A day or so ago I received this e-mail from a doctor in London.
Dear Dr Kendrick,
I work as a GP in Wandsworth London and I read that you don’t
believe that much in cholesterol and CHD.
I do agree up to 50% of MI patients have normal cholesterol
but some say what’s normal for UK is actually high. Is this argument valid?
Define ‘normal.’ Does normal mean average? If we took the average height of everyone in the UK we would find (very nearly) that 50% of those dying of CHD (coronary heart disease) were above average height and 50% below. So average is clearly normal, but then again so is being tall, or short.
However, if we decided that average height of everyone living in the UK was above ‘normal’, and we then lowered the definition of ‘normal height’ by three inches, we would find that the vast majority of people dying of CHD were now above average height. At which point we could decree that being taller than normal was a risk factor for CHD.
This would obviously be a completely bonkers thing to do. Yet, you can do it with cholesterol levels and everyone nods in general agreement.
Aha, but the argument goes that our lives are completely different than the lives of our ancestors, which has caused our cholesterol levels to be unnaturally high.
An article in the Journal of the American College of Cardiology best summed up this line of thinking. Under the heading ‘Why average is not normal’, O’Keefe, the lead author, made the claim that: ‘Atherosclerosis is endemic in our population, in part because the average LDL (“bad” cholesterol) level is approximately twice the normal physiologic level.’ In short, according to O’Keefe, our cholesterol level should be about 2.5mmol/l, not 5.2mmol/l.
He based his argument, in part on looking at the cholesterol levels of various animals e.g. elephants, and boars, and suchlike. He also used the argument that very young babies (neonates) have cholesterol level of about 2.5mmol/l. Now, in my opinion, anyone proposing this argument should have their medication increased. We should base our cholesterol levels on those found in other animals species….yes, of course we should. You mean those animal species with an average life expectancy of ten years, for example.
However, this argument is now pretty widely accepted by the medical community. We are all, everyone, living in the West, living in such an ‘unhealthy’ way that our cholesterol levels are unnaturally high. The true normal cholesterol levels is 2.5mmol/l.
Fine, if we re-set normal at 2.5mmol/l we will find that 99% of people dying of heart disease do have a ‘high ‘cholesterol level. Problem sorted, average is no longer normal, and the hypothesis that a high cholesterol level is a risk factor for heart disease is now true.
Hold on, I’ve got an idea…
well at least then the statin industry have a much larger customer base!
Dr. Kendrick: I love, love your book and blog posts. I am with you 100 percent regarding the cholesterol hypothesis, including all its variations. I call it the morphing hypothesis. It seems the latest is that the size of lipoproteins is not important, it is the particle number. When will the madness end?? I, for one, do not check cholesterol levels, and do not plan on doing so in the future. I think the obsession with cholesterol and triglycerides is crazy! Why do we have to be concerned with all these things? P.S. I live in PA, not too far from Roseto.
How is Roseto doing these days? Please keep not checking your cholesterol levels.
In 2010 the cardiologist told me my arteries were “normal”. I asked whether that was normal in the sense of average or in the sense of desirable. He was startled: I reckon that not only had nobody asked him before, but he had never asked himself either. I sometimes get the impression that the general run of medics are not a very reflective mob.
excellent post again Dr.Kendrick.
I too advocate not having my lipid levels tested, fwiw I don’t think cholesterol has anything to to with the cause of chd , but is the fix to it, just a fix that carries on trying to fix a constantly broken body, hence clogging up arteries.
I hope one day all the lipid theorists/governments/scientists who follow the “normal” path of the lipid hypothesis finally grow a pair and stand up to say ” we were wrong!, now here is what is happening, and most importantly here is how to cut down the risk of dying from chd”, but hey ho, who knows when that will be.
personally, and I’m not a doctor, I think the cause of chd is inflammation caused by too many carbs in the diet, high blood pressure and directly by foods that are well, just irritable to the heart muscle!
just my 2p.
as someone with congenital heart disease (aortic stenosis) I see my cardiologist every two years, and since I last saw her I have had my eyes opened up by the likes of yourself and zoe harcombe, for that I’m thankful, and enjoying food(real food that is!) to the fullest.
viva la saturates.
Thanks for your comment. It is always nice to know that there are people out there willing to think for themselves.
They will never admit they are wrong. Just imagine what would happen if they did. The stock market would collapse overnight as investors pull out of all the huge processed food and pharmaceutical companies, and it would destroy the economies of whole countries whos major exports are sugar and grains etc. There would be a world shortage of food because people will reject the nutrient deficient processed rubbish, and will seek out only natural food. A similar thing will happen to the huge GMO industry in the US, once the people force the politicians to label it. And this could all happen while the world economy is already a complete shambles with worthless fiat currencies. I am sure there are many politicians who know about the lies in the medical industry, food industry, diet industry etc, and they are trying their best to stop the whole house of cards from falling. But the truth is always there, waiting to bite them when they least expect it.
