Diet and Heart Disease:
Not What You Think

by Sally Fallon and Mary G. Enig, Ph.D.

Heart disease is America's major killer; it's prevention is our most urgent public health priority. Americans must change their diet, say the experts. Steer clear of traditional foods like butter, cream, cheese, eggs, and meat, they tell us. Rich foods contain cholesterol and saturated fats — "artery clogging substances."

The accumulation of hardened plaque in the arteries, or atherosclerosis, is indeed a major cause of heart disease in Western nations.

The accepted explanation for its prevalence in civilized countries is the lipid hypothesis, namely that dietary saturated fat and cholesterol lead to elevated levels of cholesterol in the blood, and that these elevated levels of cholesterol cause the pathogenic atheromas that block blood vessels.

This theory has been promoted by the American Heart Association since the mid-1960s. It forms the basis of governmental nutritional recommendations, which in turn have spurred consumer acceptance of a vast array of low-fat, cholesterol free food products, most of which contain ingredients that are new to the American diet.

Numerous studies, both national and international, have explored the lipid hypothesis — and consumed the lion's share of research dollars in this area — including three major projects funded by the National Heart Lung and Blood Institute, a division of the National Institutes of Health (NIH).

The first and best known of these studies was the Framingham Heart Study, carried out in the town of Framingham, Massachusetts.

Although Framingham is often associated with proof of the lipid hypothesis, the results of this 40-year study have been a disappointment to its promoters.

Investigators claimed that there was a 240% increase in "risk" of coronary heart disease, or CHD, between cholesterol levels of 182 and 244. But the actual rate of increase was only .13%.

Between cholesterol levels of 244 and 294, the rate of CHD actually declined.

Thus Framingham investigators found virtually

no difference in heart disease for serum cholesterol levels between 182 and 284

the vast majority of the U.S. population.

Nor did they find that diets high in fat and cholesterol predisposed an individual to heart disease.

As Dr. William Castelli, the current director of the Framingham project, admitted as recently as 1992: "In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more lories one ate, the lower people's serum cholesterol...we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active."

 The second government-funded study was the Multiple Risk Factor Intervention Trial (MRFIT) for 362,000 men.

Researchers found that annual heart disease deaths increased from about 1 per 1,000 for cholesterol levels of 180 to slightly less than 2 per 1,000 for cholesterol levels of 300 — a 100% increase in "risk" but a trivial increase in rate of less that .1%.

A more significant finding was an increase in total deaths for cholesterol levels below 160.

The final major NIH study was the Lipid Research Clinics Coronary Primary Prevention Trial (LRC), a project that cost $150 million and received intense media attention.

All subjects in the trial were put on a low-cholesterol, low-saturated fat diet. One group received a cholesterol lowering drug, the other a placebo. Average cholesterol reduction for the drug group was 8.6% which had, according to researchers, a 17% reduction in rate of heart disease.

This led to the oft repeated statement: "For each 1% reduction in cholesterol, we can expect a 2% reduction in CHD events." But when independent researchers tallied the LRC data, they found no difference in CHD between the two groups. An unequivocal but rarely published finding of the LRC was an increase in deaths from cancer, intestinal disease, stroke, violence, and suicide in the group taking the cholesterol-lowering drug.

Both the popular press and medical journals portrayed the LRC as the long-sought proof that animal fats and dietary cholesterol are the cause of heart disease. The 1984 government-sponsored Cholesterol Consensus Conference called for mass cholesterol screening and defined all Americans with cholesterol levels over 200 as "at risk."

Participating scientists recommended the prudent diet for "at risk" Americans, one low in saturated fat and cholesterol. A specific recommendation was the replacement of butter with margarine. The ensuing National Cholesterol Education Program instructed American physicians in techniques for lowering serum cholesterol through diet ant drugs.

The estimated current cost for cholesterol screening and treatment in the United States now exceeds $60 billion annually.

