This article was published in the February/March 2005 Wedge newsletter. The following information may be outdated.

Turning the World Upside Down - Radical Views on Health

By Elizabeth Archerd, Member Services Director

In early December I was treated to dinner at French Meadow Bakery and Cafe in honor of Ann Louise Gittleman, author of "The Fat Flush Plan." Seated near me at dinner were several fascinating women, one originally from Trinidad. She commented that before coming to the U.S. she had never heard of the chronic diseases that are constantly in the news here. "People die of old age" in Trinidad, she said.

That got me to thinking. I suspect people die of many things in Trinidad, but the thrust of her comment is that those who make it to old age do not die after years of chronic illness accompanied by high-tech medical management.

I am not anti-medical-establishment. Scientific medicine saved the lives of many family members. I will be eternally grateful for obstetrical interventions that brought my son and me safely through a risky labor.

Even so, all is not right with the current state of medical practice in this country. I worry about sounding like a conspiracy theorist when I mention doubts about the use of statin drugs (Lipitor, Prevachol, Zocor, etc.), the "fat causes heart disease" theory, or the idea that cholesterol is our enemy. The country appears to be within a few years of having a medical bill that is bigger than aggregate corporate profit, yet we're putting healthy people on expensive drugs that have not been proved to prevent illness in healthy people.

The growing national health care bill is financing prime-time television advertisements to get you to ask your doctor for drugs. Do you have any idea how many millions of dollars that costs? You, the consumer, pay for it with each prescription.

There are huge issues of drug safety and effectiveness. Vioxx just made the headlines by increasing heart disease risks. Remember "Fen-Phen," the diet drugs that caused heart valve defects? Or 50 years of hormone replacement therapy (HRT) that finally proved ineffective and potentially dangerous? Recent studies on anti-reflux drugs indicate that turning off your stomach acid may increase your risk of pneumonia because stomach acid is anti-bacterial.

A ticking time bomb may be these cholesterol-lowering drugs that some cardiologists joke about adding to the water supply. It's a horrible joke, by the way. The damage to a fetus from low maternal cholesterol is devastating. Even so, Great Britain is considering selling these drugs over the counter.

The old theory about statins was that they prevented heart disease by lowering cholesterol. Recently it has been noted that some of these drugs reduce inflammation as measured by C-reactive protein (CRP), and there is increasing evidence that a high CRP level is more predictive of impending heart disease than cholesterol. Big Pharma will no doubt rush to develop expensive anti-CRP drugs. Other voices recommend caution, because just as it may not be that high cholesterol causes heart disease as that it sometimes accompanies it (remember, half of heart attacks are in persons with "normal" cholesterol), it may be that CRP is just an indicator that something is wrong, not the cause of the problem. As one fellow put it, a deep crease in the earlobe is also associated with heart disease risk, but no one suggests we cut off creased ear lobes.

In November 2004, a study published in the American Journal of Clinical Nutrition concluded, among other things, that "Among post-menopausal women with established CHD [coronary heart disease], greater saturated fat intake was associated with less progression of coronary atherosclerosis over an average follow-up of 3 years, whereas polyunsaturated fat and carbohydrate intakes were associated with greater progression."

Yes, you read it correctly. More saturated fat, less progression of heart atherosclerosis in women with heart disease. Why wasn't that trumpeted all over the headlines? Research consistently fails to prove the "dietary fat causes heart disease" theory, and much research on cholesterol and heart disease fails to confirm a causal relationship. In fact in the elderly, high cholesterol is associated with longevity. In the MRFIT study, a long study of men and heart health, cholesterol below 160 was associated with a higher mortality rate. That is, lower cholesterol was associated with more deaths during the study period. Most statin drug trials have resulted in a tiny reduction in strokes or heart attacks, mostly non-fatal, but no reduction in the death rate during the study.

The trials that purport to prove the effectiveness of statin drugs to prevent heart attack or stroke have been done on heart disease patients, not healthy people. Even for those with heart disease, the drugs reduce the number of additional "events" so minimally that it is a scandal how heavily these drugs are promoted. For each heart attack prevented or delayed, doctors have to treat hundreds of persons for years. Hundreds of healthy individuals are exposed to the risks of statin side effects for each event prevented. Is that a wise use of health care money?

Backing up a little, did you know that after World War II, there was no "epidemic" of heart disease? The perception of an epidemic eventually led to a theory that post war dietary changes in the form of increased animal food consumption, caused heart disease. But government records indicate an unchanged rate of heart disease for every age group. There was more overall heart disease because more Americans survived to the older ages at which heart disease develops, thanks to improved sanitation and antibiotics earlier in the century. With fewer deaths from infectious diseases, more lived to develop diseases of aging. In addition, the causes of death listed on death certificates were later expanded to include more specific heart diseases that would have been listed differently in earlier decades. Both of these facts gave rise to a belief that heart disease was on the rise.

The theory that saturated fat in the diet leads to heart disease does not bear out in long-term studies. In fact, there is increasing suspicion that the U.S. dietary guidelines issued by the McGovern Committee in the late 1970s contributed to the current obesity and diabetes surge - and diabetes is a risk factor for heart disease. The recommendation to reduce fat consumption was a change of unprecedented proportion and most nutrition researchers testified against it. Something had to replace the fat and in most cases the "something" was refined carbohydrate. Reduced fat dairy products have higher carbs too. Take out the fat and the sugar concentration goes up. (Not to mention that we need fat to absorb calcium.)

It almost appears that pharmaceutical company marketing departments write up study results, and our FDA "watchdog" is not questioning the distortions. But question the current medical orthodoxy, and faster than you can say "Vioxx, Fen-Phen and HRT" you are labeled as a kook.

Where is all this leading? What are we to do?

Nutrition science is young and there are still many mysteries about how our bodies work, so resist getting overly excited by the latest news or developing chronic fear about small risks. Then follow Grandma's and Jennette Turner's advice: Eat fruit and vegetables. Get enough sleep. Drink clean water. Take a walk. Find meaningful work and practice generosity in your friendships. Turn off the news for a week. Replace processed or fast food with real food by learning to cook one new dish every weekend - you'll have quite a repertoire after a year.

Then stop worrying.

References on heart disease: