If you are one of the five million people in the US with heart failure and you are taking a cholesterol-lowering drug called a statin (examples are lipitor, crestor, vytorin, zocor), you should know about two studies that your doctor probably hasn’t read.

One is called CORONA and the other GISSI-HF. These two large studies are the first to examine whether people with heart failure should take statins.

Most patients with coronary artery disease (arterial plaques) are already on statins because that has become standard of care. But many people with cornary artery disease also have heart failure (weak heart muscle) and, until now, no study could tell doctors whether or not statins should be continued once people develop heart failure. Now, it looks like they should be stopped.

The issue is mevalonate. Statins block the production of mevalonate, which is a chemical the body uses for all kinds of stuff, including building muscle. The heart is a muscle and mevalonate blockers may damage it. (More on that, here.)

Unfortunately, cardiologists still consider it “obvious that statins would be beneficial” in heart failure, and may not be willing to read the studies. The assumption that statins are good for all heart conditions was so powerful that researchers had a hard time getting funding for CORONA. (See article, below) Many could not see through the haze of statin-euphoria to realize that heart failure studies still needed to be done, even calling one of the studies “unethical” because people would be off statins for the duration of the study.

Dr. Poole-Wilson, who presented the studies at a medical conference, is one of the few cardiologists who is willing to admit he was wrong, saying now that the results are in he would not put anyone with heart failure on them, not even if they had the earliest stage of heart failure, called class one heart failure, in which people don’t typically have any symptoms.

Why isn’t this making national headlines?

You can probably guess what I’m going to say: the pharmaceutical companies are threatening to pull TV, magazine, and newspaper ads if reporters mention this study. This information will probably be very slow to trickle through the labyrinth of spin doctors to inform actual doctors.

If you are on a statin, it’s time to ask your doctor if he’s read the studies describe in the article posted below:

Statins Offer No Benefit In Chronic Heart Failure

MUNICH — Rosuvastatin at 10 mg perday had no impact on clinical outcomes in patients with chronic heart failure in a large clinical trial.

Results of the GISSI-HF trial, in which 4,574 Italian patients with chronic heart failure were randomized double blind to the statin or placebo and followed for a median of 3.9 years, suggest that there is no indication for giving statins as a treatment for heart failure, Dr. Gianni Tognoni said at the annual congress of the European Society of Cardiology.

He noted that this is the second large clinical trial that has failed to show a mortality benefit for statin therapy in patients with symptomatic chronic heart failure. The GISSI-HF trial follows the 5,011-patient Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA), which featured 33 months of follow-up in a population with a history of ischemic heart disease (N. Engl. J. Med.;357:2248–61).

In GISSI-HF, all-cause mortality was 29% in the rosuvastatin (Crestor) group and 28% with placebo. The other primary end point—death or hospitalization for cardiovascular reasons—occurred in 57% of statin-treated patients and 56% on placebo, according to Dr. Tognoni, cochair of the GISSI-HF steering committee and professor of cardiology at the Mario Negri Research Institute South, Chieti, Italy. Both differences were statistically nonsignificant.

The GISSI-HF was a nested study designed to test two hypotheses. Unlike the statin hypothesis, the other one—that a once-daily, low-dose, fish oil capsule would reduce morbidity and mortality in patients with symptomatic chronic heart failure—was supported by the findings (see accompanying story, p. 1). The only GISSI-HF participants in the larger fish oil study who weren’t randomized to rosuvastatin or placebo were already on a statin or had a contraindication.

Discussant Dr. Philip Poole-Wilson commented that he found GISSI-HF persuasive and generalizable, particularly taken together with CORONA. The findings are surprising and disappointing in light of the much-discussed pleiotropic effects of statins, which now appear to be clinically irrelevant in the setting of heart failure.

The trials, he said, contain a valuable lesson: “GISSI-HF has refuted many observational studies, and yet again meta-analyses have been shown to be wanting. They all predicted a positive outcome. And there were even those who said that the CORONA study and this study were unethical because it was so obvious that statins would be beneficial; they were wrong,” declared Dr. Poole-Wilson, professor of cardiology and head of cardiac medicine at the National Heart and Lung Institute, Imperial College, London.

The GISSI-HF trial indicates patients with symptomatic heart failure should not be started on a statin. That’s obvious. But the studies also raise several new controversies, he continued.

“If a patient has severe heart failure and is already on a statin, are you going to withdraw it? The trial didn’t actually address that question, yet we have to make a judgment. My judgment is that the answer is probably yes,” Dr. Poole-Wilson said.

