Diet and Disease: Not What You Think
by Sally Fallon and Mary G. Enig, Ph.D.
Heart disease is America's major killer; it's
prevention is our most urgent public health priority. Americans must change
their diet, say the experts. Steer clear of traditional foods like butter,
cream, cheese, eggs, and meat, they tell us. Rich foods contain cholesterol and
saturated fats — "artery clogging substances."
The accumulation of hardened plaque in the arteries, or atherosclerosis, is
indeed a major cause of heart disease in Western nations.
The Accepted Explanation
for its prevalence in civilized countries is the lipid hypothesis, namely
that dietary saturated fat and cholesterol lead to elevated levels of
cholesterol in the blood, and that these elevated levels of cholesterol cause
the pathogenic atheromas that block blood vessels.
This theory has been promoted by the American Heart Association
since the mid-1960s. It forms the basis of governmental nutritional
recommendations, which in turn have spurred consumer acceptance of a vast array
of low-fat, cholesterol free food products, most of which contain ingredients
that are new to the American diet.
Numerous studies, both national and international, have explored the lipid
hypothesis — and consumed the lion's share of research dollars in this area
— including three major projects funded by the National Heart Lung and Blood
Institute, a division of the National Institutes of Health (NIH).
The first and best known of these studies was the Framingham Heart Study,
carried out in the town of Framingham, Massachusetts.
Although Framingham is
often associated with proof of the lipid hypothesis, the results of this 40-year
study have been a disappointment to its promoters.
Investigators claimed that there was a 240% increase in
"risk" of coronary heart disease, or CHD, between cholesterol levels
of 182 and 244. But the actual rate of increase was only .13%.
Between cholesterol levels of 244 and 294, the rate of CHD actually declined.
Thus Framingham investigators found virtually no difference in heart
disease for serum cholesterol levels between 182 and 284 the vast majority of the U.S. population.
Nor did they find that diets high in fat and cholesterol predisposed an
individual to heart disease.
As Dr. William Castelli, the current director of the Framingham project,
admitted as recently as 1992: "In Framingham, Massachusetts, the more
saturated fat one ate, the more cholesterol one ate, the more lories one ate,
the lower people's serum cholesterol... we found that the people who ate the most
cholesterol, ate the most saturated fat, ate the most calories weighed the least
and were the most physically active."
The second government-funded study was the Multiple Risk Factor Intervention
Trial (MRFIT) for 362,000 men.
Researchers found that annual heart disease deaths increased from about 1 per
1,000 for cholesterol levels of 180 to slightly less than 2 per 1,000 for
cholesterol levels of 300 — a 100% increase in "risk" but a trivial
increase in rate of less that .1%.
A more significant finding was an increase in total deaths for cholesterol
levels below 160.
The final major NIH study was the Lipid Research Clinics Coronary Primary
Prevention Trial (LRC), a project that cost $150 million and received intense
All subjects in the trial were put on a low-cholesterol, low-saturated fat
diet. One group received a cholesterol lowering drug, the other a placebo.
Average cholesterol reduction for the drug group was 8.6% which had, according
to researchers, a 17% reduction in rate of heart disease.
This led to the oft repeated statement: "For each 1% reduction in
cholesterol, we can expect a 2% reduction in CHD events." But when
independent researchers tallied the LRC data, they found no difference in CHD
between the two groups. An unequivocal but rarely published finding of the LRC
was an increase in deaths from cancer, intestinal disease, stroke, violence, and
suicide in the group taking the cholesterol-lowering drug.
Both the popular press and medical journals portrayed the LRC as the
long-sought proof that animal fats and dietary cholesterol are the cause of
heart disease. The 1984 government-sponsored Cholesterol Consensus Conference
called for mass cholesterol screening and defined all Americans with
cholesterol levels over 200 as "at risk."
Participating scientists recommended the prudent diet for "at risk"
Americans, one low in saturated fat and cholesterol. A specific recommendation
was the replacement of butter with margarine. The ensuing National Cholesterol
Education Program instructed American physicians in techniques for lowering
serum cholesterol through diet ant drugs.
