Main Say No to Heart Disease: The Drug-Free Guide to Preventing and Fighting Heart Disease

Say No to Heart Disease: The Drug-Free Guide to Preventing and Fighting Heart Disease

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Using food to eliminate chances of a heart attack or stroke Eating the right diet and correctly supplementing one's diet can eliminate chances of a heart attack, lower blood pressure without drugs, reverse artery disease, maximize recovery after a stroke or heart attack, and add 20 years to a healthy lifespan, and this guide reveals how. Informative and practical, it describes the cardiovascular system and what goes wrong with it, the key theories on the major contributors to heart disease, how to work out one's own risk, and which areas of diet and lifestyle to focus on in order to minimize risk. It also gives advice on maximizing recovery from a heart attack or stroke.
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About the author

Patrick Holford BSc, DipION, FBANT, NTCRP is a leading spokesman on nutrition in the media, specialising in the field of mental health. He is the author of over 30 books, translated into over 20 languages and selling over a million copies worldwide, including The Optimum Nutrition Bible, The Low-GL Diet Bible, Optimum Nutrition for the Mind, Food is Better Medicine than Drugs and The 10 Secrets of Healthy Ageing.

Patrick started his academic career in the field of psychology. He then became a student of two of the leading pioneers in nutrition medicine and psychiatry – the late Dr Carl Pfeiffer and Dr Abram Hoffer. In 1984 he founded the Institute for Optimum Nutrition (ION), an independent educational charity, with his mentor, twice Nobel Prize winner Dr Linus Pauling, as patron. ION has been researching and helping to define what it means to be optimally nourished for the past 25 years and is one of the most respected educational establishments for training nutritional therapists. At ION he was involved in groundbreaking research showing that multivitamins can increase children’s IQ scores. He was one of the first promoters of the importance of zinc, antioxidants, essential fats, low-GL diets and homocysteine-lowering B vitamins and their importance in mental health and Alzheimer’s disease prevention.

Patrick is director of the Food for the Brain Foundation and director of the Brain Bio Centre, the Foundation’s treatment centre that specialises in helping those with mental issues ranging from depression to schizophrenia. He is an honorary fellow of the British Association of Nutritional Therapy, as well as a member of the Nutrition Therapy Council and the Complementary and Natural Health Care Council. He is also Patron of the South African Association of Nutritional Therapy.


Balance Your Hormones

Beat Stress and Fatigue

Boost Your Immune System (with Jennifer Meek)

Food GLorious Food (with Fiona McDonald Joyce)

Food is Better Medicine than Drugs (with Jero; me Burne)

Hidden Food Allergies (with Dr James Braly)

How to Quit Without Feeling S**t (with David Miller and Dr James Braly)

Improve Your Digestion

Natural Highs (with Dr Hyla Cass)

Optimum Nutrition Before, During and After Pregnancy (with Susannah Lawson)

Optimum Nutrition for the Mind

Optimum Nutrition for Your Child (with Deborah Colson)

Optimum Nutrition Made Easy

Say No to Arthritis

Say No to Cancer

Say No to Diabetes

Six Weeks to Superhealth

Smart Food for Smart Kids (with Fiona McDonald Joyce)

Solve Your Skin Problems (with Natalie Savona)

The 9-day Liver Detox (with Fiona McDonald Joyce)

The 10 Secrets of 100% Healthy People

The 10 Secrets of 100% Health Cookbook (with Fiona McDonald Joyce)

The 10 Secrets of Healthy Ageing (with Jerome Burne)

The Alzheimer’s Prevention Plan (with Shane Heaton and Deborah Colson)

The Feel Good Factor

The Homocysteine Solution (with Dr James Braly)

The Low-GL Diet Cookbook (with Fiona McDonald Joyce)

The Low-GL Diet Counter

The Low-GL Diet Bible

The Optimum Nutrition Bible

The Optimum Nutrition Cookbook (with Judy Ridgway)


Published by Hachette Digital

ISBN: 978-0-7481-3376-5

Copyright © Patrick Holford 1998, 2012

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher.

Hachette Digital

Little, Brown Book Group

100 Victoria Embankment

London, EC4Y 0DY


About the Author

By the Same Author



Guide to Abbreviations, Measures and References

References and Further Sources of Information


Part 1: The Dynamics of Heart Disease

1 Your Healthy Heart Check: Identify Your Critical Risk Factors

2 Understanding Blood Pressure and Pulse

3 Understanding Blood – Cholesterol and Triglycerides

4 The Red Herring of Cholesterol and Fat

5 Defining Heart Disease and Understanding Your Diagnosis

6 The Truth About Cardiovascular Drugs

Part 2: Ten Keys for Preventing and Reversing Heart Disease

7 Why You Need Omega-3 Fats and Vitamin D

8 The Sugar Factor and Why You Need to Keep Your Insulin Down

9 Why Stress Really Matters

10 How High is Your Homocysteine?

11 Lipoprotein(a), Niacin and Vitamin C

12 Antioxidant Protection – Why You Need More than Vitamin E

13 Increase Magnesium and Potassium and Reduce Sodium

14 Are Your Arteries Inflamed?

15 The Exercise Equation

16 What You Drink Makes a Difference

Part 3: Heart-friendly Strategies for Rapid Recovery

17 How to Lower Your Cholesterol Without Drugs

18 How to Lower High Blood Pressure Naturally

19 Easing Angina and Recovering from a Heart Attack

20 How to Maximise Recovery from a Stroke

Part 4: Your Heart-friendly Action Plan

21 Your Heart-friendly Diet

22 Essential Supplements

23 How to Exercise Your Heart

24 How to Live a Low-stress Life

Appendix 1: The GL Index of Hundreds of Foods

Appendix 2: Personalising Your GL Intake


Recommended Reading




I am immensely grateful to Nina Omotoso, my nutritional therapist researcher, and also to Jerome Burne, Dr Stephen Sinatra, Dr Fedon Lindberg and many other switched-on doctors and researchers who have helped to keep me up to date with the ocean of studies on nutrition, medicine and heart disease. I am also grateful to the ‘hands-on’ feedback from the participants in our Zest4Life groups who have shared their experiences of trying out the principles in this book. Also, a big thanks to the editorial team at Little, Brown – Gill Bailey, Jillian Stewart and Jan Cutler – and everyone else who has helped to get this information out to as many people as possible. Most of all I am grateful to my wife, Gaby, who is always there for me.

Guide to Abbreviations,

Measures and References


European and American laboratories use different measures to record test results. Figures in this book are in mmol/l and pmol/l, the UK measures (although blood cholesterol and triglyceride levels are given in UK and US measurements in the charts). If necessary, your results can be easily converted using the following rules.

To convert blood glucose readings:

Multiply the mg/dL (US) by 0.0555 to get mmol/l (UK).

To convert glycosylated haemoglobin (glycated haemoglobin A1, A1C, HbAIC) readings:

Multiply ‘proportion of total haemoglobin’ by 100 to get ‘per cent of total haemoglobin’.

To convert insulin readings:

Multiply the µIU/mL (US) by 0.6.945 to get mmol/l (UK).

To convert total cholesterol, HDL and LDL readings:

Multiply the mg/dl (US) by 0.0259 to get mmol/l (UK).

To convert triglyceride readings:

Multiply the mg/dl (US) by 0.0113 to get mmol/l (UK).


1 gram (g) = 1,000 milligrams (mg) = 1,000,000 micrograms (mcg, also written as µg)

1mcg of retinol (1mcg RE) = 3.3ius of vitamin A

1mcg RE of beta-carotene = 6mcg of beta-carotene

100iu of vitamin D = 2.5mcg

100iu of vitamin E = 67mg

Most vitamins are measured in milligrams or micrograms. Vitamins A, D and E used to be measured in International Units (iu), a measurement designed to standardise the various forms of these vitamins, which have different potencies.

1 pound (lb) = 16 ounces (oz)/450g

2lb 4oz = 1 kilogram (kg)

1 pint = 600ml/20fl oz

1¾ pints = 1 litre

In this book ‘calories’ means kilocalories (kcals)

References and Further

Sources of Information

In each part of the book, you’ll find numbered references. These refer to research papers listed in the References section on page 279, and are there for readers who want to study this subject in depth. More details on most of these studies can be found on the Internet, at PubMed, a service of the US National Library of Medicine. This is where you can access most of the studies mentioned (see

On page 300 you will find a list of the best books to read to enable you to dig deeper into the topics covered. You will also find many of the topics touched on in this book covered in detail in feature articles available at If you want to stay up to date with all that is new and exciting in this field, we recommend you subscribe to Patrick Holford’s 100% Health newsletter, details of which are on the website.


Although all the nutrients and dietary changes referred to in this book have been proven safe, those seeking help for specific medical conditions are advised to consult a qualified nutritional therapist, clinical nutritionist, nutritionally oriented doctor or equivalent health professional. The recommendations given in this book are solely intended as education and information, and should not be taken as medical advice. Neither the author nor the publisher accepts liability for readers who choose to self-prescribe.

If you are on medication for a heart condition, consult your doctor before adjusting any medication. If you are on medication for diabetes, it is especially important to monitor your blood sugar levels and to consult your doctor if you wish to adjust your medication. Do not change your medication without consulting your doctor.

All supplements should be kept out of the reach of infants and children.


When I wrote the first edition of this book, in 1998, many of the key drivers of heart disease that I proposed – high blood sugar levels, lack of omega-3 fats and magnesium, high homocysteine and lipoprotein(a) – were largely unknown in mainstream medicine. Now, 14 years on, the small hill of evidence backing up an optimum-nutrition approach to heart disease has turned into a large mountain, yet, with a few exceptions such as the more widespread prescription of omega-3, very few people with cardiovascular risk are being given the right advice about what to eat and supplement.

Too many people are told to eat a low-fat, low-cholesterol diet despite clear evidence that this doesn’t work; too few are given vitamin B3 (niacin) to lower cholesterol despite the fact that it is safer, and it lowers cholesterol better, than statin drugs, nor are they given vitamin C, now well established to substantially reduce risk, and almost none are given magnesium, an inexpensive mineral that lowers blood pressure, reduces heart attack and stroke risk, and maximises recovery.

