Fear makes money. When the unscrupulous and the gullible meet there is money in the bank for someone, hope for the other. It is a pact. It exists in many areas of human experience, from finance to automobile repair. We the layperson go to an expert to have investment taken care of or our car repaired. “You must invest now in this golden opportunity before it disappears”, we hear, or “Your suspension is shot, you need new shocks and all other components all round.”
Fear of missing out on the latest El Dorado or fear of our car’s suspension collapsing will inevitably cause an increase in trust towards the expert giving us the advice. We may have undertones of scepticism but the quality of the pitch and the level of our own fear combine to make us reach for the credit card.
Nowhere is this more evident than in the turbulent and ever-changing world of health. Most of us don’t have time to research the latest advice, let alone its source. If it sounds good we usually accept it, particularly if it is swarming over the Internet and influencing our preferred sources of information.
“Inflammation” is the latest bogey in the health of our heart and blood vessels. It’s actually been around for quite a while and has a sound scientific basis for consideration but its new cheerleader vaunts its sole role in heart disease and asks us to challenge long-held orthodoxy that cholesterol is the prime factor in heart disease, and that statins are useless and dangerous. In fact the routinely-prescribed low-saturated fat diet is useless and dangerous in combating the true cause of the “silent killer” waiting for us all unless we take a controversial doctor’s advice.
We’ll get back to inflammation in a minute but bear in mind that a certain sector of health advice feeds us the “fear” factor. It used to be “toxins”. These built up in the body from incorrect diet. People tire rapidly of bogey men and go back to old habits and recycle the self-help health/diet book they read feverishly in an enthusiastic, single-factor purge of the thing holding them back from being thinner, happier and healthier.
Insulin has been at the heart of recent health scaremongering. Spikes in insulin after eating inappropriate foods were causing weight gain and the development of diseases. That gave way to gluten, the elastic protein that a small percentage of the population were intolerant of but so many pounced on as a badge of individualism and path to better health as they eschewed foods that contained it.
The toxin, insulin and gluten bogies have waned but have a fresh dose of fear – inflammation is here.
It always has been but its over-simplification in heart disease and its link to pernicious foods that cause it is the latest horror show, gaining by Internet Chinese Whispers as it swamps past stars of fear.
OK, a little science. Inflammation is part of the body’s response to injury, infection and other invaders it reads as threats that must be removed. Donna Arnett, PhD, chair and professor of epidemiology at the School Of Health at the University of Alabama uses the analogy of a splinter: “redness and swelling” indicate inflammation as the body sends in damage-control cells and molecules to protect and reduce harm.
In a human artery the same process is invoked as part of the formation of plaques. Currently recognised factors like smoking, injury, infection and oxidised LDL (“bad”) cholesterol will cause an atherogenic response, that is the formation of an arterial plaque. White blood cells (macrophages) rush to suck away harmful substances, one of which is cholesterol. Over-filled macrophages no longer work efficiently, form “foam cells” and die, lingering at the site they went to clean up. Other enzymes and agents that increase blood clotting also gather, trapped under the fibrous cap of what is now arterial plaque. The middle is filled with soft, flaky cholesterol that harbours dangerous chemicals that may eat away at this unfortunate capsule and encourage rupture.Throw in calcium and other crystallized materials for the genesis of an arterial phenomenon that may be life-threatening in the future.
The body is remarkably accommodating. According to Dr Jeremy Kaslow of the Wall St Journal “most plaques grow slowly, probably through a helter-skelter of small fissures that rupture and heal over again and again. They amount to scar tissue on the arterial wall. And they have pools of cholesterol, which become covered by a fibrous cap. Mature plaques may fill 70% or more of a blood vessel, detectable by angiogram. Blood flow may be restricted causing angina but they are typically stable with little risk of rupture”.
By contrast, younger plaques have a softer, thinner cap, a rich lode of cholesterol on board and are volatile. They narrow the artery by only 30-40%, the wall expands to accommodate them and they go unnoticed in an angiogram. If they rupture, massive, sudden clots form that block the artery and lead to a life-threatening heart attack.
OK, I’m scared now. The prospect of a heart attack, and even the complexity of how the body goes about forming plaques from its own self-defense mechanism can be confusing and terrifying. Although the American Heart Association declares unproven that inflammation causes heart disease and Harvard Medical School’s associate professor of medicine Dr Deepak Bhatt counsels: “Exactly how inflammation plays a role in heart attack and stroke remains a topic of ongoing research”, the alternative health world is abuzz with the latest single-cause fear factor.