The estimated current cost
for cholesterol screening and treatment in the United States now exceeds $60
The application of a modicum of common sense could have prevented
the massive expenditures lavished on the lipid hypothesis during the past 30
The lipid hypothesis implies that animal fat consumption must have increased
significantly since 1920 to correlate with the rise in heart disease, but in
fact the consumption of saturated animal fats in America declined steadily
during that period, while use of vegetable fats increased dramatically.
Autopsy studies of
vegetarians reveal that although they have lower serum cholesterol values than
non-vegetarians, they have as much atherosclerosis as non-vegetarians.
In fact, the International Atherosclerosis Project, which analyzed
31,000 autopsies from l5 countries, found no correlation between animal
fat intake and degree of atherosclerosis or serum cholesterol level.
Michael DeBakey, the famous heart surgeon, surveyed 1,700 patients with
atherosclerosis and found no relation between levels of serum cholesterol and
degree of hardening of the arteries. Other U.S. studies — the Veterans
Clinical Trial, the Minnesota State Hospital Trial, the Honolulu Heart Program,
and the Puerto Rico Heart Health Study — found no significant relation between
a diet high in cholesterol and saturated fats with CHD.
Unfortunately, these studies do not receive front page coverage in
American newspapers, and dissenting voices must content themselves with
publication in obscure medical journals. One of these voices is the eminent
researcher Dr. George Mann, who states categorically:
hypothesis has been repeatedly shown to be wrong, ant yet, for complicated
reasons of pride, profit, and prejudice, the hypothesis continues to be
exploited by scientists, fund-raising enterprises, food companies, and even
governmental agencies. The public is being deceived by the greatest health scam
of the century."
Michael Gurr, Ph.D., renowned expert on lipids and author of
the authoritative textbook on lipid biochemistry, recently stated that
"whatever causes coronary heart disease, it is not primarily a high intake
of saturated fat." He criticized "...the degree of self delusion in
research workers wedded to a particular hypothesis despite the contrary
So if it ain't saturated fats ant cholesterol, what causes
heart disease? There are, in fact, a number of dissenting theories, most of
which dovetail into a compelling list of dietary and lifestyle factors that are
unique to civilized societies. Consider the following:
- In the 1940s and 1950s, researchers Yudkin and Lopez discovered a
link between consumption of refined sugar and heart disease. Sugar
consumption lowers the body's resistance to bacteria, viruses, and
yeasts that may cause inflammation in both the heart and the arteries.
Excess sugar leads to deficiencies in the entire B-vitamin complex,
needed for healthy arteries. Ongoing research at the U.S. Department
of Agriculture indicates that fructose may be even more dangerous than
sugar. Fructose, mainly in the form of high-fructose corn syrup (HFCS),
has become the sweetener of choice for soft drinks, condiments and
many so-called health foods.
- Also in the 1960s, a researcher named Annand discovered a
correlation between the consumption of heated milk protein and a
tendency to thrombosis — the formation of blood clots — and noted
that the rise in coronary heart disease began in the 1920s with laws
requiring milk pasteurization.
- Researcher Kilmer McCulley has found a positive relationship between
deficiencies in folic acid, B 6 and B l2 , and severity of hardening
or stiffness of the arteries, as well as the buildup of pathogenic
plaque. B 6 and B 12 are found almost exclusively in animal products
— the very foods that proponents of the lipid hypothesis advise us
to avoid. B 6 deficiency is also associated with hardening of the
tendons leading to carpal tunnel syndrome. Deficiencies of this
heat-sensitive vitamin are widespread in America, partly because B 1
and B 2 added to white flour interfere with its proper use, and partly
because it is destroyed during milk pasteurization. (Although
pasteurization may help prevent foodborne illness, the process
destroys nutrients.) Although McCulley's research has gained
widespread, albeit grudging, recognition in the scientific community,
it continues to lack appropriate funding and public recognition.
- Vitamin C deficiency makes arterial walls more subject to
inflammation and tearing. A diet rich in natural vitamin C complex
helps maintain the integrity of both blood vessels and heart muscle.
Vitamin C also plays a role in collagen synthesis, along with copper,
through the enzyme lysyl oxidase. Deficiencies occur in diets that
lack fresh fruits and vegetables.
- Heart disease has been correlated with mineral deficiencies.
