Have you ever wondered if there’s a natural way to lower your high blood pressure, guard against Alzheimer's, lose weight, and feel better? Well as it turns out there is. Michael Greger, M.D. FACLM, founder of NutritionFacts.org, and author of the instant New York Times bestseller “How Not to Die” celebrates evidence-based nutrition to add years to our life and life to our years.

New Research on Cholesterol

Cholesterol is a vital component of our cells, which is why our body makes all that we need…until our diet gets in the way.

This episode features audio from How Do We Know that Cholesterol Causes Heart Disease?The Best Food for High Cholesterol, and Amla vs. Drugs for Cholesterol, Inflammation, & Blood-Thinning. Visit the video pages for all sources and doctor’s notes related to this podcast.

Discuss

 

Isn’t it crazy to think of all the different kinds of foods so many of us eat every day? Chips, cookies, burgers, fries. Our bodies dutifully process whatever it is we choose to swallow – regardless of whether or not what we eat could actually harm us or shorten our lives.  Our bodies are amazing as they try and pull out nutrients while trying to protect us from all the garbage.  So – maybe – just maybe – we should try and give our bodies a break. 

I’m Dr. Michael Greger and you’re listening to the Nutrition Facts podcast.  I’m here to tell you that nutrition matters.  We could choose a diet proven to not only prevent and treat but reverse our #1 killer, heart disease, along with other deadly diseases such as type 2 diabetes and high blood pressure. But many of us – don’t make that choice. 

Our goal today is to help you make that choice – and present you with the results of the latest in peer-reviewed nutrition and health research, presented in a way that’s easy to understand.

Cholesterol is a vital component of our cells, which is why our body makes all that we need.  For most Americans eating a conventional diet, cholesterol-laden plaque accumulates inside the coronary arteries that feed our heart muscle. This plaque buildup, known as atherosclerosis, is the hardening of the arteries by pockets of cholesterol-rich fatty material that builds up beneath the inner linings of our blood vessels. This process seems to occur over decades, slowly bulging into the space inside the arteries, narrowing the path for blood to flow.

So – knowing that – what would happen if you randomized babies at birth to a lifetime of low cholesterol levels? Nature did it for us! In this video, I introduce the concept of Mendelian randomization.

“It is well accepted that coronary atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before [symptoms arise]. However, the average age in cholesterol-lowering drug trials is 63, and therefore, people “had already been exposed to a lifetime of circulating LDL-[cholesterol].” So, no wonder pharmaceutical “therapies…typically [reduce] cardiovascular disease risk by [only] 20% to 30%.”

We know LDL, so-called bad cholesterol, plays “a central role…in the initiation, development, and progression” of our #1 killer. Over a hundred prospective studies involving more than a million people have demonstrated that those with higher LDL levels are at higher risk.

“It seems reasonable to assume…that if lowering [cholesterol] later in life” can help, then “keeping LDL[-C] levels low…earlier” in life may prevent our arteries from getting clogged in the first place. But, let’s not just assume.

“It would be [considered]…unethical to set up a controlled clinical trial in which young adults with elevated serum cholesterol levels were treated or not treated over their lifetime”—just like you couldn’t ethically set up a study in which half the kids are made to start smoking, to see if smoking really does cause lung cancer. That’s where observational studies come in. You can follow people who already smoke, and compare their disease rates to those that don’t.

It’s like 40 years ago, when the president of the American Heart Association tried to argue that we should all stop smoking—even though there were no randomized controlled trials. Look, those who smoke have a higher risk of heart attack; the more we smoke the higher the risk; and, after we stop, our risk drops. The same can be said for high cholesterol.

If you look at young men, aged 18 through 39, and follow them for up to 34 years, cholesterol levels, even when you’re young, predict long-term risk of heart disease and death. Men in their 20s and 30s who have a total cholesterol even just under 200, have a “substantially longer estimated life expectancy”—around four to nine years longer—than those over 240.

“Evidence from observational studies, however, [is] vulnerable to [so-called] confounding [factors].” Eating a diet plant-based enough to lower cholesterol below average may add years to our lives, regardless of what our cholesterol is. Ideally, we’d have “a long-term randomized controlled trial.”

And, nature may have actually set one up for us. Each of us, at conception, gets a random assortment of genes from our mother and our father, and some of those genes may affect our cholesterol levels. Just like there’s rare genetic mutations that result in unusually high cholesterol, there are rare genetic mutations that lead to unusually low cholesterol—providing an ideal system “to assess the consequences of low LDL cholesterol levels independent…of” confounding diet and lifestyle factors.

