Does cholesterol cause heart disease

Dear Dr Lim

Not sure if this article by Dr Dwight is true? It is going against normal things that have been taught in the medical school. If it is true, the medical texts have to be rewritten. These are some of age old questions & beliefs.

Dato Dr Vincent Ng,


Dear Dato Dr Vincent,

Many thanks for this interesting article by a heart surgeon-turned-nutritionist about the true aetiology of coronary heart disease.

Let me give you my professional opinion as briefly as possible as a chemist, physiologist, nutritionist and a physician with special interest in natural medicine.

Right but off tangent simultaneously:

Dr Dwight Lundell is right that it is the inflammation of the inner wall of the coronary artery that gives rise to coronary arterial disease (CAD) and not the increased buildup of fatty layers, known as atheroma due to cholesterol deposits.

But he was off tangent in blaming polyunsaturated oils like soybean, corn and sunflower oils, omega-6 fatty acids, and highly processed carbohydrates as the trigger factors for the inflammatory response. Neither in my opinion is CAD caused by high density or low density cholesterol.

Even the huge on-going Framingham longitudinal cohort study beginning in 1948 into three subsequent generations in Massachusetts has concluded that no levels of cholesterol per sec, be it high or low, be a single predictor of CAD.

There are so many other intertwining trigger factors such as genetic make-up, blood pressure, stress levels, smoking, lifestyle changes, etc that play a role in cardiovascular disease and its events. It is this massive long term Framingham cohort heart study that has caused all of us in the health-care professions to be so obsessed and so blind to levels of cholesterol in the blood and its correlation to cardiovascular events.

Medical vs. Chemistry Professions:

Unfortunately the medical profession has almost no understanding of chemistry and their colleagues in the chemistry profession likewise has little clue in medical research and its advances. Being also a qualified chemist myself I specifically believe it is the damaging free radicals – highly reactive molecules, molecular fragments or atomic fragments that has lost one of their paired electrons in their shared co-valent bond that is the culprit in causing so much damage to the DNA, cells, tissues, organs, systems and eventually to the entire body into degenerative disorders and rickety shape like CVA (stroke), CAD, autoimmune disorders, neoplastic diseases like malignancies, brain, kidney, liver, musculoskeletal, eye, hair, skin disorders. In fact death ultimately overwhelms all of us either due to any of the big classes of causes – accidents, cancers, infections, degenerations or genetic disorders.

No escape from free radicals:

There is no escape because highly damaging free radicals are everywhere – in the food, medicines, chemicals in the environment, pollutants, radiation from mobile phones, x-rays, CAT scans, PET scans, EMG scans, nucleotide and radioactive tagging and scans, metabolic wastes, ultra-violet rays, cosmic radiation from outer space, stress hormones like adrenalin, anger, ageing, etc, etc….down the endless lists.

If only cardiologists, neurologists, nephrologists, oncologists and other specialist clinicians can understand the highly, highly, destructive nature of these unquenched reactive molecules that they would not single out diet, nutrition and lifestyle has the sole causes to all these medical events.

Framingham benchmark:

A lot of scientists, nutritionists, cardiologists, physicians are very blind to refer to the Framingham Heart Study on their findings of blood cholesterol levels, hypertension, smoking etc as the benchmark as a predictor of cardiovascular events. But even they a few years ago came to the conclusion after such a massive and long haul study that cholesterol whether high or low has little bearing on morbidity and mortality from cardiovascular events. It came from the horse mouth. Unfortunately all our ideas about cholesterol and CAD came from this massive Framingham Study. Nowhere else we got this idea or theory.

My own experience:

In fact even my own experience having signed thousands of diagnostic forms for blood lipids analysis sent to us at IMR from Government hospitals throughout the country showed very little relationship between suspected AMI or angina pectoris (chest pains) and what we found on the blood cholesterol levels. Initially we thought we may have made analytical errors. We checked and checked again on the analytical procedure, and did quality control, but there was no mistake. There was very relation between what the clinician reported and what we found.

