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    • In the last few years the commonly held belief that high cholesterol causes heart disease has been challenged. What's your view on this and what's your best supporting evidence?

      Note: I am not a doctor or expert in this area and information in this conversation is not medical advice. You should always consult with a trusted MD doctor.

    • I'm fascinated in this from a how-do-bloggers-get-Internet-famous point of view, and how do they drive doctors like my son-in-law crazy.

      The background is one of the giants of the field, William Castelli, directed the famous Framingham Heart Study. It's a 50+ year longitudinal study with some fascinating findings. Here's a great New York Times article about it from 1986.

      They found that people with total cholesterol of 230 are more than twice as likely to get heart disease as those with a level of 180. For those with a level of 300 or higher, the risk is four times greater. They didn't find anyone below 150 who had heart disease. He didn't claim causality, but the correlation is striking.

      The question now is whether getting there by taking drugs is as effective as getting there via diet and controlling weight. It doesn't seem to be.

      What's interesting to me is how bloggers like Harriet Hall can get Internet famous by taking a study this consequential and writing emotionally-charged posts that call it bad science.

    • Large longitudinal studies are the gold standard. Why I bring this up is that a more recent news article I read discussed new and much lower measures of what level people should be put on statins or other drugs (I've included two somewhat older news article below to illustrate). This new level will mean there will be a huge increase in the number of people put on those drugs and as you've mentioned in your comment - what will the results of that be? Currently the commonly held belief among researchers is that cholesterol level DOES cause increased risk of heart disease so that is my default position. I just wanted to hear from other people what the evidence for this has been.

      I also have similar concerns like you that people suddenly become more informed than their doctors after spending 30 minutes 'researching' on the Internet. That's not to say that a lay person can't become aware of a fantastic longitudinal study that overturns conventional wisdom before their doctor does though. Anti vaccers are an excellent supporting group for your Internet experts concern.

    • I find this quote from the study to be very interesting:

      "Another curious finding was that the thinner people ate more than the heavier ones. Although they consumed more calories, more fat and more sodium than those who weighed more, they had a lower risk of cardiovascular disease. The confounding factor in this case was physical activity: The more active people ate more and weighed less and were less likely to get heart disease. Relatively few in Framingham were joggers in decades past; rather, their main activity came through their work: blue- collar labor and housework without many labor-saving devices."

      They consumed more calories, more fat and more sodium. It seems that ideal weight and exercise was much more important than amount of fat or sodium. Chris have you read anything more on this or looked at studies that breaks this down for a closer analysis?

    • This is where I take the role of skeptic. 🧐 My story is I developed heart disease in my 40s and since my sister and father died of heart attacks, the doc put me on statins. I was one of the small percentage of people whose liver didn't like them. So I decided to spend three years training for an IronMan. I lost 43 pounds, got in the shape of my life, and my cholesterol went from 230 to 230.

      Doc said "you can't outrun your genes." And like Bill Clinton, that set me on a path of discovery that led to Caldwell Esselstyn, The China Study, yada. And my cholesterol dropped to 171 in a few weeks with no meds, first time in my life.

      The skeptic in me wonders if statins are effective, or whether they are the world's most profitable drug so the drug companies have all the money in the world to buy the recommendations we're seeing. I may have missed it, but I haven't yet seen the independent study that I trust that says they work. I see plenty of stories that suggest they probably don't.

      Whatever, there is no claim that they cure type II diabetes, reduce cancer rates, etc., but a good diet does. So why not just eat a good diet?

    • My concerns with statins are the same as yours. I'm glad to hear you've taken steps to change your lifestyle and you've seen an improvement in your overall health and outlook on life. I've made a diet recommendation request to you in another conversation post. Thanks again for your time and educated take on these great topics.

    • I was on statins for 3 years and stopped taking them. The side effects were horrible, cramps and muscle pain and a deabilitating tiredness. I'm on shift work and the exhaustion caused by statins was affecting m ability to work.
      This article was one that influenced me

      The mayo clinic listed the side effects of statins and that also influenced me to stop.

      I haven't had my cholesterol checked since I stopped taking the statins but I feel 100% better and will deal with heart issues if they arise... the loss of quality of life the statins caused weren't worth the possible benefits of lower cholesterol.

      Since then, sugar has beren identified as the main cause of obesity and health issues, not fatty cholesterol.

      Regular exercise and a reasonable diet mean I feel far better now than I did while taking the drugs. I retire next year and getting off shift work will be a huge benefit to my health and well being.

      The health services are definitely over prescribing statins... diet and exercise will be far more beneficial .

