63 replies to this topic

[DePaw]

http://www.lef.org/m...paign=2013Wk6-1

[misterE]

I guess you aren't familiar with doctors Dean Ornish or Caldwell Esselstyn who get their patients total-cholesterol below 150mg (by eating low-fat, whole-grains, vegan) and demonstrate reversal of atherosclerosis. How does this fit in with your argument? Do you have any studies demonstrating reversal of atherosclerosis any other way?



Coronary angiograms of the distal left anterior descending artery before (left) and after (right) 32 months of a plant-based diet without cholesterol-lowering medication, showing profound improvement.

Edited by misterE, 08 February 2013 - 05:02 PM.

[Mind]

I invited Dr. Ornish for an interview for the LongeCity Now podcast. One question I really wanted to ask him is why he advises people to avoid olive oil at all costs...and tells people to NOT eat olives or avocados at all. Some of the longest-lived people in the world, with hardly any incidence of heart disease, consume olive oil basically like water. Many other long-lived vegetarians and vegans eat plenty of olives and avocados.

[misterE]

Ornish has, what's called "The Spectrum". Ornish has on one end of the spectrum, the optimal-diet (whole-grains, beans, fruits, vegetables), on the opposite spectrum is the rich American-diet (meat, dairy, fat/oil, sugar, processed-foods). He argues that if you are trying to reverse western-diseases, you should follow the optimal-diet, if you don't have those diseases, you can be a bit more flexible with your diet, perhaps some lean meat or nuts on occasion, etc. But the emphasis is still high-fiber/low-fat.

[Turnbuckle]

http://onlinelibrary...11.01767.x/full

RESULTS:
Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD [ischaemic heart disease] mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) [<193 & >271 mg/dl]

Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.

With men, the total cholesterol level associated with the lowest mortality was from the moderate to high range. With women, the higher the better.

Edited by Turnbuckle, 08 February 2013 - 09:16 PM.

[misterE]

I invited Dr. Ornish for an interview for the LongeCity Now podcast. One question I really wanted to ask him is why he advises people to avoid olive oil at all costs...and tells people to NOT eat olives or avocados at all. Some of the longest-lived people in the world, with hardly any incidence of heart disease, consume olive oil basically like water. Many other long-lived vegetarians and vegans eat plenty of olives and avocados.

OK... But the record still stands! The low-fat/high-carbohydrate Ornish-diet has actually been shown (in peer-reviewed literature) to reverse cardiovascular-disease and prostate-cancer (and probably breast-cancer to). Plus studies using the Pritikin-diet, which is nearly identical to Ornish's proven diet, has completed nearly 30 studies showing complete reversal of diabetes and metabolic-syndrome when combined with exercise!

Those incredible feats have yet to be accomplished with high-fat diets rich in animal-protein, despite some improvement in risk-factors, which is at best, what those types of diets accomplish.

[misterE]

With men, the total cholesterol level associated with the lowest mortality

You do know that impotence and sexual-dysfunction is much more common in men with high-cholesterol [1-3]! And eating saturated-fat and cholesterol (found in meat, dairy, eggs and fish) is what boosts serum cholesterol levels. So perhaps a low-carb diet can make you thinner and improve your risk-factors (if you stay on it), but it also could cause impotence long-term! Is that a risk you want to take? To avoid impotence, I would follow a diet been shown to drastically lower cholesterol (to 150mg/dl) and reverse atherosclerosis like the diet Dr. Esselstyn eats.



[1] Int J Impot Res. 2005 Nov-Dec;17(6):523-6. The relationship between lipid profile and erectile dysfunction. Nikoobakht M, Nasseh H, Pourkasmaee M.

[2] J Urol. 2003 Jun;169(6):2262-4. Laboratory evaluations of erectile dysfunction: an evidence based approach. Bodie J.

[3] J Gend Specif Med. 2002 Nov-Dec;5(6):19-24. Prevalence of cardiovascular risk factors in erectile dysfunction. Walczak MK .