Similarly, he would now be inclined not to start a statin in an asymptomatic patient with New York Heart Association class I heart failure, although that’s a decision that needs to be individualized.

There is, however, overwhelming evidence that statins are beneficial in patients with coronary heart disease but who don’t have heart failure.

“And one of these benefits is to reduce new-onset heart failure. So all of those patients must be started and maintained on a statin,” Dr. Poole-Wilson emphasized.

The GISSI-HF trial was funded by the Societa Prodotti Antibiotica, Pfizer Inc., Sigma Tau, and AstraZeneca Pharmaceuticals, which provided Dr. Tognoni with research support and honoraria. The trial was simultaneously published online (Lancet 2008 Aug. 31 [doi:10.1016;50140–6736(08)61240–4]).

Have you lost your job and your insurance? Or is your employer cutting back on your benefits?

Are you cutting back on medications to save money?

You’re not alone.

The New York Times tells us that “For the first time in at least a decade, the nation’s consumers are trying to get by on fewer prescription drugs.” As a doctor, I’m not too excited about patients discontinuing medications without the advice of a physician. But there is a potential upside. With radical reductions in the amount of money available to spend on medications, I hope that people are going to consider more seriously the option of taking care of their bodies. Not only will that prevent the need for many medicines, it will keep them alive longer and make them feel better than taking pills.

Health is more important than healthcare.

While nobody wants to get sick, people assume that if they -or their children - do fall ill, they’ll be taken care of. I see this attitude taken to dangerous extremes. Some examples of what I see:

• Diabetics eat cake and cookies whenever they want by adjusting their dosages of medication to lower their blood sugar levels. Keeping blood sugar under control this way puts them at high risk of sugar swings. While it does prevent developing diabetic coma from their terrible diets, it does little to prevent the long term damage done by high sugar.
• Women know that breastfeeding reduces ear infections and other illnesses in their children, but if formula is covered by their insurance, they stop breastfeeding much sooner than women whose insurance doesn’t pay for formula.
• Adults with cholesterol problems caused by diet would rather take the cholesterol pill than change their diet. Of course, cutting cholesterol out of your diet is not the way to reduce your cholesterol levels. Unfortunately, most doctors don’t know this and will tell you to avoid healthy foods like milk, eggs, and meat.

I hope that a reduction in healthcare coverage will lead to a rise in people’s interest in healthy lifestyles!

And it will save money:

In 2005, a Northwest region study showed that “obesity increases annual medical spending per person by 37.4%, or around $730 a year. And overweight increases spending per person by 14.5%, or $247 per year.” In 2007, the American Diabetes ssociation calculated that “the 2007 per capita annual costs of health care for people with diabetes is $11,744 a year…”

Deep Nutrition, my new book, will help you understand the power of food to reduce your need for prescription medications and make you healthy!

Diabetes.

So many families are dealing with it these days, you could be tricked into thinking diabetes a normal condition. TV commercials with little girls showing off glucose testing monitors in new fun colors—to match their cell phones—could almost convince you that diabetes is now so treatable that it’s nothing to be concerned about. But diabetes is serious problem, and can lead to some scary complications down the road. What is more, it’s a sure sign that there are other related metabolic issues that need to be addressed.

What Is Diabetes

Diabetes is a condition in which a person’s blood sugar levels are too high. There are two types of diabetes, 1 & 2, and most people have type 2. I’ll be focusing on type 2.

People get diabetes mainly because of poor eating habits. Years of consuming processed foods, snack foods, soda, juice, and other low-nutrient high-calorie edibles can damage a person’s metabolism so that hormones don’t work properly. One of the hormones that doesn’t work right is insulin. Before people are diagnosed with diabetes they may be diagnosed with insulin resistance, and all diabetics are resistant to insulin. What does that mean?

Insulin helps the cells in your body suck the sugar they need to produce energy right out of the bloodstream. You can imaging that cells have little straws they put on the surface and some of those straws select glucose from the bloodstream as it floats by, and slurps it right into the cell.

When you have insulin resistance, your cells don’t have enough straws, and they can’t slurp up sugar very fast. This makes people tired, especially a few hours after eating when their sugar levels drop. Some people interpret this feeling as hunger, and go find something to eat—usually something sweet—which puts them on the fast track to gaining more weight, and making the problem worse. People with insulin resistance have slightly elevated fasting blood sugar levels. (90 mg/dl or higher)

Eventually, the body “learns” that it needs to keep blood sugar levels higher, so that there’s more sugar in the bloodstream. With more sugar floating around, it’s easier for hungry cells to slurp it up. But sugar damages cell surfaces too, by a process called Advanced Glycation End-Product (or AGE for short) formation. AGEs make the cell membranes stiff and that means cells have a harder time poking their little straws through the surface. And when the cells put out fewer and fewer straws, the sugar levels go up higher and higher. This is a vicious cycle that takes a person from from insulin resistance all the way to to diabetes.