The application of a modicum of common sense could have prevented the massive expenditures lavished on the lipid hypothesis during the past 30 years.

The lipid hypothesis implies that animal fat consumption must have increased significantly since 1920 to correlate with the rise in heart disease, but in fact the consumption of saturated animal fats in America declined steadily during that period, while use of vegetable fats increased dramatically.

Autopsy studies of vegetarians reveal that although they have lower serum cholesterol values than non-vegetarians, they have as much atherosclerosis as non-vegetarians.

In fact, the International Atherosclerosis Project, which analyzed 31,000 autopsies from l5 countries, found no correlation between animal fat intake and degree of atherosclerosis or serum cholesterol level.

Michael DeBakey, the famous heart surgeon, surveyed 1,700 patients with atherosclerosis and found no relation between levels of serum cholesterol and degree of hardening of the arteries. Other U.S. studies — the Veterans Clinical Trial, the Minnesota State Hospital Trial, the Honolulu Heart Program, and the Puerto Rico Heart Health Study — found no significant relation between a diet high in cholesterol and saturated fats with CHD.

 Unfortunately, these studies do not receive front page coverage in American newspapers, and dissenting voices must content themselves with publication in obscure medical journals. One of these voices is the eminent researcher Dr. George Mann, who states categorically:

"The diet-heart hypothesis has been repeatedly shown to be wrong, ant yet, for complicated reasons of pride, profit, and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprises, food companies, and even governmental agencies. The public is being deceived by the greatest health scam of the century."

Michael Gurr, Ph.D., renowned expert on lipids and author of the authoritative textbook on lipid biochemistry, recently stated that "whatever causes coronary heart disease, it is not primarily a high intake of saturated fat." He criticized "...the degree of self delusion in research workers wedded to a particular hypothesis despite the contrary evidence!"

So if it ain't saturated fats ant cholesterol, what causes heart disease? There are, in fact, a number of dissenting theories, most of which dovetail into a compelling list of dietary and lifestyle factors that are unique to civilized societies. Consider the following:

• In the 1940s and 1950s, researchers Yudkin and Lopez discovered a link between consumption of refined sugar and heart disease. Sugar consumption lowers the body's resistance to bacteria, viruses, and yeasts that may cause inflammation in both the heart and the arteries. Excess sugar leads to deficiencies in the entire B-vitamin complex, needed for healthy arteries. Ongoing research at the U.S. Department of Agriculture indicates that fructose may be even more dangerous than sugar. Fructose, mainly in the form of high-fructose corn syrup (HFCS), has become the sweetener of choice for soft drinks, condiments and many so-called health foods.

• Also in the 1960s, a researcher named Annand discovered a correlation between the consumption of heated milk protein and a tendency to thrombosis — the formation of blood clots — and noted that the rise in coronary heart disease began in the 1920s with laws requiring milk pasteurization.

• Researcher Kilmer McCulley has found a positive relationship between deficiencies in folic acid, B 6 and B l2 , and severity of hardening or stiffness of the arteries, as well as the buildup of pathogenic plaque. B 6 and B 12 are found almost exclusively in animal products — the very foods that proponents of the lipid hypothesis advise us to avoid. B 6 deficiency is also associated with hardening of the tendons leading to carpel tunnel syndrome. Deficiencies of this heat-sensitive vitamin are widespread in America, partly because B 1 and B 2 added to white flour interfere with its proper use, and partly because it is destroyed during milk pasteurization. (Although pasteurization may help prevent foodborne illness, the process destroys nutrients.) Although McCulley's research has gained widespread, albeit grudging, recognition in the scientific community, it continues to lack appropriate funding and public recognition.

• Vitamin C deficiency makes arterial walls more subject to inflammation and tearing. A diet rich in natural vitamin C complex helps maintain the integrity of both blood vessels and heart muscle. Vitamin C also plays a role in collagen synthesis, along with copper, through the enzyme lysyl oxidase. Deficiencies occur in diets that lack fresh fruits and vegetables.

