inflammatory cytokine has a strong association with rial plaque while calcium makes up 50 percent! In the years since the original edition of this book was
Elevated homocysteine strongly predicts both a not only heart disease but also asthma. (Asthma is The Florida cardiologist Arthur Agatston, M.D., is published, genetic testing has gone mainstream. From
first and a recurring cardiovascular incident (including the result of airways swelling and constricting, so it best known for his wildly popular South Beach diet, 23 and Me to the most advanced genetic testing13 it’s
death).6 Too much homocysteine adversely affects the makes sense that an inflammatory agent is behind but what many people don’t know is that he also now possible for the average person to get all kinds
function of the endothelium, the all-important lining the curtains here as well.) The Iowa 65+ Rural Health developed a widely accepted test for coronary calcifi- of cardiometabolic genetic profiles that weren’t
of the artery walls. It also increases oxidative damage Study demonstrated that elevated levels of cation known as the Agatston test. Individuals who available even a decade ago. And the price is coming
and promotes inflammation and thrombosis—a regular interleukin-6 and CRP were associated with an score less than 10 on the Agatston test have minimal down. Quest Labs now offers an advanced lipid panel
7
evil trifecta for heart disease. One study looked at increased risk for both cardiovascular disease and calcification; those with Agatston scores of 11 to 99 called the Cardio IQ as well as an advanced

However, your Lp(a) level can give you a good more than 3,000 patients with chronic heart disease general mortality in healthy older people. have moderate calcification; those with scores of 100
idea of your real risk for heart disease, and a high and found that a subsequent coronary event was 2.5 Interleukin-6 may be an even better marker for to 400 have increased calcification; and those with
level may serve as a wake-up call to inspire you to times more likely in patients with elevated levels of inflammation than CRP is because these “precursor” scores above 400 have extensive calcification.
work harder to improve your heart health using the homocysteine. What’s more, each 5 μmol/L of homo- levels rise earlier. If you’re concerned about inflamma- It is well established that individuals with
8
strategies, foods, supplements, and lifestyle changes cysteine predicted a 25 percent increase in risk! tion and its effect on your heart, ask your doctor to Agatston scores above 400 have an increased occur-
suggested in this book. That said, Dr. Sinatra feels Fortunately, there’s an easy way to bring down do an interleukin-6 test. (Dr. Sinatra’s recommenda- rence of coronary procedures (bypass, stent place-
that Lp(a) can be lowered with a combination of 1 to homocysteine levels. All you have to do is give the tion for an optimal interleukin-6 level is 0.0 to ment, and angioplasty) and events (myocardial infarc-
2 g of fish oil, 500 to 2,500 mg of niacin (not the body the three main nutrients it needs to metabolize 12.0 pg/mL.) tion and cardiac death) within the two to five years
slow-release kind), and 20 mg of lumbrokinase. homocysteine back into harmless compounds. The following the test. Individuals with very high Agatston
Worth noting: Statin drugs can sometimes raise three nutrients are folic acid, vitamin B12, and vitamin CORONARY CALCIUM SCAN scores (over 1,000) have a 20 percent chance of suf-
Lp(a) levels! This is mentioned on the warning labels B6. All it takes is about 400 to 800 mcg of folic acid, Calcium is great—as long as it stays in the bones and fering a heart attack or cardiac death within a year.
of statin drug ads in the Canadian edition of the New 400 to 1,000 mcg of B12, and 5 to 20 mg of B6. If teeth. One place you don’t want it is in the coronary Even among patients over the age of seventy who fre-
England Journal of Medicine, but such labeling is not you’ve had a heart attack or other cardiovascular arteries. quently have calcification, an Agatston score above
required by the Food and Drug Administration, so you event; if you have a family history of early heart dis- Coronary calcification is one of the major risk 400 was associated with a higher risk of death.11
won’t see it in ads published in the United States.5 ease; or if you have hypothyroidism, lupus, or kidney factors that predicts coronary heart disease and The American Heart Association and the
9
disease, consider asking your doctor to test your future heart attacks. The more calcium present, the American College of Cardiology provide guidelines for
HOMOCYSTEINE homocysteine levels. Finally, if you take drugs that greater the risk of suffering a heart attack. Men coronary calcification testing, available online, www.
Homocysteine is an amino acid by-product that tend to elevate homocysteine—theophylline (for develop calcifications about ten to fifteen years ear- ahajournals.org/misc/sci-stmts_topindex.shtml. These
causes your body to lay down sticky platelets in blood asthma), methotrexate (for cancer or arthritis), or lier than women do. Calcification can be detected in guidelines currently suggest—and we agree—that
vessels. Having some homocysteine is normal, but an L-dopa (for Parkinson’s)—you should be tested. (Dr. the majority of asymptomatic men over fifty-five screening for calcification is of value for an individual
excess might affect your cardiovascular health. Sinatra’s recommendation for an optimal homocyste- years of age and in women over sixty-five. who is considered to be at intermediate ten-year risk,
Evidence shows that homocysteine contributes to ine level is between 7 and 9 μmol/L.) As far back as 1991, cardiologist Stephen Seely, which means that he or she has a 10 to 20 percent
atherosclerosis, reduces the flexibility of blood M.D., published a paper in the International Journal of likelihood of experiencing a cardiac event within the
vessels, and helps make platelets stickier, thus slowing INTERLEUKIN-6 Cardiology titled “Is Calcium Excess in the Western next ten years.12
blood flow. Net result: There’s a direct correlation Interleukin-6 is important because it stimulates the Diet a Major Cause of Arterial Disease?” He pointed
between high homocysteine levels and an increased liver to produce CRP. And we are learning that this out that cholesterol only makes up 3 percent of arte- CARDIAC AND GENETIC MARKERS
10
risk of heart disease and stroke. inflammatory cytokine has a strong association with rial plaque while calcium makes up 50 percent! In the years since the original edition of this book was
Elevated homocysteine strongly predicts both a not only heart disease but also asthma. (Asthma is The Florida cardiologist Arthur Agatston, M.D., is published, genetic testing has gone mainstream. From
first and a recurring cardiovascular incident (including the result of airways swelling and constricting, so it best known for his wildly popular South Beach diet, 23 and Me to the most advanced genetic testing13 it’s
death).6 Too much homocysteine adversely affects the makes sense that an inflammatory agent is behind but what many people don’t know is that he also now possible for the average person to get all kinds
function of the endothelium, the all-important lining the curtains here as well.) The Iowa 65+ Rural Health developed a widely accepted test for coronary calcifi- of cardiometabolic genetic profiles that weren’t
of the artery walls. It also increases oxidative damage Study demonstrated that elevated levels of cation known as the Agatston test. Individuals who available even a decade ago. And the price is coming
and promotes inflammation and thrombosis—a regular interleukin-6 and CRP were associated with an score less than 10 on the Agatston test have minimal down. Quest Labs now offers an advanced lipid panel
7
evil trifecta for heart disease. One study looked at increased risk for both cardiovascular disease and calcification; those with Agatston scores of 11 to 99 called the Cardio IQ as well as an advanced

inflammatory markers test, and more cardiac genetic Measuring Inflammation and the tein is called Apo-B, and any damage that’s done to it the American College of Cardiology.
tests are just around the corner. Vulnerability of Plaque: is due to oxidation. Oxidized LDL (or oxidation of
If you really want to dig beneath the surface, Myeloperoxidase (MPO) ApoB) is one of the events that initiates the process The 9p21 Test: Measures
here are some of the tests that are getting traction Myeloperoxidase is an inflammatory enzyme that gets of macrophage recruitment, the formation of foam Susceptibility to Inflammation
with doctors and that are worth discussing with your released in the lumen, the “inner tube” of the artery. cells from the dead macrophages, and the whole cycle Although technically not a gene, 9p21 is an important
physician. It gets released when white blood cells start going of vascular inflammation inside the artery wall. genetic marker that can give you an idea of how
crazy and mount a counterattack in response to Elevated OxLDL levels are associated with a 4.3x resistant or susceptible you are to inflammation.
Measuring Oxidative Damage: fissures, erosions, or degradation of the fibrous cap 16
increased risk of having a CHD event and a 3.5x Our friend, Dr. Mansoor Mohammed, clinical gen-
F2-isoprostanes (F2-IsoPs) that protects the plaque. Measuring MPO gives us a increased risk of developing metabolic syndrome omicist at the YouTrients personalized nutrition com-
17
As you read in chapter 5, inflammation and oxidation specific marker of vascular inflammation. It’s also a (see chapter 9, The Real Cause of Heart Disease ). pany in Canada, explains the 9p21 genetic marker by
are the twin towers of cellular destruction. And heart measure of how vulnerable your plaque is (and using the example of a Teflon pan as a stand-in for
disease is, in large measure, an inflammatory disease. remember that plaque only does real damage to your The Plaq™ Test (LP-PLA2): Measures your arteries.
(Remember, oxidation and inflammation are like heart when it ruptures, which begins with damage to How Likely Plaque Imagine that you’re got three different versions
inseparable twins and are always found together.) the fibrous cap). Elevated levels of MPO independently Is to Rupture of a Teflon pan. One is the super-deluxe model that
Some of the things that trigger the oxidation/ predict 2.0–2.4x increased risk of future As we explained in chapter 4, a fibrous cap eventually has a double coating of Teflon. The second is an ordi-
inflammation cascade include poor diet, smoking, and cardiovascular events such as a heart attack or forms around plaque, kind of like a scab forms on a nary but effective Teflon pan with a nice clean,
15
sedentary lifestyle. F2-isoPs are the by-products of CVD-related death. One of the best treatments for wound. Stable plaque may never cause a problem, but unmarred surface. And the third is pretty scratched
that damage, the evidence that the oxidation/ elevated MPO is high-dose fish oil. the when it ruptures, look out. Plaque “disruption” up and has a bunch of nicks and crevices.
inflammation cascade leaves behind. (rupture) is one of the primary causes of heart The 9p21 genetic marker tells you what version of
F2-isoprostanes are compounds that are formed Oxidized LDL (oxLDL) 18
attacks and sudden death and is significantly the Teflon pan you have. If you have the “double
19
from oxidation, specifically from the oxidation of ara- Oxidized LDL (oxLDL) is associated with a 4.3x associated with stroke. Teflon” version of the 9p21, you have “reduced sensi-
chidonic acid (an important omega-6 fat). You can increased risk of cardiovascular events. By anyone’s Lp-PLA2 is considered a specific marker for vas- tivity” to inflammatory agents (such as cigarette
think of F2-IsoPs as “by-products” of the “rusting” standards, that’s a pretty serious increase in risk. cular inflammation and for the vulnerability of plaque smoke and sugar). You may be able to handle some
(oxidation) process. And they can be measured. The Oxidized LDL—as you read in chapter 5—is choles- to rupturing. When the artery walls become inflamed, inflammatory substances a little better than most. If
F2-IsoPs contribute to heart disease by, among other terol that has been damaged by oxidation. You’ll the plaque itself makes this enzyme—Lp-PLA2. High you have the ordinary Teflon version of the pan,
things, constricting the arteries and contributing to recall that this is what initiates the problem in the levels may indicate a likelihood that the plaque is you’ve got “average sensitivity” to inflammation, and
platelet aggregation (blood clotting). first place, as a damaged LDL particle lodges itself likely to rupture through the inside of the lining of if you’ve got the scratched version of the pan, you
Elevated levels of F2-IsoPs more than double the inside the wall of the artery and begins the process of the artery wall and get into the bloodstream, leading have increased sensitivity to things that cause inflam-
risk for coronary artery disease (making it 2.6x more atherosclerosis. Prior to being attacked by free radi- to a dangerous clot. The result could be heart attack matory responses and a 2x increased risk of an early
likely). They almost double the risk for death—people cals and oxidized, LDL is simply going about its busi- or stroke. myocardial infarction (a heart attack).
with high levels are 1.8x more likely to die from car- ness in the bloodstream and not causing much mis- The presence of Lp-PLA2 indicates arterial In our opinion, everyone should consume as
14
diovascular disease than those with low levels. chief. But once it’s oxidized, that’s another story. inflammation and is a recognized risk factor for heart much anti-inflammatory foods and supplements as
This test measures damage to the protein attach- disease. Lp-PLA2 is now included in four major guide- possible, regardless of genes. (Just because you’re a
ment on the surface of the LDL molecule. That pro- lines, including the American Heart Association and fast swimmer doesn’t mean you shouldn’t avoid

inflammatory markers test, and more cardiac genetic Measuring Inflammation and the tein is called Apo-B, and any damage that’s done to it the American College of Cardiology.
tests are just around the corner. Vulnerability of Plaque: is due to oxidation. Oxidized LDL (or oxidation of
If you really want to dig beneath the surface, Myeloperoxidase (MPO) ApoB) is one of the events that initiates the process The 9p21 Test: Measures
here are some of the tests that are getting traction Myeloperoxidase is an inflammatory enzyme that gets of macrophage recruitment, the formation of foam Susceptibility to Inflammation
with doctors and that are worth discussing with your released in the lumen, the “inner tube” of the artery. cells from the dead macrophages, and the whole cycle Although technically not a gene, 9p21 is an important
physician. It gets released when white blood cells start going of vascular inflammation inside the artery wall. genetic marker that can give you an idea of how
crazy and mount a counterattack in response to Elevated OxLDL levels are associated with a 4.3x resistant or susceptible you are to inflammation.
Measuring Oxidative Damage: fissures, erosions, or degradation of the fibrous cap 16
increased risk of having a CHD event and a 3.5x Our friend, Dr. Mansoor Mohammed, clinical gen-
F2-isoprostanes (F2-IsoPs) that protects the plaque. Measuring MPO gives us a increased risk of developing metabolic syndrome omicist at the YouTrients personalized nutrition com-
17
As you read in chapter 5, inflammation and oxidation specific marker of vascular inflammation. It’s also a (see chapter 9, The Real Cause of Heart Disease ). pany in Canada, explains the 9p21 genetic marker by
are the twin towers of cellular destruction. And heart measure of how vulnerable your plaque is (and using the example of a Teflon pan as a stand-in for
disease is, in large measure, an inflammatory disease. remember that plaque only does real damage to your The Plaq™ Test (LP-PLA2): Measures your arteries.
(Remember, oxidation and inflammation are like heart when it ruptures, which begins with damage to How Likely Plaque Imagine that you’re got three different versions
inseparable twins and are always found together.) the fibrous cap). Elevated levels of MPO independently Is to Rupture of a Teflon pan. One is the super-deluxe model that
Some of the things that trigger the oxidation/ predict 2.0–2.4x increased risk of future As we explained in chapter 4, a fibrous cap eventually has a double coating of Teflon. The second is an ordi-
inflammation cascade include poor diet, smoking, and cardiovascular events such as a heart attack or forms around plaque, kind of like a scab forms on a nary but effective Teflon pan with a nice clean,
15
sedentary lifestyle. F2-isoPs are the by-products of CVD-related death. One of the best treatments for wound. Stable plaque may never cause a problem, but unmarred surface. And the third is pretty scratched
that damage, the evidence that the oxidation/ elevated MPO is high-dose fish oil. the when it ruptures, look out. Plaque “disruption” up and has a bunch of nicks and crevices.
inflammation cascade leaves behind. (rupture) is one of the primary causes of heart The 9p21 genetic marker tells you what version of
F2-isoprostanes are compounds that are formed Oxidized LDL (oxLDL) 18
attacks and sudden death and is significantly the Teflon pan you have. If you have the “double
19
from oxidation, specifically from the oxidation of ara- Oxidized LDL (oxLDL) is associated with a 4.3x associated with stroke. Teflon” version of the 9p21, you have “reduced sensi-
chidonic acid (an important omega-6 fat). You can increased risk of cardiovascular events. By anyone’s Lp-PLA2 is considered a specific marker for vas- tivity” to inflammatory agents (such as cigarette
think of F2-IsoPs as “by-products” of the “rusting” standards, that’s a pretty serious increase in risk. cular inflammation and for the vulnerability of plaque smoke and sugar). You may be able to handle some
(oxidation) process. And they can be measured. The Oxidized LDL—as you read in chapter 5—is choles- to rupturing. When the artery walls become inflamed, inflammatory substances a little better than most. If
F2-IsoPs contribute to heart disease by, among other terol that has been damaged by oxidation. You’ll the plaque itself makes this enzyme—Lp-PLA2. High you have the ordinary Teflon version of the pan,
things, constricting the arteries and contributing to recall that this is what initiates the problem in the levels may indicate a likelihood that the plaque is you’ve got “average sensitivity” to inflammation, and
platelet aggregation (blood clotting). first place, as a damaged LDL particle lodges itself likely to rupture through the inside of the lining of if you’ve got the scratched version of the pan, you
Elevated levels of F2-IsoPs more than double the inside the wall of the artery and begins the process of the artery wall and get into the bloodstream, leading have increased sensitivity to things that cause inflam-
risk for coronary artery disease (making it 2.6x more atherosclerosis. Prior to being attacked by free radi- to a dangerous clot. The result could be heart attack matory responses and a 2x increased risk of an early
likely). They almost double the risk for death—people cals and oxidized, LDL is simply going about its busi- or stroke. myocardial infarction (a heart attack).
with high levels are 1.8x more likely to die from car- ness in the bloodstream and not causing much mis- The presence of Lp-PLA2 indicates arterial In our opinion, everyone should consume as
14
diovascular disease than those with low levels. chief. But once it’s oxidized, that’s another story. inflammation and is a recognized risk factor for heart much anti-inflammatory foods and supplements as
This test measures damage to the protein attach- disease. Lp-PLA2 is now included in four major guide- possible, regardless of genes. (Just because you’re a
ment on the surface of the LDL molecule. That pro- lines, including the American Heart Association and fast swimmer doesn’t mean you shouldn’t avoid

sharks!) But for those who have the “bad” version of heart disease, even independent of other factors like
this genetic marker, avoidance of things like smoke, age, gender, smoking, and diabetes. And about 60
overconsumption of vegetable oils, and sugar
becomes even more critical. 20
percent of patients have this variant.
The KIF-6 genetic test will basically tell you two
ABOUT THE AUTHORS
things: one, which variant of the gene you have, and
THE KIF-6 TEST: ARE YOU A GOOD two, whether you are likely to benefit from statin JONNY BOWDEN, PH.D, C.N.S., IS A BOARD-CERTIFIED NUTRITIONIST, the author of fifteen books including
CANDIDATE FOR A STATIN? therapy. The 150 Healthiest Foods on Earth, Living Low Carb, and The Great Cholesterol Myth, and the creator of the
The KIF-6 test is controversial, but we’re including it (Since not everyone benefits from statins, and best-selling weight loss program, The Metabolic Factor. Popularly known as “the Nutrition Myth Buster™”,
here because there’s a good chance your doctor may since at some point it’s likely that your doctor may his no-nonsense approach to medical and nutritional misinformation has made him a popular guest on television
actually recommend it, and there’s some good talk to you about them, knowing your likelihood of (Dr. Oz, The Doctors, ABC-TV, MSNBC-TV, CNN, CBS-TV, CBN, Fox News, NBC-TV, and virtually every morning
21
research to justify such a recommendation. (Full your benefiting would be good info to have.) show in America). Dr. Bowden is a popular speaker at conferences all over the world and has spoken at such
disclosure: There is also research to suggest that If the KIF-6 test were a stock, our recommenda- venues as Beijing University, The American Academy of Anti-Aging medicine, Paleo f(x), and Low Carb USA.
KIF-6 is not a very good predictor of cardiovascular tion would be “wait and hold.” There may well be He has written or contributed to articles in The New York Times, Forbes, The Daily Beast, The Huffington Post,
22
risk. ) And so far, KIF-6 is not yet part of the some benefit to this test, but there’s likely to be a lot Vanity Fair Online, Men’s Heath, Prevention, Forbes Online, O (The Oprah Magazine), Vanity Fair Online, and
recommendations of any major health organization of benefit for statin manufacturers as well. That dozens of other print and online publications. He appears in the 2020 documentary, The Big Fat Lie (narrated
(like the AMA), though insurance payers have been doesn’t mean it can’t be good for the rest of us, but by Dr. Mark Hyman), available on Amazon and streaming services.
generally willing to pay for it. It’s considered “an it is something to think about. www.jonnybowden.com / @jonnybowden / Dr. Jonny Bowden on Facebook
emerging cardiac marker.” And consider any of the genetic tests discussed
Here’s the story: There’s a gene called KIF-6 that, earlier, which your doctor may feel will give even more STEPHEN SINATRA, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T., IS A BOARD-CERTIFIED CARDIOLOGIST
like all genes, has different variants. One of those specific detail with which to design a treatment plan. and assistant clinical professor of medicine at the University of Connecticut School of Medicine. He is the
variants dramatically increases the risk for coronary author of many books, including The Sinatra Solution: Metabolic Cardiology, Earthing: The Most Important
Health Discovery Ever, Reverse Heart Disease Now, and Lower Your Blood Pressure in Eight Weeks. Certified
as a bioenergetic psychotherapist and nutrition and anti-aging specialist, Dr. Sinatra integrates psychological,
nutraceutical, and electroceutical therapies in the matrix of healing. He is the founder of www.heartmdinstitute.
com, an informational website dedicated to promoting public awareness of integrative medicine. He is a fellow
in the American College of Cardiology and the American College of Nutrition. He is also the editor of a
national newsletter titled Heart, Health and Nutrition. His websites include www.heartmdinstitute.com and
www.drsinatra.com.
204 THE GREAT CHOLESTEROL MYTH ABOUT THE AUTHORS 205

sharks!) But for those who have the “bad” version of heart disease, even independent of other factors like
this genetic marker, avoidance of things like smoke, age, gender, smoking, and diabetes. And about 60
overconsumption of vegetable oils, and sugar
becomes even more critical. 20
percent of patients have this variant.
The KIF-6 genetic test will basically tell you two
ABOUT THE AUTHORS
things: one, which variant of the gene you have, and
THE KIF-6 TEST: ARE YOU A GOOD two, whether you are likely to benefit from statin JONNY BOWDEN, PH.D, C.N.S., IS A BOARD-CERTIFIED NUTRITIONIST, the author of fifteen books including
CANDIDATE FOR A STATIN? therapy. The 150 Healthiest Foods on Earth, Living Low Carb, and The Great Cholesterol Myth, and the creator of the
The KIF-6 test is controversial, but we’re including it (Since not everyone benefits from statins, and best-selling weight loss program, The Metabolic Factor. Popularly known as “the Nutrition Myth Buster™”,
here because there’s a good chance your doctor may since at some point it’s likely that your doctor may his no-nonsense approach to medical and nutritional misinformation has made him a popular guest on television
actually recommend it, and there’s some good talk to you about them, knowing your likelihood of (Dr. Oz, The Doctors, ABC-TV, MSNBC-TV, CNN, CBS-TV, CBN, Fox News, NBC-TV, and virtually every morning
21
research to justify such a recommendation. (Full your benefiting would be good info to have.) show in America). Dr. Bowden is a popular speaker at conferences all over the world and has spoken at such
disclosure: There is also research to suggest that If the KIF-6 test were a stock, our recommenda- venues as Beijing University, The American Academy of Anti-Aging medicine, Paleo f(x), and Low Carb USA.
KIF-6 is not a very good predictor of cardiovascular tion would be “wait and hold.” There may well be He has written or contributed to articles in The New York Times, Forbes, The Daily Beast, The Huffington Post,
22
risk. ) And so far, KIF-6 is not yet part of the some benefit to this test, but there’s likely to be a lot Vanity Fair Online, Men’s Heath, Prevention, Forbes Online, O (The Oprah Magazine), Vanity Fair Online, and
recommendations of any major health organization of benefit for statin manufacturers as well. That dozens of other print and online publications. He appears in the 2020 documentary, The Big Fat Lie (narrated
(like the AMA), though insurance payers have been doesn’t mean it can’t be good for the rest of us, but by Dr. Mark Hyman), available on Amazon and streaming services.
generally willing to pay for it. It’s considered “an it is something to think about. www.jonnybowden.com / @jonnybowden / Dr. Jonny Bowden on Facebook
emerging cardiac marker.” And consider any of the genetic tests discussed
Here’s the story: There’s a gene called KIF-6 that, earlier, which your doctor may feel will give even more STEPHEN SINATRA, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T., IS A BOARD-CERTIFIED CARDIOLOGIST
like all genes, has different variants. One of those specific detail with which to design a treatment plan. and assistant clinical professor of medicine at the University of Connecticut School of Medicine. He is the
variants dramatically increases the risk for coronary author of many books, including The Sinatra Solution: Metabolic Cardiology, Earthing: The Most Important
Health Discovery Ever, Reverse Heart Disease Now, and Lower Your Blood Pressure in Eight Weeks. Certified
as a bioenergetic psychotherapist and nutrition and anti-aging specialist, Dr. Sinatra integrates psychological,
nutraceutical, and electroceutical therapies in the matrix of healing. He is the founder of www.heartmdinstitute.
com, an informational website dedicated to promoting public awareness of integrative medicine. He is a fellow
in the American College of Cardiology and the American College of Nutrition. He is also the editor of a
national newsletter titled Heart, Health and Nutrition. His websites include www.heartmdinstitute.com and
www.drsinatra.com.
204 THE GREAT CHOLESTEROL MYTH ABOUT THE AUTHORS 205

ACKNOWLEDGMENTS REFERENCES
MY DEAREST FRIENDS: Anja Christy, Sky London, Doug Monas, Susan Wood, Christopher Duncan, Peter WHY A NEW EDITION Acid-Rich Diet in Secondary Prevention of Coronary
Breger, Scott Ellis, Oliver Beaucamp, Chris Crabb, Jeannette Bessinger, Randy Graff, Mike Danielson, and OF THIS BOOK WAS NEEDED Heart Disease,” The Lancet, no. 143 (1994): 1454–59.
1. J. B. Meigs et al., “Impact of Insulin Resistance on 6. J. Kastelein et al., “Simvastatin with or without
Lauree Dash. You give my life meaning. Thank you.
Risk of Type 2 Diabetes and Cardiovascular Disease in Ezetimibe in Familial Hypercholesterolemia,” New
My literary agent of over fifteen years, Coleen O’Shea, who has been a beacon of sanity and a great source
People with Metabolic Syndrome,” Diabetes Care 30, England Journal of Medicine 358, no. 14 (2008):
of guidance.
no.5 (2007): 1219–1225. 1431–43.
The team at Fairwinds Press, especially my publisher, Jill Alexander, who saw the need for a new edition
2. The National Institute of Diabetes and Digestive and 7. F. B. Hu et al., “Primary Prevention of Coronary Heart
and greenlighted the project, and to my brilliant editor, Jenna Nelson Patton. Disease in Women through Diet and Lifestyle,” New
Kidney Diseases Health Information Center, “Diabetes,
The writers who inspire me: William Goldman, Ed McBain, Nora Ephron, Robert Sapolsky. And the musi- Heart Disease, and Stroke,” https://www.niddk.nih.gov/ England Journal of Medicine 343, no. 1 (2000): 16–12.
cians who do the same: Allen Stone, Laura Nyro, Miles Davis, and John Coltrane. health-information/diabetes/overview/preventing-prob- 8. Ibid.
Denise Minger, for her invaluable contributions to this book. We are enormously grateful for your insights, lems/heart-disease-stroke
humor, wisdom, and intelligence. 3. D. Eddy et al, “Relationship of Insulin Resistance and CHOLESTEROL IS HARMLESS!
Robert Crayhon whose influence and presence continues to be felt by all of us who studied with him. Related Metabolic Variables to Coronary Artery 1. University of Maryland, “Trans Fats 101,” University of
Disease: A Mathematical Analysis,” Diabetes Care 32, Maryland Medical Center, last modified November 3,
My beloved family: Cadence, Jared, Logan, Jeffrey, Nancy, and Pace.
no. 2 (2009): 361–6. 2010, www.umm.edu/features/transfats.htm.
The island and the people of our “second home,” St. Martin, FWI.
2. G. V. Mann, “Coronary Heart Disease—’Doing the
The wonderful doctors, researchers, scholars, and advocates who shared their work with me for this book,
WHY YOU SHOULD BE SKEPTICAL Wrong Things,’” Nutrition Today 20, no. 4 (1985): 12–14.
especially David Diamond, Ph.D., Robert DuBroff, M.D., and Jim Greenfield, M.D. and his team at Specialty
OF CHOLESTEROL AS AN INDICATOR 3. Ibid.
Health in Nevada. And for all the giants—i.e., Uffe Ravnskov, M.D., Ph.D., Malcolm Kendrick, M.D., Anthony Colpo,
OF HEART DISEASE 4. M. F. Oliver, “Consensus or Nonsensus Conferences
and Michel de Lorgeril, M.D.,—on whose shoulders we stand. 1. D. Mozaffarian et al., “Dietary fats, carbohydrate, and on Coronary Heart Disease,” The Lancet 325, no. 8437
And to my beloved Mischa—the great love of my life. Eleven years going on forever. I love you. Progression of Coronary Atherosclerosis in (1985): 1087–89.
—Jonny Postmenopausal Women,” American Journal of Clinical 5. National Institutes of Health Consensus Development
Nutrition 80, no. 5 (2004): 1175–84. Conference Statement, December 10–12, 1984.
2. M. de Lorgeril et al. “Mediterranean Diet, Traditional 6. National Institutes of Health, “News from the
Risk Factors, and the Rate of Cardiovascular Women’s Health Initiative: Reducing Total Fat Intake
Complications after Myocardial Infarction: Final Report May Have Small Effect on Risk of Breast Cancer, No
of the Lyon Diet Heart Study,” Circulation 99, no. 6 Effect on Risk of Colorectal Cancer, Heart Disease, or
(1999): 779–85. Stroke,” NIH News, last modified February 7, 2006,
3. Channing Laboratory, “History,” The Nurses’ Health www.nih.gov/news/pr/feb2006/nhlbi-07.htm.
Study, www.channing.harvard.edu/nhs/?page_id=70. 7. A. Ottoboni and F. Ottoboni, “Low-Fat Diet and
4. Ibid. Chronic Disease Prevention: The Women’s Health
5. M. de Lorgeril et al., “Mediterranean Alpha-Linolenic Initiative and Its Reception,” Journal of American
206 THE GREAT CHOLESTEROL MYTH REFERENCES 207

ACKNOWLEDGMENTS REFERENCES
MY DEAREST FRIENDS: Anja Christy, Sky London, Doug Monas, Susan Wood, Christopher Duncan, Peter WHY A NEW EDITION Acid-Rich Diet in Secondary Prevention of Coronary
Breger, Scott Ellis, Oliver Beaucamp, Chris Crabb, Jeannette Bessinger, Randy Graff, Mike Danielson, and OF THIS BOOK WAS NEEDED Heart Disease,” The Lancet, no. 143 (1994): 1454–59.
1. J. B. Meigs et al., “Impact of Insulin Resistance on 6. J. Kastelein et al., “Simvastatin with or without
Lauree Dash. You give my life meaning. Thank you.
Risk of Type 2 Diabetes and Cardiovascular Disease in Ezetimibe in Familial Hypercholesterolemia,” New
My literary agent of over fifteen years, Coleen O’Shea, who has been a beacon of sanity and a great source
People with Metabolic Syndrome,” Diabetes Care 30, England Journal of Medicine 358, no. 14 (2008):
of guidance.
no.5 (2007): 1219–1225. 1431–43.
The team at Fairwinds Press, especially my publisher, Jill Alexander, who saw the need for a new edition
2. The National Institute of Diabetes and Digestive and 7. F. B. Hu et al., “Primary Prevention of Coronary Heart
and greenlighted the project, and to my brilliant editor, Jenna Nelson Patton. Disease in Women through Diet and Lifestyle,” New
Kidney Diseases Health Information Center, “Diabetes,
The writers who inspire me: William Goldman, Ed McBain, Nora Ephron, Robert Sapolsky. And the musi- Heart Disease, and Stroke,” https://www.niddk.nih.gov/ England Journal of Medicine 343, no. 1 (2000): 16–12.
cians who do the same: Allen Stone, Laura Nyro, Miles Davis, and John Coltrane. health-information/diabetes/overview/preventing-prob- 8. Ibid.
Denise Minger, for her invaluable contributions to this book. We are enormously grateful for your insights, lems/heart-disease-stroke
humor, wisdom, and intelligence. 3. D. Eddy et al, “Relationship of Insulin Resistance and CHOLESTEROL IS HARMLESS!
Robert Crayhon whose influence and presence continues to be felt by all of us who studied with him. Related Metabolic Variables to Coronary Artery 1. University of Maryland, “Trans Fats 101,” University of
Disease: A Mathematical Analysis,” Diabetes Care 32, Maryland Medical Center, last modified November 3,
My beloved family: Cadence, Jared, Logan, Jeffrey, Nancy, and Pace.
no. 2 (2009): 361–6. 2010, www.umm.edu/features/transfats.htm.
The island and the people of our “second home,” St. Martin, FWI.
2. G. V. Mann, “Coronary Heart Disease—’Doing the
The wonderful doctors, researchers, scholars, and advocates who shared their work with me for this book,
WHY YOU SHOULD BE SKEPTICAL Wrong Things,’” Nutrition Today 20, no. 4 (1985): 12–14.
especially David Diamond, Ph.D., Robert DuBroff, M.D., and Jim Greenfield, M.D. and his team at Specialty
OF CHOLESTEROL AS AN INDICATOR 3. Ibid.
Health in Nevada. And for all the giants—i.e., Uffe Ravnskov, M.D., Ph.D., Malcolm Kendrick, M.D., Anthony Colpo,
OF HEART DISEASE 4. M. F. Oliver, “Consensus or Nonsensus Conferences
and Michel de Lorgeril, M.D.,—on whose shoulders we stand. 1. D. Mozaffarian et al., “Dietary fats, carbohydrate, and on Coronary Heart Disease,” The Lancet 325, no. 8437
And to my beloved Mischa—the great love of my life. Eleven years going on forever. I love you. Progression of Coronary Atherosclerosis in (1985): 1087–89.
—Jonny Postmenopausal Women,” American Journal of Clinical 5. National Institutes of Health Consensus Development
Nutrition 80, no. 5 (2004): 1175–84. Conference Statement, December 10–12, 1984.
2. M. de Lorgeril et al. “Mediterranean Diet, Traditional 6. National Institutes of Health, “News from the
Risk Factors, and the Rate of Cardiovascular Women’s Health Initiative: Reducing Total Fat Intake
Complications after Myocardial Infarction: Final Report May Have Small Effect on Risk of Breast Cancer, No
of the Lyon Diet Heart Study,” Circulation 99, no. 6 Effect on Risk of Colorectal Cancer, Heart Disease, or
(1999): 779–85. Stroke,” NIH News, last modified February 7, 2006,
3. Channing Laboratory, “History,” The Nurses’ Health www.nih.gov/news/pr/feb2006/nhlbi-07.htm.
Study, www.channing.harvard.edu/nhs/?page_id=70. 7. A. Ottoboni and F. Ottoboni, “Low-Fat Diet and
4. Ibid. Chronic Disease Prevention: The Women’s Health
5. M. de Lorgeril et al., “Mediterranean Alpha-Linolenic Initiative and Its Reception,” Journal of American

