Thursday, May 4, 2017

High-cholesterol diet, eating eggs do not increase risk of heart attack, not even in persons genetically predisposed, study finds

As reported at Science Daily, a 2016 study (full text) done in Finland "shows that a relatively high intake of dietary cholesterol, or eating one egg every day, are not associated with an elevated risk of incident coronary heart disease. Furthermore, no association was found among those with the APOE4 phenotype, which affects cholesterol metabolism and is common among the Finnish population. In the majority of population, dietary cholesterol affects serum cholesterol levels only a little, and few studies have linked the intake of dietary cholesterol to an elevated risk of cardiovascular diseases. Globally, many nutrition recommendations no longer set limitations to the intake of dietary cholesterol."



As reported on Science Daily:



"The study found that a high intake of dietary cholesterol was not
associated with the risk of incident coronary heart disease -- not in
the entire study population nor in those with the APOE4 phenotype.
Moreover, the consumption of eggs, which are a significant source of
dietary cholesterol, was not associated with the risk of incident
coronary heart disease. The study did not establish a link between
dietary cholesterol or eating eggs with thickening of the common carotid
artery walls, either.




"The findings suggest that a high-cholesterol diet or frequent
consumption of eggs do not increase the risk of cardiovascular diseases
even in persons who are genetically predisposed to a greater effect of
dietary cholesterol on serum cholesterol levels. In the highest control
group, the study participants had an average daily dietary cholesterol
intake of 520 mg and they consumed an average of one egg per day, which
means that the findings cannot be generalised beyond these levels."


Table 3 of the study reports no increased risk of heart disease with egg intakes up to 36 g/d (about one large per day) nor for cholesterol intakes up to 522 mg per day, regardless of ApoE type.


The study population, ethnic Finns, are descendants of ancestors who survived the last Ice Age in Europe by hunting wild animals.  Their ancestral diet was high in animal fat and protein and contained little plant matter.  That diet selected against the survival of anyone who would have been harmed by animal fat or protein or required daily doses of plant foods to survive, thrive or reproduce.

In about 110 A.D., the Roman historian Tacitus reported on the food habits of the German people the Romans sought to conquer:

“Their food is of a simple kind, consisting of wild-fruit, fresh game, and curdled milk.”[1]
This describes a low carbohydrate, animal-based diet.  Germans did not live by agriculture in 110 A.D., and they lived south of the Finns.  We know that the Finns also ate an animal based diet. 

What is more likely toxic to Europeans, meat and fat that enabled the European stock to survive in Europe through the last Ice Age and formed the basis of the European diet up until about 500-1000 years ago, or various plant foods, particularly refined carbohydrates that were never even available to Europeans until quite recently?

It seems that the hypothesis that heart disease is caused by eating cholesterol and other animal products is dying a long, slow but sure death, skewered by evolutionary theory and evidence to the contrary. 

Note:

1.  Tacitus, Germania and Agricola (Ostara Publications, 2016), p.9. 







11 comments:

François Létourneau said...

May I ask what you think of the work of Plant Positive now that you have reverted back to a paleo approach? I know you are well familiar with is work.

FXScouse said...

I am sorry Don but I have to disagree with you on this one.

First, this is an observational study and observational studies are notoriously subject to confounding factors. For example, the Finns have an intake of dietary omega 3 plant fat, which is generally regarded as a protective factor, that is 80% higher than the Western European average.
http://www.bmj.com/content/bmj/suppl/2014/04/15/bmj.g2272.DC1/micr013795.wt1_default.pdf

Also, other observational studies have usually shown a clear dose relationship between dietary cholesterol and LDL cholesterol. As the US National Academies of Science observe, there is a i linear trend between dietary cholesterol intake and LDL cholesterol concentration.
https://www.nap.edu/read/10490/chapter/11

