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The official website of Drs. Michael and Mary Dan Eades, low carb pioneers and authors of Protein Power.

Cholesterol and heart disease: no correlation

I just ran across a video of Dr. Malcolm Kendrick discussing the lack of correlation between cholesterol levels in the blood and heart disease. As cholesterol-con.jpgyou may remember I reviewed Dr. Kendrick’s book The Great Cholesterol Con in a previous post. His book is by far and away the better of the two books out there with the same title. Dr. Kendrick has a wealth of experience from which to draw and writes in a clever, witty and easily readable style. If you’re still worried that cholesterol may be the cause of heart disease, you need to read this book.

When I reviewed this book earlier, it took several weeks to get. Now the books are available from Amazon.com and can be had quickly. Add it to your low-carb library.

One caveat about the video. Despite how compelling the data are, they still come from observational studies, and, as such, can’t really be used to prove causation or lack thereof. The reason for this video is that so many people have tried to prove that cholesterol causes heart disease with the use of observational studies, it’s nice to see one that clearly shows the opposite.

Here is the YouTube link.

23 Comments

  1. Sam on October 6, 2007 at 9:06 pm

    Dr. Mike: Is there a correlation between any blood factors and heart disease-such as LDL, VLDL, particle size, triglyceride, etc.? Beyond correlation, is there any causation between those factors and heart disease? Are these questions that if definitively answered will result in a Noble prize? Thanks.

    Hi Sam–

    There is correlation between elevated triglyceride levels and heart disease, but correlation is not causation. No one knows if the triglycerides are the problem or are a marker for a different problem or just a coincidental finding. If there is anything that looks causal it’s probably small LDL particle size. Since the elucidation of the LDL receptor garnered a Nobel, it stands to reason that an absolute for sure definitive answer to the lipid hypothesis would probably garner one as well.

    Cheers–

    MRE

  2. Anne on October 6, 2007 at 9:20 pm

    erm…Dr. Mike, the top of your blog was just displaying a video of a woman’s posterior with the title “stay at home moms looking for fun” 😉 somehow I doubt that one is about cholesterol.

    Hmmm. That’s not supposed to happen. Google must have dropped its guard momentarily.

    Thanks for the heads up.

    Cheers–

    MRE

  3. David Futoma on October 6, 2007 at 9:29 pm

    Thanks for the cue on the Kendrick book. I ordered it from Amazon tonight. I am on page 111 of Gary Taubes’ book and am absolutely appalled at the intransigence early on (and today as well) to believe that carbs (in particular sugar) could be tied to higher rates of diabetes. Joslin himself went with the fat connection and NOT sugar. I can’t help but believe (as a low carb Atkins follower and now protein-power for-life since 2003), that his book may be one of the most important books I have ever read in my life. Will look forward to your thoughts in the future.

    Thanks again,

    David Futoma

    Have fun with the Kendrick book – I think you’ll really enjoy it.

    MRE

  4. Hellistile on October 6, 2007 at 10:13 pm

    Dr. Mike:

    This is a great book, unfortunately it’s in the hands of one of my math phd’s but at least I know where it is and who to nag to get it back 😛

    Keep up the fight and thanks.

    Good luck retrieving your book.

    Cheers–

    MRE

  5. Alex on October 7, 2007 at 12:57 am

    I purchased the book and am anxious to receive it.

    Question for you: In Protein Power you mention insulin enables HGM-CoA reductase production, upping intra-cellular cholesterol synthesis. A ketogenic diet, enables glucagon to come in to the picture, and it cuts back HGM-CoA reductase, thus lowering cholesterol levels. It worked for me (from 209 to 160 tot chol, and LDL from 169 to 120) in roughly 7 weeks.

    If statins, which downregulate HGM-CoA reductase, also block CoQ10 production… does glucagon do something similar (affect CoQ10)?