Physicians and Surgeons 12, no. 1 (2007): 10–13. THE REAL DEAL ON CHOLESTEROL (New York: Hyperion Books, 2011), 78. Education Program,” National Heart, Lung, and Blood
8. G. Kolata, “Low-Fat Diet Does Not Cut Health Risks, 1. V. Marigliano, “Normal values in extreme old age,” 6. Ibid. Institute, last modified in October 2011, www.nhlbi.nih.
Study Finds,” New York Times, February 8, 2006. Annals of the New York Academy of Sciences 673 7. G. Taubes, “Is Sugar Toxic?” New York Times gov/about/ncep.
9. D. Lundell, The Cure for Heart Disease (Scottsdale: (1992): 23–28. Magazine, April 13, 2011. 20. World Health Organization, Global Strategy on Diet,
Publishing Intellect, 2012). 8. “Findings and Recommendations on the Insulin Physical Activity and Health www.who.int/dietphysica-
10. M. de Lorgeril, A Near-Perfect Sexual Crime: Statins INFLAMMATION AND OXIDATION Resistance Syndrome,” American Association of Clinical lactivity/publications
Against Cholesterol (France: A4Set, 2011). 1. D. Harman, “Aging: A Theory Based on Free Radical Endocrinologists, Washington, D.C., August 25–26, 21. J. Eilperin, “U.S. Sugar Industry Targets New Study,”
11. J. P. A. Ioannidis, “Why Most Published Research and Radiation Chemistry,” Journal of Gerontology 11, 2002. Washington Post, April 23, 2003, www.washingtonpost.
Findings Are False,” PLoS Medicine 2(8): e124. https:// no. 3 (1956): 298–300; D. Harman, “Free Radical Theory 9. Ibid. com/ac2/wp-dyn/A17583-2003Apr22?language=printer.
doi.org/10.1371/journal.pmed.0020124; A. Berezow, “John of Aging,” in Free Radicals and Aging, eds. I. Emerit and 10. M. Miller, “What Is the Association Between the 22.”Historical Analysis Examines Sugar Industry Role in
Ioannidis Aims His Bazooka at Nutrition Science,” B. Chance (Basel, Switzerland: Birkhäuser, 1992). Triglyceride to High-density Lipoprotein Cholesterol Heart Disease Research,” For the Media, JAMA Network
American Council on Science and Health August 24, 2. D. Lundell, The Cure for Heart Disease (Scottsdale: Ratio and Insulin Resistance?” Medscape Education, (9/12/16) https://media.jamanetwork.com/news-item/
2018; D. Robitzski, “Faulty Studies Mean Everything You Publishing Intellect, 2012). www.medscape.org/viewarticle/588474; T. McLaughlin historical-analysis-examines-sugar-industry-role-in-
Know About Nutrition Is Wrong,” Neoscope, July 2, 2018. 3. W. Cromwell et al., “LDL Particle Number and Risk of et al., “Use of Metabolic Markers to Identify Overweight heart-disease-research/
12. National Cancer Institute, Division of Cancer Control Future Cardiovascular Disease in the Framingham Individuals Who Are Insulin Resistant,” Annals of 23. R. B. McGandy et al., “Dietary Fats, Carbohydrates
& Population Sciences, “Usual Dietary Intakes: NHANES Offspring Study - Implications for LDL Management,” Internal Medicine 138, no. 10 (2003): 802–9. and Atherosclerotic Vascular Disease,” New England
Food Frequency Questionnaire (FFQ)” https://epi.grants. Journal of Clinical Lipidology 1, no. 6 (2007): 583–92. 11. “Type 2 Diabetes Reversed by Losing Fat from Journal of Medicine, 277(4), 186–192. doi:10.1056/
cancer.gov/diet/usualintakes/ffq.html Pancreas,” Science Daily December 1, 2015. nejm196707272770405
13. Alan R Kristal et al., “Is It Time to Abandon the Food PART TWO 12. N. Avena et al., “Evidence for Sugar Addiction: 24. G. Taubes and C. Couzens, “Big Sugar’s Sweet Little
Frequency Questionnaire?” Cancer Epidemiology, 1. https://www.dhhs.nh.gov/dphs/nhp/documents/sugar. Behavioral and Neurochemical Effects of Intermittent, Lies,” Mother Jones November/December 2012.
Biomarkers and Prevention (AACR, December 2005) pdf Excessive Sugar Intake,” Neuroscience and 25. J. Casey, “The Hidden Ingredient That Can
https://cebp.aacrjournals.org/content/14/12/2826 Biobehavioral Reviews 32, no. 1 (2008): 20–39. Sabotage Your Diet,” MedicineNet, last modified
14. W. Walker, “The National Diet-Heart Study Final SUGAR: THE REAL DEMON IN THE DIET 13. A. Gearhardt et al., “The Addiction Potential of January 3, 2005, www.medicinenet.com/script/main/
Report: American Heart Association Monograph. No. 1. M. Houston, M.D., M.S., director of the Hypertension Hyperpalatable Foods,” Current Drug Abuse Reviews 4 art.asp?articlekey=56589.
19.,” Arch Intern Med 123, no. 4 (1969): 473–474. Institute in Tennessee, May 2, 2012, telephone (2011): 140–45. 26. C. Kearns et al., “Sugar Industry Sponsorship of
doi:10.1001/archinte.1969.00300140119031 communication. 14. Taubes, “Is Sugar Toxic?” Germ-Free Rodent Studies Linking Sucrose to
15. M. Gladwell: Revisionist History season 2, episode 2. D. C. Goff et al., “Insulin Sensitivity and the Rise of 15. G. V. Mann, Coronary Heart Disease: The Dietary Hyperlipidemia and Cancer: An Historical Analysis of
10—“What Does a Son Owe His Father?” Incident Hypertension,” Diabetes Care 26, no. 3 (2003): Sense and Nonsense (London: Janus, 1993). Internal Documents,” PLoS Biology November 2017.
16. V. Dhaka et al., “Trans Fats-Sources, Health Risks 805–9. 16. G. V. Mann et al., “Atherosclerosis in the Masai,” 27. C. Kearns and S. Glantz, “Sugar Industry Influence
and Alternative Approach - A Review,” Journal of Food 3. “Too Much Insulin a Bad Thing for the Heart?” American Journal of Epidemiology 95, no. 1 (1972): on the Scientific Agenda of the National Institute of
Science and Technology 48, no. 5 (2011): 534–41. Science Daily, last modified April 19, 2010, www.science- 26–37. Dental Research’s 1971 National Caries Program: A
doi:10.1007/s13197-010-0225-8 daily.com/releases/2010/04/100419233109.htm. 17. J. Yudkin, Sweet and Dangerous (New York: Wyden, Historical Analysis of Internal Documents,” PLoS
17. Harvard School of Public Health. “Artificial Trans 4. V. Marigliano et al., “Normal Values in Extreme Old 1972). Medicine March 2015.
Fats Banned in U.S.,” 2018: https://www.hsph.harvard. Age,” Annals of the New York Academy of Sciences 673 18. A. Keys, “Letter: Normal Plasma Cholesterol in a 28. C. Kearns et al., “Sugar Industry and Coronary
edu/news/hsph-in-the-news/us-bans-artificial-trans-fats (1992): 23–28. Man Who Eats 25 Eggs a Day,” New England Journal of Heart Disease Research: A Historical Analysis of
18. Perel, Esther, The State of Affairs: Rethinking 5. J. O’Connell, Sugar Nation: The Hidden Truth Behind Medicine 325, no. 8 (1991): 584. Internal Industry Documents,” JAMA Internal Medicine
Infidelity, (Harper Paperbacks: 2018) America’s Deadliest Habit and the Simple Way to Beat It 19. National Institutes of Health. “National Cholesterol 176, no. 11 (2016): 1680–1685.

Physicians and Surgeons 12, no. 1 (2007): 10–13. THE REAL DEAL ON CHOLESTEROL (New York: Hyperion Books, 2011), 78. Education Program,” National Heart, Lung, and Blood
8. G. Kolata, “Low-Fat Diet Does Not Cut Health Risks, 1. V. Marigliano, “Normal values in extreme old age,” 6. Ibid. Institute, last modified in October 2011, www.nhlbi.nih.
Study Finds,” New York Times, February 8, 2006. Annals of the New York Academy of Sciences 673 7. G. Taubes, “Is Sugar Toxic?” New York Times gov/about/ncep.
9. D. Lundell, The Cure for Heart Disease (Scottsdale: (1992): 23–28. Magazine, April 13, 2011. 20. World Health Organization, Global Strategy on Diet,
Publishing Intellect, 2012). 8. “Findings and Recommendations on the Insulin Physical Activity and Health www.who.int/dietphysica-
10. M. de Lorgeril, A Near-Perfect Sexual Crime: Statins INFLAMMATION AND OXIDATION Resistance Syndrome,” American Association of Clinical lactivity/publications
Against Cholesterol (France: A4Set, 2011). 1. D. Harman, “Aging: A Theory Based on Free Radical Endocrinologists, Washington, D.C., August 25–26, 21. J. Eilperin, “U.S. Sugar Industry Targets New Study,”
11. J. P. A. Ioannidis, “Why Most Published Research and Radiation Chemistry,” Journal of Gerontology 11, 2002. Washington Post, April 23, 2003, www.washingtonpost.
Findings Are False,” PLoS Medicine 2(8): e124. https:// no. 3 (1956): 298–300; D. Harman, “Free Radical Theory 9. Ibid. com/ac2/wp-dyn/A17583-2003Apr22?language=printer.
doi.org/10.1371/journal.pmed.0020124; A. Berezow, “John of Aging,” in Free Radicals and Aging, eds. I. Emerit and 10. M. Miller, “What Is the Association Between the 22.”Historical Analysis Examines Sugar Industry Role in
Ioannidis Aims His Bazooka at Nutrition Science,” B. Chance (Basel, Switzerland: Birkhäuser, 1992). Triglyceride to High-density Lipoprotein Cholesterol Heart Disease Research,” For the Media, JAMA Network
American Council on Science and Health August 24, 2. D. Lundell, The Cure for Heart Disease (Scottsdale: Ratio and Insulin Resistance?” Medscape Education, (9/12/16) https://media.jamanetwork.com/news-item/
2018; D. Robitzski, “Faulty Studies Mean Everything You Publishing Intellect, 2012). www.medscape.org/viewarticle/588474; T. McLaughlin historical-analysis-examines-sugar-industry-role-in-
Know About Nutrition Is Wrong,” Neoscope, July 2, 2018. 3. W. Cromwell et al., “LDL Particle Number and Risk of et al., “Use of Metabolic Markers to Identify Overweight heart-disease-research/
12. National Cancer Institute, Division of Cancer Control Future Cardiovascular Disease in the Framingham Individuals Who Are Insulin Resistant,” Annals of 23. R. B. McGandy et al., “Dietary Fats, Carbohydrates
& Population Sciences, “Usual Dietary Intakes: NHANES Offspring Study - Implications for LDL Management,” Internal Medicine 138, no. 10 (2003): 802–9. and Atherosclerotic Vascular Disease,” New England
Food Frequency Questionnaire (FFQ)” https://epi.grants. Journal of Clinical Lipidology 1, no. 6 (2007): 583–92. 11. “Type 2 Diabetes Reversed by Losing Fat from Journal of Medicine, 277(4), 186–192. doi:10.1056/
cancer.gov/diet/usualintakes/ffq.html Pancreas,” Science Daily December 1, 2015. nejm196707272770405
13. Alan R Kristal et al., “Is It Time to Abandon the Food PART TWO 12. N. Avena et al., “Evidence for Sugar Addiction: 24. G. Taubes and C. Couzens, “Big Sugar’s Sweet Little
Frequency Questionnaire?” Cancer Epidemiology, 1. https://www.dhhs.nh.gov/dphs/nhp/documents/sugar. Behavioral and Neurochemical Effects of Intermittent, Lies,” Mother Jones November/December 2012.
Biomarkers and Prevention (AACR, December 2005) pdf Excessive Sugar Intake,” Neuroscience and 25. J. Casey, “The Hidden Ingredient That Can
https://cebp.aacrjournals.org/content/14/12/2826 Biobehavioral Reviews 32, no. 1 (2008): 20–39. Sabotage Your Diet,” MedicineNet, last modified
14. W. Walker, “The National Diet-Heart Study Final SUGAR: THE REAL DEMON IN THE DIET 13. A. Gearhardt et al., “The Addiction Potential of January 3, 2005, www.medicinenet.com/script/main/
Report: American Heart Association Monograph. No. 1. M. Houston, M.D., M.S., director of the Hypertension Hyperpalatable Foods,” Current Drug Abuse Reviews 4 art.asp?articlekey=56589.
19.,” Arch Intern Med 123, no. 4 (1969): 473–474. Institute in Tennessee, May 2, 2012, telephone (2011): 140–45. 26. C. Kearns et al., “Sugar Industry Sponsorship of
doi:10.1001/archinte.1969.00300140119031 communication. 14. Taubes, “Is Sugar Toxic?” Germ-Free Rodent Studies Linking Sucrose to
15. M. Gladwell: Revisionist History season 2, episode 2. D. C. Goff et al., “Insulin Sensitivity and the Rise of 15. G. V. Mann, Coronary Heart Disease: The Dietary Hyperlipidemia and Cancer: An Historical Analysis of
10—“What Does a Son Owe His Father?” Incident Hypertension,” Diabetes Care 26, no. 3 (2003): Sense and Nonsense (London: Janus, 1993). Internal Documents,” PLoS Biology November 2017.
16. V. Dhaka et al., “Trans Fats-Sources, Health Risks 805–9. 16. G. V. Mann et al., “Atherosclerosis in the Masai,” 27. C. Kearns and S. Glantz, “Sugar Industry Influence
and Alternative Approach - A Review,” Journal of Food 3. “Too Much Insulin a Bad Thing for the Heart?” American Journal of Epidemiology 95, no. 1 (1972): on the Scientific Agenda of the National Institute of
Science and Technology 48, no. 5 (2011): 534–41. Science Daily, last modified April 19, 2010, www.science- 26–37. Dental Research’s 1971 National Caries Program: A
doi:10.1007/s13197-010-0225-8 daily.com/releases/2010/04/100419233109.htm. 17. J. Yudkin, Sweet and Dangerous (New York: Wyden, Historical Analysis of Internal Documents,” PLoS
17. Harvard School of Public Health. “Artificial Trans 4. V. Marigliano et al., “Normal Values in Extreme Old 1972). Medicine March 2015.
Fats Banned in U.S.,” 2018: https://www.hsph.harvard. Age,” Annals of the New York Academy of Sciences 673 18. A. Keys, “Letter: Normal Plasma Cholesterol in a 28. C. Kearns et al., “Sugar Industry and Coronary
edu/news/hsph-in-the-news/us-bans-artificial-trans-fats (1992): 23–28. Man Who Eats 25 Eggs a Day,” New England Journal of Heart Disease Research: A Historical Analysis of
18. Perel, Esther, The State of Affairs: Rethinking 5. J. O’Connell, Sugar Nation: The Hidden Truth Behind Medicine 325, no. 8 (1991): 584. Internal Industry Documents,” JAMA Internal Medicine
Infidelity, (Harper Paperbacks: 2018) America’s Deadliest Habit and the Simple Way to Beat It 19. National Institutes of Health. “National Cholesterol 176, no. 11 (2016): 1680–1685.

29. Taubes, “Is Sugar Toxic?” Circulating, And Supplement Fatty Acids with Coronary Long-Chain Saturated Fatty Acids on Blood Lipid Clinical Nutrition 61, no. 6 (1995): 1368S–73S.
30. L. Tappy et al., “Metabolic Effects of Fructose and Risk: A Systematic Review and Meta-Analysis,” Annals Profile: A Systematic Review and Meta-Analysis,” The 20. S. Liu et al., “A Prospective Study of Dietary
the Worldwide Increase in Obesity,” Physiological of Internal Medicine 160, no. 6 (2014): 398–406. American Journal of Clinical Nutrition 108, no. 4 (2018): Glycemic Load, Carbohydrate Intake, and Risk of
Reviews 90, no. 1 (2010): 23–46; M. Dirlewanger et al., 4. R. de Souza et al., “Intake of Saturated and Trans 675–687. Coronary Heart Disease in U.S. Women,” American
“Effects of Fructose on Hepatic Glucose Metabolism in Unsaturated Fatty Acids and Risk of All Cause Mortality, 11. F.B. Hu et al., “Dietary Saturated Fats and Their Food Journal of Clinical Nutrition 71, no. 6 (2000): 1455–61.
Humans,” American Journal of Physiology, Cardiovascular Disease, and Type 2 Diabetes: Sources in Relation to the Risk of Coronary Heart 21. M. U. Jakobsen et al., “Intake of Carbohydrates
Endocrinology, and Metabolism 279, no. 4 (2000): Systematic Review and Meta-Analysis of Observational Disease in Women,” American Journal of Clinical Compared with Intake of Saturated Fatty Acids and Risk
E907–11. Studies,” BMJ 351 (2015). doi: 10.1136/bmj.h3978 Nutrition 70, no. 6 (1999): 1001–08. of Myocardial Infarction: Importance of the Glycemic
31. S. S. Elliott et al., “Fructose, Weight Gain, and the 5. C. Ramsden et al., “Re-evaluation of the traditional 12. M-P. St-Onge et al., “Medium Chain Triglyceride Oil Index,” American Journal of Clinical Nutrition 91, no. 6
Insulin Resistance Syndrome,” American Journal of diet-heart hypothesis: analysis of recovered data from Consumption as Part of a Weight Loss Diet Does Not (2010): 1764–68.
Clinical Nutrition 76, no. 5 (2002): 911–22; K.A. Lê and L. Minnesota Coronary Experiment (1968–73),” BMJ Lead to an Adverse Metabolic Profile When Compared 22. Ibid.
Tappy, “Metabolic Effects of Fructose,” Current Opinion 353(2016). doi:10.1136/bmj.i1246 to Olive Oil,” Journal of the American College of 23. Ibid.
in Clinical Nutrition and Metabolic Care 9, no. 4 (2006): 6. “The effect of replacing saturated fat with mostly Nutrition 27, no. 5 (2008): 547–52. 24. S.J. Nicholls et al., “Consumption of Saturated Fat
469–75; Y. Rayssiguier et al., “High Fructose n-6 polyunsaturated fat on coronary heart disease: a 13. K-T. Khaw et al., “Randomised Trial of Coconut Oil, Impairs the Anti-Inflammatory Properties of High-Density
Consumption Combined with Low Dietary Magnesium meta-analysis of randomized controlled trials,” Nutr. J Olive Oil or Butter on Blood Lipids and Other Lipoproteins and Endothelial Function,” Journal of the
Intake May Increase the Incidence of the Metabolic 2017 May 19; 16(1): 30. https://www.ncbi.nlm.nih.gov/ Cardiovascular Risk Factors in Healthy Men and American College of Cardiology 48, no. 4 (2006): 715–20.
Syndrome by Inducing Inflammation,” Magnesium pubmed/28526025 Women,” BMJ 8, no. 3. 25. R. S. Kuipers et al., “Saturated Fat, Carbohydrates,
Research Journal 19, no. 4 (2006): 237–43. 7. F. de Meester and A. P. Simopoulos, eds., “A Balanced 14. F. Rosqvist. “Potential Role of Milk Fat Globule and Cardiovascular Disease,” Netherlands Journal of
32. K. Adeli and A. C. Rutledge, “Fructose and the Omega-6/Omega-3 Fatty Acid Ratio, Cholesterol and Membrane in Modulating Plasma Lipoproteins, Gene Medicine 69, no. 9 (2011): 372–78.
Metabolic Syndrome: Pathophysiology and Molecular Coronary Heart Disease,” World Review of Nutrition and Expression, and Cholesterol Metabolism in Humans: A 26. Ibid; A. P. Simopoulos, “Overview of Evolutionary
Mechanisms,” Nutrition Reviews 65, no. 6 (2007): S13– Dietetics 100 (2009): 1–21; T. Hamazaki, Y. Kirihara, and Randomized Study,” American Journal of Clinical Aspects of w3 Fatty Acids in the Diet,” World Review of
S23; K.A. Lê and L. Tappy, “Metabolic Effects of Y. Ogushi, “Blood Cholesterol as a Good Marker of Nutrition 102, no. 1 (2015): 20–30. Nutrition and Dietetics 83 (1998): 1–11.
Fructose.” Health in Japan,” World Review of Nutrition and 15. Rice, BH, “Dairy and Cardiovascular Disease: A 27. R. O. Adolf et al., “Dietary Linoleic Acid Influences
33. “Fructose Metabolism by the Brain Increases Food Dietetics 100 (2009): 63–70. Review of Recent Observational Research,” Curr Nutr Desaturation and Acylation of Deuterium-labeled
Intake and Obesity, Study Suggests,” Science Daily, www. 8. Japan Atherosclerosis Society, “Japan Rep 2014 Mar 15; 3: 130-180 eCollection 2014. https:// Linoleic and Linolenic Acids in Young Adult Males,”
sciencedaily.com/releases/2009/03/090325091811.htm. Atherosclerosis Society (JAS) Guidelines for Prevention www.ncbi.nlm.nih.gov/pubmed/24818071 Biochimica et Biophysica Acta 1213, no. 3 (1994): 277–
of Atherosclerotic Cardiovascular Diseases,” Journal of 16. D. M. Herrington, et al., “Dietary Fats, Carbohydrate, 88; Ghafoorunissa and M. Indu, “N-3 Fatty Acids in
THE TRUTH ABOUT FAT: Atherosclerosis and Thrombosis 14, no. 2 (2007): 5–57; and Progression of Coronary Atherosclerosis in Indian Diets—Comparison of the Effects of Precursor
IT’S NOT WHAT YOU THINK de Meester and Simopoulos, “A Balanced Omega-6/ Postmenopausal Women,” American Journal of Clinical (Alpha-linolenic Acid) vs. Product (Long Chain N-3
1. F. B. Hu et al., “Meta-analysis of Prospective Cohort Omega-3 Fatty Acid Ratio, Cholesterol and Coronary Nutrition 80, no. 5 (2004): 1175–84. Polyunsaturated Fatty Acids),” Nutrition Research 12,
Studies Evaluating the Association of Saturated Fat Heart Disease.” 17. Ibid. nos. 4–5 (1992): 569–82.
with Cardiovascular Disease,” American Journal of 9. T. Hamazaki, et al., “Blood Cholesterol as a Good 18. R. H. Knopp and Barbara M. Retzlaff, “Saturated Fat 28. A. P. Simopoulos,“Evolutionary Aspects of the
Clinical Nutrition 91, no. 3 (2010): 502–9. Marker of Health in Japan,” World Review of Nutrition Prevents Coronary Artery Disease? An American Dietary Omega-6:Omega-3 Fatty Acid Ratio: Medical
2. R. S. Kuipers et al., “Saturated Fat, Carbohydrates, and Dietetics 100 (2009): 63–70; de Meester and Paradox,” American Journal of Clinical Nutrition 80, no. Implications,” World Review of Nutrition and Dietetics
and Cardiovascular Disease,” Netherlands Journal of Simopoulos, “A Balanced Omega-6/Omega-3 Fatty Acid 5 (2004): 1102–3. 100 (2009): 1–21.
Medicine 69, no. 9 (2011): 372–78. Ratio.” 19. M. B. Katan et al., “Dietary Oils, Serum Lipoproteins, 29. A. P. Simopoulos, “Overview of Evolutionary
3. R. Chowdhury et al., “Association of Dietary, 10. N. Panth et al., “Differential Effects of Medium- and and Coronary Heart Disease,” American Journal of Aspects of w3 Fatty Acids in the Diet.”

29. Taubes, “Is Sugar Toxic?” Circulating, And Supplement Fatty Acids with Coronary Long-Chain Saturated Fatty Acids on Blood Lipid Clinical Nutrition 61, no. 6 (1995): 1368S–73S.
30. L. Tappy et al., “Metabolic Effects of Fructose and Risk: A Systematic Review and Meta-Analysis,” Annals Profile: A Systematic Review and Meta-Analysis,” The 20. S. Liu et al., “A Prospective Study of Dietary
the Worldwide Increase in Obesity,” Physiological of Internal Medicine 160, no. 6 (2014): 398–406. American Journal of Clinical Nutrition 108, no. 4 (2018): Glycemic Load, Carbohydrate Intake, and Risk of
Reviews 90, no. 1 (2010): 23–46; M. Dirlewanger et al., 4. R. de Souza et al., “Intake of Saturated and Trans 675–687. Coronary Heart Disease in U.S. Women,” American
“Effects of Fructose on Hepatic Glucose Metabolism in Unsaturated Fatty Acids and Risk of All Cause Mortality, 11. F.B. Hu et al., “Dietary Saturated Fats and Their Food Journal of Clinical Nutrition 71, no. 6 (2000): 1455–61.
Humans,” American Journal of Physiology, Cardiovascular Disease, and Type 2 Diabetes: Sources in Relation to the Risk of Coronary Heart 21. M. U. Jakobsen et al., “Intake of Carbohydrates
Endocrinology, and Metabolism 279, no. 4 (2000): Systematic Review and Meta-Analysis of Observational Disease in Women,” American Journal of Clinical Compared with Intake of Saturated Fatty Acids and Risk
E907–11. Studies,” BMJ 351 (2015). doi: 10.1136/bmj.h3978 Nutrition 70, no. 6 (1999): 1001–08. of Myocardial Infarction: Importance of the Glycemic
31. S. S. Elliott et al., “Fructose, Weight Gain, and the 5. C. Ramsden et al., “Re-evaluation of the traditional 12. M-P. St-Onge et al., “Medium Chain Triglyceride Oil Index,” American Journal of Clinical Nutrition 91, no. 6
Insulin Resistance Syndrome,” American Journal of diet-heart hypothesis: analysis of recovered data from Consumption as Part of a Weight Loss Diet Does Not (2010): 1764–68.
Clinical Nutrition 76, no. 5 (2002): 911–22; K.A. Lê and L. Minnesota Coronary Experiment (1968–73),” BMJ Lead to an Adverse Metabolic Profile When Compared 22. Ibid.
Tappy, “Metabolic Effects of Fructose,” Current Opinion 353(2016). doi:10.1136/bmj.i1246 to Olive Oil,” Journal of the American College of 23. Ibid.
in Clinical Nutrition and Metabolic Care 9, no. 4 (2006): 6. “The effect of replacing saturated fat with mostly Nutrition 27, no. 5 (2008): 547–52. 24. S.J. Nicholls et al., “Consumption of Saturated Fat
469–75; Y. Rayssiguier et al., “High Fructose n-6 polyunsaturated fat on coronary heart disease: a 13. K-T. Khaw et al., “Randomised Trial of Coconut Oil, Impairs the Anti-Inflammatory Properties of High-Density
Consumption Combined with Low Dietary Magnesium meta-analysis of randomized controlled trials,” Nutr. J Olive Oil or Butter on Blood Lipids and Other Lipoproteins and Endothelial Function,” Journal of the
Intake May Increase the Incidence of the Metabolic 2017 May 19; 16(1): 30. https://www.ncbi.nlm.nih.gov/ Cardiovascular Risk Factors in Healthy Men and American College of Cardiology 48, no. 4 (2006): 715–20.
Syndrome by Inducing Inflammation,” Magnesium pubmed/28526025 Women,” BMJ 8, no. 3. 25. R. S. Kuipers et al., “Saturated Fat, Carbohydrates,
Research Journal 19, no. 4 (2006): 237–43. 7. F. de Meester and A. P. Simopoulos, eds., “A Balanced 14. F. Rosqvist. “Potential Role of Milk Fat Globule and Cardiovascular Disease,” Netherlands Journal of
32. K. Adeli and A. C. Rutledge, “Fructose and the Omega-6/Omega-3 Fatty Acid Ratio, Cholesterol and Membrane in Modulating Plasma Lipoproteins, Gene Medicine 69, no. 9 (2011): 372–78.
Metabolic Syndrome: Pathophysiology and Molecular Coronary Heart Disease,” World Review of Nutrition and Expression, and Cholesterol Metabolism in Humans: A 26. Ibid; A. P. Simopoulos, “Overview of Evolutionary
Mechanisms,” Nutrition Reviews 65, no. 6 (2007): S13– Dietetics 100 (2009): 1–21; T. Hamazaki, Y. Kirihara, and Randomized Study,” American Journal of Clinical Aspects of w3 Fatty Acids in the Diet,” World Review of
S23; K.A. Lê and L. Tappy, “Metabolic Effects of Y. Ogushi, “Blood Cholesterol as a Good Marker of Nutrition 102, no. 1 (2015): 20–30. Nutrition and Dietetics 83 (1998): 1–11.
Fructose.” Health in Japan,” World Review of Nutrition and 15. Rice, BH, “Dairy and Cardiovascular Disease: A 27. R. O. Adolf et al., “Dietary Linoleic Acid Influences
33. “Fructose Metabolism by the Brain Increases Food Dietetics 100 (2009): 63–70. Review of Recent Observational Research,” Curr Nutr Desaturation and Acylation of Deuterium-labeled
Intake and Obesity, Study Suggests,” Science Daily, www. 8. Japan Atherosclerosis Society, “Japan Rep 2014 Mar 15; 3: 130-180 eCollection 2014. https:// Linoleic and Linolenic Acids in Young Adult Males,”
sciencedaily.com/releases/2009/03/090325091811.htm. Atherosclerosis Society (JAS) Guidelines for Prevention www.ncbi.nlm.nih.gov/pubmed/24818071 Biochimica et Biophysica Acta 1213, no. 3 (1994): 277–
of Atherosclerotic Cardiovascular Diseases,” Journal of 16. D. M. Herrington, et al., “Dietary Fats, Carbohydrate, 88; Ghafoorunissa and M. Indu, “N-3 Fatty Acids in
THE TRUTH ABOUT FAT: Atherosclerosis and Thrombosis 14, no. 2 (2007): 5–57; and Progression of Coronary Atherosclerosis in Indian Diets—Comparison of the Effects of Precursor
IT’S NOT WHAT YOU THINK de Meester and Simopoulos, “A Balanced Omega-6/ Postmenopausal Women,” American Journal of Clinical (Alpha-linolenic Acid) vs. Product (Long Chain N-3
1. F. B. Hu et al., “Meta-analysis of Prospective Cohort Omega-3 Fatty Acid Ratio, Cholesterol and Coronary Nutrition 80, no. 5 (2004): 1175–84. Polyunsaturated Fatty Acids),” Nutrition Research 12,
Studies Evaluating the Association of Saturated Fat Heart Disease.” 17. Ibid. nos. 4–5 (1992): 569–82.
with Cardiovascular Disease,” American Journal of 9. T. Hamazaki, et al., “Blood Cholesterol as a Good 18. R. H. Knopp and Barbara M. Retzlaff, “Saturated Fat 28. A. P. Simopoulos,“Evolutionary Aspects of the
Clinical Nutrition 91, no. 3 (2010): 502–9. Marker of Health in Japan,” World Review of Nutrition Prevents Coronary Artery Disease? An American Dietary Omega-6:Omega-3 Fatty Acid Ratio: Medical
2. R. S. Kuipers et al., “Saturated Fat, Carbohydrates, and Dietetics 100 (2009): 63–70; de Meester and Paradox,” American Journal of Clinical Nutrition 80, no. Implications,” World Review of Nutrition and Dietetics
and Cardiovascular Disease,” Netherlands Journal of Simopoulos, “A Balanced Omega-6/Omega-3 Fatty Acid 5 (2004): 1102–3. 100 (2009): 1–21.
Medicine 69, no. 9 (2011): 372–78. Ratio.” 19. M. B. Katan et al., “Dietary Oils, Serum Lipoproteins, 29. A. P. Simopoulos, “Overview of Evolutionary
3. R. Chowdhury et al., “Association of Dietary, 10. N. Panth et al., “Differential Effects of Medium- and and Coronary Heart Disease,” American Journal of Aspects of w3 Fatty Acids in the Diet.”