How To Get Rid Of Your Diabetes

If you cut your carbs down to less than 100gm a day, the equivalent of 3 slices of bread, and eat fresh, healthy foods instead of processed foods as well as plenty of foods containing healthy, saturated fat, you can break the vicious cycle once and for all and get started on the path back to good health. It’s only natural.

For more information on healthy eating, click on Learn About Nutrition in the sidebar.
And if you really want to be an expert, you can buy my book!

Is Cancer Inevitable With Age?

According to the American Cancer society, a million people will get cancer this year alone. One of every two American men and one of every three American women will get some kind of cancer within their lifetimes. It’s enough to leave you feeling helpless, as if cancer is just one of the inevitables of life. But it doesn’t have to be.

Aside from getting plenty of sleep and reducing your stress ( and not smoking) there are just two steps you need to take to drastically reduce your risk of getting, or dying from, cancer.

How To Avoid Cancer: The Two Steps You Can Take Today

Step 1: Buy organic. Especially if you eat animal products.

Our food chain is tainted with carcinogens at every level, from the ground, to the pesticides on plants, to the hormones injected into animals and included in their feed, to the fungicides and preservatives, and even the plastic containers our food comes in. Most of these are present at low levels, and so the FDA allows manufacturers to pump poising into our food on the theory that just a little bit probably won’t hurt. Fortunately, by buying organic, you can avoid most and maybe all of these nasty, industrial chemicals.

But if you have a limited budget for organic, you get the most bang for your buck by buying animal products. This has to do with something called bioconcentration, which describes what happens to chemicals as you go up the foodchain from vegetable to herbivore to carnivore.

You probably have read that certain fish contain dangerously high levels of mercury, so much that pregnant women should avoid them. These fish are at the top of the food chain. The mercury gets into the food chain at the bottom, when it’s incorporated into algae and other plants. Herbivorous fish eat those plants, and usually contain only low levels of mercury. But the mercury they eat tends to get deposited in their fat and stay there for a very long time. So these fish have a higher concentration of mercury, pound for pound, than the plants they ate. The mercury has been bioconcentrated. The fish that eat herbivorous fish get larger doses of mercury than the fish that ate the plant, because of that bioconcentrating effect.

Conventionally grown plants are sprayed with all kinds of chemicals, which you avoid (more or less) by buying organic. Conventionally grown animals eat plants that have been sprayed with chemicals, and, like mercury, those chemicals bioconcentrate in the animal’s tissues. When you eat them, you’re like the fish at the top of the food chain with dangerously high levels of mercury in their tissues. When you buy organically grown animals raised on organic food themselves, you’re avoiding chemicals that were put into the plants and chemcials that were put into the animals. Not only are these animals chemical free (or nearly so) they tend to be raised in better circumstances and are healthier for you to eat because they got better care.

Step 2: Avoid pro-inflammatory foods

Certain foods are new to the food chain and our bodies can’t handle very much of them. The two kinds of foods I’m talking about are sugar and vegetable oil.

Why Sugar Causes Cancer

Sugar sticks to proteins in your body by a process called Glycation, which leads to sugar coated proteins on the surfaces of your cells and moving parts. Fortunately, a healthy body can regulate blood sugar levels and keeps them low enough so that glycation occurs very slowly and repairs can always been made.

But when a person can no longer keep their blood sugar under control, their risk of cancer increases. Research has shown high blood sugar to be a direct cause of precancerous changes in kidney cells  and in intestinal cells . But there is also research that suggests that sugar sticking to cell membranes leads to disturbances in cell function that can cause any and all types of cancer.  And if your sugar levels are high—if you have insulin resistance or diabetes—your cell membranes are coated with sugar. (A fasting blood test can tell you if your sugar levels are too high, 90mg/dl or higher means your risk of cancer is increased.

Why vegetable oils cause cancer

Vegetable oils are cheap and highly processed. During processing, the heat, pressure, and chemical deodorizers deform the fatty acids. Once healthy essential omega-3 and -6 fatty acids get transformed into toxic compounds called lipid hydroperoxides, lipid epoxides, cyclic fatty acid monomers, and other cancer causing compounds.