About 1 in 40 African Americans have a mutation that drops their LDL cholesterol from up around 130 down towards more optimal levels. Now, this group didn’t eat healthy to get there. It’s just in their genes. More than half had high blood pressure; there were lots of smokers and diabetics, yet those with genetically low LDL levels still had a “significant reduction in the incidence of [coronary heart disease]…even in the presence of [all these other] risk factors. How significant? How much less heart disease? How about 88% of heart disease gone?

The astounding finding was that the heart disease risk in these individuals was reduced by more than 80%; whereas, the same 20- to 40-point decrease in LDL from drugs only reduces risk like 30%. Makes sense, though, right? The folks with the mutation had low levels like that their whole life; they didn’t just start taking some pill when they were 60 years old.

“The magnitude of the effect of long-term exposure to lower LDL[-cholesterol] concentrations observed in each of these studies represents threefold greater reduction in the risk of [heart disease],” compared to drug treatment “started later in life.”

“Therefore, a primary prevention strategy that promotes keeping LDL[-cholesterol] levels as low as possible, beginning as early in life as possible, and sustaining those low levels of LDL[-cholesterol] throughout the whole of one’s lifetime has the potential to dramatically reduce the risk of [coronary heart disease].” And, that’s just what a healthy diet can do.

In our next story – we take a look at the amazing benefits of amla— or dried Indian gooseberries, on cholesterol.  Are they too good to be true?

“Medicinal plants are [said to be] nature’s gift to human beings to promote a disease-free healthy life”—here in reference to amla, a fruit, the Indian gooseberry, described as an “Ayurvedic wonder.” You hear a lot of that larger-than-life talk about amla coming out of Indian medical journals. Who can forget “Amla…, a wonder berry in the treatment and prevention of cancer.” Amla is so revered that you find serious scientists, at serious academic institutions, and serious peer-reviewed medical journals, making statements like this: “[E]very part of the [Indian gooseberry] plant has its unique therapeutic characteristic for the remedy of almost all the ailments…[and] can be adopted as a single bullet [against disease].” Okay, then.

I first ran across it looking at the total antioxidant content of thousands of different foods. 

I did a series of videos about it ages ago. And, to my surprise, the #1 most antioxidant-packed single whole food on the planet, on average, was amla: dried powdered Indian gooseberries, beating out the prior heavyweight champion, cloves, with, just for comparison’s sake, up to a hundred times or more antioxidants by weight than blueberries.

So, here’s this fruit that has enjoyed “a hallowed position in Ayurveda,” the ancient system of medicine in India—so hallowed it was mythologically pegged as “the first tree…in the universe.” So, for thousands of years—before we even knew what an antioxidant was—they were revering this plant that just so happens to turn out to be the most antioxidant-packed fruit on the planet Earth. Okay, you got my attention. But, I still needed to see it put to the test.

Well, indigenous tribal healers used amla to treat diabetes. So, researchers decided to give it a try. In fact, the subject of one of my first Nutrition Facts videos of all time, over five years ago: the effect of amla fruit on the blood sugars and cholesterol levels of normal subjects and type 2 diabetic patients. In my video, I talked about the jaw-dropping effects of five cents’ worth of this powdered fruit— five pennies’ worth—compared to a diabetes drug. But, what about the cholesterol effects?

If you take healthy individuals and give them a placebo sugar pill, nothing much happens to their cholesterol. Ideally, we want our total cholesterol under 150. This was a pretty healthy group; the average cholesterol in the U.S. is over 200, which is where the diabetics started out in this study. And, when you give them placebo pills, nothing much happens either. But, give people just about a half-teaspoon of amla powder a day—not some extract or something, just dried Indian gooseberries, a powdered fruit–absolutely astounding!  That’s the kind of thing we see like six months after putting people on statin drugs.

What we care about most is LDL, the so-called bad cholesterol, shooting for under at least 70, ideally. No impact of the placebos, but again, just about a half-teaspoon of amla, which would cost you about five cents a day.  That’s why I was so excited, after all these years, to dig back into the amla literature to see if these findings had been confirmed or replicated elsewhere. So, I typed amla into PubMed, and waded through all the papers on using amla to decrease methane in cow farts, and speed the growth of chickens, or hey, what about amla ice cream? After all, amla is packed with fiber and phytonutrients. In contrast, ice cream is not.

And now – we put Indian gooseberry extracts to the test – against cholesterol-lowing statin drugs and the blood thinners aspirin and Plavix.

Indian gooseberries, otherwise known as amla, have been touted as everything from a cancer fighter to a “hair tonic” to a “refrigerant,” whatever that means—what, like Freon? Not to mention, a “snake venom detoxifier.” Based on what kind of research?