30. P. Reaven et al., “Effects of Oleate-rich and Reduces Periodontal Inflammation,”Journal of the Diseases,” Epidemiology and Infection 121, no. 2 (1998): Syndrome: A Randomized Double-Blind Placebo-
Linoleate-rich Diets on the Susceptibility of Low-density American College of Cardiology 62, no. 25 (2013): 335–47; J.D. Neaton and D. N. Wentworth, “Low Serum Controlled Study,” Journal of Clinical Endocrinology &
Lipoprotein to Oxidative Modification in Mildly 2382–2391. Cholesterol and Risk of Death from AIDS,” AIDS 11, no. 7 Metabolism 94, no. 1 (2009): 103–108.
Hypercholesterolemic Subjects,” Journal of Clinical 2. Y. Almog et al., “Statins, Inflammation, and Sepsis*: (1997): 929–30. 16. C. Do et al., “Statins and Erectile Dysfunction:
Investigation 91, no. 2 (1993): 668–76. Hypothesis,” Chest 124, no. 2 (2003): 740–743. 12. Harvard Women’s Health Watch, “Statins and Results of a Case/Non-Case Study using the French
31. L. G. Cleland, “Linoleate Inhibits EPA Incorporation 3. A. E. Dorr et al., “Colestipol Hydrochloride in Women,” June 2012: https://www.health.harvard.edu/ Pharmacovigilance System Database,” Drug Safety 32,
from Dietary Fish Oil Supplements in Human Subjects,” Hypercholesterolemic Patients—Effect on Serum heart-health/statins-and-women no. 7 (2009): 591–97.
American Journal of Clinical Nutrition 55, no. 2 (1992): Cholesterol and Mortality,” Journal of Chronic Diseases 13. J. Kantor, “Prevalence of Erectile Dysfunction and 17. C. J. Malkin et al., “Low Serum Testosterone and
395–99. 31, no. 1 (1978): 5. Active Depression: An Analytic Cross-Sectional Study of Increased Mortality in Men with Coronary Heart
32. W. E. M. Lands, “Diets Could Prevent Many 4. J. Stamler et al., “Effectiveness of Estrogens for the General Medical Patients,” American Journal of Disease,” Heart 96, no. 22 (2010): 1821–25.
Diseases,” Lipids 38, no. 4 (2003): 317–21. Long-Term Therapy of Middle-Aged Men with a History Epidemiology 156, no. 11 (2002): 1035–42. 18. S. Shrivastava et al., “Chronic Cholesterol Depletion
33. Ibid. of Myocardial Infarction,” Coronary Heart Disease: 14. M. Kanat et al., “A Multi-Center, Open Label, Using Statin Impairs the Function and Dynamics of
34. W. E. M. Lands, “A Critique of Paradoxes in Current Seventh Hahnemann Symposium, eds. W. Likoff and J. Crossover Designed Prospective Study Evaluatiing the Human Serotonin (1A) Receptors,” Biochemistry 49, no.
Advice on Dietary Lipids,” Progress in Lipid Research Henry Moyer (New York: Grune & Stratton, 1963), 416. Effects of Lipid-lowering Treatment on Steroid 26 (2010): 5426–35; L.N. Johnson-Anuna et al.,
47, no. 2 (2008): 77–106. 45. D. Kuester, “Cholesterol-Reducing Drugs May Synthesis in Patients with Type 2 Diabetes (MODEST “Chronic Administration of Statins Alters Multiple Gene
35. R. de Souza et al., “Intake of Saturated and Trans Lessen Brain Function, Says ISU Researcher,” Iowa Study),” Journal of Endocrinology Investigation 32, no. Expression Patterns in Mouse Cerebral Cortex,” Journal
Unsaturated Fatty Acids and Risk of All Cause Mortality, State University, last modified February 23, 2009, 10 (2009): 852–56; R.D. Stanworth et al., “Statin of Pharmacology and Experimental Therapeutics 312,
Cardiovascular Disease, and Type 2 Diabetes: www2.iastate.edu/~nscentral/news/2009/feb/shin.shtml. Therapy is Associated with Lower Total but not no. 2 (2005): 786–93. A. Linetti et al., “Cholesterol
Systematic Review and Meta-Analysis of Observational 6. Ibid. Bioavailable or Free Testosterone in Men with Type 2 Reduction Impairs Exocytosis of Synaptic Vesicles,”
Studies,” BMJ 351 (2015); R. Chowdhury et al, 7. M. Beck, “Can a Drug That Helps Hearts Be Harmful Diabetes,” Diabetes Care 32, no. 4 (2009): 541–46; A. S. Journal of Cell Science 123, no. 4 (2010): 595–605.
“Association of Dietary, Circulating, and Supplement to the Brain?” Wall Street Journal, February 12, 2008. Dobbs et al., “Effects of High-Dose Simvastatin on 19. T. B. Horwich et al., “Low Serum Total Cholesterol Is
Fatty Acids with Coronary Risk: A Systematic Review 8. D. Graveline, Lipitor: Thief of Memory (Duane Adrenal and Gonadal Steroidogenesis in Men with Associated with Marked Increase in Mortality in
and Meta-Analysis,” Annals of Internal Medicine 2014. Graveline, 2006), www.spacedoc.com/lipitor_thief_of_ Hypercholesterolemia,” Metabolism 49, no. 9 (2000): Advanced Heart Failure,” Journal of Cardiac Failure 8,
DOI:10.7326/M13-1788; A. Malhotra et al., “Saturated Fat memory.html. 1234–38; A. S. Dobs et al., “Effects of Simvastatin and no. 4 (2002): 216–24.
Does Not Clog the Arteries: Coronary Heart Disease Is 9. Martin, et al, “Statin therapy causes gut dysbiosis in Pravastatin on Gonadal Function in Male 20. S. Brescianini et al., “Low Total Cholesterol and
a Chronic Inflammatory Condition, The Risk of Which mice through a PXR-dependent mechanism,” Hypercholesterolemic Patients,” Metabolism 49, no. 1 Increased Risk of Dying: Are Low Levels Clinical
Can Be Effectively Reduced from Healthy Lifestyle Microbiome 2017; 5: 95. https://www.ncbi.nlm.nih.gov/ (2000): 115–21; M. T. Hyyppä et al., “Does Simvastatin Warning Signs in the Elderly? Results from the Italian
Interventions,” British Journal of Sports Medicine 51 pmc/articles/PMC5550934/ Affect Mood and Steroid Hormone Levels in Longitudinal Study on Aging,” Journal of the American
(2017): 1111–1112; H. Nichols, “Artery-Clogging Saturated 10. T. Khan et al., “Effect of Atorvastatin on the Gut Hypercholesterolemic Men? A Randomized Double-Blind Geriatrics Society 51, no. 7 (2003): 991–96.
Fat Myth Debunked,” Medical News Today 2017; P.W. Siri- Microbiota of High-Fat Diet-Induced Trial,” Psychoneuroendocrinology 28, no. 2 (2003): 21. A. Alawi et al., “Effect of the Magnitude of Lipid
Tarino et al., “Meta-Analysis of Prospective Cohort Hypercholesterolemic Rats,” Scientific Reports 8, no. 1 181–94. Lowering on Risk of Elevated Liver Enzymes,
Studies Evaluating the Association of Saturated Fat (2018): 662. 15. B. Banaszewska et al., “Effects of Simvastatin and Rhabdomyolysis, and Cancer,” Journal of the American
with Cardiovascular Disease,” American Journal of 11. C. Iribarren et al., “Serum Total Cholesterol and Risk Oral Contraceptive Agent on Polycystic Ovary College of Cardiology 50, no. 5 (2007): 409–18.
Clinical Nutrition 91, no. 3 (2010): 535–46. of Hospitalization and Death from Respiratory Disease,” Syndrome: Prospective, Randomized, Crossover Trial,” 22. M.R. Goldstein et al., “Primary Prevention of
International Journal of Epidemiology 26, no. 6 (1997): Journal of Clinical Endocrinology & Metabolism 92, no. Cardiovascular Disease with Statins: Cautionary Notes,”
THE STATIN DECEPTION 1191–1202; C. Iribarren et al., “Cohort Study of Serum 2 (2007): 456–61; T. Sathyapalan et al., “The Effect of QJM: An International Journal of Medicine 102 no. 11
1. S. Subramanian et al., “High-Dose Atorvastatin Total Cholesterol and In-Hospital Incidence of Infectious Atorvastatin in Patients with Polycystic Ovary (2009): 817–820.

30. P. Reaven et al., “Effects of Oleate-rich and Reduces Periodontal Inflammation,”Journal of the Diseases,” Epidemiology and Infection 121, no. 2 (1998): Syndrome: A Randomized Double-Blind Placebo-
Linoleate-rich Diets on the Susceptibility of Low-density American College of Cardiology 62, no. 25 (2013): 335–47; J.D. Neaton and D. N. Wentworth, “Low Serum Controlled Study,” Journal of Clinical Endocrinology &
Lipoprotein to Oxidative Modification in Mildly 2382–2391. Cholesterol and Risk of Death from AIDS,” AIDS 11, no. 7 Metabolism 94, no. 1 (2009): 103–108.
Hypercholesterolemic Subjects,” Journal of Clinical 2. Y. Almog et al., “Statins, Inflammation, and Sepsis*: (1997): 929–30. 16. C. Do et al., “Statins and Erectile Dysfunction:
Investigation 91, no. 2 (1993): 668–76. Hypothesis,” Chest 124, no. 2 (2003): 740–743. 12. Harvard Women’s Health Watch, “Statins and Results of a Case/Non-Case Study using the French
31. L. G. Cleland, “Linoleate Inhibits EPA Incorporation 3. A. E. Dorr et al., “Colestipol Hydrochloride in Women,” June 2012: https://www.health.harvard.edu/ Pharmacovigilance System Database,” Drug Safety 32,
from Dietary Fish Oil Supplements in Human Subjects,” Hypercholesterolemic Patients—Effect on Serum heart-health/statins-and-women no. 7 (2009): 591–97.
American Journal of Clinical Nutrition 55, no. 2 (1992): Cholesterol and Mortality,” Journal of Chronic Diseases 13. J. Kantor, “Prevalence of Erectile Dysfunction and 17. C. J. Malkin et al., “Low Serum Testosterone and
395–99. 31, no. 1 (1978): 5. Active Depression: An Analytic Cross-Sectional Study of Increased Mortality in Men with Coronary Heart
32. W. E. M. Lands, “Diets Could Prevent Many 4. J. Stamler et al., “Effectiveness of Estrogens for the General Medical Patients,” American Journal of Disease,” Heart 96, no. 22 (2010): 1821–25.
Diseases,” Lipids 38, no. 4 (2003): 317–21. Long-Term Therapy of Middle-Aged Men with a History Epidemiology 156, no. 11 (2002): 1035–42. 18. S. Shrivastava et al., “Chronic Cholesterol Depletion
33. Ibid. of Myocardial Infarction,” Coronary Heart Disease: 14. M. Kanat et al., “A Multi-Center, Open Label, Using Statin Impairs the Function and Dynamics of
34. W. E. M. Lands, “A Critique of Paradoxes in Current Seventh Hahnemann Symposium, eds. W. Likoff and J. Crossover Designed Prospective Study Evaluatiing the Human Serotonin (1A) Receptors,” Biochemistry 49, no.
Advice on Dietary Lipids,” Progress in Lipid Research Henry Moyer (New York: Grune & Stratton, 1963), 416. Effects of Lipid-lowering Treatment on Steroid 26 (2010): 5426–35; L.N. Johnson-Anuna et al.,
47, no. 2 (2008): 77–106. 45. D. Kuester, “Cholesterol-Reducing Drugs May Synthesis in Patients with Type 2 Diabetes (MODEST “Chronic Administration of Statins Alters Multiple Gene
35. R. de Souza et al., “Intake of Saturated and Trans Lessen Brain Function, Says ISU Researcher,” Iowa Study),” Journal of Endocrinology Investigation 32, no. Expression Patterns in Mouse Cerebral Cortex,” Journal
Unsaturated Fatty Acids and Risk of All Cause Mortality, State University, last modified February 23, 2009, 10 (2009): 852–56; R.D. Stanworth et al., “Statin of Pharmacology and Experimental Therapeutics 312,
Cardiovascular Disease, and Type 2 Diabetes: www2.iastate.edu/~nscentral/news/2009/feb/shin.shtml. Therapy is Associated with Lower Total but not no. 2 (2005): 786–93. A. Linetti et al., “Cholesterol
Systematic Review and Meta-Analysis of Observational 6. Ibid. Bioavailable or Free Testosterone in Men with Type 2 Reduction Impairs Exocytosis of Synaptic Vesicles,”
Studies,” BMJ 351 (2015); R. Chowdhury et al, 7. M. Beck, “Can a Drug That Helps Hearts Be Harmful Diabetes,” Diabetes Care 32, no. 4 (2009): 541–46; A. S. Journal of Cell Science 123, no. 4 (2010): 595–605.
“Association of Dietary, Circulating, and Supplement to the Brain?” Wall Street Journal, February 12, 2008. Dobbs et al., “Effects of High-Dose Simvastatin on 19. T. B. Horwich et al., “Low Serum Total Cholesterol Is
Fatty Acids with Coronary Risk: A Systematic Review 8. D. Graveline, Lipitor: Thief of Memory (Duane Adrenal and Gonadal Steroidogenesis in Men with Associated with Marked Increase in Mortality in
and Meta-Analysis,” Annals of Internal Medicine 2014. Graveline, 2006), www.spacedoc.com/lipitor_thief_of_ Hypercholesterolemia,” Metabolism 49, no. 9 (2000): Advanced Heart Failure,” Journal of Cardiac Failure 8,
DOI:10.7326/M13-1788; A. Malhotra et al., “Saturated Fat memory.html. 1234–38; A. S. Dobs et al., “Effects of Simvastatin and no. 4 (2002): 216–24.
Does Not Clog the Arteries: Coronary Heart Disease Is 9. Martin, et al, “Statin therapy causes gut dysbiosis in Pravastatin on Gonadal Function in Male 20. S. Brescianini et al., “Low Total Cholesterol and
a Chronic Inflammatory Condition, The Risk of Which mice through a PXR-dependent mechanism,” Hypercholesterolemic Patients,” Metabolism 49, no. 1 Increased Risk of Dying: Are Low Levels Clinical
Can Be Effectively Reduced from Healthy Lifestyle Microbiome 2017; 5: 95. https://www.ncbi.nlm.nih.gov/ (2000): 115–21; M. T. Hyyppä et al., “Does Simvastatin Warning Signs in the Elderly? Results from the Italian
Interventions,” British Journal of Sports Medicine 51 pmc/articles/PMC5550934/ Affect Mood and Steroid Hormone Levels in Longitudinal Study on Aging,” Journal of the American
(2017): 1111–1112; H. Nichols, “Artery-Clogging Saturated 10. T. Khan et al., “Effect of Atorvastatin on the Gut Hypercholesterolemic Men? A Randomized Double-Blind Geriatrics Society 51, no. 7 (2003): 991–96.
Fat Myth Debunked,” Medical News Today 2017; P.W. Siri- Microbiota of High-Fat Diet-Induced Trial,” Psychoneuroendocrinology 28, no. 2 (2003): 21. A. Alawi et al., “Effect of the Magnitude of Lipid
Tarino et al., “Meta-Analysis of Prospective Cohort Hypercholesterolemic Rats,” Scientific Reports 8, no. 1 181–94. Lowering on Risk of Elevated Liver Enzymes,
Studies Evaluating the Association of Saturated Fat (2018): 662. 15. B. Banaszewska et al., “Effects of Simvastatin and Rhabdomyolysis, and Cancer,” Journal of the American
with Cardiovascular Disease,” American Journal of 11. C. Iribarren et al., “Serum Total Cholesterol and Risk Oral Contraceptive Agent on Polycystic Ovary College of Cardiology 50, no. 5 (2007): 409–18.
Clinical Nutrition 91, no. 3 (2010): 535–46. of Hospitalization and Death from Respiratory Disease,” Syndrome: Prospective, Randomized, Crossover Trial,” 22. M.R. Goldstein et al., “Primary Prevention of
International Journal of Epidemiology 26, no. 6 (1997): Journal of Clinical Endocrinology & Metabolism 92, no. Cardiovascular Disease with Statins: Cautionary Notes,”
THE STATIN DECEPTION 1191–1202; C. Iribarren et al., “Cohort Study of Serum 2 (2007): 456–61; T. Sathyapalan et al., “The Effect of QJM: An International Journal of Medicine 102 no. 11
1. S. Subramanian et al., “High-Dose Atorvastatin Total Cholesterol and In-Hospital Incidence of Infectious Atorvastatin in Patients with Polycystic Ovary (2009): 817–820.

23. Corrao G, et al., Statins and the risk of diabetes, Aggressiveness of Lipid-Lowering Treatment to Primary Prevention?” Therapeutics Letter #48, April– Diabetologia 60, no. 9 (2017): 1630–1638.
Diabetes Care 2014 Aug; 37(8): 2225–32. https://www. Changes in Calcified Plaque Burden by Electron Beam June 2003, www.ti.ubc.ca/newsletter/ 11. Diabetes Epidemic and You (Kraft, Trafford
ncbi.nlm.nih.gov/pubmed/24969582 Tomography,” American Journal of Cardiology 92, no. 3 do-statins-have-role-primary-prevention. Publishing, 2008)
24. D. Preiss et al., “Risk of Incident Diabetes with (2003): 334–36. 42. M. Pignone et al., “Primary Prevention of CHD with 12. Meridian Valley Lab, “Kraft Prediabetes Profile,”
Intensive-Dose Compared with Moderate-Dose Statin 33. W. A. Flegel, “Inhibition of Endotoxin-Induced Pharmacological Lipid-Lowering Therapy: A Meta- https://www.meridianvalleylab.com/services/
Therapy,” Journal of the American Medical Association Activation of Human Monocytes by Human Analysis of Randomised Trials,” BMJ 321, no. 7267 kraft-prediabetes-profile
305, no. 24 (2011): 2556–64. Lipoprotein,” Infection and Immunity 57, no. 7 (1989): (2000): 983–86. 13. T. Hayashi et al., “Patterns of Insulin Concentration
25. J. Kreafle, “New Cholesterol Guidelines for Heart 2237–45; W.A. Flegel et al., “Prevention of Endotoxin- During the OGTT Predict the Risk of Type 2 Diabetes in
Health: What You Need to Know,” ABC News November Induced Monokine Release by Human Low- and High- THE REAL CAUSE OF HEART Japanese Americans,” Diabetes Care 36, no. 5 (2013):
12, 2018: https://abcnews.go.com/Health/cholesterol- Density Lipoproteins and by Apolipoprotein A-I,” DISEASE 1229–35.
guidelines-heart-health/story?id=59147980 Infection and Immunity 61, no. 12 (1993): 5140–46; H. 1. A. Menke et al., “Prevalence of and Trends in Diabetes 14. J. DiNicolantonio et al, “Postprandial Insulin Assay
26. M. Nakata et al., “ Effects of Statins on the Northoff et al., “The Role of Lipoproteins in Inactivation Among Adults in the United States, 1988–2012,” JAMA as the Earliest Biomarker for Diagnosing Pre-Diabetes,
Adipocyte Maturation and Expression of Glucose of Endotoxin by Serum,” Beitr Infusionsther 30 (1992): 314, no. 10 (2015): 1021–29. Type 2 Diabetes and Increased Cardiovascular Risk,”
Transporter 4 (SLC2A4): Implications in Glycaemic 195–97. 2. A. Boldt, “Starbucks’ Pumpkin Spice Latte Nutrition Open Heart 4, no. 2 (2017): doi:10.1136/
Control,” Diabetologia 49, no. 8 (2006): 1881–92; M. 34. Jacobs et al., “Report of the Conference on Low Information,” LivestrongUpdated October 25, 2019: M.S. openhrt-2017-000656
Braulta et al., “Statin Treatment and New-Onset Blood Cholesterol.” https://www.livestrong.com/ 15. Ibid.
Diabetes: A Review of Proposed Mechanisms,” 35. Iribarren et al., “Serum Total Cholesterol and Risk article/274448-starbucks-pumpkin-spice-latte-nutrition- 16. V. Ormazabal et al., “Association Between Insulin
Metabolism 63, no. 6 (2014): 735–745. of Hospitalization”; Iribarren et al., “Cohort Study of information Resistance and the Development of Cardiovascular
27. B. A. Golomb et al., “Physician Response to Patient Serum Total Cholesterol.” 3. Starbucks, “Nutritional Information: Blueberry Disease,” Cardiovascular Diabetology 17 (2018): https://
Reports of Adverse Drug Effects,” Drug Safety 30, no. 8 36. Neaton and Wentworth, “Low Serum Cholesterol Muffin,” https://www.starbucks.com/menu/food/bakery/ cardiab.biomedcentral.com/articles/10.1186/
(2007): 669–75. and Risk of Death from AIDS.” bountiful-blueberry-muffin s12933-018-0762-4
28. Ibid. 37. A. C. Looker et al., “Vitamin D Status: United States, 4. M. Demasi et al., “The Cholesterol and Calorie 17. K.M. Flegal et al., “Excess Deaths Associated with
29. J. Stamler et al., “Is Relationship Between Serum 2001–2006,” Centers for Disease Control and Hypotheses are Both Dead — It Is Time to Focus on the Underweight, Overweight, and Obesity,” JAMA 293, no.
Cholesterol and Risk of Premature Death from Prevention, NCHS Data Brief No. 59, March 2011, www. Real Culprit: Insulin Resistance,” The Pharmaceutical 15 (2005): 1861–7.
Coronary Heart Disease Continuous and Graded? cdc.gov/nchs/data/databriefs/db59.htm. Journal July 14, 2017. 18. G. Howard et al., “Insulin Sensitivity and
Findings in 356,222 Primary Screenees of the Multiple 38. W. Faloon, “Startling Findings About Vitamin D 5. https://www.youtube.com/watch?v=UZoQiDaWnuE Atherosclerosis. The Insulin Resistance Atherosclerosis
Risk Factor Intervention Trial (MRFIT),” JAMA 256, no. Levels in Life Extension Members,” Life Extension 6. A. Eenfeldt, “The Engineer Who Knows More Than Study (IRAS) Investigators,” Circulation 93, no. 10
20 (1986): 2823–8. Magazine, January 2010, www.lef.org/magazine/ Your Doctor,” Diet Doctor June 13, 2016. (1996): 1809–17; A. Tenenbaum et al., “Insulin
30. David Diamond, Ph.D., “Demonization and mag2010/jan2010_Startling-Findings-About-Vitamin-D- 7. ibid. Resistance Is Associated with Increased Risk of Major
Deception in Cholesterol Research.” https://www.you- Levels-in-Life-Extension-Members_01.htm. 8. Crofts, Diabesity 2015; 1 (4): 34–43 Cardiovascular Events in Patients with Preexisting
tube.com/watch?v=yX1vBA9bLNk&t=3047s 39. “Health Conditions,” Vitamin D Council, last modi- 9. G. M. Fahy et al., “Reversal of Epigenetic Aging and Coronary Artery Disease,” American Heart Journal 153,
31. T. Xuan-Mai et al., “Abstract 16619: Relationship fied September 27, 2011, www.vitamindcouncil.org/ Immunosenescent Trends in Humans,” Aging Cell 18, no. no. 4: 559–65; K.B. Gast et al., “Insulin Resistance And
Between Serum Cholesterol and Risk of Premature health-conditions. 6 (2019): https://doi.org/10.1111/acel.13028. Risk of Incident Cardiovascular Events in Adults
Death from Coronary Heart Disease in Male Veterans: is 40. J. Abramson and J. M. Wright, “Are Lipid-Lowering 10. N. Barzilai, Nir et al., “Metformin as a Tool to Target Without Diabetes: Meta-Analysis,” PLoS One 7, no. 12:
it Still Continuous and Graded?” Circulation 134 supp. 1 Guidelines Evidence-Based?” The Lancet 369, no. 9557 Aging,” Cell Metabolism 23, no. 6 (2016): 1060–1065; W. doi: 10.1371/journal.pone.0052036; D. Eddy et al.,
(2016). (2007): 168–69. Valencia et al., “Metformin and Ageing: Improving “Relationship of Insulin Resistance and Related
32. H. S. Hecht and S. M. Harman, “Relation of 41. Therapeutics Initiative, “Do Statins Have a Role in Ageing Outcomes Beyond Glycaemic Control,” Metabolic Variables to Coronary Artery Disease: A

23. Corrao G, et al., Statins and the risk of diabetes, Aggressiveness of Lipid-Lowering Treatment to Primary Prevention?” Therapeutics Letter #48, April– Diabetologia 60, no. 9 (2017): 1630–1638.
Diabetes Care 2014 Aug; 37(8): 2225–32. https://www. Changes in Calcified Plaque Burden by Electron Beam June 2003, www.ti.ubc.ca/newsletter/ 11. Diabetes Epidemic and You (Kraft, Trafford
ncbi.nlm.nih.gov/pubmed/24969582 Tomography,” American Journal of Cardiology 92, no. 3 do-statins-have-role-primary-prevention. Publishing, 2008)
24. D. Preiss et al., “Risk of Incident Diabetes with (2003): 334–36. 42. M. Pignone et al., “Primary Prevention of CHD with 12. Meridian Valley Lab, “Kraft Prediabetes Profile,”
Intensive-Dose Compared with Moderate-Dose Statin 33. W. A. Flegel, “Inhibition of Endotoxin-Induced Pharmacological Lipid-Lowering Therapy: A Meta- https://www.meridianvalleylab.com/services/
Therapy,” Journal of the American Medical Association Activation of Human Monocytes by Human Analysis of Randomised Trials,” BMJ 321, no. 7267 kraft-prediabetes-profile
305, no. 24 (2011): 2556–64. Lipoprotein,” Infection and Immunity 57, no. 7 (1989): (2000): 983–86. 13. T. Hayashi et al., “Patterns of Insulin Concentration
25. J. Kreafle, “New Cholesterol Guidelines for Heart 2237–45; W.A. Flegel et al., “Prevention of Endotoxin- During the OGTT Predict the Risk of Type 2 Diabetes in
Health: What You Need to Know,” ABC News November Induced Monokine Release by Human Low- and High- THE REAL CAUSE OF HEART Japanese Americans,” Diabetes Care 36, no. 5 (2013):
12, 2018: https://abcnews.go.com/Health/cholesterol- Density Lipoproteins and by Apolipoprotein A-I,” DISEASE 1229–35.
guidelines-heart-health/story?id=59147980 Infection and Immunity 61, no. 12 (1993): 5140–46; H. 1. A. Menke et al., “Prevalence of and Trends in Diabetes 14. J. DiNicolantonio et al, “Postprandial Insulin Assay
26. M. Nakata et al., “ Effects of Statins on the Northoff et al., “The Role of Lipoproteins in Inactivation Among Adults in the United States, 1988–2012,” JAMA as the Earliest Biomarker for Diagnosing Pre-Diabetes,
Adipocyte Maturation and Expression of Glucose of Endotoxin by Serum,” Beitr Infusionsther 30 (1992): 314, no. 10 (2015): 1021–29. Type 2 Diabetes and Increased Cardiovascular Risk,”
Transporter 4 (SLC2A4): Implications in Glycaemic 195–97. 2. A. Boldt, “Starbucks’ Pumpkin Spice Latte Nutrition Open Heart 4, no. 2 (2017): doi:10.1136/
Control,” Diabetologia 49, no. 8 (2006): 1881–92; M. 34. Jacobs et al., “Report of the Conference on Low Information,” LivestrongUpdated October 25, 2019: M.S. openhrt-2017-000656
Braulta et al., “Statin Treatment and New-Onset Blood Cholesterol.” https://www.livestrong.com/ 15. Ibid.
Diabetes: A Review of Proposed Mechanisms,” 35. Iribarren et al., “Serum Total Cholesterol and Risk article/274448-starbucks-pumpkin-spice-latte-nutrition- 16. V. Ormazabal et al., “Association Between Insulin
Metabolism 63, no. 6 (2014): 735–745. of Hospitalization”; Iribarren et al., “Cohort Study of information Resistance and the Development of Cardiovascular
27. B. A. Golomb et al., “Physician Response to Patient Serum Total Cholesterol.” 3. Starbucks, “Nutritional Information: Blueberry Disease,” Cardiovascular Diabetology 17 (2018): https://
Reports of Adverse Drug Effects,” Drug Safety 30, no. 8 36. Neaton and Wentworth, “Low Serum Cholesterol Muffin,” https://www.starbucks.com/menu/food/bakery/ cardiab.biomedcentral.com/articles/10.1186/
(2007): 669–75. and Risk of Death from AIDS.” bountiful-blueberry-muffin s12933-018-0762-4
28. Ibid. 37. A. C. Looker et al., “Vitamin D Status: United States, 4. M. Demasi et al., “The Cholesterol and Calorie 17. K.M. Flegal et al., “Excess Deaths Associated with
29. J. Stamler et al., “Is Relationship Between Serum 2001–2006,” Centers for Disease Control and Hypotheses are Both Dead — It Is Time to Focus on the Underweight, Overweight, and Obesity,” JAMA 293, no.
Cholesterol and Risk of Premature Death from Prevention, NCHS Data Brief No. 59, March 2011, www. Real Culprit: Insulin Resistance,” The Pharmaceutical 15 (2005): 1861–7.
Coronary Heart Disease Continuous and Graded? cdc.gov/nchs/data/databriefs/db59.htm. Journal July 14, 2017. 18. G. Howard et al., “Insulin Sensitivity and
Findings in 356,222 Primary Screenees of the Multiple 38. W. Faloon, “Startling Findings About Vitamin D 5. https://www.youtube.com/watch?v=UZoQiDaWnuE Atherosclerosis. The Insulin Resistance Atherosclerosis
Risk Factor Intervention Trial (MRFIT),” JAMA 256, no. Levels in Life Extension Members,” Life Extension 6. A. Eenfeldt, “The Engineer Who Knows More Than Study (IRAS) Investigators,” Circulation 93, no. 10
20 (1986): 2823–8. Magazine, January 2010, www.lef.org/magazine/ Your Doctor,” Diet Doctor June 13, 2016. (1996): 1809–17; A. Tenenbaum et al., “Insulin
30. David Diamond, Ph.D., “Demonization and mag2010/jan2010_Startling-Findings-About-Vitamin-D- 7. ibid. Resistance Is Associated with Increased Risk of Major
Deception in Cholesterol Research.” https://www.you- Levels-in-Life-Extension-Members_01.htm. 8. Crofts, Diabesity 2015; 1 (4): 34–43 Cardiovascular Events in Patients with Preexisting
tube.com/watch?v=yX1vBA9bLNk&t=3047s 39. “Health Conditions,” Vitamin D Council, last modi- 9. G. M. Fahy et al., “Reversal of Epigenetic Aging and Coronary Artery Disease,” American Heart Journal 153,
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32. H. S. Hecht and S. M. Harman, “Relation of 41. Therapeutics Initiative, “Do Statins Have a Role in Ageing Outcomes Beyond Glycaemic Control,” Metabolic Variables to Coronary Artery Disease: A

