HOME   HYGIENE LIBRARY CATALOG   CHAPTER 10

   Both cholesterol and triglycerides are natural in the body and the blood and are harmful only when their natural levels become elevated. Their functions are quite different. Triglycerides (fats) are a source of fuel energy and are stored in fat cells in the body, being released as required into the bloodstream as free fatty acids. Cholesterol is a waxlike alcoholic substance which is soluble in certain body fats. It plays an important part in the body and in every body cell.

   There are high levels of cholesterol in the tissues of the brain where it acts as an insulator separating the electro-chemical processes of the individual brain cells. Similar high levels are in the spinal cord. Cholesterol is required for the manufacture of certain hormones and is produced in various organs and in the body tissues themselves. The main center of production is the liver which converts much of it to bile salts essential for digestion and elimination. The involvement by cholesterol in the function of the nervous system is reflected by the significant increase in serum cholesterol which occurs with stress.

   It is normal for a certain amount of this natural cholesterol to circulate in the bloodstream. This is called serum cholesterol and is transported in the blood as part of compounds called lipoproteins. There are several types of lipoproteins--alpha, beta, and pre-beta. The alpha and beta types predominate and are referred to as high density lipoproteins (HDL), and low-density lipoproteins (LDL), respectively.

   The main cause of the generally elevated cholesterol levels in our society is cholesterol contained in the diet. It is this type of cholesterol, a low-density form, which is implicated in forming the arterial plaques in diseased arteries.

   Another danger from this form of cholesterol is its effect of paralyzing macrophages, the large white cells of the body's immune system.

   Serum cholesterol is measured in milligrams per hundred millilitres, expressed as mg/% or in millimoles per litre (mm/L). Figures in this book are in mg/%. Medical tests refer only to total cholesterol (both natural and dietary) and if they ever differentiate between HDL and LDL types, they refer to the ratio of HDL and LDL. A vigorously healthy, middle-aged, pure vegetarian can have a ratio of 1:05 with a total of 110 mg%, and a heart patient a ratio of 1:4.0 with a total of over 300 mg%.

   Thus, regardless of the difference in total cholesterol, they each have about the same amount of natural HDL cholesterol. It is obvious then that high levels of total serum cholesterol are mainly due to increased low density cholesterol, with the body continuing to maintain much the same amount of HDL cholesterol. Variations in HDL cholesterol do occur as a natural response to stress, as already mentioned.

   Cholesterol is contained only in animal tissue or products derived from animals such as dairy food and eggs. If foods of animal origin are eaten, the cholesterol (which varies in different food items) enters the blood and results in an increased total level in the blood. The total level increases because the dietary cholesterol is in a form that the body does not want* and so the body continues to manufacture its own "naturally packaged" cholesterol.

*This applies to cholesterol consumed in cooked meat and fat but apparently not to cholesterol consumed in raw meat and fat, the difference being due to the more thorough digestive breakdown of the raw food by the natural enzymes it contains. This explains the relatively low serum cholesterol levels observed in primitive Eskimos and Masai natives discussed in later chapters.

   How does dietary cholesterol get into the bloodstream? It is the task of the liver to receive nutrients from the intestines and store them, or use them or rearrange them so that the body can use them. However, fats and cholesterol, as commonly consumed, get different treatment.

   Except for a small fraction, they don't go to the liver from the intestine at all, but are released into the lymphatic system, the cholesterol being "packaged" loosely in tiny particles of fat called chylomicrons--millions of them. You will recall that the lymph empties into the bloodstream in the veins at the base of the neck, and therefore so too do the millions of cholesterol-laden blobs of fat, in a dangerous form. They are low density. Drs Meyer Friedman and Ray Rosenman, the cardiologists and researchers referred to in the previous chapter have this to say:

   "It must be clear to you that we sharply distinguish between the cholesterol that your body itself makes and that which comes from your food. It is not that we believe that the cholesterol molecules that your body makes are chemically different, but rather that body-made cholesterol is firmly packaged in a very soluble lipoprotein 'carton', whereas food-derived cholesterol is flimsily packaged in a fat-stuffed pellet. Let alpha lipoprotein cholesterol (which is made by the liver) escape from the blood and enter the wall lining of an artery, it will quickly return to the blood. But if a cholesterol-rich chylomicron makes the same type of escape, the cholesterol more often than not will remain indefinitely in the artery wall. This fact has been repeatedly demonstrated in the laboratory, and you might do well to remember it next time you hear a layman or even a doctor claim that the cholesterol the body makes is identical to that in the food as far as its potential for causing arterial damage is concerned. This statement is not simply untrue, it is dangerously untrue."

