Can Cholesterol Be Too Low?

Typically, those individuals promoting the myth that low cholesterol levels are dangerous and the topsy-turvey "science" that saturated fat and high cholesterol are not bad, but good, are those individuals and health advisors advocating diets high in animal products, such as the Atkins devotees. Unfortunately, this advice is not merely incorrect; it is dead wrong for hundreds of individuals who heed such dangerous advice and die of heart attacks every day.

When it comes to coronary artery disease, there may be no such thing as lowering total blood cholesterol levels too far. Another recent study, published in the journal Circulation, found that the arteries in male patients with a total cholesterol level as low as 155 mg/dl benefited significantly from cholesterol-lowering medication as well.1 Both regression of atherosclerosis and a dramatic reduction in heart attacks were seen in the group treated.

While some research in the past has raised questions about the safety of very low cholesterol levels, no danger has been proven in larger, more dependable investigations. The new reports, documenting the effectiveness in saving lives with more substantial cholesterol lowering, fuels an ongoing debate about how aggressively to treat heart disease patients whose cholesterol levels are better than average and whether aggressive cholesterol lowering is valuable even in young healthy adults without signs of heart disease.

In the past, it was thought to be good enough to have a cholesterol level better than average. Until recently, doctors advised their patients to strive for a total cholesterol lower than 200 mg/dl. Eventually, this advice was found to be lacking and now we know that it is not very good to be average in a population that ubiquitously develops atherosclerosis. On autopsy, almost all American adults demonstrate significant coronary artery disease (2) and even 78% of young trauma victims who died before the age of 35 demonstrated significant atherosclerosis on autopsy.3 If you eat American food, you will inevitably develop American diseases. It is rare that someone can escape from the biological laws of cause and effect.

Clearly, if we attempt to rival the low cholesterol of populations that eat mostly natural plant foods and do not have heart disease, we are always looking at total cholesterols below 150 mg/dl. The average cholesterol level in rural China, as documented in the massive China Cornell Project, was 127 mg/dl. Heart attacks were rare, and both cancer and heart disease rates plummeted as cholesterol levels fell, which reflected very low animal product consumption. The lowest occurrence of heart disease and cancer occurred in the group that consumed plant-based diets with less than two servings of animal products per week.

There was some controversy years ago about striving for lower, protective cholesterol levels after some studies in the eighties noted that depression, suicide, hemorrhagic stroke, cancer, and death from other causes, were higher in some groups with very low cholesterol groups. Larger, recent investigations studying larger populations did not confirm these questionable findings.

When investigators looked more carefully at the individual characteristics of the studied populations they were able to explain the earlier findings. This issue is complicated because these studies evaluated individuals who were eating the modern American diet, rich in saturated fat and other components of animal products that raise cholesterol, and low in plant derived anti-oxidants, phytochemicals, and essential fatty acids that improve cholesterol ratios. Those who demonstrated very low (ideal) cholesterol levels, while following the traditional, modern, cholesterol-promoting diet, may actually have a compromised health status or undetected chronic disease.

For instance, we know cancer causes less cholesterol production in the liver. Low cholesterol may be associated with cancer, but does not cause it. Researchers showed that cholesterol starts to fall up to 8 years prior to a person dying of cancer, and that those with the greatest drop in cholesterol in a 4 year period without dietary improvements to lower cholesterol were those most likely to develop cancer.4 The low cholesterol did not cause the cancer; the cancer caused the low cholesterol. Those who work to lower cholesterol by avoiding saturated fats, eating a high nutrient diet with lots of raw vegetables, cooked green vegetables, and beans do not have a pathological condition causing their low cholesterol. They earned it.

This is why in rural China where the diets are nearly vegetarian, the average cholesterol levels are low and you see lower cancer rates, not higher. Those with the lowest cholesterol in the China study actually had the lowest cancer rates as well. Obviously, there is a difference between one who has a low cholesterol because his dietary style earns it, and one whose cholesterol seems unjustifiably low on a modern heart-disease-promoting diet that almost everyone in the west eats.