Cardiac enzymes not out yet:

Of course the release of cardiac enzymes (creatine phosphokinase (CPK, CK) and the protein troponin (TnI, TnT), etc at that time weren’t discovered yet and there was no means of using them as a diagnostic tool. Of course the clinician would also have done an ECG for ST elevation and other irregularities in the PQRST waves.

What I saw:

Let me put this straight away. In my 25 years in medical research in an analytical research laboratory at the Institute for Medical Research I have seen and handled what pure analytical grade cholesterol looks like, and how they feel on the fingers. Let me tell all these experts who believe that it is the high levels of blood cholesterol as the prime factor that cause the cholesterol to stick onto the tunica intima (inner coat of blood vessels).

Properties of cholesterol:

If these clinicians have ever worked in a chemistry laboratory to analyze cholesterol content in thee blood and foods, they would have seen what pure cholesterol looks like, how they feel on the fingers – their physical and chemical properties, etc. Let me tell them that cholesterol is just a very pale yellow powder, completely insoluble in an aqueous media like in water, blood or urine. It does not feel greasy, oily, nor does it stick on to the fingers. In fact it does not stick on to anything at all.

Cholesterol only dissolves in an organic solvent such as chloroform and petroleum ether and it is a little soluble in oil medium. That’s all. It completely does not stick to anything at all, not even to a piece of meat, beef, pork, fish, vegetables or fruits, and least of all water. It just drops off if you try to rub it on anything.

If you scatter pure cholesterol onto the surface of water, it will just float there like talcum powder. It will not dissolve like sugar or salt into water. If you rub it onto your finder tips, it is just like non-greasy powder which you can instantly wash off with just plain water. No soap or organic solvent needed.

In short, even in the blood most of them are dissolved in the small amount of blood lipids and carried around and round the body without sticking on to anything. But you need to be a analytical chemist, not a clinician to understand and experience this. This is surprising to a lot of people – especially the health freaks.

Properties altered during damage:

But when the chemical and physical properties of cholesterol is altered by heat and oxygen, and long exposure to light, and worse of all, by free radicals, that changes in their physical and chemical properties greatly. These were clearly seen by me. My personal experience using pure cholesterol as a standard reagent for analytical purposes showed that the cholesterol became sticky and gummy when subjected to light, heat and chemical attacks.

This is what makes cholesterol stick:

This is what make the cholesterol stick on to the tunica intima causing irritation and inflammation there, only after they are damaged by free radicals that attacks it into gummy substances. It is also the free radicals that at the same time irritates and damage the tunica intima and cause inflammation there. Got it? Thanks for understanding this chemo-pathophysiology. Hope you learn something new today from my night long till dawn effort in writing this comment.

Cholesterol is inert:

This is what the Cardiac Surgeon Dr Dwight the author of the attached letter circulated to me firmly believes. He was absolutely right about the inflammation and not the athermanous plaques (atheroma) which all the other medical experts – cardiologist, nutritionists, pathologists, and medical researchers erroneous are talking about.

A lot of people do not understand cholesterol is harmless per sec until its chemical properties are damaged by chemical agents to make them sticky and gummy as to stick on to the inner blood vessels like a leech. This damage is obviously more extensive and intensive the higher the content of cholesterol in the blood. The lesser the amount, the lesser the damage occur. This explains why higher blood cholesterol levels carry a higher risk of CAD, irrespective whether it is the high or low density lipoproteins.

Cholesterol is important for health:

Furthermore, a lot of people think that cholesterol is nothing but harmful to health. They just lack the knowledge of biochemistry and physiology. They don’t understand that cholesterol is absolutely essential for good health. It is used by the body to manufacture steroids, or cortisone-like hormones, including the sex hormones. These hormones include testosterone, estrogen and cortisone. Combined, these hormones control a myriad of bodily functions. They don’t realize that cholesterol helps the liver produce bile acids. These acids are essential for digestion of fats and ridding the body of waste besides acting as a cell to cell interconnects "lipid molecules". A lipid molecule is needed to stabilize our cell membranes. Without cholesterol the endocrine system malfunctions. Too low a cholesterol level may also cause mental disorders.

