What are your standards for proof here?

"For men, the risk of a first heart attack is more than doubled when cholesterol levels rise from 225 and 250 up to 300 and over, according to National Heart and Lung Institute figures. And data from the Framington study (5000 men and women starting in 1949) indicate that a man whose cholesterol changes from below 194 to over 250 will triple the risk of first attack". Kenneth Cooper MD.

Kannel, W. B. and Gordon, T. eds. The Framington Study: an Epidemiological Investigation of Cardiovascular Disease: Section 30: Some characteristics Related to the Incidence of Cardiovascular Disease and Death: Framington Study, 18 Year Follow-up. Washington: DHEW (NIH)
74-599, Feb 1974

Catch 22: You have just demonstrated that elevated serum cholesterol levels correlate with increased risk of myocardial infarction.

What you have not demonstrated is that a low-cholesterol diet reduces risk of same.

In fact, let me repeat myself:

I ask you to point me to a study which shows that eating less cholesterol reduces risk of heart disease.

Point me to the study, please. This should be relatively easy, right? So show me the study which shows that eating less cholesterol actually reduces my risk of dying.

Point me to it. I beg you. We've had well over a quarter-century of study on it. So it must be easy to point to, right?

"I eat less cholesterol, and as a result I live longer." Show me the study, please. Just show me one.

I beg you. Show me one. Just one.

"I eat less cholesterol, and I live longer as a result."

Just show it to me.

Dean,

I dunno - seems to me that if a person just eats food in moderation and wisely doesn't just eat a whole bunch of one thing, he'll be ok. You know, steak's great - but steak 7 nights a week would be (a) monotonous and (b) probably not good for you in the long run; we're omnivores, and probably for a reason. Eat a bit of everything in moderation.

Trouble is, you can't get on talk shows or have a bestseller with that....

No. Fuck that. If you understand science, you should understand this basic premise.

For well over a quarter-century, we have been told that eating a low-cholesterol diet will reduce your risk of heart disease. So now I smply ask you:

After all these years and studies, has even one--even one--study demonstrated that reducing your cholesterol or saturated fat intake reduces your risk of myocardial infarction,or your general mortality risk?

I want to see it. I eat whole eggs and fatty steaks and unskimmed milk for breakfast, lunch, and dinner. In fact, I eat ten times more saturated fat and cholesterol than the average American. So what does that mean?

Can you point me to any study--any study at all--which demonstrates that I have an increased risk of mortality as a result?

Go on. This shouldn't be hard. Show it to me. After a quarter-century of research, it shouldn't be hard.

"I eat less cholesterol, and I live longer as a result."

"I eat less saturated fat, and I live longer as a result."

Show the study to me, please.

Bet you can't do it.

Dean,

What are your blood cholesterol numbers ? What is your HDL/LDL numbers ? What is your ratio ?

The Framington Study noted above has gone on for some 30 years. It HAS demonstrated that as lower
blood cholesterol decreases, the risk of heart attacks and sudden DEATH also decreases. It has demonstrated that lower total cholesterol is desireable, low LDL desireable, High HDL desireable, low triglycerides desireable and a low ratio of total cholesterol to HDL is desireable. It will not tell you how long you will live but it will tell you the risk for that factor. One's risk profile has ten other such factors that help predict longevity. Controlling cholesterol is a major factor. It is controlled by diet and exercise primarily, if the numbers do not decrease then medications are given. And every couple of years the American Heart Assn revises the recommended levels. Some individuals may eat everything in reach and still have a good cholesterol profile. The question you ask is a bit mono-dimensional.

Oh, wait a minute. Catch 22 has just elided a major point.

Higher serum cholesterol levels, unfavorable HDL/LDL ratios, high triglyceride levels notwiwthstanding:

Where is the study which says that if I eat more cholesterol, I am more likely to die? Where is the study that says that if I eat more saturated fat, I am more likely to die?

We've had more than 30 years of study on this. So the answer should be obvious, right?

Point me to this study, please. And no, I am not being obstuse. Answer my fucking question. Where is the study which says that if I eat less saturated fat, less cholesterol, I'll live longer.

Show it to me, please.

