You Magazine, Mail on Sunday (18 & 25/5/14), featured a new book by Ian Marber and Dr Laura Corr, with recipes by Dr Sarah Schenker, called “Eat your way to lower cholesterol: Recipes to reduce cholesterol by up to 20% in under 3 months”.
My first thought, upon seeing the title, was – why would anyone want to lower cholesterol? Sadly, this will be the last thought of most people browsing amazon or a book shop. Everyone nowadays wants to lower their cholesterol – that’s how successful the cholesterol lowering industry has been at demonising this life vital substance in the name of money.
Lowering cholesterol – General consensus vs. evidence
Stop 100 people in Queen Street, Cardiff, and 99 will tell you that cholesterol is bad and the lower one’s cholesterol level the better. Now may be a useful time to remind people of the true relationship between cholesterol and deaths. Scroll down the blog post until you see four graphs showing the following:
– The higher the cholesterol, the lower the deaths from CVD (cardiovascular disease) for men;
– The higher the cholesterol, the lower the deaths from CVD (cardiovascular disease) for women;
– The higher the cholesterol, the lower the deaths from any cause for men;
– The higher the cholesterol, the lower the deaths from any cause for women.
This is pure (not-played-with) data from the World Health Organisation for 192 countries. That’s just about as good as data gets and it shows the exact opposite of what we’re being told.
This is raw data – what about studies?
The Honolulu Study (Ref 1) was a 20 year study of cholesterol levels and mortality in 3,572 Japanese American men. The study concluded that “Only the group with low cholesterol concentration at both examinations had a significant association with mortality”. The authors added “We have been unable to explain our results”. (I.e. we were expecting lower cholesterol to equal lower mortality, not the other way round).
Framingham (the longest and probably best known population study ever) similarly concluded: “There is a direct association between falling cholesterollevels over the first 14 years and mortality over the following18 years (11% overall and 14% CVD death rate increase per 1mg/dL per year drop in cholesterol levels).” (Ref 2) Dr Malcolm Kendrick did a clever calculation on this finding and translated this into – a reduction in cholesterol from 5 to 4 mmol/L would increase your risk of dying by 400%.
Elaine Meilahn reported in Circulation (2005) “In 1990, an NIH (National Institutes of Health) conference concluded from a meta-analysis of 19 studies that men and, to a lesser extent, women with a total serum cholesterol level below 4.2 mmol/L exhibited about a 10% to 20% excess total mortality compared with those with a cholesterol level between 4.2 and 5.2 mmol/L.” (Ref 3)
Still want a book claiming to lower your cholesterol?
Lowering cholesterol through diet – how?
The 18/5/2014 You Magazine article has a box-out called “six superfoods” to boost heart health“. Notice how lowering cholesterol has already become interchangeable with heart health? Before you reach the end of this article you will see that there is no evidence whatsoever for that claim… quite the opposite in fact.
The six superfoods are claimed to be fibre; healthy oils (described as those high in unsaturated fat of course); soya; nuts; oats and ‘smart foods’. Smart foods are defined as margarine-like spreads and other fortified foods that claim to “actively lower you cholesterol” (those yoghurt/drink/one-a-day kind of things).
The only two of these six that I would describe as foods are nuts and oats. Fibre is a component part of carbohydrate (not all carbohydrates contain fibre, but no pure fat/protein contains fibre). ‘Smart foods’ are a category of processed gunge. Oils are nutritionally pointless and they’re a cooking ingredient/dressing, not a food. Soya is a whole different ballgame – see “The Whole Soy Story” by Dr Kaayla Daniel for the Whole Sorry Story on this one.
Which reminds me – please tell me that this book comes with the most obvious possible warning for any female wanting to conceive? Soya alone is a plant oestrogen – think ‘the pill’. It takes a lot of cholesterol to make a healthy baby and lowering cholesterol is the last thing that a would-be-mum wants to do. I’m not sure of the impact on male sperm either – almost certainly not good.
Replacing cholesterol more like
The key thing that this strange list of foods and non-foods have in common is (phyto)sterols. Sterols are added to margarines and other substances that have cholesterol lowering claims. You don’t need to consume these fake and expensive products. If you’re daft enough to want to lower your cholesterol you can buy sterol tablets from a health food shop and save yourself the harm and expense of ingesting spreads or ‘shots’.
Phytosterols are cholesterol-like molecules found in all plant foods, with the highest concentrations found in vegetable oils. They are absorbed only in trace amounts, but they inhibit the absorption of intestinal cholesterol (Ref 4) – human cholesterol in effect. We have known this for 60 years. The ability of phytosterols to inhibit the absorption of cholesterol was first shown in 1953 (Ref 5). (Fibre per se has a similar effect – it reduces the body’s absorption of cholesterol.)
