The Prudent Heart Diet and Cholesterol Lowering Drugs: Why They Don't Prevent Heart Disease
by Wayne Martin

     I cannot turn on the TV without seeing an ad for a drug to reduce serum cholesterol in order to reduce the risk of having a heart attack caused by myocardial infarction (MI). I wonder if these ads may be fostering cancer in an attempt to prevent MI.... Let us look at two studies that suggest that these drugs may be causing cancer.

Trading Heart Attacks for Cancer?
     The first study to suggest that lowering cholesterol may be causing cancer was by A.E. Dugdale of the University of Queensland in Australia and was reported in The Lancet in the January 17, 1987 issue pp 155-6. He did a study of the population of all of Australia as of 1986. His conclusion was that lowering cholesterol in a population would result in a slight decrease in total deaths but that the effect for the most part would be trading heart disease deaths for cancer deaths. For the fifth of the population with the lowest cholesterol, deaths per 100,000 per year were from cancer, 34.0 and heart disease 33.0. For the fifth of the population having the highest cholesterol, the results were death from cancer 19.4 and from heart disease 61.0.

     So in this study, lowering cholesterol was a matter of trading deaths from heart attacks for cancer deaths. Dugdale was interested in the cost of medical treatment. He said if it were possible to reduce cholesterol in a population by 10%, it would result in a great increase in the cost of medical treatment as it will cost so much more to treat cancer than to treat heart disease.

     One may wish to brush the Dugdale study aside, however it was soon to receive confirmation in a more exact study. This study was reported in the April 8,1989 issue of BMJ pp 920-24 by Christopher Isles et al. of the Western Infirmary in Glasgow, Scotland, "Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey.”

     Between 1972 and 1976, 7,053 of the men and 8,546 of the women in these two small cities in Scotland were tested for cholesterol. By 1986 there had been among the subjects tested, deaths of 1,102 women and 1,609 men. While in the Dugdale study there had been a slight decrease in the death rate among the subjects with the lowest cholesterol, in the Renfrew and Paisley study there was no difference in survival between the subjects with the lowest cholesterol and the highest cholesterol. In this study it was a matter of the individuals with the highest cholesterol having more deaths from heart disease that was exactly matched by more cancer deaths in those with the lowest cholesterol.

     Cardiologists, in their present war on cholesterol, seem to have lost sight of the fact that there were very few deaths from MI in England in 1900 and one would presume in the USA also. That the English population was almost free from MI deaths in 1900 has been established both by Rodney Finlayson in his report in Medical History Supplement No. 5 1985 pp. 141-168 and A.U. Mackinnon in the Journal of the Royal College of General Practitioners for April 1987 pp. 174-76. Both of these doctors examined hospital records back to 1868. What they found was that in the period of 1868 to 1900 there were almost no deaths from MI. The fats in diet then were butter and lard. No one was thinking about cholesterol but we know what was in diet then and cholesterol must have been in the 200 to 250 mg % range.

     They had both found a ten-fold increase in MI deaths by 1910 and they both felt that this was the result of cigarette smoking as machine made cigarettes had come on the market and 80% of men were smoking them. They both found an 80-fold increase in MI deaths by 1980.

     There was however no knowledge or understanding of this new disease before 1925. Often during an episode of MI one will suffer stomach distress and vomit. When this happened death was said to be due to acute indigestion. It was not until 1925 that it was understood that there was an entirely new disease to be dealt with that involved the heart and not the stomach.

     The first report on this new dread disease was by J.W. McNee of the Johns Hopkins Hospital and reported in the Quarterly Journal of Medicine, vol. XIX 1925, pp. 44-52. It was said that this new disease was caused by a blood clot in a coronary artery.

     This was quickly followed by two reports from England by George Gibbon of the Radcliffe Infirmary at Oxford in The Lancet, 1925 i pp. 1270-9 and by Cary Coombs and Geoffrey Hadfield of the Bristol General Hospital and reported in The Lancet for Jan. 2, 1926. This was followed by an editorial in The Lancet for Jan., 9, 1926 with the title "The Effects of Coronary Occlusion.” By this time it was understood that there would be an infarction of the myocardium following a coronary blood clot and that this new disease which by now was causing many deaths, was called coronary thrombus.

     Cholesterol had nothing to do with heart attacks until 1955. The treatment for this new disease in 1926 was to put the patient to bed in an oxygen tent. That was the treatment or lack of treatment until 1945 when overnight patients were treated with the newly discovered warfarin. This was at long last getting at the problem of a coronary blood clot, however there was still a lack of knowledge about the nature of a blood clot. In 1945 a blood clot was made of fibrin. Warfarin would tend to prevent the formation of the fibrin thrombus, however there was little understanding then that there are two parts of a blood clot. First the platelet thrombus will form followed by the more massive fibrin thrombus. Warfarin will do nothing to prevent a platelet thrombus and a platelet thrombus by itself can cause a heart attack and death.

     Cardiologists in 1955, seemed to have forgotten that this was a new disease discovered in 1925. They seem to have lacked the knowledge that in 1900 there were almost no deaths from this new disease and that in 1900 the fats in diet in England and the USA were the saturated fats, butter and lard. Also they seem not to know that there were almost none of the polyunsaturated vegetable fats to be had in the near MI-free days of 1900 as the oil seed industry had not yet been formed then to produce tons of the new inexpensive polyunsaturated oils and the margarines made from them.

     Nonetheless, in 1955 cardiologists decided that the saturated fats, butter and lard were BAD and the polyunsaturated vegetable oils and the margarines made from them were GOOD. They also decided that blood clots in coronary arteries had nothing to do with heart attacks. The problem was that cholesterol settled out of the blood like mud out of water, clogging the coronary arteries and causing a heart attack. As blood clots had nothing to do with the disease, the name was changed from coronary thrombosis to myocardial infarction.