Back in the 1990s, one in five men and one in nine women were dying of heart disease before they reached the age of 75. I had hoped, and naively expected, that this trend would be reversed by applying the science of optimum nutrition to cardiovascular medicine. After all, it is cheap, safe and effective. But, in some respects, the situation has become worse not better, especially for women. It used to be the case that many more men than women died from heart disease, but in recent years the numbers have evened out, with more women than men dying from strokes in particular. Advances in medicine mean that more people survive a stroke or heart attack, but how is their quality of life affected? If you have had such an event, it can be a wake-up call: a chance to examine what caused the problem and to reverse that risk. If you haven’t had a stroke or heart attack, one ounce of prevention is worth several pounds of cure.

Heart disease is the number-one

cause of premature death

More people die prematurely from diseases of the heart and arteries than from anything else – 150,000 a year in England alone – roughly half from heart attacks and a quarter from strokes.1 (A stroke occurs when the flow of blood to the brain is disrupted, resulting in a sudden disabling attack or loss of consciousness.) At least 20,000 deaths occur prematurely in people under the age of 75. In the UK, there are an estimated 2.6 million people living with the condition, and angina (the most common symptom of coronary heart disease) affects 2 million people. Worldwide, over 8 million women die every year from heart disease. In America alone there are about 8 million women living with heart disease.

There is nothing natural about dying from heart disease. Many cultures in the world do not experience a particularly high incidence of strokes or heart attacks. British people, for example, have nine times as much heart disease by middle age as the Japanese. If you are a woman and you live in Scotland, your chances of having a heart attack are eight times higher than if you live in Spain.2 Why?

Autopsies performed on Egyptian mummies of people who died in 3000 bc show signs of deposits in the arteries but no actual blockages that would have resulted in a stroke or heart attack. Despite how obvious the signs of hearts attacks are (severe chest pain, cold sweats, nausea, a fall in blood pressure and a weak pulse), in the 1930s they were so rare that it took a specialist to make the diagnosis. According to American health records, the incidence per 100,000 people of heart attack was zero in 1890. By 1970 it had risen to 340. Although deaths did occur from other forms of heart disease, including calcified valves, rheumatic heart and other congenital defects, the incidence of actual blockages in the arteries, which cause strokes or heart attacks, was minimal. Heart disease used to be rare in India and Africa but is now endemic, especially in regions that have a more ‘Westernised’ diet and lifestyle. Why? I will be exploring the reasons for these differences in detail, but first, in Part 1, I will be bringing you up to speed with the dynamics of heart disease and explaining what a diagnosis actually means, as well as the risk factors such as blood pressure and blood fats.

Twenty years less of life

The cost of heart disease is, on average, 20 years less life. For those who survive a massive heart attack or stroke it may mean decades of compromised living. Yet heart attacks, heart failure and strokes are largely preventable diseases with highly familiar risk factors, such as poor nutrition, smoking, excess alcohol, obesity and lack of exercise. Investing a bit of time and energy in finding out what’s going to make all the difference to you can literally add years to your life as well as life to your years.

If you’ve just been diagnosed with some form of heart disease – angina, hypertension (high blood pressure), thrombosis, a stroke or heart attack – your doctor is probably unlikely to focus on these risk factors, although you may be given some general advice to lose weight, exercise and eat a ‘well-balanced diet’. Instead, you’ll probably be prescribed a cocktail of drugs to lower your cholesterol, bring down your blood pressure and thin your blood. The trouble is these medications all interfere with some aspect of your body’s chemistry and none are necessary long term if you address the underlying causes of heart disease (in this book I will call the family of blood-vessel related diseases – strokes, heart attacks, angina, high blood pressure – heart disease).

The combined strategy of changing your diet, improving your lifestyle, and taking the right supplements is likely to be far more effective than taking prescribed drugs for both preventing and reversing cardiovascular disease, without the side effects. If you are on medication and take these steps to reduce your risk, and thereby achieve normalisation of the signs in your body that show that you are developing cardiovascular disease (known as biochemical markers), there should be no need to continue taking cardiovascular medication unless you have suffered physical, irreversible damage. Long-term medication is often only necessary if you are unwilling to make the necessary changes to your diet and lifestyle; however, do not change any prescribed medication without first consulting your doctor and re-evaluating the measurable risk factors that medication targets.

You can normalise your blood

pressure without drugs

David is an example of how lifestyle changes can have dramatic effects:

Case Study: David

David had suffered from high blood pressure for years and was on long-term medication, but when he started following my Heart-friendly Diet (a healthy ‘low-GL diet’ based on choosing carbohydrates that slowly release in the body) the combination of the diet and drugs was too much and his blood pressure went from too high to too low. He had to stop the drugs to achieve a healthy, normal blood pressure. In his own words:

‘Two months later I had to see the cardiology professor again and I took along my own blood pressure figures for him to analyse. He was astonished and highly delighted with such brilliant figures from me. Then I broke the news to him, that those figures had been achieved without any medication at all! The initial look of horror on his face changed to total fascination when I explained that all I had done was follow your low-GL diet.

‘He carried out more tests on me, including a potassium-to-salt ratio, which showed that my salt levels were so low that he said I was just like someone from a particular tribe in Africa that does not suffer from any blood pressure problems whatsoever. By contrast, he said that my potassium levels were so high that he thought I must be eating fruit and vegetables all day long in order to achieve this. I said no, I just follow the low-GL diet. In fact, prior to the diet I was constantly eating fruit during the day but without any benefit to my blood pressure. Another benefit of the low-GL diet was that my cholesterol dropped from 5.7 to 4.6. I have now been on the diet for three years and have not had to revert to blood pressure tablets.’

The ten keys to staying free from

heart disease for life

Eating a low-GL diet is one of ten key factors for keeping healthy and keeping your blood pressure down. There are other keys, such as getting enough magnesium and omega-3 fats, or taking co-enzyme Q10 (CoQ10) and carnitine if you have heart problems. In Part 2 you’ll learn about the ten key factors that ensure you keep heart-healthy throughout your life. There is simply no need to suffer from heart disease at any age.

These keys include:

Achieving perfect cholesterol without drugs.

Eating the right kind of fats to halve your risk of a heart attack.

Becoming a master of your blood sugar control, thereby preventing arterial damage.

Following simple, five-minute techniques that teach you how to undo stress.

Learning what you can and can’t drink to reduce your risk.

Lowering your homocysteine, an independent risk factor that is more important than your cholesterol level.

Lowering lipoprotein(a), another key risk factor that probably hasn’t been checked by your health professional.

Getting the most antioxidant protection to keep your blood vessels young and flexible.

Understanding how to get your mineral balance right and the importance of magnesium for perfect blood pressure.

Learning how to switch off your heart-disease-promoting genes and how to switch on the heart-protective genes.

Put all these factors together and you have a potent package for saying no to heart disease for your whole life. The experiences of my first teacher, Dr Carl Pfeiffer, confirm this. (I first met Dr Pfeiffer in the 1970s when he introduced me to the power of nutritional therapy for mental illness when I was studying as a psychologist.)

Dr Pfeiffer had a massive heart attack at the age of 51 and was told that he would not survive without a pacemaker and medication, and even then for no more than ten years. He chose neither and instead examined the true underlying causes, which led him to radically change his diet and start taking supplements. He lived to be 80 years old, seeing patients six days a week, and was active to the last minute. My other teachers, Drs Linus Pauling, Abram Hoffer and Roger Williams, all lived well into their nineties without any form of heart disease, never retiring or losing their razor-sharp minds.

With regard to myself, at the age of 54 at the time of writing, my vital statistics – cholesterol, blood pressure and pulse – remain exactly the same as they were when I was in my twenties. My homocysteine level, a key risk factor, is at the same average level as a teenager’s. I can still climb mountains with my super-fit daughter despite a daily maintenance exercise routine of only 15 minutes (although you would need more than this to recover from a heart problem).

Working with your doctor

to reduce medication

Obviously, if you’ve had a heart attack or have very high blood pressure, I am not suggesting that you throw your drugs away. Let your doctor know that you want to pursue nutritional and lifestyle changes to minimise your need for medication.

Part 3 gives you concrete strategies for lowering cholesterol and blood pressure, as well as maximising your recovery if you’ve had a heart attack or stroke so that you can get started on the road to improved health right away.

It’s a good idea to establish the goal that would make it no longer necessary for you to have medication; for example, a cholesterol measure below 5, or blood pressure below 130/85. Then, as you start to incorporate the nutritional changes I recommend, you can monitor the effect. Some drugs become dangerous to take when you’ve achieved the goal; for example, when normalising your blood pressure or cholesterol, too low a cholesterol level is as bad as one that is too high.

If you’re on blood-thinning drugs such as aspirin or warfarin, speak to your doctor before taking concentrated supplements of omega-3 fish oils, gingko biloba or vitamin E above 300mg, because your medical practice may want to monitor your INR and platelet-adhesion index and consider reducing the drug accordingly. If you can achieve perfect blood without drugs this has to be the better way. The same is true with cholesterol and blood pressure.

As your vital heart statistics improve, any doctor worth their salt will want to reduce your medication accordingly, because almost all drugs have undesirable side effects. There’s no point in taking medication if you don’t need it; however, many drugs are given out far too freely to people for whom they are likely to be of no benefit at all. This includes the cholesterol-lowering statins given to women as a preventative, and a daily aspirin. The evidence shows that these simply do not work, yet they have achieved almost cult status in basic medical advice. I’ll be exploring the best and the worst drugs in Chapter 6 and will let you know which nutrients could interfere with the action of a

Obviously, if you’ve had a heart attack or have very high blood pressure, I am not suggesting that you throw your drugs away. Let your doctor know that you want to pursue nutritional and lifestyle changes to minimise your need for medication.

Part 3 gives you concrete strategies for lowering cholesterol and blood pressure, as well as maximising your recovery if you’ve had a heart attack or stroke so that you can get started on the road to improved health right away.

It’s a good idea to establish the goal that would make it no longer necessary for you to have medication; for example, a cholesterol measure below 5, or blood pressure below 130/85. Then, as you start to incorporate the nutritional changes I recommend, you can monitor the effect. Some drugs become dangerous to take when you’ve achieved the goal; for example, when normalising your blood pressure or cholesterol, too low a cholesterol level is as bad as one that is too high.

If you’re on blood-thinning drugs such as aspirin or warfarin, speak to your doctor before taking concentrated supplements of omega-3 fish oils, gingko biloba or vitamin E above 300mg, because your medical practice may want to monitor your INR and platelet-adhesion index and consider reducing the drug accordingly. If you can achieve perfect blood without drugs this has to be the better way. The same is true with cholesterol and blood pressure.