No, I am not being dense. I'm just asking you to answer the damned question. "This study shows that if you eat less saturated fat, you live longer." Can you back up such a statement? If so, how?

Show it to me, please. It can't be that hard.

There are two types of cholesterol. Bad Cholesterol - Low Density Lipoproteins (LDL) and Good Cholesterol - High Density Lipoprotein (HDL). The study at this website indicates there is a positive correlation between limiting intake of Low Density Lipoproteins (LDL) and the incidence of and mortality from heart disease. There's more studies here. However, this doesn't mean you'll live longer. You could be crossing the street tomorrow and get hit by a Renault.

The Aerobics Center Longitudinal Study (ACLS) 1971-1985 conducted by Dr. Steve Blair, Director of Epidemiology at the Institute of Aerobics Research looked at the relationship between total cholesterol levels and all causes of mortality in 13, 509 men.

The Multiple Risk Factor Intervention Trial (MRFIT) measured cholesterol levels in 360,000 men between 1973-1975 to 1982 in eighteen cities in the USA and recorded the deaths in the group from coronary disease.

What these two studies demonstrated is that for each one percent reduction in blood cholesterol is associated with a two percent reduction in the risk of heart attack and sudden death.

If the gentlemen in the UK want their Fish and Chips, its okay with me. Eat away.

As far as I can tell (and this is what I study) the major factors in weight gain or loss seem to be genetic determinants, exercise, and diet in that order. In general diets are not much use in losing weight without exercise and there are some fat people who will always be fat. However a low fat or cholesterol diet aren't going to do you any harm.

Ru,
I wouldn't worry about it too much, turns out it really was a serious question merely cynical baiting.

Everyone should follow Dean’s rigor when evaluating the sciences and "studies" particularly those who believe in the myth that Reagan’s tax cuts increased federal revenues.

Catch 22,
Since food is only a minor source of cholesterol (our bodies make much more of the stuff), pointing out the dangers of high cholesterol levels in the blood is nice, but irrelevent to Dean's question.
Also I suspect fish and chips are fried in vegetable oil, which means they are not good sources of cholesterol, although they might have very high levels of oxidized fatty acids. But that's a different topic.

Catch 22,
It's nice of you to point out that high cholesterol levels are bad, but since very little of the cholesterol comes from food, it's irrelevant to Dean's question.

oops

Here is my post that talks about how a moderate fat diet decreased risk factors in comparison to a low fat diet.

http://www.lowcarbfreedom.com/2004/02/moderate_fat_di.html

The study is written about in the American Journal of Clincal Nutrition.

Now they used overweight people as their subjects, but:

Results: The moderate-fat diet elicited favorable changes in the lipoprotein profile. Compared with baseline, HDL cholesterol was unchanged, whereas triacylglycerol and the ratios of total and non-HDL cholesterol to HDL cholesterol were lower at the end of the weight-maintenance period in the moderate-fat diet group. Despite similar weight loss, triacylglycerol rebounded, HDL cholesterol decreased, and the ratios of total and non-HDL cholesterol to HDL cholesterol did not change during the 10-wk interval in the low-fat diet group.

The idea that fried foods are bad is based on the idea that oxidized fatty acids are dangerous. However, saturated fats oxidize much, much less than polyunsaturated fats, which are supposed to be manna from heaven. And butter is worse than margarine because it has cholesterol, but margarine is worse than butter because it has those awful trans fatty acids!
There's a long way to go in this field.

Jesus, man, you have steak and eggs for breakfast?

Life is good in the Esmay household!

Catch 22: Stop telling me about studies which demonstrate a correlation between serum lipids and mortality. I already get that, I already grant that. I've granted it more than once.

The Framingham study, by the way, has yet to demonstrate that reduced saturated fat or reduced cholesterol intake correlates with lower mortality. Its authors admit this openly.

Have you seen the Georgia Centenarian study, by the way? The one which showed that people who live to be over 100 actually eat more saturated fat and cholesterol than the average American, and generally ignore medical advice on changing their diets?

Look man, this is a very simple, very easy question: "I eat--I said EAT--less saturated fat, eat less cholesterol, and I live longer as as result."

Show me THAT study. Focus on the eating thing, please.