Mathematical Analysis,” Diabetes Care 32, no. 2 (2009): https://www.healthline.com/health/type-2-diabetes/sta- BEYOND THE MEDITERRANEAN DIET: releases/2009/06/090625133215.htm.
361–66; G. Reaven, “Insulin Resistance and Coronary tistics#1; American Diabetes Association, “Statistics WHAT DO I EAT? 9. Tel Aviv University, “How High Carbohydrate Foods
Heart Disease in Nondiabetic Individuals,” About Diabetes,” https://www.diabetes.org/resources/ 1. Faris, Stephan, “Eat Like an Italian,” Time, (2/20/12). Can Raise Risk for Heart Problems,” Science Daily,
Arteriosclerosis, Thrombosis, and Vascular Biology 32, statistics/statistics-about-diabetes http://content.time.com/time/subscriber/arti- June 25, 2009, retrieved February 8, 2012, from www.
no. 8 (2012): 1754–59; D.J. Rader, “Effect of Insulin 22. H.F. Bligh et al., “Plant-Rich Mixed Meals Based on cle/0,33009,2106478-1,00.html sciencedaily.com/releases/2009/06/090625133215.htm
Resistance, Dyslipidemia, and Intra-Abdominal Adiposity Palaeolithic Diet Principles Have a Dramatic Impact on 2. Sardinia Unlimited, “10 Sardinian Top Dishes,” 10. S. Liu et al., “Relation Between a Diet with a High
on the Development of Cardiovascular Disease and Incretin, Peptide YY and Satiety Response, but Show https://www.sardiniaunlimited. Glycemic Load and Plasma Concentrations of High-
Diabetes Mellitus,” American Journal of Medicine 120, Little Effect on Glucose and Insulin Homeostasis: An com/10-sardinian-top-dishes Sensitivity C-Reactive Protein in Middle-Aged Women,”
no. 3 supp. 1: S12–18; D.A. Savaino and J.A. Story, Acute-Effects Randomised Study,” British Journal of 3. Elizabeth David biography, Wikipedia. https://en.wiki- American Journal of Clinical Nutrition 75, no. 3 (2002):
“Cardiovascular Disease and Fiber: Is Insulin Resistance Nutrition 113, no. 4 (2015): 574–84. pedia.org/wiki/Elizabeth_David_bibliography 492–98.
the Missing Link?” Nutrition Reviews 58, no. 11 (2000): 23. G.B. Haber et al., “Depletion and Disruption of 4. Su Cumbidu: https://www.sucumbidu.com/secondi-2 11. Ibid.
356–58; C. Kong et al., “Insulin Resistance, Dietary Fibre. Effects on Satiety, Plasma-Glucose, and 5. Lauren E O’Connor et al., “A Mediterranean-Style 12. C. Laino, “Trans Fats Up Heart Disease Risk,” WebMD
Cardiovascular Risk Factors and Ultrasonically Serum-Insulin,” Lancet 2, no. 8040 (1977): 679–82. DOI: Eating Pattern with Lean, Unprocessed Red Meat Has Health News, November 15, 2006, www.webmd.com/
Measured Early Arterial Disease in Normotensive Type 10.1016/s0140-6736(77)90494-9; C. Desmarchelier et Cardiometabolic Benefits for Adults Who Are heart/news/20061115/
2 Diabetic Subjects,” Diabetes/Metabolism research and al., “Diet-induced Obesity in Ad Libitum-Fed Mice: Food Overweight or Obese in a Randomized, Crossover, heart-disease-risk-upped-by-trans-fats.
Reviews 16, no. 6 (2000): 448–53; H.N. Ginsberg, Texture Overrides the Effect of Macronutrient Controlled Feeding Trial,” The American Journal of 13. F. B. Hu et al., “Dietary Fat Intake and the Risk of
“Insulin Resistance and Cardiovascular Disease,” Composition,” British Journal of Nutrition 109, no. 8 Clinical Nutrition 108, no. 1, (2018): 33–40. Coronary Heart Disease in Women,” New England
Journal of Clinical Investigation 106, no. 4 (2000): 453– (2013): 1518–27. 6. K. L. Stanhope et al., “Consumption of Fructose and Journal of Medicine 337, no. 21 (1997): 1491–99.143.
58; Z.T. Bloomgarden, “Insulin Resistance, Dyslipidemia, 24. A.P. Simopoulos, “The importance of the ratio of High-Fructose Corn Syrup Increase Postprandial 14. Institute of Medicine of the National Academies,
and Cardiovascular Disease,” Diabetes Care 30, no. 8 omega-6/omega-3 essential fatty acids,” Biomedicine & Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Dietary Reference Intakes for Energy, Carbohydrate,
(2007): 2164–70. Pharmacotherapy 56, no. 8 (2002): 365–379. Young Men and Women,” Journal of Clinical Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino
19. R.G. Garcia et al., “Hyperinsulinemia Is a Predictor 25. The Blood Code: HOMA IR – Insulin Resistance Endocrinology & Metabolism 96, no. 10 (2011): E1596– Acids (Washington, D.C.: The National Academies Press,
of New Cardiovascular Events in Colombian Patients Calculator: https://www.thebloodcode.com/ 605; “Fructose Consumption Increases Risk Factors for 2005), 504.
with a First Myocardial Infarction,” International homa-ir-calculator Heart Disease: Study Suggests US Dietary Guideline for 15. Harvard School of Public Health, “Eating Processed
Journal of Cardiology 148, no. 1 (2011): 85–90. 26. LabCorp: https://www.labcorp.com/test- Upper Limit of Sugar Consumption Is Too High,” Meats, but Not Unprocessed Red Meats, May Raise Risk
20. K. Kotseva, “EUROASPIRE IV: A European Society of menu/31986/nmr-lipoprofile%C2%AE-with-insulin-resis- Science Daily, July 28, 2011; K. L. Stanhope and P. J. of Heart Disease and Diabetes,” news release, May 17,
Cardiology Survey on the Lifestyle, Risk Factor and tance-markers-without-graph; https://www.labcorp.com/ Havel, “Endocrine and Metabolic Effects of Consuming 2010, www.hsph.harvard.edu/news/press-releases/2010-
Therapeutic Management of Coronary Patients from 24 test-menu/26131/glyca; https://www.labcorp.com/ Beverages Sweetened with Fructose, Glucose, Sucrose, releases/processed-meats-unprocessed-heart-disease-
European Countries,” European Journal of Preventive assets/17167 or High-Fructose Corn Syrup,” American Journal of diabetes.html.
Cardiology 23, no. 6 (2016): 636–48; K. Kortseva, “Time 27. M. Demasi et al., “The Cholesterol and Calorie Clinical Nutrition 88, no. 6 (2008): 1733S–37S. 16. Ibid.
Trends in Lifestyle, Cardiovascular Risk Factors, and Hypotheses Are Both Dead — It Is Time to Focus on the 7. S. Sieri et al., “Dietary Glycemic Load and Index and 17. J. Bowden, The 150 Healthiest Foods on Earth
Therapeutic Management in European Patients with Real Culprit: Insulin Resistance,” Clinical Pharmacist Risk of Coronary Heart Disease in a large Italian (Beverly, MA: Fair Winds Press, 2007).
Coronary Artery Disease. A comparison of Euroaspire July 14, 2017: https://www.pharmaceutical-journal.com/ Cohort: The EPICOR Study,” Archives of Internal 18. L. Zhang et al., “Pterostilbene Protects Vascular
lV and V surveys over 5 years in 21 countries.,” NHLI opinion/insight/the-cholesterol-and-calorie-hypotheses- Medicine 12, no. 170 (2010): 640–47. Endothelial Cells Against Oxidized Low-Density
Imperial College London, UK on behalf of the are-both-dead-it-is-time-to-focus-on-the-real-culprit- 8. “How High Carbohydrate Foods Can Raise Risk for Lipoprotein-Induced Apoptosis In Vitro and In Vivo,”
EuroAspire Investigators. insulin-resistance/20203046.article?firstPass=false Heart Problems,” Science Daily, June 25, 2009, Apoptosis 17, no. 1 (2012): 25–36.
21. Healthline, “Type 2 Diabetes Statistics and Facts,” retrieved February 8, 2012, www.sciencedaily.com/ 19. H. C. Ou et al., “Ellagic Acid Protects Endothelial

Mathematical Analysis,” Diabetes Care 32, no. 2 (2009): https://www.healthline.com/health/type-2-diabetes/sta- BEYOND THE MEDITERRANEAN DIET: releases/2009/06/090625133215.htm.
361–66; G. Reaven, “Insulin Resistance and Coronary tistics#1; American Diabetes Association, “Statistics WHAT DO I EAT? 9. Tel Aviv University, “How High Carbohydrate Foods
Heart Disease in Nondiabetic Individuals,” About Diabetes,” https://www.diabetes.org/resources/ 1. Faris, Stephan, “Eat Like an Italian,” Time, (2/20/12). Can Raise Risk for Heart Problems,” Science Daily,
Arteriosclerosis, Thrombosis, and Vascular Biology 32, statistics/statistics-about-diabetes http://content.time.com/time/subscriber/arti- June 25, 2009, retrieved February 8, 2012, from www.
no. 8 (2012): 1754–59; D.J. Rader, “Effect of Insulin 22. H.F. Bligh et al., “Plant-Rich Mixed Meals Based on cle/0,33009,2106478-1,00.html sciencedaily.com/releases/2009/06/090625133215.htm
Resistance, Dyslipidemia, and Intra-Abdominal Adiposity Palaeolithic Diet Principles Have a Dramatic Impact on 2. Sardinia Unlimited, “10 Sardinian Top Dishes,” 10. S. Liu et al., “Relation Between a Diet with a High
on the Development of Cardiovascular Disease and Incretin, Peptide YY and Satiety Response, but Show https://www.sardiniaunlimited. Glycemic Load and Plasma Concentrations of High-
Diabetes Mellitus,” American Journal of Medicine 120, Little Effect on Glucose and Insulin Homeostasis: An com/10-sardinian-top-dishes Sensitivity C-Reactive Protein in Middle-Aged Women,”
no. 3 supp. 1: S12–18; D.A. Savaino and J.A. Story, Acute-Effects Randomised Study,” British Journal of 3. Elizabeth David biography, Wikipedia. https://en.wiki- American Journal of Clinical Nutrition 75, no. 3 (2002):
“Cardiovascular Disease and Fiber: Is Insulin Resistance Nutrition 113, no. 4 (2015): 574–84. pedia.org/wiki/Elizabeth_David_bibliography 492–98.
the Missing Link?” Nutrition Reviews 58, no. 11 (2000): 23. G.B. Haber et al., “Depletion and Disruption of 4. Su Cumbidu: https://www.sucumbidu.com/secondi-2 11. Ibid.
356–58; C. Kong et al., “Insulin Resistance, Dietary Fibre. Effects on Satiety, Plasma-Glucose, and 5. Lauren E O’Connor et al., “A Mediterranean-Style 12. C. Laino, “Trans Fats Up Heart Disease Risk,” WebMD
Cardiovascular Risk Factors and Ultrasonically Serum-Insulin,” Lancet 2, no. 8040 (1977): 679–82. DOI: Eating Pattern with Lean, Unprocessed Red Meat Has Health News, November 15, 2006, www.webmd.com/
Measured Early Arterial Disease in Normotensive Type 10.1016/s0140-6736(77)90494-9; C. Desmarchelier et Cardiometabolic Benefits for Adults Who Are heart/news/20061115/
2 Diabetic Subjects,” Diabetes/Metabolism research and al., “Diet-induced Obesity in Ad Libitum-Fed Mice: Food Overweight or Obese in a Randomized, Crossover, heart-disease-risk-upped-by-trans-fats.
Reviews 16, no. 6 (2000): 448–53; H.N. Ginsberg, Texture Overrides the Effect of Macronutrient Controlled Feeding Trial,” The American Journal of 13. F. B. Hu et al., “Dietary Fat Intake and the Risk of
“Insulin Resistance and Cardiovascular Disease,” Composition,” British Journal of Nutrition 109, no. 8 Clinical Nutrition 108, no. 1, (2018): 33–40. Coronary Heart Disease in Women,” New England
Journal of Clinical Investigation 106, no. 4 (2000): 453– (2013): 1518–27. 6. K. L. Stanhope et al., “Consumption of Fructose and Journal of Medicine 337, no. 21 (1997): 1491–99.143.
58; Z.T. Bloomgarden, “Insulin Resistance, Dyslipidemia, 24. A.P. Simopoulos, “The importance of the ratio of High-Fructose Corn Syrup Increase Postprandial 14. Institute of Medicine of the National Academies,
and Cardiovascular Disease,” Diabetes Care 30, no. 8 omega-6/omega-3 essential fatty acids,” Biomedicine & Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Dietary Reference Intakes for Energy, Carbohydrate,
(2007): 2164–70. Pharmacotherapy 56, no. 8 (2002): 365–379. Young Men and Women,” Journal of Clinical Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino
19. R.G. Garcia et al., “Hyperinsulinemia Is a Predictor 25. The Blood Code: HOMA IR – Insulin Resistance Endocrinology & Metabolism 96, no. 10 (2011): E1596– Acids (Washington, D.C.: The National Academies Press,
of New Cardiovascular Events in Colombian Patients Calculator: https://www.thebloodcode.com/ 605; “Fructose Consumption Increases Risk Factors for 2005), 504.
with a First Myocardial Infarction,” International homa-ir-calculator Heart Disease: Study Suggests US Dietary Guideline for 15. Harvard School of Public Health, “Eating Processed
Journal of Cardiology 148, no. 1 (2011): 85–90. 26. LabCorp: https://www.labcorp.com/test- Upper Limit of Sugar Consumption Is Too High,” Meats, but Not Unprocessed Red Meats, May Raise Risk
20. K. Kotseva, “EUROASPIRE IV: A European Society of menu/31986/nmr-lipoprofile%C2%AE-with-insulin-resis- Science Daily, July 28, 2011; K. L. Stanhope and P. J. of Heart Disease and Diabetes,” news release, May 17,
Cardiology Survey on the Lifestyle, Risk Factor and tance-markers-without-graph; https://www.labcorp.com/ Havel, “Endocrine and Metabolic Effects of Consuming 2010, www.hsph.harvard.edu/news/press-releases/2010-
Therapeutic Management of Coronary Patients from 24 test-menu/26131/glyca; https://www.labcorp.com/ Beverages Sweetened with Fructose, Glucose, Sucrose, releases/processed-meats-unprocessed-heart-disease-
European Countries,” European Journal of Preventive assets/17167 or High-Fructose Corn Syrup,” American Journal of diabetes.html.
Cardiology 23, no. 6 (2016): 636–48; K. Kortseva, “Time 27. M. Demasi et al., “The Cholesterol and Calorie Clinical Nutrition 88, no. 6 (2008): 1733S–37S. 16. Ibid.
Trends in Lifestyle, Cardiovascular Risk Factors, and Hypotheses Are Both Dead — It Is Time to Focus on the 7. S. Sieri et al., “Dietary Glycemic Load and Index and 17. J. Bowden, The 150 Healthiest Foods on Earth
Therapeutic Management in European Patients with Real Culprit: Insulin Resistance,” Clinical Pharmacist Risk of Coronary Heart Disease in a large Italian (Beverly, MA: Fair Winds Press, 2007).
Coronary Artery Disease. A comparison of Euroaspire July 14, 2017: https://www.pharmaceutical-journal.com/ Cohort: The EPICOR Study,” Archives of Internal 18. L. Zhang et al., “Pterostilbene Protects Vascular
lV and V surveys over 5 years in 21 countries.,” NHLI opinion/insight/the-cholesterol-and-calorie-hypotheses- Medicine 12, no. 170 (2010): 640–47. Endothelial Cells Against Oxidized Low-Density
Imperial College London, UK on behalf of the are-both-dead-it-is-time-to-focus-on-the-real-culprit- 8. “How High Carbohydrate Foods Can Raise Risk for Lipoprotein-Induced Apoptosis In Vitro and In Vivo,”
EuroAspire Investigators. insulin-resistance/20203046.article?firstPass=false Heart Problems,” Science Daily, June 25, 2009, Apoptosis 17, no. 1 (2012): 25–36.
21. Healthline, “Type 2 Diabetes Statistics and Facts,” retrieved February 8, 2012, www.sciencedaily.com/ 19. H. C. Ou et al., “Ellagic Acid Protects Endothelial

Cells from Oxidized Low-Density Lipoprotein-Induced 30. Bazzano et al., “Legume Consumption and Risk of 38. V. Ivanov at al., “Red Wine Antioxidants Bind to HELP YOUR HEART WITH THESE
Apoptosis by Modulating the PI3K/Akt/eNOS Pathway,” Coronary Heart Disease in U.S. Men and Women,” Human Lipoproteins and Protect them from Metal Ion- SUPPLEMENTS
Toxicology and Applied Pharmacology 248, no. 2 Archives of Internal Medicine 161, no. 21 (2001): Dependent and Independent Oxidation,” Journal of 1. E. G. Campbell, “Doctors and Drug Companies—
(2010): 134–43. 2573–78. Agriculture and Food Chemistry 49, no. 9 (2001): 4442– Scrutinizing Influential Relationships,” New England
20. H. C. Hung et al., “Fruit and Vegetable Intake and 31. A. Buitrago-Lopez et al., “Chocolate Consumption 49; M. Aviram and B. Fuhrman, “Wine Flavonoids Journal of Medicine 357 (2007): 1796–97; M. M. Chren,
Risk of Major Chronic Disease,” Journal of the National and Cardiometabolic Disorders: Systematic Review and Protect Against LDL Oxidation and Atherosclerosis,” “Interactions Between Physicians and Drug Company
Cancer Institute 96, no. 21 (2004): 1577–84. Meta-Analysis,” BMJ l 343 (2011): d4488. Annals of the New York Academy of Sciences 957 Representatives,” American Journal of Medicine 107, no.
21. Ibid. 32. S. Desch et al., “Effect of Cocoa Products on Blood (2002): 146–61. 2 (1999): 182–83.
22. F. J. He et al., “Increased Consumption of Fruit and Pressure: Systemic Review and Meta-Analysis,” 39. A. Lugasi et al., “Cardio-Protective Effect of Red 2. Marchioli et al, “Early Protection Against Sudden
Vegetables Is Related to a Reduced Risk of Coronary Abstract, American Journal of Hypertension 23, no. 1 Wine as Reflected in the Literature,” Abstract, Orvosi Death by n-3 Polyunsaturated Fatty Acids After
Heart Disease: Meta-Analysis of Cohort Studies,” (2010): 97–103. Hetilap 138, no. 11 (1997): 673–78; T.S. Saleem and S.D. Myocardial Infarction: Time-Course Analysis of the
Journal of Human Hypertension 21, no. 9 (2007): 33. B. Buijsse et al., “Cocoa Intake, Blood Pressure, and Basha, “Red Wine: A Drink to Your Heart,” Journal of Results of the Gruppo Italiano per lo Studio della
717–28. Cardiovascular Mortality,” Archives of Internal Medicine Cardiovascular Disease Research 1, no. 4 (2010): 171–76. Sopravvivenza nell’Infarto Miocardico (GISSI)-
23. F. J. He et al., “Fruit and Vegetable Consumption 166, no. 4 (2006): 411–17. 40. J. Sano, “Effects of Green Tea Intake on the Prevenzione,” New England Journal of Medicine 368
and Stroke: Meta-Analysis of Cohort Studies,” The 34. M. Aviram et al., “Pomegranate Juice Consumption Development of Coronary Artery Disease,” Circulation (2013): 1800–1808.
Lancet 367, no. 9507 (2006): 320–26. Reduces Oxidative Stress, Atherogenic Modifications to Journal 68, no. 7 (2004): 665–70. 3. G. Kolata, “10 Findings That Contradict Medical
24. H. C. Hung et al., “Fruit and Vegetable Intake and LDL, and Platelet Aggregation: Studies in Humans and 41. S. L. Duffy, “Short- and Long-Term Black Tea Wisdom. Doctors, Take Note,” New York Times July 1,
Risk of Major Chronic Disease,” Journal of the National in Atherosclerotic Apolipoprotein E–Deficient Mice,” Consumption Reverses Endothelial Dysfunction in 2019.
Cancer Institute 96, no. 21 (2004): 1577–84. American Journal of Clinical Nutrition 71, no. 5 (2000): Patients with Coronary Artery Disease,” Circulation 104 4. “NYHA Classification—The Stages of Heart Failure,”
25. D. Mozaffarian et al., “Changes in Diet and Lifestyle 1062–76; M. Aviram et al., “Pomegranate Juice (2001): 151–56. Heart Failure Society of America, last modified
and Long-Term Weight Gain in Men and Women,” New Flavonoids Inhibit Low-Density Lipoprotein Oxidation 42. Medscape, “Black Tea Shown to Improve Blood December 5, 2011, www.abouthf.org/questions_stages.
England Journal of Medicine 364, no. 25 (2011): and Cardiovascular Diseases: Studies in Atherosclerotic Vessel Health,” Medscape News, July 17, 2001, www. htm.
2392–404. Mice and in Humans,” Drugs Under Experimental and medscape.com/viewarticle/411324. 5. P. H. Langsjoen , S. Vadhanavikit, and K. Folkers,
26. M. Burros, “Eating Well; Pass the Nuts, Pass Up the Clinical Research 28, no. 2–3 (2002): 49–62. 43. A. Trichopoulou et al., “Mediterranean Diet and “Response of Patients in Classes III and IV of
Guilt,” New York Times, January 15, 2003. 35. M. Aviram et al., “Pomegranate Juice Consumption Survival Among Patients with Coronary Heart Disease Cardiomyopathy to Therapy in a Blind and Crossover
27. O. H. Franco et al., “The Polymeal: A More Natural, for 3 Years by Patients with Carotid Artery Stenosis in Greece,” Archives of Internal Medicine 165, no. 8 Trial with Coenzyme Q10,” Proceedings of the National
Safer, and Probably Tastier (than the Polypill) Strategy Reduces Common Carotid Intima-Media Thickness, (2005): 929–35. Academy of Sciences of the United States of America
to Reduce Cardiovascular Disease by More Than 75%,” Blood Pressure and LDL Oxidation,” Clinical Nutrition 44. A. Ferrera et al., “Olive Oil and Reduced Need for 82, no. 12 (1985): 4240–44.
BMJ 329, no. 7480 (2004): 1447. 23, no. 3 (2004): 423–33. Antihypertensive Medications,” Archives of Internal 6. P. H. Langsjoen et al., “A Six-Year Clinical Study of
28. D. M. Winham et al., “Pinto Bean Consumption 36. L. J. Ignarro et al., “Pomegranate Juice Protects Medicine 160, no. 6 (2000): 837–42. Therapy of Cardiomyopathy with Coenzyme Q10,”
Reduces Biomarkers for Heart Disease Risk,” Journal of Nitric Oxide Against Oxidative Destruction and 45. “Olive Oil Contains Natural Anti-Inflammatory International Journal of Tissue Reactions 12, no. 3
the American College of Nutrition 26, no. 3 (2007): Enhances the Biological Actions of Nitric Oxide,” Nitric Agent,” Science Daily, September 6, 2005, www.sci- (1990): 169–71.
243–49. Oxide 15, no. 2 (2006): 93–102. encedaily.com/releases/2005/09/050906075427.htm. 7. F. L. Rosenfeldt et al., “Coenzyme Q10 in the
29. E. K. Kabagambe et al., “Decreased Consumption of 37. D. K. Das et al., “Cardioprotection of Red Wine: Role 46. American Botanical Council, “Garlic,” Herbalgram, Treatment of Hypertension: A Meta-Analysis of the
Dried Mature Beans Is Positively Associated with of Polyphenolic Antioxidants,” Drugs Under http://cms.herbalgram.org/expandedE/Garlic.html. Clinical Trials,” Journal of Human Hypertension 21, no.
Urbanization and Nonfatal Acute Myocardial Infarction,” Experimental and Clinical Research 25, nos. 2–3 (1999): 4 (2007): 297–306.
Journal of Nutrition 135, no. 7 (2005): 1770–75. 115–20. 8. S. Hendler, PDR for Nutritional Supplements, 2nd ed.

Cells from Oxidized Low-Density Lipoprotein-Induced 30. Bazzano et al., “Legume Consumption and Risk of 38. V. Ivanov at al., “Red Wine Antioxidants Bind to HELP YOUR HEART WITH THESE
Apoptosis by Modulating the PI3K/Akt/eNOS Pathway,” Coronary Heart Disease in U.S. Men and Women,” Human Lipoproteins and Protect them from Metal Ion- SUPPLEMENTS
Toxicology and Applied Pharmacology 248, no. 2 Archives of Internal Medicine 161, no. 21 (2001): Dependent and Independent Oxidation,” Journal of 1. E. G. Campbell, “Doctors and Drug Companies—
(2010): 134–43. 2573–78. Agriculture and Food Chemistry 49, no. 9 (2001): 4442– Scrutinizing Influential Relationships,” New England
20. H. C. Hung et al., “Fruit and Vegetable Intake and 31. A. Buitrago-Lopez et al., “Chocolate Consumption 49; M. Aviram and B. Fuhrman, “Wine Flavonoids Journal of Medicine 357 (2007): 1796–97; M. M. Chren,
Risk of Major Chronic Disease,” Journal of the National and Cardiometabolic Disorders: Systematic Review and Protect Against LDL Oxidation and Atherosclerosis,” “Interactions Between Physicians and Drug Company
Cancer Institute 96, no. 21 (2004): 1577–84. Meta-Analysis,” BMJ l 343 (2011): d4488. Annals of the New York Academy of Sciences 957 Representatives,” American Journal of Medicine 107, no.
21. Ibid. 32. S. Desch et al., “Effect of Cocoa Products on Blood (2002): 146–61. 2 (1999): 182–83.
22. F. J. He et al., “Increased Consumption of Fruit and Pressure: Systemic Review and Meta-Analysis,” 39. A. Lugasi et al., “Cardio-Protective Effect of Red 2. Marchioli et al, “Early Protection Against Sudden
Vegetables Is Related to a Reduced Risk of Coronary Abstract, American Journal of Hypertension 23, no. 1 Wine as Reflected in the Literature,” Abstract, Orvosi Death by n-3 Polyunsaturated Fatty Acids After
Heart Disease: Meta-Analysis of Cohort Studies,” (2010): 97–103. Hetilap 138, no. 11 (1997): 673–78; T.S. Saleem and S.D. Myocardial Infarction: Time-Course Analysis of the
Journal of Human Hypertension 21, no. 9 (2007): 33. B. Buijsse et al., “Cocoa Intake, Blood Pressure, and Basha, “Red Wine: A Drink to Your Heart,” Journal of Results of the Gruppo Italiano per lo Studio della
717–28. Cardiovascular Mortality,” Archives of Internal Medicine Cardiovascular Disease Research 1, no. 4 (2010): 171–76. Sopravvivenza nell’Infarto Miocardico (GISSI)-
23. F. J. He et al., “Fruit and Vegetable Consumption 166, no. 4 (2006): 411–17. 40. J. Sano, “Effects of Green Tea Intake on the Prevenzione,” New England Journal of Medicine 368
and Stroke: Meta-Analysis of Cohort Studies,” The 34. M. Aviram et al., “Pomegranate Juice Consumption Development of Coronary Artery Disease,” Circulation (2013): 1800–1808.
Lancet 367, no. 9507 (2006): 320–26. Reduces Oxidative Stress, Atherogenic Modifications to Journal 68, no. 7 (2004): 665–70. 3. G. Kolata, “10 Findings That Contradict Medical
24. H. C. Hung et al., “Fruit and Vegetable Intake and LDL, and Platelet Aggregation: Studies in Humans and 41. S. L. Duffy, “Short- and Long-Term Black Tea Wisdom. Doctors, Take Note,” New York Times July 1,
Risk of Major Chronic Disease,” Journal of the National in Atherosclerotic Apolipoprotein E–Deficient Mice,” Consumption Reverses Endothelial Dysfunction in 2019.
Cancer Institute 96, no. 21 (2004): 1577–84. American Journal of Clinical Nutrition 71, no. 5 (2000): Patients with Coronary Artery Disease,” Circulation 104 4. “NYHA Classification—The Stages of Heart Failure,”
25. D. Mozaffarian et al., “Changes in Diet and Lifestyle 1062–76; M. Aviram et al., “Pomegranate Juice (2001): 151–56. Heart Failure Society of America, last modified
and Long-Term Weight Gain in Men and Women,” New Flavonoids Inhibit Low-Density Lipoprotein Oxidation 42. Medscape, “Black Tea Shown to Improve Blood December 5, 2011, www.abouthf.org/questions_stages.
England Journal of Medicine 364, no. 25 (2011): and Cardiovascular Diseases: Studies in Atherosclerotic Vessel Health,” Medscape News, July 17, 2001, www. htm.
2392–404. Mice and in Humans,” Drugs Under Experimental and medscape.com/viewarticle/411324. 5. P. H. Langsjoen , S. Vadhanavikit, and K. Folkers,
26. M. Burros, “Eating Well; Pass the Nuts, Pass Up the Clinical Research 28, no. 2–3 (2002): 49–62. 43. A. Trichopoulou et al., “Mediterranean Diet and “Response of Patients in Classes III and IV of
Guilt,” New York Times, January 15, 2003. 35. M. Aviram et al., “Pomegranate Juice Consumption Survival Among Patients with Coronary Heart Disease Cardiomyopathy to Therapy in a Blind and Crossover
27. O. H. Franco et al., “The Polymeal: A More Natural, for 3 Years by Patients with Carotid Artery Stenosis in Greece,” Archives of Internal Medicine 165, no. 8 Trial with Coenzyme Q10,” Proceedings of the National
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(Montvale, NJ: PDR Network, 2008), 152. Hypertension 10, no. 7 (2008): 3–11; L. Widman et al., 23. S. Hendler, PDR for Nutritional Supplements, 2nd Hyperlipoproteinaemia,” Journal of Internal Medicine
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Therapeutic Efficacy in Post-Infarction,” Drugs Under Through Administration of Magnesium: A Double-Blind 24. E. S. Ford and A. H. Mokdad, “Dietary Magnesium 29. Shepard et al., “Effects of Nicotinic Acid Therapy”;
Experimental and Clinical Research 18, no. 8 (1992): Placebo-Controlled Crossover Trial,” American Journal Intake in a National Sample of U.S. Adults,” Journal of Wahlberg et al., “Effects of Nicotinic Acid on Serum
355–65. of Hypertension 6, no. 1 (1993), 41–45. Nutrition 133, no. 9 (2003): 2879–82. Cholesterol.”
10. I. Rizos, “Three-Year Survival of Patients with Heart 18. P. Laurant and R. M. Touyz, “Physiological and 25. R. Altschul et al., “Influence of Nicotinic Acid on 30. A. Gaby, Nutritional Medicine (Concord, NH: Fritz
Failure Caused by Dilated Cardiomyopathy and Pathophysiological Role of Magnesium in the Serum Cholesterol in Man,” Archives of Biochemistry Perlberg Publishing, 2011).
L-Carnitine Administration,” American Heart Journal Cardiovascular System: Implications in Hypertension,” and Biophysics 54, no. 2 (1955): 558–59. 31. A. Hoffer, “On Niacin Hepatitis,” Journal of
139, no. 2 (2000): S120–23. Journal of Hypertension 18, no. 9 (2000): 1177–91. 26. R. H. Knopp et al., “Contrasting Effects of Orthomolecular Medicine 12 (1983): 90.
11. L. Cacciatore et al., “The Therapeutic Effect of 19. R. Meerwaldt et al., “The Clinical Relevance of Unmodified and Time-Release Forms of Niacin on 32. McKenney et al., “A Comparison of the Efficacy and
L-Carnitine in Patients with Exercise-Induced Stable Assessing Advanced Glycation Endproducts Lipoproteins in Hyperlipidemic Subjects: Clues to Toxic Effects of Sustained Vs. Immediate-Release
Angina: A Controlled Study,” Drugs Under Experimental Accumulation in Diabetes,” Cardiovascular Diabetology Mechanism of Action of Niacin,” Metabolism 34, no. 7 Niacin”; J.A. Etchason et al., “Niacin-Induced Hepatitis:
and Clinical Research 17, no. 4 (1991): 225–35; G. Louis 7, no. 29 (2008): 1–8; A. J. Smit, “Advanced Glycation (1985): 642–50; J. M. McKenney et al., “A Comparison A Potential Side Effect with Low-Dose Time-Release
Bartels et al., “Effects of L-Propionylcarnitine on Endproducts in Chronic Heart Failure,” Annals of the of the Efficacy and Toxic Effects of Sustained vs. Niacin,” Mayo Clinic Proceedings 66, no. 1 (1991): 23–28.
Ischemia-Induced Myocardial Dysfunction in Men with New York Academy of Sciences 1126 (2008): 225–30; J. Immediate-Release Niacin in Hypercholesterolemic 33. Gaby, Nutritional Medicine.
Angina Pectoris,” American Journal of Cardiology 74, W. L. Hartog et al., “Advanced Glycation End-Products Patients,” Journal of the American Medical Association 34. E. Serbinova et al., “Free Radical Recycling and
no. 2 (1994): 125–30. (AGEs) and Heart Failure: Pathophysiology and Clinical 271, no. 9 (1994): 672–77. Intramembrane Mobility in the Antioxidant Properties
12. L. A. Calò et al., “Antioxidant Effect of L-Carnitine Implications,” European Journal of Heart Failure 9, no. 27. P. R. Kamstrup, “Genetically Elevated Lipoprotein(a) of Alpha-Tocopherol and Alpha-Tocotrienol,” Free
and Its Short Chain Esters: Relevance for the 12 (2007): 1146–55. and Increased Risk of Myocardial Infarction,” Journal of Radical Biology & Medicine 10, no. 5 (1991): 263–75.
Protection from Oxidative Stress Related 20. A. Sjögren et al., “Oral Administration of the American Medical Association 301, no. 22 (2009): 35. R. A. Parker et al., “Tocotrienols Regulate
Cardiovascular Damage,” International Journal of Magnesium Hydroxide to Subjects with Insulin- 2331–39; M. Sandkamp et al., “Lipoprotein(a) Is an Cholesterol Production in Mammalian Cells by Post-
Cardiology 107, no. 1 (2006): 54–60. Dependent Diabetes Mellitus: Effects on Magnesium Independent Risk Factor for Myocardial Infarction at a Transcriptional Suppression of 3-Hydroxy-3-
13. M. J. Bolland et al., “Effects of Calcium Supplements and Potassium Levels and on Insulin Requirements,” Young Age,” Clinical Chemistry 36, no. 1 (1990): 20–23; Methylglutaryl-Coenzyme A reductase,” Journal of
on Risk of Myocardial Infarction and Cardiovascular Magnesium 7, no. 3 (1988): 117–22; L. M. de Lordes et al., A. Gurakar et al., “Levels of Lipoprotein Lp(a) Decline Biological Chemistry 268 (1993): 11230–38; B.C. Pearce
Events: Meta-Analysis,” BMJ 341, no. c3691 (2010). “The Effect of Magnesium Supplementation in with Neomycin and Niacin Treatment,” Atherosclerosis et al., “Hypocholesterolemic Activity of Synthetic and
14. P. Raggi et al., “Progression of Coronary Artery Increasing Doses on the Control of Type 2 Diabetes,” 57, nos. 2–3 (1985): 293–301; L. A. Carlson et al., Natural Tocotrienols,” Journal of Medicinal Chemistry
Calcium and Risk of First Myocardial Infarction in Diabetes Care 21, no. 5 (1998): 682–86; G. Paolisso et “Pronounced Lowering of Serum Levels of Lipoprotein 35, no. 20 (1992): 3595–606; B.C. Pearce et al.,
Patients Receiving Cholesterol-Lowering Therapy,” al., “Dietary Magnesium Supplements Improve B-Cell Lp(a) in Hyperlipidaemic Subjects Treated with Nicotinic “Inhibitors of Cholesterol Biosynthesis. 2.
Arteriosclerosis, Thrombosis, and Vascular Biology 24, Response to Glucose and Arginine in Elderly Non- Acid,” Journal of Internal Medicine 226, no. 4 (1989): Hypocholesterolemic and Antioxidant Activities of
no. 7 (2004): 1272–77. Insulin Dependent Diabetic Subjects,” Acta 271–76. Benzopyran and Tetrahydronaphthalene Analogues of
15. Ibid. Endocrinologica 121, no. 1 (1989): 16–20. 28. J. Shepard et al., “Effects of Nicotinic Acid Therapy the tocotrienols,” Journal of Medicinal Chemistry 37,
16. U. Hoffmann et al., “Use of New Imaging Techniques 21. F. Guerrero-Romero and M. Rodríguez-Morán, “Low on Plasma High-Density Lipoprotein Subfraction no. 4 (1994): 526–41.
to Screen for Coronary Artery Disease,” Circulation 108 Serum Magnesium Levels and Metabolic Syndrome,” Distribution and Composition and on Apolipoprotein A 36. S. G. Yu et al., “Dose-Response Impact of Various
(2003): e50–e53. Acta Diabetologica 39, no. 4 (2002): 209–13. Metabolism,” Journal of Clinical Investigation 63, no. 5 Tocotrienols on Serum Lipid Parameters in Five-Week-
17. M. C. Houston and K. J. Harper, “Potassium, 22. “Magnesium, What Is It?” Office of Dietary (1979): 858–67; G. Wahlberg et al., “Effects of Nicotinic Old Female Chickens,” Lipids 41, no. 5 (2006): 453–61;
Magnesium, and Calcium: Their Role in Both the Cause Supplements, National Institutes of Health, http://ods. Acid on Serum Cholesterol Concentrations of High M. Minhajuddin et al., “Hypolipidemic and Antioxidant
and Treatment of Hypertension,” Journal of Clinical od.nih.gov/factsheets/magnesium-HealthProfessional. Density Lipoprotein Subfractions HDL2 and HDL3 in Properties of Tocotrienol-Rich Fraction Isolated from