   Further they say:

   "But please note that it is necessary to feed cholesterol to these laboratory animals to create arterial plaques. We have the means to elevate the serum cholesterol level of animals tremendously by causing them to manufacture too much of their own cholesterol; yet under such circumstances they develop few or no arterial lesions. We believe that the explanation for this is that in the latter circumstances the excess cholesterol in the animals' blood is mostly in soluble lipoprotein forms. This is not the case with cholesterol in the blood put there as part of a high cholesterol diet. It enters the injured areas and stays there initiating the cancer-like process."

   The body can handle a certain quantity of dietary cholesterol without harm (particularly if the food is consumed raw), as the liver finally restructures it or disposes of it. But as levels rise, that which cannot be disposed of is virtually forced into tissues throughout the body. Very high levels crystallize and form patches under the skin. Cholesterol even crystallizes in the tissues of the eyes and forms little white rings around the iris, called arcus senilus.

   Polyunsaturated fat in the diet, while appearing to lower serum chotesterol, has the effect of causing high concentrations, via the liver, in the gall bladder where the cholesterol crystallizes to form gallstones.

   The arteries of people eating the typical Western diet, high in animal protein, fat and cholesterol are constantly exposed to this contamination and suffer gradual disease.

   Although blood fats (triglycerides) are involved in causing atherosclerosis, in some cases without the presence of cholesterol, the serum cholesterol level has been found to be an accurate indicator of the incidence of cardiovascular disease.

   Seven-hundred and twenty-three subjects tested by the Cleveland clinic, all aged under 40, showed that with a cholesterol reading of less than 200 only one in five had significant artery closure. At levels of 225 to 250, 48% had closure, at 300 the incidence was 80%, and at 350 the incidence was 91 %.

   The famous Framingham study showed that in 28-year-old men, of those with cholesterol levels of 140, only one in 200 had any degree of artery closure whereas at a level of 360, seven out of ten did. The death rate for those with cholesterol levels of 260 was four times higher than for those with levels of 220.

   Whereas authorities in the USA have revised their ideas on what is an acceptable limit and have reduced the figure from 300 to 240, the Pritikin Longevity Center recommends 150 maximum.

   Tests of 6,000 people in Helsinki, London, Oslo and Los Angeles compared groups on the typical American diet with a group on the American Heart Association (AHA) diet and a group on the AHA modified diet. The American diet contained 40% animal fat and 500-1000 mg of cholesterol per day. The AHA diet contained 40% fat (mainly polyunsaturated corn oil) and 300 mg of cholesterol. The AHA modified diet contained 24% fat and 200 mg of cholesterol.

   Of the American diet group 100 people died. On the AHA diet 95 died but the group had a 50% higher cancer incidence and 200% higher gallstone incidence. Of the AHA modified diet group, 50 people died. fifty per cent is a big improvement, but as Nathan Pritikin says, if you are one of the 50% who dies, then that is a 100% result for you.

   As described later, the recommended diet of the Pritikin Longevity Center in California contains less than 10% fat of any kind and less than 100 mg of cholesterol per day. For patients with advanced artery disease the center insists on an even stricter diet to ensure reversal of the atherosclerosis in the arteries. This is called the "regression diet" and contains no more than 5 mg of cholesterol. The diet is effective, particularly in association with a determined exercise program and over a period the blood cholesterol level eventually drops to 100-120 mg% as the body slowly discards its unwanted stores. Pritikin achieved this level (100) himself as he worked on reversing his cardiovascular disease.

   Dr Lester Morrison of Los Angeles in his book, The Low Fat Way to Health and Longer life (1958) described a Mexican Indian woman of documented age 110 years. He said she was quite spry and repeated tests showed levels of 100 mg% with corresponding low levels of other fats. Her diet had been fruit, legumes and Indian corn. He remarked that her cholesterol level was probably the ideal.

   In his new book, The Aerobic Way, Dr Kenneth Cooper refers to the famous Dr Atkins diet. He says that on his high protein, high fat, low carbohydrate diet, one of his patients lost 26 lbs in weight but at the same time, his cholesterol rose from 164 to 252! Cooper strongly advises against this diet.

   Cooper himself at the time of writing his book was taking at least one glass of milk a day, 4-6 eggs a week, up to four meat meals a week as well as meals of fish or fowl. He eats butter occasionally and generally avoids fat. On this diet his cholesterol was 187 and triglycerides 41. He said he cannot maintain "such low levels" unless he runs 12-15 miles per week.