Rick: Heh. I'll get to you later, buddy. ;-)

Dean, This is your science project not mine. I can only blurb the comments section. All science is flawed, mostly the printed versions. I always follow Mark Twain's advice: Be careful about reading health books, you could die of a misprint. Have a nice day. My last resource is for u to contact the Cooper Research Center in Dallas, Tx.

In other words, "No, I can't point to any such study."

Thought so. ;-)

Aust N Z J Med. 1994 Feb;24(1):98-106. Related Articles, Links

Review of dietary intervention studies: effect on coronary events and on total mortality.
Truswell AS.
Department of Human Nutrition, University of Sydney, NSW, Australia.
The perfect randomised controlled dietary prevention trial of coronary heart disease has never been done. The best we can do is to look at all the trials together. Dietary trials should be separated from drug trials because they have different characteristics. Fourteen dietary trials which had disease or death as the end point are collected in this review for a meta-analysis. Three of the trials had two parts (male/female or low fat/increased fish), making a total of 17 trials. All were randomised trials, except the Finnish mental hospital trial which was a 12-year crossover in two hospitals. The trials were primary or secondary, diet only or multifactorial; numbers of subjects range from 52 to 57,460. For total deaths the ratio of intervention/control in all 17 trials is 0.94 (significantly less than 1.00) and for coronary events the pooled odds ratio is 0.87. But in the seven trials with most effective cholesterol lowering the odds ratios are 0.89 for all deaths and 0.70 for coronary events. There is thus no indication of excess all causes mortality in the dietary trials. Four recent secondary prevention trials had angiographic end points. There were a total of 275 subjects; trials were in Holland, USA, Germany and UK. In all trials plasma cholesterol was effectively lowered and coronary narrowing regressed a little, or progressed less in the diet group but significantly compared with controls. These angiographic trials strongly support the results of the major prevention trials. Lastly, a set of ten trials with fish oil after coronary angioplasty are reviewed. In some there appeared to be lower rates of restenosis, but not in all. The mechanism here is different from the major trials with plasma cholesterol-lowering diets for longer periods.
Publication Types:
* Meta-Analysis

I especially love the first line of this abstract. The perfect study has never been done, and it never will be. I had to go back almost ten years to find this study, and was not willing to go back another ten to find the original studies. 67 pages of Medline abstracts are too much for me to tackle, I stopped at about 40. Suffice it to say, over and over again, most studies I read today are based on clear evidence that dietary intervention is helpful.

It's interesting to read the trends as time goes by. First, it was low cholesterol diets are good, then they were bad, then it was monounsaturated vs. polyunsaturated fats. Then it was triglycerides more important than cholesterol. Then it was omega-3 and trans-fatty acids. Then it was genetic susceptibilty and individual cholesterol profiling.

I think were we are is this- low cholesterol diets are helpful in most people, but there are other aspects of the diet that must be taken into account, such as the type of fats consumed. In additon, the effect of diet is modest and certainly can't hold a candle to the effect of drug therapy. However, diet and exercise do seem to make a difference, though how they do that is not as straightforward as one might think. Diet and exercise alone are insufficient for preventing heart disease in those at high risk.

Dean -- It's sneaky/rude (but probably fun) to wind-up the commenters about diet without mentioning in the beginning that the VAST majority of cholesteral is produced by our bodies, not injested :)

There's a great book called TheCholesteralHoax by Zerden (not available here new, but maybe your library has it). Rather "controversial" in that it flies in the face of contemporary medical opinion that cholesteral causes heart-disease. However, the great part is that he lists reams and reams of information that makes you go "hmmm". I think he wrote it when cholesteral became a big medical "crisis" for him personally. The part I found most EXTRA interesting is in the back where he mentions that he noticed that an increase of heart-disease is directly proportionate to an increase in sugar consumption as a trend across populations (and he provides the primary-source data that leads him to that thought).

"It's nice of you to point out that high cholesterol levels are bad, but since very little of the cholesterol comes from food, it's irrelevant to Dean's question."

If you eat a lot of butter and dairy, your blood cholesterol goes up. And if you do not it will go down. And you can self test yourself if your local drug store offers cholesterol testing.