Coronary heart disease rates are lower in regions where drinking water
is naturally rich in trace minerals, particularly magnesium, which
acts as a natural anti-coagulant and aids potassium absorption,
thereby preventing heartbeat irregularities. Mineral-rich water and
soil also supply iodine, needed for a healthy thyroid gland. People
with poor thyroid function are very prone to heart disease. Calcium
also plays a role in protecting the heart and arteries. Potassium
helps maintain proper blood pressure. Traditional meat broths are rich
in magnesium, potassium, calcium, and iodine. In America, these have
largely been replaced by imitation broth products containing MSG and
- The most important change in the American diet during the years of
CHD increase has been the gradual substitution of vegetable fats for
those of animal origin. Hydrogenated fats — in the form of margarine
and shortening — have replaced butter and lard, while the
consumption of vegetable oils has increased more than 10-fold. Since
as early as 1956, a number of researchers have found that consumption
of trans-fatty acids in hydrogenated oils contributes to heart
disease, including most recently Mensink and Katan in the Netherlands,
and Walter Willett at Harvard University.
- An excess of vegetable oils, even when not hydrogenated, seems to
play a role in causing heart disease because they cause an imbalance
in the production of prostaglandins, localized tissue hormones that
play a role in all of the body's complex chemical processes; and
because industrially processed vegetable oils contain bee radicals
that damage the arteries, thereby initiating plaque deposits.
- Arterial plaque contains cholesterol because the body actually uses
cholesterol to repair injuries, tears, and irritations to artery
walls. However, like rancid vegetable oils, cholesterol that has been
oxidized by high temperatures and exposure to air can itself irritate
the arterial walls and initiate pathological buildup. High temperature
spray production of powdered milk and eggs, used as additives in many
processed foods, began in the early part of the century. Consumption
of both hydrogenated fats and products containing oxidized cholesterol
increased greatly after the war.
- A recent study found that excess consumption of omega-6 fatty acids,
the kind found in commercial vegetable oils made from corn, soy,
safflower, and canola, increases the amount of oxidized cholesterol in
the arterial plaque. Like sugar and white flour, these vegetable oils,
produced by high temperature industrial processing, are new to the
human diet. It is the polyunsaturated omega-6 fatty acids — not
saturated fat — that form the major fat component of arterial
plaque, yet for many years the American Heart Association and many
establishment nutrition writers advocated consumption of
polyunsaturated oils for the heart.
- The role of vitamin D in protecting against heart disease has been
neglected. Vitamin D is essential for the intestinal absorption of
many minerals, but particularly calcium and magnesium. Vitamin D
deficiency is associated with defective calcification of the bones and
pathogenic calcification of the arteries. Synthetic vitamin D added to
milk has the same effect as vitamin D deficiency — it causes
abnormal calcification of the soft tissues, particularly the blood
vessels. Our bodies can manufacture vitamin D from cholesterol by the
action of sunlight on the skin, but natural dietary sources give added
protection. Vitamin D is found only in animal fats.
- Short- and medium-chain saturated fatty acids have anti-microbial
effects and protect against the kind of viruses and bacteria that
contribute to heart disease. Best sources of these helpful fats are
the tropical oils, especially coconut oil, which have largely
disappeared from the American food supply due to unfounded assertions
that these healthy fats contribute to heart disease.
- Caffeine in coffee causes the body to excrete calcium and stresses
the adrenal glands, leading in some cases to general exhaustion,
including exhaustion of the heart muscle. This theory has been subject
to intense criticism. Detractors note that heavy coffee drinkers tent
to indulge in a number of habits considered unhealthy by orthodox
researchers — such as smoking and lack of exercise — as well as
consumption of sugar and processed foods, leading to deficiencies not
yet accepted by the medical establishment as being contributors to CHD.