(Montvale, NJ: PDR Network, 2008), 152. Hypertension 10, no. 7 (2008): 3–11; L. Widman et al., 23. S. Hendler, PDR for Nutritional Supplements, 2nd Hyperlipoproteinaemia,” Journal of Internal Medicine
9. P. Davini et al., “Controlled Study on L-Carnitine “The Dose-Dependent Reduction in Blood Pressure ed. (Montvale, NJ: PDR Network, 2008), 152. 228, no. 2 (1990): 151–57.
Therapeutic Efficacy in Post-Infarction,” Drugs Under Through Administration of Magnesium: A Double-Blind 24. E. S. Ford and A. H. Mokdad, “Dietary Magnesium 29. Shepard et al., “Effects of Nicotinic Acid Therapy”;
Experimental and Clinical Research 18, no. 8 (1992): Placebo-Controlled Crossover Trial,” American Journal Intake in a National Sample of U.S. Adults,” Journal of Wahlberg et al., “Effects of Nicotinic Acid on Serum
355–65. of Hypertension 6, no. 1 (1993), 41–45. Nutrition 133, no. 9 (2003): 2879–82. Cholesterol.”
10. I. Rizos, “Three-Year Survival of Patients with Heart 18. P. Laurant and R. M. Touyz, “Physiological and 25. R. Altschul et al., “Influence of Nicotinic Acid on 30. A. Gaby, Nutritional Medicine (Concord, NH: Fritz
Failure Caused by Dilated Cardiomyopathy and Pathophysiological Role of Magnesium in the Serum Cholesterol in Man,” Archives of Biochemistry Perlberg Publishing, 2011).
L-Carnitine Administration,” American Heart Journal Cardiovascular System: Implications in Hypertension,” and Biophysics 54, no. 2 (1955): 558–59. 31. A. Hoffer, “On Niacin Hepatitis,” Journal of
139, no. 2 (2000): S120–23. Journal of Hypertension 18, no. 9 (2000): 1177–91. 26. R. H. Knopp et al., “Contrasting Effects of Orthomolecular Medicine 12 (1983): 90.
11. L. Cacciatore et al., “The Therapeutic Effect of 19. R. Meerwaldt et al., “The Clinical Relevance of Unmodified and Time-Release Forms of Niacin on 32. McKenney et al., “A Comparison of the Efficacy and
L-Carnitine in Patients with Exercise-Induced Stable Assessing Advanced Glycation Endproducts Lipoproteins in Hyperlipidemic Subjects: Clues to Toxic Effects of Sustained Vs. Immediate-Release
Angina: A Controlled Study,” Drugs Under Experimental Accumulation in Diabetes,” Cardiovascular Diabetology Mechanism of Action of Niacin,” Metabolism 34, no. 7 Niacin”; J.A. Etchason et al., “Niacin-Induced Hepatitis:
and Clinical Research 17, no. 4 (1991): 225–35; G. Louis 7, no. 29 (2008): 1–8; A. J. Smit, “Advanced Glycation (1985): 642–50; J. M. McKenney et al., “A Comparison A Potential Side Effect with Low-Dose Time-Release
Bartels et al., “Effects of L-Propionylcarnitine on Endproducts in Chronic Heart Failure,” Annals of the of the Efficacy and Toxic Effects of Sustained vs. Niacin,” Mayo Clinic Proceedings 66, no. 1 (1991): 23–28.
Ischemia-Induced Myocardial Dysfunction in Men with New York Academy of Sciences 1126 (2008): 225–30; J. Immediate-Release Niacin in Hypercholesterolemic 33. Gaby, Nutritional Medicine.
Angina Pectoris,” American Journal of Cardiology 74, W. L. Hartog et al., “Advanced Glycation End-Products Patients,” Journal of the American Medical Association 34. E. Serbinova et al., “Free Radical Recycling and
no. 2 (1994): 125–30. (AGEs) and Heart Failure: Pathophysiology and Clinical 271, no. 9 (1994): 672–77. Intramembrane Mobility in the Antioxidant Properties
12. L. A. Calò et al., “Antioxidant Effect of L-Carnitine Implications,” European Journal of Heart Failure 9, no. 27. P. R. Kamstrup, “Genetically Elevated Lipoprotein(a) of Alpha-Tocopherol and Alpha-Tocotrienol,” Free
and Its Short Chain Esters: Relevance for the 12 (2007): 1146–55. and Increased Risk of Myocardial Infarction,” Journal of Radical Biology & Medicine 10, no. 5 (1991): 263–75.
Protection from Oxidative Stress Related 20. A. Sjögren et al., “Oral Administration of the American Medical Association 301, no. 22 (2009): 35. R. A. Parker et al., “Tocotrienols Regulate
Cardiovascular Damage,” International Journal of Magnesium Hydroxide to Subjects with Insulin- 2331–39; M. Sandkamp et al., “Lipoprotein(a) Is an Cholesterol Production in Mammalian Cells by Post-
Cardiology 107, no. 1 (2006): 54–60. Dependent Diabetes Mellitus: Effects on Magnesium Independent Risk Factor for Myocardial Infarction at a Transcriptional Suppression of 3-Hydroxy-3-
13. M. J. Bolland et al., “Effects of Calcium Supplements and Potassium Levels and on Insulin Requirements,” Young Age,” Clinical Chemistry 36, no. 1 (1990): 20–23; Methylglutaryl-Coenzyme A reductase,” Journal of
on Risk of Myocardial Infarction and Cardiovascular Magnesium 7, no. 3 (1988): 117–22; L. M. de Lordes et al., A. Gurakar et al., “Levels of Lipoprotein Lp(a) Decline Biological Chemistry 268 (1993): 11230–38; B.C. Pearce
Events: Meta-Analysis,” BMJ 341, no. c3691 (2010). “The Effect of Magnesium Supplementation in with Neomycin and Niacin Treatment,” Atherosclerosis et al., “Hypocholesterolemic Activity of Synthetic and
14. P. Raggi et al., “Progression of Coronary Artery Increasing Doses on the Control of Type 2 Diabetes,” 57, nos. 2–3 (1985): 293–301; L. A. Carlson et al., Natural Tocotrienols,” Journal of Medicinal Chemistry
Calcium and Risk of First Myocardial Infarction in Diabetes Care 21, no. 5 (1998): 682–86; G. Paolisso et “Pronounced Lowering of Serum Levels of Lipoprotein 35, no. 20 (1992): 3595–606; B.C. Pearce et al.,
Patients Receiving Cholesterol-Lowering Therapy,” al., “Dietary Magnesium Supplements Improve B-Cell Lp(a) in Hyperlipidaemic Subjects Treated with Nicotinic “Inhibitors of Cholesterol Biosynthesis. 2.
Arteriosclerosis, Thrombosis, and Vascular Biology 24, Response to Glucose and Arginine in Elderly Non- Acid,” Journal of Internal Medicine 226, no. 4 (1989): Hypocholesterolemic and Antioxidant Activities of
no. 7 (2004): 1272–77. Insulin Dependent Diabetic Subjects,” Acta 271–76. Benzopyran and Tetrahydronaphthalene Analogues of
15. Ibid. Endocrinologica 121, no. 1 (1989): 16–20. 28. J. Shepard et al., “Effects of Nicotinic Acid Therapy the tocotrienols,” Journal of Medicinal Chemistry 37,
16. U. Hoffmann et al., “Use of New Imaging Techniques 21. F. Guerrero-Romero and M. Rodríguez-Morán, “Low on Plasma High-Density Lipoprotein Subfraction no. 4 (1994): 526–41.
to Screen for Coronary Artery Disease,” Circulation 108 Serum Magnesium Levels and Metabolic Syndrome,” Distribution and Composition and on Apolipoprotein A 36. S. G. Yu et al., “Dose-Response Impact of Various
(2003): e50–e53. Acta Diabetologica 39, no. 4 (2002): 209–13. Metabolism,” Journal of Clinical Investigation 63, no. 5 Tocotrienols on Serum Lipid Parameters in Five-Week-
17. M. C. Houston and K. J. Harper, “Potassium, 22. “Magnesium, What Is It?” Office of Dietary (1979): 858–67; G. Wahlberg et al., “Effects of Nicotinic Old Female Chickens,” Lipids 41, no. 5 (2006): 453–61;
Magnesium, and Calcium: Their Role in Both the Cause Supplements, National Institutes of Health, http://ods. Acid on Serum Cholesterol Concentrations of High M. Minhajuddin et al., “Hypolipidemic and Antioxidant
and Treatment of Hypertension,” Journal of Clinical od.nih.gov/factsheets/magnesium-HealthProfessional. Density Lipoprotein Subfractions HDL2 and HDL3 in Properties of Tocotrienol-Rich Fraction Isolated from

Rice Bran Oil in Experimentally Induced Hyperlipidemic (1977): 52–55; H.O. Bang, et al., “The Composition of Intervention Study (JELIS)” presentation, American and Children,” International Journal of Clinical
Rats,” Food and Chemical Toxicology 43, no. 5 (2005): Food Consumed by Greenland Eskimos,” Acta Medica Heart Association Scientific Sessions, Dallas, Texas, Pharmacology and Therapeutics 24, no. 11 (1986): 630–
747–53; J. Iqbal et al., “Suppression of 7,12-Dimethyl- Scandinavica 200, nos. 1–2 (1976): 69–73; H.O. Bang and November 13–16, 2005; Medscape, “JELIS—Japan 37; C. Donati et al., “Pantethine Improves the Lipid
Benz[alpha]anthracene-Induced Carcinogenesis and J. Dyerberg, “Plasma Lipids and Lipoproteins in Eicosapentaenoic Acid (EPA) Lipid Intervention Study,” Abnormalities of Chronic Hemodialysis Patients: Results
Hypercholesterolaemia in Rats by Tocotrienol-Rich Greenlandic West Coast Eskimos,” Acta Medica Medscape Education, www.medscape.org/ of a Multicenter Clinical Trial,” Clinical Nephrology 25,
Fraction Isolated from Rice Bran Oil,” European Journal Scandinavica 192, nos. 1–2 (1972): 85–94; H.O. Bang et viewarticle/518574. no. 2 (1986): 70–74; L. Arsenio et al., “Effectiveness of
of Cancer Prevention 12, no. 6 (2003): 447–53; A. A. al., “Plasma Lipid and Lipoprotein Pattern in 46. G. Bon et al., “Effects of Pantethine on In Vitro Long-Term Treatment with Pantethine in Patients with
Qureshi et al., “Novel Tocotrienols of Rice Bran Greenlandic West Coast Eskimos,” The Lancet 1, no. Peroxidation of Low-Density Lipoproteins,” Dyslipidemia,” Clinical Therapeutics 8, no. 5 (1986):
Suppress Cholesterogenesis in Hereditary 7710 (1971): 1143–45; J. Dyerberg et al., “Fatty Acid Atherosclerosis 57, no. 1 (1985): 99–106. 537–45; S. Giannini et al., “Efeitos da Pantetina
Hypercholesterolemic Swine,” Journal of Nutrition 131, Composition of the Plasma Lipids in Greenland 47. A. C. Junior et al., “Antigenotoxic and Sobrelipides Sangineos,” Arquivos Brasileiros de
no. 2 (2001): 223–30; M. K. Teoh et al., “Protection by Eskimos,” American Journal of Clinical Nutrition 28, no. Antimutagenic Potential of an Annatto Pigment Cardiologia 46, no. 4 (1986): 283–89; F. Bergesio et al.,
Tocotrienols against Hypercholesterolaemia and 9 (1975): 958–66. (Norbixin) Against Oxidative Stress,” Genetics and “Impiego della Pantetina nella Dislipidemia dell’Uremico
Atheroma,” Medical Journal of Malaysia 49, no. 3 39. D. Mozzafarian and J. H. Wu, “Omega-3 Fatty Acids Molecular Research 4, no. 1 (2005): 94–99; G. Kelly, Cronico in Trattamento Dialitico,” Journal of Clinical
(1994): 255–62; A. A. Qureshi et al., “Dietary and Cardiovascular Disease: Effects on Risk Factors, “Pantethine: A Review of its Biochemistry and Medicine and Research 66, nos. 11–12 (1985): 433–40; G.
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of LDL Oxidation Following Alpha-, Gamma-, or Delta- and Vitamin E after Myocardial Infarction: Results of “Evaluation of the Hypocholesterolemic Activity of Pantethine and Fenofibrate: An Open Randomized
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Rice Bran Oil in Experimentally Induced Hyperlipidemic (1977): 52–55; H.O. Bang, et al., “The Composition of Intervention Study (JELIS)” presentation, American and Children,” International Journal of Clinical
Rats,” Food and Chemical Toxicology 43, no. 5 (2005): Food Consumed by Greenland Eskimos,” Acta Medica Heart Association Scientific Sessions, Dallas, Texas, Pharmacology and Therapeutics 24, no. 11 (1986): 630–
747–53; J. Iqbal et al., “Suppression of 7,12-Dimethyl- Scandinavica 200, nos. 1–2 (1976): 69–73; H.O. Bang and November 13–16, 2005; Medscape, “JELIS—Japan 37; C. Donati et al., “Pantethine Improves the Lipid
Benz[alpha]anthracene-Induced Carcinogenesis and J. Dyerberg, “Plasma Lipids and Lipoproteins in Eicosapentaenoic Acid (EPA) Lipid Intervention Study,” Abnormalities of Chronic Hemodialysis Patients: Results
Hypercholesterolaemia in Rats by Tocotrienol-Rich Greenlandic West Coast Eskimos,” Acta Medica Medscape Education, www.medscape.org/ of a Multicenter Clinical Trial,” Clinical Nephrology 25,
Fraction Isolated from Rice Bran Oil,” European Journal Scandinavica 192, nos. 1–2 (1972): 85–94; H.O. Bang et viewarticle/518574. no. 2 (1986): 70–74; L. Arsenio et al., “Effectiveness of
of Cancer Prevention 12, no. 6 (2003): 447–53; A. A. al., “Plasma Lipid and Lipoprotein Pattern in 46. G. Bon et al., “Effects of Pantethine on In Vitro Long-Term Treatment with Pantethine in Patients with
Qureshi et al., “Novel Tocotrienols of Rice Bran Greenlandic West Coast Eskimos,” The Lancet 1, no. Peroxidation of Low-Density Lipoproteins,” Dyslipidemia,” Clinical Therapeutics 8, no. 5 (1986):
Suppress Cholesterogenesis in Hereditary 7710 (1971): 1143–45; J. Dyerberg et al., “Fatty Acid Atherosclerosis 57, no. 1 (1985): 99–106. 537–45; S. Giannini et al., “Efeitos da Pantetina
Hypercholesterolemic Swine,” Journal of Nutrition 131, Composition of the Plasma Lipids in Greenland 47. A. C. Junior et al., “Antigenotoxic and Sobrelipides Sangineos,” Arquivos Brasileiros de
no. 2 (2001): 223–30; M. K. Teoh et al., “Protection by Eskimos,” American Journal of Clinical Nutrition 28, no. Antimutagenic Potential of an Annatto Pigment Cardiologia 46, no. 4 (1986): 283–89; F. Bergesio et al.,
Tocotrienols against Hypercholesterolaemia and 9 (1975): 958–66. (Norbixin) Against Oxidative Stress,” Genetics and “Impiego della Pantetina nella Dislipidemia dell’Uremico
Atheroma,” Medical Journal of Malaysia 49, no. 3 39. D. Mozzafarian and J. H. Wu, “Omega-3 Fatty Acids Molecular Research 4, no. 1 (2005): 94–99; G. Kelly, Cronico in Trattamento Dialitico,” Journal of Clinical
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Current Therapeutic Research 36 (1984): 314–21; A. Hepatic Lipid Accumulation in KK-Ay Mice with Genetic Vascular Biology 23, no. 4 (2003): 622–29. “Robert Ader, Founder of Psychoneuroimmunology,
Gaddi et al., “Controlled Evaluation of Pantethine, a Type 2 Diabetes,” Lipids Health and Disease 21, no. 10 62. W. Ross et al., “The Use of Bergamot-Derived Dies,” University of Rochester Medical Center.
Natural Hypolipidemic Compound, in Patients with (2011): 120. Polyphenol Fraction in Cardiometabolic Risk Prevention December 12, 2011. Retrieved December 20, 2011.
Different Forms of Hyperlipoproteinemia,” 53. A. Bolsoni-Lopes et al., “Palmitoleic Acid (N-7) and its Possible Mechanisms of Action,” Polyphenols in 2. M. Irwin and K. Vedhara, Human
Atherosclerosis 50, no. 1 (1984): 73–83; R. Miccoli et al., Increases White Adipocyte Lipolysis and Lipase Content Human Health and Disease 2 (2013): 1087–1105; V. Psychoneuroimmunology (Oxford University Press,
“Effects of Pantethine on Lipids and Apolipoproteins in in a PPARα-Dependent Manner,” American Journal of Mollace et al., “Hypolipemic and Hypoglycaemic 2005); S. Segerstrom, The Oxford handbook of psycho-
Hypercholesterolemic Diabetic and Non-Diabetic Physiology, Endocrinology, and Metabolism 305, no. 9 Activity of Bergamot Polyphenols: From Animal Models neuroimmunology (Oxford University Press, 2012).
Patients,” Current Therapeutic Research 36 (1984): (2013): E1093-102. to Human Studies,” Fitoterapia 82, no. 3 (2011): 309–16. 3. J. Bowden, The Most Effective Natural Cures on Earth
545–49; M. Maioli et al., “Effect of Pantethine on the 54. Queiroz JC, Alonso-Vale MI, Curi R, et al. Control of 63. W. Chang et al., “Berberine as a Therapy for Type 2 (Beverly, MA: Fair Winds Press, 2008).
Subfractions of HDL in Dyslipidemic Patients,” Current adipogenesis by fatty acids. Arquivos Brasileiros de Diabetes and Its Complications: From Mechanism of 4. J. W. Pennebaker, Opening Up: The Healing Power of
Therapeutic Research 35 (1984): 307–11; G. Ranieri et al., Endocrinologia & Metabologia 53, no. 5 (2009): 582–94. Action to Clinical Studies,” Biochemistry and Cell Expressing Emotions (New York: Guilford Press, 1997);
“Effect of Pantethine on Lipids and Lipoproteins in 55. A.M. Bernstein et al., “Purified Palmitoleic Acid for Biology 93, no. 5 (2015): 479–86; J. Yin et al., “Efficacy J. Frattaroli, “Experimental Disclosure and Its
Man,” Acta Therapeutica 10 (1984): 219–27; A. Murai et the Reduction of High-Sensitivity C-Reactive Protein of Berberine in Patients with Type 2 Diabetes Mellitus,” Moderators: A Meta-Analysis,” Psychological Bulletin
al., “The Effects of Pantethine on Lipid and Lipoprotein and Serum Lipids: A Double-Blinded, Randomized, Metabolism 7, no. 5 (2008): 712–17; L. Zheng et al., 132, no. 6 (2006): 823–65.
Abnormalities in Survivors of Cerebral Infarction,” Placebo Controlled Study,” Journal of Clinical “Antioxidant and Anti-Inflammatory Activities of 5. R. McCraty, “New Frontiers in Heart Rate Variability
Artery 12, no. 4 (1983): 234–43; P. Avogaro et al., Lipidology 8, no. 6 (2014): 612–7. Berberine in the Treatment of Diabetes Mellitus,” and Social Coherence Research: Techniques,
“Effect of Pantethine on Lipids, Lipoproteins and 56. R. Pfister et al., “Plasma Vitamin C Predicts Hindawi 2014: https://doi.org/10.1155/2014/289264; T. Technologies, and Implications for Improving Group
Apolipoproteins in Man,” Current Therapeutic Research Incident Heart Failure in Men and Women in European Lou et al., “Berberine Inhibits Inflammatory Response Dynamics and Outcomes,” Frontiers in Public Health 5
33 (1983): 488–93; G. Maggi et al., “Pantethine: A Prospective Investigation into Cancer and Nutrition— and Ameliorates Insulin Resistance in Hepatocytes,” (2017): doi: 10.3389/fpubh.2017.00267.
Physiological Lipomodulating Agent in the Treatment of Norfolk Prospective Study,” American Heart Journal Inflammation 34, no. 6 (2011): 659–67. 6. Ibid.
Hyperlipidemia,” Current Therapeutic Research 32 162, no. 2 (2011): 246–53. 64. H. Sumi et al., “Enhancement of the Fibrinolytic 7. HeartMath, “The Science of HeartMath,” https://www.
(1982): 380–86; K. Hiramatsu et al., “Influence of 57. W. Wongcharoen and A. Phrommintikul, “The Activity in Plasa by Oral Administration of Nattokinase,” heartmath.com/science
Pantethine on Platelet Volume, Microviscosity, Lipid Protective Role of Curcumin in Cardiovascular Acta Haematologica 84, no. 3 (1990): 139–43.
Composition and Functions in Diabetes Mellitus with Diseases,” International Journal of Cardiology 133, no. 2 65. “Study Shows Chocolate Reduces Blood Pressure APPENDIX A
Hyperlipidemia,” Tokai Journal of Experimental and (2009): 145–51. and Risk of Heart Disease,” European Society of 1. S. Jeffrey, “ALLHAT Lipid-Lowering Trial Shows No
Clinical Medicine 6, no. 1 (1981): 49–57. 58. M. Houston, What Your Doctor May Not Tell You Cardiology, March 31, 2010, www.escardio.org/about/ Benefit from Pravastatin,” Heartwire, December 17,
48. M. Houston et al., “Nonpharmocologic Treatment of About Heart Disease (New York: Grand Central Life & press/press-releases/pr-10/Pages/chocolate-reduces- 2002, www.theheart.org/article/263333.do.
Dyslipidemia,” Progress in Cardiovascular Disease 52, Style, 2012). blood-pressure.aspx. 2. Sever, PS et al., “Reduction in cardiovascular events
no. 2 (2009): 61–94. 59. G. Ramaswami, “Curcumin Blocks Homocysteine- 66. M. Houston et al., “Nonpharmologic Treatment for with atorvastatin in 2,532 patients with type 2 diabetes:
49. A. Mozes, “Glucosamine Joint Pain Supplement Induced Endothelial Dysfunction in Porcine Coronary Dyslipideia,” Progress in Cardiovascular Disease 52, no. Anglo-Scandinavian Cardiac Outcomes Trial--lipid-
Could Help the Heart,” HealthDay May 15, 2019. Arteries,” Journal of Vascular Surgery 40, no. 6 (2004): 2 (2009), 61–94. lowering arm (ASCOT-LLA),” Diabetes Care, 2005
50. Ibid. 1216–22. May;28(5):1151-7. https://www.ncbi.nlm.nih.gov/
51. H. Ma et al., “Association of Habitual Glucosamine 60. Houston, What Your Doctor May Not Tell You. THE SCIENCE OF HEALTHY LIVING: pubmed/15855581
Use with Risk of Cardiovascular Disease: Prospective 61. M. A. Carluccio et al., “Olive Oil and Red Wine EAT, LAUGH, PLAY, LOVE. 3. Uffe Ravnskov, “ASCOT-LLA: questions about the
Study in UK Biobank” BMJ 365(2019):l1628. Antioxidant Polyphenols Inhibit Endothelial Activation: 1. R Ader and N Cohen. Behaviorally conditioned immu- benefits of atorvastatin,” The Lancet, Vol 361, issue
52. Z.H. Yang et al., “Chronic Administration of Antiatherogenic Properties of Mediterranean Diet nosuppression. Psychosomatic Medicine, Vol 37, Issue 4 9373, P 1986, 6/7/03. https://www.thelancet.com/jour-
Palmitoleic Acid Reduces Insulin Resistance and Phytochemicals,” Atherosclerosis, Thrombosis, and 333-340 nals/lancet/article/PIIS0140-6736(03)13559-3/fulltext

Current Therapeutic Research 36 (1984): 314–21; A. Hepatic Lipid Accumulation in KK-Ay Mice with Genetic Vascular Biology 23, no. 4 (2003): 622–29. “Robert Ader, Founder of Psychoneuroimmunology,
Gaddi et al., “Controlled Evaluation of Pantethine, a Type 2 Diabetes,” Lipids Health and Disease 21, no. 10 62. W. Ross et al., “The Use of Bergamot-Derived Dies,” University of Rochester Medical Center.
Natural Hypolipidemic Compound, in Patients with (2011): 120. Polyphenol Fraction in Cardiometabolic Risk Prevention December 12, 2011. Retrieved December 20, 2011.
Different Forms of Hyperlipoproteinemia,” 53. A. Bolsoni-Lopes et al., “Palmitoleic Acid (N-7) and its Possible Mechanisms of Action,” Polyphenols in 2. M. Irwin and K. Vedhara, Human
Atherosclerosis 50, no. 1 (1984): 73–83; R. Miccoli et al., Increases White Adipocyte Lipolysis and Lipase Content Human Health and Disease 2 (2013): 1087–1105; V. Psychoneuroimmunology (Oxford University Press,
“Effects of Pantethine on Lipids and Apolipoproteins in in a PPARα-Dependent Manner,” American Journal of Mollace et al., “Hypolipemic and Hypoglycaemic 2005); S. Segerstrom, The Oxford handbook of psycho-
Hypercholesterolemic Diabetic and Non-Diabetic Physiology, Endocrinology, and Metabolism 305, no. 9 Activity of Bergamot Polyphenols: From Animal Models neuroimmunology (Oxford University Press, 2012).
Patients,” Current Therapeutic Research 36 (1984): (2013): E1093-102. to Human Studies,” Fitoterapia 82, no. 3 (2011): 309–16. 3. J. Bowden, The Most Effective Natural Cures on Earth
545–49; M. Maioli et al., “Effect of Pantethine on the 54. Queiroz JC, Alonso-Vale MI, Curi R, et al. Control of 63. W. Chang et al., “Berberine as a Therapy for Type 2 (Beverly, MA: Fair Winds Press, 2008).
Subfractions of HDL in Dyslipidemic Patients,” Current adipogenesis by fatty acids. Arquivos Brasileiros de Diabetes and Its Complications: From Mechanism of 4. J. W. Pennebaker, Opening Up: The Healing Power of
Therapeutic Research 35 (1984): 307–11; G. Ranieri et al., Endocrinologia & Metabologia 53, no. 5 (2009): 582–94. Action to Clinical Studies,” Biochemistry and Cell Expressing Emotions (New York: Guilford Press, 1997);
“Effect of Pantethine on Lipids and Lipoproteins in 55. A.M. Bernstein et al., “Purified Palmitoleic Acid for Biology 93, no. 5 (2015): 479–86; J. Yin et al., “Efficacy J. Frattaroli, “Experimental Disclosure and Its
Man,” Acta Therapeutica 10 (1984): 219–27; A. Murai et the Reduction of High-Sensitivity C-Reactive Protein of Berberine in Patients with Type 2 Diabetes Mellitus,” Moderators: A Meta-Analysis,” Psychological Bulletin
al., “The Effects of Pantethine on Lipid and Lipoprotein and Serum Lipids: A Double-Blinded, Randomized, Metabolism 7, no. 5 (2008): 712–17; L. Zheng et al., 132, no. 6 (2006): 823–65.
Abnormalities in Survivors of Cerebral Infarction,” Placebo Controlled Study,” Journal of Clinical “Antioxidant and Anti-Inflammatory Activities of 5. R. McCraty, “New Frontiers in Heart Rate Variability
Artery 12, no. 4 (1983): 234–43; P. Avogaro et al., Lipidology 8, no. 6 (2014): 612–7. Berberine in the Treatment of Diabetes Mellitus,” and Social Coherence Research: Techniques,
“Effect of Pantethine on Lipids, Lipoproteins and 56. R. Pfister et al., “Plasma Vitamin C Predicts Hindawi 2014: https://doi.org/10.1155/2014/289264; T. Technologies, and Implications for Improving Group
Apolipoproteins in Man,” Current Therapeutic Research Incident Heart Failure in Men and Women in European Lou et al., “Berberine Inhibits Inflammatory Response Dynamics and Outcomes,” Frontiers in Public Health 5
33 (1983): 488–93; G. Maggi et al., “Pantethine: A Prospective Investigation into Cancer and Nutrition— and Ameliorates Insulin Resistance in Hepatocytes,” (2017): doi: 10.3389/fpubh.2017.00267.
Physiological Lipomodulating Agent in the Treatment of Norfolk Prospective Study,” American Heart Journal Inflammation 34, no. 6 (2011): 659–67. 6. Ibid.
Hyperlipidemia,” Current Therapeutic Research 32 162, no. 2 (2011): 246–53. 64. H. Sumi et al., “Enhancement of the Fibrinolytic 7. HeartMath, “The Science of HeartMath,” https://www.
(1982): 380–86; K. Hiramatsu et al., “Influence of 57. W. Wongcharoen and A. Phrommintikul, “The Activity in Plasa by Oral Administration of Nattokinase,” heartmath.com/science
Pantethine on Platelet Volume, Microviscosity, Lipid Protective Role of Curcumin in Cardiovascular Acta Haematologica 84, no. 3 (1990): 139–43.
Composition and Functions in Diabetes Mellitus with Diseases,” International Journal of Cardiology 133, no. 2 65. “Study Shows Chocolate Reduces Blood Pressure APPENDIX A
Hyperlipidemia,” Tokai Journal of Experimental and (2009): 145–51. and Risk of Heart Disease,” European Society of 1. S. Jeffrey, “ALLHAT Lipid-Lowering Trial Shows No
Clinical Medicine 6, no. 1 (1981): 49–57. 58. M. Houston, What Your Doctor May Not Tell You Cardiology, March 31, 2010, www.escardio.org/about/ Benefit from Pravastatin,” Heartwire, December 17,
48. M. Houston et al., “Nonpharmocologic Treatment of About Heart Disease (New York: Grand Central Life & press/press-releases/pr-10/Pages/chocolate-reduces- 2002, www.theheart.org/article/263333.do.
Dyslipidemia,” Progress in Cardiovascular Disease 52, Style, 2012). blood-pressure.aspx. 2. Sever, PS et al., “Reduction in cardiovascular events
no. 2 (2009): 61–94. 59. G. Ramaswami, “Curcumin Blocks Homocysteine- 66. M. Houston et al., “Nonpharmologic Treatment for with atorvastatin in 2,532 patients with type 2 diabetes:
49. A. Mozes, “Glucosamine Joint Pain Supplement Induced Endothelial Dysfunction in Porcine Coronary Dyslipideia,” Progress in Cardiovascular Disease 52, no. Anglo-Scandinavian Cardiac Outcomes Trial--lipid-
Could Help the Heart,” HealthDay May 15, 2019. Arteries,” Journal of Vascular Surgery 40, no. 6 (2004): 2 (2009), 61–94. lowering arm (ASCOT-LLA),” Diabetes Care, 2005
50. Ibid. 1216–22. May;28(5):1151-7. https://www.ncbi.nlm.nih.gov/
51. H. Ma et al., “Association of Habitual Glucosamine 60. Houston, What Your Doctor May Not Tell You. THE SCIENCE OF HEALTHY LIVING: pubmed/15855581
Use with Risk of Cardiovascular Disease: Prospective 61. M. A. Carluccio et al., “Olive Oil and Red Wine EAT, LAUGH, PLAY, LOVE. 3. Uffe Ravnskov, “ASCOT-LLA: questions about the
Study in UK Biobank” BMJ 365(2019):l1628. Antioxidant Polyphenols Inhibit Endothelial Activation: 1. R Ader and N Cohen. Behaviorally conditioned immu- benefits of atorvastatin,” The Lancet, Vol 361, issue
52. Z.H. Yang et al., “Chronic Administration of Antiatherogenic Properties of Mediterranean Diet nosuppression. Psychosomatic Medicine, Vol 37, Issue 4 9373, P 1986, 6/7/03. https://www.thelancet.com/jour-
Palmitoleic Acid Reduces Insulin Resistance and Phytochemicals,” Atherosclerosis, Thrombosis, and 333-340 nals/lancet/article/PIIS0140-6736(03)13559-3/fulltext