• Heart disease has been correlated with mineral deficiencies. Coronary heart disease rates are lower in regions where drinking water is naturally rich in trace minerals, particularly magnesium, which acts as a natural anti-coagulant and aids potassium absorption, thereby preventing heartbeat irregularities. Mineral-rich water and soil also supply iodine, needed for a healthy thyroid gland. People with poor thyroid function are very prone to heart disease. Calcium also plays a role in protecting the heart and arteries. Potassium helps maintain proper blood pressure. Traditional meat broths are rich in magnesium, potassium, calcium, and iodine. In America, these have largely been replaced by imitation broth products containing MSG and hydrolyzed protein.

• The most important change in the American diet during the years of CHD increase has been the gradual substitution of vegetable fats for those of animal origin. Hydrogenated fats — in the form of margarine and shortening — have replaced butter and lard, while the consumption of vegetable oils has increased more than 10-fold. Since as early as 1956, a number of researchers have found that consumption of trans-fatty acids in hydrogenated oils contributes to heart disease, including most recently Mensink and Katan in the Netherlands, and Walter Willett at Harvard University.

• An excess of vegetable oils, even when not hydrogenated, seems to play a role in causing heart disease because they cause an imbalance in the production of prostaglandins, localized tissue hormones that play a role in all of the body's complex chemical processes; and because industrially processed vegetable oils contain bee radicals that damage the arteries, thereby initiating plaque deposits.

• Arterial plaque contains cholesterol because the body actually uses cholesterol to repair injuries, tears, and irritations to artery walls. However, like rancid vegetable oils, cholesterol that has been oxidized by high temperatures and exposure to air can itself irritate the arterial walls and initiate pathological buildup. High temperature spray production of powdered milk and eggs, used as additives in many processed foods, began in the early part of the century. Consumption of both hydrogenated fats and products containing oxidized cholesterol increased greatly after the war.

• A recent study found that excess consumption of omega-6 fatty acids, the kind found in commercial vegetable oils made from corn, soy, safflower, and canola, increases the amount of oxidized cholesterol in the arterial plaque. Like sugar and white flour, these vegetable oils, produced by high temperature industrial processing, are new to the human diet. It is the polyunsaturated omega-6 fatty acids — not saturated fat — that form the major fat component of arterial plaque, yet for many years the American Heart Association and many establishment nutrition writers advocated consumption of polyunsaturated oils for the heart.

• The role of vitamin D in protecting against heart disease has been neglected. Vitamin D is essential for the intestinal absorption of many minerals, but particularly calcium and magnesium. Vitamin D deficiency is associated with defective calcification of the bones and pathogenic calcification of the arteries. Synthetic vitamin D added to milk has the same effect as vitamin D deficiency — it causes abnormal calcification of the soft tissues, particularly the blood vessels. Our bodies can manufacture vitamin D from cholesterol by the action of sunlight on the skin, but natural dietary sources give added protection. Vitamin D is found only in animal fats.

• Short- and medium-chain saturated fatty acids have anti-microbial effects and protect against the kind of viruses and bacteria that contribute to heart disease. Best sources of these helpful fats are the tropical oils, especially coconut oil, which have largely disappeared from the American food supply due to unfounded assertions that these healthy fats contribute to heart disease.

• Caffeine in coffee causes the body to excrete calcium and stresses the adrenal glands, leading in some cases to general exhaustion, including exhaustion of the heart muscle. This theory has been subject to intense criticism. Detractors note that heavy coffee drinkers tent to indulge in a number of habits considered unhealthy by orthodox researchers — such as smoking and lack of exercise — as well as consumption of sugar and processed foods, leading to deficiencies not yet accepted by the medical establishment as being contributors to CHD.