   Here are some comparisons:

                                                      Total Serum 
                                                      Cholesterol
                                                      mg/%   mm/L

110-year-old Mexican Indian woman                     100    2.56
68-year-old Nathan Pritikin (runner)                  110    2.82
30-year-old SDA Health Educator, N. Keane (runner)    120    3.07
55-year-old SDA Dr G. Miller* (non-runner)            125    3.20
African Masai Tribesmen                               130    3.33
Maximum desirable, Pritikin Longevity Center          150    3.85
Level below which artery plaques regress approx.      150    3.85
Mean level of Sydney vegetarian children              161    4.13
Level above which arterial plaques may occur approx.  160    4.10
49-year-old Kenneth Cooper (runner)                   187    4.80
Mean level adolescent Sydney children--boys           180    4.60
                                     --girls          199    5.10
28% of Sydney children tested                         200+   5.10
Maximum desirable according to 
     National Heart Foundation                        240    6.15
Typical Australian (and American) adult levels        240+   6.15+

*Seventh Day Adventist, Vegetarian

   Physically fit people and people exposed to natural sunlight can handle dietary cholesterol better, and the amount of dietary fiber is a factor in its disposal as will be described later. Sugar consumption can also cause an increase of cholesterol levels, and almost always increases triglyceride levels. Sugar contains no cholesterol, nor does coffee, but both cause stress effects in the body resulting in increased cholesterol production.

   Dr Gerald S. Berensen of Louisiana State University School of Medicine surveyed the eating habits of 5,000 children up to the age of 17. A typical 10-year-old was found to consume 34% of his calories in snacks high in salt and sugar. He did a study with monkeys feeding them a diet similar to the typical children's diet. Some were fed diets high in salt but not high in sugar. These monkeys developed high blood pressure but the ones receiving both salt and sugar developed worse blood pressure. He said the effect of the sugar on the monkeys' cholesterol levels was as great as when the diet cholesterol was increased tenfold.

   Professor John Yudkin of England, an "anti-sugar man" of old, said in 1972 that sugar frequently caused an increase in blood cholesterol but also in "rats and chickens it produces atherosclerosis. In both man and animals it increases the level of blood triglycerides. Again in both man and animals, sugar causes profound changes in hormone levels, notably insulin and cortisone".

   The people of the island of St Helena have a high rate of heart disease comparable to Western countries. Dr Yudkin points out that this is despite less fat in their diets and less smoking of cigarettes, and the greater amount of exercise in a hilly country with no cars. But he points out, their diet is high in sugar. In two of his studies in which coronary patients were compared with other patients by means of a careful questionnaire of their dietary habits, the coronary patients' mean daily sugar intake was 147 gm compared to the non-coronary patients' 70 gm.

   This is not to implicate sugar as the prime instigator of cardiovascular disease, but the effect of sugar in elevating triglycerides and increasing blood viscosity is certainly a prime factor in triggering a heart attack.

   Sugar depletes the body's supply of Vitamin B1 (Thiamine). A deficiency of Vitamin B1 will increase blood cholesterol and so will a deficiency of iodine. Quoting Dr Carlton Fredericks--"The efficacy of old-fashioned cod liver oil in reducing blood cholesterol has been traced not to its unsaturated fatty acid content, but to the iodine it supplies to the thyroid gland. Since an underactive thyroid will raise the blood cholesterol, it should be remembered that a chronic mild deficiency of Vitamin B1 so easily possible in a sugar-saturated public, can cause thyroid under-activity and consequent elevation of blood cholesterol even in the absence of a high cholesterol diet".

   Dr Y. Stein, of the Hadassah Medical School, Jerusalem, observed an increase in cholesterol and triglycerides in subjects on a high sugar diet. When the diet was changed to a diet of complex carbohydrate, both cholesterol and triglyceride levels fell, but cholesterol was slower to fall than triglycerides. Similar observations were made by Dr N. Olse of the State University of Iowa, Dr I. MacDonald at Guys Hospital, London and by Professor A. Cohen in Jerusalem.

   Dr Milton Winitz in a study funded by the national Aeronautics and Space Administration (NASA) observed interesting differences between sucrose (refined sugar) and glucose in the diet. Eighteen healthy young adults were fed a chemical diet composed of glucose, adequate amino acids, vitamins, minerals and ethyl lincleate as a source of essential fat. After four weeks on this diet, 25% of the glucose was replaced by the equal amount of sucrose. In the next three weeks there was a progressive increase in total blood cholesterol from a mean average of 160 mg% to 200. Then the sucrose was exchanged with glucose again and in one week the mean average cholesterol level fell to 175 and finally to 151 at the end of the 19 week experiment. The constituents of this diet were meticulously measured of course, and the subjects' weights were constant.

   In tests, rats fed an ordinary diet had a cholesterol level of 59 and triglycerides 37. When sugar was added, the cholesterol level increased to 61 (3% increase) and the triglycerides increased to 53 (70% increase). The same rats on a high fat and cholesterol diet increased their cholesterol level to 577 and triglycerides to 144. When sugar was added, the already high level rose more, cholesterol to 787 (36%) and triglycerides to 262 (82%).