Edited by misterE, 11 February 2013 - 02:12 AM.

[Kevnzworld]

I believe in moderation, not either extreme. The Mediterranean diet is just that, with red wine and olive oil.
Quote: " Conclusions— Olive oil and red wine antioxidant polyphenols at nutritionally relevant concentrations transcriptionally inhibit endothelial adhesion molecule expression, thus partially explaining atheroprotection from Mediterranean diets."
http://atvb.ahajourn.../23/4/622.short
Quote: "Conclusions Individuals at high cardiovascular risk who improved their diet toward a TMD pattern showed significant reductions in cellular lipid levels and LDL oxidation. Results provide further evidence to recommend the TMD as a useful tool against risk factors for CHD.
( TMD is the Mediterranean diet )
http://archinte.jama...rticleid=486851
Quote: "The Mediterranean diet diminished NF-kappaB activation in mononuclear cells, compared with Western diet, supporting its cardioprotective properties. The effect of the n-3 enriched diet was intermediate.
http://www.ncbi.nlm....pubmed/17204269

[Bonee]

in my theory we need to control both cholesterol and triglycerides, and all of it we need a net transport of cholesterol AND triglycerides into the liver from the peripheral arteries
high dose niacin does both...
also most statin only therapies are flawed in my opinion, first people doesn't control their cholesterol and fat intake and the statin only adresses the problem of cholesterol, but not the triglycerides.
and also we need to factor a lot of other things like Kevnzword said

Edited by Bonee, 15 February 2013 - 10:31 PM.

[misterE]

we need to control both cholesterol and triglycerides

Yes. And the main hormone that has control over those factors is insulin. Insulin improves glucose tolerance. Insulin improves blood lipid profiles. Insulin lowers blood-pressure. But what happens if insulin stops working? Blood-sugar goes out of whack, you get dislipidemia and you develop hypertension. That is the consequences of either insulin-deficiency or insulin-resistance. Removing starches out of the diet (like people do on low-carb diets) means you will have less insulin able to lower blood-sugar and blood-lipids and promote vasodilation; less insulin to promote health.


Metabolic-syndrome and insulin-resistance is literally caused by (over)eating foods that don't stimulate insulin-secretion (like saturated-fat and fructose) at the expense of foods that do stimulate insulin-secretion (like beans, potatoes and grains). Insulin is your friend! In fact ,it's your most important anti-aging hormone... but if your body doesn't respond to the effects, or metabolic functions of insulin, you develop metabolic-syndrome and you literally begin to fall apart and age rapidly.

Edited by misterE, 16 February 2013 - 06:05 PM.

[Mike C]

The lyon heart study was done with thousands of patients with current heart disease and they ate plenty of fat-there was a reduction of 70% in mortality versus control group. Any whole food-high vegetable/fruit/whole grain diet will dramatically lower heart risk-including a low fat one-but it may have nothing to do with the fat-get it?

[misterE]

Above is an image I posted showing reversal of a diseased artery. It was reversed by a diet consisting of whole-grains, beans, vegetables and fruit. It was no more than 15% fat. This is the same diet Dr. Dean Ornish used to reverse the cardiovascular-disease in his patients back in the early 1990's. Unless there is another diet that can accomplish this amazing feat (which there hasn't yet), I think it would be foolish to side with any other diet. In fact this is the same diet former president Bill Clinton is currently using to reverse his atherosclerosis:

[DePaw]

in my theory we need to control both cholesterol and triglycerides

And a low carb diet is best for reducing triglycerides, it also increased HDL the most.

See also: http://jama.jamanetw...rticleid=205916

[misterE]

Sure it can reduce "risk-factors" or "biomarkers"... but it can't reverse the underlying disease. Show me a picture (from a study) showing a low-carb diet doing this:

Edited by misterE, 22 February 2013 - 06:03 PM.

