Those “Cholesterol” Problems

Almost everyone in America now appears to have abnormal fatty substances- of which part is cholesterol – deposited in the walls of the arteries, a condition known as Atherosclerosis. These deposits, which have the same composition as the fats in the blood, may narrow the channels through which blood passes to the point that circulation is markedly decreased. Such a partial blockage, limiting the blood supply in the eyes, hastens the onset of cataracts and other abnormalities, in the legs, feet, or hands, it causes coldness, discomfort, cramps, pain, and sometimes gangrene, making amputation necessary; in the brain it may cause confusion, forgetfulness, premature senility, or strokes; and in the heart, angina or attacks known as coronary occlusion.

These fatty deposits seriously complicate such diseases as diabetes and nephrosis1 and delay recovery from almost every illness. They may be localized as tumors, or Atheromas, on the skin or be so generalized that they clog all arteries uniformly, the space left for the blood so decreased that high blood pressure results and becomes progressively more elevated as the atherosclerosis advances. High blood pressure from other causes, however, makes atherosclerosis worse.

Although atherosclerosis has been described as “universal and life-long,” it has been produced in hundreds of thousands of animals, and when the diet is made adequate, health is restored. The same is equally true of humans.

Atherosclerosis2 is reversible. Deposits containing cholesterol can often be seen in the skin around the eyes as yellow fatty accumulations; these tiny tumors quickly disappear after the diet is improved. A woman who consulted me had dozens of them under pendulous breasts; six weeks later none remained. On one occasion I was asked to see a ten-year-old child who had more than 200 such deposits on her back and abdomen and a blood cholesterol above 1000 mg; after her diet was made adequate, the deposits seemed to melt away. A retired postman, brought to see me in a wheelchair, had such constant, severe pain in his legs because of atherosclerosis that his physician had recommended amputation; two months later he walked in to see me. Such cases indicate that this problem can be corrected.

Countless experiments with healthy volunteers, survivors of heart attacks, persons in prisons and mental institutions, and innumerable animals show that when fatty substances are being deposited in the arterial walls, the blood cholesterol is invariably high and in abnormally large particles and that the fat in the blood which is combined with phosphorus, known as Phospholipids, or lecithin, is too low. Yet these abnormalities are corrected as soon as all nutrients needed to utilize fats are supplied. Atherosclerosis and such seemingly unrelated problems as gallstones and much obesity appear to be caused by a combined under-supply of many nutrients essential before fats can be used normally. Cholesterol is merely the innocent little pig that got stuck in the barn door.

All tissues synthesize cholesterol but only that produced in the liver reaches the blood. Some of it is made into Pituitary, Adrenal, and sex hormones, some into Bile Acids which aid the absorption of foods and some into vitamin D if the skin is exposed to summer sunshine. Cholesterol, however, which is particularly concentrated in the brain, appears to have functions not yet understood. It enters the small intestine with bile, passes into the blood, and, if all nutrients are generously supplied, is eventuallybroken down by the cells into carbon dioxide and water.

Saturated and unsaturated fats. In an attempt to correct atherosclerosis, much attention has been focused on fats, which, during digestion, are broken down into fatty acids. The chemical terms saturated and unsaturated (or polyunsaturated) refer to the hydrogen content of these acids; and most fats are a combination of both varieties. Fats that are more solid are predominantly saturated: margarines, hydrogenated cooking fats, tallow, butter, lard, and fats from all meats. The unsaturated fats are liquids such as fish oils and vegetable oils. The body and blood fat of persons with atherosclerosis is made up largely of saturated fatty acids, whereas the storage and blood fat of individuals free from the disease contain a high percentage of unsaturated fatty acids.