    • Hey Shay,

      Good for you and interesting article. My personal belief is yes, sugar is correlated strongly with obesity and heart disease, but the actual cause is refining it to remove the fiber. There are other foods that also are correlated with heart disease and obesity like hydrogenated oils and what they have in common is refining to remove the fiber. I'm not aware of any foods where the fiber was left in place and the food is correlated to heart disease.

    • If someone has eaten poorly for a lifetime but then started exercising, dropped to a weight that was not considered overweight - what is there expected chance of getting heart disease at various ages? How would this answer change if they also changed their diets? How does ones genes affect their cholesterol levels?

    • It's a great question. Esselstyn seems to get very close to 100% remission of heart disease no matter your age or history, but he can't reverse nerve or muscle damage from a previous heart attack.

      I've worked with 12 people who had serious heart disease over the last 10 or so years. Some had previous heart attacks, two had previous bypass operations, my father-in-law had surgery on a valve in his 80s. His cardiologist had him on the paleo diet and he had threatening symptoms.

      6 of them read the books, a couple of them called Esselstyn, my father-in-law watched What the Health and Forks Over Knives, and they all gave up animal and refined foods. Far as I can tell, they're all doing really well. My fil is 88 and is out walking, roofing his house, etc. No symptoms anymore.

      Of the other 6, most of them heeded the advice of their cardiologists and got stents or bypass operations. Two of them have died of strokes. One is doing okay in his 80s but I worry because he's got a big belly and his bypass was almost 10 years ago. The others just don't look or feel well, but they're alive and eating their favorite foods which they say is very important to them.

      It looks like the same mechanism that causes heart disease is responsible for most strokes and Alzheimer's. Once Alzheimer's sets in, I'm not aware that it can be reversed.

    • Wow that last statement is a huge one. Just to be clear you're saying the same thing that causes heart disease also causes most cases of Alzheimers and strokes. What exactly is that thing? Poor diet? Being obese and having a poor diet? I think this is going much too far and excluding other factors. Let's see the evidence for that one. In fact that's such a big one that you should start a whole new conversation/thread on that one. Wowza.

    • The thinking goes that plaque doesn't just form in your arteries, but pretty much your entire circulatory system. It's particularly damaging where the venous system is fine and easy to damage with plaque, like the fine veins in your eyes, your spine, and your brain. It means reduced blood flow, which is extremely damaging.

      You have skeptics you enjoy following and so do I. One I admire is Dr. Greger because he and his organization are so science-based. He's slender, healthy, and a clear thinker. Anyway, here's his take on Alzheimer's.

    • Chris MacAskill

      Speaking of, Terry Gross published a new interview this morning on NPR that I caught pieces of in the car: Neuroscientist Predicts 'Much Better Treatment' For Alzheimer's Is 10 Years Away.

      Joseph Jebelli has a new book, In Pursuit of Memory. He said one problem is plaque buildup and how difficult it has been to reverse with drugs. We need to develop stem cell therapies to regenerate damaged neurons from the effects of plaque accumulation.

      I was thinking damn, plaques are bad news wherever the form: in your heart, brain, back, eyes and teeth. Heart surgeons often say when they see them in your coronary arteries they see them everywhere, including the veins they harvest from your legs to replace your arteries.

    • Interesting but in the early stages and the theory so far hasn't been holding up as well as it was hoped.

      Here's an excerpt from that page:

      Prof. Tanzi is right on the money with his observation about inflammation. More than likely, beta-amyloid plaques are merely the body’s reaction – like scar tissue – to the never-ending assault of chronic inflammation. Inflammation is a society-wide epidemic that’s implicated not only in dementia but in cancer, heart disease, arthritis and diabetes as well.

      The focus on brain plaques reminds me of another medical blooper, the decades-long mania about cholesterol and artery plaques. The medical profession decided these fatty deposits were the “cause” of heart disease. Doctors still remain puzzled why reaming the plaques out of arteries and reducing circulating blood fats like cholesterol does so little to control heart disease.

      In any case, experts like Dr. Teitelbaum say that up to half the cases of supposed Alzheimer’s disease don’t involve plaque at all and are really brain difficulties caused by other factors.

      What this person is saying is plaque comes AFTER the problem is created. Addressing plaque is not focusing on the root of the problem. They're also saying that half of the cases don't involve plaque and that many people with plaque have normal brain function. My search keeps coming up with articles that say maybe about the plaque. It's an interesting hypothesis at this time but not much more. I guess time will tell.