The Prudent Diet
     It was learned that if the polyunsaturated fats replaced saturated fats in diet, serum cholesterol would be reduced some. Thus the Prudent Diet was born. In it the polyunsaturated fats were at least double the saturated fats and cholesterol in diet was reduced.

     The Prudent Diet was introduced to the public in 1955 as the ultimate solution to the disease myocardial infarction. It was introduced with a great deal of PR and fanfare.

     One Sunday, there was an all-day program with all the TV stations having the same program. An actor of note was the MC on the program. He introduced one after another of the doctors who had decided that cholesterol was the problem of heart attacks and the Prudent Diet was going to set everything right.

     After he had introduced all the doctors who felt that the Prudent Diet was the ultimate answer to heart attacks, he introduced Dr. Paul Dudley White, Eisenhower's cardiologist. The President had had a heart attack. The MC, with much enthusiasm, asked Dr. White to tell of all the success doctors were having in solving the problem of heart attacks.

     The MC should have talked to Dr. White before the show. Dr. White said that five years of the use of antibiotics had greatly reduced death from a heart attack caused by syphilis. He said other than that there had been a great increase in deaths from myocardial infarction. He said that he had started to practice as a cardiologist in 1921 at which time the disease was unknown. He said that he did not see his first case of then coronary thrombosis until 1931 and doctor friends traveled from afar to see a case of this new and rare kind of heart attack.

     He had with him a little dog-eared booklet with the title "A Treatise on Sudden Death.” It was written by two doctors at Oxford University in 1860. It told of two deaths which in 1955 were obviously two deaths from myocardial infarction. The point that Dr. White was making was that to these two doctors at Oxford, the cause of these two deaths was a complete mystery. Dr. White said ‘what did people eat back then' when death from myocardial infarction almost never happened, ‘but butter, lard and high cholesterol food.'

     Dr. White did nothing to deter The Prudent Diet. The low cost of these polyunsaturated fats had done much to price butter and lard out of the market, but with doctors saying that these polyunsaturated fats were going to prevent heart attacks, it was not long before lard vanished from food stores, butter occupied only a foot or so of shelf space, and the GOOD polyunsaturated fats, vegetable oils and margarines made from them occupied several feet of shelf space. The result was that the polyunsaturated fats increased in our diet three-fold. That is the situation today with respect to fats in diet. Doctors are still telling us that The Prudent Diet is right and prevents heart attacks.

     Doctors, having gotten everyone avoiding butter and lard, replacing them with these GOOD polyunsaturated fats, then set about proving that this was the thing to do.

     The first test of the Prudent Diet was the Joliffe Anticoronary Club in New York City. Dr Joliffe worked for New York City and he was a vascular wreck. He was diabetic. He was in a wheelchair. He was blind is one eye and he had a cold foot with an ulcer. He was looking to The Prudent Diet for his salvation.

     The men on The Prudent Diet were mostly teachers in colleges and universities in the city. They were dedicated to following The Prudent Diet. The controls were men of wealth on Wall Street who were found to live on a high cholesterol diet with nearly all the fat in their diet being the BAD saturated fats. Dr. Joliffe had a group of men that should have proven the expected benefit of The Prudent Diet.

     The trial ran for six years and the results were reported in JAMA in the Nov. 7, 1966 issue pp 129-134. The results were said to have been a great success proving the value of The Prudent Diet as serum cholesterol in the subjects living on The Prudent Diet had dropped to 200 mg % from 225 mg %. For about a week this was headline news, the first trial of The Prudent Diet had proved that it would prevent heart attacks. What the public was not told was that there had been eight deaths from heart attacks while living on The Prudent Diet whereas there had been no deaths from heart attacks among the controls living on the high-cholesterol, high-saturated fat diet. This was followed by the death of Dr. Joliffe. It was said that the cause of his death was due to his diabetic condition.

     Cardiologists said at once there should be a follow-on trial of The Prudent Diet involving a million men. This trial was to be called the National Diet Heart Study and it was to be run by the National Heart Institute with the US Government to spend millions of dollars on it.

     Dr. Irwine Page of the Cleveland Clinic was in charge of the trial. He had survived a heart attack. I met with him at the time that this trial was in its planning stage. He was utterly confident that The Prudent Diet was going to keep him from having another heart attack. He was also expressing his sorrow for the several thousands of men who were to be the controls who were expected to die of heart attacks. He said that he expected deaths by the thousands from heart attacks among the control group and very few such deaths among the subjects on The Prudent Diet.

     There were to be food warehouses in five cities where men on the Prudent Diet were to get free food. The polyunsaturated fat was to be furnished by polyunsaturated donuts. The men on the Prudent Diet were to get free meat from which every trace of fat had been trimmed away,

     Before they would get one million men involved, a pretrial would be done with only 2,000 men, aged 45 to 54. This trial was run for six years and the final results were published in the March 1968 issue of Circulation. There were the same number of fatal and non-fatal heart attacks in both groups of subjects, the ones on The Prudent Diet and the control group. I am not certain of the date of the death of Dr. Page but he died of a second heart attack.

     There was the expected reduction in serum cholesterol from 250 mg % to 225 mg % in the group on The Prudent Diet and one group of cardiologists claimed success for the trial and urged that the million man trial be started at once. A second group of cardiologists, having looked at all the episodes of fatal and non-fatal heart attacks among the men living on The Prudent Diet, carried the day and the million man trial was aborted "for reasons of cost.” The public heard nothing about the end of this grandiose trial. By then The Prudent Diet was engraved in stone as the way not to have a heart attack.

     In England at the same time of the National Diet Heart Study, the Medical Research Council was conducting a trial on The Prudent Diet on a group of patients who had survived a heart attack. In this trial the soft margarines used in the trials in the USA were avoided. Rather, soya oil was used as the proper polyunsaturated fat. Again serum cholesterol was reduced from 250 mg % among the controls to 225 mg % among the patients on The Prudent Diet but again there were the same number of fatal and non-fatal heart attacks in both groups – among the controls and among patients living on The Prudent Diet. This was reported in The Lancet 1968 ii p 693.