Three fatty acids, linoleic, linolenic, and arachidonic (a fancy word referring to peanuts), which can be obtained from vegetable oils, are essential before cholesterol and saturated fats can be utilized. If the diet furnishes sufficient linoleic acid, the other two essential acids can be synthesized from it provided a bevy of vitamins and minerals are also present, but several of these nutrients may be undersupplied. Though many factors are involved, when fats cannot be burned readily by the tissues, they are dammed up in the blood. Because peanut, safflower, and soy oils are among the richest sources of arachidonic, linoleic, and linolenic acids respectively, I recommend using equal parts of these three, though mixtures of other oils are also excellent.

The importance of Lecithin, or Phospholipids. Like cholesterol, lecithin – the Phospholipids – is continuously produced by the liver, passes into the intestine with bile, and is absorbed into the blood. It aids in the transportation of fats; helps the cells to remove fats and cholesterol from the blood and to utilize them; and increases the production of bile acids made from cholesterol, thereby reducing the amount in the blood. Lecithin also serves as structural material for every cell in the body, particularly those of the brain and nerves. In a healthy person, it forms 30 per cent of the dry weight of the brain and 73 per cent of the total liver fat, both of which are greatly decreased in persons dying of heart disease.

Lecithin is a powerful emulsifying (can combine oil and a water-like substance together and make them mix) agent and for this very reason is particularly important in preventing and correcting atherosclerosis. Although blood is essentially water into which fats cannot dissolve, lecithin, if present in normal amounts, causes cholesterol and neutral fats to be broken into microscopic particles which can be held in suspension, pass readily through arterial walls, and be utilized by the tissues.

All atherosclerosis is characterized by an increase of the blood cholesterol and a decrease in lecithin. As early as 1935 it was shown that experimental heart disease, produced by feeding cholesterol, could be prevented merely by giving a small amount of lecithin, and atherosclerosis has since been repeatedly produced in various species either by decreasing the blood lecithin or increasing the cholesterol. If enough lecithin is given, the disease does not occur regardless of how much cholesterol is fed. Even when atherosclerosis is far advanced, health is restored after lecithin is supplied in the diet. Furthermore, animals most resistant to experimental atherosclerosis are those with the greatest ability to produce lecithin.

Under conditions of health, when a meal is eaten that is high in fat or excessive in calories which are quickly changed into fat, the production of lecithin increases tremendously, and the fat in the blood is immediately changed from large particles to smaller and smaller ones. In patients with atherosclerosis, however, the blood lecithin stays disproportionately low regardless of the amount of fat entering the blood, and the fat particles remain too large to pass readily through the arterial walls. A lack of lecithin in the cells may be even more damaging.

When a solution of lecithin has been allowed to flow continuously into the arteries of animals with severe atherosclerosis and the bile duct is tied to prevent further cholesterol from entering the blood, fatty deposits in the arterial walls are quickly removed. Similarly, if the cholesterol supply is cut off and injections of lecithin given, the blood cholesterol increases, showing that it is being picked up from the arterial walls.

Cholesterol can be made from fat, sugar, or indirectly from protein. Lecithin, however, consists of several substances (Cephalin, Sphingomyelin, etc) which require essential fatty acids and the B vitamins Cholin and inositol for their structure and numerous other nutrients to synthesize them. Because lecithin is essential to every cell in the body, the demand for these raw materials is tremendous and an under-supply of any one limits its production.

Fortunately, the identical lecithin occurs in all unrefined foods containing oil. The lecithin in vegetable oil destined to be used for paints is removed because it makes the paint smear; hence it is available in a mild flavored, granular form which can be added to foods. The lecithin is used commercially as an emulsifying agent in the candy and baking industries and in heavy industry where oil must be broken into minute particles. In preparing holiday dinners I add it to gravies, where it seems to make the fat literally disappear. Its emulsifying action is apparently identical whether outside or inside the body. When lecithin from eggs, liver, nuts, wheat, and soy oil has been tested on animals with atherosclerosis, health has invariably been restored regardless of the source.