Foods with phytosterols are competing with the cholesterol made by the human body and replacing it to an extent. Not entirely, or we’d drop dead. Blood cholesterol levels will fall, but how is this a good thing? Our bodies make cholesterol. I don’t know about you but I trust mine to make the cholesterol that it needs (so long as I don’t abuse it with statins). If my body needed plant cholesterol – surely it would make plant cholesterol? Do you know the true health impact of replacing your own cholesterol with plant cholesterol? Nope – me neither. And nor does Unilever I suspect.
The European Food Safety Authority responded to a request from Unilever PLC to be able to make cholesterol lowering claims on their plant sterol fortified products (Ref 6). The review body concluded that “plant sterols have been shown to lower/reduce blood cholesterol“. They also stated “However, there are no human intervention studies demonstrating that plant sterols reduce the risk of coronary heart disease.”
You may like to read that again (and You Magazine may like to retract their “boost heart health” claim). Plant sterols lower cholesterol (tick) but there is no evidence that plant sterols reduce the risk of heart disease. Can this mean that lowering cholesterol per se does not reduce the risk of heart disease? It sure does. However, there’s an even more important question to ask.
Is this even safe?
The area of most interest to us is phytosterol consumption and cardiovascular disease – as this is the area where health claims are made. There are a few studies of phytosterol intake and cardiovascular disease:
Rajaratnam et al studied the association of phytosterols and coronary artery disease (CAD) in postmenopausal women (Ref 7). They concluded that women with elevated ratios of sterols to cholesterol [i.e. plant cholesterol to human cholesterol] have enhanced risk for CAD. “Thus, enhanced absorption and reduced synthesis of cholesterol may be related to coronary atherosclerosis.” (My emphasis on enhanced risk).
Sudhop et al reviewed plant sterols as a potential risk factor for coronary heart disease (CHD) (Ref 8) and confirmed a strong influence of plant sterols. They concluded: “These findings support the hypothesis that plant sterols might be an additional risk factor for CHD.” (My emphasis on risk factor).
Assmann et al’s 2006 article concluded: “Elevations in sitosterol concentrations [one type of sterol] and the sitosterol/cholesterol ratio appear to be associated with an increased occurrence of major coronary events in men at high global risk of coronary heart disease.” (Ref 9) (My emphasis on increased occurrence of major coronary events).
Silbernagel et al studied 1,257 individuals in the Ludwigshafen Risk and Cardiovascular health (LURIC) study (Ref 10). They found that high absorption of phytosterols alongside low synthesis of cholesterol predicted increased all-cause and cardiovascular mortality in LURIC participants. (Naughty me again emphasising the finding that sterols replacing human cholesterol predicted dying.)
It has become so well known that ‘lowering cholesterol is a good thing’ that we are forgetting to challenge the entire and immense industry that has followed from this (drugs and spreads). Lowering cholesterol is a bad thing and replacing cholesterol with plant sterols is a very bad thing. These bad things are made even worse if the human being tampered with is of child bearing age/has parent-like aspirations. It’s also very bad for any human who wants to live longer. But, what the heck, so long as the cholesterol lowering industry is worth billions – who cares?!
1) Schatz, Masaki, Yano, Chen, Rodriguez and Curb, “Cholesterol and all-cause mortality in elderly people from the Honolulu heart programme”, The Lancet, (August 2001).
2) Anderson, Castelli and Levy, “Cholesterol and Mortality: 30 years of follow-up from the Framingham Study”, Journal of the American Medical Association (JAMA), (1987).
3) Elaine Meilahn, “Low serum cholesterol: Hazardous to health?” Circulation, (2005).
4) Ostlund, R. E., Jr. (2002) Phytosterols in human nutrition. Annu Rev Nutr. Vol.22 pp.533-49.
5) Pollak, O. J. (1953) Reduction of Blood Cholesterol in Man. Circulation. Vol.7(5), pp.702-706.
6) Bresson, J.-L. (2008) Scientific Opinion of the Panel on Dietetic Products Nutrition and Allergies on a request from Unilever PLC/NV on Plant Sterols and lower/reduced blood cholesterol, reduced the risk of (coronary) heart disease. The EFSA Journal. Vol.781 pp.1-12.
7) Rajaratnam, R. A., Gylling, H., and Miettinen, T. A. (2000) Independent association of serum squalene and noncholesterol sterols with coronary artery disease in postmenopausal women. J Am Coll Cardiol. Vol.35(5), pp.1185-91.
8) Sudhop, T., Gottwald, B. M., and von Bergmann, K. (2002) Serum plant sterols as a potential risk factor for coronary heart disease. Metabolism. Vol.51(12), pp.1519-21.
9) Assmann, G., Cullen, P., Erbey, J., Ramey, D. R., Kannenberg, F., and Schulte, H. (2006) Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Munster (PROCAM) study. Nutr Metab Cardiovasc Dis. Vol.16(1), pp.13-21.
10) Silbernagel, G., Fauler, G., Hoffmann, M. M., Lutjohann, D., Winkelmann, B. R., Boehm, B. O., and Marz, W. (2010) The associations of cholesterol metabolism and plasma plant sterols with all-cause and cardiovascular mortality. J Lipid Res. Vol.51(8), pp.2384-93.