     Meanwhile there was another trial of The Prudent Diet at a Veteran's Administration Hospital in Los Angeles, California. It was being done in a hospital and as a result had much better control of diet than could be maintained in the National Diet Heart Study trial. One problem with the National Diet Heart Study was that the entire nation was living mostly on The Prudent Diet.

     This trial in California was administered by two doctors, Seymore Dayton and M.A. Pearce of the School of Medicine of the University of California at Los Angeles. It ran for eight years. At long last a trial was done on The Prudent Diet in which The Diet had reduced heart attack deaths. Of the 846 men in this trial, fatal heart attack deaths were reduced from 70 among the controls to 48 on The Prudent Diet. However the number of deaths from cancer were almost double among the men on The Prudent Diet; 31 cancer deaths among the ones on The Prudent Diet and only 17 among the controls. The authors speculated on whether The Prudent Diet had caused cancer in this trial in a report in The Lancet for March 6, 1971 pp 464-67.

     In this trial The Prudent Diet did not increase survival at all. There were two references given that more cancer resulted in minor animal studies when they were fed a diet in which 20% of the fat was polyunsaturated.

     They concluded with "We think it premature to make a blanket prescription of a diet high in polyunsaturated fat for the entire population,” however this is exactly what the medical establishment did.

     The authors of the Renfrew and Paisley study made reference to this report of Dayton and Pearce saying that the same thing had happened here as in their study, the trading of heart attack deaths for cancer deaths.

     Cardiologists, having had no luck at all in proving the benefit of The Prudent Diet, undertook to prove a benefit by a population study. Dr. Fred Stare of the Harvard University School of Public Health said that a study of Ireland as compared to Boston, USA should show the benefit of The Prudent Diet. By the mid-1960s the population of Boston and all of the USA was living on something very close to The Prudent Diet. Ireland then was a dairy nation and the market for butter was protected by restrictions on the importation of the low-cost polyunsaturated vegetable oils and margarines made from them.

     Dr. Stare noted that the average adult in Ireland had over a pound of butter a week in diet and almost none of the GOOD polyunsaturated vegetable oil or margarines in diet. If The Prudent Diet was right, everything about the Irish diet was wrong. If The Prudent Diet was right there should be far more deaths from heart attacks in Ireland.

     Dr. Stare found cases where one brother had remained in Ireland and one brother had migrated to Boston. What was found was just the opposite of what had been expected, with a substantial excess of heart attacks with the brother in Boston. All this was reported in World Review of Nutrition and Dietetics vol. 12, 1970 pp. 1-42.

     For about a week this report was big news in the American news media. Cardiologists said that the men in Ireland did much more walking and that the extra walking had prevented heart attacks even though their diet was all wrong.

The Roseto Study
     Then we had the study the population of the small city of Roseto, in Eastern Pennsylvania. This city is made up of nearly 100% Italians. In about 1882 Italians from the South of Italy had migrated from the town of Roseto Valfortore to work in the slate quarries in Eastern Pennsylvania, These were very poor people and they worked at very low pay in the quarries,

     By 1950 the third generation of these Italians were quite prosperous, working for high pay in nearby steel mills. Their women worked in blouse factories. In their new prosperity they could eat whatever they wanted.

     There had been one study showing that the population of the South of Italy had fewer deaths from heart attacks. Also local doctors had taken note that the Italians in Roseto were having fewer heart attacks than were their Pennsylvania Dutch neighbors.

     Professor Stewart Wolf then of the School of Medicine at the University of Oklahoma decided to make a detailed study of the population of Roseto. Meanwhile he had become Vice President of the School of Medicine of nearby Temple University. He had found that indeed, the population of Roseto were having one-third fewer deaths from heart attacks as were had in the nearby town of Bangor. He found that in Roseto there were no deaths from heart attacks with men under age 55, however, there were several such deaths in Bangor. In time this study was expanded to cover the nation. There were one-third fewer deaths from heart attacks in Roseto as there were in the nation as of 1961.

     Wolf, looking at the diet of these Italians, believed that if The Prudent Diet was right, what these Italians had in diet was wrong. They had a lot of high-fat meatballs and a good deal of Italian cheese with almost none of the GOOD polyunsaturated fats in diet. Wolf reported on this study in the Transactions of the American Clinical and Climatological Association vol. 85, 1973 p. 100-10.

     In the study in Ireland, it was said that their diet was all wrong but the extra walking kept the Irish from having heart attacks. These Italians were being spared having heart attacks by being "a member of a large family which reduced the stresses of life.” The Prudent Diet was still the way not to have a heart attack.

     Roseto was revisited by Wolf again in 1973 and by then there were the same number of heart attack deaths in Roseto as there were in the nation, doctors having sold the people of Roseto on The Prudent Diet.

Indian Studies
     Then there was a study in India that seems to have been ignored by cardiologists in the USA. It was by Dr. S.L. Malhotra, chief medical officer of the Western Railway System in India. His report was in The American Journal of Clinical Nutrition May 1967 pp. 462-75.

     He told of two populations in India. One was the population in and around Udaipur in the North. These people had very few heart attacks. They had more butterfat as ghee in diet than any other population in the world. They were permitted by their religion to eat meat however their main food was whole grain wheat.

     Malhotra then told of a vegetarian population in the South in and about Madras who lived on The Prudent Diet more closely than most people in the USA. Their main food was rice but they lived on a high-fat diet and nearly 100% of the fat was the GOOD polyunsaturated fats – mostly as peanut oil and the margarine made from it. There was almost none of the BAD saturated fats in their diet. They were having 15 times as many heart attacks as were the big butterfat eaters in the North.

     That was the situation in 1967. The good fortune of the population of the North of India may not have lasted long.

