Why Does Heart Disease Really Occur?

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There’s a storm coming, and it’s raining secrets and lies.

Readers Summary

  1. What is medicine really good and bad at?
  2. Why was Framingham heart study important?
  3. What did Framingham really say?
  4. Why do you need to know if bias exists in the research and how it could affect opinions?
  5. A video to capture your attention

Let me begin by saying, I think western medicine is ideal for acute diseases. I know this is a dogmatic statement to lead with, but I believe this to be true. And those diseases are the ones that shortened our lifespans most in the first half of the 20th century. Most people I talk with always want to know why I think medicine has missed the boat with respect to chronic diseases? I have thought long and hard about this one and I think I have arrived at my reason. Healthcare, up until the 1940′s, was done anecdotally and by empiric observation. In the 1940′s, the government saw some statistics that showed close to 40% of the deaths in the US were caused by heart disease or stroke. It also appeared that the numbers were accelerating and not slowing down. The real reason they became interested is that no one knew why this was happening. So they decided to study this problem with a long term observational population study that began in 1948. That study was the Framingham Heart study. The bible has the book of Genesis, and physics has Einstein’s theory of relativity and Framingham is medicine’s raison d’etre.

They enrolled 5209 people in this Northeastern City and began to follow them and their generations for fifty years. None of these folks had heart disease at the studies origin. The study is still going on today studying the succeeding generations. This study revealed some major trends in disease patterns that were quite helpful in many ways for us as a nation. For example, this is where we found out obesity and smoking and high blood pressure mattered to our health. Framingham basically ushered in the concept of “disease risk medicine”. It was the first ever attempt at looking at how to affect chronic diseases in humans. It made sense to follow a population over time to see what may influence diseases. The big problem with Framingham was in how some of the data was interpreted. Population data collection is good public health policy, but it can be deadly for individual patient decision making when it is totally not understood in the context of your own health. Framingham data was reported to say that heart disease correlated with high cholesterol levels (LDL) best. At specific times the researchers released information from the trial based upon their interpretations. At 16 years in those who developed heart disease only showed an 11% increase in serum cholesterol levels. Yet researchers used the words, “striking increase” to describe the effect. In 1987, the 30 year data was released on cardiovascular disease and this time they told us that Cardiovascular mortality correlated with higher cholesterol in patients below 50 years old, but after this age they reported no relationship with cholesterol and CV mortality. Stop and think about that. Do patients get treated this way today? Why is everyone placed upon a statin, you may ask, for a cholesterol over 200?

Conventional wisdom is the correct answer because everyone knows fat has to cause heart disease! (Not)

Upset yet? Well, then chew on this. For those aged over 50 with a decreasing level of cholesterol as they age, they actually had an increase in CV mortality and all causes of mortality in the entire study! So if you are over 50 and your cholesterol is lowered (statin anyone) Framingham says you will die sooner from all causes! Do you think that published data is practiced in cardiology today? What is the opinion you get from your cardiologist or PCP today? Why? Because the opinions drawn from this study were not made upon what they found, but what they believed to be true in the 1980s about heart disease. Read this quote from the update, “There is a direct association between falling cholesterol over the first 14 years and mortality over the following 18 years…” Wow! The data showed that for every 1 mg/dl drop in cholesterol per year, there was a 14% increase in the rise of overall mortality. This should make you wonder why you ever stopped eating meat, bacon and eggs for one minute if this is true! I went back and read the data and reviews of the data multiple times. What I found is that what they said about what the data said was entirely opposite! Moreover, the data clearly supports you eating a high fat and protein diet to live longer from heart disease and all other causes of death. More blogs will cover that area soon. The best diet in my view for a human, based upon the current science, is a Paleolithic diet that advocates grass fed meats, wild caught fish, extremely low omega six fats, very low levels of all grains, and very low levels of fructose. Another point about Framingham; this data continued to be followed until 1998 for the original study group and stayed consistent! Do you think the USDA guidelines tell America that message today? Pretty large disconnect I’d say.