   Sugar in the diet does not always produce an increase of blood cholesterol and, as Dr Fredericks says, would appear to do so when the sugar affects the operation of the thyroid gland. This could depend on other dietary factors as well. However, triglycerides always increase with sugar intake. When cholesterol does increase in such a case, it would not be of the dietary kind but "body-made" and therefore perhaps not harmful. Dr Yudkin would therefore be correct in placing the major emphasis on elevated triglycerides as sugar's implication in cardiovascular disease.

   Physical endurance (aerobic) exercise can temporarily be accompanied by increased cholesterol levels because of the temporary stress, but the long-term effect of regular exercise is to lower blood cholesterol levels. The director of the Pritikin Longevity Center, Nathan Pritikin, was one of the busiest men I ever met. He worked a 12 hour day (excluding meal breaks and daily running), seven days a week. His work was demanding, he ran 4-6 miles a day and his only entertainment was maybe a movie every three months. His cholesterol was 110 mg%, triglycerides 40 mg%.

Cholesterol-lowering drugs

   Drugs such as thyroid hormone and Atromid S will lower total cholesterol in the blood but result in higher death rates of patients. This no doubt results from lowering the "good" body-made cholesterol and not the bad "dietary" cholesterol.

Summary of cholesterol

1. There are two significant forms in which cholesterol appears in the bloodstream, that which is contained in high density lipoproteins (HDL form) and that which is contained in low density lipoproteins. (LDL). Natural body cholesterol is largely in HDL, dietary cholesterol in LDL form. In blood tests, the reading usually made is that of the total cholesterol.
2. The only foods that contain cholesterol are those of animal origin such as meat, fish, shellfish, chicken, dairy produce and egg. Brains and egg yolks are extremely high. Egg whites are cholesterol free.
3. People whose diets contain no cholesterol, no refined carbohydrates, who are reasonably free of stress and are physically fit, have blood cholesterol levels as low as 100 mg%, predominantly the HDL type.
4. Without cholesterol in the diet, refined carbohydrates, such as sugar and alcohol, not only raise the level of triglycerides in the blood, but may also cause the body to increase production of its natural cholesterol, thus increasing the total level in the blood. Refined carbohydrates and caffeine actually cause stress in the body.
5. Increased levels of triglycerides in the blood together with the increase in body production of cholesterol, also occur as a natural effect of stress and both vary in proportion to the stimulus.
6. Cholesterol contained in the typical Western diet, particularly in association with fat of any kind, enters the bloodstream directly upon digestion in a dangerous form. It readily enters the various tissues of the body. Dietary cholesterol is responsible for elevating total blood cholesterol to statistically dangerous levels. Physically fit people, while still adversely affected by dietary cholesterol, are affected to a somewhat lesser degree because of their more efficient metabolism of dietary fat.
7. The combination of fat and cholesterol occurs in dangerously high levels in the typical American diet and almost guarantees cardiovascular disease, particularly in combination with high levels of sugar-induced triglycerides.
8. Correction of diet results in an initial rapid reduction of blood cholesterol with a continuing slow reduction as the body gradually eliminates cholesterol from the body tissues (including the arteries).
9. Whereas some authorities refer to HDL as being beneficial and LDL as being adverse, and speak of favorable ratios of HDL to LDL, this is only partly correct. It is certainly favorable to reduce LDL cholesterol by correcting the diet, but certainty not favorable to increase HDL by consuming sugar or alcohol. Less favorable again, and indeed most unfavorable, is it to reduce total cholesterol by drugs which reduce natural cholesterol.

The conclusion on cholesterol

   The argument about dietary cholesterol being a health hazard or not has been going on for many years. Despite the weight of evidence against cholesterol, certain sections of the food industry and the medical industry have kept the argument alive, and of course gourmets all over the world have hoped cholesterol would one day be exonerated. This hope has been finally shattered and the issue decided beyond all doubt by the findings (January 1984) of the $150 million ten-year trial by the National Heart, Lung and Blood Institute, whereby it was shown that reduction of cholesterol levels in the body, whether achieved by diet or drugs, significantly reduced the incidence of heart disease and heart attacks. The study was called "the Coronary Primary Prevention Trial".

   Unfortunately the findings still present a misleading picture. They indicate that a much greater reduction in cholesterol is achieved by drugs than by diet, and this conclusion is absolutely wrong. The so-called low-cholesterol diet used in the study was nowhere near strict enough and achieved a drop in cholesterol of only 4% compared to a 12.5% drop obtained by diet and drugs combined. This is piffling--because Nathan Pritikin, using his Regression diet, drops his patients' cholesterol by 29% in four weeks--entirely by diet!

   Another piece of information not mentioned in the dramatic news release was the fact that the cholesterol-lowering drugs had many bad side effects, were difficult to take, and required a lot of fluids, which indicates toxic repercussions within the body. The side effects were: gas, nausea, bloating, constipation and other gastro-intestinal discomforts which caused one-third of the study subjects to abandon the drugs before the study ended. (See also Drug control of blood pressure and cholesterol, Chapter 12.)