     In The Lancet for Nov. 14, 1987 p. 1144, Bihari Raheja of the Jaslak Hospital in Bombay reported on a vast increase in heart attacks as the low-cost polyunsaturated vegetable oils and margarines had virtually priced ghee out of the market. Then also in India, doctors may have been telling people that they should have in diet the GOOD polyunsaturated fats and be avoiding the BAD saturated fats such as butterfat.

Hard Water and Magnesium
     I had a long exchange with Dr. Henry Schroeder of Dartmouth Medical College. In 1950 he had taken note that in places with water softeners there were more deaths from heart attacks. This led him to a study of heart attacks in areas of the nation with hard and soft water. He decided to study two cities – Lincoln, Nebraska and Savannah, Georgia.

     Lincoln had very hard water, 200 ppm of magnesium. Savannah had very soft water, 50 ppm. In Savannah there was twice the death rate from heart attacks as there was in Lincoln. Water softeners remove minerals and offered less hardness than Savannah had and by 1950 over half the houses in Lincoln had water softeners. Dr. Schroeder reasoned that if he could factor out all the houses in Lincoln that had water softeners, then the population of Savannah would be having as much as four times the death rate from heart attacks as in Lincoln, in the houses with no water softeners. Dr Schroeder was stricken with cancer then and this study was never done.

     Dr. Schroeder gave the magnesium content of the water in Savannah and Lincoln and it was about five times greater in Lincoln. All the information on the great benefit to the heart of magnesium, came at a later date than 1966, the date of his report that was in JAMA for April 23, 1966 pp. 98-104. The magnesium content of hard water was no doubt preventing heart attacks in Lincoln.

     Again, the kind of heart attack called myocardial infarction which today causes over 400,000 deaths each year in the USA, was causing almost no such deaths in 1900. There were no water softeners in 1900. In view of the Schroeder report, water softeners should be looked on as being instruments of death.

Polyunsaturated Fats
     I had a long exchange with Professor Terence Anderson, first while he was at the University of Toronto and later at University of British Columbia. He looked on the disease of myocardial infarction as being muscular dystrophy of the heart. He said that corn oil (one form of the GOOD polyunsaturated fats) from which all the tocopherol antioxidants have been removed, is cardiotoxic to pigs, calves and lambs. It causes muscular dystrophy of the heart that often causes a fatal heart attack. He said in such cases of death, scattered fibrotic foci can be seen in the myocardium.

     In The Lancet for Oct. 20,1973 pp. 912-13 he reported on a study done at the University of Toronto. Hearts from men between age 40 and 59 were examined after death, ten each who had died of myocardial infarction or in an accident. All of the cases of death from myocardial infarction showed these foci, especially in the area of the left ventricle. These foci were seen in only 2 of 10 of the cases of accidental death.

     Professor Anderson suggested that this new disease of the heart had been caused by the new oil seed industry making available tons of inexpensive polyunsaturated fats from which most of the tocopherol antioxidants had been removed in refining.

     Anderson, in an article in New Scientist for Feb. 9, 1978 said that cardiologists have been concerned about too little oxygen getting to the heart causing a heart attack. He said that they should be concerned about the great harm to the heart of too much oxygen. He said that these new polyunsaturated vegetable oils and margarines made from them, from which the antioxidants have been largely removed in refining, are subjected to peroxidation and become peroxidized fat that cause these small deadly foci in the myocardium. He thinks that pathologists could find them in most cases of death from myocardial infarction if they would take the trouble to look for them.

Processed Grains
     In 1900 and before, when there were almost no deaths from myocardial infarction, bread was whole grain and had a good supply of tocopherol antioxidants. Following 1900 bread became white bread which was and is largely devoid of tocopherol antioxidants. Most of these antioxidants are in the bran which is removed in making white bread. Then the strong oxidizing agent used to bleach flour white destroys any tocopherols that are left in the flour.

     Anderson gave an example of the benefit of whole grain bread. Italy in 1919 banned the milling and bleaching of white flour as a means of reducing the importation of wheat. Italy lived on whole grain bread until 1946. During that time there was no increase in deaths from myocardial infarction in Italy whereas deaths from this cause had doubled in the USA and England as white bread had replaced whole grain bread in these nations.

     Professor Anderson has referred to the Irish Boston Brothers Study. He noted that in Ireland bread may have been white bread at the time of the study, but in Ireland oatmeal was an important item in diet and this whole grain offered a good supply of tocopherol antioxidants.

     Professor Anderson also tells of how such a simple thing as the removal of rice bran in the making of white rice caused the pandemic of beri beri that caused deaths by the millions. He says that the making of white bread and the replacing of butter and lard with the polyunsaturated vegetable oils and margarines has caused the pandemic of heart attacks that has caused deaths by the millions and is still a ca using deaths by the millions.

Aspirin as Prevention
     So we have come to 1975 and all of a sudden blood clots in coronary arteries are causing heart attacks again. This time both blood clots and cholesterol are causing heart attacks and to prevent coronary blood clots we should all take aspirin. Not long ago I went to a dermatologist to have a small skin cancer removed. His nurse told me that I must stop taking aspirin. I said ‘what makes you think that I would be taking aspirin?' It would seem that most of the patients coming to the office of this dermatologist were taking aspirin as a prevention against  having a heart attack.

     Doctors, having gotten most us taking aspirin as a prevention of heart attack, then set about proving that taking aspirin would prevent having a heart attack. The first two trials in England on aspirin showed no benefit in preventing a heart attack. The references were British Medical Journal 1974 I, p. 436 and The Lancet 1979 ii p. 1313.

     The next trial was in the USA by the National Heart Lung and Blood Institute. The US government was to spend over $16,000,000 on this trial. It was directed by Dr. Robert Levey and was reported in JAMA Feb. 1980 pp. 661-9. There was no benefit of aspirin in the prevention of heart attacks but there was a near disaster of harmful side effects, of stomach ulcer-like pain, stomach inflammation and bleeding of the stomach.