    Question part deux: in Protein Power Lifeplan (PPL), you mention Niacin to lower cholesterol levels. One of Niacin’s virtues is that it not only lowers triglycerides but also increases HDL (one of the very few ‘drugs’ to actually do that significantly). If one lowers triglycerides, and raises HDL as per Taube’s book, one may be decreasing cardiovascular risk greatly. This is what niacin does (and low carb, of course). In PPL you mention the inositol hexanicotinate (No-Flush niacin) works as well as the crystalline, without the flush. I haven’t found any literature on the subject of the no-flush niacin, but indeed when it comes to crystalline. Is the improvement something you see in your patients that take it? Have your views on Niacin changed?

    (I recently found out my doctor takes a statin and Niacin–or perhaps a statin with niacin built in). Since he takes it, Im sure he’d monitor my liver functions if I took crystalline niacin (no way in h*ll I’d take a statin).

    Thanks for your blog!

    Alex

    Hey Alex–

    Insulin stimulates HMG-CoA reductase much more than glucagon inhibits it. When insulin levels are lowered, the HMG CoA reductase gets destimulated. So, the answer is No, it doesn’t reduce the synthesis of CoQ10.

    The no-flush niacin still causes some flushing that many people find unpleasant. It also doesn’t cause flushing in a lot of other people. I don’t particularly recommend niacin of any kind much anymore because the low-carb diet all by itself works so well to increase LDL particle size, the only lipid parameter that seems to count in terms of heart disease risk.

    Cheers–

    MRE

  6. Peter on October 7, 2007 at 3:14 am

    Dr Eades, is it true that observational studies cannot disprove a hypothesis? Obviously correlation and causation are not the same thing, but if there is a total lack of correlation it seems hard to see how any hypothesis can survive (except the Cholesterol Hypothesis ofcourse)…. Malcom Kendrick cites Popper and the black swan(s), one of my favourite metaphors

    Peter

    Hey Peter–

    If you can’t prove an hypothesis with an observational study, it stands to reason that you can’t disprove one. Unless, of course, your hypothesis is that all swans are white and you observe a black one.

    Cheers–

    MRE

  7. Bruce Kleisner on October 7, 2007 at 4:56 am

    I don’t get why you say this book is “far and away the better of the two books out there with the same title.” Anthony Colpo’s book, The Great Cholesterol Con, is extensively referenced, and absolutely demolishes the myth that saturated fat and cholesterol cause heart disease (or any other disease). It seems a bit smug of Malcolm Kendrick to publish a book with the exact same title, when they are both members of The International Network of Cholesterol Skeptics (THINCS), founded by Uffe Ravnskov to discuss these topics.

    http://www.thincs.org/

    Hi Bruce–

    I’ve read them both, and I think Kendrick’s book is the better of the two. It’s better written, more accessible, easier to read (the book is laid out with better type that’s not so small), and doesn’t suffer from all the problems that self-published books fall heir to. Kendrick’s experience as a clinician shines through and makes the writing much more interesting, whereas Colpo’s book reads as if it has been written by someone who spends time reading medical literature but has never had experience actually dealing with patients, which is exactly what Colpo is. Both contain much valuable information, but if I were going to recommend a book to someone who was just going to read one book, it would be Kendrick’s.

    As to Kendrick’s being ‘smug’ in publishing a book with the exact same title…I suspect that Kendrick’s title came first. Kendrick’s book isn’t self published; it was published by a mainstream UK publisher. Having written or co-written and had published by mainstream publishers 10 plus books I can tell you how the process. When you get a book contract – this is strange, but this is how if works much of the time – the publishers starts working on the cover of the book (including the title) while the book is being written. On our books we’ve had actual covers sent to us before we had even completed the manuscript. Plus, in virtually every non-fiction book contract that a first author gets, the publisher retains the right to set the title. I hated Protein Power as a title for our first book, but I had to live with it because that’s the title the publisher chose. I suspect that the publisher set the title The Great Cholesterol Con long before the book was finished and long before anyone had ever heard of Anthony Colpo’s book.

    Cheers–

    MRE

  8. Freddy on October 7, 2007 at 10:25 am

    It’s the foods that DON’T contain saturated fat and cholesterol that cause heart disease!

    So true in many cases.