Furthermore, cholesterol is an important part of the myelin sheath in a neuron. It consists of fat-containing cells that insulate the axon from electrical activity. This ensures our brain functions properly by insulating the electrical impulses. The brain is the richest in cholesterol and without the cholesterol there, our brain would fail to focus with lost of memory. Cholesterol also has lots of beneficial effects on the human body immune system.

Cholesterol turn over:

In fact a developing brain in a foetus has the highest content of cholesterol. If cholesterol is so harmful to health, none of us would have emerged alive after intrauterine life. In the foetus itself the extremely high cholesterol content would have long clogged up all our blood vessels even before we could emerge from our mother’s womb. But did we all die inside the womb? Of course not, unless it was a pre-natal disorder. In foetal life the cholesterol is new and fresh and has not been chemically damage yet. In later life the cholesterol ages, and suffers chemical, oxidative, and free radical damage such as singlet-oxygen damage, and they then becomes sticky and gummy.

That is when they begin to stick on to the blood vessels more and more when we get older and older. Got this message? Thank you for being my obedient student.

Endogenous and exogenous feedback mechanisms:

So all these are chronic ideas people have about cholesterol. They don’t even realize that the liver can manufacture 10 times more cholesterol to meet body’s need, than all the cholesterol we can eat through food – brain, eggs, liver, etc we can eat in a day. There is a feedback mechanism in the body between endogenous (produced by the body) cholesterol and exogenous (outside the body through food) to keep that balance and stabilization of cholesterol in the blood. They also don’t realize that some 1500 -3000 mg of cholesterol is excreted by the bile daily to keep the balance in check. All these mechanisms become operative because the body needs the cholesterol and it has to stabilize its level.

The blind parrot imitates:

People are just ignorant about all these physiological homeostasis inside the body, and throw away all the food that has cholesterol in them such as egg yolk which together with the white of egg is the world’s most nutritious food because the entire chick has to depend entirely on it as its only and sole food and nourishment until the chick can come out from the empty shell.

The egg to the growing chick inside is like milk to a baby. So people who have no clue on nutrition, throw away the best part of the egg – the yolk, and eat only the albumin (white of egg) which is the ‘worse’ part with low biological value and chemical score.
Throwing away the yolk, and eating only the white of egg is like exchanging gold (yellow colour of yolk) for silver (white colour like the albumin). All their knowledge is skewed up including cholesterol which they thought is the cause of heart disease. Luckily we have Dr Dwight who wrote the attached article to come to our rescue – but unfortunately his thesis is also half-cooked that can only earn him far higher than a PhD degree - a D.Sc. degree but not yet a Nobel Prize in Medicine or Physiology. I hope I can complete the other half for him.
The heart surgeon who became a nutritionist…but one step short:

But Dr Dwight albeit right in one eye, but he was completely blind and ignorant in the other eye. He wrote a lengthy blame on unsaturated fats and oils including omega 6 vegetable oils, soybean oils, corn oils as the culprits which of course is against the understanding of mainstream orthodox medicine and nutrition. But not a single word did he mention about free radicals which is the mainstay aetiology of all degenerative diseases including cardiovascular diseases today.

Do you know why? He is a cardiothoracic and vascular surgeon one half but not a professional chemist the missing half. So I do not blame him if he only has mono-training in one area of medical science. He needs an eye implant and an extra pair of spectacles.

The emperor without clothes and the sharp-eye eagle:

This holistic vision can only be seen by a sharp-eyed eagle that can soar high up into the air to have a 3-D vision of the panorama below it. Else he will just concentrate on diet and nutrition and thinks that food is the only thing is the only answer in life about health.