So I completely accept that doing studies like Framingham are great for us as a nation to gain insight into trends on health and disease. But the real problem with relying on this data is to understand what the trials really found. You can’t leave the interpretation of the data up to groups who have a vested or financial interest in the outcome. Dr. Grundy, the lead investigator in the trial, was found to make millions off his opinions of what Framingham said to him and his friends in the pharmaceutical industry. He also controlled what got published in the journal, Circulation, at that time. How convenient!

This is why evidence based medicine today is really a house of cards in my opinion. You must ask yourself this: why is this opinion to take a statin the right thing to do for me? Could it be the wrong thing for me as well? It becomes question number one to me every time a new guideline is released for anything in medicine. Sadly, if doctors do not conform to these new guidelines they often do not get paid for services rendered. Often, patients do not understand the conundrum this places us physicians in. Guess who gets screwed by this paradigm? You do! Evidence based medicine is based upon assumptions that are not correct in many cases. The best way to see that if you’re a patient is to follow their recommendations and see if they work at all by following your own labs and data. I have done this myself now for the last 5 years. I call this my QSelf assessment. The Q stands for Quantified Self. I draw quarterly labs on myself every year for the last 4 years. If my labs don’t support what I am doing based upon biochemistry and physiology I change them immediately until I get the desired result or outcome. I no longer rely on the conventional wisdom I was taught. I do this to take full advantage of the Hawthorne effect to better my own health. This is precisely how I get patients to change too. This is how I lost my weight and dealt with my torn knee meniscus. I made the decisions to treat based upon my own customized data points. It was the only way I could gain control over my medical destiny and remove the helplessness I felt when I became a patient.

One last point about Framingham that I learned from researching it. When I was a neurosurgical resident, I used to always tell my rotating medical students and residents that you should never avoid someone or something that you perceive to be substandard or wrong. I learned some of the greatest things about neurosurgery from those who had the least ability or “street smarts” on the surgical floors and in the operating rooms. That insight I had back then, was that, if I remained self aware of their liabilities I would never fall prey to it. The lessons I experienced, both good and bad, could then be brought to my attention so that I may learn something from it. That perception has served me well in medicine I believe. This is precisely the optic that I view the Framingham heart study from.

So if you did not have health insurance from 1980 on and had heart disease this actually was likely good news for your health. If you had health insurance and heart disease, that may have been some insurance you had that you wished you’d never got. Click here to view cardiologist William Davis’ podcast.

Medicine really missed the great points that were revealed in Framingham. Good intentions don’t equal good health all the time. Context is critical to understanding your longevity.

This is Dr. Diamond is a neuroscientist from a University of South Florida. Watch this video and tell me what you think in the comments. This is why I do what I do here. This needs to be debunked because if you believe the lipid hypothesis you likely will never make the jump to the diet that will save your life from disease. That diet is the Paleolithic Diet. Medicine based upon biochemistry not opinions. Seems like some of things we believe true just might not be. I’ll let you be the judge for your own health.

Search Youtube for the video from University of South Florida. The name is called “How Bad Science and Big Business Created the Obesity Epidemic.” I could not link it here for some reason. I promise it’s worth the time.

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Comments

  1. heartburn says:

    I totally agree with you. What I like about your writing is that you did not fill it with unnecessary fluff. Most of the times, less is more and your opinion on this matter definitely highlights that. Clear and concise, very informative, and I will definitely be back for more. Thanks for the useful info!

