Afterthoughts of "The Great Cholesterol Myth"

The Great Cholesterol Myth by Jonny Bowden and Stephen Sinatra
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Book has a lot of numbers and statistics from various studies to back up the author’s claims. It looks for flaws in previous studies using meta-analysis to determine if other conclusions could be drawn from the study. Very Interesting! The book is written for the everyday person to understand. You don’t need to be a doctor or a scientist to understand the authors (Jonny Bowden and Stephen Sinatra).

What makes this book easy to read and understand is Bowden mixes in many real life examples to help make his point. I don't think Bowden has anything to gain (like pharma companies do), so this is a book worth reading. I shared some of the notes that I hope to one day look back on, but I highly recommend you go out and pick up a copy of "The Great Cholesterol Myth: Why Lowering your Cholesterol Won't Prevent Heart Disease - And the Statin-Free Plan that Will" yourself. Even if you don't have high cholesterol or only have heightened cholesterol, it's still a good read that may help you prevent high cholesterol in the future. Don't wait until it's too late!

For me personally, I don't have high cholesterol, but it get's a bit higher every year. I try to do the basics of exercise more and eat healthier, but apart from that, the company I work for that offers free health screenings can't offer more information. One thing Bowden really drove home was that if I ever need to take a statin, to make sure its truely worth it. Possibly do more research specifically on the Clincial Studies that support taking statins and look for flaws.


  • Stress hormones sends signals to your brain it’s time to fuel up for an emergency.
  • Sugar gets sent to muscles, when if inactive will deny it, which forces the insulin to send sugar to fat cells. The fat cells are then “locked” making it more difficult to lose weight. Even worse, the sugar is mixed with chemicals that contribute to inflammation.
  • Insulin resistance is directly related to high blood pressure. Insulin directs the kidneys to hold salt. But to keep the salt levels safe, the body will retain more water equating to higher blood pressure.
  • Chronically elevated insulin increases triglycerides, raises blood pressure, and lowers HDL cholesterol.
  • Triglycerides / HDL Cholesterol = X (if X is 3 or greater, it’s a reliable predictor of insulin resistance. >3 also indicator of more bad LDL (small and dense) cholesterol as opposed to the good LDL (cotton ball) cholesterol.
  • #1 dietary contributor to heart disease is sugar, not fat.
  • Glycation is when sticky sugar attach to structures. Glycated proteins are when sugars get stuck to proteins, making it too big to get through small blood vessels and capillaries. (Explains why diabetics are at risk for kidney disease, vision problems, amputations of toes feet, leg). These are toxic.
  • The sugar lobby exists, where there isn’t a fat lobby. So that’s one reason why sugar is so readily available in everything.
  • Glucose can be used by any part of the body and goes right into the bloodstream. Fructose is metabolic poison because it goes right into the liver and turns to fat (triglycerides). Too much fructose and you’ll get fatty liver. And fatty liver = insulin resistance.
  • Regular sugar (sucrose) is 50% glucose and 50% fructose. High-fructose corn syrup is 45% glucose and 55% fructose. The two are nearly identical, so just because a product is advertised as containing no high fructose corn syrup doesn’t make it any better because it’s been replaced with regular sugar.


  • Find a Fat  101 chart, which shows saturated and unsaturated fats, descriptions, and types. Michelle Moshner.
  • Saturated fat holds up to heater better than unsaturated fats (such as vegetable oil). These oils breakdown into noxious compounds including carcinogens. Restaurants replaced saturated fats for vegetable oils for frying to be more health conscious.
  • Saturated fats do raise cholesterol levels, but its causes HDL levels to go up more than HDL, and makes more of the big fluffy cotton ball cholesterol instead of the small dense inflammatory ones.
  • Swapping saturated fat for low-glycemic carbs (such as vegetables) is okay. But swapping saturated fats for high-glycemic carbs (bread, cereal, pasta) is bad a 33% increase in heart attack.
  • Omega-6s are the building blocks to build inflammatory hormones. Omega-3s are the building blocks for anti-inflammatory hormones. Lots of research shows ideal ratio of Omega-6 to Omega-3 is between 1:1 and 4:1. But the western diet ranges anywhere from 15:1 to 20:1. This feed inflammation in the body!
  • There are 3 types of Omega-3: ALA, EPA, and DHA. ALA is essential because the body can’t produce it. EPA and DHA can be made, but it’s converted from ALA. All Omega-6 and Omega-3 compete for the same enzymes, so too much Omega-6 reduces the amount of Omega-3 in the body.
  • Omega-6 has been incorporated into virtually every baked, fried, and processed food available in the supermarket (and restaurants).