• Anti-oxidants such as beta-carotene, selenium, and vitamin E may protect us against damage from highly processed vegetable oils and oxidized cholesterol. Orthodox medicine has ignored or ridiculed vitamin E therapy for heart disease, pioneered by the Shute brothers, physicians in Canada, who found that 100 mg of natural vitamin E from wheat germ oil gave excellent long-term protection from coronary heart disease. Fresh fruits and vegetables supply beta-carotene and hundreds of other carotenoids; butter is a particularly rich source of selenium.

• Other theories related to heart disease include lack of exercise, overweight, high blood pressure, smoking, and exposure to carbon monoxide gas.

Heart Disease Has Many Forms

What emerges is a clear association of heart disease with the increased consumption of devitalized, processed, fabricated foot items, including sugar and fructose, pasteurized milk, soft drinks, fortified white flour, miller and egg powders, caffeine, imitation broth products, synthetic vitamins, vegetable oils, and hydrogenated fats.

The lipid hypothesis not only clouds this picture, but inhibits necessary research that could illuminate these connections more clearly. Instead of adding to medical and nutritional understanding, it may be undermining public health — promoting the substitution of newfangled, altered, imitation products for nourishing traditional whole foods, including butter, cream, cheese, eggs, and meat.

Although not unknown, heart disease was relatively rare at the turn of the century, accounting for approximately 8% of all deaths in the United States.

Today coronary heart disease, or CHD, accounts for about 45% of all deaths.

Incidence of heart disease rose precipitously between 1920 and 1960. Since that time, mortality rates from CHD have declined somewhat. This means that victims of heart disease are living longer, due most likely to improved surgical techniques and the advent of angioplasty; but morbidity rates — the incidence of heart disease — continue to rise, although at a lower rate than before.

Of greatest concern is the high rate of heart disease in American men between the ages of 45 to 65.

Heart disease is not a single malady, but a complex of disease coming under a single rubric.

Damage to the heart muscle or myocardium may be due to a congenital defect, or result from inflammation and damage associated with any number of viral, bacterial, fungal, rickettsial or parasitic diseases; from rheumatic fever or syphilis; from toxic chemicals such as carbon monoxide or drugs; from auto-immune reactions or genetic disorders in which important cellular proteins in the heart muscle are deranged; or from disruption of enzymes affecting cardiac function.

The heart may also be damaged by an imbalance between the blood supply and the demands of the heart muscle leading to ischemia, a local deficiency of blood supply, and infarction, the death of an area of heart tissue.

Such deficiency may be caused by physical exertion or emotional trauma, increasing the heart's need for blood; or from a drop in blood supply due to excess bleeding, a spasm in an artery, a blood clot (thrombus) or by coronary artery disease, a condition in which the arteries become gradually blocked by the buildup of abnormal plaque (atheromas) and hardened through calcification. Blockage often occurs in the large arteries feeding the heart (the coronary arteries), or in those supplying the brain, increasing the risk of stroke.

In cases of moderate blockage of the coronary arteries, the patient may suffer from angina pectoris, bouts of brief chest pain; moderate blockage combined with increased demands on the heart, due to exertion or trauma; or severe blockage due to arterial plaque, a clot, a spasm, or any combination of these, may lead to a myocardial infarction, the dreaded heart attack, resulting in cardiac dysfunction and often rapid death. Sudden death is often triggered by an acute arrhythmia — disruption in the rhythms of the heart beat — during a heart attack.

While coronary artery disease is a common cause of heart attack, myocardial infarction may also occur in the absence of arterial blockage, due to a spasm, clot or organic failure of the heart muscle.

Heart disease due to syphilis and infectious disease has been around a long time and probably accounts for a good portion of CHD deaths before 1920. Fatty streaks, lesions, and plaque in the arteries are found in many primitive people, but coronary artery disease, the pathological buildup of hardened plaque leading to partial or total occlusion of major arteries, seems to be a disease of civilization, and probably accounts for a great deal — though not all — of the increase in heart disease between 1920 and 1960, and its continued menace to the present day.