This reader's letter was a bit different than most. It was from a medical student. It asked no questions. And it needed an expert to respond.
Dr. Terrance Moran is a board-certified cardiologist, lipidologist (expert in the study of fats), director of the Advanced Lipid Management Program at Community Hospital of the Monterey Peninsula and associate clinical professor at the University of California in San Francisco.
(My additions are in parentheses). Hang on to your hat …
Med student: "It is becoming apparent that the things we've been told the last 40 years cause heart disease probably aren't the culprits. Inflammation is at the root of heart disease, and cholesterol is something we can't live without. Cholesterol … is at the scene of the crime when they open up the arteries on autopsy, but it isn't the culprit. Evidence is pointing to sugar, refined carbohydrates, excess calcium supplements and inflammatory vegetable oils … that create free radicals and oxidation when heated.
The fact that 50 percent of heart attacks occur in people with 'normal' cholesterol, is basically enough to prove the cholesterol 'theory' false. The cholesterol myth and development of statin drugs is one of the worst falsehoods perpetuated on people in this world."
Dr. Moran: "You are partially right. A lot of people who have heart attacks do have normal lipid (cholesterol) levels. Some of this is because we (usually) measure (total) LDL-Cholesterol and not the LDL "particle number," which is a much better marker of risk.
"The big reason for the discrepancy is that it is not primarily cholesterol that causes (heart) disease. It is a number of factors which are best summed up by genetics, i.e. function of the endothelial cells (which line the arteries), response to inflammation, oxidative stress and many other things.
"These basically make it more or less likely that cholesterol will accumulate in the wall of the arteries. If you have bad genetics, cholesterol will accumulate. And the higher your cholesterol, the more likely it will build up.
"So even if you have a great LDL (cholesterol) level, with bad genetics, the LDL is still going to accumulate. On the other hand, if you have good genetics - even with a high cholesterol - you may have little if any LDL accumulation in the arterial wall. This is why looking at someone's "lipid profile" (cholesterol numbers) is a very poor way to estimate their risk.
"Now all that said, it is still the LDL (cholesterol) getting into the (artery) wall that results in plaque (the gunk that blocks arteries). Once it gets in and stays, it becomes oxidized and sets off an inflammatory response. How aggressive that response is will be in part determined by genetics.
"We can't change our genetics, but we can reduce the LDL cholesterol in our blood. Even if there are bad genetics, reducing LDL makes less of it available to get into the wall and develop into plaque.
"This is why the statin trials have been beneficial. Numerous studies have shown that aggressively lowering LDL cholesterol can cause plaque to regress.
"I agree that sugar and refined carbohydrates play a huge role in (heart) disease. But much of that is through their effect on lipids (fats in the blood) in patients with insulin resistance (diabetes or pre-diabetes).
"For example, high blood levels of triglycerides (common in people with diabetes) usually indicate smaller (more dangerous) LDL particles in the blood. And how many of these particles can burrow into the walls of the arteries and set off the inflammatory response is genetically determined."
Student: "From my research, coconut is one of the healthiest foods on this planet, judging from the millions of people whose dietary fat consists mainly of coconut and their low incidence of heart problems."
Dr. Moran: Before you rest on coconut as the oil of choice, please review the (medical) literature. By that I mean, how many studies compare a coconut oil-based diet to other diets in terms of reducing cardiovascular disease? Probably none.
Yet numerous studies show the Mediterranean diet supplemented with olive oil significantly reduces cardiovascular risk and cancer. And this diet has been touted as the closest diet to what our ancestors were genetically designed for.
Thank you, Dr. Moran.