Secondly, observational studies are generally regarded as weaker forms of evidence than experimental studies. And meta analyses of experimental and observational studies have concluded eg that "Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is modulated by baseline dietary cholesterol. The greatest response is expected little, if any, measurable change would be expected once baseline dietary cholesterol was > 400-500 mg/d."
http://ajcn.nutrition.org/content/55/6/1060.long

That this Finnish study found no association between increased cholesterol intake and LDL cholesterol levels and CAD, is perhaps not surprising therefore since both the second and third tertiles of dietary cholesterol intake in that study approached or exceeded the 400 mg per day threshold. It is also perhaps not surprising that many of such modern dietary cholesterol studies, often funded by the egg, dairy and meat industries, other food industries or the Atkins organisation, or people associated with those bodies, fail to account adequately for this factor even though baseline dietary cholesterol consumption in Western countries is usually high. If I were a cynic, I might suggest that such studies are deliberately designed to take advantage of this fact by observing subjects whose baseline dietary cholesterol is already high and therefore less likely to be affected by added dietary cholesterol. They seldom if ever examine the effect of added dietary cholesterol on people whose baseline dietary cholesterol level is low by Western standards.

I also find your evolutionary theory argument unconvincing. First it assumes that ancestral Western Europeans had high levels of dietary cholesterol consumption. I am not sure that there is good evidence for this and in any case a dietary factor that increases mortality in older age is unlikely to be a powerful Darwinian selection factor since its effects would presumably only be felt after individuals had reproduced and brought up the next generation. In fact there is a counter theory that white skinned Europeans evolved as a response to a diet high in cereals rather than a diet high in cholesterol from animal foods.
http://www.livescience.com/42838-european-hunter-gatherer-genome-sequenced.html

Don Matesz said...

FX,

Unfortunately before I posted this article, in editing I removed a portion that was important, and neglected to repaste it in, but I left in the Note at the end from Tacitus. I juet restored it to what I intended.

As noted, Tacitus reported that the Germanic people were eating a low carbohydrate, animal-based diet in 110 A.D.

The idea that white skin came from eating cereals is incredible. White skin came from living in the snowy, forested and low light environment of ancient Europe. Again, Tacitus wrote of the Germanic people in 110 A.D.:

"For my own part, I agree with those who think that the tribes of Germany are free from all taint of intermarriages with foreign nations, and that they appear as a distinct, unmixed race, like none but themselves. Hence, too, the same physical peculiarities throughout so vast a population. All have fierce blue eyes, red hair, huge frames, fit only for a sudden exertion. They are less able to bear laborious work. Heat and thirst they cannot in the least endure; to cold and hunger their climate and their soil inure them."

Aside from the obvious error that people can't build "huge frames" if they are actually suffering from hunger, this passage indicates that the Germans were Caucasian, yet they were not living on cereals. Tacitus mentions that what grain was grown was used to make beer and liquor, or feed animals, not eaten directly by the people, at that time.

Now imagine living in an environment that has snow cover 6-10 months of the year. If you have dark skin, you stand out like a sore thumb. You are an easy target for predators. Prey can see you coming a mile away. If you have white skin, you blend in. Its harder for a predator to find you against the background.

Arctic animals have white and/or gray fur – think polar bears, arctic fox, arctic wolf e.g. https://www.google.com/search?q=Blue+eye+wolf&tbm=isch&tbo=u&source=univ&sa=X&ved=0ahUKEwj58MHt8djTAhXEhFQKHbhZCBAQsAQIKA&biw=1221&bih=662

White skinned humans are arctic born humans. White skin hunters would be more successful than dark skinned because the prey can't see you coming; and white skin also protects a human from other arctic predators. The idea that this came from eating cereals is weak. Any reasonable theory has to also account for the natural selection of white coloration among non-humans as well. Did polar bears get white fur by eating cereals? LOL.

