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The American Heart Association suggests in general not to take supplements, to limit saturated fats and to eat less than 300 mg cholesterol per day.  However:

1.  It has never been shown that not taking supplements improves health and helps prevent heart disease, or any other disease for that matter.
2.  In the real world, very low-cholesterol diets fail to significantly raise good or lower bad cholesterol in high-risk people (NEngJMed.; 98-7-2).
3.  Many foods with cholesterol (liver and eggs) have key vitamins, proteins and other nutrients.
4.  Groups can have 4 times more heart disease despite 10% less 'bad' cholesterol ... while over age 65, cholesterol is no risk-factor anyway (low cholesterol is!).
5.  Low saturated-fat diets may be dangerously low in vitamins A, E and omega-3 --while some saturated fats (butter and coconut) can have health benefits.
6.  Benefits of drug-based prevention are poorly documented and results uncertain:

Two classic studies:
1. After 2 years most (75%) of the not-treated patients "remained free of major cardiac events" but only 57% of those told to avoid animal fat, dairy, butter, eggs, fried food and cholesterol but given olive oil, and only 52% of those on the same restrictions given (omega-6) corn oil.  Conclusion: ...under the circumstances of this trial corn oil cannot be recommended in the treatment of ischaemic heart disease." [Br Med J; June 1965 (1): 1531-3].
Predictably the corn oil group had less cholesterol but little good that did!  While this trial clearly suggests harm, it proves with 99% probability the lack of benefit of these dietary changes [...and of low cholesterol levels per se].

2. The large U.S. "Veterans Trial" (corn oil) found slightly less heart disease wiped out by doubled cancer deaths (58.4 +/-0.6% survivors after 8 long years; Circ.; 1969 (40): Suppl. II and Pearce and Dayton in Lancet; '71: 464-7).  94 out of 100 similar studies would find more cancer after 8 years --which is more "cancer-causing" than smoking for 8 years!

There is no benefit in failure so there were no subsequent high-linoleic "omega-6 polyunsaturate" trials.  Corn, soy, sunflower, safflower and cottonseed oils all have between 51-75% linoleic.  This stuff winds up in your arteries, making "plaque" more fragile (not good).

The omega-6 / cancer link reappears regularly, as in the "Israeli Paradox": this country's very high omega-6 (soy) and low animal fat intake should produce little heart disease but instead there are respectively 1.5, 2.3 and 3.4x higher rates of diabetes, heart disease and cancer in Jewish versus non-Jewish Israelis.  P.S. Omega-3 studies with fish or canola do have happier results.

One sad example of medical prevention involved intensive cholesterol and blood pressure lowering drugs and 15 doctor visits over 5 years.  Five years after the trial 50% more treated men had died (67 vs 46) and 2½ times more cardio-deaths had occurred (34 vs 14) than in the untreated half of 1222 high-risk Finnish men -JAMA; '91-9-4.  Is there evidence that, 20 years later, your drugs and your doctor are better than those in Finland?  Ask your doctor but mention the famous U.S. MrFit trial: 45,000 man-years of "Special Intervention Program" and 5 more deaths after 7 years.

The Lancet; Aug. 29 '98: "Despite reductions in the age-related incidence of myocardial infarction and improved control of blood pressure the prevalence of heart failure does not seem to be falling and may be rising."  This reference concerns heart failure and reveals the current state of medical "management" and prevention of heart conditions: not great.

The cholesterol focused approach is dangerous (except possibly in about 0.3% of people with genetic problems -a group worse hit in this 90 year old epidemic).  The drug and care-giver industries promote the idea that lowering cholesterol, using "vegetable" oils and low-fat foods (high in sugar and starch) would be beneficial, but their science is, at best, shaky.

The focus of the AHA and AMA is to raise "good" and lower "bad" cholesterol.  This tide is slowly turning, even at the AHA: when its Dr. Sixsmith was asked on the Nov. 10 '99 NBC Today show if people should take a multi, her answer was: "Absolutely."  The purpose of life is life and the content of life is time.  Can you afford to wait .. ?