    • Hmmm, you might want to put on your skeptical and critical thinking hats wrt that reference. The things that raise yellow flags for me are:

      • There's no attribution for that article. You have to dig to find out it's singer/songwriter Peggy Sarlin.
      • That page is an intro to get you to buy her DVDs.
      • She has a book on Amazon but far as I can tell all the positive reviews are fake, one-word reviews like good.
      • She believes fat is the key to brain health but her own husband had a debilitating stroke at a comparatively young age on their diet.
      • She has no scientific or medical background.
      • She opens that article with the line The theory that brain plaques cause Alzheimer’s disease may be on its last legs. Meanwhile, Terry Gross interviews respected Phd in neurobiology Joseph Jebelli with 6 highly regarded scientific papers like this one, who goes into detail in the interview about the role of plaque in Alzheimer's.
      • Here is how she describes her writing background:

    • In this case it really doesn't matter who wrote the article. The author of the article is accurately passing along Dr. Rudolph E. Tanzi's scientific opinion on the matter. He may be wrong of course but he is the professor of neurology at Harvard and "has published roughly 500 scientific papers including the top three most cited papers in the field of Alzheimer's disease research." He, along with his coworker Robert D. Moir, PhD (assistant professor in neurology at Harvard Medical School and Massachusetts General Hospital) are working on a competiting theory to the plaque theory. For an easy to read summary of it you can see the Forbes article

      According to Tanzi: “The news is that the amyloid plaques which trigger disease are being made for a reason, and maybe they are made to protect the brain from viruses, bacteria and fungus,” (from page 2 of the article)

      Tanzi's credentials far surpass Jebelli's and even Esselstyn's. That doesn't however mean he is right and Jebelli is wrong. I'm just trying to balance your often used argument from authority.

      I'll still add that I've failed to see other experts in the field find definitive support or proof for the theory that plaque is CAUSING the alzheimer's disease and that that plaque is DUE TO POOR DIETS. You still haven't provided reasoning for the large drug study to be dropped. The plaque theory is certainly an interesting one but thus far it's more of a hypothesis than solidly supported scientific theory. At this point I'd say that all of these doctors and researchers have some great working hypothesis that will require a heck of a lot more research to confirm one way or the other. It's far too early (in my opinion - and I'm sure I'd be supported by the Alzheimer's research community) to jump on the bandwagon of any one hypothesis and say it has been decided that 'blank' causes Alzheimer's disease and the cure is to 'blank'.

    • You're right, she does reference Dr. Tanzi, and he is respected as a force for developing drugs to combat Alzheimer's, but I think she misrepresents him.

      He doesn't deny that plaques trigger Alzheimer's or that cholesterol triggers heart disease. He's advancing a hypothesis that perhaps microbes trigger the formation of the plaques.

      However, when asked the most important things you can do to avoid Alzheimer's, he always replies:

      A Mediterranean diet, more fiber, more fruit (what are called prebiotics) and probiotics. And then after diet – exercise. And sleep.

      What Dr. Tanzi is respected for is his research into genes that predispose you to Alzheimer's and research into drugs for treatment. But I think even he would say none of that has yet had success in prevention or treatment.

      He isn't known for expertise in dietary intervention or treatment with probiotics. He just says Mediterranean diet when asked and oral probiotics. Many other researchers have far more expertise in those areas and, so far, they are the only approaches to Alzheimer's which have shown success.

    • Dr. Tanzi in fact DOES deny that plaques trigger Alzheimer's disease at least in the sense you say it does. He say it may be the result of an infection and not the initiating cause of the disease. I know he's the world's leader in how genetics affects Alzheimer's and not an expert on the diet but it's absolutely irrelevant because he doesn't even think that the plaque causes Alzheimer's disease but is more likely a result of something else like the body defending itself from a pathogen. If he doesn't think it causes the disease but is rather a symptom or intermediary stage of the disease then he's not going to be worrying about diet causing the disease. Keep in mind that Tanzi's is not positive how exactly Alzheimer's is caused because nobody does and he's not pretending he has all of the answers but rather forwarding what his research and investigations have pointed to so far. He is merely following up on his hunches "that plaques might actually form to help the brain fight infection" and searching for the pathogens or cause of the infection or inflammation.

      To me it does not matter what scientists find is the cause of Alzheimer's but just that they eventually do figure it out and then find a way to cure it or at least treat it. If it turns out Tanzi and his colleagues are right then we could have a vaccine cure. If it turns out that food is the culprit then we could have a diet cure. Unfortunately the research is suggesting that at least half of the cause cannot be diet but again it's in the early stages of research.