  2. Jack,

    Off topic but I corresponded with you via email earlier this month. I am a young 22 year old male with testosterone levels averaging around 300-400 in the afternoon. I am pretty sure my decresed testosterone has alot to do with my chronic melatotin supplementation for 2 years, as well as a bit of undereating and overtraining. I have recently stopped this and noticed increases in T via morning erections, better libdo, but I am wondering if this can still be fully recovered. From my understanding, melatonin decreases GnRH and thus testosterone… can this be reversed? How long can it take? I have read up to 6 months for some…

    • @Bill. I did get your email and yes it can be reversed. It takes time for the brain to recalibrate but generally this should reverse in 3-6 months. If you want it to happen faster you can "facilitate" it by turning off all your lights as soon as the sun sets and blacking out your sleeping area. I also recommend listening to quiet relaxing music while you dark adapt or advocate activities that release oxytocin. (orgasm or nipple massage) I also recommend using L-theanine to help as well. Believe it or not men can get defects in progesterone metabolism with prolonged melatonin use and this will also effect their ability to sleep as well as their libido. Not sure this has anything to do with todays post but I hope this helps you.

    • J Androl. 2002 Jul-Aug;23(4):572-8.
      Melatonin administration alters semen quality in healthy men.

      Luboshitzky R, Shen-Orr Z, Nave R, Lavi S, Lavie P.
      Department of Endocrinology, Haemek Medical Center, Afula, Israel. luboshitzky_r@clalit.org.il

      The role of melatonin in the regulation of reproduction in humans is unknown. We conducted a 6-month, double-blind, crossover study of a daily treatment dose of 3 mg melatonin or placebo given orally at 1700 hours in 8 healthy men. Semen quality (concentration, motility, and morphology), serum and seminal plasma 17-beta-estradiol (E(2)), testosterone, melatonin, and serum gonadotropin levels were determined every 3 months throughout the study. In 6 men, there was no change in semen quality or in serum and seminal plasma hormone levels during the study period. In 2 men, during the melatonin treatment period, sperm concentration decreased to 3 x 10(6)/mL and 12 x 10(6)/mL, and motility declined to 32% and 30%. These coincided with a decline in seminal plasma and serum E(2) levels and with an increase in testosterone:E(2) ratios. Six months after the cessation of melatonin, sperm concentration and motility were normal in 1 man but remained abnormal in the other one with a still elevated testosterone:E(2) ratio. Serum gonadotropin levels were unchanged during the study in all 8 men. Our preliminary observations suggest that long-term melatonin administration is associated with decreased semen quality in a number of healthy men, probably through the inhibition of aromatase at the testicular level.

      PMID: 12065466 [PubMed – indexed for MEDLINE]

  3. CJ Williamson says:

    My son was just told his triglycerides are over 500 and that his liver is in trouble. He has fat deposits, bumps that are visible. He was told absolutely nothing with fat. He is 25. He never was fat, but in the last year, the weight has come. Also, his infant son is having some severe health problems. Any ideas how to help this?

    • Yes but the advice he is going to get and what I would do are completely opposite. If I were him, I would go on a strict paleolithic diet and consume alot of offal and omega three eggs. He needs a ton of choline rich foods to get the fat out of his liver. I would also be in very high dose marine fish oil of Rx grader quality and make sure I was in hormonal balance with leptin and cortisol.

  4. Thank you a bunch for sharing this with all folks

  5. San Diego General Co says:

    Im grateful for the blog post. Keep writing.

  6. Helps alot! Thanks Doc!

  7. Wow, incredible weblog.

  8. Is it possible that the higher mortality rate in those with lower cholesterol has something to do with the use of statins?

    • Not well established. But I will tell you the one thing I am paying close attention to is the current CETP trials. These drugs lowed LDL to unreal low levels. And Framingham's data predicts that if we artificially lower LDL's to low levels they will die and die early of cancer. This first trial on a CETP drug was an epic failure for the drug companies. Now the cardiologists have made every excuse in the book and believe that studying the subgroups for good effects is now worth it. Well pay attention folks. I bet the CETP trials will be the beginning of the end for Ancel Key's lipid hypothesis. It is critical to get rid of it because I see no tipping point occurring for health until paleolithic eating is routinely the advice given to patients. Since conventional wisdom says fat causes heart disease the lipid hypothesis must be destroyed. The data already is pretty clear but the house of cards is supported by big pharma and docs on the payrolls. My advice is say not to statins and avoid the real cause of heart disease……refined carbs and omega six fats.