For sure, cholesterol, blood pressure, adult diabetes and impotence are important as wakeup calls.  Yet, by "normalizing" the numbers with drugs one masks the symptoms without fixing underlying problems.  Statin drugs, for example, slow the bicycle by (1) putting a brake on one of the wheels and (2) by reducing the "battery acid" [CoQ10] in the energizers of all cells, including those of the heart muscle... think: muscle pain and (congestive) heart failure in the elderly.

Modified Morrison/Willis/Stone/Pauling/Rath/McCully/others --
Heart Disease as Micronutrient Deficiency and Artery Repair Mechanism

"High cholesterol" doesn't explain heart or blood vessel disease as most people with coronary heart disease have "normal" cholesterol levels (BMJ; March 7 '98).

About survival: "Summary odds ratios for total mortality were heterogeneous [mixed], generally failing to support the value of cholesterol reduction." -AmJEpid; March 1 '99 and points 20 and 21 in 31 Tips & Comments].

While some cholesterol related factors do play roles [low "good" HDL, and LDL made "bad" by containing oxygen damaged cholesterol, homocysteine or clotting protein Lp(a)], any lowering of cholesterol has made no dent in early heart disease.

The "bad cholesterol" concept is truly misleading.  The "good" cholesterol particle is beneficial and impossible to "corrupt" but its larger sister, the LDL particle, can be corrupted to which your arteries take offense.  All these "corrupting influences" can be minimized with the proper foods and supplements, even or especially so if your genetics are not on your side.

The best 'thermometer' for most people in the cholesterol department is the ratio of total to HDL cholesterol, over 9 being high risk and below 4 being low risk -Criqui/Golomb, AJM 1998.  Total cholesterol 240 (6.2) with HDL 40 (1.03) would give you a ratio of 6.

Niacin -about 2 g/day- is the most effective agent to shift this ratio by raising the good HDL and it (with vitamin C and L carnitine) will lower Lp(a) while the multi lowers the homocysteine in your LDL.  Avoiding dried milk and egg-powder containing foods -and eating anti oxidant rich foods- reduces the load of oxidized cholesterol.  All this helps the 'bad' cholesterol emulsion particle LDL to become beneficial again.

Following is a nutrition oriented theory, based on past and ongoing research, about the basic causes of heart & blood vessel diseases: [the 'why' page has more on the basics]

  1. Most blood vessel problems start with inflammation [latin: "-itis"] and repair mechanisms, such as artery wall thickening (hardening, atherosis, sclerosis --slow processes) and blood clotting, a fast process, from hours to many days.

  3. Repair mechanisms activate when arteries are weakened by infection, by free radical attack (due to low antioxidant intake, smoking, or by your immune system) and by life-long or periodic low vitamin C.  However, MOST IMPORTANTLY, it is corrosion by homocysteine of the structural proteins of the artery wall due to refined diets low in many nutrients.  SOLUTION: a 'high vitamin B' multivitamin with 1 mg copper and some extra vitamin C.  In very high homocysteine, a few grams of betaine is useful.  Homocysteine damage is called thiolation which is incredibly similar but overlapping damage to what is called glycation damage found in diabetes from excess blood sugar.  Thiolation damage starts at or before birth, glycation damage rarely does and may be more repairable.

  5. High vitamin C lowers infection and inflammation (viral & bacterial) and, as said above, maintains strong vessel walls not needing repair.  Vitamin C helps make the mortar of the structural cement (connective tissue or ground substance) between cells, that breaks down in scurvy, a condition with internal bleeding and tissue degradation.  This connective tissue is the elastic and collagen fibre and water filled mesh 'cartilage' that regulates nutrient access and that supports and positions artery muscle and lining cells.  Vitamin C is also the recycler of vitamin E which shields cells, fats, cholesterol and LDL from oxidation and it's a relaxer of arteries.

  7. Long-term or periodically low vitamin C weakens this connective tissue (made of collagen, elastin and 'cartilage proteo-glycans') which then allows blood to enter the artery walls, thickening and hardening them with repair and clotting materials, with calcium and with cholesterol crystals.  Muscle cells then multiply inside the connective tissue to strengthen the wall.  Such thickened artery walls increase the risk for stroke and heart disease --NEJM; Jan. 7 99.  Chondroitin (4-sulfate) cartilage supplements have been shown to similarly benefit heart-health (Morrison / Schjeide, 1985).