References

Sugar and Kidney cancer: “Renal carcinogenesis in models of diabetes in rats: metabolic changes are closely related to neoplastic development.”

Sugar and intestinal cancer: “Hyperinsulinaemia and hyperglycaemia: possible risk factors of colorectal cancer among diabetic patients.”

High blood sugar as a carcinogen:  “A novel function of the receptor for advanced glycation end-products (RAGE) in association with tumorigenesis and tumor differentiation of HCC.”

Dangerous fats in vegetable oils: Formation of modified fatty acid and oxyphytosterols during refining of low eruic acid canola oil.

The lovely Oprah Winfrey, one of the wealthiest women in the world with a private chef and whole team of doctors and nutritionists at her beck and call, struggles with her weight. If she has a hard time maintaining a healthy weight, what chance do the rest of us have?

The answer to that depends on the advice we’re getting. Unfortunately for her, Oprah and her advisers are working from the standard models of nutrition—the idea that the USDA Food Pyramid and “everything in moderation” will get results. If you’ve struggled with your weight, even while you’re done your best to follow the rules, you may already suspect that there’s something very wrong with a lot of the advice we’re getting about food. So let’s clear up the confusion.

Beyond Calories

When I was in medical school, I learned that the only way to loose weight was to consume fewer calories than you burned. The theory was based on a simple energy balance principle, which basically describes the human metabolism like a coal-fired furnace. In practice, however, I found that the formula frequently failed. My patients would cut back on portion sizes, exercise, and still fail to loose weight. At first, I assumed people were embarrassed to tell me about secret snacks and midnight refrigerator raids. But after applying the molecular biology and biochemistry I learned in graduate school to the physiology I learned in medical school, I discover that the energy balance formula fails because it ignores the complex effects of food on the human metabolism.

Food As A Language

One of the most important things to understand before you can loose weight is that food is far more than calories; it’s actually complicated chemical information. What your body does with that information determines how your body grows. Certain foods tell your body to build fat. Trans fat, found in margarine, hydrogenated vegetable oil, and products made with processed vegetable oil is one. If you are eating foods containing these chemicals on a regular basis, then you are constantly telling your body to pack on pounds. It’s not your metabolism, it’s your diet. And you control your diet.

Deep Nutrition helps you understand hidden sources of trans fat, and fats that are worse for you than trans, as well as how to cut your sugar and why butter, steak, and salt can help you loose weight.

Hey, give us a break! We get foot-tall stacks of journals every week. You can’t really expect us to do all that reading? What many people do is skim the titles and conclusions. It’s the Readers Digest way to get the information down.

Unfortunately, a little knowledge is dangerous and there’s a huge problem with practicing this kind of Readers Digest medicine. Why? Because the conclusions that get printed aren’t necessarily true!

A 2003 article in JAMA shows that most of their own articles, as well as articles in other well-respected journals, contain data that doesn’t support the statements made in the conclusion. This happens nearly 100 percent of the time in drug-company sponsored research articles, which were found to exaggerate benefits and minimize potential harms, sometimes to the extent that they make false claims of safety and efficacy.

I was never a big fan of bone density drugs because I understood that they worked by suppressing an important physiologic process called bone turnover. A recent NYT article now warns that they may indeed be harmful. I practice what I believe to be safe medicine by remembering the basic physiology I learned in medical school, and you can encourage your doctor to do the same by asking him to explain to you how any “preventative” drug you are taking works, and why he or she thinks a given pill is safe enough to take for (potentially) 10 or 20 or more years.

In 2009, HMSA (Hawaii’s largest health insurance company) will start fining doctors who don’t put every last one of their diabetics over the age of 40 on a cholesterol lowering pill. No matter what your cholesterol, if you are a diabetic, your doctor will probably write you a prescription. Even if you don’t have heart disease. How can they justify this?

I asked HMSA’s medical director, an internal medicine MD. He says the practice is well supported by extensive research. But it appears he didn’t do the research himself, nor did anyone in HMSA. HMSA hired a company to outsource this decision making process. When I look at their package of supporting information, I see some very fishy writing.

Two of the articles are based on the opinions of nine doctors, eight of whom are paid drug company consultants.

One citation is a CDC web site that has disappeared.