Yes, “[d]ietary intake of [both turmeric and amla] increases the lifespan [of fruit flies].” But, do we really care about the effects of amla on the lifespan, or the “sexual behavior” for that matter, of fruit flies? How do you even study the sexual behavior of fruit flies? Why, obviously, you just introduce “a virgin female and [a] bachelor male…into an “Elens-Wattiaux mating chamber.” Can you imagine having an insect-mating chamber named after you? Then, it’s just a matter of getting out a stopwatch. Twenty minutes is the average duration, but almost a half-hour on amla, the studly beast, and it dropped the mating latency, the time between when they were introduced to one another in the chamber, and when they started getting busy from ten down to seven…seconds! They don’t mess around. Well, actually, they do mess around—and quite rapidly.  And, on amla, they lay more eggs, and more hatch into larvae. But, just like when you hear amla is “the best medicine to increase…lifespan,” you’re probably not thinking about flies. When you read about amla may be a “potent aphrodisiac”, you’re probably not thinking, “More maggots!”

They found extraordinary improvements in total cholesterol and LDL cholesterol—in actual humans, but that was compared to placebo. What about compared to simvastatin, a leading cholesterol-lowering drug, sold as Zocor? Treatment with the drug “produced significant reduction[s]” in cholesterol, as one would expect. But, so did the amla. In fact, you could hardly tell which was which. Now note, this was only about a 10 to 15% drop in total and LDL cholesterol. How about versus Lipitor, the cholesterol-lowering drug known as atorvastatin? No effect of taking placebos, but significant improvements for the drug, and significant improvements for two amla doses—but again, only about 15% or so. Did they just use the juice again? No, worse; some patented extract of amla. So, instead of five cents a day, it’s 50 cents a day, and doesn’t seem to work as well.

It’s like the cancer story. “For [Indian gooseberries] to become relevant clinically,” they’re praying that “patentable derivatives [be] synthesized. Without the possibility of patents, the pharmaceutical industry [isn’t going to] invest” in the research; their shareholders wouldn’t let them. It’s patents over patients. But, without that research, how can we ever prove its worth—or worthlessness, for that matter?

So, drug and supplement industry interest in patenting natural food product remedies is a double-edged sword. Without it, there would never have been this study—showing not only benefits for cholesterol, but also arterial function: reducing artery stiffness in the two amla-extract groups and the drug group, but not placebo, as well as a dramatic drop in inflammation; C-reactive protein levels cut in half.

So, amla—or at least amla extracts—”may be a good therapeutic alternative to statins in diabetic patients with [artery] dysfunction because it has [many of] the beneficial effects of the statins but without the well-known [potential] adverse [side-]effects of [the drugs]”—including muscle damage or liver dysfunction.

The amla extract was also compared to the blood-thinning drugs, aspirin and Plavix, often prescribed after heart attacks, and achieved about three-quarters of the same platelet aggregation-inhibiting effect as the drugs; significantly increasing the “bleeding and clotting time,” where they poke you with a needle, and see how many seconds it takes you to stop dripping. So, that’s actually a good thing, if you have a stent or something that you don’t want to clog up. But, it didn’t thin the blood outside the normal range, and so it may not unduly raise the risk of major bleeding.

It also appears to decrease the effects of stress on the heart. They had people plunge their hand into ice water, and keep it there until the pain became “unbearable.” This causes your arteries to constrict and your blood pressure to go up—but not as much if you’re taking amla extract. Good to know for your next ice bucket challenge.

To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.

Be sure to also check out my new How Not to Die Cookbook, beautifully designed, with more than 100 recipes for delicious, life-saving, plant-based meals, snacks, and beverages.  And, like all my books, DVDs, and speaking engagements, all the proceeds I receive are donated to charity. 

NutritionFacts.org is a nonprofit, science-based public service, where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles.

Everything on the website is free. There are no ads, no corporate sponsorship. It’s strictly non-commercial. I’m not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.

Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.

This is just an approximation of the audio content, contributed by Allyson Burnett.

 

11 responses to “New Research on Cholesterol

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  1. Is it possible to identify / acquire the research articles sited related to amla / cholesterol reduction and blood thinning results.

    1. Yes: you can take the references list under Dr G’s videos, copy the references, and post them into a web browser like Google Scholar, and see if there is free text or at least an abstract available. Or, you could take the references to a librarian who could get the articles for you. Or, you can do a search on PubMed for research on a certain topic, and scroll through findings for abstracts and full text articles.

      Here’s a quick PubMed search on amla: https://www.ncbi.nlm.nih.gov/pubmed/?term=amla

      -Dr Anderson, volunteer

  2. Many of us were raised on the standard American diet long before the new-ish nutrition awareness emerged. And have ancestry indicating a high risk for heart disease.

    Various of the reports over the past decade have *suggested* that dietary practices can REVERSE the accumulation of arterial plaque. High fiber, anti-inflammatory, anti-oxidants, etc. The origin of the pomegranate fad was an Australian publication claiming that patients whose atherosclerosis was so bad they were hospitalized had a reduction in plaque from 8 oz. /day of whole pomegranate juice.