Statin Drugs

  • Statin drugs are anti-inflammatory: they lower C-reactive protein (a protein in blood for measuring systemic inflammation) and decrease blood viscosity (make blood flow better). Statin drugs are good for lowering cholesterol, but not for preventing heart disease.
  • Stain drugs works by cutting off the enzyme responsible for initiating the cholesterol manufacturing pathway. This is good because your cholesterol levels go down. But this is bad because it the pathway for Coenzyme Q10 is downstream of the cholesterol manufacturing pathway. If the cholesterol pathway doesn’t start, the Coenzyme Q10 doesn’t start. And Coenzyme Q10 is one of the most vital nutrients for the heart.
  • Statin drugs work too well. They lower the amount of cholesterol in the brain. The brain needs cholesterol for brain cells to properly “talk” to each other. This negatively impacts cognition and memory. And the brain contains 25% of the body’s cholesterol.
  • Lack of Coenzyme Q10 is a known issue and Merck even developed a drug combination Statin-CoQ10, but never manufactured it, many believe because there was no incentive.
  • As you age, your body makes less Coenzyme Q10, and statins are prescribed more often later in life, so it’s important to know how to preserve it instead of depleting it with statins.
  • Stains reduce inflammation, but the immune system needs it to fight infectious microbes. NF-kB (nuclear factor kappa B) production is blocked by Statins. E-coli and salmonella infect the body by also inhibiting NF-kB.
  • Statins reduce testosterone, which is an increase cause of erectile dysfunction in men. Women also need testosterone and can sometimes be prescribed with it. That alone isn’t a deal breaker in life/death situations. But statins also blocks oxytocin, which reach target organs via cell receptors which are dependent on cholesterol-rich membranes. Lastly, statins interfere with serotonin receptors (preventing serotonin from reaching the brain), which is critical for mood.


  • Understand “relative number” vs “absolute number” to show how numbers can be advertised to sound amazing when there isn’t much true benefit.
  • Understand the difference between “primary prevention” and “secondary prevention”. Primary prevention is preventing the first incident in a patient while secondary prevention is preventing another incident in a patient who has already experienced an incident.
  • Interpreting data. A study can show multiple effects, but the advertisement will only show positive key points and leave out the negative. Studies are often run by the companies selling the drugs.
  • Of 5 major statin drug trials, 84% where primary prevention while 16% were secondary prevention. A total 1.5% reduction in heart attack and total stroke for men. This means you would take an expensive drug for 3-5 years with side effects to reduce your chance of a heart attack or stroke by 1.5%. Coronary events were not reduced by statin therapy in the women (28% of the pool). For both men and women, total mortality is not reduced by statin therapy.