     Doctors said that if they could get a trial with doctors as subjects they could prove that aspirin would prevent heart attacks. Such a trial was done in England again with no benefit in the prevention of heart attacks by aspirin, R. Peto et al. British Medical Journal 1988 vol. 296 pp. 313-6.

     However a test of doctors taking aspirin in the USA was said to be of the greatest success. This trial was suddenly stopped because the success of aspirin was so great that "all doctors in the trial” should be taking aspirin at once. The results were not all that great. There was no reduction in fatal heart attacks and survival was not increased. What was good about this trial was that aspirin resulted in a 40% reduction of non-fatal heart attacks.

     James Landauer of the Electrolyte Laboratories in Denver commented on this trial in the New England Journal of Medicine vol. 318, p. 925. He said that Bufferin was used as aspirin in this trial and Bufferin contains aspirin and some magnesium. Landauer listed the benefits to the heart of magnesium. He gave two references to fewer heart attacks in areas of hard water. He did not mention the Schroeder study in so doing. He said that magnesium, in a powerful way, will reduce platelet adhesion which is what aspirin is said to do. Magnesium acts as anticoagulant, it prolongs bleeding time. It is a powerful vasodilator, it increases prostacyclin whereas aspirin inhibits this most beneficial prostaglandin. It is a natural calcium antagonist with the potency of verapamil. It is a potent arrhythmic agent.

     So we now have most of our population living on the polyunsaturated fats in The Prudent Diet and we have a great many people taking aspirin, and we still have in excess of 400,000 deaths a year from heart attacks whereas in 1900 we had almost no such deaths.

     All of the aspirin trials led to no reduction in heart attack deaths. A trial of 500 mg a day of magnesium as the citrate could lead to a very substantial reduction in heart attack deaths.

     It is worth mention at this time that a study done by Mathew Gillman M.D. et al. of the Harvard Medical School, published in JAMA for Dec. 24, 1987 pp. 2145-50 showed that a diet high in polyunsaturated fats was associated with an increased risk of thrombotic stroke as compared to a diet high in saturated fat.

The Role of Antioxidants
     Next we will return to the benefit of antioxidants in the prevention of heart attacks, as suggested by Professor Anderson. He had suggested that the removal of tocopherol antioxidants from diet had played a large part in the pandemic of heart attacks.

     In The Lancet for March 23, 1996 pp. 721-86 is a report by Dr. M.J. Mitchinson et al. of the Cambridge Heart Antioxidant Study (CHAOS). Patients who had survived a heart attack were given either 400iu or 8O0iu of natural vitamin E a day and followed for 510 days. There were 2002 patients in this trial of which there were 1035 given vitamin E. There were two results. One was that there were 41 non-fatal heart attacks among the patients not taking vitamin E and only 14 among the ones taking vitamin E. This was a reduction of 77% in non-fatal heart attacks. There were 27 fatal heart attacks among the patients taking vitamin E and 23 such deaths among the ones not taking vitamin E.

     By 1996, the time of the CHAOS trial, cholesterol no longer settled out of the blood like mud out of water, clogging the coronary arteries. Rather, some cardiologists felt that there is very little cholesterol in the atheroma that blocks coronary arteries. Rather, atheroma in now made up of proliferating smooth muscle cells. This is explained in an article in Science for July 1994 p. 320.

     Here we read how much human atheroma is made up of non-invasive neoplastic smooth muscle cells. This reports tells of a vast increase in these cancer-like cells in a coronary artery following the opening of a blocked coronary artery by angioplasty. It is said that this neoplastic process is held in check by the p53 gene. This gene prevents the cytomegalovirus from causing the neoplastic growth of smooth muscle cells. What is happening is that the trauma of the angioplasty deactivates the p53 gene, permitting the cytomegalovirus to cause a rapid growth of smooth muscle cells. It may be presumed that the formation of atheroma occurs by the same process but much more slowly when there is no angioplasty.

     Back to the CHAOS trial, the doctors who ran the trial presumed that the harm due to cholesterol was due to that portion called low density lipoprotein, LDL. When LDL is oxidized it causes great damage to the coronary arteries. Antioxidants in blood will tend to prevent this oxidation and the doctors conducting the CHAOS trial presumed that if LDL in not oxidized, it may not be harmful.

     The medical establishment looked at the slightly increased number of fatal heart attacks among the patients who were taking vitamin E and concluded that vitamin E was cardiotoxic and should not be taken to prevent a heart attack. Dr. Mitchinson, answering for the CHAOS doctor group, had this reply. He said that the people who died of a heart attack had hearts so badly damaged that they could not be saved by any means. He said that the time to take vitamin E is before one has had a heart attack and in so doing it held the possibility of enormous benefit in the prevention of heart attacks. He was championing a lost cause. There is not one orthodox cardiologist in a thousand who tells patients to take vitamin E to prevent a heart attack.

     Back to the subject of the proliferating of smooth muscle cells blocking coronary arteries – some cardiologists are thinking of treating the blockage as if they were treating cancer – with high-dose radiation pellets implanted in coronary arteries.

     It has been a long time since cholesterol was blocking coronary arteries.

The French Paradox
     There is more on antioxidants in the prevention of heart attacks. There was the South of France-Scotland study reported in The Lancet for June 20, 1992 p. 1423-6. Both of these populations had the same total cholesterol of about 230 mg % and the people in the South of France lived on a diet somewhat removed from The Prudent Diet. They liked butter in their diet. The population of Scotland had five times the death rate from heart attacks in men and eleven times greater in women as compared to the death rate from heart attacks in the South of France.

     The difference was thought to be caused by the people in the South of France consuming about 500 cc of French wine a day which contained about 100 mg of the flavonoid antioxidant quercetin. It has been suggested that drinking the same amount of grape juice may have the same benefit in the prevention of heart attacks.