    MRE

  9. Judy B. on October 7, 2007 at 2:29 pm

    I have seen that video and read Kendrick’s book. Both were excellent and certainly gave me a lot to think about. Currently I am in the middle of Taubes’ book. Last night, I was struck with the idea that the truth (i.e. the lipid hypothesis is wrong) has been in front of us for the whole time. It is the proverbial elephant in the room!!

    Why has mainstream medicine ignored this? Could it be intentional, i.e., a matter of money? Healthier people = fewer office visits, hospital admissions, tests, procedures and prescriptions filled. Not to mention the loss of face and credibility in admitting an error of this magnitude after so many years of jamming it down our throats.

    I really don’t want to believe this but there seems to be an elephant in the room with me……

    Hi Judy–

    As you get further along in Taubes’ book I think you’ll probably learn the reasons.

    Cheers–

    MRE

  10. Ressy on October 7, 2007 at 9:40 pm

    Hey Doc!

    I got some extra money to spend….Now I can afford a new book!

    I dropped my Lipitor drug……and already feel so much better after only one week. Tomorrow I get to tell my doc about the change….pray for me…

    Also….getting closer to Bernsteins diet for diabetics I’ve been able to get that total insulin dose down from 56 units Lantus a day to 26 units in a combination of Lantus and Humalog.

    I’m feeling so much better…so much better…losing weight too!!

    Ressy

    Hey Ressy–

    Thanks for the report. I really glad you’re doing so well. Keep me posted.

    Cheers–

    MRE

  11. Alex on October 7, 2007 at 10:46 pm

    Thanks for the speedy reply regarding niacin and HGM-CoA reductase. A followup question is: is there a practical test for LDL particle size?

    I have Hashimoto’s hypothyroidism and thus inherently am at a higher heart disease risk. When I took my thyroid hormone pill along with a protein and fiber shake (vanilla whey with sugar free orange metamucil, berries, cream and coconut oil) and the supplements in the book… my cholesterol skyrocketed to above 300. My TSH was also off the chart, along with the T4 low and T3 high. I got the results along with a prescription for a statin (my doctor’s third attempt).

    I returned to the original indication to take the thyroid pill on an empty stomach at least an hour before eating, and my next set of tests is in a couple of weeks.

    I could not convince the doc to do a homocysteine, Lp(a), or insulin test (to see what the fasting insulin level was). I did convince him to do the ferritin (230; I started donating blood after the result), and a vitamin D test (I was borderline low). I told him obviously hypothyroid puts me at higher cardiovascular risk, he said it did through “cholesterol” so there was no need to do the other tests and the insurance may not pay for them. Sigh.

    Thanks!

    Alex

    Geez. You can get your LDL particle size tested. Just ask for it. It used to be a difficult test to come by, but it’s being run more and more now so most labs can do it for you.

    Best–

    MRE

  12. Ned on October 8, 2007 at 2:30 pm

    Hi Dr. Mike,

    I just finished Good Calories, Bad Calories and I have to say that I’m very sad (and mad). First, for the simple fact that I’m finished with the book and second, of course, because of the current state of things, knowing now that they could be so much better. I see obese people in the gym miserable, busting their behinds trying to lose weight with no apparent success. I have a friend at work who at 40 years old just had a heart attack and a sextuple bypass (he wasn’t really even overweight) and lots of other co-workers and friends with strange conditions and diseases that they believe are just a consequence of the cards they’ve been dealt. It just doesn’t seem right. The more I learn about all this the angrier I get and the more I’m contemplating a career change to medicine. Thanks for helping lead the fight.

    Regards,

    Ned

    Hi Ned–

    It is indeed a pisser. Now you know how I’ve felt for the last 25 years.

    Cheers–

    MRE

  13. Max on October 9, 2007 at 9:37 am

    I want to add a comment to Alex. I too have Hashimoto. If you are taking a replacement thyroid hormone, the fine print instructions suggest taking it half an hour before or two hours after any other food to improve absorption. And no fiber with it, ever. The fiber blocks absorption, ditto the food. I used to take it with fiber in the AM, then read that, and after a couple days, felt immensely better. You might look into taking it apart from everything else by half an hour. Might be the difference.