  • If you’re on a statin, you must take Coenzyme Q10 supplements will improve (reduce) blood pressure. Also good for those not on statin drugs.
  • D-ribose helps combat energy-drain effects of certain drugs that cause heart to beat stronger. Energy restoration and benefits for heart failure, cardiac surgery recovery, and restoration of energy, and control of free radical formation in tissues.
  • L-Carnitine supplements help shuttle around fats to the mitochondria in the cell. Shown to improve the ability of those with angina to exercise without pain.
  • Magnesium to block calcium channel to prevent calcium from reaching the cells, which is good for the heart. A study shows of 495 patients, of 41 patients that experienced heart attacks, they saw a 42% increase per year in arterial calcium. Increase in arterial calcium is a 17.2 fold increase in heart attack risk. When magnesium is depleted, the calcium in the cells increase. Magnesium also inhibits platelet aggregation. Magnesium also helps manage blood sugar. Recommends supplementing with 400 mg/day.
  • Niacin. 1000 to 4000 mg of niacin per day lower triglycerides by 20-50% and LDL cholesterol by 10-25%. And it shows the LDL cholesterol reduction is the bad type (small and dense). Niacin also increases HDL by 10-30%. Too much niacin can be bad, as it’s hard on the liver. But this is not seen in patients taking 3g or less per day.
  • Vitamin E is good for the heart, but too much can be pro-oxidant effects. Vitamin E can protect the very low-density lipoproteins (VLDL) against oxidation, which is a good thing. If you take Vitamin E supplements, recommendation is get ones labelled “mixed tocopherols” to avoid problems with pure alpha-tocopherol supplements and problems with synthetic dl-alpha-tocopherol.
  • Fish Oils Omega-3 lowers plasma triglycerides, resting heart rate, and blood pressure. It may also lower inflammation and improve vascular function. Book recommends taking 1-2g of fish oil daily and eat cold water fish as often as possible. Specifically, they recommend the brand Vital Choice, a great source of wild salmon from Alaska. When looking for Omega-3 supplements, (don’t get the cheapest ones) get ones with at least 1g of combined EPA and DHA. Higher DHA because it penetrates more into the heart, brain, and retina than EPA.
  • Pantethine is a type of vitamin B5 that have a positive change to triglycerides, LDL cholesterol and VLDL, and increase in HDL cholesterol. The book recommends 900 mg of pantethine divided into 3 daily doses of 300 mg each.


  • Stress hormones responsible for “fight or flight”. Adrenaline raises heart levels and blood pressure to get blood to organs that need them. Cortisol releases sugars to the bloodstream so they can be burned for energy.
  • Chronic stress leads to an abundance of cortisol which hardens the arteries.
  • When chronically stressed, your body creates more hormones like epinephrine and glucocorticoids, but less of other hormones like growth hormones.
  • Stress hormones produce platelets for clotting blood in anticipation of an injury, which is good for acute stress, but bad for chronic stress. Too much platelets and they create a super clot called a thrombus. If a thrombus blocks an artery, that’s a heart attack.
  • Chronic stress leads to elevated blood pressure because the body is preparing for possible injury, there’s a hormone called the anti-diuretic hormone (ADH) that tells the kidney to put more water into circulation to increase blood volume. Chronically, this increases your chances of a heart attack.
  • With high blood pressure (or more blood volume in circulation), your heart needs to pump harder which adds stress to blood vessels. In a chronic situation, the blood vessels decide they should add more muscle to the blood vessel, which means your heart needs to pump harder. The cycle repeats. The heart takes a toll in the presence of high blood pressure.
  • With high blood pressure, too much force on the bifurcation (point where vessels divide), the added pressure can cause bits of scarring and tearing which become inflamed.