As your vital heart statistics improve, any doctor worth their salt will want to reduce your medication accordingly, because almost all drugs have undesirable side effects. There’s no point in taking medication if you don’t need it; however, many drugs are given out far too freely to people for whom they are likely to be of no benefit at all. This includes the cholesterol-lowering statins given to women as a preventative, and a daily aspirin. The evidence shows that these simply do not work, yet they have achieved almost cult status in basic medical advice. I’ll be exploring the best and the worst drugs in Chapter 6 and will let you know which nutrients could interfere with the action of a drug (very few) and, more importantly, which drugs interfere with the action of a nutrient, making you even more deficient. drug (very few) and, more importantly, which drugs interfere with the action of a nutrient, making you even more deficient.

Unfortunately, too many doctors and dieticians, out of fear and ignorance, may tell you there’s no evidence that you can make these changes through nutritional and lifestyle changes and they’d rather you didn’t take supplements in case they interfere with your medication. I had first-hand experience of this recently when a dear friend, in his seventies, had just come out of a coma and was in the hospital’s stroke recovery unit. I presented a paper, with all the references of all the nutrients, proven to be safe, that could help recovery, and the tests that should be run – including homocysteine and his vitamin D status (he had had three months with no direct sunlight and his vitamin D status was in all probability very low). Despite the fact that there could only be benefit from testing and adding in any deficient nutrients, they refused to run the tests or give the supplements, instead giving him an RDA (Recommended Daily Allowance) multivitamin in recognition that a hospital diet may not provide enough nutrients, plus one of the least effective blood pressure drugs with the most side effects. As many studies have proven, however, RDA levels of nutrients just aren’t enough to make a difference, and especially when your body is out of balance, because you need a much higher intake of nutrients to restore your body to good health.

If you encounter this kind of closed-mind resistance, it is best to find a medical team who will support you, not hinder you, in taking responsibility for your own health, and perhaps work with a registered nutritional therapist who can help present the evidence for adding a nutrition-based strategy to your prevention or recovery programme. Be wary of any advice that you have to take medication ‘for life’. In my experience, this is rarely necessary if you truly follow an optimum nutrition programme.

Your Healthy-heart Action Plan

Whether you are reading this book for prevention, to help you or someone you know recover from cardiovascular disease, a heart attack or a stroke, or to make sure the tell-tale signs you’ve started to develop don’t go any further, and will hopefully recede, you will be pleasantly surprised, and perhaps amazed, to find how much evidence there already is that optimum nutrition really can help you to say no to heart disease. The trouble is that doctors simply aren’t taught this in medical school, and since nutrients are not patentable, hence not significantly profitable, there’s no industry pushing postgraduate education. The mainstay of modern medicine is still based on the prescribing of drugs and it is hard for a doctor to step out of the box. In the UK, doctors are remunerated for testing, and lowering, cholesterol and often give cholesterol-lowering drugs that don’t actually reduce heart disease risk. Few doctors have the experience, or the confidence, to tackle heart disease with a largely nutrition-based strategy. That means it is up to you to find out what you can do for yourself.

In Part 4 you’ll discover how to build your own Healthy-heart Action Plan depending on your current level of health, together with the practical information you will need on my Heart-friendly Diet, supplements, exercise and stress reduction. If you wish, you can consult a registered nutritional therapist to help devise a plan of action for you (see Resources) who will use these tried-and-tested principles to deliver measurable results in weeks, not months, giving you the confidence to keep going and change the baseline of what you eat and how you live. But you can also get these results by working through the book.

Back in the 4th century BC Hippocrates, the father of modern medicine, said ‘what’s good for the heart is good for the mind’. You’ll be pleased to discover that there are good side effects to the optimum-nutrition approach to heart disease, such as more energy, a sharper mind, a more balanced mood and less pain. It’s a win–win situation all round and it’s yours for the taking.

Wishing you the best of health,

Patrick Holford




One in two men and women die from heart disease. More people die prematurely, and many more suffer, from diseases of the heart and arteries than from anything else. Decades of research have made it clear that there is not one single cure. It’s more complicated than that. This Part explains the dynamics of cardiovascular health, how your heart and arteries work, what the critical risk factors are and what measurements, such as your blood pressure, cholesterol and blood-fat levels, actually mean. You’ll also learn why you may be offered certain drugs, what they do and how effective they are.


Your Healthy Heart

Check: Identify Your

Critical Risk Factors

No disorder has been more thoroughly investigated than heart disease. Now the fruits of all this research are yours to benefit from. Strangely though, all the pieces of information have yet to be compiled and presented as a clear strategy for eliminating the risk of heart disease. That is the purpose of this book, and you may be amazed to find that you can reduce your risk almost completely.

You can divide your critical risk factors into things that you do or have, such as your diet, smoking or excess weight, and measurements of something going on in your body, such as your cholesterol or homocysteine levels. The usual assumption is that lowering a measure that is associated with a higher risk, such as your cholesterol or homocysteine, will always reduce your risk. Although this is usually true, it isn’t always the case.

Also, we tend to be sold a very linear story, such as ‘cholesterol blocks the arteries, therefore eat less cholesterol by avoiding, for example, eggs, and take drugs that lower cholesterol’. In this particular case, having a high cholesterol level is a predictive marker of heart disease, but it isn’t caused by high dietary intake. Avoiding eggs won’t make any difference, as you’ll discover later. One of the main reasons cholesterol goes up is eating too much sugar and refined carbohydrates, as well as having too much stress. Both too much sugar and concomitantly high insulin (the result of a diet high in sugar and refined carbohydrates) damages the arteries and raises blood pressure. Simply taking a drug that stops you making cholesterol has little effect if you don’t change your diet.

Why lowering cholesterol isn’t the full story

In the case of cholesterol, it’s not a particularly good predictive marker. The odds are that if you have a heart attack you don’t also have high cholesterol. A massive US survey of 136,905 patients found that the majority of those hospitalised for a heart attack had normal cholesterol levels.1 Although you don’t want to have a high cholesterol level it also means that you shouldn’t think you are in the clear just because your cholesterol level is normal. It is only one of a number of risk factors, and not the most predictive at that.

The trouble is that, due to extensive marketing of cholesterol-lowering drugs, doctors have become too focused on this and are, at least in the UK, financially rewarded if they test your cholesterol, and then again if they lower your level, which is easiest to do by giving you a cholesterol-lowering drug. It is not the drug that most reduces your risk, however, but changing your diet and lifestyle, which although it requires more effort is much more effective.

Among elderly people, for example, cholesterol is a very poor predictor of cardiovascular-disease death, as is a widely used index of conventional risk factors called the Framingham Risk Score, based on assessments of blood pressure, cholesterol, ECG (electrocardiograph), diabetes and smoking. The best predictor by far is your homocysteine level, according to a study published in the British Medical Journal.2 (Homocysteine is a critical risk factor that I’ll be exploring in detail.) The study found that if a person’s homocysteine level was above 13, which is not much higher than the average for a 50-year-old, it predicted no less than two-thirds of all deaths five years on.

You can lower it easily by simply taking homocysteine-lowering B vitamins. According to some studies, if you’ve already had a heart attack, lowering homocysteine doesn’t appear to lower the risk of another heart attack, but it does lower the risk of stroke. (Although, as you will see later, this lack of benefit may be more to do with common heart-disease drugs interfering with the ability of B vitamins to work.) Homocysteine-lowering B vitamins are more effective in reducing your risk if your homocysteine level is high to start with, as you’d expect. Less promising results with B vitamins in those with heart disease and on medication do not alter the fact that homocysteine is an excellent predictor of cardiovascular risk, better than cholesterol, yet in the UK few doctors ever check it. In Germany doctors routinely check homocysteine, running millions of tests a year. Other risk factors include your level of blood fats (triglycerides), your blood sugar balance (reflected by your HbA1c level) and something called lipoprotein(a).

Why the bigger picture is so important

It is very important to look at all risk factors, and the predictive markers, and to do your best to reduce them all. Don’t put all your eggs in one basket, such as concentrating on your cholesterol level.

The chart on page 6 shows the major known risk factors for heart disease, and the percentage decreased risk you can expect by going from a bad score or diet to an optimum score, diet and lifestyle. The good news is that every one, except a genetic predisposition, can be eliminated by relatively simple, painless dietary and lifestyle changes.

What are the risk factors?

Look at the list of risk factors on page 6. All can be corrected by making simple dietary and lifestyle changes, and by doing so you may reduce your risk by the estimated percentages:

Medical statistics

High blood fats (triglycerides)

70 per cent*

High glycosylated haemoglobin (HbA1c)

68 per cent

High blood cholesterol (low HDL, high LDL)

60 per cent

High blood homocysteine

50 per cent

High lipoprotein(a)

50 per cent

High blood pressure

30 per cent

Insulin resistance

30 per cent

C-reactive protein (CRP)

20 per cent


A high-GL (glycemic load) diet** (especially in women)

50 per cent

Too much meat and dairy products

50 per cent

Too much alcohol

50 per cent

Too little antioxidant-rich foods and nutrients

50 per cent

Too little B vitamins

50 per cent

Too little potassium, magnesium and calcium

50 per cent

Too little omega-3 fats (from fish and seeds)

40 per cent

Too little fresh fruit and vegetables

30 per cent

Too much salt (sodium)

25 per cent

Too little vitamin D

20 per cent

Too much dietary saturated fat

20 per cent


Smoking (20 cigarettes a day)

70 per cent

Lack of aerobic and resistance exercise

50 per cent

Too much stress

50 per cent


30 per cent

Lack of sunlight (vitamin D)

10 per cent

Genetic predisposition

5 per cent

Please note, however, that you can’t take these percentage reductions too literally. And you can’t just add all the percentages together, because many of these factors overlap, but the point is that we already do know how to effectively eliminate the vast majority of risks for heart disease. To illustrate this let’s say you are an average person with an average diet and lifestyle, with an average 50 per cent risk of dying from heart disease. Now you decide to eat more fruit and vegetables (which are rich in antioxidant vitamins, potassium, magnesium and calcium), you follow a low-GL diet (one that is low in fast-releasing carbohydrates such as sugar and refined foods) and you stop adding salt to your food. This will lower your blood pressure, reducing your risk by 25 per cent.