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Pomegranate Power

Pomegranate juice is a rich source of phytochemical compounds shown to benefit the heart and blood vessels. It not only lowers cholesterol, but lowers blood pressure and increases the speed at which heart blockages (atherosclerosis) melt away.

Recent medical research completed in 2004 studied heart patients with severe carotid artery blockages. They were given an ounce of pomegranate juice for a year, and not only did their blood pressure lower by over 20 percent, but there was a 30 percent reduction in atherosclerotic plaque.1

The data was measured by IMT technology. IMT stands for Intima Media Thickness. It has been shown in medical studies that the thickness of the plaque in a specific place in the neck has an excellent correlation with coronary artery atherosclerotic burden. The control group who did not receive the juice had their arteries close off even further. IMT thickness increased 9 percent.

Not only are pomegranates good for your heart and blood vessels but they have been shown to inhibit breast cancer, prostate cancer, colon cancer, leukemia and to prevent vascular changes that promote tumor growth in lab animals.2

Pomegranates' potent antioxidant compounds have also been shown to reduce platelet aggregation and naturally lower blood pressure, factors that prevent both heart attacks and strokes.3 Pomegranates contain high levels of flavonoids and polyphenols, potent antioxidants offering protection against heart disease and cancer. A glass of pomegranate juice has more antioxidants than red wine, green tea, blueberries, and cranberries.

Pomegranate juice has also been found to contain phytochemical compounds that stimulate serotonin and estrogen receptors, improving symptoms of depression and improving bone mass in lab animals.4

Given the fact that pomegranate juice is so rich in heart protective compounds and there are animal studies to support the beneficial findings in human studies, it makes the results of these recent investigations understandable and believable. Pomegranate is a powerful food for good health.5

Summary Features of Pomegranate

1. Most powerful anti-oxidant of all fruits
2. Potent anti-cancer and immune supporting effects
3. Inhibits abnormal platelet aggregation that could cause heart attacks, strokes and embolic disease
4. Lowers cholesterol and other cardiac risk factors
5. Lowers blood pressure
6. Shown to promote reversal of atherosclerotic plaque in human studies.
7. May have benefits to relieve or protect against depression and osteoporosis

I recommend all my patients who have heart disease, high cholesterol, or high blood pressure to incorporate pomegranate juice into their diet and, for the above reasons I have added pomegranate concentrate to my cholesterol lowering formula, LDL Protect.

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Preventing Heart Attacks with Aggressive Dietary Intervention

Most people think going to cardiologists and radiologists to get evaluated to see if they have a significant coronary blockage will enable an intervention at an early enough point to save their life; they are dead wrong. Angioplasties and stent placements as well as cardiac surgery treat symptoms, not the disease. Seventy to eighty percent of all myocardial infarctions (heart attacks) are caused by plaque that is not obstructive or visible on angiography or stress tests.

Heart attacks result from a defect in the plaque wall which leads to a thrombus (blood clot). Even a small coating of vulnerable plaque, invisible to cardiac testing, can cause a heart attack and typically does. The important point to remember is this: Individuals without major blockages of their great vessels, with only 30 to 50 percent stenosis (narrowing), are even more likely to develop a fatal cardiac event, (compared to those with more significant blockages) yet these individuals are not even shown to have heart disease with a stress test or angiography. Stress testing only identifies blockages that obstruct greater than eighty-five percent of the vessel lumen. A normal stress test is meaningless and does not mean you do not have significant heart disease or won't shortly have a heart attack.

Bypass surgery and angioplasty only attempt to treat a small segment of the diseased heart, usually with only temporary benefit. Since atherosclerotic plaque blankets all the vessels in the heart, bypassing or removing the most diseased portion, still does not address all the shallow and non-obstructive lipid deposits. The major burden of disease is left intact and therefore the potential for a deadly heart attack is largely unaffected. These mechanical interventions do not address the cause of the disease and only treat the symptoms it is not surprising that the patients undergoing bypass and angioplasty experience disease progression, graft shutdown, restenosis, and more procedures because their heart disease continues to advance.