  • Bowden Recommend Tests:
    • LDL Particle Size – Example tests include NMR LipoProfile, Lipoprint, Berkeley, VAP, LPP. These are much more sophisticated than the standard cholesterol test which won’t tell you the type of LDL cholesterol in your body.
    • Hs-CRP – Get the high sensitivity CRP, to tell how sticky your blood is. This is a marker for inflammation and gives you a good picture overall heart and cardiovascular health.
    • Fibrinogen – Clauss method and a new method called FiF. This tells how “sticky” your blood is.
    • Serum ferritin (iron) – Iron overload can contribute to heart disease because it is highly susceptible to oxidation. Iron is additive in your body (you won’t pee out excess iron) and is stored in muscles and other tissues.
    • Lp(a) – By itself, its fine. But if its needed much more, it can concentrate leading to inflammation and plaque. Those with elevated Lp(a) are at serious risk factor, as many people with heart attack have high Lp(a).
    • Homocysetine – This causes the body to lay down sticky platelets in blood vessels. A little is normal, but high amounts is bad. There’s a direct correlation between high homocysteine and increased risk of heart disease. Can be easily brough down by taking folic acid, vitamin B12, and vitamin B6.
    • Interleukin-6 – For those concerned about inflammation.
    • Coronary calcium scan – Because calcium is bad if it’s in the artery, this test will check for that.
  • Things to Avoid Eating:
    • Cut Sugar: No soda, fruit juices, energy drinks, cakes, candies, pastries, doughnuts, and anything similar to this. Remember that high fructose corn syrup is bad, but regular sugar is only marginally better. Both are still bad for your health.
    • Cut Carbohydrates: Cereals, pastas, bread, rice. Avoid high glycemic, because they are inflammatory.
    • Cut Trans Fat: Nondairy “creamers”, margarines, cake mixes, ramen noodles, soup cups, virtually all baked good (like chips and crackers), doughnuts, breakfast cereals, energy bars, cookies, fast food. One exception is Conjugated Linoleic Acid (CLA) is a type of trans fat that’s not man-made, but is natural. Avoid “partially hydrogenated” or “hydrogenated” oils.
    • Cut Processed Meats: Meats that have been cured, salted, smoked, or with added chemical preservatives like salami, sausage, hot dog, lunch meats, and bacon.
    • Cut Omega-6 Fats: Vegetables oils (corn, canola, and soybeans). These may not be bad, but are pro-inflammatory. Nearly all processed foods contain Omega-6 fats and almost exclusively used in fast food and restaurants for frying, sautéing, and baking.
  • Things to Start Eating:
    • Add Wild Alaskan Salmon: These are the best source of anti-inflammatory omega-3 and far superior to farm raised salmon. Also because wild salmon is cleaner and contains a powerful antioxidant astaxanthin. Recommends Vital Choice.
    • Add Berries: Have natural anti-inflammatory properties and natural antioxidants. Examples are blueberries, raspberries, strawberries.
    • Add Cherries: They have a compound called anthocyanin, which helps with pain and inflammation.
    • Add Grass-fed Beef: Factory farmed meats and full of antibiotics, steroids, and hormones, which make it high in inflammatory Omega-6 and no Omega-3. Grass-Fed beef have less omega-6 and a fair amount of omega-3.
    • Add Vegetables: We can all add more vegetables to our diet, but green, leafy veggies (like spinach and swiss chard) and cruciferous ones (broccoli, Brussel sprouts, kale, cabbage, and cauliflower). Unlike fruit, which is also healthy, vegetables are better. You can eat unlimited vegetables, but can’t eat unlimited fruit (due to the sugars).
    • Add Nuts: Any nuts is good in moderation (1 ounce a day, 5 times a week). An amino acid, arginine, can help ease blood flood.
    • Add Beans: Eat 1 serving (1/2 cup to 1 cup) of beans a day, 4 times a week) All for their fiber, because it’s healthy. 3 of the 4 top scoring foods were beans (red beans, kidney beans, and pinto beans) because they have folic acid that help bring down inflammatory compound homocysteine.
    • Add Dark Chocolate: They contain flavanols, which can lower blood pressure and reduce inflammation. You want high cocoa chocolate, so look for at least 60% cocoa.
    • Add Turmeric: It’s a spice that makes curries yellow and good due to anti-inflammatory properties. Goes well on veggies, eggs, sautéed dishes, meats, fish, and poultry.
    • Add Pomegranate Juice: Only juice that holds up to the hype (protecting against heart disease). But avoid juice blends that have less pomegranate juice, but more sugar. A brand called Just Pomegranate has pure pomegranate, but is expensive. Another brand is Pom Wonderful.
    • Add Red Wine: Resveratrol, is highly concentrated in red wine helps prevent harmful elements in the body from attacking healthy cells. Have a glass at dinner, but if you’re not a drinker, don’t add it.
    • Add Green Tea: Tea is loaded with polyphenols, good for anti-cancer and for cardiovascular health.
    • Add Extra-virgin Olive Oil: It’s a monounsaturated fat that has been shown in studies to reduce death among those  with heart disease. It also contains polyphenols, similar to tea. Get olive oil that is “Extra-Virgin”.
    • Add Garlic: Garlic can lower lower lipids, prevent blood coagulation, is antihypertensive, antioxidant, antimicrobial, and antiviral properties. Reduce triglyceride levels and reduce plaque; great for cardiovascular health. Preparing is key: the garlic must be crushed or chopped for the compounds to mix together to create allicin. Allicin starts to degrade immediately, so use it right away. And microwaving will destroy it.
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