And I did offer some excellent studies, but the Dean seems more interested in the abstraction rather than the hard science. If you are goiong to study cholesterol you are invariably connected to atherosclerosis, coronary heart disease and mortality and yes blood chemistry.

If you abstract all that out and ask, show me the relationship between burgers and longevity
you'll need to read the NYT or better yet watch Larry King.

You know what I love best about you, Dani? You get it. Really get it. I wish you were my physician.

That said: the study shows, at best, a very minor link. And does not indictate that a change in dietary behavior actually changes mortality risk.

After 50 years of study, should we not be able to give a more definitive answer, if it were really so simple?

I often think of my grandfather, who absolutely loved to eat egg sandwiches slathered in butter. He avoided them for years, because his doctors told him they'd kill him. He pined for them, craved them, and once in a while gave up to temptation and ate one.

I am not at all convinced that by doing so he shortened his life. Indeed, I am more inclined to believe that he spent the last years of his life constantly wondering if eating something he loved was going to kill him, even though it wouldn't have.

Again I say that I do not blame docs, at all. They're doing their best, they really are. But we're dealing with a pernicious problem that cannot be answered by easy recommendations.

No, try again, Catch 22:

Where is study that says that I live longer if I eat less butter and eggs?

Show it to me, please.

Catch 22, just one reference to support the claim that "If you eat a lot of butter and dairy, your blood cholesterol goes up. And if you do not it will go down." As someone concerned with their cholesterol levels, I, like Dean,really want to find some facts to support or disprove these types of claims.

"If you eat a lot of butter and dairy, your blood cholesterol goes up. And if you do not it will go down. And you can self test yourself if your local drug store offers cholesterol testing."

Hmm. I don't think my drug store does that. Also I'm too lazy to do that. I'd rather you showed me an article. I hope it's not true, because I consume much less milk than I used to, and back then I had very low cholesterol levels. So now I'm worried my cholesterol levels are TOO low. Of course I'm too lazy to check if that's the case. :)

By the way, if you're talking about say, a 5% rise, that's nothing. The dangerous cholesterol levels you mentioned before were much higher than average.

"I eat less cholesterol, and am thereby less likely to die as a result."

Show it to me.

Thanks for the kudos, Dean. It means a lot coming from you. You'd have to have a sex change operation to be my patient, though ;-)

It seems a low-cholesterol diet will help a little for most people . Whether or not it will help Dean Esmay is hard to say. Helping a population lower the cholesterol level 10% overall is a good thing, but it's an entirely different question for each individual. An individual is just trying to improve their own odds. They don't know if it will lower THEIR risk by none- or by 50%. It is very irritating for me to read epidemiological studies. I want something I can use to help people, and this ain't it. The benefits are too marginal in comparison to the radical change in lifestyle that is required.

Who wants to stick to a blech diet for possible benefit? I wouldn't. I'd do just what my husband does- he takes a statin on an irregular basis and eats what he wants. I had a partner who had a near-miss with an MI, got a stent, has a terrible family history. He takes statins daily and eats what he wants. These people are doctors, and they know what a real risk is.

Hopefully, in the future, we'll have algorithms that will say something like this, "Given your family history, genetic makeup, and chemistry profile, a low-cholesterol diet wil lower your chance of death from heart disease to 1 in 50 over the next ten years, down from 1 in 15." Now THAT, I can use!

Simply put:
The animals that we consider "fatty" all got that way by eating low-fat diets (i.e. grass and other vegetables). I don't think carnivores are major staple of US culinary art. Pigs, maybe, as omnivores.
...and none of the "fatty" animals we eat died of heart problems, did they? :)

I've thought for some time that the link between cholesterol ingestion and serum cholesterol levels was suspect. After all, steak is high in cholesterol, but cows don't have an obviously high-cholesterol diet.

To confirm my suspicions, I did a quick google search on (alfalfa cholesterol) and found this abstract. It seems that alfalfa seeds lower serum LDL. Now, this doesn't speak directly to Dean's question or to the underlying issue of a link between serum cholesterol and ingested cholesterol, but I still found it amusing.

FWIW

Well, here's a study linking adherence to a "Mediterranean diet" to decreased risk of heart attack, independent of other lifestyle factors, including exercise.

