The Great Cholesterol Myth (11 page)

What does this have to do with cholesterol and heart disease? Actually, everything. You may recall our earlier discussion about LDL cholesterol in which we pointed out that LDL cholesterol is never a problem until it becomes damaged. (Remember, damaged LDL cholesterol of the BB gun pellet variety [pattern B] gets stuck to the artery walls, ultimately triggering the immune system reaction that causes inflammation.) We discussed one primary way in which LDL cholesterol gets damaged—through oxidative stress generated by free radicals.

Can you guess the other way it gets damaged?

Glycation.

So now you have sugar at the scene of several crimes, all related to heart disease. “High blood sugar causes the lining cells of the arteries to be inflamed, changes LDL cholesterol, and causes sugar to be attached to a variety of proteins, which changes
their normal function,” says Dwight Lundell, M.D., author of
The Cure for Heart Disease
. High blood sugar, as we’ve seen, also sends insulin levels skyrocketing, and in most people that will lead to insulin resistance, the central player in every condition we’ve examined that is intimately connected to heart disease: diabetes, obesity, high blood pressure, and metabolic syndrome.

Is it any surprise that we think reducing sugar is far more important than reducing fat or cholesterol?

And by the way, we’re hardly the first people to say so.

By 1970, Ancel Keys’s research had been published and was being picked up by the media; the low-or nocholesterol brigade was gearing up for an assault on the consciousness of the American public. Then in 1972, Robert Atkins published
Diet Revolution
, which became the de facto poster child for the low-carb movement two decades later. Atkins advocated an approach completely opposite to the one promoted by Keys: He said that insulin and carbohydrates, not fat and cholesterol, were the problem in the American diet.

Because his high-fat, high-protein, low-carb diet went so dramatically against the conventional wisdom of the times, Atkins was attacked mercilessly in the press and vilified by the medical mainstream, which turned him into a pariah in the medical community. But in the same year that Atkins published his book, an English doctor named John Yudkin was making waves by politely and reasonably suggesting to the medical establishment that perhaps its emperor, while indeed cholesterol-free and low-fat, was nonetheless naked as a jaybird.

A professor of nutrition at Queen Elizabeth College, University of London, Yudkin was a highly respected scientist and nutritionist who had dozens of published papers in such renowned peer-reviewed journals as
The Lancet,
the
British Medical Journal,
the
Archives of Internal Medicine,
the
American Journal of Clinical Nutrition
, and
Nature
.

Yudkin was typically portrayed by his detractors as a wild-eyed fanatic who blamed sugar as the cause of heart disease, but in fact he was nothing of the sort. In his 1972 book,
Sweet and Dangerous
, he was the embodiment of reason when he called for a reexamination of the data—which he considered highly flawed—that led to the hypothesis that fat causes heart disease.

In the 1960s, Yudkin did a series of animal experiments in which he fed sugar and starch to a variety of critters, including chickens, rabbits, pigs, and college students. Invariably he found that the levels of triglycerides in all these subjects were raised. (Remember, high triglycerides are a major risk factor for heart disease.) In Yudkin’s experiments, sugar also raised insulin, linking sugar to type 2 diabetes, which, as you now know, is intimately related to heart disease as well.
¹²

Yudkin was one of the many who pointed out that statistics for heart disease and fat consumption existed for many more countries than those referred to by Keys, and that these other figures didn’t fit into the “more fat, more heart disease” relationship that was evident when only the seven selected countries
were considered. He pointed out that there was a better and truer relationship between
sugar consumption
and heart disease, and he said that “there is a sizable minority—of which I am one—that believes that coronary disease is
not
largely due to fat in the diet.” (Three decades later, Dr. George Mann, an associate director of the Framingham Heart Study, arrived at the same conclusion and assembled a distinguished group of scientists and doctors to study the evidence that fat and cholesterol cause heart disease, a concept he later called “the greatest health scam of the century.”
¹³
)

In the same year that Atkins published the first edition of his book, an English doctor named John Yudkin was making waves by politely and reasonably suggesting to the medical establishment that perhaps its emperor, while indeed cholesterol-free and low-fat, was nonetheless naked as a jaybird.

Around the same time, the brilliant Danish scholar Uffe Ravnskov, M.D., Ph.D., reanalyzed the original Keys data and came to an identical conclusion. His exemplary scholarship is supported by hundreds of referenced citations and studies from prestigious peer-reviewed medical journals and can be found in his book,
The Cholesterol Myths
, or on his website (
www.ravnskov.nu/cholesterol.htm
).

Though Yudkin did not write a low-carb diet book per se, he was one of the most influential voices of the time to put forth the position that sugar was responsible for far more health problems than fat was. His book called attention to countries in which the correlation between heart disease and sugar intake was far more striking than the correlation between heart disease and
fat
. And he pointed to a number of studies—most dramatically of the Masai in Kenya and Tanzania—in which people consumed copious amounts of milk and fat and yet had virtually no heart disease. Interestingly, these people also consumed almost no sugar.
¹⁴

To be clear, Yudkin never said that sugar
causes
the diseases of modern civilization, just that a case could easily be made that it deserved attention and study, certainly as much as, if not more than, fat consumption.
Heart disease is associated with a number of indicators, including fat consumption, being overweight, cigarette smoking, a sedentary lifestyle, television viewing, and a high intake of sugar. (Yudkin himself did several interesting studies on sugar consumption and coronary heart disease. In one he found that the median sugar intake of a group of coronary patients was 147 g, twice as much as it was in two different groups of control subjects that didn’t have coronary disease; these groups consumed only 67 g and 74 g, respectively.
¹⁵
)

“Many of the key observations cited to argue that dietary fat caused heart disease actually support the sugar theory as well,” Taubes wrote. “During the Korean War, pathologists doing autopsies on American soldiers killed in battle noticed that many had significant plaques in their arteries, even those who were still teenagers, while the Koreans killed in battle did not. The atherosclerotic plaques in the Americans were attributed to the fact that they ate high-fat diets and the Koreans ate low-fat. But the Americans were also eating high-sugar diets, while the Koreans, like the Japanese, were not.”