[Turnbuckle]

Sure it can reduce "risk-factors" or "biomarkers"... but it can't reverse the underlying disease. Show me a picture (from a study) showing a low-carb diet doing this:

So now you've posted the same picture twice. Is there a control? Are there more pictures? Because one picture isn't proof of anything.

[misterE]

Is there a control? Are there more pictures?

These angiograms were taken from the Esselstyn study. There was no control group with the Esselstyn study, but Dean Ornsih and Richard Fleming did indeed have control groups for their heart-disease reversal studies.




Figure 2 -- Coronary angiograms of the circumflex artery before (left) and showing 20% improvement (right) following approximately 60 months of a plant-based diet with cholesterol-lowering medication.




Figure 3-- Coronary angiograms of the proximal left anterior descending artery before (left) and showing 10% improvement (right) following approximately 60 months of a plant-based diet with cholesterol-lowering medication.



Figure 4--Coronary angiograms of right coronary artery before (left) and showing 30% improvement (right) following approximately 60 months of a plant-based diet and cholesterol-lowering medication.

[Turnbuckle]

A 10-30% improvement after 60 months with a "cholesterol-lowering medication." Does he say what this is? A statin?

[misterE]

A 10-30% improvement after 60 months with a "cholesterol-lowering medication." Does he say what this is? A statin?

The goal of the Esselstyn study was to get total-cholesterol below 150ml/dl. Esselstyn believed that if you could get your cholesterol level down to levels that matched populations who were completely absent of cardiovascular-disease and atherosclerosis (like the rural-Chinese or Tarahumara-Indians), you could essentially reverse the underlying process of atherosclerosis. He didn’t conduct a large controlled trial like Ornish did, but what he did do was take some of the sickest patients who had a history of severe heart-disease and did everything he could to get their cholesterol below 150mg/dl, satins included, in some, but not all patients, but remember… these were people with prior history of heart-attacks and heart-surgery. Also, exercise, although encouraged by Esselstyn, was not a mandatory part of the study.The results show that cholesterol levels do play a significant (if not the largest) role in atherosclerosis and cardiovascular-disease and that getting cholesterol levels below 150mg/dl can melt away that greasy atherosclerotic-gunk out of your veins no matter how old or sick you are.


Esselstyn has latter said years after his study, that nitric-oxide is very crucial for arterial health. And that every time you eat a high-fat meal, it damages the endothelium and reduces its ability to produce nitric-oxide. The role of nitric-oxide is to prevent cholesterol from sticking to the walls of the endothelium and to promote vasodialtion (also called flow-mediated-dilation; FMD). Insulin (which is stimulated by starch, and inhibited by fatty-acids and fructose) promotes nitric-oxide production from the endothelium and even promotes angiogenesis (creation of new blood-vessels). Both of those mechanisms explains why insulin is extremely anti-atheroscrotic and promotes a healthy cardiovascular-system, it also explains why people who are unresponsive to the effects of insulin (insulin-resistant) have increased atherosclerosis and increased likeliness of having a heart-attack or stroke.

Edited by misterE, 24 February 2013 - 05:04 PM.

[Turnbuckle]

misterE, your post has the air or religion, not science. You seem to buy into the myth of cholesterol that has foisted stains upon the population, but the data goes against you. If you look at the big studies, you'll find that low cholesterol is bad, not good. Look at the chart below, which is the "Ten-year incidence of fatal cardiovascular disease per 1000 person-years in the population of Nord-Trøndelag (HUNT 2 study)." Look especially to the age group of 60 and above, where most of the deaths occur.

http://www.ncbi.nlm....les/PMC3303886/

The chart breaks the data at 5.5 mmol/L, which is 213 mg/dl.

Attached Files

•  Cholesterol v mortality.jpg   134.51KB   28 downloads

Edited by Turnbuckle, 24 February 2013 - 05:49 PM.

