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Heart Disease

Question the “expert opinion” on heart disease..

Let’s start with a quote that describes our position with the rampant problem of heart disease. Apparently some researchers are a bit overconfident in their abilities…

“We advanced from little pathophysiologic understanding to a near-complete understanding and effective, evidence-based therapeutics for vascular disorders and a similar development of pharmacotherapy to address heart failure.”

— Levin R & Fishman GI. (2011). The power of Pasteur’s quadrant: cardiovascular disease at the turn of the century. The Journal of the Federation of American Societies for Experimental Biology 25(6): 1788-1792.

That certainly is quite the claim. It sounds pretty good! We finally understand heart disease and have all the drugs to help prevent or stop it. Oh, but wait…

Heart disease is still the number one killer in America. And what about the problem of sudden cardiac death? That’s something most people don’t hear about. Don’t worry, we will get to those stats down below. It’s pretty scary stuff. It doesn’t exactly “line up” with Dr. Levin and Fishman’s point. For right now, let’s start with questions and see where the experts are coming from.

Heart disease is going down

Coronary heart disease death rates by decade from 1950 - 2000

What really causes coronary artery disease? Are we measuring the true “risk factors” for it? What are the best predictors of it? How about the best ways to prevent it?

There are so many questions around heart disease. The major one being: Are we approaching it the right way now? It may look like it at first glance. Check out the graph to the left from the Framingham Heart Study.[1]

There is one question out there that creates a lot of confusion: How is the rate of death by heart disease doing?

As you can see, the rate of heart disease has dropped quite a bit in the last few decades.[1][2][3]  We are so happy to see the number of people dying from heart problems going down. It really is a miracle, and there is a lot that contributes to it.

However, this gets people to jump to the conclusion that this is due to the recent dietary guidelines to lower cholesterol and saturated fat. This one topic has created a large amount of controversy. There are many trends that follow the decrease in heart disease, so why do people only focus on saturated fat / cholesterol? Who knows. Conspiracy maybe…

But anyway, there certainly is a correlation – we cannot deny that. Let’s start down the rabbit hole, shall we?

Macronutrient trends

Since the 1960’s the US population’s dietary fat has decreased (somewhat), and carbohydrate intake has increased.[4][5] It looks like people have actually been following the guidelines. The exact amounts they decreased or increased varies with each study, but the general trends are still there.

Macronutrient trends - carbs increase & fat decrease

The graph above shows the estimated trends total macronutrient intake.[6] It is the average total amount of energy intake for people from 1970 – 2010 from the NHANES study. It appears as though the amounts don’t change much, but it’s enough for noticeable trends.

So carbs went from about 43% to 50%, and fat went from 37% to 33%. Not really a large change, right? Nonetheless, it gets the point across. These are very rough estimates, but the point is that carb intake increased and fat intake decreased.

Saturated fat decreased over last few decades

We estimate the amount of saturated fatspecifically, has dropped significantly more so than the above graph. The total amount of fat decreased, but the amount of added vegetable oil (polyunsaturated fat) consumption has increased. A lot.[7]

That means there must have been a large drop in saturated or monounsaturated fat. We assume most of this drop was from saturated fats because of the constant fear people have around it. (The graph below shows the added fats – not total consumption of fats. Total fat still decreased by a bit.)

Added polyunsaturated fats have increased

That means we are coming from a place where saturated fat, specifically, has decreased alongside the rate of heart disease. That makes it pretty hard to argue for saturated fat. But watch us…

Correlation VS Causation

The key here is the old saying, “correlation does not mean causation.” Although cliche, it is still true. These are trends, not actual randomized experiments. But we still take them as fact. We can’t argue with the data.

However, all the research we’ve done leads to the conclusion that it is not really saturated fat that helps with the decline in heart disease.

There are so many factors out there that can contribute to less heart disease, (such as a decrease in smoking). It is hard to find out exactly what causes what.

That’s why we have to take a correlation, form a hypothesis, and test the hypothesis with randomized controlled trials (RCTs). We cannot simply make such claims to heart heath based on epidemiological studies.

We will be going through those with each subtopic under this category. Take a look for yourself at the evidence. There is no reason to believe the drop in heart disease is related to the drop in saturated fat. We would even argue that the drop in heart disease would have been greater if saturated fats were not demonized. But that remains our speculation for now.

Why don’t we take a look at one very troubling occurrence…. Sudden. Cardiac. Death. This ought to get us thinking about how we really are doing with heart disease.

Sudden Cardiac Death (SCD)

That doesn’t sound very good… As you might have guessed, it isn’t! The Cleveland Clinic defines it:

Sudden cardiac death (SCD) is a sudden, unexpected death caused by loss of heart function (sudden cardiac arrest).[8]

Since the adoption of the “absolute and definite truth” that saturated fats are bad, why do we still see random heart deaths? Perhaps people are just not following professional advice or taking their medications. But with this kind of problem, there has to be a better reason… People are getting the proper screenings done, but apparently, they are not good enough to predict anything! If random deaths occur, then there is no point to even looking at their “risk factors.”