  9. Jack,

    I'm a vegeterian – I don't (and won't) eat meat or fish, but do eat eggs and dairy products. What do you recommend I do?

    I've no doubt I have a leptin problem as my BMI is 42, and I also have PCOS.

    By the way, my Insulin and Corisol levels (recently tested) are still normal, fortunately, but my CRP level is very high – 22.40.

    Thanks

  10. D I am sorry to tell you if you eat that way your future will be compromised from a health stand point. I think you need to strongly reconsider your position. You are eating an incongruent diet to our biologic make up and biochemistry. There is no fix for that mismatch. Good Luck

  11. Is there no way to improve my eating to some extent?

  12. Not if you remain a vegetarian I'm afraid. I would strongly recommend you read Robb Wolf's book, The Paleo Solution. It explains why you need to change

  13. Apryl Testicular Can says:

    This was very informative. I have been reading your blog alot over the past few days and now its in my bookmarks.

  14. San Diego Land Surve says:

    I truly appreciate this blog article.Really thank you! Awesome.

  15. physical therapist s says:

    It's hard to seek out educated individuals on this subject, but you sound like you know what you're talking about! Thanks

  16. dentalque says:

    Here is the link to Dr. Diamond's talk. It is long, If you want to get to the heart of his talk, start at about the 40 minute mark.
    http://www.youtube.com/watch?v=3vr-c8GeT34

    @D, dude please rethink your ethics in light of what your metabolism is screaming at you to do. What you are doing is not healthy. You will not get healthy until you change your paradigm.

  17. Trinidad Aridas says:

    Im obliged for the article post. Really thank you! Want more.

  18. Sherril Cuoco says:

    Thank you for this great post! It has been extremely helpful. I hope that you'll proceed posting your wisdom with us.

  19. Dr. Kruse, in some future post, would you be open to listing the tests that you include in your QSelf Assessment each quarter? Including what you think are the resulting normal ranges would also be greatly appreciated.

  20. For more reading I would suggest getting your hands on this article as well by J Abramson et al. "Are lipid lowering guidelines evidence based?," The Lancet, no 369 (2007):168-69. This was an editorial on heart disease prevention trials (8 total) that reveal statins were completely ineffective in reducing overall death risk from heart disease. The study found that the risk of CV events was only minimally reduced by statins. The data revealed that 67 people would need to be treated for five years for just one medical event to be prevented. That event was a heart attack. The trials showed that statins did nothing to lower the death rates at all. The biggest shocker of the trial is this one……….STATINS SHOWED NO BENEFIT IN WOMEN AT ANY AGE! I wonder how many women even know this?

  21. Mililani says:

    Great info! I love to see someone openly questioning conventional medical "wisdom." It is so compromised by the pharmaceutical co. influence and also by not seeing a problem in a different way. It might be helpful for the general public to understand that drugs are tested and considered to be effective when 50% +1 of the tested population finds effective results. The other 49% percent may show no effect or may have adverse reactions. So our "one size fits all" mentality gives us the current less than perfect system. Thanks so much!

  22. @D – I suffered PCOS on an almost meatless diet. Low carb with a majority of my calories coming from meat was the only cure (and now you could set a clock by my reasonably painless periods.)

    If you of the unwilling to switch from vegetarian are concerns about mortality, here are 2 alternative thoughts to chew on:

    1)Plants are also life. I have no idea why vegetarians ignore this fact. There is no escaping killing life forms to remain alive. The nature of life is always intertwined with death, as much as we wish otherwise. 2)As far as I can tell the idea that vegetarianism is more "moral" comes to us from India. Hindu society is highly hierarchical, with all the animals, plants, and people in their neat, unchangeable slots. I fail to see how much mortality comes from the idea that some life forms and human lives are more important and better than others. We can do without untouchables and literal sacred cows.