4. Devroey, Dirk and Vander Ginst, Leslie, “ASCOT-LLA: in the Framingham Offspring Population,” Circulation Disease,” Circulation 108 (2003): e50–e53 American College of Cardiology 51, no. 4 (2008):
questions about the benefits of atorvastatin,” The 102, no. 14 (2000): 1634–38. 12. Ibid. 444–8; J. A. Hubacek et al., “Gene Variants at FTO,
Lancet, Vol 361, issue 9373, P 1985–86, 6/7/03 https:// 3. J. T. Salonen et al., “High Stored Iron Levels Are 13. M. Roest et al., “High levels of Urinary 9p21, and 2q36.3 are age-Independently Associated
www.thelancet.com/journals/lancet/article/PIIS0140- Associated with Excess Risk of Myocardial Infarction in F2-Isoprostanes Predict Cardiovascular Mortality in with Myocardial Infarction in Czech Men,” Clinica
6736(03)13558-1/fulltext Eastern Finnish Men,” Circulation 86, no. 3 (1992): 803– Postmenopausal Women,” Journal of Clinical Lipidology Chimica Acta 454 (2016): 119–23.
5. Ibid. 11; L. K. Altman, “High Level of Iron Tied to Heart Risk,” 2, no. 4 (2009): 298–303. 22. R. Spector, “Stanford-led Study Disproves Link
6. Heart Protection Study Collaborative Drug, “MRC/ New York Times, September 8, 1992. 14. Ibid. Between Genetic Variant, Risk of Coronary Artery
BHF Heart Protection Study of Cholesterol Lowering 4. Salonen et al., “High Stored Iron Levels.” 15. Y. Kataoka et al., “Myeloperoxidase Levels Predict Disease,” Stanford Medicine October 7, 2010: https://
with Simvastatin in 20,536 High-Risk Individuals: A 5. “Statins Can Damage Your Health,” Vitamin C Accelerated Progression of Coronary Atherosclerosis in med.stanford.edu/news/all-news/2010/10/stanford-led-
Randomised Placebo-Controlled Trial,” The Lancet 360, Foundation, www.vitamincfoundation.org/statinalert. Diabetic Patients: Insights from Intravascular study-disproves-link-between-genetic-variant-risk-of-cor-
no. 9326 (2002): 7–22. 6. H. Refsum et al., “The Hordaland Homocysteine Ultrasound,” Atherosclerosis 232, no. 2 (2014): 377–83; onary-artery-disease.html; B.J. Arsenault et al., “The
7. U. Ravnskov, “Statins as the New Aspirin,” BMJ 324, Study: A Community-Based Study of Homocysteine, Its R. Zhang et al., “Association Between Myeloperoxidase 719Arg Variant of KIF6 and Cardiovascular Outcomes in
no. 7340 (2002): 789. Determinants, and Associations with Disease,” Journal Levels and Risk of Coronary Artery Disease,” JAMA Statin-Treated, Stable Coronary Patients of the Treating
8. “The Lipid Research Clinics Coronary Primary of Nutrition 136, no. 6 (2006): 1731S–40S; Homocystein 286, no. 17 (2001): 2136–42. to New Targets and Incremental Decrease in End
Prevention Trial Results. I. Reduction in Incidence of Studies Collaboration, “Homocysteine and Risk of 16. C. Meisinger et al., “Plasma oxidized low-density PointsThrough Aggressive Lipid-Lowering Prospective
Coronary Heart Disease,” JAMA 251, no. 3(1984): Ischemic Heart Disease and Stroke: A Meta-Analysis,” lipoprotein, a strong predictor for acute coronary heart Studies,” Circulation: Cardiovascular Genetics 5, no. 1
351–64. Journal of the American Medical Association 288, no. disease events in apparently healthy, middle-aged men (2012): 51–57.
9. S. Boyles, “More May Benefit from Cholesterol 16 (2002): 2015–22; D.S. Wald et al., “Homocysteine and from the general population,” Circulation 112, no.5
Drugs,” WebMD Health News, January 13, 2009, www. Cardiovascular Disease: Evidence on Casualty from a (2005): 651–57.
webmd.com/cholesterol-management/news/20090113/ Meta-Analysis,” BMJ 325, no. 7374 (2002): 1202. 17. P. Holvoet et al., “Oxidized LDL and the Metabolic
more-may-benefit-from-cholesterol-drugs. 7. D. S. Wald et al., “The Dose-Response Relation Syndrome,” Future Lipidology 3, no.6 (2008): 637–49.
10. M. de Lorgeril et al., “Cholesterol Lowering, Between Serum Homocysteine and Cardiovascular 18. F. Erling et al., “Coronary Plaque Disruption,”
Cardiovascular Diseases, and the Rousuvastatin- Disease: Implications for Treatment and Screening,” Circulation 92, no. 3 (1995): 657–671
JUPITER Controversy: A Critical Reappraisal,” Archives European Journal of Cardiovascular Prevention and 19. A. Mauriello ete al., “A Pathobiologic Link Between
of Internal Medicine 170, no. 12 (2010): 1032–36. Rehabilitation 11, no. 3 (2004): 250–53. Risk Factors Profile and Morphological Markers of
11. M. A. Hlatky, “Expanding the Orbit of Primary 8. M. Haim et al., “Serum Homocysteine and Long-Term Carotid Instability,” Atherosclerosis 208, no. 2 (2010)):
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9. M. Houston, What Your Doctor May Not Tell You Altered Gene Expression in Normal Heart and Vascular
APPENDIX B About Heart Disease (New York: Grand Central Life & Tissues,” PLoS One 7, no.6 (2012): e39574.
1. J. Fan et al., “Small Dense LDL Cholesterol Is Style, 2012). 21. D. Allingham-Hawkins et al., “KIF6 p.Trp719Arg
Associated with Metabolic Syndrome Traits 10. S. Seely, “Is Calcium Excess in Western Diet a Major Testing to Assess Risk of Coronary Artery Disease and/
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& Metabolism 16, no. 7 (2019) Cardiology 33, no. 2 (1991): 191–98. currents.RRN1191; D. Shiffman et al., “A Kinesin Family
2. J. J. Stec et al., “Association of Fibrinogen with 11. U. Hoffmann, T. J. Brady, and J. Muller, “Use of New Member 6 Variant Is Associated with Coronary Heart
Cardiovascular Risk Factors and Cardiovascular Disease Imaging Techniques to Screen for Coronary Artery Disease in the Women’s Health Study,” Journal of the

4. Devroey, Dirk and Vander Ginst, Leslie, “ASCOT-LLA: in the Framingham Offspring Population,” Circulation Disease,” Circulation 108 (2003): e50–e53 American College of Cardiology 51, no. 4 (2008):
questions about the benefits of atorvastatin,” The 102, no. 14 (2000): 1634–38. 12. Ibid. 444–8; J. A. Hubacek et al., “Gene Variants at FTO,
Lancet, Vol 361, issue 9373, P 1985–86, 6/7/03 https:// 3. J. T. Salonen et al., “High Stored Iron Levels Are 13. M. Roest et al., “High levels of Urinary 9p21, and 2q36.3 are age-Independently Associated
www.thelancet.com/journals/lancet/article/PIIS0140- Associated with Excess Risk of Myocardial Infarction in F2-Isoprostanes Predict Cardiovascular Mortality in with Myocardial Infarction in Czech Men,” Clinica
6736(03)13558-1/fulltext Eastern Finnish Men,” Circulation 86, no. 3 (1992): 803– Postmenopausal Women,” Journal of Clinical Lipidology Chimica Acta 454 (2016): 119–23.
5. Ibid. 11; L. K. Altman, “High Level of Iron Tied to Heart Risk,” 2, no. 4 (2009): 298–303. 22. R. Spector, “Stanford-led Study Disproves Link
6. Heart Protection Study Collaborative Drug, “MRC/ New York Times, September 8, 1992. 14. Ibid. Between Genetic Variant, Risk of Coronary Artery
BHF Heart Protection Study of Cholesterol Lowering 4. Salonen et al., “High Stored Iron Levels.” 15. Y. Kataoka et al., “Myeloperoxidase Levels Predict Disease,” Stanford Medicine October 7, 2010: https://
with Simvastatin in 20,536 High-Risk Individuals: A 5. “Statins Can Damage Your Health,” Vitamin C Accelerated Progression of Coronary Atherosclerosis in med.stanford.edu/news/all-news/2010/10/stanford-led-
Randomised Placebo-Controlled Trial,” The Lancet 360, Foundation, www.vitamincfoundation.org/statinalert. Diabetic Patients: Insights from Intravascular study-disproves-link-between-genetic-variant-risk-of-cor-
no. 9326 (2002): 7–22. 6. H. Refsum et al., “The Hordaland Homocysteine Ultrasound,” Atherosclerosis 232, no. 2 (2014): 377–83; onary-artery-disease.html; B.J. Arsenault et al., “The
7. U. Ravnskov, “Statins as the New Aspirin,” BMJ 324, Study: A Community-Based Study of Homocysteine, Its R. Zhang et al., “Association Between Myeloperoxidase 719Arg Variant of KIF6 and Cardiovascular Outcomes in
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Beta-glucuronidase, 78 magnesium and, 167–168
Big Pharm. See Pharmaceutical industry Calcium supplements, 167
INDEX
Bile acids, 8, 111, 125 Caloric intake, weight loss and, 68, 69
Black tea, 156 Cancer(s), 35, 37–38, 53, 116–117, 123, 134, 135, 194
Blaine, David, 112 Candies and cakes, 145, 148
B (small, dense) LDL, 9 Canola oil, 39, 96, 149
Blood cholesterol. See also Cholesterol levels; HDL (high- Capric acid, 93–94
A vegetables, 151 density lipoprotein); LDL (low-density lipoprotein) Caproic acid, 93–94
Abdominal fat, 80, 134, 179 Antioxidants eating cholesterol having no impact on, 50–51 Caprylic acid, 93–94
Abramson, John, 108, 127 in beans, 153 heart disease risk and, 119 Carbohydrates. See also Processed carbohydrates
Acute inflammation, 52 in berries, 150 Blood clots, 57–58, 178, 199 diets limiting intake of, 20–21
Adams, Roger, 76, 78 L-carnitine, 166 Blood Code Insulin Resistance calculator, 139 foods with good vs. bad, 97
Adipokines, 177 neutralizing free radicals, 53 Bloodletting, 7 high-carb, low-fat diets, 9, 19, 30, 31–33, 72, 74–75, 77,
Adiponectin, 68 in olive oil, 156 Blood pressure 102–103
Adrenaline, 64 turmeric, 154 CoQ10 and, 163 hormones and, 20
Advanced glycation end products (AGEs), 71, 79, 169 in vegetables, 151 deep breathing and, 184 insulin resistance and, 61, 138
Adventist Health Study, 152, 153 vitamin C, 177 flavanols and, 153, 180 low-carb diets, 21, 72, 73, 74, 140
Advertisements, Lipitor, 121–122 Apolipoprotein(a), 199 insulin resistance and, 64, 66 lowering triglycerides and insulin by reducing, 65,
Agatston, Arthur, 168 Apolipoprotein-B-escalate, 145 magnesium and, 168, 169 140
Agatston score/test, 168, 201 Apple pectin supplement, 171 olive oil and, 156 study on high-glycemic, 146
AGEs (advanced glycation end products). See Advanced Archives of Internal Medicine, 156, 195 omega-3s and, 174 swapping for polyunsaturated fat, 98
glycation end products (AGEs) Arginine, 152 stress and, 183 swapping saturated fats for, 95–99
Aging Cell, 133 Arteriosclerosis, 47 Blood sugar. See also High blood sugar Carcinogens, 84
Agus, David, 114 Arthritis, chronic inflammation and, 53 elevated insulin and, 130–131 Cardiac markers, 201–204
ALA (alpha-linolenic acid), 101, 174 Arthritis drugs, 150–151 foods raising your, 145 Cardiovascular Diabetology, 135
ALLHAT study, 123, 124, 190 ASCOT-LLA trial, 123, 190–192 hidden diabetes and, 137 Cardiovascular disease. See Heart disease
Allicin, 157 Ashton, Jennifer, 117 insulin and glucagon’s role in, 63–64 Cardiovascular risk
Almonds, 152 Association studies, 37–38 magnesium and, 169 accurate measures of, 10–11, 14
Alpha-tocopherol Vitamin E supplements, 172, 173 Astaxanthin, 150, 180 Blueberries, 150 ideal meal for reducing, 152
Alzheimer’s disease, 53, 93, 108 Asthma, 200 Blue Zones, 144 misleading information on cholesterol levels and,
American College of Cardiology, 201, 203 AstraZeneca, 195 Bowden, Jonny, 19–22 119–124
American Heart Association, 19, 59, 86, 90, 117, 145, 171, Atherosclerosis, 47–50, 55, 74, 97–98, 136, 169, 200 Brachial reactive testing, 146 swapping saturated fats for carbs and, 98, 99
201, 203 Atkins diet, 19–20, 73 Brain tests measuring, 10–11, 14
American Journal of Cardiology, 125, 154 Atkins, Robert, 72, 73–74, 167 cholesterol and, 23, 109 Cavities, sugar and, 78
American Journal of Clinical Nutrition, 95, 98, 99, 144, 160 ATP (adenosine triphosphate), 161, 163–164, 165, 167 glucose vs. fructose’s behavior in, 81 Celebrex, 150–151
Amnesia, statin drugs and, 112, 113 Attia, Peter, 48 serotonin receptors in, 115–116 Cell membranes, cholesterol and, 125–126
Angina, 164, 165, 166 Autism, 93 statin drugs and, 108–109 Cenegenics Medical Institute, 115
Angiograms, 23, 48 sugar’s impact on the, 69–70 Centenarians, commonalties among, 65
Animal foods, 84, 100. See also Dairy; Meat(s) B Bread(s), 97, 99, 145 Centers for Disease Control and Prevention, 126
Annals of Internal Medicine, 76, 89 Baby aspirin, 171 Breathing deeply, 184 Cereals, 97, 99, 146–147
Anthocyanins, 150–151 Bacteria Briscoe, Andrew, 75 Cherries, 150–151
Antidepressants, 115–116 cholesterol’s role in fighting, 24, 112, 126 British Heart Foundation, 54 Chia seeds, 101
Anti-inflammatory sources inflammation and, 53 British Medical Journal, 72, 89, 152, 153, 176 Children, statin drugs for, 114
berberine, 179–180 statin drugs and gut, 111 Brown rice, 102, 138 China, 90, 178
berries, 150 “Bad” cholesterol. See LDL (low-density lipoprotein) Butter, 93, 94, 95 Cholesterol. See also Lipoproteins; Low cholesterol
curcumin, 179 Barlean’s, 177 Butyrate, 94, 111 anti-fat mania and, 74
glucosamine, 175–176 Beans, 97, 99, 102, 153 Butyric acid, 93, 94 authors’ personal stories related to, 19–25
insulin and, 65 Beef, 93, 100, 151, 162 the brain and, 23, 109
olive oil, 156 Benson-Henry Institute for Mind and Body, 184 C cannot travel unaccompanied in the bloodstream, 44
omega-3s, 101–102, 138, 149, 174 Benson, Herbert, 184 Calcium classifying into “good” or “bad,” 170
statin drugs and, 25, 111–112 Berberine, 179–180 coronary calcium scan, 201 content in lipoprotein classes, 45
turmeric, 154 Berries, 150 development of atherosclerosis and, 48 demonization of, 51, 82
228 THE GREAT CHOLESTEROL MYTH INDEX 229

Beta-glucuronidase, 78 magnesium and, 167–168
Big Pharm. See Pharmaceutical industry Calcium supplements, 167
INDEX
Bile acids, 8, 111, 125 Caloric intake, weight loss and, 68, 69
Black tea, 156 Cancer(s), 35, 37–38, 53, 116–117, 123, 134, 135, 194
Blaine, David, 112 Candies and cakes, 145, 148
B (small, dense) LDL, 9 Canola oil, 39, 96, 149
Blood cholesterol. See also Cholesterol levels; HDL (high- Capric acid, 93–94
A vegetables, 151 density lipoprotein); LDL (low-density lipoprotein) Caproic acid, 93–94
Abdominal fat, 80, 134, 179 Antioxidants eating cholesterol having no impact on, 50–51 Caprylic acid, 93–94
Abramson, John, 108, 127 in beans, 153 heart disease risk and, 119 Carbohydrates. See also Processed carbohydrates
Acute inflammation, 52 in berries, 150 Blood clots, 57–58, 178, 199 diets limiting intake of, 20–21
Adams, Roger, 76, 78 L-carnitine, 166 Blood Code Insulin Resistance calculator, 139 foods with good vs. bad, 97
Adipokines, 177 neutralizing free radicals, 53 Bloodletting, 7 high-carb, low-fat diets, 9, 19, 30, 31–33, 72, 74–75, 77,
Adiponectin, 68 in olive oil, 156 Blood pressure 102–103
Adrenaline, 64 turmeric, 154 CoQ10 and, 163 hormones and, 20
Advanced glycation end products (AGEs), 71, 79, 169 in vegetables, 151 deep breathing and, 184 insulin resistance and, 61, 138
Adventist Health Study, 152, 153 vitamin C, 177 flavanols and, 153, 180 low-carb diets, 21, 72, 73, 74, 140
Advertisements, Lipitor, 121–122 Apolipoprotein(a), 199 insulin resistance and, 64, 66 lowering triglycerides and insulin by reducing, 65,
Agatston, Arthur, 168 Apolipoprotein-B-escalate, 145 magnesium and, 168, 169 140
Agatston score/test, 168, 201 Apple pectin supplement, 171 olive oil and, 156 study on high-glycemic, 146
AGEs (advanced glycation end products). See Advanced Archives of Internal Medicine, 156, 195 omega-3s and, 174 swapping for polyunsaturated fat, 98
glycation end products (AGEs) Arginine, 152 stress and, 183 swapping saturated fats for, 95–99
Aging Cell, 133 Arteriosclerosis, 47 Blood sugar. See also High blood sugar Carcinogens, 84
Agus, David, 114 Arthritis, chronic inflammation and, 53 elevated insulin and, 130–131 Cardiac markers, 201–204
ALA (alpha-linolenic acid), 101, 174 Arthritis drugs, 150–151 foods raising your, 145 Cardiovascular Diabetology, 135
ALLHAT study, 123, 124, 190 ASCOT-LLA trial, 123, 190–192 hidden diabetes and, 137 Cardiovascular disease. See Heart disease
Allicin, 157 Ashton, Jennifer, 117 insulin and glucagon’s role in, 63–64 Cardiovascular risk
Almonds, 152 Association studies, 37–38 magnesium and, 169 accurate measures of, 10–11, 14
Alpha-tocopherol Vitamin E supplements, 172, 173 Astaxanthin, 150, 180 Blueberries, 150 ideal meal for reducing, 152
Alzheimer’s disease, 53, 93, 108 Asthma, 200 Blue Zones, 144 misleading information on cholesterol levels and,
American College of Cardiology, 201, 203 AstraZeneca, 195 Bowden, Jonny, 19–22 119–124
American Heart Association, 19, 59, 86, 90, 117, 145, 171, Atherosclerosis, 47–50, 55, 74, 97–98, 136, 169, 200 Brachial reactive testing, 146 swapping saturated fats for carbs and, 98, 99
201, 203 Atkins diet, 19–20, 73 Brain tests measuring, 10–11, 14
American Journal of Cardiology, 125, 154 Atkins, Robert, 72, 73–74, 167 cholesterol and, 23, 109 Cavities, sugar and, 78
American Journal of Clinical Nutrition, 95, 98, 99, 144, 160 ATP (adenosine triphosphate), 161, 163–164, 165, 167 glucose vs. fructose’s behavior in, 81 Celebrex, 150–151
Amnesia, statin drugs and, 112, 113 Attia, Peter, 48 serotonin receptors in, 115–116 Cell membranes, cholesterol and, 125–126
Angina, 164, 165, 166 Autism, 93 statin drugs and, 108–109 Cenegenics Medical Institute, 115
Angiograms, 23, 48 sugar’s impact on the, 69–70 Centenarians, commonalties among, 65
Animal foods, 84, 100. See also Dairy; Meat(s) B Bread(s), 97, 99, 145 Centers for Disease Control and Prevention, 126
Annals of Internal Medicine, 76, 89 Baby aspirin, 171 Breathing deeply, 184 Cereals, 97, 99, 146–147
Anthocyanins, 150–151 Bacteria Briscoe, Andrew, 75 Cherries, 150–151
Antidepressants, 115–116 cholesterol’s role in fighting, 24, 112, 126 British Heart Foundation, 54 Chia seeds, 101
Anti-inflammatory sources inflammation and, 53 British Medical Journal, 72, 89, 152, 153, 176 Children, statin drugs for, 114
berberine, 179–180 statin drugs and gut, 111 Brown rice, 102, 138 China, 90, 178
berries, 150 “Bad” cholesterol. See LDL (low-density lipoprotein) Butter, 93, 94, 95 Cholesterol. See also Lipoproteins; Low cholesterol
curcumin, 179 Barlean’s, 177 Butyrate, 94, 111 anti-fat mania and, 74
glucosamine, 175–176 Beans, 97, 99, 102, 153 Butyric acid, 93, 94 authors’ personal stories related to, 19–25
insulin and, 65 Beef, 93, 100, 151, 162 the brain and, 23, 109
olive oil, 156 Benson-Henry Institute for Mind and Body, 184 C cannot travel unaccompanied in the bloodstream, 44
omega-3s, 101–102, 138, 149, 174 Benson, Herbert, 184 Calcium classifying into “good” or “bad,” 170
statin drugs and, 25, 111–112 Berberine, 179–180 coronary calcium scan, 201 content in lipoprotein classes, 45
turmeric, 154 Berries, 150 development of atherosclerosis and, 48 demonization of, 51, 82

dietary guidelines related to phobia about, 19 Chronic stress, 183, 184 Death, cholesterol and risk of, 90–91, 119–121. See also bloodletting practiced by, 7
diet-heart hypothesis and, 86 Circulation (journal), 58, 121, 155 Mortality herd mentality of, 7–8
in diet, not influencing your blood cholesterol, 50–51 Citrus bergamot, 179 Deep breathing, 184 house calls by, 43
functions and benefits of, 8, 23, 24, 124–127 Citrus fruits, 151 De Lorgeril, Michel, 33, 116 nutritional supplements and, 159–160
high-fat diet and, 20 Cleveland Clinic, 177 Desaturation, 101 research on nutritional supplements for, 180
hypothetical cases on being concerned about your, 28 Clinical studies, 39–40 Desulfovibrio, 111 use of out-of-date medical ideas, 11
insulin’s influence on, 64–65 Cocoa butter, 84, 93 Devroey, Dirk, 191 Doughnuts, 145, 147, 148
lowering with niacin, 169–170 Cocoa flavanols, 180 DHA (docosahexaenoic acid), 101, 160, 174–175 D-ribose, 163–165
low-fat diets and, 74 Cocoa-rich chocolate, 153–154 Diabetes. See also Pre-diabetes
Lyon Diet Heart Study and, 26 Coconut oil, 84, 92, 93, 94 chronic inflammation and, 53 E
on Mediterranean diet, 26 Cognitive problems, statin drugs and, 109 heart disease and, 11, 12, 61 Eat Rich Live Long (Cummins and Gerber), 133
misinformation on, 18 Cohort studies, 90 hidden, 137 Eenelt, Andreas, 133
new technology for measuring, 10 Columbia, 136 insulin/insulin resistance and, 63, 65, 131, 134 Egg yolks, 93
NIH study on low-fat diet and, 32, 33 Confirmation bias, 38 low-fat, high-carb diets and, 30, 31 Eicosanoids, 100
as not causing heart disease, 12, 19, 20–22 Confounding variable, 37–38 MGmin-low-density lipoprotein and type 2, 54 Eilperin, Juliet, 75
as a predictor of heart disease, 90, 132–133 Connecticut Medicine, 96 prevalence of, 130 Eingin, Orli, 109
saturated fats and, 8, 87–88, 89, 90–92 Conway, Erik, 78 statin drugs and, 116, 117, 123, 124 Ellagic acid, 150
subfractions of, 45 Cookies, 97, 147, 148 sugar and type 2, 72 Elongation, 101
sugar’s impact on heart disease vs. impact by, 81 CoQ10 weight loss and type 2, 68 Emotions, expression of, 184, 186
The Cholesterol Conspiracy (Smith and Pinckney), 107 deficiency of, 161, 162 Diabetes Care, 117 Endocrinology, 62–67
Cholesterol fractionization, 43 energy molecule ATP and, 161 Diabetes in situ, 137 The End of Illness (Agus), 114
Cholesterol levels function of, 161–162, 163 Diabetic dysfunction, 135 Endothelial cells, 47
American Heart Association guidelines, 90 L-carnitine and, 166–167 Diabetic physiology, 136, 176 Endothelial dysfunction, 47–48, 54, 59, 135, 146
deaths from heart disease and, 119–121 oxidative damage and, 163 Diagnostic tests, 43–44 Endothelial progenitor cells, 117
impact of medium chain versus long-chain saturated fats, 92 statin drugs and, 24, 109–111, 162 Diamond, David, 119, 122 Endothelium, 47, 49, 54–56, 55, 152
lowering of “optimal,” 29 studies on, 162–163 Diastolic dysfunction, 164 “Energy drinks,” 145
research on risk of deaths and, 90–91 vitamin E and, 163, 172 Diet(s). See also Food(s) Energy, statin drugs and, 109–111
saturated fat and, 8 Cornflakes, 146–147 argument against a high-fat, 20 ENHANCE trial, 26–27
studies on cardiovascular risk and, 119–124 Corn oil, 138, 149 Atkins diet, 19–20, 72 Enig, Mary, 21, 96
study on risk of heart attack an, 119 Corn Refiners Association, 79 epidemiology used for studying, 34–37 Environmental Working Group, 150
Cholesterol-lowering medication. See also Statin drugs Coronary artery calcium, 167–168 fat and protein in, 19–21 EPA (eicosapentaenoic acid), 101, 102, 160, 174–175
based on “good” versus “bad” cholesterol results, 43 Coronary calcium scan, 201 high-carb, low-fat, 9, 19, 30, 31–33, 72, 74–75, 77, Epidemiological studies, 34–35
fibrates, 106 Coronary heart disease. See Heart disease 102–103 food frequency questionnaires, 36–37
insulin resistance and, 65 Cortison, 64 high in protein, 20, 21, 24 National Diet Heart Study, 38–42
not influencing number of deaths, 107 Cousins, Norman, 185 low-carb, 21, 72, 73, 74, 140 Epigallocatechin gallate (EGCG), 155
as not necessary, 7–8 COX-2 inhibitors, 150 Lyon Diet Heart Study on, 21, 25–26 Epilepsy, 93
prescribed by doctors practicing conventional Crackers, 97 Mediterranean, 25–26, 100, 143–144, 156 Epsom salts/salt baths, 142, 168
medicine, 11 C-reactive protein (CRP), 106, 146–147, 177, 194, 198, 200–201 “model’s diet,” 69 Equinox Fitness Club, 19–20, 69
testing of Vytorin, 26–27 Crestor, 115, 194–196, 195 to reduce triglycerides, 67 Erectile dysfunction (ED), 59, 113, 115
Cholesterol test(s) Crofts, Catherine, 134 reversing/stopping insulin resistance with, 13 Esselstyn diet, 102
diagnoses based on “good” versus “bad,” 43 Cruciferous vegetables, 151 Twinkie diet, 67–68, 69 Estrogen, 23, 113, 124
doctors prescribing medications based on, 11 Crying, 184 Zone diet, 20 EUROASPIRE study, 137
HDL-LDL, 12, 13–14, 18, 45 Cummins, Ivor, 132–133 Dietary Goals for the United States (1977), 75 Extra-virgin olive oil, 157
making predictions about heart disease with, 13–14 Curcumin, 179 Dietary guidelines, 19, 144–145
NMR particle test, 44, 47, 139, 197–198 Curcumin/curcuminoids, 154, 179 Diet , Blood Cholesterol, and Coronary Heart Disease: F
problems related to “great” results, 45–46 A Critical Review of the Literature (Russell), 107
Cytokines, 56, 177 F2-isoprostanes (F2-IsoPs), 202
Cholesterol Treatment: A Review of the Clinical Trials Diet-heart hypothesis, 29–30, 82, 86
Cytotoxicity, 117–118 Factory-farmed meat, 151
Evidence, 24 Diet, Nutrition and the Prevention of Chronic Diseases (WHO),
Fallon, Sally, 96
Chronic disease(s), insulin resistance and, 133, 135–137 75
D Familial hypercholesterolemia, 51
Chronic inflammation, 52, 53. See also Inflammation Diet Revolution (Atkins), 72
Dairy, 93, 94–95 Familial hypertriglyceridemia, 119
Chronic lower respiratory disease, chronic inflammation Dl-alpha-tocopherol form of vitamin E, 172, 173
Dark chocolate, 152, 153–154 Farm-raised salmon, 150
and, 53 Doctors
David, Elizabeth, 144 Fast food, 147

dietary guidelines related to phobia about, 19 Chronic stress, 183, 184 Death, cholesterol and risk of, 90–91, 119–121. See also bloodletting practiced by, 7
diet-heart hypothesis and, 86 Circulation (journal), 58, 121, 155 Mortality herd mentality of, 7–8
in diet, not influencing your blood cholesterol, 50–51 Citrus bergamot, 179 Deep breathing, 184 house calls by, 43
functions and benefits of, 8, 23, 24, 124–127 Citrus fruits, 151 De Lorgeril, Michel, 33, 116 nutritional supplements and, 159–160
high-fat diet and, 20 Cleveland Clinic, 177 Desaturation, 101 research on nutritional supplements for, 180
hypothetical cases on being concerned about your, 28 Clinical studies, 39–40 Desulfovibrio, 111 use of out-of-date medical ideas, 11
insulin’s influence on, 64–65 Cocoa butter, 84, 93 Devroey, Dirk, 191 Doughnuts, 145, 147, 148
lowering with niacin, 169–170 Cocoa flavanols, 180 DHA (docosahexaenoic acid), 101, 160, 174–175 D-ribose, 163–165
low-fat diets and, 74 Cocoa-rich chocolate, 153–154 Diabetes. See also Pre-diabetes
Lyon Diet Heart Study and, 26 Coconut oil, 84, 92, 93, 94 chronic inflammation and, 53 E
on Mediterranean diet, 26 Cognitive problems, statin drugs and, 109 heart disease and, 11, 12, 61 Eat Rich Live Long (Cummins and Gerber), 133
misinformation on, 18 Cohort studies, 90 hidden, 137 Eenelt, Andreas, 133
new technology for measuring, 10 Columbia, 136 insulin/insulin resistance and, 63, 65, 131, 134 Egg yolks, 93
NIH study on low-fat diet and, 32, 33 Confirmation bias, 38 low-fat, high-carb diets and, 30, 31 Eicosanoids, 100
as not causing heart disease, 12, 19, 20–22 Confounding variable, 37–38 MGmin-low-density lipoprotein and type 2, 54 Eilperin, Juliet, 75
as a predictor of heart disease, 90, 132–133 Connecticut Medicine, 96 prevalence of, 130 Eingin, Orli, 109
saturated fats and, 8, 87–88, 89, 90–92 Conway, Erik, 78 statin drugs and, 116, 117, 123, 124 Ellagic acid, 150
subfractions of, 45 Cookies, 97, 147, 148 sugar and type 2, 72 Elongation, 101
sugar’s impact on heart disease vs. impact by, 81 CoQ10 weight loss and type 2, 68 Emotions, expression of, 184, 186
The Cholesterol Conspiracy (Smith and Pinckney), 107 deficiency of, 161, 162 Diabetes Care, 117 Endocrinology, 62–67
Cholesterol fractionization, 43 energy molecule ATP and, 161 Diabetes in situ, 137 The End of Illness (Agus), 114
Cholesterol levels function of, 161–162, 163 Diabetic dysfunction, 135 Endothelial cells, 47
American Heart Association guidelines, 90 L-carnitine and, 166–167 Diabetic physiology, 136, 176 Endothelial dysfunction, 47–48, 54, 59, 135, 146
deaths from heart disease and, 119–121 oxidative damage and, 163 Diagnostic tests, 43–44 Endothelial progenitor cells, 117
impact of medium chain versus long-chain saturated fats, 92 statin drugs and, 24, 109–111, 162 Diamond, David, 119, 122 Endothelium, 47, 49, 54–56, 55, 152
lowering of “optimal,” 29 studies on, 162–163 Diastolic dysfunction, 164 “Energy drinks,” 145
research on risk of deaths and, 90–91 vitamin E and, 163, 172 Diet(s). See also Food(s) Energy, statin drugs and, 109–111
saturated fat and, 8 Cornflakes, 146–147 argument against a high-fat, 20 ENHANCE trial, 26–27
studies on cardiovascular risk and, 119–124 Corn oil, 138, 149 Atkins diet, 19–20, 72 Enig, Mary, 21, 96
study on risk of heart attack an, 119 Corn Refiners Association, 79 epidemiology used for studying, 34–37 Environmental Working Group, 150
Cholesterol-lowering medication. See also Statin drugs Coronary artery calcium, 167–168 fat and protein in, 19–21 EPA (eicosapentaenoic acid), 101, 102, 160, 174–175
based on “good” versus “bad” cholesterol results, 43 Coronary calcium scan, 201 high-carb, low-fat, 9, 19, 30, 31–33, 72, 74–75, 77, Epidemiological studies, 34–35
fibrates, 106 Coronary heart disease. See Heart disease 102–103 food frequency questionnaires, 36–37
insulin resistance and, 65 Cortison, 64 high in protein, 20, 21, 24 National Diet Heart Study, 38–42
not influencing number of deaths, 107 Cousins, Norman, 185 low-carb, 21, 72, 73, 74, 140 Epigallocatechin gallate (EGCG), 155
as not necessary, 7–8 COX-2 inhibitors, 150 Lyon Diet Heart Study on, 21, 25–26 Epilepsy, 93
prescribed by doctors practicing conventional Crackers, 97 Mediterranean, 25–26, 100, 143–144, 156 Epsom salts/salt baths, 142, 168
medicine, 11 C-reactive protein (CRP), 106, 146–147, 177, 194, 198, 200–201 “model’s diet,” 69 Equinox Fitness Club, 19–20, 69
testing of Vytorin, 26–27 Crestor, 115, 194–196, 195 to reduce triglycerides, 67 Erectile dysfunction (ED), 59, 113, 115
Cholesterol test(s) Crofts, Catherine, 134 reversing/stopping insulin resistance with, 13 Esselstyn diet, 102
diagnoses based on “good” versus “bad,” 43 Cruciferous vegetables, 151 Twinkie diet, 67–68, 69 Estrogen, 23, 113, 124
doctors prescribing medications based on, 11 Crying, 184 Zone diet, 20 EUROASPIRE study, 137
HDL-LDL, 12, 13–14, 18, 45 Cummins, Ivor, 132–133 Dietary Goals for the United States (1977), 75 Extra-virgin olive oil, 157
making predictions about heart disease with, 13–14 Curcumin, 179 Dietary guidelines, 19, 144–145
NMR particle test, 44, 47, 139, 197–198 Curcumin/curcuminoids, 154, 179 Diet , Blood Cholesterol, and Coronary Heart Disease: F
problems related to “great” results, 45–46 A Critical Review of the Literature (Russell), 107
Cytokines, 56, 177 F2-isoprostanes (F2-IsoPs), 202
Cholesterol Treatment: A Review of the Clinical Trials Diet-heart hypothesis, 29–30, 82, 86
Cytotoxicity, 117–118 Factory-farmed meat, 151
Evidence, 24 Diet, Nutrition and the Prevention of Chronic Diseases (WHO),
Fallon, Sally, 96
Chronic disease(s), insulin resistance and, 133, 135–137 75
D Familial hypercholesterolemia, 51
Chronic inflammation, 52, 53. See also Inflammation Diet Revolution (Atkins), 72
Dairy, 93, 94–95 Familial hypertriglyceridemia, 119
Chronic lower respiratory disease, chronic inflammation Dl-alpha-tocopherol form of vitamin E, 172, 173
Dark chocolate, 152, 153–154 Farm-raised salmon, 150
and, 53 Doctors
David, Elizabeth, 144 Fast food, 147