  14. Marilyn Leahy on October 9, 2007 at 1:01 pm

    I am reading Taubes book for the third time and am still angry. New studies are being published daily with the same answers to the same old questions, like does exercise help you lose weight. And people react as if the findings are heresy, not science.

    I am old enough to remember a time when most people were NOT fat, did NOT exercise and did NOT eat fankenfoods. or gulp gallons of soda everyday.

    Taubes asked “can we get the low fat crowd to apologize.” Apologize hell, I wanna sue somebody. Is being stupid a legal defense?

    Ah, were it only stupidity. I think there is more there than simple stupidity, and that’s what I find most troubling.

    Cheers–

    MRE

  15. Anna on October 9, 2007 at 1:51 pm

    Another comment for Alex. Check out Mary Shoman’s thyroid.about.com/ website for lots of useful info on hypothyroidism and the range of treatment options that your doctor may not be willing to consider or tell you about. And it can be worth it to just pay out of pocket and go outside your network for tests and treatment. That’s what I had to do (my thyroid doc prescribes T4 for me, but also a very small dose of time-released compounded natural thyroid extract and T2, which works much better than just T4). Worth every penny and extra effort (though I think it saves me aggravation and $$$ in the long run).

  16. maurile on October 9, 2007 at 8:56 pm

    I haven’t read Kendrick’s book, but Colpo’s is excellent.

    The title of Kendrick’s book was chosen by his publisher. When Kendrick realized that Colpo had already published a book by the same title, he recommended several other titles, but the publisher had the final say. (This is according to Colpo on his message board.)

    Hi Maurile–

    I suspected that’s what happened with the title situation.

    Cheers–

    MRE

  17. David on October 10, 2007 at 12:20 am

    Hi Dr. Mike,

    I find it quite interesting that you hated the title “Protein Power” as you noted above.

    I’m very curious what you and/or MD would have preferred to call it instead?

    -David

    Hi David–

    When we submitted the book proposal the working title was The Insulin Connection with a subtitle that I can’t remember now that kind of told what the book was about. I think that is a more appropriate title.

    Cheers–

    MRE

  18. David on October 10, 2007 at 2:08 pm

    Thanks Dr. Mike.

    Yes, I agree, insulin is certainly what it’s all about, but that may not have marketed nearly as well (as with the prior working titles for Taubes’ Good Calories, Bad Calories). Nonetheless, PP is still one of my favorite books and as much as I like PP, PPLP totally blew me away and is a constant recommendation (if not outright gift) from me.

    I’ve got to get into reading GCBC, especially based on everything you and Regina have said about it. Sounds like it’s going to be tough recommendation competition for PPLP.

    -David

    Hi David–

    GCBC and the PPLP are complimentary, not competitive.

    Also, I guess PPLP is a better title than The Insulin Connection LifePlan would have been.

    Cheers–

    MRE

  19. Neil Wilkinson on October 10, 2007 at 6:41 pm

    The title of Kendrick’s book was chosen by his publisher.

    I remember when the book was still in manuscript form, Dr Kendrick referred to his book as yet to find a publisher book as “Cholesterolmania”

    Neil

    Yeah, these working titles seem to never make it past the publisher.

    MRE

  20. Alex on October 25, 2007 at 12:26 pm

    Hi Dr. Mike,

    I thought I would append to these comments to thank both Max and Anna for their thyroid input.

    I’m not asking for medical advice, but rather some kind of logical explanation of what could be going on….

    April 07, I get a panel done
    Triglycerides TG 120, TOT-C 206, HDL-C 43, LDL-C 139, but my TSH (thyroid stimulating hormone) is a bit high at 4.3 so he increases dosage… from 90mg to 120mg.. I go home with a statin prescription (that I never fill out, and instead i decide to go lower carb, to reduce insulin and thereby destimulate HMG-CoA Reductase)

    June 07,
    I go lower on my carbs,
    TG 99, TOT-C 163, HDL-C 37, LDL-C 106, I get back a complement on how well my low-fat diet must be working along with exercise (al I did was go very low carb, and replace some meals with protein shakes with vanilla protein). TSH came back too low at 0.10 I suggest 105mg, which I get.