     Then there was the ten-year study of older men in the city of Zutphen in the Netherlands. Here the men who had less than 10 mg of quercetin in diet were having twice the death rate from heart attacks compared to the ones with over 30 mg of quercetin a day in diet. This study looked at the drinkers of black tea as compared to the coffee drinkers. Black tea contains quercetin whereas coffee has very little of it. It would seem that flavonoid antioxidants are just as effective as the tocopherols in the prevention of heart attacks,

     Now a report on a population free from death from myocardial infarction as late as 1960. Reference is made to a report in the American Journal of Cardiology for Jan. 1960 pp. 41-7 by Wilber Thomas et al.

     This study was undertaken with the knowledge that death from myocardial infarction was almost non-existent among the natives of Uganda. They were grain vegetarians living on a whole grain diet mostly of boiled millet and corn.

     In this study the hearts of 1,427 men and women were examined following death from any cause in Uganda, There was only one slight and well-healed infarction found among them. A larger number of hearts were examined of men and women who had died from any cause in St. Louis USA, both whites and Blacks. Among them were found many infarctions and signs of death from heart attacks. This study confirmed that the people in Uganda had no deaths from myocardial infarction.

     It was of interest to note that the degree of atheroma was very close to the same in the population of Uganda and St. Louis. What was greatly different in these two populations was in coronary blood clots, there being almost none in the Ugandan sample and many in the St. Louis sample.

     It has been suggested that the population of Uganda had so short a lifespan that little could be told from a study of them. In this trial the average age of deaths of the Ugandans was 55. That of the subjects in St. Louis was 65.

     In the whole grain diet of the population in Uganda there was a great amount of tocopherol antioxidants. There were also only about eight grams a day of the polyunsaturated fats as compared to about 40 grams of people living on The Prudent Diet.

Iron Overload
     There was also only about 20% of the iron that is in the typical diet in the USA. The low iron content of the Ugandan diet may have had much to do with their freedom from heart attacks. Dr. Jerome Sullivan of the South Florida College of Medicine had a report in The Lancet for June 13, 1981 pp. 1293-1300 with the title of "Iron and the Sex Difference in Heart Disease Risk.” He said that in our population with a high meat diet we develop excess body iron stores which are cardiotoxic causing heart attacks. He says that this iron overload on a small scale is like what happens in thalassaemia major. A kind of fibrosis of the heart develops and tends to set off arrhythmias. This condition does not develop in premenopausal women in the USA. They have the same freedom from myocardial infarction as did men in Uganda.

     Dr. Sullivan says that while women here have much more iron from our high meat diet, premenopausal women lose iron in menstruation. This loss of iron protects them from having a heart attack. However, he says that once they become postmenopausal in the USA, they develop excess body iron stores and become just as at risk of heart attack as are men here.

     Dr. Sullivan says that our men could gain a great reduction in the risk of having a heart attack by giving three blood donations a year. The same protection could be had by post-menopausal women.

     The natives of Uganda may have had in their diet another protection against heart attacks. I had an exchange with Professor R.G. MacFarlane in 1960. He was Professor of Hematology at the Radcliffe Infirmary at the University of Oxford. In 1947 he discovered that soya protease inhibitor acts like warfarin in preventing the formation of the fibrin portion of a blood clot. He commented on this report of no heart attacks among the Ugandan natives. He said that the whole grains that made up most of their diet had a good amount of protease inhibitors in them that were preventing coronary thrombosis in this population. Reference to his work was published in the Journal of Physiology 1947, vol. 106 p. 104.

     He said that any population living mostly on whole grain would have protease inhibitors in diet that would be acting in the prevention of heart attacks. He also said that the tocopherols in the Ugandan diet was helpful in the prevention of heart attacks as was the low iron in their diet, but he held that the protease inhibitors in their diet was a more important factor in their not having heart attacks.

Coenzyme Q10
     I had a friendship with Professor Karl Folkers from 1969 until his death in 1989. In 1948 while working for Merck he discovered vitamin B12 and learned how to make it synthetically. Merck sold it as hypodermic injections worldwide, putting an end to death from pernicious anemia thus saving over 20,000 lives a year.

     From 1960 until his death in 1998 at the University of Texas he worked on Coenzyme Q10, finding that it is life-saving in many ways. I write of his work on Coenzyme Q10 with a bit of sadness. There can be no patent had on Coenzyme Q10 and as a result no major drug firm has been selling it. Notwithstanding all the benefits of it in medicine, the orthodox medical establishment makes no use of it.

     First Folkers found that we make some Coenzyme Q10 and that it's important to the process of life. It is perhaps the most potent antioxidant known. With late onset muscular dystrophy, it will delay the progression and give the patients many extra years of life. A small trial at the University of Texas on treating patients with AIDS showed some benefit. There was a trial on it in treating breast cancer in Denmark that produced a few remarkable remissions. There has been a trial on Coenzyme Q10 on treating hormone refractory prostate cancer that has shown remarkable success. However, it is in the field of congestive heart disease that it has been outstanding. Dr. Peter Langsjoen, cardiologist at the University of Texas has this to say of it in the treatment of heart failure: "The clinical experience with Coenzyme Q10 in heart failure has been nothing short of dramatic and it is reasonable to believe that the entire field of medicine should be reevaluated in light of this growing knowledge.”

     There are good indications that Coenzyme Q10 can be of great help in treating all forms of heart disease yet there is not one cardiologist in a thousand who will tell a patient with heart disease to take Coenzyme Q10.

     At the very least if they will not tell patients with heart disease to take Coenzyme Q10, they should do nothing to inhibit the Coenzyme Q10 that we make ourselves. In the July issue of the Townsend Letter for Doctors and Patients, there are excerpts from a new book with the title of Brain Recovery by David Perlmutter, MD on treating Parkinson's disease. He tells of some outstanding success in so doing.