Many physicians have successfully reduced blood cholesterol with lecithin. For example, 4 to 6 tablespoons has been given daily to patients who had suffered heart attacks and been consistently resistant to many cholesterol lowering medications, some for as long as ten years. Although no other dietary change was made, within three months the level of blood cholesterol dropped markedly, in one case from 1, 012 186 milligrams. These patients felt more energetic, had an increased capacity for work, and were relieved of pain and other symptoms. After the blood cholesterol has once decreased, 1 or 2 tablespoons of lecithin daily have kept the blood fats at normal levels, though larger amounts have been taken over long periods with good results.

Supplements of lecithin have also caused the pain of angina to disappear and have been especially beneficial to elderly persons who have suffered strokes or have cerebral atherosclerosis.

The need for vegetable oil. Adding any nutrients to the diet which allows lecithin to be produced in normal amounts helps to alleviate atherosclerosis. Although Arachidonic acid is necessary before lecithin can be synthesized, saturated animal fats, hydrogenated cooking fats, and most margarines contain little or no essential fatty acids, hence they cannot increase lecithin production. The more Arachidonic acid there is in the blood of animals, the more resistant they are to atherosclerosis.

Giving vegetable oils or Arachidonic and/or Linoleic acids, however, elevates low blood lecithin almost immediately. Moreover, when a solid fat in an experimental diet is partly or completely replaced by vegetable oil, the blood cholesterol and fat decrease as their utilization improves, but if the vegetable oil is gradually hydrogenated and fed to groups of animals, the blood cholesterol rises with each increase in hydrogenation.

Any oils, including fish oils which contain no essential fatty acids, help reduce blood cholesterol by decreasing its absorption. Giving vegetable oils rich in linoleic acid, however, markedly increases the quantity of cholesterol changed into bile salts and accelerates the breakdown of fats and cholesterol to carbon dioxide and water in the tissues.

The amount of oil needed daily appears to be no more than 1 or 2 tablespoons, although 2 teaspoons have not decreased blood Cholesterols. The more solid fats eaten, the greater becomes the need for linoleic acid. If the intake of solid fats is high, a deficiency of linoleic acid can be produced even when oils are included in the diet. It is important to understand that there is nothing wrong with natural saturated fats as long as the cells are supplied with all nutrients necessary to utilize them. The need for these nutrients is markedly decreased, of course, if the saturated fats themselves are largely avoided, which is the approach now most commonly used to combat atherosclerosis.

Practical advice is to eat the same amount of fat as usual but decrease animal fat except that from fish; use oils for cooking, seasoning, and salad dressings; and avoid all hydrogenated fats – margarines, cooking fats, hydrogenated peanut butter, and processed cheeses – and foods prepared with them.

Above all else, do not go overboard in using oils. They supply 100 calories per tablespoon, and any not used are stored as a particularly soft, flabby fat. Furthermore, oils alone cannot correct atherosclerosis. For example, deposits removed from fat-plugged femoral arteries quickly returned when patients made no change in their diets except to get half of the fat from oils.

Inositol and Cholin are essential. If either of the B vitamins Cholin or inositol is under-supplied, lecithin cannot be produced in adequate amounts. Little research has been done on inositol deficiencies, but a mild lack of cholin causes the amount of lecithin in the blood rats to decrease, much less cholesterol to change into bile salts, and heavy fatty deposits to be laid down in the arteries. A cholin deficiency also inhibits the utilization of cholesterol in the tissues, the burning of fats to produce energy, and the excretion of cholesterol in the feces.

Cholin can be made in the body from the amino acid Methionine, provided the diet is high in protein; and blood cholesterol drops when this amino acid is generously supplied. All cells need Methionine, however, and they have priority over the available supply; only when an “excess” exists is it changed into Cholin; hence this vitamin is frequently deficient. Because eggs are particularly rich in Methionine and lecithin itself, they should never be restricted in the diets of persons with atherosclerosis.