Fasting insulin, 65, 67, 135, 138 Food frequency questionnaire, 36–37, 42 coconut oil vs. butter’s influence on, 94 Hegsted, Mark, 75–76
Fasting insulin test, 138 Food lobbyists, trans fats labels and, 148 impact of medium-chain versus long-chain saturated fats Hemochromatosis, 179, 199
Fat(s). See also Polyunsaturated fats; Saturated fats; Framingham Heart Study, 23, 72 on, 92–93 Hepatic steatosis, 79–80
Trans fats Frant, Ivan, 39–42 insulin resistance and, 66, 135 Hepatitis, 170
deconstructing mythology about, 61 Frantz, Robert, 40, 41–42 low-fat diets and, 74–75 Hepatotoxicity, 170
demonization of, 74, 82 Fred Hutchinson Cancer Research Center, 37 low levels of, 134, 135 Hidden diabetes, 137
fatty acids and, 83 Free radicals, 53–54, 55 niacin raising, 170 High blood pressure (hypertension), 48, 64, 71, 80–81, 134, 138,
fructose and, 79–80 Free Radical Theory of Aging, 53–54 NMR particle test, 47 163
in the liver, fructose and, 79–80 Fructose, 79, 80–81, 102–103, 145 pantethine and, 175 High blood sugar, 56, 137
sugar lobby promoting harm of, 76, 77, 78 Fruit(s), 80, 97, 99, 102, 151–152 protein/cholesterol/triglyceride content of, 45 High-fat diet, 20, 72
sugar’s impact on heart disease vs. impact by, 72–73, 81 Fruit juices, 145 ratio of triglycerides to, 46–47, 58, 67, 71, 75, 139–140 High-fructose corn syrup (HFCS), 79, 80, 145
three families of, 83 Functional medicine, 141 red wine and, 155 High-fructose sweeteners, 81
Fat theology saturated fat and, 21, 88, 92, 93–94, 97 High-glycemic foods, 145, 146
beliefs, 86, 88, 98 G trans fats and, 147 Hippocrates, 69–70
debunking tenets of, 90–92 Gaby, Alan, 170 vitamin E and, 172 Hirsch, Jules, 33
Fatty liver, 79–80, 132 Galen, 7 HDL-2, 97, 170 Hlatky, Mark A., 196
‘Fatty streak,’ 56–57 Gamma-tocopherol Vitamin E, 172 HDL-3, 170 HMG-CoA reductase, 65
Feelings, expressing your, 184, 186 Garlic, 152, 157 HDL-LDL tests, 13–14, 15, 18, 45 Hoffer, Abram, 170
Fiber, 74, 102, 153 Genetic markers, 43, 201–204 Health Professional Follow-up Study, 151 HOMA-2 calculator, 139
Fibrates, 106 Genetic testing, 11, 201–202, 204 Heart attack(s), 203 Homocysteine, 200
Fibrin, 178 Gerber, Jeffrey, 133 association between LDL and second, 136 Hormones
Fibrinogen, 155, 198 Gestalt psychotherapy, 184 cholesterol levels and, 18, 27 blood sugar and, 63–64
Fibrinogen test, 178 Ginst, Leslie Vander, 191 effect of lowering cholesterol on, 107 cholesterol and, 124–125
Fibrous cap, 48–49, 57, 202, 203 GISSI-Prevenzione trial, 173–174 effect of statin drugs on having, 118–124 chronic stress and, 183
Fish, 100, 102, 144, 150, 152, 173, 174 Gladwell, Malcolm, 38–40 events leading to, 48–49, 57–58 lifestyle choices and, 62–63
Fish oil, 102, 112, 160, 173, 174, 175, 202 Glucagon, 63–64 insulin resistance and preventing, 13, 73 oxytocin, 115
Flavanols, 153–154, 180 Glucosamine suflate, 175–176 L-carnitine supplement after having a, 165–166 sex, 8, 113–115
Flavonoids, 151, 155 Glucose, 65, 79, 81 magnesium and, 167–168 weight loss/gain and, 20
Flaxseed oil, 100, 174 Glucose metabolism, 66–67 omega-3s and, 175 Houston, Mark, 59, 175, 180
Flaxseeds, 101 Glycated proteins, 71 saturated fat and, 89, 99 Hs-CRP, 198
Foam cells, 48, 56, 57, 58, 203 Glycation, 54, 71 statins for men who have already had a, 114 Hu, Charlene, 147
Folic acid, 153, 155, 200 Glycemic index, 99–100 studies on statins and prevention of, 193–195 Hu, Frank B., 88
Food(s). See also Diet(s) Glycemic load, 98, 99, 146–147 Heart disease Human growth hormone, 64
with bad carbs, 97 Goff, David, 64 cholesterol as a predictor of, 90, 132–133 Hydrogenated oil, 31, 41, 148
cholesterol, 74 “Good” cholesterol. See HDL (high-density lipoprotein) cholesterol as not causing, 12, 19, 20–22 Hydrogenated soybean oil, 148
with cholesterol, having no impact on blood Gout, 80, 150 chronic inflammation and, 53 Hyperinsulinemia, 117, 133, 134, 137–138
cholesterol, 50–51 Grass-fed meat, 100, 151 connection between diabetes and, 11, 12, 61 Hyperinsulinemia: A Unified Field Theory of Chronic
with CoQ10, 162 Graveline, Duane, 106, 112, 113 emotional and psychological influences on, 183–184 Disease, 134
to eat in your diet, 150–157 Greenland Eskimos, 173 five factors preventing, 27 Hyperpalatability, 69–70
engineered to be hyperpalatable, 69–70 Green, leafy vegetables, 101, 151 high omega-6 diets and, 101 Hypertension. See High blood pressure (hypertension)
with good carbs, 97 Green tea, 155–156 indicators of, 73 Hypothesis, epidemiology and, 35
high-glycemic, 99 Gut bacteria, 78, 111 insulin resistance and, 65–67, 73, 129–130, 131, 134–137
hormonal effect of, 20, 62–67 real causes of, 18, 22 I
ideal meal for reducing risk of heart disease, 152 H smoking and, 55 IDL (intermediate density lipoprotein), 45
insulin resistance and, 138 The Hamptons Diet, 96 studies on link between saturated fats and, 29–30, 75–76, Immune system
low-glycemic, 99 Harman, Denham, 53–54 87–90 cholesterol’s importance for the, 126
of Mediterranean diet, 144 Harvard Medical School, 96, 108, 145 studies related to (See Studies) response to oxidized LDL, 56
to omit from your diet, 144–148 Harvard School of Public Health, 145, 149, 173 sugar intake and, 71–73, 81 statin drugs’ impact on, 111–112
processed meats, 148–149 Harvard University, 27 Heart disease risk. See Cardiovascular risk Infections, cholesterol’s role in fighting, 24
with saturated fats, 84 Harvey, William, 7 HeartMath, 187–189 Inflammation, 11, 18, 22. See also Chronic inflammation;
with trans fats, 147–148 Heart Protection Study (HPS), 124, 192 Anti-inflammatory sources
Haub, Mark, 67–68
Food and Drug Administration (FDA), 77 Heart rate variability (HRV), 188 acute vs. chronic, 52
HDL (high-density lipoprotein), 9, 65

Fasting insulin, 65, 67, 135, 138 Food frequency questionnaire, 36–37, 42 coconut oil vs. butter’s influence on, 94 Hegsted, Mark, 75–76
Fasting insulin test, 138 Food lobbyists, trans fats labels and, 148 impact of medium-chain versus long-chain saturated fats Hemochromatosis, 179, 199
Fat(s). See also Polyunsaturated fats; Saturated fats; Framingham Heart Study, 23, 72 on, 92–93 Hepatic steatosis, 79–80
Trans fats Frant, Ivan, 39–42 insulin resistance and, 66, 135 Hepatitis, 170
deconstructing mythology about, 61 Frantz, Robert, 40, 41–42 low-fat diets and, 74–75 Hepatotoxicity, 170
demonization of, 74, 82 Fred Hutchinson Cancer Research Center, 37 low levels of, 134, 135 Hidden diabetes, 137
fatty acids and, 83 Free radicals, 53–54, 55 niacin raising, 170 High blood pressure (hypertension), 48, 64, 71, 80–81, 134, 138,
fructose and, 79–80 Free Radical Theory of Aging, 53–54 NMR particle test, 47 163
in the liver, fructose and, 79–80 Fructose, 79, 80–81, 102–103, 145 pantethine and, 175 High blood sugar, 56, 137
sugar lobby promoting harm of, 76, 77, 78 Fruit(s), 80, 97, 99, 102, 151–152 protein/cholesterol/triglyceride content of, 45 High-fat diet, 20, 72
sugar’s impact on heart disease vs. impact by, 72–73, 81 Fruit juices, 145 ratio of triglycerides to, 46–47, 58, 67, 71, 75, 139–140 High-fructose corn syrup (HFCS), 79, 80, 145
three families of, 83 Functional medicine, 141 red wine and, 155 High-fructose sweeteners, 81
Fat theology saturated fat and, 21, 88, 92, 93–94, 97 High-glycemic foods, 145, 146
beliefs, 86, 88, 98 G trans fats and, 147 Hippocrates, 69–70
debunking tenets of, 90–92 Gaby, Alan, 170 vitamin E and, 172 Hirsch, Jules, 33
Fatty liver, 79–80, 132 Galen, 7 HDL-2, 97, 170 Hlatky, Mark A., 196
‘Fatty streak,’ 56–57 Gamma-tocopherol Vitamin E, 172 HDL-3, 170 HMG-CoA reductase, 65
Feelings, expressing your, 184, 186 Garlic, 152, 157 HDL-LDL tests, 13–14, 15, 18, 45 Hoffer, Abram, 170
Fiber, 74, 102, 153 Genetic markers, 43, 201–204 Health Professional Follow-up Study, 151 HOMA-2 calculator, 139
Fibrates, 106 Genetic testing, 11, 201–202, 204 Heart attack(s), 203 Homocysteine, 200
Fibrin, 178 Gerber, Jeffrey, 133 association between LDL and second, 136 Hormones
Fibrinogen, 155, 198 Gestalt psychotherapy, 184 cholesterol levels and, 18, 27 blood sugar and, 63–64
Fibrinogen test, 178 Ginst, Leslie Vander, 191 effect of lowering cholesterol on, 107 cholesterol and, 124–125
Fibrous cap, 48–49, 57, 202, 203 GISSI-Prevenzione trial, 173–174 effect of statin drugs on having, 118–124 chronic stress and, 183
Fish, 100, 102, 144, 150, 152, 173, 174 Gladwell, Malcolm, 38–40 events leading to, 48–49, 57–58 lifestyle choices and, 62–63
Fish oil, 102, 112, 160, 173, 174, 175, 202 Glucagon, 63–64 insulin resistance and preventing, 13, 73 oxytocin, 115
Flavanols, 153–154, 180 Glucosamine suflate, 175–176 L-carnitine supplement after having a, 165–166 sex, 8, 113–115
Flavonoids, 151, 155 Glucose, 65, 79, 81 magnesium and, 167–168 weight loss/gain and, 20
Flaxseed oil, 100, 174 Glucose metabolism, 66–67 omega-3s and, 175 Houston, Mark, 59, 175, 180
Flaxseeds, 101 Glycated proteins, 71 saturated fat and, 89, 99 Hs-CRP, 198
Foam cells, 48, 56, 57, 58, 203 Glycation, 54, 71 statins for men who have already had a, 114 Hu, Charlene, 147
Folic acid, 153, 155, 200 Glycemic index, 99–100 studies on statins and prevention of, 193–195 Hu, Frank B., 88
Food(s). See also Diet(s) Glycemic load, 98, 99, 146–147 Heart disease Human growth hormone, 64
with bad carbs, 97 Goff, David, 64 cholesterol as a predictor of, 90, 132–133 Hydrogenated oil, 31, 41, 148
cholesterol, 74 “Good” cholesterol. See HDL (high-density lipoprotein) cholesterol as not causing, 12, 19, 20–22 Hydrogenated soybean oil, 148
with cholesterol, having no impact on blood Gout, 80, 150 chronic inflammation and, 53 Hyperinsulinemia, 117, 133, 134, 137–138
cholesterol, 50–51 Grass-fed meat, 100, 151 connection between diabetes and, 11, 12, 61 Hyperinsulinemia: A Unified Field Theory of Chronic
with CoQ10, 162 Graveline, Duane, 106, 112, 113 emotional and psychological influences on, 183–184 Disease, 134
to eat in your diet, 150–157 Greenland Eskimos, 173 five factors preventing, 27 Hyperpalatability, 69–70
engineered to be hyperpalatable, 69–70 Green, leafy vegetables, 101, 151 high omega-6 diets and, 101 Hypertension. See High blood pressure (hypertension)
with good carbs, 97 Green tea, 155–156 indicators of, 73 Hypothesis, epidemiology and, 35
high-glycemic, 99 Gut bacteria, 78, 111 insulin resistance and, 65–67, 73, 129–130, 131, 134–137
hormonal effect of, 20, 62–67 real causes of, 18, 22 I
ideal meal for reducing risk of heart disease, 152 H smoking and, 55 IDL (intermediate density lipoprotein), 45
insulin resistance and, 138 The Hamptons Diet, 96 studies on link between saturated fats and, 29–30, 75–76, Immune system
low-glycemic, 99 Harman, Denham, 53–54 87–90 cholesterol’s importance for the, 126
of Mediterranean diet, 144 Harvard Medical School, 96, 108, 145 studies related to (See Studies) response to oxidized LDL, 56
to omit from your diet, 144–148 Harvard School of Public Health, 145, 149, 173 sugar intake and, 71–73, 81 statin drugs’ impact on, 111–112
processed meats, 148–149 Harvard University, 27 Heart disease risk. See Cardiovascular risk Infections, cholesterol’s role in fighting, 24
with saturated fats, 84 Harvey, William, 7 HeartMath, 187–189 Inflammation, 11, 18, 22. See also Chronic inflammation;
with trans fats, 147–148 Heart Protection Study (HPS), 124, 192 Anti-inflammatory sources
Haub, Mark, 67–68
Food and Drug Administration (FDA), 77 Heart rate variability (HRV), 188 acute vs. chronic, 52
HDL (high-density lipoprotein), 9, 65

endothelial dysfunction and, 48 International Journal of Cardiology, 166, 201 MGmin-low-density lipoprotein, 54 Lp(a), 163, 170, 199–200
high-glycemic carbs and, 145 Intimacy, 186 niacin lowering, 170 LP-IR test, 65, 139
insulin resistance and, 65 Iowa 65+ Rural Health Study, 200–201 NMR particle test and, 47 Lp-PLA2, 49, 203
Interleukin-6 and, 201 Iowa State University, 109 plaque and, 125 Lumbrokinase, 178, 200
omega-6 fats and, 138, 149 Iowa Women’s Health Study, 152 as predictor of heart disease and mortality, 91 Lundell, Dwight, 33, 56, 71
oxidized LDL and, 55–56 Irish Heart Disease Association, 133 protein/cholesterol/triglyceride content of, 45 Lustig, Robert, 79, 80, 81, 131
processed carbs and, 145 Iron, 198–199 receptor activity, 49–50 Lyon Diet Heart Study, 21, 25–26
process of, explained, 55–58 Isehara Study, 91 saturated fats and, 21, 91, 92, 93–94
ratio of omega-6s to omega-3s and, 101 Italian Longitudinal Study on Aging, 116 second heart attacks and, 136 M
saturated fats and, 85 of smokers vs. nonsmokers, 55 Macadamia oil, 100, 149
smoking and, 55 J studies on statins and, 116, 124, 192–193 Macrophages, 48, 56, 57
statin drugs and, 106 JAMA Internal Medicine, 75 subtypes, 45, 197 Magnesium, 161, 167–169
sugar intake and, 71 Japan, 80, 90–91, 155, 162, 178 sugar and, 71, 77 Mann, George, 23, 32, 72–73
tests measuring, 202–204, 203 Japan Atherosclerosis Society, 91 tests measuring particle size an particle number, Margarine, 31
Inflammatory markers, 43 Japanese Lipid Intervention Trial, 123, 192–193 197–198 Masley, Steven, 41
Influenza, chronic inflammation and, 53 Journal of Cardiac Failure, 116 trans fats and, 147 Massage, 187
Inner Balance app, 188 Juice drinks, 97, 145, 154 Legumes, 97, 99, 146, 153 McCraty, Rollin, 188
Institute of HeartMath, 187–188 JUPITER study, 123, 124, 194–196 Lexapro, 115 McDougall diet, 102
Insulin Libido, 114–115 McGandy, Robert, 76
Atkins diet and control of, 73–74 K Life Extension Foundation, 126 MCT oil, 93
diabetes and, 63, 65, 131, 134 Kearns, Cristin, 76, 77 Lifestyle choices, 27, 62–63, 74, 144 Meat(s)
function of, 63–64 Keto diet, 144 Lifestyle Heart Trial, 74 with CoQ10, 162
as inflammatory in people with insulin resistance, 65 Keys, Ancel, 8, 29–30, 34, 72, 143 Linoleic acid, 40, 42, 89–90, 102 grass-fed, 151
influence on blood pressure, 64 Kidney disease, 53, 169, 200 Lipid core of plaque, 56, 57 Mediterranean-type diet with, 144
influence on cholesterol, 64–65 Kidneys, insulin and, 64 Lipid hypothesis, 8–9 processed, 148
raising blood pressure, 64 KIF-6 Test, 204 Lipid rafts, 115, 125 saturated fat in red, 93
Insulin assay, 135 Korean War, 73 Lipid Research Clinics Coronary Primary Prevention Media messages, being critical readers of, 42
Insulin resistance Kraft, Joseph R., 132, 134 Trial (LRC-CPPT), 193 Medications. See Cholesterol-lowering medication; Statin drugs
catching early, 58–59 Kraft Prediabetes Profile, 134 Lipid triad, 135 Meditation, 142, 184
cause of, 61 Krauss, Ronald, 88 Lipitor, 109, 111, 112, 121–122, 121–123, 124, 190–192 Mediterranean Diet, 25–26, 100, 143–144, 156
determining if you have, 66, 67 Lipoprotein(a). See Lp(a) Medium-chain saturated fats/medium-chain triglycerides
as early warning sign of heart disease, 11, 64 L Lipoproteins, 9, 44–45, 47. See also HDL (high-density (MCTs), 92–93
lipoprotein); LDL (low-density lipoprotein) Memory, statin drugs and, 23, 109, 112, 113
fructose and, 80 LabCorp, 139
Liver Merchants of Doubt (Oreskes and Conway), 78
functions of, 63 The Lancet, 26, 72, 108, 127, 191
CoQ10 and, 162 Merck, 26, 110
heart disease and, 65–67, 73, 129–130, 134–137 Lands, Bill, 103
fructose and, 79–80 Meridian Valley, 134
hidden diabetes and, 137–138 Lane, M. Daniel, 81
niacin and, 170, 171 Meta-analyses, 86, 87, 88, 89–90
leading to diabetes and heart disease, 61 Lard, 83, 84, 86, 92, 93, 100, 102
as source of cholesterol, 50, 125 Metabolic events, hormones and, 62, 63
magnesium and, 169 Laughing, 184–186
weight loss and, 68 Metabolic syndrome, 45, 71, 80, 132, 135, 179, 203. See also
metabolism and, 64, 66–67, 130–131 Lauric acid, 93, 94
Liver disease, chronic inflammation and, 53 Insulin resistance
in a person of normal weight, 138 L-carnitine, 163, 164–167
Long-chain saturated fats, 92, 93 Metabolism
prevalence of, 66 LDL (low-density lipoprotein), 9. See also Oxidized LDL
Long-Term Intervention with Pravastatin in Ischaemic dairy and cholesterol, 95
preventing heart disease and early detection of, 12 addressing inflammation vs. removing, 58
Disease (LIPID), 117 insulin and, 73
related to hypertension, 64 atherosclerosis and, 49
Low-carb diets, 21, 72, 73, 74, 140 insulin resistance and, 64, 66–67, 130–131
as “root cause” of chronic disease, 133 butter’s impact on, 94, 95
Low cholesterol Metformin, 133, 161
sugar intake and, 61, 71, 79 coronary artery calcium and, 168
higher risk of death from non-heart related issues with, 46, Mevacor, 106
testing for, 13, 14, 135, 139 dairy and, 95 91
Insulin Resistance Atherosclerosis Study (IRAS), 136 endothelial dysfunction and, 47–48 MGmin-low-density lipoprotein, 54
immune system and, 126
Insulin sensitivity glycation and, 71 Microbiome, 11
infectious diseases and, 24
insulin as anti-inflammatory with normal, 65 HDL-LDL tests, 13–14, 18, 45 Milk fat globule membrane, 94–95
low testosterone and, 115
omega-7 and, 176–177 immune system and, 112 Minger, Denise, 38
mortality and, 116, 120, 121
weight loss and, 68 inactivating bacterial products, 126 Minnesota Coronary Experiment, 89–90
Low-fat, high-carb diets, 9, 19, 30, 31–33, 72, 74–75, 77, 102–103
Interleukin-6, 200–201 measuring, vs. measuring insulin resistance, 139 MIT (Massachusetts Institute of Technology), 104–105, 110

endothelial dysfunction and, 48 International Journal of Cardiology, 166, 201 MGmin-low-density lipoprotein, 54 Lp(a), 163, 170, 199–200
high-glycemic carbs and, 145 Intimacy, 186 niacin lowering, 170 LP-IR test, 65, 139
insulin resistance and, 65 Iowa 65+ Rural Health Study, 200–201 NMR particle test and, 47 Lp-PLA2, 49, 203
Interleukin-6 and, 201 Iowa State University, 109 plaque and, 125 Lumbrokinase, 178, 200
omega-6 fats and, 138, 149 Iowa Women’s Health Study, 152 as predictor of heart disease and mortality, 91 Lundell, Dwight, 33, 56, 71
oxidized LDL and, 55–56 Irish Heart Disease Association, 133 protein/cholesterol/triglyceride content of, 45 Lustig, Robert, 79, 80, 81, 131
processed carbs and, 145 Iron, 198–199 receptor activity, 49–50 Lyon Diet Heart Study, 21, 25–26
process of, explained, 55–58 Isehara Study, 91 saturated fats and, 21, 91, 92, 93–94
ratio of omega-6s to omega-3s and, 101 Italian Longitudinal Study on Aging, 116 second heart attacks and, 136 M
saturated fats and, 85 of smokers vs. nonsmokers, 55 Macadamia oil, 100, 149
smoking and, 55 J studies on statins and, 116, 124, 192–193 Macrophages, 48, 56, 57
statin drugs and, 106 JAMA Internal Medicine, 75 subtypes, 45, 197 Magnesium, 161, 167–169
sugar intake and, 71 Japan, 80, 90–91, 155, 162, 178 sugar and, 71, 77 Mann, George, 23, 32, 72–73
tests measuring, 202–204, 203 Japan Atherosclerosis Society, 91 tests measuring particle size an particle number, Margarine, 31
Inflammatory markers, 43 Japanese Lipid Intervention Trial, 123, 192–193 197–198 Masley, Steven, 41
Influenza, chronic inflammation and, 53 Journal of Cardiac Failure, 116 trans fats and, 147 Massage, 187
Inner Balance app, 188 Juice drinks, 97, 145, 154 Legumes, 97, 99, 146, 153 McCraty, Rollin, 188
Institute of HeartMath, 187–188 JUPITER study, 123, 124, 194–196 Lexapro, 115 McDougall diet, 102
Insulin Libido, 114–115 McGandy, Robert, 76
Atkins diet and control of, 73–74 K Life Extension Foundation, 126 MCT oil, 93
diabetes and, 63, 65, 131, 134 Kearns, Cristin, 76, 77 Lifestyle choices, 27, 62–63, 74, 144 Meat(s)
function of, 63–64 Keto diet, 144 Lifestyle Heart Trial, 74 with CoQ10, 162
as inflammatory in people with insulin resistance, 65 Keys, Ancel, 8, 29–30, 34, 72, 143 Linoleic acid, 40, 42, 89–90, 102 grass-fed, 151
influence on blood pressure, 64 Kidney disease, 53, 169, 200 Lipid core of plaque, 56, 57 Mediterranean-type diet with, 144
influence on cholesterol, 64–65 Kidneys, insulin and, 64 Lipid hypothesis, 8–9 processed, 148
raising blood pressure, 64 KIF-6 Test, 204 Lipid rafts, 115, 125 saturated fat in red, 93
Insulin assay, 135 Korean War, 73 Lipid Research Clinics Coronary Primary Prevention Media messages, being critical readers of, 42
Insulin resistance Kraft, Joseph R., 132, 134 Trial (LRC-CPPT), 193 Medications. See Cholesterol-lowering medication; Statin drugs
catching early, 58–59 Kraft Prediabetes Profile, 134 Lipid triad, 135 Meditation, 142, 184
cause of, 61 Krauss, Ronald, 88 Lipitor, 109, 111, 112, 121–122, 121–123, 124, 190–192 Mediterranean Diet, 25–26, 100, 143–144, 156
determining if you have, 66, 67 Lipoprotein(a). See Lp(a) Medium-chain saturated fats/medium-chain triglycerides
as early warning sign of heart disease, 11, 64 L Lipoproteins, 9, 44–45, 47. See also HDL (high-density (MCTs), 92–93
lipoprotein); LDL (low-density lipoprotein) Memory, statin drugs and, 23, 109, 112, 113
fructose and, 80 LabCorp, 139
Liver Merchants of Doubt (Oreskes and Conway), 78
functions of, 63 The Lancet, 26, 72, 108, 127, 191
CoQ10 and, 162 Merck, 26, 110
heart disease and, 65–67, 73, 129–130, 134–137 Lands, Bill, 103
fructose and, 79–80 Meridian Valley, 134
hidden diabetes and, 137–138 Lane, M. Daniel, 81
niacin and, 170, 171 Meta-analyses, 86, 87, 88, 89–90
leading to diabetes and heart disease, 61 Lard, 83, 84, 86, 92, 93, 100, 102
as source of cholesterol, 50, 125 Metabolic events, hormones and, 62, 63
magnesium and, 169 Laughing, 184–186
weight loss and, 68 Metabolic syndrome, 45, 71, 80, 132, 135, 179, 203. See also
metabolism and, 64, 66–67, 130–131 Lauric acid, 93, 94
Liver disease, chronic inflammation and, 53 Insulin resistance
in a person of normal weight, 138 L-carnitine, 163, 164–167
Long-chain saturated fats, 92, 93 Metabolism
prevalence of, 66 LDL (low-density lipoprotein), 9. See also Oxidized LDL
Long-Term Intervention with Pravastatin in Ischaemic dairy and cholesterol, 95
preventing heart disease and early detection of, 12 addressing inflammation vs. removing, 58
Disease (LIPID), 117 insulin and, 73
related to hypertension, 64 atherosclerosis and, 49
Low-carb diets, 21, 72, 73, 74, 140 insulin resistance and, 64, 66–67, 130–131
as “root cause” of chronic disease, 133 butter’s impact on, 94, 95
Low cholesterol Metformin, 133, 161
sugar intake and, 61, 71, 79 coronary artery calcium and, 168
higher risk of death from non-heart related issues with, 46, Mevacor, 106
testing for, 13, 14, 135, 139 dairy and, 95 91
Insulin Resistance Atherosclerosis Study (IRAS), 136 endothelial dysfunction and, 47–48 MGmin-low-density lipoprotein, 54
immune system and, 126
Insulin sensitivity glycation and, 71 Microbiome, 11
infectious diseases and, 24
insulin as anti-inflammatory with normal, 65 HDL-LDL tests, 13–14, 18, 45 Milk fat globule membrane, 94–95
low testosterone and, 115
omega-7 and, 176–177 immune system and, 112 Minger, Denise, 38
mortality and, 116, 120, 121
weight loss and, 68 inactivating bacterial products, 126 Minnesota Coronary Experiment, 89–90
Low-fat, high-carb diets, 9, 19, 30, 31–33, 72, 74–75, 77, 102–103
Interleukin-6, 200–201 measuring, vs. measuring insulin resistance, 139 MIT (Massachusetts Institute of Technology), 104–105, 110