If you then stop smoking 20 cigarettes a day, you reduce your risk by another 50 per cent. If you decide to supplement vitamin C and B complex to your diet, the vitamin C will lower your cholesterol and homocysteine, thereby reducing your risk by 50 per cent; the B complex will also lower your homocysteine (which is a toxin for the arteries), further reducing your risk. If you also supplement vitamin D and spend more time outdoors, that reduces your risk by 20 per cent. Then, if you cut your alcohol consumption down, but not out (because some alcohol is protective), to, on average, one drink a day, you will further reduce your risk by 50 per cent. If you start exercising three times a week, that’s another 50 per cent risk reduction. Exercise also helps to bring down your stress level, but you can also learn some simple techniques such as HeartMath (explained in detail later) to keep your stress levels under control. Start eating more fish, such as salmon and tuna (providing essential omega-3 fats), and less meat and you have an associated 40 per cent reduction in risk.

Could you reduce your risk completely?

Even if these are over-exaggerations of the kinds of risk reduction you can achieve, just how far do you need to go before you have no risk at all?

In truth, it is not exactly known, because studies haven’t been done on the combined effects of all these well-proven preventions. The chances of virtually eliminating all risk are, however, very high indeed, even if you are genetically predisposed to heart disease.

One study that tried to evaluate the significant contributors to overall risk of having a heart attack was the INTERHEART study, involving people from all over the world to get a truly global picture.3 Their conclusion was that ‘Abnormal lipids [e.g. cholesterol, triglycerides, etc.], smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions.’ By ‘most’ they meant a 90 per cent reduction, and they recommended that prevention strategies should focus on these key drivers.

Another important point to make is that what you need to do to prevent heart disease is much less than what you need to do to reverse it. You need much larger amounts of nutrients, for example, to lower a high homocysteine level, or to restore blood sugar balance, than you need to maintain it in a healthy range. I’ll explain what you need for both scenarios in Parts 2 and 3.

Vital statistics you should aim to improve

The main measures that indicate you have risk or have reduced risk that should be measured in any thorough medical screening are your blood pressure, cholesterol levels (your HDL to LDL ratio and your total cholesterol level), triglyceride levels, glycosylated haemoglobin (HbA1c – a measure of your ability to keep your blood sugar level in balance) and your homocysteine level. Let’s look at each one separately.

Your blood pressure This is measured as, for example, 120/76 mmHg. The top figure is the systolic blood pressure, the bottom figure the diastolic blood pressure. It’s the bottom figure – your diastolic blood pressure – that’s the most important. If your blood pressure is above 140/90, you have a much greater risk of heart disease. In fact, roughly every 10-point increase above 76 (your diastolic pressure) doubles your risk of death from cardiovascular disease. I explain how this works in Chapter 2.

Your triglyceride level This reflects the level of fats in your bloodstream and is raised by eating diets that are high in fat and sugar, or by excessive alcohol. It’s a very good, and often neglected, predictor of heart disease risk. Your triglyceride level should be below 1.7 mmol/l although the optimal is below 1mmol/l. As a rough indicator, every 0.5mmol/l potentially doubles your risk. If it is high, go on a low-GL diet as explained in this book. You don’t have to be on a lowfat diet, just have more omega-3 fats from fish, raw nuts and seeds, and less fatty meat, dairy products and junk food. Chapter 3 explains why it’s not really just about eating less fat.

Your homocysteine level This is measured in micromoles per litre (mcmol/l); for example, as 7mcmol/l. A healthy score is below 7. As a rough indicator, with every 5-point increase above 7mcmol/l you double your risk of death from cardiovascular disease. You certainly don’t want to have a level above 10mcmol/l. Above 15mcmol/l and you have probably quadrupled your risk. This test is available as a home test kit if your doctor won’t measure it for you. The solution is a change in both diet and lifestyle, plus B vitamins, as I explain in Chapter 10.

Your glycosylated haemoglobin level This is also called HbA1c and measures the percentage of red blood cells that are effectively sugar-coated, giving you an average figure of how many blood sugar spikes you have, which cause damage to your arteries. You usually get a score of between 4 and 9 per cent. Below 5 per cent is very healthy. Above 7 per cent and you are likely to be diabetic, or likely to become diabetic. If you have a level of 6.5 per cent you’ve probably doubled your risk of heart disease compared to if it had been just 0.5 per cent lower; however, standard blood tests might measure your fasting glucose first, which should be low. The solution is to eat a low-GL diet, as well as supplementing chromium, as I explain in Chapter 8. This test is available as a home test kit if your doctor won’t measure it for you.

Your cholesterol level This is broken down into your total cholesterol, your LDL (‘bad’) cholesterol and your HDL (‘good’) cholesterol. You should have a low LDL cholesterol (ideally below 2.6mmol/l), a high HDL cholesterol (ideally above 1.6mmol/l), and a total cholesterol of not less than 3.9mmol/l and not more than 5.2mmol/l. As a rough indicator, with every 1-point increase in your total cholesterol above 5, you double your risk of death from cardiovascular disease. With every 1-point increase in LDL, you double your risk, and with every 0.5 decrease in HDL below 1.5mmol/l, you double your risk. So you should have a high HDL and low cholesterol. The ratio of cholesterol to HDL is particularly predictive. According to one study it accounts for 37 per cent of one’s overall risk of heart disease.4

Even better is the ratio between triglycerides and HDL. This should be as low as possible. Chapters 4 and 7 give you the low-down on cholesterol.

There are other important measures, such as your platelet adhesion index, fibrinogen and lipoprotein(a) levels, which all affect the stickiness of your blood and the preponderance to atherosclerosis (hardening of the arteries); lipoprotein(a); and C-reactive protein level, which indicates inflammation in the arteries – all these will be discussed later in the book. It’s essential that your doctor measures all of these important risk factors as well. I’ll explain why they are important to know for a full-scale personalised prevention policy and recovery plan.

Are you suffering from metabolic syndrome?

A number of the above risk indicators are grouped together to diagnose a condition called metabolic syndrome. This describes a common pattern of shift in your body’s biology that not only increases the risk of heart disease but also of diabetes, cancer and many other conditions. Reversing metabolic syndrome is one of the essential keys to preventing and reversing heart disease.

Einstein apparently once said, ‘Not everything that counts can be counted and not everything that can be counted counts.’ Modern medicine loves quantifiable factors such as these indicators. Often your apparent state of health is determined by a drop in one of these scores, and drugs are sold with the intention of changing these scores. As we explore these in more detail in this book bear in mind that something can be a predictive marker of risk, but not necessarily part of the cause. One doesn’t necessarily lead to the other. Sometimes a treatment might, for example, lower cholesterol but not stop heart attack deaths. This is the kind of thing we have to examine.

Other risk factors

There are other factors of tremendous importance but which are not easily measured, such as your stress level, how much exercise you take and your overall diet. Since these cannot be easily quantified by medical professionals they are usually assigned to general platitudes about the need to exercise more, eat well and try to reduce stress. But all these things are much harder to do than to take a pill, even though the likelihood is that it was not attending to these things that got you to where you are today.

Is heart disease acquired or inherited?

One often asked question is to what extent one’s risk is genetic. Some people are told they have genetically high cholesterol, or triglycerides, or some other risk factor. Cardiovascular disease often runs in families – a factor which led to the debate on whether we inherit it from our parents or acquire it through diet and lifestyle habits. The answer is both. As you’ll discover, your level of cholesterol, triglycerides, homocysteine and lipoprotein(a) all predict an increased risk of cardiovascular disease. The tendency to overproduce these appears to be, in part, inherited, yet your diet can prevent these risk factors ever emerging and can also reverse the risk once developed. This means that even if you have a family history of cardiovascular disease you don’t have to suffer. In any case, family histories of disease often have nothing to do with inheriting genetic predispositions as such, rather they occur from inheriting certain lifestyle and dietary habits that put you at risk. In both cases the good news is that you can do something about it. This is especially encouraging, since it is a lot easier to improve your diet than to change your genes. And the earlier you start the better.

Does heart disease start in the womb?

Thanks to the extraordinary work of Professor Barker and colleagues at the Environmental Epidemiology Unit at Southampton University we now know that cardiovascular disease can be ‘programmed’ during foetal development, depending on the nutrition a foetus receives from its mother during pregnancy.

The researchers found that those born with a low birth weight had a high risk of hypertension, diabetes and cardiovascular disease later in life. Other surveys had found double the risk of cardiovascular disease or diabetes in infants who were thin at birth or short in terms of body length.

To investigate this new risk factor more fully, Professor Barker collaborated with researchers from Helsinki University Central Hospital in Finland in a remarkable study of 3,302 men born in the hospital between the years of 1924 and 1933.5 Since Finland has among the highest cardiovascular disease rates in the world, and an excellent system for recording details at birth, here was a unique opportunity to put the ‘foetal programming’ theory to the test. They tracked down each of these 3,302 men to determine whether they were alive, and, if so, their health, and, if not, their cause of death. What they found confirmed the strong connection between foetal development and a later risk of cardiovascular disease and also gave strong clues as to why.

The men with the highest rates of death from cardiovascular disease were those who were thin at birth, where the placenta was low in weight, and where the mother was short and fat. Professor Barker explains this finding in the following way. If a mother is grossly undernourished during foetal development and infancy she will grow up to be shorter. As her nutrition improves in adulthood she gains weight, but not height, so ends up short and fat. The ability to produce a large, healthy placenta, which is the network of blood vessels that nourish her offspring during pregnancy, is more dependent on her own early development not just her level of nutrition during pregnancy. So her offspring will not have as good a supply of nutrients during the development of her foetus, despite her own improved nutrition. As a consequence her baby is more likely to be short and thin, indicating poor foetal nutrition, and will have a greater risk of diabetes and cardiovascular disease later in life. Conversely, a taller well-nourished mother giving birth to a chubby baby means minimal risk of cardiovascular disease later in life.

Survival of the fattest

But what exactly is going on in the womb that programmes disease decades later? The theory is that the developing foetus adapts to the inadequate nutrition by changing its metabolism and organ structure, favouring protection of the developing brain. The end result is that the infant is effectively born with insulin resistance (problems with blood sugar control: the hormone insulin becomes less able to lower sugar in the blood, potentially leading to diabetes later in life). This altered metabolism of glucose and resistance to insulin programmes the infant to develop blood sugar and cardiovascular problems later in life.

Of course, if you happen to have been born small and thin to a mother who was short and fat this news may not be exactly welcome; however, what we now know about insulin resistance is that a specific nutrition strategy, including the right balance of protein and carbohydrate, plus key amino acids, vitamins and minerals, may be able to reprogramme metabolism to reduce the risk. Also, knowing this, early nutritional intervention in infants born short and thin in relation to their gestational age may have a significant effect in reducing the risk of cardiovascular disease later in life.