Arctic animals also have blue eyes. Blue eyes reflect the blue light that is reflected off snow, thus are not easily "blinded by the light" that is reflected off snow, and they also allow in more light in dim environments than dark brown eyes. This has obvious survival advantages. Dark eyes are an adaptation to bright light (tropics), as they are more resistant to damaging effects of sunlight (like dark skin), and light eyes to predominantly dim environments (forests, long winters, etc.).

Don Matesz said...

Finally, the idea that eating a diet high in animal foods and cholesterol kills you in old age has yet to be supported by evidence. In fact this research indicates just the opposite. Despite having high cholesterol diets, above the threshold you may consider toxic, they are not dying from heart disease.

Then there is the fact that the body naturally produces about 1500 mg of cholesterol daily, and this increases under the influence of insulin, which the body releases in response to consumption of carbohydrate, not fat. High blood sugar raises cholesterol:

"The study population was classified into subgroups according to glucose tolerance as follows: normoglycemia, impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes. LDL cholesterol did not differ between the groups. Cholesterol synthesis markers were lowest and absorption markers highest in normoglycemia." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903787/ Translation, when you have high blood sugar your body produces more cholesterol.

And, high normal fasting plasma glucose, which I sustained over 5 years of a low fat vegan diet (and it even may have risen a bit), is a stronger predictor of cardiovascular disease than total cholesterol: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934381/ "Elevated CVD risk is strongly and independently associated with glucose levels within the normoglycemic range." and "The importance of each risk factor for CVD was ranked independently by the Wald score: for FPG levels the score was 15.3, after age (171), gender (39) and smoking (17.9) similar to hypertension (15.2) and more significant than BMI (3.6), family history (10.6), cholesterol (12.4), and TG (7.2)."

As for your commercial insinuation, if you walk into a grocery store, what percentage of the "foods" therein are high fat, low carbohydrate, versus low fat, high carbohydrate?

I estimate ~90% of what is sold in a typical grocery is high in carbohydrate, and most of that is low in fat. Imagine that people accepted that carbohydrates were the real culprits. How many industries would suffer if people started turning away from carbohydrate rich foods? Compare that to how many food industries would be affected by condemning fat. A look at a grocery store quickly confirms that the money is in selling low fat, high carbohydrate foods. Cheap to produce, with a high profit margin. Those industries can't allow carbohydrate to be vilified.

Then consider how the pharmaceutical industry benefits from the idea that cholesterol is the culprit. Researchers (funded by the drug producers) are suggesting that everyone take statins daily: http://www.cnn.com/2016/04/03/health/statin-usage-heart-disease-stroke/

Statins deliver the drug industry about $30 billion annually. The cholesterol theory is of benefit to the drug industry and the carbohydrate-rich food industry as a whole, which as I said, is clearly the most profitable.

Don Matesz said...

One more thing: As mentioned above, high blood sugar stimulates cholesterol synthesis:

"The study population was classified into subgroups according to glucose tolerance as follows: normoglycemia, impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes. LDL cholesterol did not differ between the groups. Cholesterol synthesis markers were lowest and absorption markers highest in normoglycemia." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903787/

And normal blood sugar results in more cholesterol absorption, but dietary cholesterol actually suppresses cholesterol synthesis: http://atvb.ahajournals.org/content/16/10/1222 "In all subjects the cholesterol synthesis rate as measured by deuterium incorporation was significantly lower (P<.05) after the transition from low- to medium- and low- to high-cholesterol diets."


Don Matesz said...