Someone once said something to the effect that the problem with popular thinking is that it stops people from thinking.
I started reading your book and enjoy your approach to debunking the fat-cholesterol-heart disease idea (not worthy of the term hypothesis?). We need more science and less scientism.
I am fascinated by human thought, how it works, what we all believe. Most importantly, how to change a firmly held idea. Any suggestions are welcome.
And the problem with common sense is that it’s not very common!
From what I have seen the best way to make or change a firmly held idea is to buy off all the people who make policy. You will need lots of money.
Do you think twenty quid will do it?
It is long story but one worth hearing and therefore one worth relating. I am presently working hard upon relating it in my own style with a view to publication.
The way to bring about change in the balance of ideas is to alter the ‘selection pressures’ that act upon them. As it happens money acts as a selection pressure and bears upon the survival or failure and extinction of ideas. Something we find difficult to take on board is that alternate money systems can act as alternate selection pressures and therefore influence the derivation of alternate outcomes. Though it is difficult I am working hard to make the explanation as simple and as objective as is possible. I never thought the project would see the light of day, but progress has lately been encouraging.
You could source The Ecology of Money (Richard Douthwaite) or venture to Lietaer.com which links to all manner of intriguing things. ‘Money as debt’ is a good feature on YouTube, and Paul Grignon has good content on moneyasdebt.net
The curious aspect of our predominating money system is that its presence is not the most striking aspect making it a selection pressure, it’s influence has more to do with its scarcity; and at once that sounds enigmatic.
With best regards, Christopher Palmer
Thanks for you comment, most intriguing
On Thu, 23 May 2013 08:20:40 +0000
I have elaborated a bit about the scarcity of money and how money works as a selection pressure, but didn’t run to it’s involvement on ideas, in a short blog published under the title ‘A HELP TO BUY SCHEME’.
The persistence of fictional ideas is favoured simply because they permit fictional markets. Fictional markets are real but only justified by a false narrative or a false perception. The company here should have little difficulty recognising the market stance upon satins and cholesterol for being markedly fictional. For reasons that run on a bit the need for many markets, including fictional ones, is greater than it need be.
Could the tide be turning, doc?
Interesting. I cannot work out who the ‘expert’ is.
The author appears to be a cardiologist from the Royal Free Hospital, London.
Yes, I was being silly. The expert is the author – as has now been pointed out to me.
Dr Kendrick, I just finished your book and loved it and would agree with you wholeheartedly on the stress thing. I am a 46 year old woman who has had two heart attacks (one at 35 and the other at 46) both occurred after periods of extreme stress, plus I also have moderate Rheumatoid Arthritis. But, because I was diagnosed with hypercholesterolmenia back in my early 20’s, that is all my doctor wants to talk about and why I won’t take the statins he keeps trying to shove down my throat (I stopped taking them, 4 years ago). My thought process on those, is why take them if all you want to do is die everyday from depression. I won’t do it and I refuse to let them test my cholesterol anymore. I eat healthy whole foods and stay away from the junk as much as possible (you should have seen what they tried to feed me in the hospital, all processed crap). I try to exercise as often as I am able, as well, it helps with the RA and the stress.
I just wish other people wouldn’t be so blind about cholesterol and food for that matter. I am a certified health coach and will recommend your book too all my clients, chances are, that even if they don’t need it, they know at lease one (if not more) person who does.
Another sorry tale of statin bullying. As a doctor I feel my job is to advise and recommend – not to manipulated and try to force people to do things they do not want to do. As for your RA, I presume you took steroids? Steroids are, of course, corticosteroids with cortisol (a key stress hormone) as their basic structure. It is clear that steroids are an important causal risk factor for CHD. I would suggest looking at l-arginine supplementation, vitamin D, a very highly reduced carbohydrate diet. I have seen this combination work well to reduce RA symptoms.
I recently reported to A&E because I thought I was having a heart attack, chest pains that wouldn’t go away. This was after a period of particularly high stress at work. Fortunately I was not having a heart attack but my blood pressure was high (no real surprise) and I had a non fasting blood test taken which returned results of 8 for cholesterol. I was then given a lecture by my GP about avoiding fatty foods etc. and given a list of recommended foods. Avarados were off the list (something I know to have benficial effects for the heart) as were nuts. On were Pasta and a whole host of other non food that I normally do not touch.