  23. For those of you who still think cholesterol cause heart disease……take a peak at this link. http://www.perfecthealthdiet.com/?p=3836

  24. heart disease is a misnomer; the underlying disease process reduces the supply of blood to the heart and other organs leading to angina heart cramp, heart attack and stroke. The disease is characterized by scab-like build-ups that grow on the walls of blood vessels. The correct terminology for this disease process is chronic scurvy, a slower form of the classic vitamin C deficiency disease. collagen supplements The hypothesis that CVD is an ascorbic acid vitamin C deficiency disease was first conceived and tested in the early 1950s Willis devised a method of photographing plaques with X-rays and observed a strange phenomenon in his heart patients. Willis saw that atherosclerotic plaques were not uniformly distributed throughout the vascular system; rather these "blockages" are concentrated near the heart, where arteries are constantly bent or squeezed. Another Canadian, Paterson, had found that the tissues of heart patients were generally depleted of ascorbate vitamin C and it was well known that vitamin C is required for strong and healthy arteries. Willis reasoned that only the mechanical stress caused by the pulse could explain the typical pattern of atherosclerosis that he so often observed in different patients. To Willis, the body was laying down plaque precisely where it was needed in order to stabilize the vascular system. By the late 1980s, medical researchers had made several intriguing discoveries. First came the discovery that heart disease begins with a lesion, a crack or stress fracture, in the arterial wall. The question became, and remains, as to the cause of these lesions in human beings since they do not arise in most other animals. Then a variant of the so-called "bad" LDL cholesterol called lipoprotein(a), or Lp(a) for short, was studied and found to be really bad. It is sticky because of receptors on the surface of the molecule called lysine binding sites. Work that led to the 1987 Nobel prize in medicine discovered that lysine and proline binding sites cause the formation of atherosclerotic plaques. Then, Beisiegel et. al. in Germany examined plaques post mortem and found only Lp(a), not ordinary LDL cholesterol.

  25. Loveland Health Insu says:

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  26. http://drrosedale.com/resources/pdf/Cholesterol%2

    Nice article here for folks to read.

  27. This video is a MUST SEE. It confirms the Paleo Diet, and proves that the Standard American Diet is totally unhealthy & wrong because of corruption & lies all for profit at the expense of American Health.

    How Bad Science and Big Business Created the Obesity Epidemic
    http://www.youtube.com/watch?v=3vr-c8GeT34

    This video should be posted on every facebook page, and sent out to everyone's email list.

    Many thanks to Dr. Kruse for bringing this exceptional Expose' to our attention. This has to be the most important video of our time, well worth watching!

    Grizz

  28. I see much mentioned about Heart disease, cholestrerol and statins but not much mentioned about high blood pressure and how to treat it. I have hypothyroidism and high blood pressure but my cholsterol is fine. Whats up?

    • @Les if you eat a paleo diet and use my leptin Rx you wont have to worry about high blood pressure long term…..it demolishes it.

  29. Well, the NIH has finally said it! It's not sat fats or cholesterol that cause cardiovascular disease–it's the combination of sat fats WITH HIGH CARB INTAKE, PARTICULARLY those with a HIGH GLYCEMIC INDEX. (Yes, I'm shouting the news!) Low-carbers have been saying it for years, Dr Atkins having led the charge.

    http://www.ncbi.nlm.nih.gov/pubmed/21978979

  30. I know, I'm just so excited that they're getting it!! 🙂 A doctor I know took the link down so she can share it to defend the low-carb diet with a conventional-medicine source! Great way to spread the re-education. 🙂 Those us on LC get tired of the misinformation, don't we…nice to be able to throw a CW source at it. 🙂

  31. @harry If your doc tells you he reads about heart disease show him this link listed below.