When patients recovering from heart attacks received daily 2,000 and 750 milligrams of Cholin and inositol respectively, the size of the cholesterol particles and the amount of fat in the blood quickly decreased; two months later the blood cholesterol had dropped to normal. Blood lecithin has also increased and cholesterol been reduced after Cholin alone has been given. Some investigators have observed similar results, but in studies where multiple deficiencies have limited lecithin production, cholesterol has not been reduced by Cholin and/or inositol alone. Neither do a guard and a quarterback make a football team.

Liver, yeast, wheat germ, and particularly lecithin are the richest natural sources of Cholin and inositol. In addition to using these foods liberally, I take daily and recommend to others B-complex tables supply 1,000 milligrams of both inositol and Cholin.

Vitamin B6 and magnesium. Lecithin cannot be synthesized in the body without enzymes containing vitamin B6 or Pyridoxine. These enzymes, in turn, are active only if magnesium is present. Extremely severe atherosclerosis has been produced in a variety of animals kept on diets adequate in all nutrients except vitamin B6. When monkeys, for example, were given such a diet, the arteries in the heart, pancreas, kidneys, abdomen, limbs, muscles, and all tissues were clogged with fatty deposits; and the blood analyses showed both an extremely low lecithin and high cholesterol. Though in every respect the condition was said to resemble atherosclerosis in man, monkeys given the identical diet including vitamin B6 remained health.

Diets high in vitamin B6, Cholin, and inositol supplied by wheat germ, yeast, liver, or B vitamins extracted from bran have been particularly effective in reducing blood Cholesterols. Liver not only contains lecithin and all of these vitamins but also less saturated fats than any other meat.

Even when vitamin B6 is adequate, a lack of magnesium prevents lecithin from being formed and thus inhibits the utilization of fats and cholesterol. Patients with heart disease given 500 milligrams of magnesium daily made “dramatic improvement”, and many of the blood Cholesterols fell drastically in a single month.

The need for magnesium is tremendously increased when the blood cholesterol is high. For example, the magnesium requirements of rats fed hydrogenated fat and cholesterol multiplied 16 times over that of normal animals. Giving sufficient magnesium, however, prevented atherosclerosis from being produced despite feeding huge amounts of cholesterol and hydrogenated fats. Even after the arteries were severely plugged with fatty deposits, adequate magnesium cause the blood cholesterol to drop to normal and the arteries to become healthy.

The American diet is now extremely low in magnesium; this mineral is readily lost in the urine; and, because of the high intake of saturated fats, the magnesium requirement is apparently much greater than has been realized. For these reasons, inadequate magnesium may well prove to be a major cause of our national atherosclerosis.

Vitamin E has much to offer. Numerous toxic substances such as those from cigarette smoke, nitrites from fertilizers, and the deposition of cholesterol itself cause scars to form in the arterial walls. Fats are first laid down over these tough scars and may accumulate quickly until the flow of blood is drastically decreased or completely cut off at certain points. Vitamin E, therefore, is especially needed to help dissolve such scars. The scar4ring of arterial walls, however, is found in persons of every nation, many of which nations have little or no atherosclerosis.

Occasionally vitamin E has elevated blood lecithin and reduced cholesterol, apparently by preventing the essential fatty acids from being destroyed by oxygen. Moreover, this vitamin tremendously decreases the body’s need for oxygen; hence it is particularly important to persons with atherosclerosis. Pain caused by a lack of oxygen, common in the heart, eyes, legs, feet, or any tissue where the circulation is decreased by fatty deposits, is often markedly relieved in a few days after vitamin E is added to the diet; and when patients have taken 600 units of vitamins E or more daily, the pain of angina has subsided, gangrene has cleared up, and amputation has been avoided.

Other nutritional influences. Persons suffering from atherosclerosis often have a particularly high intake of refined sugar, which, if not burned, is quickly converted into saturated fat. Animals fed sugar instead of starch develop high blood cholesterol; and the essential fatty acids in their blood and tissues decrease far more than when starch is fed. The blood cholesterol of healthy volunteers fell when they ate unrefined starches, but substituting sugar caused their blood fats and cholesterol to increase markedly. In the United States the consumption of such foods as potatoes, dry beans and peas, and whole-grain bread and cereals has unfortunately decreased steadily while the sugar intake has increased and paralleled the rise in atherosclerosis. If we are to combat this disease, natural starches should be appreciated and refined sugar restricted. The more deficient diets become, however, the greater is the craving for both sweets and alcohol.