Using surgical and high-tech interventions as a substitute for a healthful diet is doomed to fail. When extensive coronary artery disease is present and surgical/high-tech intervention occurs, we still leave the vast bulk of plaque essentially untreated because atherosclerosis is a dietary-induced disease and is spread all over the heart, not only in those areas visualized by angiograms and then treated. When we combine these marginally effective or ineffective medical interventions with the wrong dietary advice given by most doctors and dieticians (to reduce fat and cholesterol and eat less red meat and more chicken and fish) we get predictable future cardiac tragedies. Numerous studies have demonstrated that following the typical dietary recommendations of the American Heart Association to hold cholesterol to less than 200 mg per day and to reduce dietary fat to less than 30 percent doesn't work.1 These diets fail to realize that the nutritional cause of heart disease is not simply a question of eating less fat. Moderation kills, because heart disease still advances.

There is irrefutable evidence that high cholesterol levels are associated with increased risk of coronary heart disease (CHD). Make no doubt about it: lowering your Low Density Lipoprotein (LDL) cholesterol below 100 offers powerful protection against heart disease. LDL cholesterol is the bad guy that promotes the plaque that leads to blockages and heart attacks. Thus, the more LDL-cholesterol you have in your blood, the greater your risk of heart disease. The evidence is overwhelming today that heart attacks, which kill half of all Americans, are entirely preventable. Heart disease is a condition that is preventable and reversible through aggressive nutritional intervention and cholesterol-lowering.

The good news is symptoms, as well as blockages, easily melt away with nutritional excellence, without any cardiac intervention. The risks and complications of cardiac interventions and bypass surgeries are simply not necessary when people adopt an effective nutritional strategy. Instead of expensive and invasive medicine, we need doctors to educate and motivate patients to take charge of their own health. While our population is committing suicide with their knives and forks, they run to doctors expecting to be saved. Unfortunately, it is almost impossible to escape from the biological laws of cause and effect. Good health has to be earned, it can't be bought.

Compelling data from numerous population and interventional studies show that the combination of a natural plant-based diet and aggressive lipid-lowering will prevent, arrest, and even reverse heart disease. Only via nutritional excellence can you address all the invisible, but potentially dangerous plaque throughout your coronary arteries. Unlike surgery and angioplasty, the dietary approach addressed in this book does not merely treat your heart, but rejuvenates all your blood vessels and protects your entire body against heart attacks, strokes, pulmonary embolisms, venous thrombosis, peripheral vascular disease, and vascular dementia. It is your most valuable insurance policy to secure a longer life free of medical tragedy.

Studies preformed by Dean Ornish and other investigators have also documented the effects of a low-fat vegetarian (vegan) diet on patients with heart disease and found reversal of the condition occurred in the majority of patients. The reversal was modest, but nevertheless, no study previously showed diet could be so effective at preventing and reversing heart disease.

Caldwell Esselstyn, Jr., M.D. of the Cleveland Clinic went a step further and put together a program utilizing a vegetarian plant-based diet with the addition of cholesterol-lowering medication in 18 patients who had severe angiographically demonstrated coronary artery disease. All of these high-risk patients with advanced heart disease were noted to have no coronary events during the following 12 years, and on repeat angiogram, 70% were found to have regression of their disease and none had progression.2 When you consider these 18 patients had experienced 50 coronary events during the 8 years before this study, you have to agree on the effectiveness of combining plant-based nutrition with cholesterol lowering.

I have observed the same thing in my medical practice over the last 15 years: the combination of superior nutrition with a plant-based, vegetable-predominant diet and cholesterol-lowering therapy stops heart disease cold.