I have just ordered your book from Amazon and have started the Atkins diet together with making time for regular exercise and magnesium oil and zinc supplements. Won’t be going back for the follow up consultation. I only started to gain weight after starting a low fat high carb diet – used to run 25-30 miles per week on a high fat protein based diet in the past.
Will be reading your book with interest.
“Aha, but the argument goes that our lives are completely different than the lives of our ancestors, which has caused our cholesterol levels to be unnaturally high.”
Well at least the human origins program is illuminating our ancestors may have eaten meats from as far back as 500,000 years or perhaps 1 million.
Spear points that would have been a feature of hafted spears have been dated to 500,000 years, and something called ‘electron spin analysis’ applied to proteins detected in a layer dating back 1 million years suggests some steak or other could have been cooked in a man-made fire that far back in time, though this is open to conjecture. For an old fashioned food to be causally implicated in a modern disease seems a bit far out. We have had time to form an adaptive relationship with fat and cholesterol in our food. And the significance of cholesterol to biology suggests cholesterols part in biology, and in the physiology of ‘us’ would be one that is more adaptive than maladaptive.
The modern diet is distinguished, though, when compared to diets in the past, for being high in highly glycaemic carbohydrates and high in polyunsaturated fats, and the omega-6 species of PUFA in particular. Barry Groves made a striking case in ‘Trick and Treat’ that these developments are strikingly implicated in several chronic conditions that plague the time and places in which we live. While these suspects are not implicated with certainty where one condition is concerned, the recurrence of these suspects in alternate conditions does lend weight to the thesis that have some part.
I recently learned Barry passed away on 29th April 2013, aged 77. Barry is survived by his unassuming and charming wife Monica. News of his death is one of the saddest moments of this year for me, and I would send a message of condolence to Monica if I were able. I have recently advanced ‘connections’ that I think would have interested Barry. I met him very briefly in September 2011 and thence harboured the ambition to converse in a more extended way. we exchanged a few short emails. Barry always appreciated contact from his readers. I wondered, Dr Kendrick, if news had reached you? Barrys’ contribution deserved official recognition within his lifetime, would you agree? Bless him.
Yes, I knew of Barry’s death, and sent a few comments to be read out by Zoe Harcombe. Most sad.
I agree official recognition would have been good, but he was too far ahead of his time
On Thu, 23 May 2013 08:46:09 +0000
Here’s a tongue in cheek, very simplistic suggestion re how to change minds: we all buy a copy of your book and send it to everyone in the medical world. Ok so I’m only a layperson, but it changed mine! The trouble is one does have to have a mind prepared to be changed, which is apparently a rarity almost never to be seen in the medical arena as far as I can tell.
I have just started reading your blog – have read your book (Chol. Con)- good stuff. On the possibility that human cholesterol levels abnormally exceed that of other animals… I first heard this on our ABC radio podcast some months ago. Intrigued, I found the original O’Keefe paper – so they found 8 wild animal species, and 5 human groups whose cholesterol levels were less than that of an average adult American – is that it? and do 8 wild species represent a good sampling of the world’s wildlife?. Well, being a veterinarian, I have access to information sitting on my bookshelf. Specifically, the text “Zoo and Wild Animal Medicine” by Fowler (2nd edition, 1986 – I’m almost retired, I’m not going to get the latest edition for my small animal practice!) After a bit of index searching and flipping pages, I am pleased to report that there are at least a dozen other species in the world with a similar cholesterol level to the average American (or at least they did before 1986). This is not an impressive paper by O’Keefe et al, but I fear its message may further distort the cholesterol story. Someone should send O’Keefe a copy of a vet text!!
O’Keefe’s paper is utter hogwash. The idea that you can look at other animal species (some of which live for five years) and claim anything about human health is so ridiculous that it made me laugh. Unfortunately, I hear his ideas sticking in people’s brains. ‘The real healthy level of human cholesterol is one – or two.’ I have had this quoted by doctors. The reality is that people believe exactly what they want to believe, and angrily reject the facts that create cognitive dissonance.
What I’ve been reading here is really depressing for people like me who have no medical knowledge at all, and just follow their gut instinct, part of which is that you, Dr K are spot on and ought to be head of the GMC. The more I read about what doctors are telling their patients, and the little they obviously know or understand about cholesterol levels and CHD, the less I realise we can trust them. This is a terrible situation – to not be able to trust what your GP or medical ‘experts’ tell us. They probably groan when we say ‘I’ve been reading this book…! But we must just stick up for ourselves and refuse to be bullied by them. On behalf of others like me, I would just like to say thank you to you, Dr K and to all those who fight for common sense (even though, as someone has said, it isn’t all that common). Thank you for this blog which remains sane in an insane society. You are a hero in a world of wimps.