Every nutrient appears to help prevent atherosclerosis. Pectin effectively reduces experimental high cholesterol. Vitamin B12 accelerates the production of bile salts, thus decreasing the cholesterol in the blood. Lecithin increased markedly and Cholesterols fell to normal when coronary patients were given 100,000 units of vitamin A daily for three to six months. Adequate protein causes the blood cholesterol to fall provided it is not obtained from well-marbled steaks or roasts accompanied with rich gravies and potatoes French-fried in hydrogenated fats. Alcohol not burned as calories and an excess of carbohydrate and/or protein are so quickly changed into saturated fat that they cause the blood fats and cholesterol to increase as readily as if saturated fats were eaten.

Monkeys under-supplied with vitamin C produce cholesterol six times more rapidly than do well-fed animals. Severe atherosclerosis in rabbits and guinea pigs has been corrected by giving large amounts – 50 times the normal requirements – of vitamin C; and the formation of bile acids and the excretion of cholesterol both increased. When patients with atherosclerosis and high blood pressure received large amounts of this vitamin, their blood Cholesterols fell markedly and their blood pressure slowly dropped. The fact that toxic substances from cigarettes destroy vitamin C may in part explain why heavy smokers are susceptible to atherosclerosis.

Animals whose thyroid glands take up iodine readily are not susceptible to heart disease; and giving iodine to rats prevents atherosclerosis produced by feeding excessive amounts of cholesterol. When 12 drops of 10 per cent solution of potassium iodide were given in milk three times daily to hospitalized coronary patients, in a single month the blood lecithin increased markedly, the Cholesterols dropped, sometimes as much as 125 milligrams, and the size of the fat and cholesterol particles were reduced. Heart pain decreased, and the patients felt “fresh and cheerful”. In cases where the basal metabolic rate had been low, or the speed with which the body utilizes energy was subnormal, it increased 11 to 28 per cent. Though adequate iodine with vitamin E stimulates the thyroid gland and thus accelerates the utilization of cholesterol and fats, it has been particularly neglected.

Every variety of animal allowed only two meals daily develops severe atherosclerosis, but when the identical kind and amount of food is taken in small, frequent feedings, excellent health is maintained. Numerous small meals also correct atherosclerosis even after it has become severe. Similarly, coronary patients given six or more small meals daily rather than the same kind and amount of food in one to three larger meals have invariably shown marked decreases in the blood fats and cholesterol.

Stress makes atherosclerosis worse by increasing the need for nutrients to utilize fats; and cortisone therapy, which simulates severe stress, quickly elevates blood fat and cholesterol. Stress is not necessarily destructive provided the increased requirements are met.

Though atherosclerosis is often considered to be hereditary, when 123 persons of two families, all of whom had excessively high blood Cholesterols, were given improved diets, their blood fats and Cholesterols readily decreased. Such families undoubtedly have unusually high genetic requirements for certain nutrients needed to utilize fat.

Low-fat and low-cholesterol diets. When low-fat diets have been given to patients with atherosclerosis, appetites have usually become ravenous. Excessive calories, mostly from starches and sugars, have been consumed and quickly changed to saturated body fat, causing the blood fat and cholesterol to soar. The size of the fat and cholesterol particles has also become much larger, the amount of cholesterol changed to bile acids has greatly reduced; and coronary patients adhering to such a diet have become markedly worse. The American Medical Association has warned physicians not to recommend such diets, but they are still being used.

