The Great Cholesterol Con: The Truth about What Really Causes Heart Disease and How to Avoid It
By Dr. Malcolm Kendrick
John Blake Publishers, 2008
The great American essayist H.L. Mencken wrote, “There is always a well-known solution to every human problem—neat, plausible, and wrong.” This observation is also true of the cardiovascular disease problem and Ancel Keys’s cholesterol-avoidance solution, which Dr. Malcolm Kendrick systematically demolishes in his recent book.
The pharmaceutical industry successfully obfuscates the details regarding actual cardiovascular death rates versus overall mortality. As Kendrick makes perfectly clear, one should be more concerned about the date on one’s death certificate rather than the descriptive cause of death. And then there is the inconvenient fact (Ravnskov, The Cholesterol Myths) that autopsies are rarely performed to confirm the diagnosis, so whatever is recorded on the death certificate is just a guess, and not suited for sophisticated statistical manipulation.
Kendrick makes the case for and against statins with the following trio of facts:
1. Statins do not reduce overall mortality in women.
2. Statins do not reduce overall mortality in men without heart disease.
3. Overall mortality is not reduced in greater than ninety five percent of the population.
In other words, you might be able to make a weak case for men who have suffered a cardiovascular event to take statins, but don’t count on it. If there is a benefit, it is likely due to an interruption of the acetyl CoA cycle, rather than cholesterol reduction. This hardly constitutes an endorsement of either the cholesterol hypothesis or the use of statins.
The book is funny and sarcastic and is an easier read than Uffe Ravnskov’s The Cholesterol Myths. By giving the historical precedents and reviewing the present literature, it is worthwhile. In fact, I have recommended it to my patients who buy into the Big Pharma-driven-statin drug craze, so they can get the real picture.
Dr. Kendrick, who is a leading Scots cardiologist, makes the case against the distortions, but comes to a conclusion that is only partially correct. Instead of indicting all the known offenders, he stops at psychological stress. Although stress levels are a powerful cause of heart disease, it is hardly the whole enchilada.
Kendrick believes that social dislocation, which is the loss of your support network, causes elevated cortisol levels, which in turn cause inflammation that is correlated with heart disease. To give credit, he does make an argument using assorted data. These include countries that have had forced dislocation and resulting increased death rates, depression, increased Monday morning deaths among Americans, and increased rates among Asians on dates that have the number four in them (because four is considered unlucky and in numerous Asian languages the words for four and death are eerily similar).
In the process, however, Kendrick ignores the larger picture of how nutrition can affect your internal stressors. The late Dr. Mendelsohn stated that a social meal eaten slowly, resulted in much better digestion than one gobbled quickly or consumed in isolation. This example illustrates the difference between dietetics or the consumption of food, verses assimilation, which is what gets absorbed by the intestinal villi. Your dining environment and choice of companions will have a great effect on the nutritional status of that meal.
What is less obvious is the social effect on the menu. Social eating often places an emphasis on taste and health, which makes nutritionally dense food the logical choice.
Kendrick explains how the population of Roseto, Pennsylvania is protected from heart disease with the same argument that was made in Malcolm Gladwell’s book Outliers. Misreading the Roseto evidence seems to be a cottage industry among these authors. Residents of Roseto immigrated from Roseto Valfortore, Sicily in a surprisingly coherent pattern. Yes, there was relatively little social disruption but that also included continuation of the Mediterranean diet. As Sally Fallon Morell and Mary Enig pointed out in a previous Caustic Commentary, there sure was a whole lot of lard consumed in that town, but why let that fact conflict with Kendrick’s good story?
Many well-intentioned medical doctors have been jaded by the medical system and have become nihilistic. To their credit, they are against the excesses in “Medicine,” but they never commit themselves to healthy alternatives. They need to become proponents for lifestyle choices that can actually make a difference. It is easier to be professional when you are against something than taking a stand for a practice that present research may not completely support. It is sad; many physicians fear appearing silly more than they embrace getting excited about improving patients’ lives.
Kendrick talks of diabetes being a risk factor for heart disease but never mentions sugar avoidance and consumption of nutritionally dense foods as an antidote—hardly a quantum leap. Anyone who has studied diabetes knows that nutrition is paramount but Kendrick avoids the subject. I know he is writing to a broad audience and his main priority is to sell books and slam statins, but is that enough? In my own practice I’ve seen patients with uncontrolled diabetes on insulin handle their disease so well dietetically that they were able to get off all medication and keep their blood sugar in a healthy range through food choices alone.
Another concern is his discussion of stress levels. Obviously stress is difficult to measure. He repeats a quote, often attributed to Albert Einstein, that everything important cannot be measured and everything that can be measured is not necessarily important. That is a bit glib for the reality of clinical practice.
Cortisol levels barely rate a mention and even then in the most general way. Taking a utilitarian approach, cortisol levels can and should be measured, but not by standard blood tests. Salivary cortisol testing is acceptable according to the Massachusetts General Hospital Handbook. The best way to measure it is in multiple readings from when one wakes up until when one goes to sleep. The readings should be taken with concomitant DHEA levels, which should be an inverse proportion. Finally, a healthy cortisol level should be highest in the morning, waking one up, and lowest at night so you can go to sleep. Unfortunately, too many people have this reversed, and can’t wake up in the morning or get to sleep at night.
This is an excellent book to debunk the cult of cholesterol bashing and its bogus treatment, but it never transcends itself to help create health. As I advise my patients, read the first eight chapters but feel free to skip the last three and replace it with all of Eat Fat, Lose Fat. The Great Cholesterol Con gets a conditional thumbs up.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Winter 2009.