    Is there any evidence of any dietary intervention reducing plaque?

  3. Hi Michael- I’m Dr Anderson, a cardiologist and volunteer here. Yes, there is. Randomized, placebo controlled trial using lifestyle intervention vs usual care showed only the intensive lifestyle group had regression of plaque by coronary catheterization. Also dramatic decrease in angina. Here: https://static1.squarespace.com/static/593c611720099e64e1bed78e/t/5984a4306f4ca38052bb98eb/1501865010781/can-lifestyle-changes-reverse-coronary-heart-disease.pdf

    Increasing numbers of my interventional cardiology (stent placing) colleagues advise a whole food, plant based diet for patents after stents as it decreases the need for future interventions. The recent past president of the American College of Cardiology, Dr Kim Williams, has said, “There are two kinds of cardiologists. Vegans and those who haven’t read the data.” (We’d specify, “whole food plant based” rather than vegan, but you get the picture.)

    While the study above was the first showing that only intensive lifestyle change (not bypass surgery, not stents, not usual medical care) can reverse atherosclerotic plaque, there are many additional studies corroborating this finding. Here’s a video by Dr Greger that reviews additional data on this topic. His references are always included at the bottom of the video.

    I encourage skeptics to eat whole food, plant based, no oil for a month and assess their own chest pain and LDL cholesterol for themselves. They are not disappointed.

  4. To manderson,
    First, thanks for being a moderator and making a great post on this thread. I started WFPB July 1, 2017 and not looking back. My current interest is in the nut and seed contribution, if any, to the oil factor. I started with no oil and no seeds or nuts after reading up on Dr. Esselstyn’s work. Then I started adding back in nuts and seeds after reading and watching the related videos by Dr. Greger.
    Are there any studies or evidence regarding limiting nuts and seeds when trying to reverse the plaque?
    Are there recommended yard sticks for an individual not having angina that could help track the personal level of progress in the reversal effort such as ldl level, crp tests or calcium score?
    The 1990 Lifestyle study generally states that one might expect a 4 to 5% reduction over a year with intensive changes. What is the current expectation of reduction with intensive or just WFPB for one year and perhaps each year thereafter?
    The canary in the coal mine between my legs would like to know…

    1. Hi there. I’m another one of the nutritionfacts.org moderators. Congratulations on making the change to a healthy diet. As far as the nuts and seeds, I really do think the newest research shows that nuts and seeds do not cause disease. I believe Dr. Esselstyn’s work (who I love) was a little earlier. I’ve watched some of his talks on youtube and he was asked about nuts a few times and he basically said it’s not that he thinks seeds and nuts are bad in and of themselves, but he was concerned if he told his patients they could eat nuts, they would hear that and eat any and all nuts- including ones cooked in oil and coated with salt and sugar.
      I think the newest research has shown nuts only have benefit in preventing heart disease:
      https://nutritionfacts.org/video/walnuts-and-artery-function/
      https://nutritionfacts.org/video/four-nuts-once-a-month/
      https://nutritionfacts.org/video/predimed-does-eating-nuts-prevent-strokes/

      LDL is probably the best measure for your risk of heart disease. Elevated CRP is very concerning, but we want to know our risk before this is elevated. This is a much later sign.

      I know Dr. Essylstyn says you can make yourself “heart attack proof” after just weeks on a plant based diet by strengthening the “cap” over the plaque in your arteries preventing it from rupturing and causing a heart attack.
      You might like these videos if you haven’t seen them yet:
      https://nutritionfacts.org/video/heart-disease-starts-in-childhood/
      https://nutritionfacts.org/video/how-not-to-die-from-heart-disease/

      And speaking of erectile dysfunction, “Men eating pistachio nuts experienced a significant improvement in blood flow through the penis accompanied by significantly firmer erections in just three weeks”. Here is some more great info on E.D.
      https://nutritionfacts.org/video/pistachio-nuts-for-erectile-dysfunction/
      https://nutritionfacts.org/video/survival-of-the-firmest-erectile-dysfunction-and-death/
      https://nutritionfacts.org/video/saffron-for-erectile-dysfunction/
      https://nutritionfacts.org/video/50-shades-of-greens/

      NurseKelly

  5. After being on the wfpb diet for one year, my husband’s cholesterol numbers including triglyceroids have spiked to all time highs. Any insight into why?

  6. Hi Dr. Greger,
    Thank you for making this podcast. You contributed in convincing me to change to a plant based diet.
    All the best!
    An 8h/day desk sitting biped.

  7. Hi,
    Interested to know whether people at nutrition facts ever run the tests to determine if they have any signs of blocked arteries while on WFPB diet.

    Would be interesting to see anonymized data perhaps?

    Thanks for the great website.

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