    Aug 07,
    I start taking the protein shakes with fiber for breakfast, along with PPLP supplements and thyroid prescription.
    Results:
    TG 145, TOT-C 312, HDL-C 44, LDL-C 239, TSH 24.30 and all thyroid hormones are out of whack
    to me, the thyroid explained the high cholesterol and LDL… so back to 120mg thyroid

    -I start IF, with low carb, ketosis everyday

    18-Oct-07 (last week)
    Triglycerides 144, TOT-C 297, HDL-C 46, LDL-C 222 , TSH 0.30 (too low again).
    I was surprised that these results, although marginally better than August’s above, are so similar. No thyroid panel was done, so I dont know what the levels are. I am a little upset that everything has remained out of whack. of course I get another statin prescription, along with the words that the levels are awful and worrisome and I’m at increased risk of heart attack or stroke.

    Why would my TG’s be so high (~145) could I be eating too many calories during the eating periods of IF? I’m not gaining weight, I may be losing actually. Could this be TGs that are released from adipose tissue (vs generated by the liver from carbs) or is this leftover from thyroid havoc? I’ve been in ketosis!

    My guess is I should cut back on calories… continue IF, perhaps cut out the berries with sour cream that were such a great dessert, along with the glass of dry cabernet/merlot.. but I’ve been in ketosis so I can’t explain the higher TGs… during IF if anything my insulin levels should’ve gone down, thus downregulation of HMG-CoA reductase through increase of glucagon during ketosis… but that’s not happening. I’m suggesting increasing thyroid to 105mg, in between.

    Any scientific comments are appreciated… not medical advice.

    Warm Regards, thanks to any who may have ideas/speculation about what is going on physiologically,

    Alex

    Hi Alex–

    Interesting history. I can’t begin to speculate as to what happened without a whole lot more information. Given what I know, it doesn’t make sense to me that your triglyceride levels would be going up if you were keeping your carbs low. You might want to go back and retry your diet that you followed between April 7 and June 7 to see if you get the same lab results again.

    Best–

    MRE

  21. abc2008 on July 10, 2008 at 12:31 am

    I need your help in this thread regarding cholesterol issue. I can’t defend my position due to non native English speaker.

    http://forum.bodybuilding.com/showthread.php?t=109058441

    Regards

    Just enter ‘cholesterol’ in the search function of this blog. That should give you all the info you need.

  22. Vic on August 19, 2008 at 12:26 pm

    Just a thought on obesity. I was a RAF National Serviceman from 1955-57 & I cannot recall ever seeing anyone that could be called obese. There were hundreds of us in age range 18 – 25 all slim. There might have been an occasional older serviceman who had put on a bit of weight but no obesity.
    Something has clearly gone wrong in society for this incredible weight increase in so many people. There can be many guesses as to what the cause might be but it shouldn’t be too hard to find out what exactly has changed since the late 1950s. Just making assumptions about lazy people who eat too much is not good enough. Has science given up on proper research or is it so much compromised by commercial itnerests.

  23. Kris on August 20, 2008 at 10:15 am

    Hi Dr. Eades. Do you ever rely on a product such as ‘Carb Ease’ for times when you indulge? I can’t seem to go more than a week or so without a treat and I’m wondering how bad that is. I could have an occasional dessert made with splenda but I can’t get past the fact that it is made using toxic chemicals, one being chlorine. I assume you probably have addressed this already.

    Also I remember you commenting somewhere that you stay away from commercial mayonaise. I know homemade would be preferred… is it the type of oil that is used in the other that makes it bad?

    Thanks.
    Kris

    I’ve never used Carb Ease. I’m not a big fan of these carb blockers because I’m a little worried about what happens to the tissues as the carbs move downstream. And there have been some studies showing pancreatic enlargement in people taking large doses of them. It’s much easier for me to simply avoid the carbs.

    As to Splenda, I have written on it. Here is the post.

    I like homemade everything, including mayonnaise, because I can control the ingredients. Commercially produced mayonnaise can be crawling with all kinds of bad fats.

    Cheers–

    MRE

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