The rest of the old-fashioned thinkers are even worse. They just follow one another blindly and repeat some ideology like parrots; else if they deviate even slightly from the standard thinking, the rest of the other fools will laugh at him and say he is mad without stopping to think critically. You may call me mad if you like.

Sorry…

Sorry Dr Dwight. You need to have a degree in chemistry also specializing on free radicals and understand their role in internal medicine and nutrition This will help you to change your thesis. You thesis currently is new and original, and running counter current with orthodox consensus, but you need to upgrade it from a PhD to a D.Sc. thesis, if possible a Nobel Prize winning Award in Medicine or Physiology. A holistic education will do this job.

But you need an extra degree:

I am a compulsive writer who likes to explain in fine details, but unfortunately that’s all the time I have for this very brief comment for the cardiothoracic surgeon-nutritionist. Maybe when Dr Dwight goes back to the university to read for another degree in chemistry, he will come out with his revised version of his theory just like mine here.

Thanks Professor Dato:

Thanks a lot Dato Dr Vincent Ng. I appreciate the tens of hundreds of e-mail articles you have been sending me over the last 2-3 years. When shall we have a hearty crab and prawn dinner together? Don’t worry about the cholesterol inside. I will be beside you as your nutritionist and emergency physician in the event you went into an eventful acute myocardial infraction.

I have to close now as it is already nearly 5:30 a.m.

Yours truly,

Lim Ju Boo

http://www.diamondinterest.com.my/technicalboard.htm

Dear All,

Bravo! I did not expect such a good and lengthy response from Dr. Lim JB on this topic. I must admit that it has given me better and deeper insight into the whole subject matter. Thanks.

- Dr. Chew BH

Yg Arief Prof Dr.Lim,

Thank you for your prompt response and the lengthy explaination you have given. I really appreciate your time spent in writing such a thesis in expounding the intricacy & truth of such theory. Indeed, your exposition is most enlightening and acceptable. I believe you are right on the dot and balanced in your view. All of us are always inspired by your wisdom, knowledge and great insights. I never forget how you can give your lecture none stop for hours on end and learning mandarin within hours at your age. Wah! great genius. You deserve to be the next Noble Price holder. Keep up the good work. God

Bless.

With kind regards,
Dato Dr Vincent Ng

Wow Dr J B Lim,

Incredible write-up that was a joy to read! I learned a lot of new things at the end of your so-called “brief” article.

I admire your holistic approach to subjects such as these, and it is true that only by holistic study via macro view and micro scrutiny that you get closer to the truth. But I must say, there is still one area that you lack. And that is the unscientific aspect of spirituality – the area of life where there are no logical explanations for unfathomable events that take place. This would certainly include the subject of visualization, actualization, materialization, mentalism, mind over matter, and such. But i do not know if your highly scientific and analytical acumen to look at things in such fine detail can stomach something as intangible as the spirit and the ether, from which there are no hard solid evidence but only empirical observations and data for consideration.

Dr Deepak Chopra wrote a very good book on heart disease from a spiritual standpoint that I have actually benefited from. However, science often will not tolerate opinions that do not have measurable data and facts to rely upon. I believe that ethereal energy is always there, whether we can see it or not. Sometimes the potential for it to be there requires human intervention, and at other times, it has always been there, just not so visible to the naked eye. Like Uranus before its discovery, and the invention of a telescope powerful enough to bring it closer to us in the 18th century. But it has always been there. Man just needed to make a machine to bring the un-see-able into reality. I believe the same is with energy. Man just needs to create a contraption to measure this. But i think Marcel Vogel who was originally with IBM came rather close with his Omega V machine, before he died almost 20 years ago. You can read him up by googling “the legacy of Marcel Vogel”.

In the meantime, do continue to write your thesis. You must be very patient to stay up so late (or early rather!) to finish it. At least you know, some 34-year-old who plays the violin, will be keen to read every word of it, and i hope that makes your effort all the more worthwhile.

To more ramblings!

- Hainanese Buy