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Don't Hurry Your Death
Death: Part 2
Low cholesterol increases death rates in young . . .
In 1991 the US National Cholesterol Education Programme recommended that children over two years old should adopt a low-fat, low-cholesterol diet to prevent CHD in later life. A table showing a good correlation between fat and cholesterol intakes and blood cholesterol in seven to nine-year-old boys from six countries was published to support this advice. What it did not show, however, was the even stronger correlation between blood cholesterol and childhood deaths in those countries: it clearly demonstrated that in 5-year-olds, the death rate rises dramatically as blood cholesterol levels fall.[i]
. . . and old alike
Two studies, which considered total blood cholesterol levels and mortality in the elderly, were published in the Lancet almost simultaneously in 1997. In the first, scientists working at Leiden University's Medical Centre found that 'each 1 mmol/L increase in total cholesterol corresponded to a 15% decrease in mortality'.[ii] Similarly, doctors at Reykjavik Hospital and Heart Preventive Clinic in Iceland noted that the major epidemiological studies had not included the elderly. They too studied total mortality and blood cholesterol in men over eighty to show that those with blood cholesterol levels over 6.5 mmol/L had less than half the death rate (48%) of those whose cholesterol level was a 'healthy' 5.2 mmol/L.[iii]
This relationship between low cholesterol and higher mortality was strengthened by a further study published six years later. The UCLA School of Medicine, Los Angeles, studied the association between blood cholesterol levels and 7-year all-cause mortality.[iv] What they found was that people whose cholesterol levels were below 4.4 mmol/L (169 mg/dL) had nearly double the death rate over the period of those with higher levels. While some of this increase was attributed to inflammation and poor diet, the low cholesterol link was still apparent even after these factors had been allowed for.
Studies in Japan added yet more weight to this argument. Japan is reported to have low levels of death from coronary heart disease but Okinawa has the lowest of all. Yet Okinawa's cholesterol levels are similar to those in Scotland ? much higher than the average in Japan. In 1992 a paper examined the relationship of nutritional status to further life expectancy and health in the Japanese elderly based on three population studies.[v] It found that Japanese who lived to the age of one hundred were those who got their protein from meat rather than from rice and pulses. The centenarians also had higher intakes of animal foods such as eggs, milk, meat and fish; significantly, their carbohydrate intake was lower than that of their fellow countrymen who died younger.
These comparisons are important, as Japan might not have the low levels of heart disease deaths that are attributed to it. Although heart disease deaths are reportedly low, deaths from stroke and cerebral haemorrhage are very high. Keys attributed the lowest levels of heart deaths to Japan in his studies. These findings have been used to support recommendations that we should adopt Japanese eating patterns based on fish and rice.
But vital statistics from death certificates are too unreliable for scientific use. One of the recognized facts about Japanese statistics is that the cause of many deaths was not certified by a qualified doctor. Another is that coronary heart disease was an undesirable cause of death; stroke was a more desirable one as it was thought to be indicative of intelligence in the family. More recent autopsies have revealed that stroke is not as common as once believed and that heart disease is much more common than original figures suggested.[vi] This is a good example of why vital statistics used by Ancel Keys and others may be unreliable.
However, if we lump deaths from all causes together, we get a figure that cannot be fudged. Comparing average age at death from all causes and food intake, we find that the Japanese who live longest are the ones who eat the most animal products and the least carbs.
The generally held belief that cholesterol concentrations should be kept low to lessen the risk of cardiovascular disease is clearly wrong. In 2001 Dr Schatz, professor of medicine at the University of Hawaii, wrote: 'those with cholesterol levels widely assumed to healthy had a roughly 35-40% greater chance of dying from any cause in the following 25 years'.[vii] And in 2004 yet another new study suggested that low cholesterol predicted a shorter lifespan.[viii] So don't worry if yours goes up on the low-carb diet recommended on this website.
References
[i]. Child mortality under age 5 per 1,000. 1992 Britannia Book of the Year. Encyclopaedia Britannica, Chicago.
[ii]. Weverling-Rijnsburger AWE, et al. Total cholesterol and risk of mortality in the oldest old. Lancet 1997; 350: 1119-23.
[iii]. Jonsson A, Sigvaldason H, Sigfusson N. Total cholesterol and mortality after age 80 years. Lancet 1997; 350: 1778-9.
[iv]. Hu P, Seeman TE, Harris TB, Reuben DB. Does inflammation or undernutrition explain the low cholesterol-mortality association in high-functioning older persons? MacArthur studies of successful aging. J Am Geriatr Soc 2003; 51: 80-4.
[v]. Shibata H, et al. Nutrition for the Japanese elderly. Nutr Health 1992; 8: 165-75.
[vi]. Stehbens WE. The Lipid Hypothesis of Atherogenesis. RG Landes Co, Austin, Texas 1993.
[vii]. Schatz IJ, Masaki K, Yano K, et al. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet 2001; 358: 351-5.
[viii]. Garasto S, et al. Low cholesterol trait linked to shorter life span. BMC Medical Genetics 2004; 5: 3.
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