As Yudkin put it, “It may turn out that [many factors, including sugar] ultimately have the same effect on metabolism and so produce coronary disease by the same mechanism.” What is that mechanism? Fingers are beginning to point suspiciously to an
overload of insulin
as a common culprit at the root of at least some of these metabolic and negative health effects, such as heart disease; controlling insulin was the main purpose of the original Atkins diet and has become the raison d’être of the low-carb approach to living. Though the Atkins diet is certainly not the only way to control insulin, Atkins—who was after all a cardiologist—is to be commended for being prescient when it comes to identifying carbohydrates and insulin resistance as causative factors in diabetes, obesity, hypertension, and, you guessed it, heart disease.

Yudkin’s warnings against sugar and Atkins’s early low-carb approach to weight loss were mere whispers lost in the roar of anti-fat mania. By the mid-1980s, fat had been utterly and completely demonized, and fat phobia was in full bloom, with hundreds of cholesterol-free foods being foisted on a gullible public.
¹⁶
In November 1985, the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program with the stated goal of “reducing illness and death from coronary heart disease in the United States by
reducing the percent of Americans with high blood cholesterol
[italics ours].”
¹⁷

In 1976, Nathan Pritikin opened his Pritikin Longevity Center in Santa Barbara, California, and for the next decade preached the super-low-fat dogma to all who would listen, which included most of the country. Pritikin died in 1985, but his mantle was quickly taken up by Dr. Dean Ornish. Ornish’s reputation—and much of the public’s faith in the low-fat diet approach—was fueled by his famous five-year intervention study, the Lifestyle Heart Trial, which demonstrated that intensive lifestyle changes may lead to regression of coronary heart disease. Ornish took forty-eight middle-aged white men with moderate to severe coronary heart disease and
assigned them to two groups. One group received “usual care,” and the other group received a special, intensive, five-part lifestyle intervention consisting of (1) aerobic exercise, (2) stress-management training, (3) smoking cessation, (4) group psychological support, and (5) a strict vegetarian, high-fiber diet with 10 percent of the calories coming from fat.

When Ornish’s study showed some reversal of atherosclerosis and fewer cardiac events in the twenty men who completed the five-year study, the public perception—reinforced by Ornish himself—was that the results largely stemmed from the low-fat diet. This conclusion is an incredible leap that is in no way supported by his research. The fact is that
there’s no way to know
whether the results were because of the low-fat diet portion of the experiment (highly unlikely in our view), the high fiber, the whole foods, the lack of sugar, or some combination of the interventions. It is entirely possible that Ornish would have gotten the same or better results with a program of exercise, stress management, smoking cessation, and group therapy plus a whole foods diet high in protein and fiber and low in sugar.

Yet low-fat eating managed to remain the dietary prescription of every major mainstream health organization. This recommendation was built on a foundation of two basic beliefs: that low-fat diets will reduce cholesterol, and that reducing cholesterol will actually reduce heart disease and extend life.

Although some studies have shown that low-fat diets do reduce overall cholesterol, many have shown nothing of the sort. When you replace fat in the diet with carbohydrates, which is exactly what low-fat diets do, you wind up with
higher
triglycerides and
lower
HDL cholesterol.

Bad news indeed. Higher triglycerides are an independent risk factor for heart disease—and raising them while lowering HDL cholesterol at the same time is a double whammy, a really bad “side effect” of the supposedly heart-healthy low-fat diet. Not only do you raise one important independent risk factor for heart disease (triglycerides) while at the same time lowering one
protective
measure (HDL cholesterol), but you
also
change the all-important ratio of triglycerides to HDL cholesterol in the worst way possible. A higher triglycerides number and a lower HDL cholesterol number mean a much
higher
ratio of triglycerides to HDL. As we’ve seen, you want your ratio to be
low
, not high; low-fat, high-carbohydrate diets make the ratio
higher
.

So how did fat get demonized while sugar got a “get out of jail free” card?

Well, there’s no political lobby for “fat,” but there’s a powerful one for sugar.

In 2003, the World Health Organization (WHO)—not exactly a bunch of wide-eyed radicals—published a conservative, reasonable report called
Diet, Nutrition and the Prevention of Chronic Diseases
.
¹⁸
In it, the WHO made the unexceptional statement that it would be a good idea for people to derive no more than 10 percent of their daily calories from added sugars. The report suggested that people could lower their risk of obesity, diabetes, and heart disease simply by curbing some of the sugar they were consuming. A
completely mainstream, noncontroversial, “vanilla” recommendation if ever there was one. Who could possibly object, you might think?