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Colpo's The Great Cholesterol Con
A Review of Anthony Colpo's The Great Cholesterol Con: Why everything you've been told about cholesterol, diet, and heart disease is wrong!
July 31, 2008
Saturated fat will clog your arteries. It raises the level of cholesterol in your blood, which clogs up your blood vessels like grease clogs up a pipe, causing them to narrow and shut off the flow of blood to your heart - that means eating butter could literally kill you.
Heard these things before? Anthony Colpo says they're wrong. Dead wrong.
Colpo is a personal trainer from Australia, but in recent years has carved out a career as a writer and devloped a reputation for rigorous and thorough research. His book, containing over 1,400 references, is the most well-researched contribution to the debate about cholesterol coming from the side of the cholesterol skeptics that I've read to date.
While I disagree with Colpo on some points, which I'll discuss further below, the detailed level of analysis Colpo brings to the table backs up his claim to have read every reference cited in the book in full.
Colpo begins by tearing apart the myth that the rate of heart disease has been declining since the anti-fat, anti-cholesterol crusade began, and moves on to cast doubt on the hypothesis that cholesterol in the blood causes heart disease while thoroughly destroying the idea that saturated fat in the diet causes heart disease. He tells the story of the politics and economics behind the cholesterol theory, and then, more than any other book on the subject, presents an alternative - nine chapters each detailing the research on important contributors to heart disease like stress, oxidative damage, and high blood sugar.
Have Heart Disease Rates Really Been Declining?
According to the official story, heart disease rates have been going down since the anti-fat, anti-cholesterol campaign began in the 1950s and 1960s. Colpo shows, however, that most of the changes in heart disease rates have corresponded to changes in diagnostic criteria, and that, while heart disease mortality has been going down, heart disease incidence has been staying the same or possibly going up.
The explanation? Heart disease mortality is going down because emergency medical care is stopping people from dying once they have a heart attack. But with the dramatic decrease in smoking that has occurred over the past several decades, we should expect to see a dramatic decrease in heart disease incidence. The fact that we do not suggests that the dietary advice to which we have been exposed may not only be doing nothing to prevent heart attacks, but may even be making the situation worse!
On these points, Colpo's case is convincing.
Is Cholesterol a Killer?
Colpo presents a slew of evidence showing that the correlation between cholesterol and heart disease is inconsistent at best, that lowering cholesterol can be harmful - especially to your mental health - and that the advocates of the anti-cholesterol campaign have had to completely ignore a large number of native populations who eat huge amounts of saturated fat and live their lives free of heart disease in order to make their case.
This section of the book, however, would be stronger if Colpo differentiated between the lipid hypothesis and the diet-heart hypothesis. According to cholesterol expert and famed lipid hypothesis proponent Daniel Steinberg, the lipid hypothesis states that high cholesterol levels in the blood cause heart disease while the diet-heart hypothesis states that saturated fats and/or cholesterol in the diet cause heart disease. Colpo lumps the two together into a single hypothesis, when in fact they can be evaluated separately.
Colpo demolishes the concept that dietary saturated fat causes heart disease not only by describing many examples of populations eating diets high in saturated fat that have low or non-existant rates of heart disease, but also by reviewing nineteen controlled experimental studies conducted in humans in which polyunsaturated oils were exchanged for saturated animal fats. For a review of this section of the book, see my discussion of Daniel Steinberg's dietary advice here.
On the other hand, Colpo's consideration of the effect of blood cholesterol levels on heart disease risk is incomplete. Colpo dismisses the cholesterol-fed rabbit model because rabbits are herbivores and because the rabbits never developed advanced plaques (containing fibrous caps and calcification), but Steinberg presents evidence that all animal models, regardless of the species, produce atherosclerosis when the level of cholesterol in the blood increases sufficiently, and he reproduces drawings from the original cholesterol-fed rabbit studies depicting advanced plaques.