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A New Way of Addressing Heart Disease

More than 1.5 million people will have a heart attack this year with about 1 million deaths due to heart disease. This amounts to another needless death every 30 seconds. In 1997 the direct medical costs attributed to heart disease came to 59 billion--more than any other medical condition. Drugs, medical procedures and surgery are the recommended approach to deal with heart disease in America. As a result, the demand for high-tech expensive, but largely ineffective, medical care is high, causing medical costs and insurance rates to skyrocket. The medical answer to heart disease is both financially devastating and futile. An entire industry has blossomed to attempt to deal with the dangers of heart-disease-causing food. It wouldn't be so bad if patients were told there was another option that was more effective and could reverse heart disease and protect their life with certainty. If good information was distributed to all patients, then they could choose which road was right for them.

If all the physicians in America gave patients this information, we would have a new major problem. The patients would get well, the doctors and hospitals would lose most of their business and the drug companies would lose billions. People would have to be re-trained for new careers as a multi-billion dollar industry would lose almost all of its customers. Not a likely scenario. Nevertheless, my goal is to recruit an army of heart-disease-proof individuals, who will be winners in the war against unnecessary heart disease deaths.

High cholesterol and resultant heart disease is a far too common problem--but it is both preventable and reversible. The risk of cardiovascular disease, resulting in a heart attack or embolic stroke, is directly related to your cholesterol level.

Today's cardiac protective recommendations are:
-LDL cholesterol below 100 mg/dl
-Total cholesterol below 150 mg/dl

Unfortunately, less than 10% of adults in the United States meet this requirement and heart disease and stroke kill more people than all other causes of death combined.

Dramatic cholesterol lowering results, without drugs

In my medical practice, I have helped thousands of patients successfully lower their cholesterol levels without drugs. I recommend that my patients lower their cholesterol through natural methods whenever possible, using prescription drugs only when absolutely necessary because of their potentially serious side effects. Almost all of my patients prefer this judicious approach and it is very rare that they are not able to achieve these protective levels naturally.

Hundreds of my patients have dropped their cholesterol into the favorable range and protected themselves against heart disease, without drugs, using my methods.

Just for an example, in one day, last month I had five patients who dropped their LDL cholesterol below 100 mg/dl. Don't forget, this was just one day in my practice!

Not only did all these individuals have dangerously high cholesterols, but each patient also reported numerous health problems. Peggy suffered from chronic anemia, Eugene was tired all the time, Keith had chronic heart burn and allergies, and Maria had become severely ill from a statin drug prescribed to her by her prior physician. These four patients needed help and they realized that prescription drugs were risky and not the answer. They all returned to my office between 6 and 8 weeks after their first visit and this is what we found.

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Fishing for the Truth

Michael Hawthorne and Sam Roe of the Chicago Tribune report that the United States safety net for safeguarding consumers against the increased mercury levels in fish is in tatters. In the article the reporters detail the fate of one particular piece of fish:

Shipped from Singapore, the swordfish entered the U.S. this year without being tested for the toxic metal mercury.

When a fillet from that fish reached a display case at a supermarket in suburban Des Plaines, it carried no government warning labels, even though federal officials know swordfish often is so contaminated that young children and pregnant women should never eat it.

The Chicago Tribune actually bought and tested a portion of this fish, which produced alarming results:

When the Tribune bought and tested this particular piece of fish, the results showed not just high amounts of mercury, but levels three times the legal limit.

Hawthorne and Roe point out the dangers lurking in the fish and in the actions of U.S. health officials:

Even though mercury can cause learning disabilities in children and neurological problems in adults, regulators do not even bother to routinely check fish for metal. This leaves consumers with little idea about which fish are most hazardous.

In some cases, regulators have ignored the advice of their own scientists who concluded that mercury was far more dangerous than what consumers were being told.

In other instances, regulators have made decisions that benefited the fishing industry at the expense of public health.