  9. High Lp(a) (a repair protein working like "radiator-stop-leak", uniquely developed in non vitamin C producing primates, & piggybacked to LDL) and high (clotting) fibrinogen are risk factors, as are most clinical inflammation and repair indicators (more damage and inflammation: more repair, more clotting (ex: Circ; 00-9-5: 60% more risk in highest 1/3rd of Lp(a)-).

  11. Vitamin C & niacin (B3) reduce inflammation (C-Reactive Protein -where B6 may also be helpful -Circ; '01-5-12 & Circ: March 2002: inflammation, a great scientific summary).  "C and B3" also lower the production or need for repair Lp(a) and alcohol lowered Lp(a) in some studies -BMJ;98-5-30

  13. Oxidized fats & oxidized cholesterol (only) are toxic to cells and degrade LDL, generating immune and repair response & adherence of LDL to connective tissue components. This is avoided by a good diet and by the taking of supplemental antioxidants (carotenoids, C, the vitamin E family, selenium, CoQ10, others). 

  15. Amino acids lysine and proline possibly dissolve Lp(a) based repair clots in arteries (best sources: wheat germ, oats or yoghurt, and eggs respectively).  Arginine makes artery relaxant and blood fluidity factor nitric oxide (same sources + meats).

  17. Anti-inflammatory aspirin (very low-dose) and all omega-3 oils (fish, canola, flax) work like vitamin C to decrease the level of vessel repair mechanisms.  They and vitamin E also have anticlot (thrombosis) and blood fluidity roles (Vitamin E reduced circulation related leg amputations by 90% --in a study by Dr. Knut Haeger, -Vas. Dis. 12-68:199-213).  Omega-3 oils decrease sudden cardio-death caused by irregular heart beat, as do potassium and magnesium foods.

  19. Most harmful effects described above as well as high-insulin(-amyloid) and high-glucose caused vessel damage in adult diabetes [high glucose slows vitamin C use by cells] are prevented or improved by appropriate nutrients and supplements.  Quoting from a historical series of studies by Dr. G.C. Willis: "Massive doses of vitamin C may be of therapeutic value in the treatment of atherosclerosis and the prevention of intimal haemorrhage and of thrombosis." (CanMAJ; 7-'53, CanMAJ; 12-'54 & 4-'55 --faxed copies upon request).  Benefits of C in heart disease and deaths were found 40 years later in the NHANES study on 11,348 typical U.S. adults (Epidemiology; May '92).

Artery disease is usually, but not always, a very slow process (loss of function, angina, congestive heart disease, claudication, impotence).

A heart attack and most strokes start with sudden vessel obstructions by a piece of plaque or blood clot.  In clotting and plaque break-away, minuscule flat platelets become round balls of "velcro" that inter-lock using sticky fibrinogen "rope".  Then the vessel constricts! 

You want your artery muscles as relaxed, responsive and flexible as possible, permitting blood flow.  You also want the blood itself as liquid as possible and to only clot in the case of a real injury or cut.  Here are some examples about reductions in deaths in high risk groups on a low-dose of the anti-clot drug Coumadin/Warfarin: Circ; July 11 2000 and ArchIMed; Sept. 11 2000.

Omega-3 (fish, flax & canola oil) made hormones, ultra low dose aspirin, vitamins E, C and niacin decrease the tendency to make the clots that lead to sudden (heart, leg, lung & brain) obstructions, before, during and after heart attacks. 

In a pending heart attack, and while waiting for an ambulance, I would first chew some aspirin in water, and then take some vitamin C, E, flax oil & niacin (all of these are anti-clot and blood flow promoting).

I would also consider some magnesium if I could be low.  Preventive heart arrhythmia regulating plant (maybe fish) omega-3, potassium foods and magnesium supplements (and after heart attack intravenous Epsom salt) appear safe in most people.

Best, you would want to study if these data might apply to yourself -but these are life threatening situations where emergency medicine is your main recourse.  Hopefully the information in this prevention aimed website may help you lower your chances of needing such care.   Sept. 7, 2011  

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