The only article of any merit is about a study done on about 2,000 people with diabetes, half of whom took a sugar pill and half of whom took a cholesterol pill. Almost two hundred people had to stop the cholesterol pill due to side effects. This effectively weeds out the more sickly people and so it is not surprising that in the group taking the pill there were fewer heart attacks - at least to start with. The study was stopped early, for reasons they don’t explain. What has me worried is that, when I look at the graph comparing death rates in the two groups, the first few years look pretty good for the group on the drug. But by the end of year three, people start dropping dead fast - so fast the line looks like its starting to go straight up. What is the real reason they stopped the study prematurely? Could it be that they saw where the line was heading, and decided to quit while they were ahead?

Remember, this line is the group of healthier people (b/c they could handle the side effects of the drug) and even they started to die after taking it for almost four years. HMSA wants diabetics to stay on it for life.

The research does show that some people who have had heart attacks do benefit from statins. But the research does not support what HMSA plans to pay your doctor to do now. If I don’t go along with this, I will lose money. This is not fair to me as a conscientious physician, and its not fair to HMSA’s customers who may pay a price with their lives in four years time.

If the drug helped the lines would diverge, like this (From 4S trial, which studied the effects of statins primarily in male smokers who already had a heart attack)

from Lancet, 2004. 364(9435): p.685-96

Safe For Four Years? In this highly selected group of people, problems seem to increase just before the study was ended prematurely by the organizers.

A quick glance, and the graphs make the drug look pretty good. The two lines represent cumulative “endpoints” over time of (top to bottom) major heart attack, death, or other heart-related emergency room visit. And the top line represents people on placebo, the bottom represent people on the pill. The higher the line, the more people have been diagnosed with one of the endpoints, either major heart attack, death, or other heart-related emergency. But all is not as it seems, so to understand, you have to take a better look.

The middle graph is the most important because it answers the one question we really care about - does taking this pill prevent anyone from dying? So let’s look at the middle one. (Why is that the most important question? See below)

Right above the graph it says there’s a risk difference of 27%. That sounds pretty good. It sounds like more than a quarter. And if it were true that cholesterol pills could prevent one heart attack for every four people taking it, I’d be all for it. But that’s not what relative risk means. Relative risk is a handy way to exaggerate a minimal benefit of a drug. Most busy doctors fall for the trick.

If your doctor took the time to look real close, she’d see that at year one the number of people who were not taking the drug who died was 1418, versus only 1395 deaths in the group taking the drug. A minimal effect - less than one percent. Though the drug may have saved 22 lives that year, and the difference is real, certainly, to those 23 people, but it means that if you give the drug to 100 people, not even one will benefit. (So what if you take drugs that don’t help? Side effects, that’s so what- including memory problems, cancer, accidental death, and more. See my posts here and here.)

But the scary thing about the graphs, that most doctors don’t catch, is the total numbers of people who stay in the study till the end. Of the over 1400 who start, 5 years later the number dwindles to 350. Why? Did they die?

For the answer, stay tuned. There’s much more to “evidence based medicine” than meets the eye!

Many of the comments on the NYT and other articles on the new recommendations for pediatricians and family doctors to put children on brain-damaging statins are expressing outrange that drug companies are taking over the minds of doctors. Don’t blame doctors. We’re being threatened by insurance companies. If we don’t do exactly what drug companies want, we’ll be paid less. In some cases, some of us might loose our jobs. (OKay, we do deserve some blame for not standing up for ourselves!)

I went for a job interview in Portland and in a conversation with the medical director of a large group there, I was told that if I failed to get my patients LDL levels down to 100 “someone will sit down and talk with you.” This particular group was able to offer a better starting salary than average. I had assumed that the reason they could offer more was through efficiencies. During the interview, I learned there was more to it than that. They had special arrangements with drug companies called ‘incentive programs.’ The medical director told me with absolute glee “we keep asking them [meaning drug companies] for money and they keep giving it to us.” He sounded like a kid at Christmas!

This group’s policy is to get everyone’s LDL under 100, regardless of risk factors. Stratifying risk is “too complicated.” So they make it simple for their docs. How convenient for the drug companies. I suspect that because this organization has such an aggressive general policy, the drug companies reward them handsomely for taking such a progressive position. They can offer about $50,000 more per year than doctors working in their own, independent offices.

HMSA is Hawaii’s largest medical insurance company. They are paying me to prescribe statins to people who have had heart attacks. Next year, they will pay me to prescribe statins to every single one of my diabetic patients. If I don’t I may loose about $20,000 and my entire group will be penalized financially as well. [Update: As of July 22, thanks in part to consumer concerns, HMSA has scrapped the plan to require all diabetics get statins. Thank you, Hawaii, for your help. And thank you HMSA for listening!]