Francois,

I just find it hard to reconcile the idea that humans are best adapted to a whole foods plant based diet with the very large amount of historical, anthropological, and archaeological data that indicates that humans are by nature carnivorous. I tried my best to argue for the idea that humans were molded by evolution to thrive on a whole foods plant based diet in Powered by Plants, and I tried in my personal life to prove it by eating such a diet for more than five years. But evidence has refuted most of the key arguments I made in Powered by Plants, and my own personal experience did not readily confirm what I wanted to believe or argued for either. Since I am seeking healing of my own chronic inflammatory skin conditions and a whole foods plant based diet did not in 5+ years improve the condition at all, and the condition has in fact worsened on the WFPBD, I find it necessary to re-evaluate the evidence and try a different approach myself. Perhaps I will never find a solution, but I think that I will and I won't stop trying any time soon. The evidence in favor of an anti-inflamatory effect of ketosis

http://news.yale.edu/2015/02/16/anti-inflammatory-mechanism-dieting-and-fasting-revealed#
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352123/

which is consistent with the idea that human metabolism (or at lest European human metaoblism) evolved on an animal-based, high fat diet,

and some anecdotal evidence that confirms the anti-inflammatory effect of a ketogenic animal based diet
https://zerocarbzen.com/tag/psoriasis/

gives me enough reason to try what I have never tried before because I believed that "the authorities" knew for certain that humans "need" carbohydrate and are in fact primarily plant-eating animals.

François Létourneau said...

Thanks, Don, for your answer.

I think I will rephrase my question if you don't mind.

Plant Positive explained why he don't think that an evolutionnary approach to nutrition makes any sens. I would tend to agree with him. I know you are well aware of his critics to the paleo diet.

Also, this very article of yours would have probably serve him as excellent showcase of a confutionist article. He explained to great length why those kind of observational studies in population with already high dietary cholesterol and SFAs intake and already high baseline serum cholesterol won't show much of the negative impact of eggs/dietary cholesterol on mortality.

Healthy longevity did the same on his blog with his article on the confusion regarding eggs and cardiovascular disease, blog on which you commented so i'm sure you are well aware of those critics.

Yet, here you are, back at writting those kind of articles. So I was wondering if you had found faults in the arguments put forth by plant positive in his series of work.

You also wrote

''It seems that the hypothesis that heart disease is caused by eating cholesterol and other animal products is dying a long, slow but sure death''

Which again has been debated lengthly in the plant positive video, so clearly it appears you no longer think that plant positive work is convincing.

What fault did you find in his reasoning?

You also wrote in a few places on your blog since making the switch that ''Nature'' (with a capital N) provided something for us. Why the capital N? Is that referring to a creator of some sort? Isn't that as strong as the appeal to nature fallacy can get? Are you suggesting that ''Nature'', as some sort of an entity, or force, or manifestation, has any intention for us? I'm perplexed by this.

I myself think that a plant-based diet, but with some animal product, mainly fish and white meat (probably something around 70-30% plant/animal) is the most well supported diet by both modern science and historical records. That would be in line with what most ominovorous species do in the wild, would be in line with most long lived population, and would be in line with modern scientific evidences.

Thanks for the link. Interesting fundamental research, but a far cry from a clinical trials showing any benefits to inflammatory disorders in human. I'm remaining open to anything, but would rather remain prudent and I won't lower my standard of evidences. I'm not convinced either that a 100% plant-based, vegan diet is optimal. I'd rather keep fish (which appears to benefits health) and white meat (which appears to be neutral to health) and hence be prudent and make sure that I don't miss on anything beneficial from meat products.

That said, I certainly won't adopt a diet such as a the ketogenic diet with no long term studies nor any serious clinical trials looking at hard end-points, solely based on an evolutionary framework or in vitro research.

FXScouse said...