     One of the treatments among many are 120mg of Coenzyme Q10 a day. He says that two drugs in common use cause a dramatic lowering of the level of Coenzyme Q10 in serum. They are pravastatin (Pravachol) and lovastatin (Mevacor) that are given to lower cholesterol. We have mentioned lowering cholesterol may be trading heart attacks for cancer. Now here we see these drugs that are used to lower cholesterol, are depriving us of highly beneficial Coenzyme Q10.

     While Dr. Perlmutter was writing about Parkinson's disease he said that Coenzyme Q10 is of benefit in general to the aging brain.

     Before renal transplants were done it was thought by most doctors that it took many years for a cancer to develop. When renal transplants were first done it was found that a transplant patient had to be treated with immunosuppressive drugs to prevent the rejection of the transplant. Doctors were astounded at how fast cancer developed in these immunosuppressed patients. Some cancers they found were occurring up to twenty times more than what had been expected.

Polyunsaturated Fats Cause Immunosuppression
     In The Lancet for March 19, 1977, p. 654, Dr. E.A. Newholme of the Department of Biochemistry, the University of Oxford had a report with the title "Mechanism for Starvation Suppression and Refeeding Activation of Infection.” He said that polyunsaturated (GOOD) fats are highly immunosuppressive. He said that in conditions of starvation the body's store of polyunsaturated fats is depleted. There is no longer the immunosuppression of polyunsaturated fats and one recovers from an infection. On eating more food, the body's store of polyunsaturated fat is increased with the result of the new immunosuppression reactivating the infection.

     This immunosuppression mechanism of polyunsaturated fats, he has told us, could make them highly beneficial in treating autoimmune diseases. He said that they are well suited as a means of immunosuppression in renal transplants, P.R. Uldall et al., The Lancet 1974 ii. 514, Polyunsaturated fats have been found beneficial in treating multiple sclerosis where immunosuppression is needed. J.H.D. Miller et al., British Medical Journal 1973 i 765.

     Later in The Lancet for March 18, 1978 pp. 583-5. Dr. Newsholme and Dr. B.D. Bower of the Radcliffe Infirmary at Oxford told of treating two small children who were severely disabled with Guillan-Barré syndrome with 30 cc a day of a polyunsaturated fat (sunflower-seed oil). All known immunosuppressive drugs had failed in these two cases. One of the patients was Dr. Newsholme's daughter. Both children made a complete recovery in one year on treatment with sunflower-seed oil as a monotherapy.

     Dr. Newsholme never made mention of the immunosuppression of the polyunsaturated fats as causing cancer.

     It is suggested that the immunosuppression of polyunsaturated fats may have, since 1930, caused a vast increase in lung cancer deaths. In 1930 in the USA 80% of men smoked cigarettes. In 1930 there was very little lung cancer in the USA. Cigarette smoking was causing very little lung cancer then. By 1978 less than 40% of men were smoking cigarettes, but by 1978 the death rate from lung cancer had increased by a vast 30-fold. The reference to this is in Helen Coley Nauts' Monograph on Breast Cancer p. 91, Cancer Research Institute Monograph No. 18, 1984.

     It is a fact that as polyunsaturated fats have increased in our diet by a factor of three, largely at the insistence of the medical establishment, deaths from lung cancer in the USA have increased 30-fold.

     In the October 6, 1973 issue of the British Medical Journal there was an editorial asking the question if polyunsaturated fats were causing cancer. No mention was made in this editorial of the immunosuppression of polyunsaturated fats but the editor had a "feeling” that polyunsaturated fats were causing cancer.

     It is logical to believe that the immunosuppression of the polyunsaturated fats have combined with cigarette smoking to cause a great increase in lung cancer among smokers. It is logical to believe that the immunosuppression of polyunsaturated fats in our diet has been increasing the number of other kinds of cancer.

The Arachidonic Acid Cascade
     In The Lancet for Jan. 1, 1977 pp. 18-20, Drs. S. Moncada, E.J. Higgs and J.R. Vane of the Wellcome Research Laboratories had a report of epochal importance on the discovery of what has been called the Arachidonic Acid Cascade.

     Arachidonic acid is a polyunsaturated fatty acid. In diet we get it in meat, however we can make a little of it from linoleic acid, a very common polyunsaturated fatty acid. We have mentioned sunflower-seed oil. It is 50% linoleic acid. Arachidonic acid is acted on by the enzyme cyclo-oxygenase to produce the 2 series of prostaglandins. Prostaglandins are slightly oxidized polyunsaturated fatty acids. The authors of this report tell of the need of an antioxidant such as vitamin E to prevent prostaglandins from being converted to harmful peroxide fats.

     One prostaglandin-like substance is thromboxane A2. This causes the platelets to get very sticky and form a platelet thrombus that will give off clotting factors that will cause the more massive portion of a blood clot, the fibrin thrombus, to form. We need thromboxane A2 to get a life-saving blood clot in a wound and also to prevent internal bleeding. If we get too much thromboxane A2, it will cause the blood clot of a thrombotic stroke or a heart attack. At the same time prostaglandin E2 is formed which is thought to be procancer. Another highly beneficial prostaglandin is formed which at first was called prostaglandin X but was later called prostacyclin. Prostacyclin tends to prevent platelets from adhering to the blood vessel wall, artery or vein. This prostaglandin is our first line of defense against having the thrombosis of a heart attack or a stroke. Dr. Vane was to share the Nobel Award for Medicine in 1988 for this discovery.

     Aspirin, by inhibiting cyclo-oxygenase also inhibits thromboxane A2. Doctors felt that by the inhibition of thromboxane A2, aspirin would protect one from having a heart attack. The first trial on aspirin had just been done showing no benefit. Dr. Moncada said in this report that the failure of the first trial of aspirin in the prevention of a heart attack was due to two things. One was that aspirin also inhibits prostacyclin which is bad. And then in this trial an antioxidant such as vitamin E was not used and some lipid peroxides were formed from polyunsaturated fats and the lipid peroxides would add to the inhibition of aspirin to the formation of prostacyclin.