If any of this disturbs you, please write to John Berthiaume MD, HMSA Vice President/Medical Director. 818 Keeaumoku Street, Honolulu, HI 96814 and tell him what you think. Or, you can write to the medical director of your own insurance company and let them know what you think about your payments going into programs that force doctors to write bad prescriptions or loose money!

Overview of The Lipid Cycle

The lipoproteins must deliver fatty nutrients to the tissues that need them, and then be removed from circulation (by the liver) when spent. The cycle is continual, with new nutrients entering into circulation by way of the liver, the skin, and many other tissues, on a continual basis. Major inputs come from the diet, and the ultimate disposal of broken-down fatty nutrients occurs with excretion into the bile. Because the flow of nutrients is continuous, the phases outlined below are broken into arbitrary points only for the sake of clarity.

Phase One

The small intestinal cells manufacture the very first lipoprotein particles that newly ingested fats will circulate within, called chylomicrons. Chylomicrons enter the bloodstream via the thoracic duct, which bypasses the liver to dump directly into the left subclavian vein. Sometimes the term nascent chylomicron is used to describe the first lipoproteins particle manufactured by the intestinal cells. When nascent chylomicrons circulate through the bloodstream they encounter HDL and acquire certain marker proteins called apoproteins, some investigators prefer to describe chylomicrons as particles containing these apoproteins exchanged with HDL. (Because the science is in flux, the names are changing.) Chylomicrons circulate throughout the bloodstream for several hours distributing fatty nutrients to the tissues that are in need and receptive, and acquiring apoprotein markers from HDL.

Phase Two

Spent chylomicrons, also called chylomicron remnants, enter the liver carrying their new apoprotein markers presumably to identify them as non-foreign material, as well as to direct them into the correct section of the liver for further processing. The liver repackages useful fatty nutrients for the second phase of circulation, as well as adding some of its own newly manufactured or stored nutrients. The particle exits the liver with new apoprotein biomarkers, and at this point it is called Very Low Density Lipoprotein, or VLDL.

Phase Three

VLDL circulates through the bloodstream and, analogous to the process with chylomicrons, distributes fatty materials to the tissues that are in need and receptive. And just as with the chylomicrons, as they circulate they encounter HDL and acquire apoprotein surface markers. At this point the terminology becomes muddy. Some investigators describe the shrunken, spent VLDL particle as Intermediate Density Lipoprotein and others describe them as Low Density Lipoprotein. Again, the science is in flux and clouded by emotionality and a particularly unscientific set of assumptions, as the terms “good” and “bad” cholesterol suggest.

Vascular Disease

When dietary imbalances (such as low intakes of omega-3 fatty acids, excess intakes of hydrogenation made trans fats), smoking, vitamin deficiencies, genetic disease or other insult intervenes in the healthy role that plays the lipid cycle, some lipoprotein particles may start playing a deleterious role in health. Some may generate inflammatory processes at the endothelial lining of the blood vessels as well as inside the artery walls themselves. The extent and duration of an individuals inflammatory response, coupled with the underlying support strength of the vascular wall, determine whether the artery becomes scarred with atherosclerotic plaque, and determines the thrombotic potential of that plaque.

Controversy

Many lipid scientists began their career with the understanding that cholesterol molecules are inherently dangerous and that the modern diet is unusually high in cholesterol, hence modern cardiovascular diseases are unusually prevalent among industrialized nations. As the science has become more sophisticated, we now understand that native cholesterol is not disease causing, and that oxidized cholesterol and other oxidized fats are the important class of fat-related factors, with other factors involved in atherosclerotic vascular disease being cigarette smoking, genetics, stress, and nutrient deficiencies, specifically low intakes of B-vitamins that allow a toxic agent, homocysteine, to be distributed by lipoproteins. However, the older belief that cholesterol is inherently bad still permeates the medical literature. This leaves us with a dichotomy of viewpoints and presents a significant barrier to progress in this field.

Source Material:

Textbook of Biochemistry With Clinical Correlations, Devlin. Fifth ed. Harrison’s Principles of Internal Medicine, 14th edition.

Grass fed beef is available at several stores around the island.

• West side: Ishihara Market in Waimea. Look for the “Island Beef” label
• South side: Medeiros Farms in Kalaheo. All beef, chicken and eggs are local. Chicken and eggs are feed raised. Beef is grass fed and delicious. Check out my post about why they make such tasty meat.
• more coming soon!