The first 1,000 days

It isn’t just what happens during pregnancy that sets the cardiovascular disease clock ticking. The wrong kind of diet in the first few years of life can switch a child’s metabolism towards metabolic syndrome later in life. Although we used to have the concept that a person’s genes contain programmes that run the body and are ‘fixed’ to run so there’s nothing you can do to change them, since the early 1990s there has been research into the effects of the environment on genes. Epigenetics is the study of how the environment that genes are exposed to can actually switch genes on and off – at a cellular level this is largely to do with what you eat and drink. This is called genetic expression; it isn’t just an on/off switch but a process by which genes can be hyped up or dampened down.

The most important diet to feed yourself and infants is a low-GL diet – my Heart-friendly Diet – as explained in Chapter 21. (Pregnant women would also do well to follow this, see my book Optimum Nutrition Before, During and After Pregnancy; as would children, see Optimum Nutrition for Your Child.) The core principles are, in essence, the same for healthy children and healthy adults.

The environment is more important than the genes

What research is learning is that the environment to which we are exposed, especially the nutritional environment during foetal development and early life, but also throughout life, is as important as the genes we inherit. You can always, at considerable expense, have a genetic screen test to find out if you have any of the genes that would create a weakness in your biological matrix, so to speak. If the gene is active, the end result is that one of these markers, which I’ll be discussing in detail later, will be raised – then you could take the appropriate action. If, for example, you have the genes that raise homocysteine, then why not measure your homocysteine and, if it is high, take more of the B vitamins that lower it? If you have the genes that raise lipoprotein(a) and LDL cholesterol and lower HDL, then why not measure these and, if high, take high-dose vitamin B 3 (niacin)? I will be explaining exactly what to measure, and what to do to lower your risk, whatever your genetic predisposition might be.

Even those with genetic predispositions, or inherited predispositions due to a poor nutritional environment during foetal development, can decrease their risk through nutritional intervention. There is something positive that you can do to change the quality and length of your life.

How to get sick – guaranteed results

The good news is that after years of confusing, conflicting and complicated research and theories, we are starting to see some light at the end of the tunnel. A clear picture of how cardiovascular disease develops is emerging. With the knowledge of what you need to do to get heart disease, all you need do is flip the card to know how to prevent and reverse the situation.

The story starts before birth, ends with premature death and goes like this:

1 Inherit the genes that predispose you to producing lipoprotein(a) and homocysteine.

2 Be born short in length and skinny to a short, overweight mother, thereby developing insulin resistance.

3 Eat a refined-food diet deficient in vitamins C, B3, B6, B12 and folic acid, thereby increasing lipoprotein(a) and homocysteine.

4 Expose yourself to plenty of oxidants from fried and burnt food, smoking, pollution and exhaust fumes.

5 Eat a diet deficient in antioxidant nutrients such as beta-carotene and vitamins C and E by avoiding fruit and vegetables, raw nuts and seeds.

6 Eat plenty of saturated fat from meat, dairy produce and non-free-range eggs and be deficient in essential fats from carnivorous fish, nuts and seeds.

7 Eat plenty of carbohydrates from sugar and refined foods.

8 Drink excess alcohol, avoid exercise, don’t deal with your emotions and stay stressed. Also, eat when you are stressed.

9 Raise your blood pressure by eating salted and high-sodium foods, while avoiding fruits and vegetables, which are rich in important magnesium and potassium.

Do all this and you can reliably expect to have cardiovascular disease at a young age. On the other hand, eliminate these factors and you can expect to lead a long and healthy life, free from cardiovascular and other related diseases, adding at least ten years to your life, and improving its quality. Part 2 gives you a clear way to assess and reduce your risk.

The Holford low-GL diet put to the test

It is one thing to know what to do and another to do it. For this reason I set up some highly motivational groups across the UK and abroad, called Zest4Life. Run by registered nutritional therapists, the groups are attended by participants once a week for ten weeks, during which they learn how to start hardwiring good habits.

Ideally, these good habits mean a better diet, the right supplements, and exercise and lifestyle changes to reduce stress. We recently completed a 12-week project to assess the impact of the Zest4Life low-GL diet, including many of the key diet factors you’ll be learning in this book, on a group of 21 patients at a GP surgery in Berkshire. All the participants had been identified as being at high risk of developing diabetes and/or heart disease, and exhibited one or more of the following risk factors (which are also a sign of metabolic syndrome, and I will be discussing this further in Chapter 3):

Impaired fasting glucose

Elevated glycosylated haemoglobin (HbA1c)

Waist-to-hip ratio greater than 1 for men or 0.85 for women

Elevated blood pressure

Elevated LDL, and HDL and triglycerides outside the target range

Patients were encouraged to follow the low-GL eating plan and were supported in making lifestyle changes, including exercise and developing new habits. Nutritional supplements were not used, as we wanted to test the effects of the diet plus lifestyle changes alone. The clinical markers for chronic disease listed above were measured at the beginning of the programme and again at the end of 12 weeks, and weight and body composition were tracked during the 12 weeks.

The results speak for themselves. Everyone taking part lost weight and nine of the 21 participants lost over a stone (7kg). For the majority of participants, there was a clinically significant reduction in most of the markers. Not all these markers will make sense to you at this stage, but after you’ve finished reading Part 1 turn back and check out these results again.

Case Study: Roger

In his own words Roger describes the experience and the results.

‘Although I was not grossly overweight or particularly unfit, joining Patrick Holford’s Zest4life group for a 12-week programme gave me the opportunity to exercise some control over the direction of travel of my own health, reducing my risk of obesity, heart disease, high blood pressure and diabetes – all associated with diet and exercise.

‘The structure of weekly group meetings provided practical “bite size” knowledge of nutrition, supporting and justifying the changing of our eating habits and exercise routines. Being given weekly factual data of “outcomes/results” from the weight and body analysis machines was very motivational in monitoring the direct effects of the changes we were making. Clearly the level of motivation was directly proportional to the level of commitment individuals were able to make to change. Many of the improvements recorded in our blood results between the beginning and the end of the programme were truly impressive. For me personally the experience is potentially life changing and maybe even life saving. Before starting the programme I was eating what I thought was a reasonably healthy diet almost devoid of any processed foods, ready meals and takeaways so I was surprised that my risk of suffering heart disease and diabetes was much higher than I could reasonably have expected. This risk was reduced by half following the 12-week programme and in the process I lost nearly 1½ stone [9.5kg] in weight (from 16 stone 8 lbs [105.25kg] to 15 stone 2lbs [96kg]).

‘What I found really convincing as a natural sceptic was the considerable lowering of blood pressure from 128/88 to 100/66 and other test results that showed a truly significant improvement, especially the reduction in triglycerides from 5.4 to 1.2 [a 78 per cent reduction] and HbA1c dropping from 6 per cent to 5.3 per cent [11.67 per cent]. Amazingly, these improvements were achieved purely by making relatively few changes to my eating habits and taking regular but moderate exercise involving walking and cycling. The only medication I had been taking prior to the programme was for hypertension, and as a result of my reduced blood pressure my doctor has reduced the dose by half, and he has commented that this is not a very common occurrence. I now have the knowledge and tools to continue to improve my overall health.’

Any drug that could produce these kinds of results would be an instant best-seller. Yet, here you see that small changes to your diet and exercise can make a massive difference to preventing and recovering from heart disease. As you’ll see later, adding certain nutritional supplements can make a big difference, but they are supplements to a healthy diet, not a substitute for it. Sometimes it’s necessary to have the support of a group of people or to see a nutritional therapist one-to-one, and I’ll let you know how you can do this. But the first step to taking control of your heart health is to get informed. The rest of Part 1 explains the nature of the problem, and how your cardiovascular system works. Then, in Part 2, I’ll examine the main keys to preventing and reversing heart disease.


Understanding Blood Pressure and Pulse

Inside you is an amazing network of blood vessels which, if put end to end, would reach the moon! At their widest point these blood vessels measure 2.5cm (1in). At their narrowest point – the capillaries – they are only 1/400,000th of a centimetre. The cardiovascular system is made up of the heart and these blood vessels, which carry oxygen, fuel (in the form of glucose), building materials (amino acids), vitamins and minerals to every single cell in your body. Blood becomes oxygenated in the lungs where the tiny blood vessels (capillaries) absorb oxygen and then discharge carbon dioxide, which we breathe out. The oxygenated blood is then fed into the heart, which pumps it to all our cells. In the cells the blood vessels once more become a network of extremely thin capillaries through which oxygen and other nutrients pass.

Oxygen plus glucose is needed to make energy within every cell. The waste products are carbon dioxide and water, which pass from the cells into the capillaries. Blood vessels supplying cells with nutrients and oxygen are called arteries, while those that carry away waste products and carbon dioxide are called veins. Arterial blood is redder because oxygen is carried on a substance called haemoglobin, which contains iron, giving it a red tinge. The pressure in the arteries is also greater than in the veins. As well as returning to the heart, all blood passes through the kidneys, where waste products are removed and formed into urine, which is stored in the bladder ready for excretion.

The cardiovascular system

One of the first signs of cardiovascular disease is increased blood pressure. To picture what happens, imagine a hosepipe attached to a tap that turns on and off. When the tap is on the pressure is greatest, and when the tap is off the pressure is lowest. That’s what blood pressure is all about. A blood pressure of 120/80 means that the maximum pressure when the heart has just beaten is 120 units, and the minimum pressure when the heart is in a lull is 80 units. A blood pressure (also called BP) measurement consists of these two numeric readings. The first, written on top, is called systolic; the other, written underneath, is the more important diastolic, which measures the pressure when your heart is at rest. BP is measured in millimetres of mercury, written as ‘mmHg’ because HG is the symbol for mercury. A normal reading would be around 120/76 mmHg. If your blood pressure is above 140/90, you have hypertension – high blood pressure.

Approximately one in four people in the UK have hypertension, whereas only half the population have a blood pressure in the optimal range (below 120/80).

To understand what causes this, imagine that the hosepipe I used as an illustration earlier was metal rather than rubber. This would raise the pressure. If the hosepipe was furred up, or if the fluid was thicker, these too would raise the pressure. So raised blood pressure is a reliable indication that all is not right. Life-insurance companies rely heavily on blood pressure to predict expected lifespan.