Thanks, Don. I appreciate the time and effort put into your responses. Nevertheless, those arguments seem unconvincing to me.
First you wrote "As noted, Tacitus reported that the Germanic people were eating a low carbohydrate, animal-based diet in 110 A.D.The idea that white skin came from eating cereals is incredible. White skin came from living in the snowy, forested and low light environment of ancient Europe." I don't think that the Tacitus report is relevant. White skinned Europeans evolved many thousands of years before 110AD and the sophisticated Germanic tribal society of 110AD was unlikely to be identical to early neolithic societies. In any event, it is possible and even probable that Tacitus was talking about the Germanic social elites, tribal chieftains and the warrior class, who would have been most likely to come into contact with high ranking Romans like Tacitus. Ordinary tribespeople may well not have eaten such rich diets except perhaps on special occasions. The argument that white skin evolved because of low light, this does not seem like a complete explanation. I am also doubtful about your claim that white skinned Europeans are Arctic evolved humans. To my knowledge, there is no evidence for this. Further, Inuit and other Arctic/circumpolar peoples live in arguably lower light environments than Europeans yet have noticeably darker skin. The cereal diet hypothesis explains this difference. The low light and Arctic evolved hypotheses do not.
Secondly, you wrote "Finally, the idea that eating a diet high in animal foods and cholesterol kills you in old age has yet to be supported by evidence. In fact this research indicates just the opposite." This is not my understanding. Eating diets high in cholesterol appears to raise LDL cholesterol which is associated with increased risk of mortality and adverse events generally. Observational studies are subject to confounding variables and are not stronger forms of evidence than for example feeding trials which generally do show that increased dietary cholesterol,up to a certain threshold, increases LDL cholesterol.
On this point, you also observed "dietary cholesterol actually suppresses cholesterol synthesis: http://atvb.ahajournals.org/content/16/10/1222 "In all subjects the cholesterol synthesis rate as measured by deuterium incorporation was significantly lower (P<.05) after the transition from low- to medium- and low- to high-cholesterol diets." This is correct and uncontentious. However, the point is that it does not suppress it sufficiently to prevent a net increase in total blood cholesterol. This is clear from the article that you cite which states "Effects of diet and cholesterol classification were observed on plasma lipid levels. Plasma TC levels increased with each level of added cholesterol (P<.001). From the lowest to the highest dietary cholesterol level, the mean increase in plasma TC levels were 8.3% (hypocholesterolemic), 8.7% (normocholesterolemic), and 7.1% (hypercholesterolemic). TC levels differed significantly (P<.0001) across subject classifications." In other words, the article you have referenced to support your belief that dietary cholesterol does not increase blood cholesterol in actuality appears to refute it.

FXScouse said...

Thirdly, nobody is arguing that processed junk food is healthy. However, the argument that food companies are somehow behindverd studies that show ase health effects from cholesterol (and saturated fat) consumption is a common one in cholesterol and saturated fat sceptic circles. Yet there is never any specific evidence offered, merely vague unsubstantiated allegations, whereas a number of studies appearing to exonerate cholesterol/saturated fat do appear to be funded by industry or the Atkins Foundation. Even the Finnish study, which your blog post refers to, appears to have been at least part-funded by a large Finnish confectionery company. And if you think there is no big money to be made from high cholesterol and high saturated fat foods, I would beg to differ. So would the dairy, egg and meat industries, McDonalds, KFC and a host of others.
I also don't understand your remarks about pharmaceutical companies financially benefiting from statin sales. Cholesterol lowering drugs were invented AFTER high blood cholesterol was identified as a significant risk factor, so I have no idea where you are trying to go with this argument.

Shameer Mulji said...

"I also don't understand your remarks about pharmaceutical companies financially benefiting from statin sales. Cholesterol lowering drugs were invented AFTER high blood cholesterol was identified as a significant risk factor, so I have no idea where you are trying to go with this argument."

The argument is, is that it is in the interest of pharmaceutical companies to sell drugs to manage symptoms as opposed to seeing humans fully healed, otherwise there is no reason for them to exist. It's the age-old tactic of come up with the problem and present the solution

FXScouse said...

Thanks Shameer but Don posted links to studies showing that feeding additional cholesterol to humans increases blood cholesterol (although he states that it doesn't). Is he suggesting that pharmaceutical companies (as well as as the egg industry) have a vested interest in obscuring this fact and actively work to do this? Is that where he is going? If so, where is the evidence that this is happening?

Conspiracy theories are great fun and a wonderful way of rationalising away the evidence that refutes our beliefs but evidence is rather important.