[Kevnzworld]

I do believe that highly elevated cholesterol numbers are associated with increased CVD . Cholesterol is a repair agent. If one keeps inflammation, homocysteine, glucose and endothelial dysfunction mitigated then cholesterol numbers aren't as important.
The size and density of the particles is a more predictive measure than the absolute LDL number. Cardiovascular disease is more complex than a simple LDL number. The pharmaceutical industry promotes the cholesterol number to sell statins.
" Fasting Insulin and Apolipoprotein B Levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease "
" Beyond the mechanisms underlying the atherogenicity of hyperinsulinemia, hyperapobetalipoproteinemia, and small, dense LDL, and irrespective of whether these mechanisms share common paths, results of the present study suggest that the risk of IHD is increased substantially when these metabolic abnormalities cluster. The synergistic contribution of the nontraditional cluster of risk factors to IHD risk and the fact that almost 1 of every 2 IHD cases had these abnormalities simultaneously reflect the multifactorial etiology of IHD. It also emphasizes the importance of defining the risk of IHD based on more than 1 risk factor."
http://jama.jamanetw...rticleid=187669

Edited by Kevnzworld, 24 February 2013 - 06:03 PM.

[misterE]

the myth of cholesterol that has foisted stains upon the population

No, it's the rich cholesterol laden fatty/sugary American diet that caused the rise of satin use. Cultures that eat very low-fat grain-based vegetarian diets and maintain cholesterol levels below 150mg/dl have no heart-disease and crystal-clean arteries when autopsied.

Esselstyn’s results prove that total-cholesterol is a huge factor (much larger than HDL, LDL or particle-size) and Ornish agrees with the recommendation to lower total-cholesterol below 150mg/dl for atherosclerosis regression.

Edited by misterE, 24 February 2013 - 06:33 PM.

[Turnbuckle]

Again, misterE, your statements are contradicted by studies, such as this one--

The present non-intervention screening study was undertaken to explore the relationships between pre-existing low total cholesterol and all-cause mortality. ...(5%) of this largely unselected population who had total cholesterol levels < or = 160 mg.dl-1 formed the study population. The remaining 10968 patients acted as controls. The relative risk of all-cause mortality among patients with low cholesterol compared to others was 1.49 (95% CI: 1.16-1.91). The relative risk of non-cardiac death was 2.27 times higher in the low cholesterol group than in the controls (95% CI: 1.49-3.45), whereas the risk of cardiac death was the same in both groups (relative risk 1.09; 95% CI: 0.76-1.56). The most frequent cause of non-cardiac death associated with low total cholesterol was cancer.

http://www.ncbi.nlm..../pubmed/9049515

[nameless]

Did Ornish take into account the ApoE profile of the patients he treated?

The whole 'fats = good/bad' thing seem to overlook (or don't mention) ApoE very often.

If the majority of his patients were ApoE 4/4 or even perhaps 3/4, then going to a low fat diet would probably benefit their CVD risk profile. And by their nature, more ApoE 4/4 and 3/4 people would have heart disease than other genotypes. So it could stand to reason that the majority of patients he treated did very poorly with fats, and their previously poor diet contributed to their heart disease. So any decrease in fats at all would be beneficial to them.

However, that doesn't mean that diet is best for everyone, nor even every 3/4 person either. Or that certain fats (like olive oil) would be bad for them.

It's also possible that many of his patient's diets were so god awful previously, that changing to anything at all remotely healthy (like cutting out twinkies) would show a benefit -- not that his diet was the most optimal diet.

Edited by nameless, 24 February 2013 - 07:53 PM.

[Sillewater]

the myth of cholesterol that has foisted stains upon the population

No, it's the rich cholesterol laden fatty/sugary American diet that caused the rise of satin use. Cultures that eat very low-fat grain-based vegetarian diets and maintain cholesterol levels below 150mg/dl have no heart-disease and crystal-clean arteries when autopsied.