The symptoms of hypertension include nosebleeds, tinnitus (ringing in the ears), dizziness and headaches – but you can easily have it without any obvious signs. Hypertension can be the result of any one of three main changes in the artery and is usually a combination of these:

Increased constriction The blood vessels contain a layer of muscle. If this muscle contracts too much the pressure increases. Smoking, caffeine and stress can cause this kind of constriction as can too much salt (sodium), or not enough magnesium, calcium or potassium. Insulin, the sugar hormone, also causes the kidneys to retain both water and salt, which then pushes up your blood pressure. This is because you have a greater volume of water in the blood, and because salt controls the balance between muscles contracting and relaxing. That’s why balancing blood sugar, which reduces insulin, is critical for lowering blood pressure (see Chapter 8). When you’re frightened or you’re exercising you need your blood vessels to tense and narrow to pump more blood around the body, but then they should relax. When they stay tense for too long the result is high blood pressure – or hypertension. That’s why stress is a major factor in heart disease, which I’ll be discussing in Chapter 9.

Thicker blood If the blood is thicker, or stickier, this alone can cause small increases in blood pressure. The blood contains tiny plates, called platelets, which stick to each other. This ability to clot is what stops you bleeding to death if you cut yourself. Too much clotting, however, and you increase the risk of producing life-threatening blood clots, especially if the arteries are already narrow due to atherosclerosis.

Atherosclerosis This is a term that has come to mean a narrowing of a blood vessel due to damage and thickening of the blood vessel wall, often resulting in increased deposits of cholesterol and other substances. The blood vessel may also become more rigid and less elastic, increasing the pressure, much like the skin loses its elasticity with age. This can be caused by oxidation, fuelled by a lack of antioxidants, and also by sugar damage and raised homocysteine.

Blood pressure control is a complex, normally self-regulating system that is partly controlled by the ebb and flow of two pairs of minerals in and out of the cells lining the blood vessel walls. One of these pairs consists of sodium (salt) and potassium; sodium inside the cell pushes the pressure up, potassium inside brings it down. The other pair consists of calcium and magnesium – calcium raises while magnesium lowers. This explains why you’re advised to keep your salt intake down (more sodium raises BP) and why one of the types of drug is a calcium channel blocker (keeping calcium out lowers BP). But it also highlights the way that two halves of the pairs are largely ignored by the conventional approach. As we’ll see in Part 2, getting good amounts of potassium and magnesium in your diet or via a supplement is a sensible starting point for any blood pressure-lowering regime.

The body produces a potent antioxidant, nitric oxide (NO), to help promote healthy circulation and normal blood pressure. NO expands blood vessels, stops platelets clumping together, and reduces atherosclerosis, all of which helps control blood pressure. Many drugs work by mimicking or promoting NO; for example, a whiff of nitrogylcerine has an immediate, but short-term effect like NO. The famous Viagra drug, first introduced for cardiovascular health, promotes NO and hence circulation to the sex organs. It didn’t prove sufficiently effective for heart disease. Later on we’ll talk about nutrients that help promote NO.

Your ideal blood pressure and pulse

A blood pressure of 120/80 or less is ideal. A top figure (the systolic pressure) of more than 140, or a bottom figure (the diastolic pressure) of more than 90, indicates a potential problem. A blood pressure of 150/100 indicates a serious risk of heart disease; for example, a 55-year-old man with a blood pressure of 120/80 will, on average, live to the age of 78. A 55-year-old man with a blood pressure of 150/100 is predicted to live to 72. High blood pressure, or hypertension, is a silent killer. Only one in ten people with raised blood pressure are aware of it. After the age of 25 most people’s blood pressure increases quite rapidly. So a yearly blood pressure check is always recommended. If you’re healthy there’s no reason why your blood pressure should increase with age. Many primitive cultures show no such rise.

What your pulse and blood-pressure readings indicate

Low risk







Blood Pressure










Your pulse rate, the number of heartbeats a minute, is less a measure of the health of your blood vessels and more an indication of the fitness of your heart; for example, a very fit cyclist may have a pulse rate of 40 whereas many people have a pulse rate of 80 beats per minute. So the cyclist’s heart can get all the blood round the body with half the number of beats. His or her heart, which is essentially a muscle, is clearly stronger. The healthiest people have a pulse rate below 70 beats per minute. Interestingly, there is one lifespan statistic that is relatively consistent for all animals. We all have around 3 billion heartbeats in a life. It follows that if your pulse rate were 80, you would have a lifespan of 71 years, if it were 60, 95 years. The better your diet and exercise regime the lower your pulse will be.

Both your pulse and blood pressure can be lowered with optimum nutrition. A three-month trial on 34 people with high blood pressure at the Institute for Optimum Nutrition in London achieved an average 8-point drop in systolic and diastolic blood pressures, with the greatest decreases in those with the highest initial blood pressure.6 Dr Michael Colgan found that, irrespective of age, people placed on comprehensive nutritional supplement programmes for five years had gradual decreases in blood pressure from an average of slightly above 140/90 to below 120/80.7 Dr Colgan also found that their pulse rate dropped from an average of 76 to 65 over the five years.

The effects of multinutrients on blood pressure and pulse

In Chapter 18 I’ll show you how to put all these pieces together to lower your blood pressure to normal.


Understanding Blood –

Cholesterol and Triglycerides

Most people think that eating too much fat and high-cholesterol foods blocks the arteries with cholesterol and that causes a heart attack. Every part of this sentence is untrue, as I will show you. Nevertheless, having a high cholesterol level is a risk factor for heart disease, but why your level goes high has almost nothing to do with eating cholesterol.

Cholesterol is a vital nutrient for both your body and brain, where it is most concentrated. The body actually makes cholesterol in the liver and we all carry approximately 150g (4¾oz) of it in our bodies. Of this, only 7g (¼oz) is carried in our blood. The body needs cholesterol to make sex and stress hormones and vitamin D and to digest and transport fats (lipids). It’s also vital for brain function because it helps the brain cells to work properly. Cholesterol is not really the villain in relation to heart disease, but what happens to cholesterol is part of the problem.

Having said that, having a high blood cholesterol level, especially LDL cholesterol, is associated with a doubling of the risk of cardiovascular disease. But it is the type of cholesterol in the body and the way the body clears the excess from the arteries that makes cholesterol relevant.

The ins and outs of Cholesterol

Cholesterol is made in the liver and should return there after it has been released in bile into the digestive tract, where it helps to digest fats before being reabsorbed into the bloodstream. Certain protein ‘ships’, known as low-density lipoproteins (LDLs), have been found to be responsible for carrying cholesterol to the artery wall. Others, high-density lipoproteins (HDLs), help to return cholesterol to the liver. So if you have a low LDL cholesterol count and a high HDL cholesterol count, that is good news because it would mean that most of your cholesterol was on the HDL ‘ship’ that could remove it from the arteries. Actually, even LDL cholesterol is not all bad – we need some of it. But when there’s too much it becomes particularly prone to oxidation and also glycation (a damaging process linked to too much sugar in the blood), and then the LDL particles don’t look or function correctly. The immune system, your police force, ‘arrests’ them, engulfing them with cells called phagocytes, which then become full of fat and become ‘foam’ cells, which are found in the plaque of damaged arteries and are the main process that causes atherosclerosis.

How the body transports cholesterol

HDL cholesterol is sometimes thought of as ‘good cholesterol’ and LDL cholesterol as ‘bad cholesterol’. Because of this, the cholesterol test reports not only your overall cholesterol level, but also how much of that cholesterol is on the good HDL ship, and how much is on the bad LDL ship. If, for example, you have a high total cholesterol and much of it is in the form of LDL, your risk is high. Whereas if you have a low total cholesterol and much of it is on the HDL ship your risk is low. This is usually reported as the ratio of total cholesterol to HDL cholesterol. If it’s 5:1 you have an average risk, if it’s 8:1 you have a high risk and if it’s 3:1 you have a low risk. Later on we’ll examine the effect of drugs on changing your cholesterol statistics for the better, and what this means in terms of risk reduction.

Your ideal cholesterol statistics

Most laboratories will report a ‘normal’ range for total blood cholesterol of somewhere between 3 and 5mmol/l. Many cardiovascular experts, such as Dr Malcolm Kendrick, author of The Great Cholesterol Con, argue that you don’t have to have a cholesterol level below 5, especially if more of your cholesterol is the HDL form. The upper level of the normal total cholesterol range used to be 6 and, statistically, having a level below this, between 5 and 6, doesn’t increase risk. Some experts consider the ever-lowering ‘normal’ range has much more to do with widening the market for statin drugs than the evidence of any risk.

Although high cholesterol is considered a significant risk factor, low scores have, until recently, been ignored. Yet increasing evidence is linking low cholesterol levels to a number of mental and physical health problems. Among these are a hyperactive thyroid, certain cancers, suicidal and homicidal tendencies and mental illness. So there is a healthy balance – not too high, not too low. (Some cardiologists have the view that the lower your cholesterol the better and give strong drugs, statins, even to those with normal cholesterol levels. We will explore this idea in more detail in Chapter 6.)

Ideally, your HDL should be above 1.6mmol/l. If your HDL is below 1.04 mmol/l that’s indicative of metabolic syndrome and a higher risk of heart disease.

One point to bear in mind is that so-called ‘normal’ cholesterol levels are based on people in average poor health. So what ranges exist in healthy people? This is the question Dr Emmanuel Cheraskin and colleagues set out to answer in a study on 1,281 doctors, using an accepted health rating scale, called the Cornell Medical Index (CMI), in which the participants complete a questionnaire asking health-related questions. In the entire group, they found a range of cholesterol scores between 2.8 and 13.5mmol/l. The healthiest people – those with a score of 0 on the CMI – had cholesterol levels between 4.6mmol/l and 6.2mmol/l.8 In another study on dental students, Cheraskin measured the effects of eliminating refined carbohydrates and comparing it with the health of their gums. Those who achieved the best dental rating after dietary changes had cholesterol scores in the narrow band of 4.9 to 5.4mmol/l. I’d suggest that the healthiest cholesterol level is between 3.5 and 5.5mmol/l provided you’ve also got high HDL levels.

Triglycerides – fats in the blood

Although nutritionists have been writing about the importance of triglycerides for several years, they have only recently been taken seriously as a major risk factor – perhaps more so than cholesterol. All fats, good and bad, are carried in the blood in the form of triglycerides. Sugar and alcohol can also be converted in the liver into fat, so they too can increase your level, as can eating too much fat, especially saturated fat. The fruit sugar, fructose, particularly, raises triglycerides.9 The second biggest influence is a lack of omega fats. Increasing your intake of omega-3s (from fish, raw nuts and seeds) actually halves your triglyceride level so you need to have more omega-3 fats and fewer saturated or damaged trans-fats. (I’ll go into this in much more detail in Chapter 7.)