Diets low in cholesterol have also achieved exactly the opposite from what was hoped. Such diets throw the liver into a frenzy of cholesterol-producing activity, causing the amount in the blood to increase. Conversely, liver biopsies showed that when volunteers were fed 3 or 4 grams of cholesterol daily – far more than would ever be obtained from foods – the production of cholesterol by the liver was “almost completely suppressed”.

Experimental heart disease has been produced with diets completely devoid of cholesterol.

Nevertheless, low-cholesterol diets have restricted so many excellent foods that the very nutrients needed to utilize fat and cholesterol have been decreased or omitted. Eggs have been condemned, their high lecithin and Methionine content ignored. Even mayonnaise has been forbidden, yet it averages 52 to 67 percent essential fatty acids and 10 to 14 per cent lecithin. Volunteers recovering from heart attacks have consumed daily for varying periods 10 eggs, 16 egg yolks, the fat from 32 eggs, and even 9 to 60 grams of pure cholesterol; their blood Cholesterols have not increased provided the eggs were cooked without saturated or hydrogenated fat.

Some experiments have shown that butter has increased blood cholesterol, yet person in Denmark, Switzerland, and Finland eat far more butterfat than we and have much less heart disease. Certain African natives obtain 60 to 65 per cent of their calories from butterfat, but all their foods are unrefined; they have no atherosclerosis, no heart disease, and their blood Cholesterols average an amazingly low 125 milligrams. In the days when atherosclerosis was unheard of in America, butter was slathered in or on practically every food not cooked in cream. Butterfat appears to be a problem only when nutrients needed to utilize it are under-supplied.

Lowering blood cholesterol. Though blood cholesterol varies constantly, that of persons with atherosclerosis is uniformly high, or usually above 250 milligrams in about a half cup of blood (100 cc). A group of patients with heart disease or cholesterol tumors had average blood Cholesterols of 259 and 423 milligrams respectively, and persons over 60 years of age with Cholesterols above 260 milligrams have been found to have twice as many strokes as others with Cholesterols below 200. Physicians do not agree on the amount most compatible with health, but it appears to be below 180 milligrams.

If a diet is adequate in every respect, lowering the cholesterol to 180 milligrams or less is usually not difficult. For example, one man whose cholesterol was 330 shortly after a heart attack quickly reduced it to 170 milligrams and then more gradually to 121. Almost every week someone whose cholesterol was formerly high tells me, “My doctor says my cholesterol’s now the lowest he has ever taken,” and quotes a figure from 130 to 150 milligrams.

None of these persons has avoided eggs, liver, or butter but they did obtain magnesium, iodine, lecithin, yeast, skim or whole milk, the anti’s tress formula, and supplements of vitamins A, D, E, and the B vitamins. A few have taken 250 milligrams each of cholin and inositol six times daily for a short period. All were asked to reduce natural saturated fats and to avoid every form of hydrogenated fats including anything prepared with them, such as French-fried foods and package mixes; and each had 2 tablespoons of mixed vegetable oils daily. Not only did the blood cholesterols decrease, but the appearance, energy, and general well-being of these individuals can well be envied.

In correcting experimental atherosclerosis, it has been found that some fatty deposits, especially those in the arteries of the eyes and heart, remain long after the blood cholesterol is normal. Such a finding indicates that an adequate diet should be followed for months or years after apparent recovery.

Have your cholesterol determined annually. Every person with a high blood cholesterol is a potential candidate for a heart attack, a stroke, high blood pressure, and/or various abnormalities resulting from prolonged faulty circulation. For this reason, I believe that every individual, regardless of age, should have an annual blood cholesterol determination. If this figure is above 180 milligrams, immediate steps should be taken to lower it. Untold suffering and innumerable premature deaths could be prevented were such a procedure followed.

There is no evidence that cholesterol alone causes general atherosclerosis, strokes, or heart attacks, but an elevated blood cholesterol invariably accompanies these abnormalities. Neither is a gas gauge on a car responsible when the tank is empty, but it indicates trouble ahead which can be prevented.

With acknowledgment to Adelle Davis, world famous nutritionist.