While Dr Bhatt concludes “It appears that the inciting event in many heart attacks and strokes is buildup of fatty, cholesterol-rich plaque in blood vessels” a champion of simplification and fear stepped up to the plate in 2007 to debunk this accepted view.
Dr Dwight Lundell says “Simply stated, without inflammation being present in the body there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped”.
Lundell first proposed this hypothesis after 25 years as a heart surgeon. Up till now, we’ve seen that LDL cholesterol is the irritant starting the formation of plaques in the orthodox view. He is saying that inflammation alone is the key factor in heart attack.
If he stuck to that controversial point of view and perhaps did some studies to contribute to further research there would be no argument. Lundell however prefers to smash all cardiac shibboleths and raise an altar to the stand-alone mantra of inflammation. He further says “recommending cholesterol-lowering medications and low-fat diets is no longer morally defensible”. Most reputable cholesterol – lowering strategies follow the Mediterranean Diet or Harvard’s Healthy Eating Pyramid but Lundell urges us to “forget the ‘science’ that has been drummed into your head for decades. “The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat increases blood cholesterol is also very weak. Since we know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today”.
I love the way he invokes science to condemn the established principles of managing heart disease but offers no more than his own observational experience to back up his claims. He says “the long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences”. That’s strong talk for no reference to any evidence beyond what he has seen with his own eyes.
And that’s raw, inflamed arteries from eating the wrong foods. No one else has seen this inflammation without the presence of cholesterol-filled plaques but he says he has “peered inside thousands upon thousands of arteries. A diseased artery looks as if some one took a brush and scrubbed repeatedly against its wall”.
You may feel as I do, that inflammation and its complex and interdependent role in the body along with complex substances like cytokines, lipo-proteins and so on is a difficult subject but Lundell assures us it is “not complicated”. “If we chronically expose the body to injury by toxins or foods the human body was never designed to process, a condition occurs we call chronic inflammation”.
Put aside the fact that the body evolved and was not designed, you begin to get the idea that Lundell has a unique dietary prescription flying in the face of established recommendations to eliminate heart disease.He says the mainstream therapeutic diet of low-fat, high polyunsaturated fats and carbohydrates causes repeated injury to the blood vessels leading to chronic inflammation and heart disease, stroke and obesity.
Having invoked toxins, he goes on to include insulin before having a bet each way with cholesterol. Simple carbohydrates cause an insulin spike and subsequent sugar spills that attach to a variety of proteins that harm the blood vessel wall. Excess omega 6 from polyunsaturated vegetable oils provoke cytokines which also inflame every cell membrane. Inflammation encourages cholesterol deposition in his view.
To be honest, I wouldn’t mind if he just railed against sugar and highly-refined convenience foods laden with omega 6 polyunsaturated oils. His dietary prescription isn’t too bad, although he’s down on carbohydrate and advocates high-protein, low starch and fruit and vegetables and olive oil or butter over polyunsaturates. Where he ramps up the fear is turning foods into toxic irritants that “have been slowly poisoning everyone”. Instead of looking at the diet overall and following established guidelines he utterly refutes the role saturated fat plays in contributing to heart disease and demonises sugars and simple carbohydrates.
He has let a genie out of the bottle that is now sweeping across alternative health sources. Any food can be deemed “inflammatory” and disease-causing without consideration of well-researched findings about saturated fat and cholesterol. Even milk has been thrown in this grab bag by some on the inflammation bandwagon.
While some of his recommendations are worthy, like: “Don’t eat anything your grandmother wouldn’t recognise as food”, he is given to sweeping statements not backed up by evidence.
Fear doesn’t need evidence. It takes hold in an irrational atmosphere best of all. The fact that Lundell has a sketchy past, with legal problems like bankruptcy and pleading guilty to three counts of willful failure to file income tax returns shouldn’t condemn him, however the stripping of his medical licence by the Arizona Medical Board in 2008 following investigations of six deaths of patients after surgery performed by him should raise concern.
Lundell did not contest the revocation of his licence, he had retired to sell controversial books and supplements. He formulated and promotes “Heartshot – to dramatically reduce inflammation” and “RealW8 – to help you control the addiction to sugars and carbohydrates, thus allowing you to lose weight”.