An optimal triglyceride level is around 1mmol/l. You certainly don’t want to have a level above 3.9 mmol/l, although, according to one study in the US, about a third of adults do, and the percentage is much higher among those who are both overweight and don’t exercise.10 Eating high-fat foods, such as red meat and dairy products, or a high-sugar or diet that is ‘high GL’ (meaning full of refined foods), especially if you have insulin resistance, raises your triglycerides, as does drinking too much alcohol.

Certain drugs, notably the contraceptive pill, steroid drugs (based on cortisone) and diuretics, given to lower blood pressure, can also increase triglycerides.

Triglycerides are normally tested as part of a routine medical and would be included in a standard medical screening. If you ask for a copy of your test results, this will be shown. If you’ve had your cholesterol measured, the chances are you will also have a result for your triglycerides. Ideally, your level should be below 1 mmol/l and certainly not above 2.5 mmol/l.

Although triglycerides are now being increasingly recognised as an independent indicator of risk, there is much debate about whether or not triglycerides actually cause heart disease. It is certainly likely that having too many circulating blood fats puts pressure on the clearance systems, involving HDL, and may provide more unhealthy lipoproteins which can contribute to arterial damage and the development of plaques.

The perfect ratio – low triglycerides:high HDL

Probably the most predictive measure of all is your HDL-totriglyceride ratio. This is because your triglycerides go higher in direct response to the excess fat you make if your blood sugar keeps going too high. This happens because the liver converts the excess glucose (or alcohol) from the blood into fat. As blood sugar spikes increase, the more LDL cholesterol and the less HDL cholesterol you have. This ratio is the most predictive of cardiovascular disease, so you should aim to get your ratio of triglycerides to HDL down to 3 or lower; for example, if your triglyceride level is 2 and your HDL level is 1, then you have a relatively low risk. For good health you want to have high HDL cholesterol and low triglycerides.

Is your metabolism overheating?

Whether you already have heart disease or you are concerned about the possibility, or if you are overweight and not feeling great, there’s a very good chance that your metabolism is already starting to shift into an unhealthy pattern which, when particularly pronounced, is called ‘metabolic syndrome’. This is a precursor for both heart disease and type-2 diabetes. Heart disease is just one of a number of increasingly common health issues of the 21st century that are probably affecting you and members of your family, right now. And to get to the source of the problem it’s important to recognise that good health means addressing the other health issues that are connected to it. Have a look at the illustration below; which diseases do you or your close circle of family and friends have? Many of those health issues were extremely rare a hundred years ago, so what has changed to make us more susceptible to them?

Health issues associated with metabolic syndrome

If you are suffering from what I call ‘internal global warming’ that means that you have metabolic syndrome. The cluster of problems illustrated above is being recognised more and more in mainstream medicine as metabolic syndrome, originally called ‘syndrome x’. Since mainstream medicine prefers objective test results to nebulous ‘subjective’ symptoms, metabolic syndrome is officially diagnosed when you have three or more of the following:

High blood sugar or glycosylated haemoglobin (above 5.7 per cent)

High blood pressure (above 130/85)

Increased waist circumference (above 102cm (40in) in men or 89cm (35in) in women)

High triglycerides (above 3.9)

Low HDL cholesterol (the ‘good’ cholesterol – below 1.03 in men and 1.3 in women)

Insulin resistance

Many of these will be measured in a standard screening for cardiovascular health. You can also complete a free online Metabolic Check at This is part of an overall free check called the 100% Health Check. It will give you a better idea as to whether or not this is likely to be a problem for you.

An analysis of 87 studies involving almost a million people found that people with metabolic syndrome more than double their risk of developing cardiovascular disease, having a stroke or a heart attack or dying from it.11 So it is important that you work on reversing this trend, and I am going to tell you how to do this in Parts 2, 3 and 4. The single biggest key is to eat a low glycemic load (low-GL) diet – my Heart-friendly Diet – which I explain in Chapter 8.


The Red Herring of

Cholesterol and Fat

Back in 1913 a Russian scientist, Dr Anitschkov, thought he had found the answer to heart disease: he found that it was induced by feeding cholesterol to rabbits. What he failed to realise, however, was that rabbits, being vegetarians, have no means for dealing with this animal fat.

Since the fatty deposits in the arteries of people with heart disease have also been found to be high in cholesterol, it was soon thought that these deposits were the result of an excess of cholesterol in the blood, possibly caused by an excess of cholesterol in the diet.

Such a simple theory had its attractions and many doctors still advocate a low-fat, low-cholesterol diet as the answer to heart disease, despite a consistent lack of positive results. In truth, this prevailing myth has been fuelled by the existence of highly profitable statin drugs, sold for their cholesterol-lowering ability, which are more easily marketed by making cholesterol the villain.

If the cholesterol theory were correct, we could expect that:

A Eating lots of dietary cholesterol and fat would raise blood cholesterol and that people who do this would have a high incidence of heart disease;

B Blood cholesterol levels would be good predictors of heart disease, and lowering blood cholesterol level would reduce the risk.

You would then have to prove that A leads to B, in other words that eating cholesterol raises cholesterol, which leads to heart disease.

Let’s examine the evidence for the cholesterol theory, step by step, starting with whether or not eating cholesterol raises blood cholesterol.

Putting cholesterol to the test

An average egg contains about 275mg of cholesterol and two-thirds of its calories come from fat. So eggs are the perfect candidate for testing the theory that eating cholesterol, or high fat, raises blood cholesterol.

Dr Alfin-Slater, from the University of California, was one of the first, back in the 1970s, to test the cholesterol theory.12 ‘We, like everyone else, had been convinced that when you eat cholesterol you get cholesterol. When we stopped to think, none of the studies in the past had tested what happens to cholesterol levels when eggs, high in cholesterol, were added to a normal diet.’

He selected 50 healthy people with normal blood cholesterol levels. Half of them were given two eggs per day (in addition to the other cholesterol-rich foods they were already eating as part of their normal diet) for eight weeks. The other half were given one extra egg per day for four weeks, then two extra eggs per day for the next four weeks. The results showed no change in blood cholesterol. Later, Dr Alfin-Slater commented, ‘Our findings surprised us as much as ever …’

I’ve kept an eye on studies ever since and they all show the same thing: eating cholesterol doesn’t raise blood cholesterol. Here’s a more recent study from the University of Surrey in 2009. The researchers fed two eggs per day to overweight but otherwise healthy volunteers for 12 weeks while they simultaneously followed a reduced-calorie diet. A control group followed the diet but cut out eggs altogether.

Both groups lost between 3–4kg (6½–9lb) in weight and saw a fall in the average level of blood cholesterol.13 Research leader, Professor Bruce Griffin, stated: ‘When blood cholesterol was measured at both six weeks and twelve weeks, both groups showed either no change or a reduction, particularly in their LDL (bad) cholesterol levels, despite the egg group increasing their dietary cholesterol intake to around four times that of the control.’

But what if you’ve got a high blood cholesterol level already? A study from the University of Washington took 161 people with high cholesterol levels and fed them either two eggs a day or a cholesterol-free egg substitute. After 12 weeks those eating two eggs a day had a tiny non-significant increase in LDL cholesterol of 0.07mmol/l, and a significant increase in the ‘good’ HDL of 0.1mmol/l, and therefore no real change in the ratio of HDL to LDL cholesterol, which is the more important statistic.14 To put this in context, if you turn to page 29 you’ll see that having an LDL cholesterol below 1.8 is consistent with a low risk whereas having a level above 3.4 is consistent with a high risk. A tiny 0.07 increase is inconsequential.

What if there’s something special about eggs? Other foods rich in cholesterol include shrimps. A more recent study from Rockefeller University gave participants either three servings (300g/10½oz) of shrimps or two large eggs a day, each providing 580mg of cholesterol. Researchers found that both groups had an increase in both the good HDL cholesterol and the less desirable LDL cholesterol, which they interpreted to mean that neither diet would be likely to make any significant difference to cardiovascular risk.15

Does eating high-cholesterol foods increase heart disease risk?

Surely eating lots of eggs or other high-cholesterol and high-fat foods must be bad news? The Inuit people of North America (Eskimos) were always an enigma with regard to the cholesterol theory. Their traditional diet, high in seal meat, has among the highest cholesterol levels of any cultural diet, yet their rate of cardiovascular disease is among the lowest. We now know, however, that their diet of seal meat is exceptionally high in omega-3 fats, which confer protection, as I’ll explain in Chapter 7. But what about people eating high-cholesterol foods that aren’t high in omega-3?

In fact, as long ago as 1974, a British advisory panel set up by the government to look at ‘medical aspects of food policy on diet related to cardiovascular disease’ issued this statement: ‘Most of the dietary cholesterol in Western communities is derived from eggs, but we have found no evidence which relates the number of eggs consumed to heart disease.’16

Every study I’ve ever seen says the same thing. Study after study has repeatedly failed to find any increased risk of heart disease from eating six eggs a week.17 One study finds that seven eggs or more a week confers a very slight increased risk but this is not confirmed by other studies, while two studies find that the risk is slightly higher in diabetics either eating lots of eggs or having a very high cholesterol intake in their diet.

It is now evident that there is no clear relationship between intake of dietary cholesterol and cardiovascular disease. How many millions of people have been avoiding eating eggs unnecessarily?

Having said this, however, a lot of high-cholesterol foods also happen to be high in saturated fat and are often also fried. Although this might not significantly raise cholesterol, you might get more oxidised cholesterol, which is bad news. It is therefore prudent not to go overboard on high-cholesterol foods, while at the same time there is no need for cholesterol phobia.

So if you are not diabetic you can assume that it is certainly safe to have six eggs a week. If you are diabetic it may be wise to limit your total cholesterol by having no more than three eggs a week and fewer other cholesterol-rich foods such as prawns, shrimps and shellfish; however, it is likely that if your overall diet is healthy, following the principles in this book, even this may be unnecessary.

Does eating a high-fat diet increase heart disease risk?

We’ve all been told to eat low-calorie low-fat diets, and supermarkets are full of low-fat foods that imply they can reduce your risk of heart disease.

There are a lot of inconsistencies in this subject in that some countries with a high fat intake (for example Finland) have a high rate of heart disease while others (like Greece) have a very low rate of heart disease. Then, of course, we have the Inuit, and also Pacific and other islanders who eat a large amount of coconut produce, high in saturated fat, and have a low risk of heart disease.