As I explain in my recent all-new lecture, Cholesterol: Villain or Hero? Fact and Fiction About the Food Chain's Most Misunderstood Nutrient, which will be available as an audio file from WolfRiverNaturals.Com, these experiments never showed that cholesterol causes heart disease. Combined with other evidence accumulated over the last three decades, what they actually show is that polyunsaturated fatty acids in the membrane of the LDL particle (which carries cholesterol in the blood) oxidize when the level of antioxidants in the diet is insufficient to protect them, and that can contribute to heart disease.
Colpo does discuss the potential role of oxidized LDL in the blood but in his chapter on free radicals, he states that its harmfulness remains to be proven. When one compares the evidence for the harmfulness of oxidized LDL to the evidence for the harmfulness of high blood sugar, however, which Colpo states "sure as hell does" cause heart disease, the double standard Colpo applies to these two issues becomes clear.
Chapter 20 is all about the protective role of nitric oxide, and as discussed in my article on Rho Activation, oxidized LDL demolishes nitric oxide synthesis. The accumulation of lipids in white blood cells called macrophages and their metamorphosis into "foam cells" is a hallmark of atherosclerosis, and as discussed in Steinberg's book, it has been well-demonstrated since the early 1980s that oxidized LDL (or sugar-damaged "glycated" LDL) accumulates in macrophages, but non-damaged LDL does not. More recent evidence has showed that oxidized derivatives of linoleic acid present in the LDL particle bind to receptors and act at the level of DNA to alter gene expression and turn these cells into the "foam cells" that gobble up more and more lipid. Colpo supports the response-to-injury hypothesis, but oxidized LDL is cytotoxic and thus can injure blood vessels. Colpo reviews the evidence connecting inflammation to heart disease, but oxidized LDL causes inflammation.
Colpo's evidence connecting blood sugar malfunction to heart disease is good, but it isn't any better than the evidence connecting oxidized LDL to heart disease, certainly not good enough to say that it "sure as hell" contributes to heart disease while simultaneously saying that the case against oxidized LDL remains to be proven.
Nevertheless, since the polyunsaturated fatty acids (PUFA) of the LDL membrane are the first targets for the oxidation of the LDL particle, it is a moot point. Colpo's case against polyunsaturated fatty acids is top-notch. Chapter eight, in fact, which reviews the PUFA substitution studies, is so excellent that it makes up for any of the book's flaws.
The Politics and Economics of the Diet-Heart and Lipid Hypotheses
So if eating butter and eggs doesn't cause heart disease after all, how did this theory come to the fore? A massive right-wing conspiracy? No. According to Colpo, it rose to the fore because of a mix of personal vengeance and aimless bureacracy. Only after researchers developed effective cholesterol-lowering drugs did profit come into play; from there, the conflict-of-interest-loaded government agencies like the FDA and National Cholesterol Education Program (NCEP) locked into step and the theory became unbreakable.
Colpo describes Ancel Keys's performance of his famous Seven Countries Study and his subsequent rise to power at the American Heart Association (AHA) as acts of vengeance against the majority of researchers who originally flouted his theory. He quotes a later president of the AHA saying they massaged the statistics showing the supposed success of the anti-fat campaign at reducing heart disease to "get more money from politicians," and quotes members of the original McGovern Committee who made the first government recommendations to reduce animal fat in the diet as saying they were a "bunch of kids" who were essentially looking for something to do.
Chapter twelve is a phenomenal exposé showing the AHA to be essentially a for-profit corporation selling its heart-healthy logo to junk food companies in exchange for millions of dollars, headed by a CEO making a mind-boggling salary, rather than the non-profit do-gooder organization as which it masquerades. The American Dietetic Association gets loads of funds from pharmaceutical companies and other companies who have an interest in the high-carb low-fat diet it recommends to diabetics, a diet it even admits may cause blood sugar problems, but should be eaten anyway since it is "healthy."