In his book Eat to Live Dr. Fuhrman explains that consumption of fish creates a parodox:

Fish contains omega-3 fatty acids (EPA and DHA) that interfere with blood clotting much the same way aspirin does. Once you have significant atherosclerosis, it is helpful to take such anti-clotting agents, especially if you continue a dangerous diet. These fish derived-fats also have some effect on protecting the arterial walls from damage from other fats.

However, the best way to prevent a heart attack or stroke is to follow a high-nutrient diet with little or no animal products, thereby ensuring that such blockages don't develop in the first place. Then eating fish won't matter. In fact, the reason fish-derived fats, EPA and DHA, are not considered essential fats is that almost all people have enzymes to convert the plant-derived omega-3 fat rapidly into EPA and DHA.1

Fish is a double-edged sword, especially because fish has been shown to increase heart attack risk if polluted with mercury.2 It seems that the cardioprotective effects of eating a little fish is lost when you eat lots of fish, most likely because lots of fish exposes you to high mercury levels, which can promote lipid peroxidation.3 Lipid peroxidation plays a major role in the development of diseases such as heart disease, diabetes, and arthritis.

Dr. Fuhrman provides important information to consider when deciding whether or not to consume fish:

Higher levels of mercury found in mothers who eat more fish have been associated with birth defects, seizures, mental retardation, developmental disabilities, and cerebral palsy.4 This is mostly the result of women having eaten fish when they were pregnant. Scientists believe that fetuses are much more sensitive to mercury exposure than adults, although adults do suffer from varying degrees of brain damage from fish consumption.5 Even the FDA, which normally ignores reports on the dangers of our dangerous food practices, acknowledges that large fish such as shark, swordfish, and yellowfin and bluefin tuna, are potentially dangerous. Researchers are also concerned about other toxins concentrated in fish that can cause brain damage way before the cancers caused by chemical-carrying fish appear.

Fish with Highest and Lowest Mercury Levels

Highest
  • tilefish
  • swordfish
  • mackerel
  • shark
  • white snapper
  • tuna

Lowest
  • salmon
  • flounder
  • sole
  • tilapia
  • trout

Source: Mercury levels in seafood species. U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition. Office of Seafood, May 2001.

The bottom line: Choose fish over other animal products, but be aware that the place where it was caught, and the type of fish, matters. Don't accept recreational fish from questionable waters. Farmed fish is safer. Never eat high-mercury-content fish. Don't eat fish more than twice a week, and if you have a family history of hemorrhagic stroke, limit it further to only once a month.

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Nuts to Heart Disease!

Harvard Health Publications reports that consumption of nuts is healthy, especially for men at risk for heart disease.

Researchers from Harvard Medical School and the Harvard School of Public Health decided to crack old myths by examining how eating nuts affects the cardiovascular health of men and women.

A 1993 trial evaluated 18 healthy male volunteers who were divided into two groups, then placed on diets providing 30% of calories from fat and conforming to the Step 1 diet of the National Cholesterol Education Program. Half the men got their dietary fat from the usual foods; the others got two-thirds of their fat from walnuts. At the end of a month, the walnut eaters had lower cholesterol levels, enjoying a 12% drop, which could translate into a 20%-30% decline in the risk of heart disease if it was maintained.

In Dr. Fuhrman's book Eat to Live he explains how nuts are an important part of an optimal diet.

Multiple studies have shown the protective effects of consuming walnuts, which are rich in omega-3 fatty acids. A study of 34,192 Californian Seventh-Day Adventists showed a 31 percent reduction in the lifetime risk of ischemic heart disease in those who consumed raw nuts frequently.1 The ideal diet for heart disease reversal, then, is free of saturated fat, trans fat, and cholesterol; rich in nutrients and fiber; and low in calories, to achieve thinness. However, it should contain sufficient essential fatty acids, so it is important to add a small amount of nuts and seeds, such as walnuts and flaxseed.

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