Esselstyn’s results prove that total-cholesterol is a huge factor (much larger than HDL, LDL or particle-size) and Ornish agrees with the recommendation to lower total-cholesterol below 150mg/dl for atherosclerosis regression.

misterE, even though I agree with the fact that lower cholesterol is better, one should be careful citing Ornish's studies as there were many other interventions other than a low-fat diet. Esselstyn on the other hand also used statins, and not just a low-fat diet. However as I write about here whether one is arguing from a paleo-perspective or modern-human perspective shooting for a cholesterol under 150mg/dl is most likely very prudent (unless one has a high hemorrhagic stroke risk but still trying to wade through the data).

[Turnbuckle]

...a cholesterol under 150mg/dl is most likely very prudent (unless one has a high hemorrhagic stroke risk but still trying to wade through the data).

Don't you think a 50% higher total mortality is a high price to pay for a "prudent" assumption?

[Chupo]

http://youtu.be/8GDx5sObceI

Dr. Attia explains how high triglycerides can lead to a high LDL-P even if LDL-C is low. He also says that in a small subset of his patients, LDL-P doesn't come down yet the markers for inflammation directly at the arterial wall do come down. Could it be higher HDL protecting them?

This study suggests that an HDL of 60 and over is protective regardless of other risk factors such as hypercholesterolemia, hypertension, hypertriglyceridemia, and diabetes.






As for nitrous oxide, I found this study interesting. Obese rats were fed ether a low carb diet or a high carb diet. The low carb rats restored endothelial function by a mechanism independent of NO. Restoration of coronary endothelial function in obese Zucker rats by a low-carbohydrate diet.

[Sillewater]

...a cholesterol under 150mg/dl is most likely very prudent (unless one has a high hemorrhagic stroke risk but still trying to wade through the data).

Don't you think a 50% higher total mortality is a high price to pay for a "prudent" assumption?

I'm assuming your 50% higher total mortality comes from epidemiological studies where reverse causation cannot be ruled out. These studies:

10. BMJ. 1995 Aug 12;311(7002):409-13.Low serum total cholesterol concentrations and mortality in middle aged British men.Wannamethee G, Shaper AG, Whincup PH, Walker M.
11. Int J Cancer. 2009 Dec 1;125(11):2679-86.Serum cholesterol levels in relation to the incidence of cancer: the JPHC study cohorts.Iso H, Ikeda A, Inoue M, Sato S, Tsugane S; JPHC Study Group.
12. Am J Epidemiol. 1992 Jun 1;135(11):1251-8.Short- and long-term association of serum cholesterol with mortality. The 25-year follow-up of the Finnish cohorts of the seven countries study.Pekkanen J, Nissinen A, Punsar S, Karvonen MJ.

show that before you become sick (whether from heart disease, cancer, etc...) cholesterol levels decrease ahead of time. This probably goes the same for low-BMI.

[Turnbuckle]

I'm assuming your 50% higher total mortality comes from epidemiological studies where reverse causation cannot be ruled out. These studies:

I was referring to the paper I linked to in post #22, which said, "The relative risk of all-cause mortality among patients with low cholesterol compared to others was 1.49."

[Dolph]

You realize that the studied population consisted of people with existing coronary disease? If someone with a TC <160mg/dl suffers from CD, this probably is a strong sign of a bigger problem. Strange enough the study doesn't seem to give any information about other differences between the groups. Smoking for example would explain the incidence of CD despite low TC and the higher incidence of cancer.

[Dolph]

http://onlinelibrary...11.01767.x/full

RESULTS:
Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD [ischaemic heart disease] mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) [<193 & >271 mg/dl]

Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.

With men, the total cholesterol level associated with the lowest mortality was from the moderate to high range. With women, the higher the better.

They used a completely ridiculous cutoff of 215 mg/dl, TC at that level being known not to tell us much if anything. So what's all the fuss??? This might have been an interesting paper in 1955 but not for todays standards.