Unseen death by heart disease - SCD

Prevalence of SCD

Unexpected death does not seem optimal. But, of course, life happens, and people sometimes don’t listen to or see their doctor. When you look at the numbers below, you will understand that this can’t be the explanation. If this many people die randomly, then we have a bigger problem than people not seeing their doctor. We have to assume with the relative ease of health care availability that people are actually seeing their doctors.

If people are seeing their doctors but are dying randomly, then the predictive signs of heart disease the doctors are looking for are the problem.

This is what the American Heart Association’s journal, Circulation, has to say about the subject:

Sudden cardiac death is the most common and often the first manifestation of coronary heart disease and is responsible for ≈50% of the mortality from cardiovascular disease in the United States[9]

50%?????

So, let us make sure we’re understanding this correctly. Half of the people who die from heart attacks didn’t even see it coming? That means you have the same ability to predict heart attacks if you flip a coin. Half the people you say are good end up dying. Half the people you say are bad end up living.

That’s pretty shocking. If the medical profession has such good measures of predicting heart complications, then why are random heart attacks such a huge problem? Ohhhhhh… It’s because the things we measure and try to take care of aren’t the real problem! Clearly…

Not looking at the root cause…

If saturated fats were the problem, then lowering their consumption should help, right? Yeah, it should — if they were the real problem. If cholesterol was the problem, then statin drugs (which reduce your cholesterol) should definitively stop heart disease. Again, yes they should — if cholesterol was the actual problem.

Coronary heart disease death rates by decade from 1950 - 2000

We Americans are eating much less saturated fat than we used to, but the rate of sudden deaths has actually increased!! Hmmmm… Let’s take a look at that first graph again.[1]

At the beginning (~1950), SCD made up about 40% of all cardiac deaths. Then by the end (~1999), SCD made up about 50% of all heart disease deaths.[1]

WHAT THE HECK IS GOING ON?!?!

You must pay very close attention to get it. Although total heart disease deaths have declined, the amount of those that were unforeseen have gone up! There is a larger percentage of random people dropping dead of heart disease…

That’s what happens when we look at the wrong risk factors. Bad things and misplaced attention… Let’s just say people don’t do so well when the wrong things are considered root causes (like saturated fat).

Again, that doesn’t sound very good. Pretty much it means that people randomly drop dead from heart problems.

This should be extremely uncomforting to you. This is the medical profession we live with today. We keep repeating these points because they are so important. Once you understand that we might not being doing as well as we thought, you can open your mind to find the true root causes. That’s what we do with the other pages on this website. We combined all the information we can get, and we came to the conclusion that heart disease is an inflammation problem – not a cholesterol or saturated fat problem.

Next steps forward

Alright. So now that we know the medical profession still can’t accurately predict heart problems, what do we do next? We start looking at each risk factor they have claimed in the past. And then we look at some new ones that have come up.

We also use knowledge of biological function to figure out what “makes sense” and could actually be the root cause. So far, we see a problem with cholesterol and we lower it. But this isn’t enough to prevent unwanted deaths.

Let’s look at an analogy to close off the introduction to the problem of heart disease:

If a student is failing class, is the answer to give him an “A” so he can move on? Of course not! We need to actually teach him and figure out why he isn’t doing well. Giving an “A” is just a cover up. The root cause isn’t the teacher giving a failing grade. The problem is either a bad teacher or his lack of focus. Fix these problems and the good grades will flow naturally.

Fix the root causes of heart disease (instead of covering them up by lowering cholesterol), and the unclogging of American arteries will flow naturally.

References:

[1] Fox CS, Evans JC, Larson MG, Kannel WB, Levy D. (2004). Temporal Trends in Coronary Heart Disease Mortality and Sudden Cardiac Death From 1950 to 1999. Circulation 110(5): 522-527.

[2] Cooper R, Cutler J, Desvigne-Nickens P, et al. (2000). Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United StatesCirculation 102(25): 3137-3147.

[3] McGovern PG, Pankow JS, Shahar E, et al. (1996). Recent Trends in Acute Coronary Heart Disease — Mortality, Morbidity, Medical Care, and Risk Factors. The New England Journal of Medicine 334(14): 884-890.

[4] Cohen E, Cragg M, deFonseka J, Hite A, Rosenberg M, Zhou B. (2015). Statistical review of US macronutrient consumption data, 1965–2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition 31(5): 727-732.

[5] Austin GL, Odgen LG, Hill JO. (2011). Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971–2006. The American Journal of Clinical Nutrition 93(4): 836-843.

[6] Ford ES, Dietz WH. (2013). Modeling dietary patterns to assess sodium recommendations for nutrient adequacy. The American Journal of Clinical Nutrition 97(4): 848-853.

[7] Wells HF, Buzby JC. (2008). Economic Research Service. “Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005“. United States Department of Agriculture.

[8] “Sudden Cardiac Death (Sudden Cardiac Arrest)”. Cleveland Clinic. (2018). [Online]. Available: https://my.clevelandclinic.org/health/diseases/17522-sudden-cardiac-death-sudden-cardiac-arrest. Accessed: 11 May 2018.

[9] Zipes DP, Wellens HJ. (1998). Sudden Cardiac Death. Circulation 98(21): 2234-2351.

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