However, it's not exactly the study you're looking for. An MSNBC article about this study says that this may be a cumulative or synergistic effect of the various characteristics of the Mediterranean diet (low cholesterol, high vitamin E, high beta carotene, etc.).

I just know that now I'm hungry for a nice marinated squid salad with lots of olive oil and tomatoes. It's health food!

"Catch 22, just one reference to support the claim that "If you eat a lot of butter and dairy, your blood cholesterol goes up. And if you do not it will go down."

"Saturated fats raise your blood cholesterol level more than anything else. So, the best way to reduce your cholesterol level is to cut back on the amount of saturated fats that you eat. These fats are found in largest amounts in animal products such as BUTTER, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils--coconut, palm, and palm kernel oils.” National Heart, Lung, and Blood Institute, NATIONAL INSTITUTES OF HEALTH

http://www.nhlbi.nih.gov/health/public/heart/chol/chol_iq.htm

"I ask you to point me to a study which shows that eating less cholesterol reduces risk of heart disease”

Turpeinen O. Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 59:1,7;1979.

http://www.milksucks.com/heartdisease.html

“I ask you to point me to a study which shows that eating less cholesterol reduces risk of heart disease”

American Journal of Clinical Nutrition, Vol. 70, No. 3, 516S-524S, September 1999 Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies1,2,3 Mortality from heart disease was 24% lower in vegetarians than in nonvegetarians.

Catch 22... details, please.

"Saturated fats raise your blood cholesterol level more than anything else"  The NIH didn't provide anything at all to back up that assumption.

And exactly what was this "cholesterol-lowering diet" that you cite from milksucks.com, of all places?

"Mortality from heart disease was 24% lower in vegetarians than in nonvegetarians."  How did they make that determination, and what was the comparison of total mortality rates?

Any study that tries to prove that the consumption of fat or cholesterol alone leads to higher cholesterol levels needs to also take into account other factors, such as what amounts of carbohydrates were also consumed and how much physical activity the subject engaged in.

And one more thing... while you were cutting and pasting from milksucks, did you happen to read this: "Researchers who studied dietary links to heart disease in 32 countries found that, of all dietary factors studied, milk carbohydrates played the biggest role in the development of heart disease in men over 35, and nonfat milk played the biggest role in the development of coronary heart disease in men over 45."

"And exactly what was this "cholesterol-lowering diet" that you cite from milksucks.com, of all places? " well, the site: references among others:

Turpeinen O. Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 59:1,7;1979.

Dean's challenge was: "point me to A study which shows that EATING less cholesterol reduces risk of heart disease”. Next question:

"Any study that tries to prove that the consumption of fat or cholesterol alone leads to higher cholesterol levels needs to also take into account other factors, such as what amounts of carbohydrates were also consumed and how much physical activity the subject engaged in."

And if you look at my above comment you will have noted this comment:

The Framington Study noted above has gone on for some 30 years. It HAS demonstrated that as lower
blood cholesterol decreases, the risk of heart attacks and sudden DEATH also decreases. It has demonstrated that lower total cholesterol is desireable, low LDL desireable, High HDL desireable, low triglycerides desireable and a low ratio of total cholesterol to HDL is desireable. It will not tell you how long you will live but it will tell you the risk for that factor.

One's risk profile has TEN other such factors that help predict LONGEVITY."

What are the ten: Blood Glucose, Blood Pressure,
Cholesterol, Triglycerides, Uric Acid, Body Fat,
Resting Heart Rate, Personal History of Cardiac Disease, Family History (genes), Smoking, Stress,
Age, Resting EKG, Exercise EKG etc...

Like I said, This is Dean's science project not mine. That does not mean, I do not know whereof I speak, nor that I accede to his interpretation of what he thinks, I do or do not know.

I will take on your challenge. I don't believe a properly researched peer review study exists which shows a reduced mortality rate from eating a low fat or low cholesterol diet. My copy of Protein Power is on loan to a friend, and I know for a fact that the Drs. Eades debunked the reduced mortality rate from eating a low fat diet. And they can probably give you an answer on the low cholesterol diet as well. Check out www.eatprotein.com and ask the doctors themselves!