Mitochondria, 161, 165 Nutritional supplements. See also CoQ10 resveratrol and, 155, 179 resistance
Monocytes, 56 berberine, 179–180 test measuring, 202–203 “Pre-heart disease,” 11, 117–118
Monosaccharides, 79 citrus bergamot, 179 vitamin E and, 172–173 Primary prevention, 123
Monounsaturated fats, 41, 83, 94, 96, 99, 100, 149, 156 cocoa flavanols, 180 Oxygen free radicals, 53, 54 Pritikin Longevity Center, 74
Mortality CoQ10, 161–163 Oxytocin, 115, 116 Pritikin, Nathan, 74
cholesterol levels and, 90–91 curcumin, 179 Proceedings of the National Academy of Sciences of the
CoQ10 and, 173–174 D-ribose, 163–165 P United States, 162
low testosterone and, 115 glucosamine sulfate, 175–176 Packaged foods, 102, 145, 147 Processed carbohydrates
omega-3s and, 173–174 L-carnitine, 165–167 Paleo-type diets, 138 food considered, 145
statin drugs and, 107–108, 116, 119–120, 124, 127, 190, 192, 193 niacin, 169–171 Palm kernel oil, 93 insulin and, 138
vitamin D and, 126 omega-3s, 173–175 Palm oil, 84, 93 reducing or eliminating from your diet, 65, 67, 71, 103, 145,
Moss, Michael, 70 omega-7, 176–177 Pancreas, 68, 71, 130, 131, 137 147
Mother Jones, 77 pantethine, 175 Pantethine, 175 replacing fats with, 22, 31
Mozaffarian, Dariush, 96, 173 problems with research on, 159–160 Partially hydrogenated oil, trans fats and, 31, 147–148 replacing saturated fats for, 98–99
MRFIT study, 102, 119–121, 126 resveratrol, 179 Particle (LDL) size test, 197–198 Processed foods, 79, 149
Mutton, 93 used alone or with conventional therapy, 161 Pasta, 97, 99, 145 Processed meats, 148
Myeloperoxidase, 202 vitamin C, 177, 179 Pastries, 97, 145 Progesterone, 23, 113, 124
Myocardial infarction. See Heart attack(s) vitamin E, 171–173 PCSK9, 50 Progress in Lipid Research, 103
Myristic acid, 93 Nutrition facts label of foods, 148 PCSK9 inhibitors, 50 Project 259: Dietary Carbohydrate and Blood Lipids in Germ-
Free Rats, 78
Nutrition studies. See Studies Pennebaker, James, 186
Pro-oxidant effect from vitamin E, 172
N Nuts, 35, 100, 146, 152–153 Perel, Esther, 42
Prospective Study of Pravastatin in the Elderly Risk
National Cancer Institute, 36 Perilla seeds, 101
(PROSPER), 117
National Cholesterol Education Program, 29, 74, 127 O Pescatore, Fred, 96
PROSPER study, 117, 123, 124, 193–194
National Diet Heart Study, 38–42 Obesity, 21–22, 31, 33, 53, 65, 75, 80–81, 135 Pharmaceutical industry
Protein(s)
National Health and Nutrition Examination Survey (NHANES) Observational studies, 34–36 doctors courted by, 159
content in lipoprotein classes, 44, 45
Food Frequency Questionnaire, 36–37 Olive oil, 25, 83, 93, 95, 100, 144, 149, 156–157 government advisory committees and, 29
diets high in, 20, 21, 74
National Heart, Lung, and Blood Institute, 74 Oliver, Michael, 32 misleading information by, 121–122
glycated, 71
National Institute of Dental Research, 78 Omega-3 fatty acids, 83, 84, 85, 100, 101, 103, 160, 173–175 statins for children and, 114
Protein Power diet, 20
National Institute of Medicine, 159 Omega-6 fatty acids, 83, 85, 86, 100, 101–102, 103, 138, 139, 149 statin trials/studies and, 107–108, 127, 191
Proteoglycans, 48
National Institutes of Health (NIH), 31–32, 40, 133 Omega-6:omega-3 ratio, 101, 102, 149, 151 testing of Vytorin and, 26
Prozac, 115
Natto (soy food), 178 Omega-7, 176–177 Physicians. See Doctors
Psychoneuroimmunology, 182, 188
Nattokinase, 178, 198 Oreskes, Naomi, 78 Physicians’ Health Study, 152–153
Pterostilbene, 150
Natural killer cell cytotoxicity, 116–117 Ornish, Dean, 74, 102 Phytonutrients, 152
“Natural” Vitamin E, 172 Overdosed America (Abramson), 108 Pinckney, Edward, 107
A Near-Perfect Sexual Crime: Statins Against Cholesterol Oxidation and oxidative damage, 11, 45. See also Inflammation; PlaqTM Test, 203 Q
(De Loregeril), 116 Oxidized LDL Plaque, 26–27, 47, 48–49, 55, 57, 102, 125, 157, 199, 202, 203 Qi, Lu, 176
Netherlands Journal of Medicine, 89 as cause of heart disease, 18, 58 Play, 187
Neurodegenerative diseases, chronic inflammation and, 53 endothelial dysfunction and, 48 Pneumonia, chronic inflammation and, 53 R
Neurotransmitters, 109, 115, 116 explained, 55–56 Polychlorinated biphenyls (PCBs), 150 Ramsden, Christopher, 40
New England Journal of Medicine, 26, 27, 76–77, 160, 196, 200 immune system’s response to, 56 Polycystic ovary syndrome (PCOS), 115 Randomized control studies, 39–42, 90
New York Heart Association (NYHA), 162 iron and, 198 Polymeal, 152 Rapeseed oil, 138
NF-kB, 111–112 as prime initiator of inflammation, 53–54 Polyphenols, 155, 156, 157, 179 Raspberries, 150, 151
Niacin, 125, 169–171, 200 test measuring, 202–203 Polyunsaturated fats, 40, 83, 100. See also Omega-3 fatty Ratio
Niacin “flush,” 170–171 Oxidized LDL acids; Omega-6 fatty acids; Vegetable oils of omega-6s to omega-3s, 101, 102, 149, 151
Nicotinamide, 170 atherosclerosis and, 48, 49 inflammation and, 100–101 of triglycerides to HDL, 46–47, 58, 67, 71, 75, 139–140
9p21 Test, 203–204 berries and, 150 saturated fats and, 84, 89 Ravnskov, Uffe, 191, 192
Nitric oxide, 152, 154, 180, 184 CoQ10 and, 163 studies on influence on heart health, 38–39, 40, 89, 96–98 Reaven, Gerald, 66, 134–145
NMR Lipo-Profile test. See NMR particle test curcumin and, 179 swapping carbs for, 98 Red meat, 93, 144
NMR particle test, 44, 47, 139, 197–198 linoleic acid and, 102 Pomegranate juice, 154 Red wine, 155, 179
Non-processed carbs, 145, 147 omega-6s and, 102 Postmenopausal women, influence of fats on, 95–98 Refined carbs, 98, 138
Noradrenaline, 64 pantethine and, 175 Pravastatin/Pravachol, 111, 117, 190, 193–194 Refractory angina, 164
Nurses’ Health Study, 21, 27, 92–93, 98, 147, 151, 152 pomegranate juice and, 154 Pre-diabetes, 12, 61, 130, 132, 134, 135, 137. See also Insulin Regulatory T-cells, 117

Mitochondria, 161, 165 Nutritional supplements. See also CoQ10 resveratrol and, 155, 179 resistance
Monocytes, 56 berberine, 179–180 test measuring, 202–203 “Pre-heart disease,” 11, 117–118
Monosaccharides, 79 citrus bergamot, 179 vitamin E and, 172–173 Primary prevention, 123
Monounsaturated fats, 41, 83, 94, 96, 99, 100, 149, 156 cocoa flavanols, 180 Oxygen free radicals, 53, 54 Pritikin Longevity Center, 74
Mortality CoQ10, 161–163 Oxytocin, 115, 116 Pritikin, Nathan, 74
cholesterol levels and, 90–91 curcumin, 179 Proceedings of the National Academy of Sciences of the
CoQ10 and, 173–174 D-ribose, 163–165 P United States, 162
low testosterone and, 115 glucosamine sulfate, 175–176 Packaged foods, 102, 145, 147 Processed carbohydrates
omega-3s and, 173–174 L-carnitine, 165–167 Paleo-type diets, 138 food considered, 145
statin drugs and, 107–108, 116, 119–120, 124, 127, 190, 192, 193 niacin, 169–171 Palm kernel oil, 93 insulin and, 138
vitamin D and, 126 omega-3s, 173–175 Palm oil, 84, 93 reducing or eliminating from your diet, 65, 67, 71, 103, 145,
Moss, Michael, 70 omega-7, 176–177 Pancreas, 68, 71, 130, 131, 137 147
Mother Jones, 77 pantethine, 175 Pantethine, 175 replacing fats with, 22, 31
Mozaffarian, Dariush, 96, 173 problems with research on, 159–160 Partially hydrogenated oil, trans fats and, 31, 147–148 replacing saturated fats for, 98–99
MRFIT study, 102, 119–121, 126 resveratrol, 179 Particle (LDL) size test, 197–198 Processed foods, 79, 149
Mutton, 93 used alone or with conventional therapy, 161 Pasta, 97, 99, 145 Processed meats, 148
Myeloperoxidase, 202 vitamin C, 177, 179 Pastries, 97, 145 Progesterone, 23, 113, 124
Myocardial infarction. See Heart attack(s) vitamin E, 171–173 PCSK9, 50 Progress in Lipid Research, 103
Myristic acid, 93 Nutrition facts label of foods, 148 PCSK9 inhibitors, 50 Project 259: Dietary Carbohydrate and Blood Lipids in Germ-
Free Rats, 78
Nutrition studies. See Studies Pennebaker, James, 186
Pro-oxidant effect from vitamin E, 172
N Nuts, 35, 100, 146, 152–153 Perel, Esther, 42
Prospective Study of Pravastatin in the Elderly Risk
National Cancer Institute, 36 Perilla seeds, 101
(PROSPER), 117
National Cholesterol Education Program, 29, 74, 127 O Pescatore, Fred, 96
PROSPER study, 117, 123, 124, 193–194
National Diet Heart Study, 38–42 Obesity, 21–22, 31, 33, 53, 65, 75, 80–81, 135 Pharmaceutical industry
Protein(s)
National Health and Nutrition Examination Survey (NHANES) Observational studies, 34–36 doctors courted by, 159
content in lipoprotein classes, 44, 45
Food Frequency Questionnaire, 36–37 Olive oil, 25, 83, 93, 95, 100, 144, 149, 156–157 government advisory committees and, 29
diets high in, 20, 21, 74
National Heart, Lung, and Blood Institute, 74 Oliver, Michael, 32 misleading information by, 121–122
glycated, 71
National Institute of Dental Research, 78 Omega-3 fatty acids, 83, 84, 85, 100, 101, 103, 160, 173–175 statins for children and, 114
Protein Power diet, 20
National Institute of Medicine, 159 Omega-6 fatty acids, 83, 85, 86, 100, 101–102, 103, 138, 139, 149 statin trials/studies and, 107–108, 127, 191
Proteoglycans, 48
National Institutes of Health (NIH), 31–32, 40, 133 Omega-6:omega-3 ratio, 101, 102, 149, 151 testing of Vytorin and, 26
Prozac, 115
Natto (soy food), 178 Omega-7, 176–177 Physicians. See Doctors
Psychoneuroimmunology, 182, 188
Nattokinase, 178, 198 Oreskes, Naomi, 78 Physicians’ Health Study, 152–153
Pterostilbene, 150
Natural killer cell cytotoxicity, 116–117 Ornish, Dean, 74, 102 Phytonutrients, 152
“Natural” Vitamin E, 172 Overdosed America (Abramson), 108 Pinckney, Edward, 107
A Near-Perfect Sexual Crime: Statins Against Cholesterol Oxidation and oxidative damage, 11, 45. See also Inflammation; PlaqTM Test, 203 Q
(De Loregeril), 116 Oxidized LDL Plaque, 26–27, 47, 48–49, 55, 57, 102, 125, 157, 199, 202, 203 Qi, Lu, 176
Netherlands Journal of Medicine, 89 as cause of heart disease, 18, 58 Play, 187
Neurodegenerative diseases, chronic inflammation and, 53 endothelial dysfunction and, 48 Pneumonia, chronic inflammation and, 53 R
Neurotransmitters, 109, 115, 116 explained, 55–56 Polychlorinated biphenyls (PCBs), 150 Ramsden, Christopher, 40
New England Journal of Medicine, 26, 27, 76–77, 160, 196, 200 immune system’s response to, 56 Polycystic ovary syndrome (PCOS), 115 Randomized control studies, 39–42, 90
New York Heart Association (NYHA), 162 iron and, 198 Polymeal, 152 Rapeseed oil, 138
NF-kB, 111–112 as prime initiator of inflammation, 53–54 Polyphenols, 155, 156, 157, 179 Raspberries, 150, 151
Niacin, 125, 169–171, 200 test measuring, 202–203 Polyunsaturated fats, 40, 83, 100. See also Omega-3 fatty Ratio
Niacin “flush,” 170–171 Oxidized LDL acids; Omega-6 fatty acids; Vegetable oils of omega-6s to omega-3s, 101, 102, 149, 151
Nicotinamide, 170 atherosclerosis and, 48, 49 inflammation and, 100–101 of triglycerides to HDL, 46–47, 58, 67, 71, 75, 139–140
9p21 Test, 203–204 berries and, 150 saturated fats and, 84, 89 Ravnskov, Uffe, 191, 192
Nitric oxide, 152, 154, 180, 184 CoQ10 and, 163 studies on influence on heart health, 38–39, 40, 89, 96–98 Reaven, Gerald, 66, 134–145
NMR Lipo-Profile test. See NMR particle test curcumin and, 179 swapping carbs for, 98 Red meat, 93, 144
NMR particle test, 44, 47, 139, 197–198 linoleic acid and, 102 Pomegranate juice, 154 Red wine, 155, 179
Non-processed carbs, 145, 147 omega-6s and, 102 Postmenopausal women, influence of fats on, 95–98 Refined carbs, 98, 138
Noradrenaline, 64 pantethine and, 175 Pravastatin/Pravachol, 111, 117, 190, 193–194 Refractory angina, 164
Nurses’ Health Study, 21, 27, 92–93, 98, 147, 151, 152 pomegranate juice and, 154 Pre-diabetes, 12, 61, 130, 132, 134, 135, 137. See also Insulin Regulatory T-cells, 117

“The Relaxation Response,” 184, 185 Seven Countries Study, 29–30, 34, 38, 143 Steroid hormones, 8, 23, 124 on statin drugs, 107–108, 109, 111, 115, 116, 119–120, 121–124, 127,
Research, on nutritional supplements, 159–160. See also Sex(uality) Strawberries, 150 190–196
Studies aging and, 186 Stress, 18, 63, 142, 183 on tea, 156
Resveratrol, 155, 179 statin drugs and, 112–116 Studies using a food frequency questionnaire, 36–37
Reward centers, 62, 69, 70 Sex hormones, 8, 113–115 association, 37–38 on vitamin C, 177, 179
Rheumatoid arthritis, 53 Shechter, Michael, 146 on association between saturated fat intake and Sucrose. See Sugar(s) and sugar intake
Russia, 118 Shin, Yeon-Kyun, 109 cardiovascular risk, 87–90 Sugar(s) and sugar intake. See also Blood sugar; Fructose
Short-chain saturated fats, 92, 93, 94 on berberine, 180 acceptance of, 61
S Sinatra, Steve, 22–25 on calcium supplements, 167 addictive nature of, 70
Safflower oil, 138, 149 Siri-Tarino, Patty, 88 on cancer risk with statins, 117 American consumption of, 77
Salmon, 93, 100, 150, 158, 174, 180 Small, dense type B LDL, 9 on carbs for saturated fat swap, 95–96 as cause of several conditions related to heart disease, 71
Salt Sugar Fat: How the Food Giants Hooked Us (Moss), 70 Smith, Russell, 106, 107 on cholesterol-heart disease connection, 21, 24, 90–91 composition of, 79
Sardinia, 144 Snack foods, 97 on cholesterol levels and risk of heart disease, 119–124 contributing to heart disease, 71–72
Saturated fats “Snackwell Phenomenon,” 31–33 on cholesterol-lowering drugs, 107–108 creating advanced glycation end products (AGEs), 169
carbohydrates replaced for, 95–99 Soda (soft drinks), 75, 81, 97, 145, 158 confirmation bias in, 38 in fruit, 152
characteristics of, 84 Sodium retention, blood pressure and, 64 on CoQ10, 162–163 glycation and, 54
cholesterol and, 87–88, 89, 90–92 Soft drinks. See Soda (soft drinks) on coronary artery calcium, 167–168 high-fructose corn syrup and, 79
diet-heart hypothesis and, 86 The South Beach Diet (Agatston), 168 on diabetes risk with statins, 117 impact on our brain, 69–70
different types of, 92–94 Soybean oil, 138, 149 on D-ribose, 164 insulin resistance and, 61, 71, 79
epidemiological studies and, 37 Stanhope, Kimber, 145 drug company-sponsored, 121–123 omitting from diet, 144–145
foods with, 84 Statin drugs on effects of sugar on heart disease risk, 78 as real cause of heart disease, 18, 22, 30
HDL and, 21, 88, 92, 93–94, 97 benefits of cholesterol and, 23, 24 ENHANCE trial, 26–27 Seven Countries Study on, 30
heart disease and, 87–90, 103 the brain and, 108–109 epidemiological, 34–36 studies on correlation between heart disease and, 72–73,
cancer and, 116–117 on fibrates, 106 75–77
lard and, 84, 86
caution practiced by physicians and patients with, 127–128 Framingham Heart Study, 58 tooth decay and, 78
LDL and, 21, 91, 92, 93–94
for children, 114 on fruits and vegetables, 151 triglycerides and, 65, 67, 71
low-fat, high-carb diets and, 102–103
cholesterol levels and cardiovascular risk data and, 119–124 on garlic, 157 triglycerides and fasting insulin levels impacted by, 67
National Diet Heart Study on, 38–39, 40
cholesterol-lowering impact of, 106 on glucosamine sulfate, 176 Twinkie diet, 67–68
as not perfect or entirely bad, 85
CoQ10 depleted by, 24, 109–110, 162 on high-glycemic foods, 146–147 weight loss and, 68, 69
reducing carbohydrates in your diet and, 99–100
diabetes and, 116, 117, 123, 124 on immune system and cholesterol, 126 Sugar Association, 75, 77
reexamination of case against, 86–87
doctors’ promotion of, 22 on impact of medium-chain versus long-chain saturated Sugar lobby, 75–79
relation to heart disease, 19
gut bacteria and, 111 fats, 92–93 Sugar Research Foundation, 76, 78
replaced with diets high in trans fats, 21–22
gut microbiomes and, 111 on influence of sugar, 75–77 Sunflower oil, 138, 156
replaced with vegetable oils, 22, 38, 40, 98
HDL-LDL tests and, 13 on insulin resistance, 136–137 Supplements. See Nutritional supplements
as rising cholesterol levels, 8
KIF-6 test and, 204 Isehara Study, 91 Sustained-release niacin, 170
Seven Countries Study on, 29–30
limited benefits of, 106 on L-carnitine, 166–167 Sweet and Dangerous (Yudkin), 72
small, dense (type B) LDL and, 8
as lowering cholesterol but not preventing deaths, 107–108 Lifestyle Heart Trial, 74 Sweeteners, high-fructose, 81
studies on link between heart disease and, 29–30, 75–76,
89–90 lowering inflammation, 25 on link between saturated fats and heart disease, 29–30,
75–76, 89–90
Schering-Plough, 26 Lp(a) levels and, 200 T
on low-fat diet, 31–32
Sears, Barry, 20, 63, 138 memory and, 23 Tappy, Luc, 80
Lyon Diet Heart Study, 21, 25–26
Secondary prevention, 123 misleading information from studies on, 123–124 Taubes, Gary, 66, 73, 77
on MCT oil versus olive oil, 93
Second heart attacks, 136 misleading messages about benefits of, 118–119 Tea, 155–156
meta-analyses and, 86, 87
Seed oils, 138. See also Vegetable oils MIT researcher on, 105–106 Technion-Israel Institute of Technology, 154
Nurses’ Health Study, 21, 27, 98
Seely, Stephen, 201 mortality and, 107–108, 116, 127 Tel Aviv University, 146
on nuts, 152–153
Selective serotonin reuptake inhibitors (SSRIs), 115–116 oxytocin and, 115 Test(s), 197–204. See also Cholesterol test(s)
on olive oil, 156
Seneff, Stephanie, 104–105, 110 pharmaceutical ads/studies on, 121–123 determining your risk for having plaque ruptured, 49
on omega-3s, 173–174
Series 1 prostaglandins, 101 risks versus benefits of, 108–109, 124 fasting insulin, 139
on omega-6s, 102
Series 2 prostaglandins, 101 serotonin and, 115–116 insulin assay, 134
on omega-7, 177
Series 3 prostaglandins, 101 sex life and, 112–116 for insulin resistance, 13, 14, 135, 139
randomized and controlled, 30, 33–34
Serotonin receptors, 115–116 side effects, 105, 108 measuring risks of heart disease, 10–11, 14
on real culprits of heart disease, 22
Serum ferritin, 198–199 studies on, 190–196 triglycerides to HDL, 46–47
Seven Countries Study, 29
Sesame oil, 149 Stearic acid, 93, 94 Testosterone, 113, 114–115, 124–125

“The Relaxation Response,” 184, 185 Seven Countries Study, 29–30, 34, 38, 143 Steroid hormones, 8, 23, 124 on statin drugs, 107–108, 109, 111, 115, 116, 119–120, 121–124, 127,
Research, on nutritional supplements, 159–160. See also Sex(uality) Strawberries, 150 190–196
Studies aging and, 186 Stress, 18, 63, 142, 183 on tea, 156
Resveratrol, 155, 179 statin drugs and, 112–116 Studies using a food frequency questionnaire, 36–37
Reward centers, 62, 69, 70 Sex hormones, 8, 113–115 association, 37–38 on vitamin C, 177, 179
Rheumatoid arthritis, 53 Shechter, Michael, 146 on association between saturated fat intake and Sucrose. See Sugar(s) and sugar intake
Russia, 118 Shin, Yeon-Kyun, 109 cardiovascular risk, 87–90 Sugar(s) and sugar intake. See also Blood sugar; Fructose
Short-chain saturated fats, 92, 93, 94 on berberine, 180 acceptance of, 61
S Sinatra, Steve, 22–25 on calcium supplements, 167 addictive nature of, 70
Safflower oil, 138, 149 Siri-Tarino, Patty, 88 on cancer risk with statins, 117 American consumption of, 77
Salmon, 93, 100, 150, 158, 174, 180 Small, dense type B LDL, 9 on carbs for saturated fat swap, 95–96 as cause of several conditions related to heart disease, 71
Salt Sugar Fat: How the Food Giants Hooked Us (Moss), 70 Smith, Russell, 106, 107 on cholesterol-heart disease connection, 21, 24, 90–91 composition of, 79
Sardinia, 144 Snack foods, 97 on cholesterol levels and risk of heart disease, 119–124 contributing to heart disease, 71–72
Saturated fats “Snackwell Phenomenon,” 31–33 on cholesterol-lowering drugs, 107–108 creating advanced glycation end products (AGEs), 169
carbohydrates replaced for, 95–99 Soda (soft drinks), 75, 81, 97, 145, 158 confirmation bias in, 38 in fruit, 152
characteristics of, 84 Sodium retention, blood pressure and, 64 on CoQ10, 162–163 glycation and, 54
cholesterol and, 87–88, 89, 90–92 Soft drinks. See Soda (soft drinks) on coronary artery calcium, 167–168 high-fructose corn syrup and, 79
diet-heart hypothesis and, 86 The South Beach Diet (Agatston), 168 on diabetes risk with statins, 117 impact on our brain, 69–70
different types of, 92–94 Soybean oil, 138, 149 on D-ribose, 164 insulin resistance and, 61, 71, 79
epidemiological studies and, 37 Stanhope, Kimber, 145 drug company-sponsored, 121–123 omitting from diet, 144–145
foods with, 84 Statin drugs on effects of sugar on heart disease risk, 78 as real cause of heart disease, 18, 22, 30
HDL and, 21, 88, 92, 93–94, 97 benefits of cholesterol and, 23, 24 ENHANCE trial, 26–27 Seven Countries Study on, 30
heart disease and, 87–90, 103 the brain and, 108–109 epidemiological, 34–36 studies on correlation between heart disease and, 72–73,
cancer and, 116–117 on fibrates, 106 75–77
lard and, 84, 86
caution practiced by physicians and patients with, 127–128 Framingham Heart Study, 58 tooth decay and, 78
LDL and, 21, 91, 92, 93–94
for children, 114 on fruits and vegetables, 151 triglycerides and, 65, 67, 71
low-fat, high-carb diets and, 102–103
cholesterol levels and cardiovascular risk data and, 119–124 on garlic, 157 triglycerides and fasting insulin levels impacted by, 67
National Diet Heart Study on, 38–39, 40
cholesterol-lowering impact of, 106 on glucosamine sulfate, 176 Twinkie diet, 67–68
as not perfect or entirely bad, 85
CoQ10 depleted by, 24, 109–110, 162 on high-glycemic foods, 146–147 weight loss and, 68, 69
reducing carbohydrates in your diet and, 99–100
diabetes and, 116, 117, 123, 124 on immune system and cholesterol, 126 Sugar Association, 75, 77
reexamination of case against, 86–87
doctors’ promotion of, 22 on impact of medium-chain versus long-chain saturated Sugar lobby, 75–79
relation to heart disease, 19
gut bacteria and, 111 fats, 92–93 Sugar Research Foundation, 76, 78
replaced with diets high in trans fats, 21–22
gut microbiomes and, 111 on influence of sugar, 75–77 Sunflower oil, 138, 156
replaced with vegetable oils, 22, 38, 40, 98
HDL-LDL tests and, 13 on insulin resistance, 136–137 Supplements. See Nutritional supplements
as rising cholesterol levels, 8
KIF-6 test and, 204 Isehara Study, 91 Sustained-release niacin, 170
Seven Countries Study on, 29–30
limited benefits of, 106 on L-carnitine, 166–167 Sweet and Dangerous (Yudkin), 72
small, dense (type B) LDL and, 8
as lowering cholesterol but not preventing deaths, 107–108 Lifestyle Heart Trial, 74 Sweeteners, high-fructose, 81
studies on link between heart disease and, 29–30, 75–76,
89–90 lowering inflammation, 25 on link between saturated fats and heart disease, 29–30,
75–76, 89–90
Schering-Plough, 26 Lp(a) levels and, 200 T
on low-fat diet, 31–32
Sears, Barry, 20, 63, 138 memory and, 23 Tappy, Luc, 80
Lyon Diet Heart Study, 21, 25–26
Secondary prevention, 123 misleading information from studies on, 123–124 Taubes, Gary, 66, 73, 77
on MCT oil versus olive oil, 93
Second heart attacks, 136 misleading messages about benefits of, 118–119 Tea, 155–156
meta-analyses and, 86, 87
Seed oils, 138. See also Vegetable oils MIT researcher on, 105–106 Technion-Israel Institute of Technology, 154
Nurses’ Health Study, 21, 27, 98
Seely, Stephen, 201 mortality and, 107–108, 116, 127 Tel Aviv University, 146
on nuts, 152–153
Selective serotonin reuptake inhibitors (SSRIs), 115–116 oxytocin and, 115 Test(s), 197–204. See also Cholesterol test(s)
on olive oil, 156
Seneff, Stephanie, 104–105, 110 pharmaceutical ads/studies on, 121–123 determining your risk for having plaque ruptured, 49
on omega-3s, 173–174
Series 1 prostaglandins, 101 risks versus benefits of, 108–109, 124 fasting insulin, 139
on omega-6s, 102
Series 2 prostaglandins, 101 serotonin and, 115–116 insulin assay, 134
on omega-7, 177
Series 3 prostaglandins, 101 sex life and, 112–116 for insulin resistance, 13, 14, 135, 139
randomized and controlled, 30, 33–34
Serotonin receptors, 115–116 side effects, 105, 108 measuring risks of heart disease, 10–11, 14
on real culprits of heart disease, 22
Serum ferritin, 198–199 studies on, 190–196 triglycerides to HDL, 46–47
Seven Countries Study, 29
Sesame oil, 149 Stearic acid, 93, 94 Testosterone, 113, 114–115, 124–125

Therapeutics Initiatives, 127 Vegetables, 97, 99, 102, 151–152
Thompson, Tommy G., 75 Vervana, 157
Tocopherols, 172 Very low-density lipoprotein (VLDL). See VLDL (very-low-
Tocotrienols, 172–173 density lipoprotein)
Tooth decay, sugar and, 78 Vioxx, 150–151
Total particle number, 14, 197 Vita, Joseph, 156
Touch, power of, 187 Vital Choice, 150
Touch therapy, 187 Vitamin B3, 170
Trans fats, 83, 100, 103 Vitamin B5, 175
banned by the US Government, 41 Vitamin B6, 200
eliminating from your diet, 147–148 Vitamin B12, 200
on nutrition facts packaging, 148 Vitamin C, 172, 173, 177, 179, 199
saturated fats replaced with diets high in, 21–22 Vitamin D, 8, 23, 126–127
Snackwell Phenomenon and, 31 Vitamin E, 163, 171–173, 174
Transient global amnesia (TGA), 112, 113 VLDL (very-low-density lipoprotein), 9, 45, 172, 175
Trewby, Peter, 191 Volek, Jeff, 65
Triglycerides Vytorin, 26–27
Atkins diet and, 20
gut bacteria influencing how sugar impacts, 78 W
insulin resistance and, 65, 66, 67, 135 Wake Forest Baptist Medical Center, 64
lowering on high-protein, low-carb diets, 21 Walnuts, 101, 144
low-fat diets and, 74–75 Weight loss, 19–20, 68–69
niacin lowering your, 170 Weight loss studies, 68, 69
reducing processed carbs and sugar in the diet and, 65, 140 White bread, 99
sugar intake and, 65, 67, 71 White rice, 97, 99, 138
Triglycerides to HDL ratio, 46–47, 58, 67, 71, 75, 139–140 “Whole grains,” 145
Tunica intima, 48 Wild Alaskan salmon, 150, 158, 174
Tunica intima (artery wall), 48 Wine, 152, 155, 179
Turmeric, 154 Women
Twinkie Paradox, 67–69 fibrinogen, 198
Type 2 diabetes, 54, 68, 72, 89, 134, 135. See also Diabetes serum ferritin, 198–199
Type B LDL, 9 statin drugs and, 114, 129
testosterone and, 114–115
U who eat high amount of carbs, 145
“Ultra-bad” cholesterol, 54 Women’s Health Initiative, 32
Ultra-low-fat diet, 102–103 Women’s Health Study, 152
University of British Columbia, 127 World Health Organization (WHO), 75
Uric acid, 80–81, 164
U.S. Department of Health and Human Services, 75 Y
U.S. Government Accountability Office, 24 Yellow finger syndrome, 37–38
Yudkin, John, 30, 72–73, 78
V
Vegetable oils, 40, 84, 149 Z
easily damaged, 84 Zimmer, Heinz-Gerd, 164
lard vs., 86 Zocor, 110, 192
myths and misconceptions about, 98–100 Zoloft, 115
National Diet Heart Study and, 38–39, 40–41 Zone diet, 20
omega-6s and, 100, 102, 138, 149
replacing saturated fats with, 22, 38, 40, 98
trans fats and, 31, 41
when exposed to heat, 84
240 THE GREAT CHOLESTEROL MYTH

The Great Cholesterol Myth, Revised and Expanded

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Praise for The Great Cholesterol Myth

Digital edition published in 2020

Revised and Expanded

WHY LOWERING YOUR CHOLESTEROL

WON’T PREVENT HEART DISEASE—

DEDICATION Chapter 1: Why a New Edition of This Book Was Needed 10

Chapter 9: The Real Cause of Heart Disease 129

DEDICATION Chapter 1: Why a New Edition of This Book Was Needed 10

Chapter 9: The Real Cause of Heart Disease 129

Chapter 11: Help Your Heart with These Supplements 159

Chapter 11: Help Your Heart with These Supplements 159

8 THE GREAT CHOLESTEROL MYTH FOREWORD 9

8 THE GREAT CHOLESTEROL MYTH FOREWORD 9

OF THIS BOOK WAS NEEDED

OF THIS BOOK WAS NEEDED

CHOLESTEROL and sociology. It’s got a cast of characters ranging

CHOLESTEROL and sociology. It’s got a cast of characters ranging

30 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 31

30 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 31

32 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 33

32 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 33

34 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 35

34 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 35

36 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 37

36 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 37

38 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 39

38 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 39

40 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 41

40 THE GREAT CHOLESTEROL MYTH CHOLESTEROL IS HARMLESS 41

42 THE GREAT CHOLESTEROL MYTH 43

42 THE GREAT CHOLESTEROL MYTH 43

44 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 45

44 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 45

46 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 47

46 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 47

48 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 49

48 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 49

50 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 51

50 THE GREAT CHOLESTEROL MYTH THE REAL DEAL ON CHOLESTEROL 51

INFLAMMATION AND component of virtually every single degenerative

52 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 53

INFLAMMATION AND component of virtually every single degenerative

52 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 53

54 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 55

54 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 55

56 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 57

56 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 57

58 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 59

58 THE GREAT CHOLESTEROL MYTH INFLAMMATION AND OXIDATION 59

60 THE GREAT CHOLESTEROL MYTH 61

60 THE GREAT CHOLESTEROL MYTH 61

DEMON IN THE DIET

DEMON IN THE DIET

IT'S NOT WHAT

IT'S NOT WHAT

THE STATIN her two great interests—biology and computer dia-

104 THE GREAT CHOLESTEROL MYTH THE STATIN DECEPTION 105

THE STATIN her two great interests—biology and computer dia-

104 THE GREAT CHOLESTEROL MYTH THE STATIN DECEPTION 105

106 THE GREAT CHOLESTEROL MYTH THE STATIN DECEPTION 107