    For instance, a recent study published in the 2009 Journal of American Medical Association studied the evidence supporting the practice guidelines and consensus statements published by the American College of Cardiology and the American Heart Association. It was found that only 11% of the recommendations, practice guidelines and consensus statements were based on quality evidence and over half were based on poor quality evidence that was little more than the panel's opinion. The review also found that even the strongest (Class 1) recommendations, which are considered medical dogma, cited as a legal standards and often go unquestioned as medical fact, were only supported by high quality evidence 19% of the time and not revised based on new evidence.

    1.Tricoci P, Allen JM, Kramer KM, et al. Scientific evidnce underlying the ACC/AHA clincal practice guidelines. JAMA 2009;301(8):831-841.

  32. Slightly more people die on statin treatment

    This study was published in the Lancet 2008 Oct 4;372(9645):1231-9

    Everyone should read this one!!!

  33. Joe Brancaleone says:

    I think there must be a confusing typo in this line in paragraph 2 that should be fixed: "Framingham data was REPORTED to say that heart disease correlated with heart disease best." It should say "heart disease correlated with high cholesterol levels best" or something along those lines?

  34. Gloria Howey says:

    I am 57 yrs old with a brain disease. NOthing in my body worked right. I had a TIA last week and probably have been having them for several yrs. My cholesterol is 164 and I have HBP now. My doctor put me on Plavix, aspirin and Atorvastin. I don't want to be on the Plavix or Stain in particular. I just started Paleo. Will my cholesterol go down and will the plaque build up go away? I don't know what to do. My case is complicated because I have Cerebellar Atrophy secondary to radiation tx as an infant.

    • @Gloria The XRT as a child to your posterior fossa in your brain worries me. That means the major nerve that covers your gut is likely not working well and you have a leaky gut because of it. You need to find a functional medicine doctor close to you to help you. Go google funtionalmedicine.org to find one near you

  35. Gloria Howey says:

    Oops! My cholesterol is 264 not 164. I used to have low blood pressure but now since my TIA.

  36. Douglas Calvin says:

    I sent this blog post to a Doctor/Teacher friend of mine.
    This is his response:
    Dear Doug,

    The lipid hypothesis is alive and well, but it is evolving in ways that are difficult to capture in simplistic blogs like the one you sent me. Lipid particle size and subclasses of each lipoprotein are vitally important in ways that we are just beginning to understand. And most cardiologists today realize that lipoprotein particles are just part of the story.

    As for the paleolithic diet there is a lot to like about it. But any time that you eliminate a whole food class (in this case whole grains) you end up with an unbalanced diet. My preference is the Mediterranean diet with a bit more emphasis on low fat protein sources.

    • @Douglas…..if he were my doc I’d fire him…….whole grains are not balanced for anyone. He needs to read Cordain’s work more. Buy him The Paleo Answer by Cordain and tell him to really read the bibliography about grains……then get him Wheat Belly written by a cardiologist William Davis. Then tell him how simplistic my blog is………..

  37. Casey Scott says:

    Oh yes, the wonders of Lipitor. I have a brother-in-law who took it and sung it’s praises. He has been in a home for Alzheimers patients for several years. And, he is a MD. I am an RN and tried talking to him about associated memory loss and he ignored me.

    Love what you are doing!

Trackbacks

  1. […] of the cholesterol hypothesis. Check out these websites for more info: Dr. William Davis, Dr. Jack Kruse, Dr. Michael Eades, Dr. Kurt […]

  2. […] I’ve been doing more research on the web (here, here, here, here, and especially here, for example), and it has reassured me that I’m not […]

  3. […] The Framingham Heart Study that began in 1948 and followed over 5,000 people for 50 years. One of the early results of this study was the observation of a correlation between high cholesterol and heart disease. It is important to note that this result was strictly observational and that when we consider the actual data, those with heart disease only had an 11% increase in serum levels. Additionally, the data only held up until the subjects were 50 years old. After age 50, the study found no correlation between heart disease and high cholesterol. (2) […]

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