"Dean's challenge was: "point me to A study which shows that EATING less cholesterol reduces risk of heart disease”.

Here is as requested ONE peer reviewed study:

Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 59:1,7;1979.

"International statistics indicate that there is a close correlation between the consumption of saturated fats (dairy fats and meat fats) and the mortality from coronary heart disease (CHD), and this conception has been confirmed by many epidemiological studies. Such studies alone, however, cannot prove the existence of a cause-and- effect relationship between these two variables; dietary intervention trials are needed. The Finnish Mental Hospital Study was such a trial, conducted in two hospitals near Helsinki in 1959--1971. Practically total replacement of dairy fats by vegetable oils in the diets of these hospitals was followed by a substantial reduction in the mortality of men from CHD." Turpeinen O.

Dean

I'm a bit late at this party but here's my 2 cents worth.

Why do we produce so much cholesterol if it's so bad for us?

Well it turns out that cholesterol is vital for all living things.

Lipoproteins, (including HDL& LDL) are used to transport cholesterol around the body, via the bloodstrem, to where it's needed.

Have a look at this site.

http://www.ravnskov.nu/cholesterol.htm

Even if you don't accept the author's main premise, (his book is called The Cholesterol Myth), you will be able to increase your knowledge of cholesterol, lipids, statins and the studies that the 'Cholesterol Myth' is based on.

Catch 22,
Turpeinen is saying that if you eat less saturated fat, you live longer because your cholesterol goes down. That is NOT AT ALL the same as saying that if you eat less cholesterol, you live longer.
The anti-milk claim is similar. It's not the cholesterol in the milk which they claim is dangerous.
Thanks for the nutrition tips, though.

Dean, requested, point out to him ONE study that shows in his words:

"No. Fuck that. If you understand science, you should understand this basic premise.

For well over a quarter-century, we have been told that eating a low-cholesterol diet will reduce your risk of heart disease. So now I smply ask you:

After all these years and studies, has even ONE---even ONE--study demonstrated that reducing your cholesterol or saturated fat intake reduces your risk of myocardial infarction, or your general mortality risk? "

And Dean says:

"Point me to this study, please. And no, I am not being obstuse. Answer my fucking question. Where is the study which says that if I eat less saturated fat, less cholesterol, I'll live longer."

Those are Dean's specific words,not mine. What's the point:

Well, ONE study has been found:

"The Finnish Mental Hospital Study was such a trial, conducted in two hospitals near Helsinki in 1959--1971. Practically total replacement of dairy fats by vegetable oils in the DIETS of these hospitals was followed by a substantial reduction in the MORTALITY of men from CHD."
O Turpeinen

Eating low cholesterol food doesn't necessarily lower your blood cholesterol numbers.

By followed a South Beach/Atkins-type diet full of high-cholesterol foods like whole eggs, I lowered by cholesterol numbers (220 to 160) in 4 months.

DB,

Others on Atkins like diets show similar results, as well as opposite blood cholesterol results. That was not the question. The question involved was mortality vs. diet. Dean asked:

"Can anyone point me to a peer-reviewed study which shows a reduced mortality rate from eating a low-fat or low-cholesterol diet?"

I have tried to demonstrate that with Osol Turpeinen's study which I referenced. The study was a Finnish study. Its significance is because Finland has one the the world's highest rates of
milk and dairy consumption and also has one of the largest if not the largest rate of cardiovascular death. Dr. Turpeinen demonstrated that significant mortality can be reduced by changing the dietary intakes. That it applies to all individuals may not be true as there are many other factors.

What is the matter with exercising three times a week (walking works very well, but yoga is more fun) and eating pretty well, with a dessert twice a week and fresh fruit and vegetables the rest of the time? Diets don't work-- healthy eating habbits do!

(I've had eight children, the most recent a c-section two and a half months ago. I am a size eight just as I was one year ago. I know what works for an average person!)

What is the matter with exercising three times a week (walking works very well, but yoga is more fun) and eating pretty well, with a dessert twice a week and fresh fruit and vegetables the rest of the time? Diets don't work-- healthy eating habbits do!

(I've had eight children, the most recent a c-section two and a half months ago. I am a size eight just as I was one year ago. I know what works for an average person!)