- Anti-oxidants such as beta-carotene, selenium, and vitamin E may
protect us against damage from highly processed vegetable oils and
oxidized cholesterol. Orthodox medicine has ignored or ridiculed
vitamin E therapy for heart disease, pioneered by the Shute brothers,
physicians in Canada, who found that 100 mg of natural vitamin E from
wheat germ oil gave excellent long-term protection from coronary heart
disease. Fresh fruits and vegetables supply beta-carotene and hundreds
of other carotenoids; butter is a particularly rich source of
- Other theories related to heart disease include lack of exercise,
overweight, high blood pressure, smoking, and exposure to carbon
Heart Disease Has Many Forms
What emerges is a clear association of heart disease with the
increased consumption of devitalized, processed, fabricated food items,
including sugar and fructose, pasteurized milk, soft drinks, fortified white
flour, miller and egg powders, caffeine, imitation broth products, synthetic
vitamins, vegetable oils, and hydrogenated fats.
The lipid hypothesis not only clouds this picture, but
inhibits necessary research that could illuminate these connections more
clearly. Instead of adding to medical and nutritional understanding, it may be
undermining public health — promoting the substitution of newfangled, altered,
imitation products for nourishing traditional whole foods, including butter,
cream, cheese, eggs, and meat.
Although not unknown, heart
disease was relatively rare at the turn of the century, accounting for
approximately 8% of all deaths in the United States.
Today coronary heart disease, or CHD, accounts for about 45%
of all deaths.
Incidence of heart disease rose precipitously between 1920 and
1960. Since that time, mortality rates from CHD have declined somewhat. This
means that victims of heart disease are living longer, due most likely to
improved surgical techniques and the advent of angioplasty; but morbidity rates
— the incidence of heart disease — continue to rise, although at a lower
rate than before.
Of greatest concern is the high rate of heart disease in
American men between the ages of 45 to 65.
Heart disease is not a single malady, but a complex of disease
coming under a single rubric.
Damage to the heart muscle or myocardium may be due to a
congenital defect, or result from inflammation and damage associated with any
number of viral, bacterial, fungal, rickettsial or parasitic diseases; from
rheumatic fever or syphilis; from toxic chemicals such as carbon monoxide or
drugs; from auto-immune reactions or genetic disorders in which important
cellular proteins in the heart muscle are deranged; or from disruption of
enzymes affecting cardiac function.
The heart may also be damaged by an imbalance between the
blood supply and the demands of the heart muscle leading to ischemia, a local
deficiency of blood supply, and infarction, the death of an area of heart
Such deficiency may be caused by physical exertion or
emotional trauma, increasing the heart's need for blood; or from a drop in blood
supply due to excess bleeding, a spasm in an artery, a blood clot (thrombus) or
by coronary artery disease, a condition in which the arteries become gradually
blocked by the buildup of abnormal plaque (atheromas) and hardened through
calcification. Blockage often occurs in the large arteries feeding the heart
(the coronary arteries), or in those supplying the brain, increasing the risk of
In cases of moderate blockage of the coronary arteries, the
patient may suffer from angina pectoris, bouts of brief chest pain; moderate
blockage combined with increased demands on the heart, due to exertion or
trauma; or severe blockage due to arterial plaque, a clot, a spasm, or any
combination of these, may lead to a myocardial infarction, the dreaded heart
attack, resulting in cardiac dysfunction and often rapid death. Sudden death is
often triggered by an acute arrhythmia — disruption in the rhythms of the
heart beat — during a heart attack.
While coronary artery disease is a common cause of heart
attack, myocardial infarction may also occur in the absence of arterial
blockage, due to a spasm, clot or organic failure of the heart muscle.
Heart disease due to syphilis and infectious disease has been
around a long time and probably accounts for a good portion of CHD deaths before
1920. Fatty streaks, lesions, and plaque in the arteries are found in many
primitive people, but coronary artery disease, the pathological buildup of
hardened plaque leading to partial or total occlusion of major arteries, seems
to be a disease of civilization, and probably accounts for a great deal —
though not all — of the increase in heart disease between 1920 and 1960, and
its continued menace to the present day.
Sally Fallon is the author of Nourishing Traditions: The Cookbook that
Challenges Politically Correct Nutrition and the Diet Dictocrats (NewTrends
Publishing 877-707-1776) and Mary G. Enig, Ph.D. is the author of Know Your Fats:
The Complete Primer for Understanding the Chemistry of Fats, Oils and
Cholesterol (Bethesda Press 301-680-8600).
Reprinted with the permission of the authors.