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Instead of an informative how to article today I’d like to throw something out here. I’m going to complain a bit – because I’m good at it – and I’m going to pick on a group that made a video today that I saw on Facebook.

 

I watched a video this morning on Facebook titled: “The Best Video You Will Ever See,” and it reconfirmed my dislike for popularized medicine. This video is a story put out by our beloved National Medical Correspondent, Sanjay Gupta. I have no problem with his effort to show people how to prevent and potentially reverse heart disease but the fact is, I’m tired of the continuous onslaught from the “dietary fat and cholesterol are the cause of heart disease camp.”

This story talks about the Esselstyn diet developed by Caldwell Esselstyn of the world renowned Cleveland Clinic. Esselstyn developed a diet that he teaches in a daylong seminar that teaches people that diet has a huge impact on the risk for coronary artery disease. He teaches that heart disease is completely preventable. “We know that if people are eating this way, they are not going to have a heart attack.” He claims that we shouldn’t eat oil, dairy, meat, fish, and chicken.

The Esselstyn diet includes whole grains, beans, veggies, yellow, red and green fruit, bok choy swiss chard, kale, collards, parsley, beet greens, cilantro, arugula, asparagus, turnip greens, broccoli, cauliflower, mustard greens, napa cabbage, and spinach.

Gupta goes on to say, “I was curious about the science…….. Patients on this diet and cholesterol lowering medication had no heart attacks and no coronary events after five years, and ¾ of these patients saw their blockages get smaller.”

 

I have no doubt in my mind that people that there are some individuals who can eat this type of diet and have reduced risk of coronary artery disease and death caused by heart attacks. But the idea that dietary cholesterol causes coronary artery disease is ridiculous, and I wish the proponents of this theory would stop.

Here are my problems with this:

 

The authors make assumptions about why a diet is healthy without backing it up with studies. For instance, they didn’t use a control group who ate dairy, meat, chicken, fish, and oils in addition to the diet they say is healthier;

They didn’t know that they take into account the other lifestyle changes that usually go along with eating healthier;

They didn’t investigate the myriad of health effects that come with eating a low-fat diet. (We’ve been over this before, and we need to move on);

All of the patients were on cholesterol-lowering medications;

The results aren’t that good, to begin with. Take a look at the data from one of the studies summarized below:

From the Esselstyn website:

 

Results. Of the 22 participants, five dropped out within two years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL (6.36 mmol/L) to below 150mg/dL (3.88 mmol/L). Lesion analysis by percent stenosis showed that of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2% (estimated decrease=7%; 95% confidence interval [CI], 3.3 to 10.7, P<.05). Analysis by minimal lumen diameter of 25 lesions found that six regressed, 14 remained stable, and five progressed. Mean lumen diameter increased from 1.3 mm to 1.4 mm (estimated increase=0.08 mm; 95% CI, –0.06 to 0.22, P=NS). The disease was clinically arrested in all 11 participants, and none had new infarctions. Among the 11 remaining patients after ten years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their pre-study diet reported ten coronary events.

  1. They didn’t take into account the fact that most of the dietary cholesterol is not absorbed! Check out this quote from Peter Attia who is one of the most knowledgeable individuals on the subject of lipids:

 

“Much (> 50%) of the cholesterol we ingest from food is esterified (CE), hence we don’t actually absorb much if any, exogenous cholesterol (i.e., cholesterol in food).” 2

 

If someone could contradict my suspicions about this subject and convince me that going back to the low fat/ low cholesterol diet is a good idea for everyone, then I’ll stop eating butter every morning for breakfast. Heck, I’ll even quit eating bacon from pork that my dad raised. If, after reading this, you continue to believe the cholesterol myth, go read information from Peter Attia’s website and check out Anthony Colpo’s book “The Great Cholesterol Con.” Dietary fat and cholesterol are not the problems. There are many lifestyle factors that play into this and we need to stop listening to the jokers that are perpetuating this myth.

One thought on “Yet another joke about cholesterol

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