In 2010 the American Dietetic Association hosted the Great Fat Debate with top experts to explore these inconsistencies. One of these was Professor Walter Willetts from Harvard School of Public Health. He summarised the findings from decades of research.18 For example, in 1989, the National Academy of Sciences concluded that the intake of total fat, independent of the relative content of different types of fatty acids, is not associated with high blood cholesterol levels and coronary heart disease. A review by the Food and Agricultural Organization, as well as a World Health Organization review, also states that there was no probable or convincing evidence for significant effects of total dietary fat on coronary heart disease.19 However, if you do eat less fat you are also going to be eating more of something else, and what you replace it with makes all the difference. According to Willetts, ‘If you replaced saturated fat with polyunsaturated fat there was a reduction in risk [of heart disease]. But if you replaced total fat or saturated fat with carbohydrate, no reduction in risk [was found].’ In Chapter 7 you’ll see that increasing omega-3 fats, which are the most polyunsaturated, reduces your risk, while increasing your carbohydrate load, explained in Chapter 8, quite dramatically increases your risk and also raises both cholesterol and blood fats (triglycerides).

The same conclusion is reached in a study of studies: a metaanalysis in the American Journal of Clinical Nutrition reports that ‘an independent association of saturated fat intake with cardiovascular disease risk has not been consistently shown in prospective epidemiologic studies’. Replacement of saturated fat by polyunsaturated or monounsaturated fat lowers both LDL and HDL cholesterol; however, replacement with a higher carbohydrate intake, particularly refined carbohydrate, can exacerbate many risk factors for cardiovascular disease including the ‘atherogenic dyslipidemia associated with insulin resistance and obesity, increased triglycerides, small LDL particles, and reduced HDL cholesterol’.20

In other words, if you eat a diet high in sugar and refined carbohydrates not only are they converted into fat but they also raise cholesterol, whereas slow-releasing carbs, high in soluble fibres, such as oats, reduce risk. In Chapter 17 you’ll also learn about other cholesterol-lowering foods, including beans.

So, even though I have shown you that dietary fat per se, and cholesterol in particular, does not increase your risk of heart disease, switching from a high animal-protein diet towards more fish and vegetable protein, especially soya, does have significant effects in terms of lowering both blood cholesterol and fat levels, as well as reducing heart disease risk.

Cholesterol is more a marker than a cause

Although you’ve seen that eating cholesterol and fat does not raise either blood cholesterol or heart disease risk, you’ll find out that foods that tend to reduce cardiovascular risk do tend to lower cholesterol levels as well. So your blood cholesterol statistics are not irrelevant, they are just not quite as important as we’ve been led to believe. According to Professor Meir Stampfer from Harvard School of Public Health ‘total cholesterol is not a great predictor of risk’. His research group finds that eating a low-carb (low-GL) diet is one of the best ways of both reducing risk and lowering cholesterol.

If you or your doctor rely only on cholesterol to predict risk without assessing other critical risk factors such as triglycerides, homocysteine, glycosylated haemoglobin and lipoprotein(a), you may still be at high risk despite a normal cholesterol level. A massive US survey of 136,905 patients found that more than half of those hospitalised for a heart attack had perfectly normal cholesterol levels (LDL below 2.6mmol/l), according to National Institute of Clinical Excellence and Department of Health guidelines which recommend an LDL below 3mmol/l. Seventeen per cent had healthy cholesterol levels (LDL below 1.8mmol/l).21

A five-year survey of elderly people aged 85 found that cholesterol was also a very poor predictor of cardiovascular death several years later. The best predictor by far is your homocysteine level. If a person’s homocysteine level was above 13, it predicted no less than two-thirds of all deaths five years on.22 (More on this in Chapter 10.)

You certainly don’t want to put all your eggs in the cholesterol basket, because you might miss other important indicators. If you do have a high cholesterol level, however, avoiding cholesterol foods isn’t going to make much difference. But there are other diet and lifestyle changes that will.

The reason for this is that the body needs cholesterol and makes what it needs. It is only when you are eating, or living, in such a way that stops the normal cycle of cholesterol production and clearance by HDL that you start to get a change in cholesterol statistics; for example, if you eat a lot of fried foods or smoke (both of which are high in oxidants) and eat very few vegetables (which are high in antioxidants) cholesterol can become damaged by oxidation. Then the immune system attacks it, producing harmful foam cells. Alternatively, if you eat a high-sugar or high-GL diet, you start making more insulin, and both the high sugar and insulin damage cholesterol particles that start to accumulate. Also, the excess sugar is converted into fat, and up go your triglycerides (blood fats). Also, those soluble fibres in low-GL foods help to eliminate excess cholesterol. So the wrong kind of diet means you have more garbage and less efficient waste disposal, which is reflected by raised LDL and lowered HDL.

It’s not just about diet, though. In Chapter 9 you’ll find out that stress (and exercise) also plays a major part in raising heart disease risk and cholesterol.

It is not really the cholesterol per se that causes the damage that leads to arterial disease, but that high LDL and low HDL cholesterol is a predictive marker, or an indicator, that you are eating the wrong kind of diet or living too stressful a life.

If you take a statin drug that blocks the enzyme in the liver that makes cholesterol it is a no brainer that cholesterol levels will come down. After all, the brain and body need cholesterol to stay healthy. So, in effect, your liver and brain, when starved of cholesterol by taking these drugs, are going to suck every bit of available cholesterol out of the blood for use elsewhere. While these drugs do slightly reduce the risk in those who have heart disease it is highly likely that the mechanism by which they do this involves their anti-inflammatory effects,23 rather than because they lower cholesterol per se. Lowering cholesterol is more likely to be a side effect, and a bad one at that.

Why low cholesterol is as bad for you as high cholesterol

Some people never give up and there’s talk that we just need to lower cholesterol even more to get more benefit from these rather ineffectual drugs – as if the lower your cholesterol is the better.

All the talk of aggressively lowering cholesterol tends to ignore just how vital it is for the smooth running of our bodies; for example, it helps to repair damaged arteries, it is the raw material for making sex hormones, it is vital for laying down memories in the brain and for the proper working of the body’s communication chemicals, called neurotransmitters.24

So it’s hardly surprising that blocking the production of cholesterol in the liver, which is what statins do, causes all sorts of problems. Many of these are simply the problems that happen when you have too low cholesterol, but some are the consequence of statins knocking out the essential nutrient CoQ10.

When you realise that cholesterol is a vital nutrient for the brain and body, it makes no sense to lower it beyond healthy levels (between 4 and 6mmol/l, provided your HDLs are reasonably high). But could low cholesterol be bad for you? Here are a few facts you might want to know:

Having too low a cholesterol level increases the risk of stroke Japan used to have a very low fat intake in the 1950s, and average cholesterol levels of 3.9mmol/l, but it also had a very high number of people suffering haemorrhagic strokes (that’s the worst kind; see Chapter 5 for a full explanation of strokes).25 After following advice to increase fat intake, largely from animal protein, their cholesterol levels went up to an average of 4.9mmol/l by 1999, and their stroke risk went down. In the last 50 years stroke risk (both haemorrhagic and ischaemic) has reduced by 600 per cent.

Having too low cholesterol increases risk of death Once you are getting below 4mmol/l risk of death actually increases. The danger of having too low cholesterol seems strongest in older people, say over the age of 60. This association is made clear in Dr Malcolm Kendrick’s book The Great Cholesterol Con if you’d like to dig deeper.

Having too low cholesterol is also associated with increased rates of depression and suicide According to a study of 121 healthy young women by Duke University psychologist Edward Suarez, low cholesterol is a potential predictor for depression and anxiety.26 An eight-year Finnish study of 29,000 men aged 50–69, published in the British Journal of Psychiatry, found that those reporting depression had significantly lower average blood cholesterol levels than those who did not, despite a similar diet.27 One possible reason is that vitamin D is made from cholesterol and, as we will see in Part 2, exposure to sunlight converts cholesterol in the skin into vitamin D.

Having too low cholesterol is associated with feeling more aggressive This association is thought to be because not having enough cholesterol disrupts serotonin, a key brain neurotransmitter required for balancing your mood.28 Having a low HDL has the strongest association.

None of this should be at all surprising if you recognise cholesterol for what it is: a vital nutrient, and a relatively poor marker for heart disease – certainly not the principal cause. It is extraordinary how much emphasis has been put on it, and its treatment with rather ineffective cholesterol-lowering drugs, as I’ll show you in Chapter 6.

So what does cause heart disease, and how do you reverse it? That’s what Part 2 is about, starting with the need to eat more fat of the right kind: essential omega-3 fats.


Defining Heart Disease

and Understanding

Your Diagnosis

Any disease of the blood vessels is called cardiovascular disease. More popularly it’s known as ‘heart disease’, although this is slightly misleading because cardiovascular disease can occur in the brain too, resulting in a blockage there which can cause a stroke (see below). This is known as cerebrovascular disease (cerebro = brain). Blockages can also occur in the legs and other parts of the body, in which case they are known as thrombosis. But the most common site of blockage is in the coronary arteries, which actually feed the heart itself with blood. This is called coronary artery disease. About half of all deaths from cardiovascular disease are from coronary heart disease and a quarter are from strokes.

The main life-threatening diseases are diseases of the arteries. Over a number of years, changes can occur within the artery walls that lead to deposition of unwanted substances, including cholesterol, other fats and calcium. These deposits are called arterial plaque, or atheroma from the Greek word athr for groats (porridge), because of their porridge-like consistency. The presence of arterial deposits and thickening is called atherosclerosis. Atherosclerosis occurs in very particular parts of the body, as shown on page 45. Atherosclerosis, coupled with thicker blood containing blood clots, can lead to a blockage in the artery, stopping blood flow. If this occurs in the arteries feeding any part of the heart, that section of the heart dies from a lack of oxygen. This is called a myocardial infarction, or heart attack. Before this occurs many people are diagnosed as having angina, a condition in which there is a limited supply of oxygen to the heart due to partial blockage of coronary arteries, characterised by chest pain, usually on exertion or when under stress.

common atherosclerotic sites

Understanding strokes

Stroke affects around 150,000 people in the UK each year.29 It is the third most common cause of death in England and Wales,30 responsible for over 50,000 deaths a year.31 Although most people think that stroke affects only middle-aged or older men, women, young adults and children can all be affected. In fact, stroke accounts for 13 per cent of deaths in women in the UK32 and although men are more likely to suffer a stroke, women are more likely to die from one.

A stroke happ