    • Chris MacAskill

      Hmmm, I've read a lot of his stuff and heard his TEDx talk but don't remember him saying the plaques don't trigger the disease. The express purpose of his GSM drug he spent almost two decades developing is to stop the plaques from forming.

      Maybe this article from Forbes makes the language clearer? His argument is plaques ==> nerve tangles ==> Alzheimer's. As far as I can tell, the only controversy is what causes the plaques. He hypothesizes it might be infection from microbes. But while he hypothesizes that, his recommendations are not to avoid harmful microbes, but to eat better, exercise and sleep.

      From the article:

      Alzheimer’s-in-a-Dish also solved the decades-old argument of whether the amyloid plaques or the tangles are to blame for Alzheimer’s disease, Tanzi said. “There is not a debate anymore,” he said. “All data say that if you keep the amyloid low, then you stop Alzheimer’s.”

    • You're making it seem like he's saying eat properly and your problems will be solved when in fact that's not the case. He believes that diet is not causing the plaques and that while plaques are part of the disease Alzheimer's, they aren't the root cause of it in the first place. He even says that his medication may reduce the amount of plaque building components but we wouldn't want to eliminate them all together. He in no way says that diet is the cure to Alzheimer's. We're talking past one another a bit here but I think we are making progress because I think you actually may agree with me that the cause of the plaque is unknown. Maybe a better thing to ask is how confident are you that the cause of Alzheimer's in all cases (or say 99%) is simply a poor diet?

      According to the Mayo Clinic: "Scientists believe that for most people, Alzheimer's disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time. Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease."

      As an aside wouldn't it be great if we could get those doctors themselves to have this conversation on Cake so we could read them hashing it out?

      Another counter to your comment is that almost all doctors will say to eat better, exercise and sleep. That does not mean they see those as the cure to the illness.

      I think we're hyjacking our own conversation to focus on Alzheimers. Maybe we should add that into the topics.. It does serve a purpose though and that would be very important to know that not only could you help reduce your chances of having heart disease by eating better but also reduce the chance of getting Alzheimer's.

    • Weird how we can read the very same simple words so differently. I think you and I were probably the last two people in this conversation and the net result is we ended up in two completely different places.

    • I say the cause of the plaque is unknown but with different theories competing for the answer. You say the cause of the plaque is a poor diet. You keep focusing on the plaque causing Alzheimer's but I'm saying it hasn't been determined what causes the plaque in the first place. You keep reflecting it back to the plaque causing Alzheimer's when that's not even what I'm interested in talking about. I'm more interested in why the plaque is there in the first place. Are you willing to say where your level of confidence is on the statement "poor diet is the main cause of the plaque building up in the first place and the proper diet will prevent the plaque from building up"?

    • What people can do according to Harvard Medical School

      The following is a quote from the above page:

      "It's true you should eat a diet low in saturated fat, partially hydrogenated fat, and trans fat. But other fats, notably the unsaturated fats in vegetable oils and other foods, are beneficial. In fact, eating fish high in omega-3 fatty acids, such as salmon, twice a week can lower the risk of heart disease.

      What you can do: Include low-fat dairy products, fatty fishes, nuts, and olive oil in your diet. If you eat meat, make sure the cuts are lean, and remove the skin from your poultry."

      *They also say that being active is a good thing even if you've been diagnosed with heart disease. Please see your doctor about this as I'm not doctor and not giving medical advice!

      Here's another link that provides some things you can do to help reduce the effects of alzheimer's and possibly slow the onset of the disease.

    • I think that last link, to the Alzheimer's Organization, is very trustworthy. Maybe I think so because of my confirmation bias based on studies I'm familiar with. From that page:

      Several conditions known to increase the risk of cardiovascular disease — such as high blood pressure, diabetes and high cholesterol — also increase the risk of developing Alzheimer's. Some autopsy studies show that as many as 80 percent of individuals with Alzheimer's disease also have cardiovascular disease.

      As far as Harvard goes, it's a long, exhausting story I've dealt with for more than 10 years. Great brand. Awesome business and law schools. For people who've been involved in nutrition research I guess the easiest thing to say is many people think of their school of public health like they think of Apple's social networks.

      Yes, some things Harvard mentions are associated with lower risk. If you substitute oily fish for beef, pork and poultry, rates of Alzheimer's and heart disease go down. But not as much as if you substitute beans, greens, ground flax seeds for beef, pork and poultry. Yes, nonfat dairy is better than full-fat dairy. Nuts better than most other snack foods.

      For people who want to moderate, I understand, and that's who Harvard focuses on and it's the majority. I just think for people who want to do better they should know you can do better.

    You've been invited!