     Dr. Bengt Samuelsson of the Karinska Institute also shared the 1988 Nobel Award for Medicine in 1988 for his discovery of prostaglandin E1 and the many benefits derived from it. It is derived from the polyunsaturated fatty acid gamma linolenic acid.

     We get almost no gamma linolenic acid in food. We make gamma linolenic from linoleic acid, one of the "good” polyunsaturated fatty acids of The Prudent Diet. It was the teaching of Dr. Samuelsson that the enzyme delta-6-desaturase (D-6-D) converts linoleic acid to gamma linolenic acid and then into prostaglandin E1.

     One of the things wrong with aspirin is that it inhibits D-6-D. In the New England Journal of Medicine for Jan. 20, 1983 pp. 139-41, Dr. Timothy Gerrity of the University of Illinois College of Medicine tells how aspirin tends to cause emphysema. He says that we breathe in dust particles often containing bacteria. Our lungs have a cleaning process, the mucociliary process whereby cilia – small hair-like appendages in the lung – coat the dust and bacteria with mucus and then sweeps it up the bronchi where it is swallowed. Stomach acid then will tend to kill the bacteria. One of the many good things which prostaglandin E1 will do is to activate this process. When this process is stopped or slowed by aspirin, dust particles build up in the lungs and the macrophages deal with the bacteria in the lungs and the corrosive chemicals they give off tends to make the lungs non-elastic. Even a small daily dose of aspirin will tend to cause emphysema.

Evening Primrose Oil
     Many patients who are diabetic suffer from neuropathy. This is the cause of blindness in some diabetic patients. While gamma linolenic acid is not in food it is to be had as a supplement of evening primrose. In The Lancet for May 10, 1986 p. 1096, Goran Jamal et al. of St. Bartholomew's Hospital in London conducted a small double blind trial in which half the diabetic patients were given eight, 500 mg capsules of evening primrose oil containing 360 mg of gamma linolenic acid. All the patients taking evening primrose oil showed a substantial improvement in neuropathy.

     Dr. David Horrobin is both an MD and PhD from Magdalen College, Oxford. He formed Efamal Research Institute and marketed evening primrose oil capsules. In 1990 he published Reviews in Contemporary Pharmacotherapy – Gamma Linolenic Acid, Marius Press with 467 references. With respect to myocardial infarction he gives references that gamma linolenic acid tends to reduce platelet adhesion while unlike aspirin it induces prostacyclin. It could be that aspirin, by inhibiting D-6-D tends to prevent the body from making gamma linolenic acid and this is one reason for the failure of the aspirin trials.

     It is in the field of cancer where gamma linolenic acid is outstanding. Dr. Horrobin has references to trials of cultures of mixed cancer cells and normal cells. In just a few days' time all the normal cells are dead and the culture will be 100% cancer cells. However when gamma linolenic acid was added to the culture, just the reverse happens. In ten days' time l00% of the cancer cells are dead and the culture is 100% normal cells. This test has given the same result with over 23 different kinds of cancer cells.

     The medical establishment has acted as if they have no knowledge of all the benefits of evening primrose oil. There is not one cardiologist in 1,000 that will tell patients to take evening primrose oil. While it can be freely bought now, the first shipment, worth $500,000 which Dr. Horrobin had sent to this country from England, was seized by our FDA and to my knowledge he never got it back.

     There is another polyunsaturated fatty acid, alpha linolenic acid. About 6% of it is in the fat of the oil of millet, the diet of the heart attack-free Ugandan natives. As they were not taking aspirin, their D-6-D was converting it to eicosapentoinic acid, which is fish oil and then to prostaglandin I 3. It has the same antiheart attack, anticancer effects as prostaglandin E1. The oils of wheat, and soya oil also contain about 6% of this fatty acid. The fat in corn oil is 50% linoleic acid as is the oil of millet. Again, as the Ugandans were not taking aspirin to inhibit D-6-D, the small amount of linoleic acid in their diet was being converted to prostaglandin E1. In like manner the alpha linolenic acid in their diet was being converted to prostaglandin I3. However, they had only about 8 grams of these polyunsaturated fats in their diet – enough of them to be acting in the prevention of heart attacks and cancer but too little to be causing cancer.

     This was the same small amount of polyunsaturated fatty acids that were in the English diet of 1900 when the English were nearly free from both heart attacks and lung cancer.

     There were no water softeners in Uganda to deprive the natives there of needed magnesium. These people were not getting added iron in bread or in vitamin pills.

     As this is the sad saga of heart attacks over the past 100 years, it will end on a light note. In The Lancet for March 9, 1974 there was an editorial with the title "Myocardial Infarction Then and Now.” The editor took note of the fact that in 1927 many cardiologists, when taking the examination for the MRCP, had no knowledge of the new disease, coronary thrombosis.

Old William went to bed at home
With a pain across his chest
The doctor used his stethoscope
And said he needed rest.
The doctor saw him twice a day,
Gave morphia injections
Said they could only wait and see
The family asked no questions.
The family looked after him
His pain soon settled down.
The doctor mentioned pleurisy
But he had a puzzled frown.
His textbooks gave him no help at all
Nowhere did they contain
The details of his illness
To account for William's pain.
Since William's pain was better
They got him out of bed
And in ten days back on his feet
Just as the doctor said.
Old William was well recovered
For five more years lived on
Until he dropped dead suddenly
When he was eighty-one.

     The question is – how much better are cardiologists now treating myocardial infarction? We still have over 400,000 deaths a year from this "new” disease, when in 1900 we had almost none.

Correspondence:

Wayne Martin
25 Orchard Court
Fairhope, Alabama 36532 USA

334-928-3975
Fax 334-928-0150