Good summary.

On Wed, 17 Feb 1999, Richard Geller wrote:

> 1. cholesterol, meaning that the intake of dietary cholesterol, or the
> intake of saturated fat, causes increased serum cholesterol levels which
> correlate with increased atherosclerosis and increased incidence of
> other heart disease. I don't believe that intake of cholesterol
> correlates with increased serum cholesterol levels, but obviously intake
> of saturated fats for some correlates with increased levels. The
> importance of this increase is what is debated (here), though to most
> cardiologists and the lay public it's an established fact (which it
> isn't).

Most cardiologists are well aware that most people (about 60%)
with CHD have normal cholesterol levels.  I have been unable to
determine what percentage of people with elevated cholesterol
have or get CHD, as compared to those without elevated
cholesterol.  Instead there seem to be only various graduated
"risk factor" charts, which are often hard to interpret.

The question for me is, given the reasonable assumption that CHD
has multiple causes, is high cholesterol one of them, or a marker
for a different cause?  I don't think there is enough information
to answer this yet.

> 2. homocysteine, correlates very well, easily controlled with B complex
> vitamins (I believe in vitamins).

Yes, a strong case can be made that homocysteine causes at least
some cases of CHD, even in people with normal cholesterol.
Kilmer McCully's book, The Homocysteine Revolution, is very
interesting reading.

> 3. vitamin C, some say decreased levels of C intake correlate with
> increased heart disease.
>
> 4. triglycerides, insulin, carb intake. Seems to be some truth in this,
> high carb intake causes elevated trig levels, elevated insulin levels,
> leading to higher chance of heart disease. I eat a reduced carb version
> of Neanderthin.

I believe there is lab evidence that insulin itself causes
arterial damage, in high enough concentrations.  I don't think I
understand the possible role of TGL in CHD, though.

> 5. foreign proteins, e.g. Neanderthin hypothesis. Seems to be a lot of
> truth to this, too. Dr. Atkins doesn't have the whole story, a carb is
> not a carb, there is a difference between eating onions and eating the
> equivalent in chocolate.

I'm not sure that the difference comes down to foreign proteins,
however.  I don't know how much direct evidence for foreign
proteins as a cause of CHD -- do you know of any?  I know that
protein composition affects things such as cholesterol and
glucagon secretion, but that's not relevant to the "foreignness"
of the protein.

> 6. sodium imbalance. Ratio of sodium to potassium has been upside down
> for quite a while. Some evidence that this causes mitochondrial damage,
> I believe.

True, but I was interested to learn that electrolyte depletion
can be a problem in ketogenic diets, and that extra sodium, as
well as potassium, may be required.

> 7. calcium and magnesium deficiency. Most people are perhaps deficient
> in calcium and magnesium, and this could contribute to heart disease.
>
> 8. essential fatty acid imbalance, unfavorable omega 6 to omega 3 ratio.
> Seems to have a good bit of truth. I take flaxseed oil, I know it's not
> paleo but it corrects this imbalance caused by eating a lot of grain fed
> muscle meat (which I eat a lot of)

I suspect that this is an important one.  The increased incidence
of CHD in the 20th century alone seems very significant to me.
It is a fact that this is the first time in history that humans
have eaten such large quantities of w-6 laden vegetable oils,
hydrogenated or not.  I use fish oil myself, or I just eat
sardines.

> 9. hydrogenated fat intake. I don't eat any of this, but a lot of people
> do, it's in every form of processed food, and studies show correlation
> with heart disease.

Yes, and the hydrogenated fats are almost always the w-6 fats.  I
wonder if the two effects can be disentangled.

> 11. vitamin E deficiency. Vitamin E is only found in nuts, in any
> quantity, I believe. Supplemental vitamin E over many years has been
> shown to reduce incidence of heart disease, I believe. I take a lot of
> Vitamin E, the natural mixed tocopherols and not just the alpha
> tocopherol.

Or eat a lot of nuts.

> 12. bacterial theory. Studies have shown decreased heart disease in
> people who have taken anti-biotics, and suspicious bacterial
> colonization in arteries. This could be a secondary result of weakened
> immune system, of course, rather than a primary cause.

Another possibility is

13. Iron overload.  Hereditary hemochromatosis is known to cause
heart disease, and is believed to be underdiagnosed.  Some people
believe that even those without full-scale HH are still
susceptible to iron overload, which may explain the study that
showed that men who are frequent blood donators have CHD risk
comparable to that of pre-menopausal women.

And don't forget

14. Stress.  There have been many studies indicating that various
stress factors are strong predictors of heart disease, apart from
these other recognized risk factors.

It's a jungle out there.

Todd Moody
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