Colpo describes how the NIH caved in to employee protest after it tried to institute conflict-of-interest rules, and how the FDA violated its own conflict-of-interest rules by waiving them over 800 times in the course of just two years, and how the New England Journal of Medicine got rid of its previously successful conflict-of-interest rule several years ago because the research community had become so dominated by pharmaceutical companies that it was becoming impossible to find sufficient material to fill the journal's pages.
And, of course, he describes the massive profits reaped from the cholesterol-lowering statin drugs - drugs that probably cause cancer, may wreck your brain, and arguably cause side effects more often than they save people from heart disease. But with over $37 billion raked in over the past year, it's no wonder a bad set of drugs could be held in such high esteem - when it comes down to it, a lot of people just love to make money.
So What Does Cause Heart Disease
Colpo provides nine chapters detailing well-supported contributors to heart disease that are independent of cholesterol. He describes the importance of antioxidants, maintaining stable blood pressure, avoiding excessive PUFA, maintaining healthy nitric oxide status, staying free of systemic infection, avoiding high iron levels, and maintaining a positive attitude and a happy marriage rather than leading a stressful and lonely life.
These chapters are essential reading for anyone who cares about their heart health. They outline critical strategies for preventing heart disease that are largely ignored in the mainstream due to the dominance of the cholesterol theory.
A Few Caveats — PUFA, Selenium, and Fish Oil
There are a few places in these final chapters where I disagree with Colpo.
Colpo states that monounsaturated fats are more vulnerable to oxidation than saturated fats, that alpha-linolenic acid and linoleic acid are essential, and that a diet that includes nuts but excludes vegetable oils provides our basic requirement of PUFA. In my PUFA Report, I come to very different conclusions. The point on a fatty acid that is vulnerable to oxidation is the point located between two double bonds, so the vulnerability of monounsaturated fats, which have only one double bond, seems to be minimal. A diet that includes nuts provides far more PUFA than we require - the true requirement is unbelievably small - and nuts do not provide arachidonic acid or DHA, which are the only fatty acids for which I believe there is any convincing evidence evidence of essentiality.
Colpo reports a selenium trial that found a reduction in cancer and states that no adverse effects have ever been observed for selenium. In reality, this trial showed that selenium decreased the risk of cancer in the two-thirds of people who started out with moderate and low selenium status. In the third who started out with high selenium status, cancer incidence was 20 percent higher, although the effect could not be conclusively distinguished from that of chance. In the same top third, however, the risk of diabetes was definitely increased.
Personally, I think that had this study used selenocysteine, the animal form of the mineral, rather than selenomethionine, the form found in plants and yeast, and had other cofactors such as bioavailable cyteine (in the form of raw or undenatured proteins, n-acetyl-cysteine or vitamin B6), the supplementation may have proved beneficial even in the top third. But it certainly isn't correct to say that selenium has never been associated with adverse effects.
I am also skeptical of the benefits of fish oil, but I will be clarifying my position on fish oil in my PUFA Report Part 2, coming later this year. My current opinion is that we should be cautious, using small amounts of high-vitamin cod liver oil to provide both fat-soluble vitamins and very modest amounts of omega-3 fatty acids. Even Colpo, however, suggests limiting fish oil to a gram of omega-3 fatty acids per day, which I think is a reasonable limit.
Who Should Buy This Book?
Anyone interested in the controversy over cholesterol should read this book. In my opinion, it's the most well-written and well-researched book on the "skeptic" side of the debate currently on the market. Steinberg's The Cholesterol Wars: The Skeptics Versus the Preponderance of the Evidence is an excellent companion to this book, promoting the other side of the controversy.
People who are research-minded and want a summary of recent research on often-overlooked contributors to heart disease should also read this book. Those who instead want something easy to follow that is less focused on research and more focused on how to form a heart-healthy diet should take a look at Dr. Al Sears' The Doctor's Heart Cure.
The original paperback edition of The Great Cholesterol Con was difficult to read because of its small print, but Colpo has since published a downloadable version that is probably much easier to read. Anthony Colpo has done an outstanding job compiling the research in this book and has made a valuable contribution to the cholesterol debate.